bubble_chart Preparation and Dosage

Grind equal parts of the medicinal ingredients separately into powder. Use 300 milliliters of water to first boil ten plump Chinese dates, then reduce to 160 milliliters. Remove the dregs and add the medicinal powder. Strong individuals should take 1 gram per dose, while weaker individuals should take 0.5 grams, to be taken warm before breakfast. If the condition does not improve after a small bowel movement, take another dose the next day, increasing by half a qian. After achieving rapid diarrhea, nourish the body with congee.

bubble_chart Efficacy

Expelling water by purgation.

bubble_chart Indications

1. Pleural fluid retention or thoracic fluid retention, stopping in the chest and hypochondrium, coughing and spitting with pain in the chest and hypochondrium, epigastric stuffiness and hardness, retching and shortness of breath, headache and dizzy vision, or pulling pain in the chest and back with inability to rest, slippery tongue coating, and deep and wiry pulse.
2. Edema, generalized swelling especially severe in the lower half of the body, abdominal distension and fullness, panting and fullness, difficulty in urination and defecation, belonging to excess pattern.

bubble_chart Formula Principles

This syndrome is caused by excessive water retention in the interior, stagnating in the chest and hypochondrium, or water retention overflowing to the limbs. When water stagnates in the chest and hypochondrium, qi movement is obstructed, leading to pain in the chest and hypochondrium. When water retention presses upward on the lungs, causing dysfunction of lung qi, it results in coughing and spitting that induces pain in the chest and hypochondrium, or even pulling pain in the chest and back, making it difficult to breathe. As water retention is a yin pathogen, it flows with qi and settles below the heart, causing qi to stagnate in the middle, leading to epigastric stuffiness, hardness, and distension, as well as retching and shortness of breath. When the pathogenic water disturbs the clear yang, it causes headache, dizziness, and blurred vision. When water retention accumulates, causing pain in the chest and hypochondrium, the pulse becomes deep and wiry. When water retention overflows to the limbs and accumulates in the abdomen, obstructing the triple energizer's water passages, it results in generalized swelling, abdominal distension and fullness, panting, and difficulty in urination and defecation. This syndrome is an excess pattern of water retention, and the treatment should focus on expelling water by purgation to quickly eliminate the pathogenic water. In the formula, Gansui Root is effective in moving water-dampness through the channels and is used as the sovereign medicinal. Peking Euphorbia Root is effective in draining water-dampness from the zang-fu organs, and Lilac Daphne is effective in resolving recurrent fluid retention and phlegm accumulation in the chest and hypochondrium, both serving as minister medicinals. These three medicinals are potent and each has a specific function. When used together, they can attack and eliminate water retention in the channels, zang-fu organs, and chest and hypochondrium, with an enhanced effect of expelling water. However, these three medicinals are potent and toxic, and can easily damage healthy qi. Therefore, Chinese Date is added as an adjuvant, with ten pieces decocted in water to be taken with the formula, serving three purposes: to moderate the harsh nature of the medicinals, to tonify qi and protect the stomach, reducing adverse reactions after taking the medicine, and to strengthen the spleen to control water, addressing both the pathogenic factors and the healthy qi.

bubble_chart Pattern Identification

The key points for pattern identification include coughing with pain radiating to the chest and hypochondrium, or edema with abdominal distension and fullness, difficulty in urination and defecation, and a deep, wiry pulse.

bubble_chart Documentation

1. Compendium of Materia Medica, Volume 17: "Ten Jujubes Decoction expels internal pathogens, allowing water and qi to be discharged through urination and defecation. This is the method described in the Neijing as 'cleansing the fu organs and removing stagnation and accumulation.'... The properties of Lilac Daphne, Peking Euphorbia Root, and Gansui Root expel water and dampness, directly reaching the hidden and secluded areas of water retention. However, they should be used gradually, as they are very effective but should not be overdosed, as they can deplete the body's true essence. Chen Yan In the Sanyin Fang, Ten Jujubes Decoction is ground into powder and mixed with jujube flesh to form pills, used to treat conditions of water panting, acute edema, and swelling. This is a skillful adaptation."
2. "Treatise on Cold Damage Diseases: Differentiation of Taiyang Disease Pulse Patterns and Treatment": "In cases of taiyang apoplexy, diarrhea, and vomiting, if the exterior symptoms have resolved, then the interior can be treated. If the patient experiences profuse sweating that occurs intermittently, headache, epigastric fullness and hardness, pain radiating to the hypochondrium, retching, shortness of breath, and sweating without aversion to cold, this indicates that the exterior has resolved but the interior is still unbalanced. Ten Jujubes Decoction is the appropriate treatment."

bubble_chart Cautions and Contraindications

This formula is potent and should only be used temporarily, not for prolonged periods. If both mental state and appetite are good, but fluid retention persists, this formula can be administered again. If diarrhea leads to mental fatigue and loss of appetite, the aggressive treatment should be paused. For patients with a deficiency-type constitution where aggressive treatment is necessary, this formula can be alternated with spleen-tonifying formulas, or the approach of elimination before tonification, or tonification before elimination can be applied. Four points should be noted when using this formula: First, the three herbs should be taken as a powder with a decoction of Chinese dates. Second, it should be taken on an empty stomach in the morning, starting with a small dose to avoid excessive diarrhea and damage to the body's vital energy; if the effect is minimal, the dose can be increased the next day. Third, after achieving rapid relief, it is advisable to consume porridge to nourish the spleen and stomach. Fourth, it should be used with caution in the elderly and those with weak constitutions, and is contraindicated in pregnant women.

bubble_chart Modern Application

Enhance the repair of pleural membrane inflammation and the reabsorption of exudate. Mainly used for exudative pleuritis (pleural effusion) and cirrhosis complicated with ascites.