Gentle Lax (Excess) ^™

CLINICAL APPLICATIONS

* Constipation

* Excess-type constipation with red tongue, yellow tongue coat, and red face

* Food stagnation or indigestion with abdominal distension and pain

 

WESTERN THERAPEUTIC ACTIONS

* Strong laxative effect which treats moderate to severe constipation

* Emollient effect which lubricates the bowels and promotes normal peristalsis of intestines

* Increases intestinal peristalsis and removes food stagnation

 

CHINESE THERAPEUTIC ACTIONS

* Relieves constipation

* Disperses lower abdominal distension and pain

* Purges accumulation of stagnant heat

 

DOSAGE

Take 3 to 4 capsules three times daily with warm water. To avoid stomach discomfort for individuals with sensitive gastrointestinal tract, take the herbs with meals, or decrease dosage and increase frequency of intake. The recommended starting dosage is 2 capsules four times daily.

 

INGREDIENTS

Bai Shao (Radix Paeoniae Alba)

Da Huang (Radix et Rhizoma Rhei)

Fan Xie Ye (Folium Sennae)

Hou Po (Cortex Magnoliae Officinalis)

Mang Xiao (Natrii Sulfas)

Tao Ren (Semen Persicae)

Zhi Shi (Fructus Aurantii Immaturus)

 

BACKGROUND

Constipation is the infrequent or incomplete passage of stools. The stools are usually dry and hard, and are difficult to pass even with straining. Individuals with constipation often have two or fewer bowel movements per week, and will usually have feelings of incomplete evacuation after bowel movement. Common causes of constipation include lack of exercise, insufficient intake of water and fiber, stress, overuse of laxatives, and use of certain drugs (opioids, antipsychotics, antidepressants, and anticholinergics).

 

FORMULA EXPLANATION

Gentle Lax (Excess) is an herbal formula designed to treat patients with excess-type constipation. Excess-type constipation is defined as acute and severe constipation, constipation in young adults, constipation with abdominal distension or pain, or constipation in patients with a red tongue, red face, and yellow tongue coat.

        Da Huang (Radix et Rhizoma Rhei) is a strong purgative that clears heat and detoxifies. Mang Xiao (Natrii Sulfas) softens and facilitates the passage of stool. Zhi Shi (Fructus Aurantii Immaturus) and Hou Po (Cortex Magnoliae Officinalis) dissipate stagnation and reduce distension. Bai Shao (Radix Paeoniae Alba) nourishes blood and relieves abdominal or intestinal pain, which may be associated with constipation. Fan Xie Ye (Folium Sennae) and Tao Ren (Semen Persicae) are emollients used to lubricate the Large Intestine to facilitate the passage of stool.

 

CAUTIONS & CONTRAINDICATIONS

* This is a strong herbal formula that should be reserved for those with severe constipation. Stop taking the herbs when the desired effect is achieved. Use of Gentle Lax (Excess) at a large dosage or for a prolonged period of time is not recommended as it may cause diarrhea and dehydration.

* Patients with intestinal obstruction should be referred to a medical doctor for immediate help. Surgical intervention may be necessary in some cases.

* Patients with hemorrhoids should only take Gentle Lax (Excess) to relieve constipation. Should more bleeding occur, stop taking the formula immediately and switch to Notoginseng 9 instead.

* A more serious etiology should be suspected if the constipation is accompanied by vomiting, blood in the stools, weight loss, or a distended, tympanitic abdomen.

* This formula is contraindicated during pregnancy and nursing.

* Gentle Lax (Excess) may be irritating to the intestinal mucosa. Patients should take this formula with caution by starting with a lower dosage or taking it with food.

* The following warning statement is required by the State of California: “This product contains Da Huang (Radix et Rhizoma Rhei) and Fan Xie Ye (Folium Sennae). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang (Radix et Rhizoma Rhei) and Fan Xie Ye (Folium Sennae) may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition.”

 

CLINICAL NOTES

* Use of herbs is very effective to prevent drug-induced constipation. There are two types of drugs that are most likely to cause constipation: opioids [i.e., Vicodin (hydrocodone/acetaminophen), Darvocet (propoxyphene/acetaminophen), Tylenol/Codeine (acetaminophen/codeine)] and antipsychotic drugs [i.e., Haldol (haloperidol), Thorazine (chlorpromazine)].

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Constipation due to constriction: Yinqiao pulse, a thin, straight, wiry pulse on or extends proximal to the left chi

* Constipation due to dryness in the Large Intestine and Stomach: floating and forceful on the right cun and guan

 

SUPPLEMENTARY FORMULAS

* For deficient types of constipation, use Gentle Lax (Deficient).

* To detox the colon, use GI DTX instead.

* For constipation due to stress, add Calm.

* For gastrointestinal disorders such as acid reflux or ulcers, use GI Care instead.

* For irritable bowel syndrome (IBS), use GI Harmony instead.

* For ulcerative colitis, use GI Care (UC) instead.

* For hemorrhoids and pain, use GI Care (HMR) and Herbal ANG instead.

