Digestion & Elimination

Opioid-based Formula for Diarrhea (Zhen Ren Yang Zang Tang)

By Fornia ⋅ November 22, 2009 ⋅  Print This Post ⋅ Post a comment

Formula Composition:

One well-known formula to treat deficiency diarrhea is zhenren yangzang tang (真人养脏汤). The formula make-up is as below:

• yingsuke (罂粟壳)
• roudoukou (肉豆蔻), hezi (诃子)
• renshen (人参), baizhu (白术)
• danggui (当归), baishao (白芍)
• muxiang (木香)
• gancao (甘草)

On Opium:

Papaver somniferum (罂粟) is the opium plant, which is the source for most known opiates e.g. morphine, codeine. The pods of the poppy seed (罂粟壳) are used in this formula — and we now know that the pods contain a higher concentration of opiates.

Apart from being able to bind and activating the μ-opioid receptors in our brain and give us that addictive high, opioids can also do the following:

1. Depression of the respiratory system (抑制呼吸), nausea and vomiting (恶心呕吐), antitussive effect (镇咳) — all these are CNS effects.
2. Reduced motility in the GIT, reduced secretion of digestive juices, increased absorption of water, tightening of the oddi and bladder sphincter muscles — these are the peripheral effects.

Reducing motility of the GIT, secretion of digestive juices, while increasing absorption of water is how the opium pods in this formula works to contain inveterate diarrhea. It is also how loperamide and lomotil work.

Nutmeg (肉豆蔻) and Terminalia chebula (诃子) contribute to the ‘astringing’ (涩) function of the papaver pods, assisting this ‘drying up’ of the intestinal tract.

The other herbs serve to regulate the digestive system by building the spleen and its maintenance of qi and blood production and flow.

Modern day version:

Dr. Xia used a modification of this formula to treat chronic colitis (慢性结肠炎). The formula is as follows:

• xuanhu (玄胡) 9-15g
• chishizhi (赤石脂) 15-30g, wumei (乌梅) 9-15g, wei hezi (煨诃子) 9-15g, wei roudoukou (煨肉豆蔻) 9-15g
• huangqi (黄芪) 12-15g, dangshen (党参) 12-15g, chaobaizhu (炒白芍) 12-15g, zhi gancao (炙甘草) 6-9g
• danggui (当归) 9-12g, baishao (白芍) 9-15g, rougui (肉桂) 3g
• muxiang (木香) 6-12g

Note how corydalis (玄胡) is a painkiller like opium is, but how it is going to help ‘constipate away’ the diarrhea here is not so clear. One paper (click here) does give a clue in asserting that “Inhibitory action of Corydalis tuber on glycine-activated ion current was partially abolished by treatment with naltrexone, a non-selective opioid antagonist.”

Miscellaneous:

Take a look at another similar formula called tao hua tang （桃花汤）.

Also check out how an overdose of poppy seed tea can cause pulmonary edema secondary to respiratory depression.

Reference:

1. 中国中医药出版社, 方剂学,  p. 190-191
2. 上海科学技术出版社, 药理学, p. 114-118
3. http://en.wikipedia.org/wiki/Opium_Poppy
4. http://en.wikipedia.org/wiki/Papaver
5. http://en.wikipedia.org/wiki/Morphine

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