| 【Chinese Name】 |
大黃牡丹湯
|
| 【Phonetic】 |
Da Huang Mu Dan Tang
|
| 【English Name】 |
Rhubarb and Cortex Moutan Decoction |
| 【Classification】 |
Purgative formulas |
| 【Source】 |
《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 |
| 【Combination】 |
Rhei Radix et Rhizoma (Da Huang) 4 liang (12g), Moutan Cortex (Mu Dan Pi) 1 liang (3g), Persicae Semen (Tao Ren) 50 pieces (9g), Benincasae Semen (Dong Gua Ren) 0.5 sheng (30g), Natrii Sulfas (Mang Xiao) 3 he (9g) |
| 【Method】 |
Decoct the first four medicinals with water and thereafter add máng xiao into the hot decoction. |
| 【Action】 |
Drains heat, breaks up stasis, dissipates masses, and relieves swollen sores. |
| 【Indication】 |
Da Huang Mu Dan Tang is indicated for the initial stage of intestinal abscess caused by the stagnation of dampness, heat, and blood stasis. The symptoms are pain which refuses pressure in the right lesser abdomen (lateral aspects of the lower abdomen), pain that can be as severe as strangury or even accompanied with swollen mass in the right lesser abdomen, bent right foot which cannot stretch otherwise the pain being worsened, normal urination, frequent fever, spontaneous sweating, and aversion to cold. The tongue coating is thin, greasy, and yellow. The pulse is slippery and rapid. |
| 【Pathogenesis】 |
The binding of qi and blood causes this type of intestinal abscess. The pain that refuses pressure, as well as the swollen mass, is generated by damp-heat stagnating and blocking intestinal collaterals. Because the right foot is bent, unable to stretch open without increasing the pain, the disease can be concretized as “contracting foot intestinal abscess”. The pain may be as severe as strangury; yet the urination is normal, which differentiates it from strangury. Frequent fever, spontaneous sweating, and aversion to cold indicate that while there is qi and blood stagnation that has caused the abscess, ying and wei qi have become disharmonious. The greasy yellow tongue coating and rapid slippery pulses are signs of damp-heat. Intestinal abscesses caused by stagnation of dampness, heat, and blood stasis should be treated by draining heat and dampness, breaking up stasis, and dissolving the abscess. |
| 【Clarification】 |
1. Why does this formula use the purgative method to treat intestinal abscesses?
The type of intestinal abscess that this formula treats is caused by dampness, heat, and blood stagnated in the intestines. As one of the six fu-organs, the intestine functions properly when there is free flow. Once there is blockage, there is pain; and once there is free flow, the pain will be gone. To cure this disease, pathogens must be given an exit. Specifically, excess pathogens in the intestines must be cleared up through defecation. In Da Huang Mu Dan Tang, mang xiao and da huang are used to drain heat and promote defecation. They not only drastically remove pathogens by purging them but they also restore the free flow in the intestines so that the pain is relieved.
2. At what stage is an intestinal abscess to be indicated for this formula?
It was recorded in the《Essentials from the Golden Cabinet》that “big and surging pulses tell of the formation of pus and the necessity to purge". However, in terms of using this formula, it also says that: “if there is pus, the pus should be purged; if there is no pus, static blood should be purged.” This inconsistency led to disputes by later generations. Currently, the overwhelming opinion is all intestinal abscesses that are due to an excess stagnation of damp, heat, and blood can be treated with this formula no matter whether the pus is formed or not. |
| 【Application】 |
1. Essential pattern differentiation
Da Huang Mu Dan Tang is commonly used to treat intestinal abscesses due to the stagnation of damp, heat, and blood stasis. This clinical pattern is marked by pain which refuses pressure in the right lower abdomen, yellow, greasy tongue coating, and rapid, slippery pulse.
2. Modern applications
This formula is commonly used to treat acute simple appendicitis, intestinal obstruction, acute biliary tract infection, biliary ascariasis, pancreatitis, acute pelvic inflammation, and infections after oviduct ligation when the patient shows signs and symptoms of stagnation of dampness, heat, and blood stasis.
3. Cautions and contraindications
Those whose abdominal abscess has been perforated, the elderly, pregnant, postpartum, or the weak should either not use it or use it with caution. |
| 【Additonal formulae】 |
1. Qing Chang Yin (Intestine Clearing Beverage, 清腸飲)
[Source]《Record of Syndrome Differentiation》bian zheng lu《辨證錄》
[Ingredients] Yín hua 3 liang (90g), dang gui 2 liang (60g), di yu 1 liang (30g), mai dong 1 liang (30g), xu an shen 1 liang (30g), sheng gan cao 3 qian (9g), yi yi ren 5 qian (15g), huang qin 2 qian (6g)
[Preparation and Administration] Prepare it as a decoction.
[Actions] Resolves toxins and invigorates blood, enriches yin and subdues fire.
[Applicable Patterns] Large intestinal abscess.
2. Lan Wei Hua Yu Tang (Vermiform Appendix Stasis Dissolving Decoction, 闌尾化瘀湯)
[Source]《New Research on Acute Abdominal Pain》Xin Ji Fu Zheng Xue《新急腹症學》
[Ingredients] Yin hua 15g, chuan lian zi 15g, da huang (added later) 9g, mu dan pia 9g, tao ren 9g, yan hu suo 9g, mu xiang 9g
[Preparation and Administration] Prepare it as a decoction.
[Actions] Moves qi and invigorates blood, clears heat and removes toxins.
[Applicable Patterns] Initial stage of acute appendicitis due to stasis and stagnation. Symptoms include: fever, abdominal distention and pain, and local tenderness and rebounding pain in the right lower abdomen. The latter stage of appendicitis. Symptoms include: less obvious heat, abdominal distention, belching, and poor appetite.
3. Lan Wei Qing Hua Tang (Vermiform Appendix Heat-Clearing and Stasis-Expelling Decoction, 闌尾清化湯)
[Source]《New Research on Acute Abdominal Pain》Xin Ji Fu Zheng Xue《新急腹症學》
[Ingredients] Yin hua 45g, pu gong ying 30g, mu dan pi 15g, da huang 15g, chuan lian zi 10g, chi shao 10g, tao ren 10g, gan cao 10g
[Preparation and Administration] Prepare it as a decoction.
[Actions] Clears heat and removes toxins, moves qi and invigorates blood.
[Applicable Patterns] The stages of heat accumulation or early pus formation in acute appendicitis or mild peritonitis. Symptoms include: low fever or afternoon fever, dry mouth and thirst, abdominal pain, constipation and yellow urine.
4. Lan Wei Qing Jie Tang (Vermiform Appendix Coptis Clearing and Resolving Decoction, 闌尾清解湯)
[Source]《New Research on Acute Abdominal Pain》Xin Ji Fu Zheng Xue《新急腹症學》
[Ingredients] Yin hua 60g, da huang 25g, dong gua zi 30g, pu gong ying 30g, mu dan pi 15g, chuan lian zi 10g, sheng gan cao 10g, mu xiang 6g
[Preparation and Administration] Prepare it as a decoction.
[Actions] Clears heat and removes toxins, promotes defecation and dissipates masses, moves qi and invigorates blood.
[Applicable Patterns] The stage of heat toxin in acute appendicitis. Symptoms include: fever and aversion to cold, red eyes and complexion, dry mouth, thirst and desire for water, nausea, abdominal pain which refuses pressure, tension of the abdominal muscles, rebounding pain, constipation, a red tongue with a yellow and dry or yellow and greasy coating, and a surging, big slippery and rapid pulse. |
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