Tiao Wei Cheng Qi Tang: A Classic TCM Formula for Relieving Constipation and Heat

Hongji Medical
Mar 2
3 min read

Updated: May 7

Tiao Wei Cheng Qi Tang is a revered traditional Chinese medicine (TCM) prescription documented in the Treatise on Febrile and Miscellaneous Diseases by Zhang Zhongjing, a renowned physician of the late Eastern Han Dynasty.

This classic formula is designed to clear excess heat, promote bowel movements, and harmonize the stomach, making it an effective remedy for constipation and related symptoms caused by heat accumulation in the gastrointestinal tract.

Widely used by TCM practitioners across centuries, it remains a cornerstone for treating heat-related digestive disorders.

Composition of the Formula

Tiao Wei Cheng Qi Tang consists of three herbs, organized according to the TCM principle of “monarch, minister, assistant, and envoy”:

Monarch Herb:
- Da Huang (Rhubarb): The primary herb, with bitter and cold properties, clears heat, detoxifies, promotes blood circulation, and acts as a potent laxative to relieve gastrointestinal stagnation and expel heat through stool.
Minister Herb:
- Mang Xiao (Mirabilite/Sodium Sulfate): Salty and cold, it softens dry stool, moistens the intestines, clears heat, and enhances rhubarb’s purgative effect to alleviate constipation.
Assistant Herb:
- Gan Cao (Licorice): Sweet and mild, it harmonizes the formula, mitigates the harsh effects of rhubarb and mirabilite, protects stomach Qi, and prevents damage to vital energy.

This balanced combination ensures effective heat clearance and bowel regulation while safeguarding the digestive system.

Pathogenesis: Understanding the Condition

Tiao Wei Cheng Qi Tang targets Yangming Fushi syndrome, a condition caused by excessive heat accumulating in the gastrointestinal tract, leading to impaired body fluids and Qi stagnation. This results in symptoms such as:

Constipation with dry, hard stools.
Abdominal bloating and pain.
Hot flashes, fever, or delirium.
Dry mouth and tongue, with a yellow, dry, or cracked tongue coating.
A deep, solid, or slippery, rapid pulse.

The heat buildup obstructs gastrointestinal function, causing stagnation and discomfort. The formula’s purgative action expels heat through bowel movements, while licorice ensures the process is gentle to avoid harming the body’s vitality.

Indications

Tiao Wei Cheng Qi Tang is used to treat a range of symptoms associated with heat accumulation and gastrointestinal dysfunction, including:

Yangming Fushi Syndrome: Constipation, abdominal pain, hot flashes, delirium, and dry mouth.
Persistent Sweating and Fever: As noted in Compendium of Materia Medica Easy to Read, it addresses unrelenting sweating and steaming fever.
Stomach Qi Disharmony: Symptoms like incoherent speech or irritability, as described in Treatise on Cold and Miscellaneous Diseases.
Yang Syndrome: Madness, irritability, red face, and strong pulse, per Wei Sheng Bao Jian.
Heat-Related Symptoms: Rashes, toothache, sore throat, nosebleeds, or palpitations caused by lower body heat accumulation.
Severe Constipation: Including cases with forehead sweating or fullness, as cited in Lei Zheng Zhi Cai.

Therapeutic Effects of Tiao Wei Cheng Qi Tang

Tiao Wei Cheng Qi Tang excels in:

Clearing Heat and Promoting Defecation: Rhubarb and mirabilite purge heat and relieve constipation by clearing gastrointestinal stagnation and expelling toxins through stool.
Harmonizing Stomach Qi: Licorice softens the formula’s purgative effects, protects the spleen and stomach, and ensures a gentle action that preserves vital energy.

This dual action alleviates symptoms like bloating, pain, and fever while restoring digestive balance, making it ideal for heat-induced constipation and related disorders.

Modern Applications

In modern medicine, Tiao Wei Cheng Qi Tang is widely used to treat conditions such as:

Chronic or acute constipation.
Acute gastritis with heat accumulation.
Abdominal pain and bloating due to intestinal stagnation.

