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Free the Flow

This formula is a combination of Zhang Jie-bin’s Ji Chuan Jian (Flow the River Decoction) and Li Dong-yuan’s Bu Zhong Yi Qi Tang (Supplement the Center & Boost the Qi Decoction) with additions and subtractions based on Bob Flaws’s personal clinical experience. Blue Poppy Herbs’ version is a 10:1 extract. 500mg. 60 capsules

Rx:
Radix Astragali Membranacei (Huang Qi) Astragalus membranaceus root
Radix Angelicae Sinensis (Dang Gui) Angelica sinensis root
Radix Polygoni Multiflori (He Shou Wu) Polygonum multiflorum root
Radix Codonopsitis Pilosulae (Dang Shen) Codonopsis pilosula root
Herba Cistanchis Deserticolae (Rou Cong Rong) Cistanches salsa herb
Semen Pruni Persciae (Tao Ren) Prunus persica seed
Radix Scutellariae Baicalensis (Huang Qin) Scutellaria baicalensis root
Radix Achyranthis Bidentatae (Niu Xi) Achyranthes bidentata root
Rhizoma Alismatis (Ze Xie) Alisma orientalis rhizome
Fructus Citri Aurantii (Zhi Ke) Citrus aurantium fruit
Rhizoma Cimicifugae (Sheng Ma) Cimicifuga racemosa rhizome

Indications:

This formula is for the treatment of chronic constipation due to a combination of qi, blood, yin, and yang vacuities with qi stagnation and blood stasis complicated by internal heat. This is a common complicated scenario, especially in perimenopausal women and older patients.

Formula explanation

Chronic constipation is typically due to a combination of disease mechanisms and is especially common in perimenopausal women and the elderly in general. In such cases, most Western patients present with qi, blood, and yang vacuities complicated by liver depression qi stagnation transforming internal heat and possible blood stasis. As we age, first the spleen becomes vacuous and weak. Since it is the latter heaven root of qi and blood engenderment and transformation, both qi and blood tend to become vacuous and insufficient. Because the clear is not upborn, the turbid is not downborne. Inhibition of the qi mechanism is then aggravated by liver depression qi stagnation. This means that there is no power to moves the stools through the intestines, insufficient fluids to “float the boat,” or lack of free and uninhibited flow. Because blood and essence share a common source, blood vacuity over time may evolve into blood and yin vacuity. Because the former and latter heavens are mutually rooted, spleen qi vacuity eventually becomes complicated by kidney yang vacuity. In that case, there will also be a lack of yang to warm and transform the qi mechanism, especially in the lower burner, liver, and intestines. This further negatively affects fluid metabolism and the movement and transportation of the stools. Long-term qi stagnation, qi, blood, yin, and yang vacuity combined with non-freely flowing stools must eventually become complicated by blood stasis. Conversely, blood stasis further complicates both qi stagnation and blood vacuity. And finally, long-term depression may transform internal heat which further consumes and damages yin, blood, and fluids. Thus a vicious circle is created which tends to be self-perpetuating.

Astragalus and Codonopsis fortify the spleen and boost the qi. Dang Gui and Polygonum Multiflorum nourish the blood and moisten the intestines. Dang Gui also quickens the blood and transforms stasis. Cistanches nourishes the blood, invigorates yang, and frees the flow of the stools. Persica quickens the blood and dispels stasis at the same time as it moistens the intestines and frees the flow of the stools. Scutellaria clears heat from the stomach, intestines, and liver-gallbladder. Achyranthes supplements the kidneys and enriches yin, quickens the blood and moves the blood downward. Alisma seeps dampness. Thus it has a descending nature which also helps downbear turbidity, especially when combined with Achyranthes. In addition, it helps downbear any upward stirring of ministerial fire. Aurantium moves and descends the qi, Cimicifuga upbears the clear, and upbearing and downbearing are reciprocal. If the clear is upborne, the turbid can be downborne. If the turbid is downborne, the clear can be upborne. Hence Aurantium downbears, while Cimicifuga upbears, and the entire qi mechanism is regulated and rectified.

Dosage

Three capsules two times per day equal not less than 30g of raw medicinals. However, because our extraction process is so much more efficient than stovetop decoction, we believe this amount of our extract is actually more like the equivalent of 45-60g of bulk-dispensed herbs.

Combinations

For more severe perimenopausal or senile qi, blood, yin, and yang vacuity, this formula can be combined with Supplement Yin. This is especially so if there is yin vacuity-fire effulgence. For greater supplementation of qi, it may be combined with Bu Zhong Yi Qi Wan (Supplement the Center & Boost the Qi Pills) or Shen Qi Da Bu Wan (Ginseng & Astragalus Greatly Supplementing Pills). For greater supplementation of blood, it may be combined with Shou Wu Pian (Polygonum Multiflorum Tablets) or Si Wu Tang Wan (Four Materials Decoction Pills). For more moistening of the intestines and freeing the flow of the stools, it can be combined with Wu Ren Wan (Five Seeds Pills). For more marked liver depression qi stagnation, it can be combined with Xiao Yao Wan (Rambling Pills), and for more marked blood stasis, it can be combined with Tao Hong Si Wu Tang Wan (Persica & Carthamus Four Materials Decoction Pills).

Contraindications

Loose stools or diarrhea, even if diarrhea alternates with constipation, as in irritable bowel syndrome

For more information on the Chinese medical treatment of constipation, see Philippe Sionneau and Lü Gong’s Treatment of Disease in TCM, Vol. 6, Blue Poppy Press’s Research Report on Constipation, A and B, and Bob Flaws’s Distance Learning Program on Digestive Diseases.

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