* For hemorrhoid bleeding, use GI Care (HMR) and Notoginseng 9 instead.

* For hypertension, add Gastrodia Complex.

* To help with detoxification, add Liver DTX.

* For constipation due to neuro-degenerative disorders such as Alzheimer’s disease, Parkinson’s disease or stroke, use with Neuro Plus.

* With excess fire, add Gardenia Complex.

* For severe blood stagnation, add Circulation (SJ).

* For acne, add Dermatrol (Clear).

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Tianshu (ST 25), Shangjuxu (ST 37)

* Tianshu (ST 25), Dachangshu (BL 25), Zusanli (ST 36), Hegu (LI 4), Zhigou (TH 6), Taichong (LR 3), Xingjian (LR 2)

 

Classic Master Tung's Points:

* Constipation (general): Tushui (T 22.11), Qimen (T 33.01), Qijiao (T 33.02), Qizheng (T 33.03), Simashang (T 88.18), Simazhong (T 88.17), Simaxia (T 88.19), Tongtian (T 88.03), Fuchang (T 77.12), Huochuan (T 33.04)

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Constipation: Qimen (T 33.01), Qijiao (T 33.02), Qizheng (T 33.03), Huochuan (T 33.04) , Dabai (T 22.04)

 

Balance Method by Dr. Richard Tan:

* Left side: Waiguan (TH 5), Zhigou (TH 6), Zhaohai (KI 6), Quchi (LI 11)

* Right side: Shangjuxu (ST 37), Tiaokou (ST 38), Kongzui (LU 6) or ah shi points nearby, Quze (PC 3)

* Left and right sides can be alternated from treatment to treatment.

 

Ear Acupuncture:

* Large Intestine, Colon, Rectum, Sympathetic. Tape magnetic balls onto the points and switch ears every three days. If both ears are taped at the same time, rest one day in between the three-day treatments.

* Large Intestine, Rectum. Strong stimulation is necessary two or three times daily. Leave the needles in for one hour. Embed ear seeds in Spleen, Large Intestine and Rectum. Switch ear every week.

 

Auricular Medicine by Dr. Li-Chun Huang:

* Abdomen, Spleen, Lung, Liver, San Jiao, Large Intestine, Sigmoid, Digestive Subcortex

 

NUTRITION

* Eat plenty of foods with high fiber, such as fresh fruits, green leafy vegetables, cabbage, peas, sweet potatoes, and whole grains.

* Drink plenty of water, at least 8 glasses per day.

* A combination of honey with grapefruit will also relieve dry stool or constipation.

* Prunes or prune juice are very effective to regulate bowels and relieve mild cases of constipation.

* Long-term use of laxatives wipes out the normal flora of the intestines and leads to frequent constipation and/or secondary infections. Therefore, if purgatives are to be used for a prolonged period of time, acidophilus should also be used to replenish the “good” intestinal flora.

* Increase intake of nourishing, cooling foods/roots such as Mexican yam, yam, radishes, potatoes, carrots, melons, cucumbers, beets, turnips, malanga, celeriac, taro, and rutabaga.

* Avoid deep-fried foods. Follow a low-fat diet.

* Avoid fatty and spicy foods, which may irritate the mucous membranes of the intestines.

* Avoid spicy/pungent/aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, funnel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

 

The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:

* Recommendations: bananas, apples, walnuts, figs, spinach, peaches, pears, pine nuts, sesame seeds, mulberries, grapefruit, yams, honey, apricot kernel, milk, yogurt, alfalfa sprouts, beets, cabbage, bok-choy, cauliflower, and potato.

* Eat two bananas on an empty stomach, followed by a glass of water.

* Drink a glass of lukewarm water with 2 teaspoons of honey on an empty stomach.

* Drink blended beets and cabbage on an empty stomach.

* Eat 5 to 10 figs on an empty stomach, followed by a glass of water.

* Eat a fresh apple on an empty stomach daily.

* Drink mulberry juice.

* Eat lightly steamed asparagus and cabbage at night before retiring.

* Avoid spicy foods, fried foods, and meat.

 

LIFESTYLE INSTRUCTIONS

* Avoid stress, anxiety and tension whenever possible.

* Exercise regularly to increase peristalsis of the intestines. Walking is one of the best exercises as it massages the intestines to regulate the bowels.

* Do not suppress the urge to relieve the bowels. Suppressing the urge is one of the main causes of chronic constipation. Empty the bowels whenever there is a desire, especially in the morning when the digestive system is most active.

* Massaging the abdomen along the directional flow of the large intestine (clock-wise) will also help.

* Patients with hemorrhoids should not lift anything heavy.

 

CASE STUDIES

* A 63-year-old retired male presented with lower abdominal pain, abdominal swelling, foul-smelling flatulence and constipation persistent for almost three days. His diet consisted of large amounts of chili. His tongue body appeared red with a thick, white, dry, tongue coating. His pulse was noted to be deep, “rolling,” and wiry. Pain was elicited upon abdominal palpation. The practitioner diagnosed his condition as excess heat in the Large Intestine. Bowel movement was induced after three doses of Gentle Lax (Excess). The herbal treatment was continued for another week with smaller doses. The patient soon experienced a daily bowel movement activity. Submitted by T.G., Albuquerque, New Mexico.