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For example, in Japan, Tsumura’s Tiao Wei Cheng Qi Tang Essence Granules, based on Zhang Zhongjing’s formula, are prescribed for constipation, abdominal discomfort, and bloating in physically robust patients.

Emerging research also suggests potential benefits for metabolic syndrome, obesity, and hypertension, expanding its relevance in contemporary healthcare. These studies reinforce the formula’s role in both TCM and modern medical practice.

Precautions for Use

When using Tiao Wei Cheng Qi Tang, consider the following:

Contraindications: Avoid in individuals with weak constitutions, pale complexions, or frail abdomens, as the formula’s cold and purgative nature may exacerbate deficiency.
Dosage Adjustment: Modern patients may require adjusted dosages compared to ancient prescriptions to prevent overuse. Consult a TCM practitioner for tailored guidance.
Administration: Typically taken in one dose, but follow medical advice for safe use.

Conclusion

Tiao Wei Cheng Qi Tang is a powerful and enduring TCM formula that effectively clears heat, relieves constipation, and restores stomach harmony. Rooted in Zhang Zhongjing’s ancient wisdom, its blend of rhubarb, mirabilite, and licorice addresses heat-related digestive issues while protecting vital energy.

From constipation and gastritis to emerging applications in metabolic disorders, this formula continues to prove its value in both traditional and modern medicine. However, careful use under professional guidance is essential to ensure safety and efficacy, particularly for those with weaker constitutions.

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中醫知識

Chinese Medicine - Qi

Blood and semen

Heart and lungs

Spleen and Liver

Kidney

Gallbladder, stomach, intestines, bladder

Interrelationships among the five internal organs

Other questions

Qi is the constantly moving subtle substance that constitutes the human body and maintains its vital activities.

There are three main sources of Qi in the human body: the innate essence inherited from parents, the essence of water and grain in food, and the pure Qi existing in nature.

Qi has many important physiological effects on the human body. The normal functioning of the internal organs, meridians, limbs, bones, five senses and nine orifices all depends on the physiological effects of Qi.

Generally speaking, the physiological effects of Qi include five aspects: promotion, warming, defense, consolidation, and qi transformation.

Yuan Qi is the most original Qi in the human body.

Yuan Qi is mainly composed of the essence of the kidneys and is generated from the essence of the kidneys.

The distribution of primordial energy is throughout the body, reaching everywhere. The internal organs, meridians, body parts, five senses and nine orifices are all places where primordial energy rises, falls, enters and exits.

The main physiological functions of Yuan Qi are twofold: one is to promote and stimulate the growth, development and reproduction of the human body. The other is to promote and stimulate the physiological activities of the internal organs and meridians.

If the kidneys are deficient in essence and energy due to congenital deficiency, postnatal malnutrition, or long-term illness, and the kidneys lack the source of vital energy, various diseases may occur.

Zong Qi is the Qi that accumulates in the chest. The place where Zong Qi accumulates is called "Tan Zhong" (between the two breasts). Because it is the place where Zong Qi is most concentrated, it is also called "Qi Hai".

Zong Qi is mainly composed of the fresh air from nature inhaled by the lungs and the essence of water and grain produced by the spleen and stomach from food.

The main functions of Zong Qi are twofold:

1. It is to walk the Xi Dao to control breathing. All breathing, speech, and voice are related to the Zong Qi. When the Zong Qi is abundant, the breathing is slow and the rhythm is even, the speech is clear and the voice is loud; otherwise, the breathing is short and the voice is low.

Second, it is to circulate Qi and blood through the heart meridians. All the beating of the heart and the circulation of Qi and blood are related to Zong Qi. If the pulse is gentle, the rhythm is consistent, and there is spirit and root, it is a manifestation of abundant Zong Qi. On the contrary, if the pulse is agitated, scattered, weak, or irregular, it means that the Zong Qi is insufficient or even weak.

