Library

Rhubarb (Da Huang), bitter in taste, cold in nature, belonging to Yin within Yin, descending in action, non-toxic. It enters the Stomach and Large Intestine meridians. However, with appropriate adjuvant drugs (Zuo Shi), it can reach all meridians.

Its nature is extremely rapid, moving without staying, good at scouring accumulation and stagnation, regulating the Middle Jiao, transforming food, unblocking water and grain, pushing out the old and generating the new, guiding blood stasis, rolling up phlegm-saliva, breaking mass formations, dissipating hard accumulations, stopping pain, defeating heat-toxin of carbuncles and sores, reducing swelling; its efficacy is miraculous in all these aspects. To make it ascend, it must be processed with wine; to make it descend, Sal Niter (Mang Xiao) should be added; for rapid action, raw use is best; for mild regulation, decocted use is excellent. To make it stay slightly longer in the body, Licorice Root (Gan Cao) can be used to moderate its effect. This herb possesses the swiftness of charging forward and the divine merit of pushing down hardness and scouring accumulation; it is truly a product that stabilizes chaos, and a formula that dispels evil and saves lives. However, when using it, one must clearly diagnose the condition before administering the drug to ensure efficacy; otherwise, it may kill within moments. Rhubarb is a sovereign drug, hence nicknamed "General". Yet, a General without the wisdom of an advisor who combines suppression and pacification is brave but not benevolent. Therefore, in Chengqi Tang (Cinnamon Twig and Rhubarb Decoction), Ginseng Root (Ren Shen) and Angelica Sinensis Root (Dang Gui) must be added to assist it. In other formulas containing Rhubarb, tonifying Qi and Blood herbs are invariably added. However, Qi-tonifying herbs should not be heavily dosed, whereas Blood-nourishing herbs should be used generously. Because dryness and constipation in the intestines lead to stagnation, if only Rhubarb is used to purge, the intestines will remain dry, lacking fluid to float the boat. Although Rhubarb is brave, how can it navigate a boat on land? Thus, in cases of closure and constipation, one must use more tonifying agents to generate blood, expel the old, and eliminate stasis to promote the new. As for Qi-tonifying herbs, they might seem dispensable, but one must realize that Blood requires Qi to be generated easily. Moreover, since Rhubarb purges, it inevitably damages the Qi of the Stomach and Intestines. By first using Ginseng [and likely Astragalus] to tonify, the Qi is not damaged, and it assists Rhubarb's power, facilitating the expulsion of pathogens while preserving healthy Qi, eliminating the need to rescue after purgation. The reason Qi-tonifying herbs can be used sparingly is to avoid over-assisting Qi, which might consolidate the intestines and hinder Rhubarb's action. However, for those with weak constitution and timid Qi, when Rhubarb is necessary, one must not adhere to the notion that it is "safe" to reduce or omit Ginseng [and Astragalus], lest there be concern about Qi collapse. In summary, tonifying Qi prevents Qi collapse; nourishing Blood prevents Yin exhaustion. The key lies in careful examination during clinical practice, rather than arbitrary speculation beforehand.

Some may doubt: If pathogens are abundant, purging is indicated; what if five or six qian of Rhubarb fail to induce purgation? Alas! One must not be rigid in using Rhubarb. For light pathogens, even a small dose requires vigilance against changes; for heavy pathogens, a large dose requires advance planning for subsequent treatment. As long as control is appropriate, why worry about heavy dosage? However, starting low allows gradual increase, whereas starting high is difficult to manage. Therefore, for heavy pathogens, it is acceptable to increase gradually from a small dose, but never to suddenly increase due to impatience with small doses.

Someone asks: In Chengqi Tang, a slight error in using Rhubarb leads to immediate death upon ingestion. What benefit justifies its use? Chengqi Tang is a life-snatching medicine. Misuse turns life-saving into life-destroying. This is not Rhubarb's fault. Do you know Rhubarb's merits? When there is hardness and pain in the lower abdomen, where one cannot seek life nor accept death, once Rhubarb is used to purge, the realm of suffering suddenly becomes a place of joy. Not only does the abdomen become peaceful, but pain, fever, and distress in the body, limbs, and extremities are resolved. How great is its merit? If Sal Niter, Magnolia Bark (Hou Po), and Immature Bitter Orange (Zhi Shi) are used without Rhubarb, although they can also drive out pathogens and dissolve hardness, they certainly cannot achieve such speed and miraculous efficacy. Can one doubt its utility and refrain from using it?

