Da Huang Mu Dan Tang (大黄牡丹皮湯), Rhubarb and Moutan Decoction, is Da Huang, Mang Xiao, Mu Dan Pi, Tao Ren and Dong Gua Ren. The catalogue classes it among the formulas that drain downward, and records it as purging accumulation while breaking up Blood stasis.

Herb

Amount

12 g

9 g

3 g

9 g

15 g

Actions and indications

Drains Heat and purges accumulation

Early intestinal abscess, before pus has formed: Heat and Blood stasis clumping in the Intestines
Fever that comes and goes or stays low, then chills and sweating; dislike of cold
Constipation may be present
Before pus forms the pain is severe with local hardness and heat; once pus has formed, heat and pain lessen, the tissue softens and the pulse becomes tight
Tongue pink, with a thin white or thin, yellow, greasy coat; pulse slippery and rapid, tight, wiry and tight, or tight and rapid

Breaks up Blood stasis and invigorates the Blood

Distending pain of the lower abdomen, usually on the right, worse for pressure, with rebound tenderness and guarding of the abdominal wall
Groin pain that seems urinary though passing urine is normal; bending hip and knee eases it, straightening the hip makes it worse

Disperses nodules and reduces swelling

A hard lump that may be felt in the right lower abdomen, the skin over it looking unchanged
Feeling of fullness or tightness low in the abdomen

Modern uses

Acute uncomplicated appendicitis
Chronic appendicitis
Ruptured appendicitis with peritonitis
Periappendicular abscess
Iliac fossa abscess
Peritonitis
Mesenteric lymphadenitis
Intestinal obstruction
Diverticulitis
Colitis
Ulcerative colitis
Ulcerative enteritis
Bacterial dysentery
Proctitis
Periproctitis
Hemorrhoids
Incarcerated internal hemorrhoids
Rectal prolapse
Abdominal pain
Lower abdominal masses
Nausea and vomiting
Constipation
Diarrhea
Anorexia
Acute cholecystitis
Hepatic abscess
Renal abscess
Pulmonary abscess
Subdermal abscess
Osteomyelitis
Mastitis
Folliculitis of the abdomen or legs
Eczema
Conjunctivitis
Suppurative tonsillitis
Cerebral thrombosis
Pyelonephritis
Pyelitis
Cystitis
Urolithiasis
Ureteral stones
Enuresis
Chronic prostatitis
Benign prostatic hypertrophy
Orchitis
Infection after vasectomy
Gonorrhea
Pelvic inflammatory disease
Adnexitis
Salpingitis
Blocked fallopian tubes
Perimetritis
Primary dysmenorrhea
Amenorrhea
Retained lochia
Puerperal fever
Vaginitis
Trichomonas infection
Vaginal discharge
Leukorrhea

Modifications

Palpable lower abdominal mass: + dang gui, + chi shao, + zi hua di ding

Intestinal abscess with pus: + jin yin hua, + pu gong ying, + bai hua she she cao

Blood deficiency: + dang gui, + dan shen

Qi deficiency: + tai zi shen

Rough, dysentery-like diarrhea with red tongue and thin rapid pulse: + xuan shen, + sheng di huang, − mang xiao

Worse pain: + yan hu suo, + chuan lian zi, + mu xiang

Abdominal fullness: + zhi zi, + hou po, + bing lang

Abdominal fullness, second option: + yan hu suo, + chuan lian zi, + ru xiang, + mo yao

High fever: + huang lian

High fever, second option: + chi shao, + tao ren, + chuan lian zi

High fever, third option: + huang lian, + shi gao

Sense of incomplete bowel movement from Yin deficiency: + xuan shen, + sheng di huang