Zhongqi refers to the Qi of the middle burner. Because the spleen and stomach are located in the middle burner, the Qi of the spleen and stomach is generally called "Zhongqi".

It is generally believed that the formation of Zhong Qi is formed by the combination of the Yuan Qi distributed in the Zhongjiao and the water and grain essence produced by the spleen and stomach.

The middle qi is mainly distributed in the middle burner, spreading between the spleen, stomach, and intestines, and it rises and falls, constantly mediating.

The main functions of Zhongqi include three aspects:

1. It controls the rise and fall of Qi. The middle burner is the hub of the rise and fall of Qi. When the middle Qi is abundant and harmonious, the Qi of the liver and spleen will rise healthily, and the Qi of the lungs and stomach will descend smoothly. When the rise and fall are smooth, all organs will be at peace.

Second, it stimulates the spleen and stomach to absorb and transport. When the middle qi is abundant, the spleen rises and the stomach descends normally, the water and grain are received and transported normally, and the essence of water and grain is continuously produced to generate qi and blood, nourishing the whole body.

Third, it maintains the position of the internal organs. The reason why the internal organs maintain their relatively constant position depends on the rise and fall of the qi of the middle jiao spleen and stomach.

Ying Qi, also known as "Rong Qi", is the Qi that flows in the veins.

The distribution and movement of Ying Qi are clearly discussed in Suwen Bi Lun, which points out that Ying Qi "harmonizes the five internal organs, flows through the six bowels, and then enters the meridians."

It explains that the nutrient energy enters the meridians, circulates throughout the body, flows into the internal organs, and reaches the limbs, repeating the cycle over and over again.

The main functions of Ying Qi:

1. It is the transformation of blood.

Second, it nourishes the whole body. The nourishing qi enters the blood vessels and causes the body fluids to penetrate into the blood vessels. The two combine to form blood.

The so-called Qi can produce blood, mainly refers to: Ying Qi transforms into blood. Ying Qi is produced by the refined part of the essence of grains, and is a nutrient necessary for physiological activities such as viscera and meridians, and plays an important role in maintaining human life activities.

The Inner Canon of Medicine states that the Nutritive Qi "harmonises the five internal organs, and spreads throughout the six bowels", "nourishes the four extremities", etc., which emphasizes that the Nutritive Qi has a nourishing effect.

Wei Qi is the Qi that circulates outside the veins. It is so called because it protects the skin and resists external pathogens.

The distribution of Wei Qi is fast, smooth and agile, and is not restricted by blood vessels, so it can "flow through the skin, between the flesh, fumigate the peritoneum, and spread to the chest and abdomen" (Suwen Bi Lun). This shows that Wei Qi spreads throughout the body, externally between the skin and muscles, and internally to the peritoneum of the chest and abdomen - the area inside the diaphragm of the chest cavity.

The main physiological functions of Wei Qi are three-fold:

First, it protects the skin and prevents the invasion of external pathogens. In clinical practice, if a patient is prone to colds and fever, the treatment is usually based on the theory that the Wei surface is not solid. The theoretical basis is here. Second, it warms the internal organs, muscles, fur, etc. Wei Qi has a strong warming effect. If Wei Yang is deficient, the warming power is weakened, and cold symptoms such as cold body, cold limbs and low body temperature may appear. If Wei Qi is stagnant and turns into heat, hot symptoms such as fever and malignant fever may appear.

Third, it regulates the opening and closing of pores and controls sweat excretion, which is what Lingshu Benzang says about the Wei Qi having the function of “controlling opening and closing”.

Tiao Wei Cheng Qi Tang: A Classic TCM Formula for Relieving Constipation and Heat

Composition of the Formula

Pathogenesis: Understanding the Condition

Indications

Therapeutic Effects of Tiao Wei Cheng Qi Tang

Modern Applications

Precautions for Use

Conclusion

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中醫知識

The concept of Qi

Vitality

Zong Qi

Middle Qi

Ying Qi

Health

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