* A 50-year-old female patient presented with bowel obstruction and constipation that had persisted for five or six days. On a scale of severity of 1 to 10, with one being minimal or no severity, the patient described her condition as 10+. The TCM diagnosis was qi deficiency with internal heat. In the beginning, she took four capsules of Gentle Lax (Excess) four times daily, and she had a bowel movement the next day. Dosage was then reduced to three capsules, three times daily until bowel functioning normalized. Submitted by M.C., Sarasota, Florida.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

Gentle Lax (Excess) is a potent formula that has laxative, purgative, and osmotic effects to treat constipation and intestinal obstruction.

        Pharmacologically, many of these herbs have excellent laxative, purgative, and osmotic effects. Da Huang (Radix et Rhizoma Rhei) has direct laxative and purgative effects to quickly and powerfully treat constipation.[1] Da Huang (Radix et Rhizoma Rhei) works mainly on the transverse and descending colon as it inhibits the re-absorption of water and causes evacuation of the stools.[2]^,[3] In addition, it increases peristalsis of the large intestine without interfering with absorption of nutrients in the small intestine.[4] Mang Xiao (Natrii Sulfas) is an osmotic agent and has a marked purgative effect. As an osmotic agent, it increases water content and pressure in the intestines, thus inducing peristalsis and bowel movement.[5] Mang Xiao (Natrii Sulfas) works best when it is taken with plenty of extra fluids. Together, Da Huang (Radix et Rhizoma Rhei) and Mang Xiao (Natrii Sulfas) have a synergistic effect to “push” and “pull,” and have a powerful and reliable effect to treat all types of acute and/or severe constipation. In addition, Fan Xie Ye (Folium Sennae) and Zhi Shi (Fructus Aurantii Immaturus) are used in this formula as they have a stimulant effect on the large intestine to increase contraction and peristalsis.[6]^,[7] Lastly, Hou Po (Cortex Magnoliae Officinalis) has an excitatory effect on the smooth muscles of the gastrointestinal tract. It promotes strong, forceful, and rhythmic peristalsis.

        Clinically, the herbs in Gentle Lax (Excess) have been used successfully to treat constipation and intestinal obstruction. One study reported great success using Da Huang (Radix et Rhizoma Rhei) and Mang Xiao (Natrii Sulfas) to treat 72 patients with constipation from hospitalization.[8] Another study reported 95.6% rate of effectiveness using Fan Xie Ye (Folium Sennae) to treat 276 patients with post-surgical patients.[9] Furthermore, 60 patients with chronic habitual constipation were treated with great success using herbs such as Bai Shao (Radix Paeoniae Alba), Gan Cao (Radix et Rhizoma Glycyrrhizae), and others as needed.[10] Lastly, 44 patients with intestinal obstruction were treated with 97.7% rate of effectiveness using Da Huang (Radix et Rhizoma Rhei) and Feng Mi (Mel).[11]

        In summary, Gentle Lax (Excess) is an excellent formula to treat acute and/or severe constipation in patients who are otherwise healthy.

 

COMPARATIVE ANALYSIS

Constipation is a very common problem that may be treated effectively using Western and traditional Chinese medicines. In Western medicine, bulking agents (bran, psyllium, and methylcellulose) are the gentlest and safest. These drugs are not habit forming, and may be used safely on a long-term basis. However, they act slowly and are not very strong. Laxatives (docusate and mineral oil) soften stool by increasing the implementation of intestinal water. However, these drugs must be used carefully, as they interfere with the absorption of nutrients and other drugs. Lastly, cathartics (senna, cascara, and bisacodyl) are used for severe cases of constipation by increasing intestinal peristalsis and intraluminal fluids. However, these drugs should only be used on a short-term basis, as prolonged use will cause “lazy bowel” syndrome and serious fluid and electrolyte imbalance.

        Constipation is treated with great success in TCM. Those with mild to moderate constipation are usually treated with herbs that moisten the Intestines and regulate bowel movement. Those with moderate to severe constipation are generally treated with herbs that purge the intestines and induce bowel movement. These formulas should be used as needed, and discontinued when the desired effects have been achieved. Herbal formulas that contain Da Huang (Radix et Rhizoma Rhei) should be taken with meals, as it may irritate the stomach if taken on an empty stomach. Prolonged use of formulas with Da Huang (Radix et Rhizoma Rhei) are not recommended, as this may increase the risk of habitual constipation and fluid and electrolyte imbalance.

        Both drugs and herbs are equally effective in treating constipation. Both modalities of medicines should be used sparingly, and when needed, as prolonged use may cause side effects. Once a bowel movement is induced, herbal therapy may be initiated to change the fundamental constitution of the body in those with habitual constipation. Lastly, diet and lifestyle adjustments are also needed to ensure regular bowel movement.