Show all 55 modifications

To strengthen the effect: + huang lian, + jin yin hua, + pu gong ying, + bai jiang cao, + chi shao
Intestinal or periappendiceal abscess without pus: + zao jiao ci, + bai zhi
Before pus forms: + jin yin hua, + pu gong ying, + bai jiang cao, + lian qiao, + chi shao, + hong teng
Heat toxin with dry yellowish coat: + zi hua di ding
Heat toxin with dry yellowish coat, second option: + bai hua she she cao
Acute appendicitis, stagnation and accumulation: + chuan lian zi, + chi shao
Acute appendicitis, Damp-Heat: + jin yin hua, + yi yi ren
Acute appendicitis, Heat toxin: + huang lian, + bai jiang cao
Acute appendicitis, toxic sores: + huang lian, + hu zhang
Acute appendicitis, Damp-Heat masses: + chuan shan jia, + chi shao
Chronic appendicitis: + bai jiang cao
Ruptured appendix with peritonitis: + jin yin hua, + chuan lian zi, + tao ren
Ruptured appendix with peritonitis, high fever (combined with antibiotic drugs): + jin yin hua, + chuan lian zi, + tao ren, + shi gao, + tian hua fen
Ruptured appendix with peritonitis, nausea and vomiting (combined with antibiotic drugs): + jin yin hua, + chuan lian zi, + tao ren, + zhu ru, + lu gen
Ruptured appendix with peritonitis, severe pain (combined with antibiotic drugs): + jin yin hua, + chuan lian zi, + tao ren, + ru xiang, + mo yao, + yan hu suo
Ruptured appendix with peritonitis, abscess and swelling (combined with antibiotic drugs): + jin yin hua, + chuan lian zi, + tao ren, + bing pian, + mang xiao
Periappendiceal abscess (combined with antibiotic drugs)
Periappendiceal abscess, stagnation and accumulation (combined with antibiotic drugs): + yan hu suo, + chi shao
Periappendiceal abscess, Excess Heat (combined with antibiotic drugs): + jin yin hua, + zhi zi, + pu gong ying
Pelvic inflammatory disease (combined with antibiotic drugs): + jin yin hua, + lian qiao, + huang bai, + pu gong ying, + sheng di huang, + bai jiang cao, + gan cao
Chronic prostatitis, frequent painful urination (by rectal enema): + bian xu, + qu mai
Chronic prostatitis, testicular pain (by rectal enema) (combined with antibiotic drugs): + chuan lian zi, + yan hu suo
Chronic prostatitis, lower abdominal pain (by rectal enema): + du zhong, + xu duan
Chronic prostatitis, hard nodular prostate (by rectal enema): + chuan shan jia, + e zhu
Chronic prostatitis, red or white cells in semen (by rectal enema): + pu gong ying, + mo han lian
Suppurative tonsillitis: + lian qiao, + huang lian, + jin yin hua, + gan cao
Suppurative tonsillitis, seizures: + lian qiao, + huang lian, + jin yin hua, + gan cao, + gou teng, + quan xie
Suppurative tonsillitis, abdominal pain: + lian qiao, + huang lian, + jin yin hua, + gan cao, + mu xiang, + yan hu suo
Suppurative tonsillitis, swollen submandibular nodes: + lian qiao, + huang lian, + jin yin hua, + gan cao, + chuan shan jia, + xia ku cao
Incarcerated internal hemorrhoids: + mang xiao, + pu gong ying, + hong hua, + di yu, + zhi shi
Crohn's disease: + yan hu suo, + jin yin hua, + hong teng, + bai jiang cao, + lian qiao, + ru xiang, + mo yao
Crohn's disease, Heat injuring Yin: + yan hu suo, + jin yin hua, + hong teng, + bai jiang cao, + lian qiao, + ru xiang, + mo yao, + sheng di huang, + shi hu
Crohn's disease, marked abdominal distention: + yan hu suo, + jin yin hua, + hong teng, + bai jiang cao, + lian qiao, + ru xiang, + mo yao, + hou po, + mu xiang
To strengthen clearing of accumulation: + hong teng, + bai jiang cao
Intestinal abscess or diverticulitis, mainly Qi stagnation: + qing pi, + wu yao
Intestinal abscess or diverticulitis, mainly Blood stasis: + dan shen
Intestinal abscess or diverticulitis, obvious palpable mass: + e zhu, + san leng
Intestinal abscess or diverticulitis, marked abdominal distention: + zhi shi, + gua lou
Intestinal abscess or diverticulitis, severe pain: + yan hu suo, + chuan lian zi, + mu xiang
Intestinal abscess or diverticulitis, exterior signs: + zi su ye
Nausea in intestinal abscess or diverticulitis: + zhu ru
Intestinal abscess or diverticulitis, developing interior Heat: + pu gong ying, + lian qiao, + jin yin hua
Subacute intestinal abscess: + da huang, + mang xiao

Cautions

contraindication Appendicitis that has become necrotic, or has spread to cause peritonitis

contraindication Appendicitis caused by parasites

contraindication Classically withheld once the abscess has matured and pus has fully formed

paediatric Not for appendicitis in infants

pregnancy Not for use in pregnancy, given the strong purging and Blood-moving herbs (Tao Ren, Mang Xiao, Da Huang)

caution The purging and Blood-breaking action is strong: use with great care, or modify, in the elderly and the weak

caution Suspected appendicitis, diverticulitis or any acute, worsening abdominal pain is a surgical emergency needing immediate medical assessment; putting it off for herbal treatment risks perforation, peritonitis and sepsis

Pinyin

da huang mu dan tang·da huang mu dan (pi) tang

Chinese

大黄牡丹皮湯

English Name

Rhubarb and Moutan Decoction·Rhubarb and Moutan Combination·Decoction of Rhubarb and Moutan Bark·Decoction of Rhei and Moutan Radicis

da huang mu dan tang

About da huang mu dan tang

Ingredients

Actions and indications

Drains Heat and purges accumulation

Breaks up Blood stasis and invigorates the Blood

Disperses nodules and reduces swelling

Modern uses

Symptoms

Modifications

Cautions

Preparation

Names

Classification