Da Huang Mu Dan Pi Tang — Rhubarb & Moutan Decoction

On this page

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

Overview

Da Huang Mu Dan Pi Tang — the “Rhubarb and Moutan Decoction” — is from Zhang Zhongjing’s Jin Gui Yao Lue. It is the classical formula for intestinal abscess (chang yong, the TCM term for what corresponds to acute appendicitis and similar deep abdominal infections) in the early stage before pus has fully formed, where Damp-Heat and Blood stasis are accumulating. Modern TCM gastroenterology uses it for early uncomplicated appendicitis, mild diverticulitis and pelvic inflammatory disease — always alongside conventional medical assessment because perforation is a life-threatening surgical emergency.

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

TCM pattern

Da Huang Mu Dan Pi Tang is prescribed for early intestinal abscess (Damp-Heat with Blood stasis):

• Severe lower abdominal pain, classically right-lower quadrant
• Pain worse with pressure (rebound)
• Fever, possibly with chills
• Constipation, dark urine
• Possible localised abdominal mass
• Tongue — red with yellow-greasy coat
• Pulse — slippery, rapid, forceful

Key herbs

1. Da Huang (Rx. Rhei, 6–12g) — chief; purges Heat-accumulation downward; moves Blood
2. Mu Dan Pi (Cx. Moutan, 9–15g) — cools and moves Blood; clears Heat from the Blood
3. Tao Ren (Sm. Persicae, 9–12g) — moves Blood; breaks stasis; assists Da Huang
4. Mang Xiao (Mirabilitum, 6–9g) — softens hardness; purges Heat downward
5. Dong Gua Ren (Sm. Benincasae, 15–30g) — drains pus from the abdomen; clears Damp-Heat

Formula actions

1. Purges Heat-accumulation downward
2. Moves Blood and resolves stasis
3. Drains incipient pus
4. Reduces inflammation in the lower abdomen

Conditions treated

1. Early uncomplicated acute appendicitis (with concurrent surgical assessment)
2. Acute diverticulitis with localised abdominal pain (adjunctive)
3. Acute pelvic inflammatory disease with Damp-Heat and stasis
4. Acute prostatitis with Damp-Heat lower abdominal pain
5. Tubo-ovarian abscess in the resolving phase (adjunctive)

Cautions

Acute appendicitis requires urgent surgical assessment — this formula is an adjunct to (NOT a replacement for) surgical evaluation. Suspected perforation, sepsis or peritonitis is a medical emergency — call 999.

Contains Da Huang and Mang Xiao — strictly contraindicated in pregnancy.

Once pus has fully formed or in late-stage abscess, different formulas are indicated.

For short-term acute use only.

Always consult a qualified Chinese herbalist registered with the RCHM.

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