Fivefold Freeing Rhubarb Decoction

The smallest and most pointed formula on the draining side of the chapter. Five drugs: rhubarb roasted in ashes, mirabilite, scutellaria, gardenia and cimicifuga. Rhubarb and mirabilite are the standard precipitating pair; scutellaria and gardenia drain heat; cimicifuga is the one drug pushing the other way, upward and outward, so that the prescription does not simply empty downward. The indication is unusually specific about who it is for, and that is the point of the leaf. The method passage reads: when an abscess first effuses in a patient whose qi is repleted, hurry to give Ohyangyeongyo-tang or Cheongeumnuro-tang; in the young and robust, Oridaehwang-tang or Hwadok-dan, to get one or two free movements of the bowel. Youth, strength and a stopped gut are the conditions. Where they are absent — where the patient is depleted, the pus thin, the sore mouth not closing — the chapter turns to the opposite arm of the pair, the 托裏 and 內托 formulas, which supplement so that the swelling is thrust outward. The two arms are not alternatives for the same patient; they are a triage rule. Clinically this is a saline and anthraquinone purgative with two cold bitters. It will move the bowel. It will not touch an abscess, and the leaf's own measure — one or two free movements — is at least honest about how far it goes. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.