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Source: Jīn Guì Yào Lüè 金匮要略

Alternate Chinese names: 大黄牡丹皮汤方; 大黄牡丹汤

Ingredients:

• Dà huáng (大黄 Rhei Radix et Rhizoma, rhubarb) 9–12g
• Mǔ dān pí (牡丹皮 Moutan Cortex, moutan [bark]) 9–12g
• Táo rén (桃仁 Persicae Semen, peach kernel) 9–15g
• Dōng guā rén (冬瓜仁 Benincasae Semen, winter melon seed) 15–30g
• Máng xiāo (芒硝 Natrii Sulfas , mirabilite) (drenched) 9–12g

Action: Drains heat and expels stasis; disperses binds and welling-abscesses (yōng).

Indication: Intestinal welling-abscess (yōng) with pain on the right side of the lower abdomen that is exacerbated by pressure, inability to stretch out the right leg, heat effusion, and fear of cold. Tongue fur: Yellow and either slimy or dry. Pulse: Stringlike and tight or rapid. In modern clinical practice, this formula is used for acute appendicitis, as well as annexitis and pelvic inflammation.

Category: External medicine formulas

Method: Decoct with water.

Warnings: Contraindicated in severe peritonitis due to appendicitis.

Rationale: Dà huáng not only clears heat and precipitates, but also quickens the blood and dispels stasis (for which reason it is not added at the end as it would otherwise normally be). Mǔ dān pí clear heat and cools the blood, but also quickens the blood and dispels stasis. These two agents are bitter and acrid and have a freeing and downbearing action. Hence together they are the sovereign agents for the formula. Máng xiāo softens hardness and disperses bind, thereby enhancing the flushing action of Dà huáng. Táo rén breaks blood and complements the blood-quickening action of Mǔ dān pí. Dōng guā zǐ disperses binds and welling-abscess (yōng) whether pus has formed or not.

Variations:

• High fever with acute abdominal pain: Add Huáng lián (黄连 Coptidis Rhizoma, coptis [root]), Pú gōng yīng (蒲公英 Taraxaci Herba, dandelion), Jīn yín huā (金银花 Lonicerae Flos, lonicera [flower]), and Bài jiàng cǎo (败酱草 Patriniae Herba, patrinia).
• Stool similar to that of dysentery with ungratifying defecation, red tongue and fine rapid pulse indicating damage to yīn: Omit Máng xiāo (芒硝 Natrii Sulfas , mirabilite) and add Xuán shēn (玄参 Scrophulariae Radix, scrophularia [root]) and Shēng dì huáng (生地黄 Rehmanniae Radix Exsiccata seu Recens, dried/fresh rehmannia [root]).
• Suppuration: Add Jīn yín huā (金银花 Lonicerae Flos, lonicera [flower]), Pú gōng yīng (蒲公英 Taraxaci Herba, dandelion), and Bái huā shé shé cǎo (白花蛇舌草 Oldenlandiae Herba, oldenlandia).
• Severe abdominal pain: Add Chuān liàn zǐ (川楝子 Toosendan Fructus, toosendan [fruit]), Yán hú suǒ (延胡索 Corydalis Rhizoma, corydalis [rhizome]), Rǔ xiāng (乳香 Olibanum , frankincense) and Mò yào (没药 Myrrha , myrrh).

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