Some suspect that Rhubarb has many merits but also many faults, and I ultimately do not believe it is a life-snatching drug to be used lightly. Using Rhubarb treats critical conditions; chronic conditions can wait, but critical ones must not be delayed. Hesitating, being cautious through inertia, often leads to death. When pathogens enter the Lower Jiao, causing wheezing and fullness in the Upper Jiao and stuffiness in the Middle Jiao, rapid purgation is essential. If pressing causes severe pain that cannot be tolerated, urgent purgation is unquestionable, which can save life. Otherwise, rebellious Qi leads to death. How can one fear the fault of Yin exhaustion while ignoring the merit of saving Yang?

It is said that erroneous purgation with Rhubarb often leads to incurable states; can we ignore Yin exhaustion and only focus on saving Yang? I reply: The disaster of Yin exhaustion is the fault of erroneous purgation, not of indicated purgation. Failing to purge when indicated is equivalent in fault to purging when not indicated. If one fears erroneous purgation and difficulty in rescue, one should preventively use tonifying agents or add them as adjuvants, avoiding the sin of erroneous purgation. Even if purgation is erroneous, there is no difficult emergency, let alone Yin exhaustion.

Some doubt: Rhubarb is like a general breaching gates; why is Ginseng not suitable? Rhubarb is indeed compatible with Ginseng, but ancients rarely combined them. Conditions requiring Rhubarb usually involve downward movement rather than upward. Upward-moving pathogens are unpredictable; downward-moving pathogens disperse safely. When using Rhubarb to expel pathogens, Angelica Sinensis Root (Dang Gui) is added to boost momentum, while Ginseng is omitted to prevent interference.

Some doubt: Rhubarb removes stasis, yet people with weak Qi often die following purgation. Why not use Ginseng to support Qi? I stated earlier that Rhubarb is compatible with Ginseng, specifically for those with weak Qi. Pathogens in the Large Intestine cause pain due to dry feces. Without Rhubarb's potency, how can pathogens be swiftly expelled and dry feces removed? If the patient is weak, harmonization seems appropriate. However, since pathogens have moved to the Lower Jiao, harmonizing the Middle Jiao makes the Lower Jiao situation more urgent, increasing pain. Purging brings relief. But purging causes Qi to collapse simultaneously. If Ginseng is not used urgently to tonify Qi, how can collapsed Qi be rescued? Rather than rescuing collapsed Qi with Ginseng after purgation, why not combine Ginseng with Rhubarb beforehand to prevent collapse? When used together, Ginseng aids Rhubarb's efficacy, while Rhubarb moderates Ginseng's strength. Only dry feces are removed without depleting weak Qi, achieving harmony between the two.

Another question: If Ginseng is combined with Rhubarb, could it trap the pathogen, preventing the passage of dry feces, thus causing error due to Ginseng? Rhubarb moves without staying; how can Ginseng retain it? Moreover, the pathogen is not in the Upper or Middle Jiao, but in the Large Intestine of the Lower Jiao. Pathogens in the Large Intestine should be directed downward. Using Rhubarb is merely assisting this downward direction, not opposing it. Assisting downward movement with Ginseng cannot reverse the flow. Thus, combining Ginseng with Rhubarb poses no risk of trapping pathogens.

Some doubt: Weak patients should not undergo attack therapies. Ancients sometimes had patients take Ginseng first, then Rhubarb. Is this acceptable? No. This is a temporary expedient, not a standard. I suggest combining Ginseng and Rhubarb simultaneously. Taking Rhubarb first risks untreatable Qi collapse; taking Ginseng first risks pathogen congestion preventing attack. Using them together ensures mutual restraint and compatibility: Rhubarb avoids excessive attacking, and Ginseng avoids excessive tonifying.

Someone asks: Rhubarb is potent and rapid; cooked use seems inappropriate. Why did ancients prefer raw over cooked? Over-cooking Rhubarb disperses its aroma and flavor, making it less vigorous in detoxification and less urgent in expelling pathogens, rendering it useless. The brilliance of Rhubarb lies in raw use. After decocting other herbs, add Rhubarb, boil briefly, and serve. This yields rapid and significant effects, utilizing its swift nature. Do not fear its potency by over-decocting to remove its harshness.