Da Huang Fu Zi Tang — Rhubarb & Aconite Decoction

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions

Overview

Da Huang Fu Zi Tang — the “Rhubarb and Aconite Decoction” — is from Zhang Zhongjing’s Jin Gui Yao Lue. It is the classical example of a “warm-purge” formula — combining the strong cold purgative Da Huang with the powerful warming herbs Fu Zi and Xi Xin to address cold-accumulation constipation: severe abdominal pain with constipation, cold extremities, no Heat signs. The cold-natured pathogen has accumulated in the bowels and must be expelled, but a plain cold purgative would damage the Yang; the warming herbs allow the purgation to occur without worsening the cold.

I prescribe Da Huang Fu Zi Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Da Huang Fu Zi Tang is prescribed for Cold accumulation in the bowels with constipation:

• Severe abdominal pain, often one-sided
• Constipation with hard stool
• Cold extremities, aversion to cold
• Pain worse with cold, relieved by warmth
• Possible fever (a paradoxical sign in this Cold pattern)
• Tongue — pale or pale-purple, white slippery coat
• Pulse — deep, wiry, tight

Key herbs

1. Da Huang (Rx. Rhei, 9–12g) — purges accumulation through the bowels
2. Fu Zi (Rx. Aconiti Lateralis Preparata, 3–9g) — warms Kidney Yang; disperses cold; counteracts Da Huang’s cold
3. Xi Xin (Hb. Asari, 1.5–3g) — warms the channels; expels cold; relieves severe cold pain

Formula actions

1. Warms the channels; disperses Cold
2. Purges Cold-accumulation through the bowels
3. Relieves severe abdominal pain from Cold

Conditions treated

1. Acute constipation with severe abdominal pain in cold-deficient patients
2. Cold-pattern ureteric colic (kidney stones with cold abdominal pain)
3. Acute cholecystitis with cold pain
4. Acute on chronic constipation in elderly cold-deficient patients
5. Severe cold-pattern dysmenorrhoea with constipation
6. Cold-pattern hernia with constipation

Cautions

Contains Fu Zi — must use pharmaceutical-grade processed (zhi/pao) Fu Zi only; raw Fu Zi is toxic. Even processed Fu Zi requires expert prescription.

Contains Xi Xin — use only at classical low dose; absolutely contraindicated in renal impairment due to aristolochic acid risk.

Contains Da Huang — strictly contraindicated in pregnancy.

Strictly for cold-accumulation patterns — not for Heat-accumulation (use Cheng Qi variants).

Severe acute abdominal pain requires urgent medical assessment to exclude bowel obstruction, perforation, ureteric stones, ectopic pregnancy or other surgical emergencies.

Always consult a qualified Chinese herbalist registered with the RCHM.

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