Xie Huang San — Drain the Yellow Powder

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Comparisons with related formulas
7. Modifications
8. Cautions

Overview

Xie Huang San — “Drain the Yellow Powder” — is a Song-dynasty pediatric formula from Qian Yi’s Xiao Er Yao Zheng Zhi Jue (Key to Therapeutics of Children’s Diseases, c. 1119), the foundational text of TCM paediatrics. “Yellow” refers to the Earth element which corresponds to the Spleen and Stomach; the formula drains accumulated Heat from these organs.

What makes Xie Huang San distinctive is that it does more than just clear Heat. It clears latent Spleen Heat that lurks deep in the middle burner (rather than acute, vigorous Stomach Fire). It uses warming, dispersing Fang Feng and Huo Xiang alongside cold-clearing Shi Gao and Zhi Zi to release and disperse latent Heat rather than just suppress it. The combination is unusual but clinically very effective.

The formula was originally developed for children but is widely used in adults today — particularly for recurrent mouth ulcers, halitosis, hunger and irritability that have failed to respond to simpler Heat-clearing formulas.

I prescribe Xie Huang San as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

Xie Huang San is prescribed for lurking Spleen-Stomach Heat:

• Recurrent mouth ulcers — particularly on the tongue, inner cheek and gums
• Halitosis — foul-smelling breath
• Hunger soon after eating — eats more than usual but never satisfied
• Constant desire for cold drinks
• Dry, cracked lips
• Red, dry mouth
• Irritability and restlessness
• Yellowish skin (in classical cases)
• Fidgeting in children, restlessness, poor concentration
• Burning sensation in the abdomen
• Tongue — red body, particularly red on the sides (Stomach region); yellow coat; sometimes peeled
• Pulse — slightly rapid, possibly thin

Key herbs

1. Shi Gao (Gypsum / calcium sulfate) — powerfully clears Stomach Fire; cold, dispersing
2. Zhi Zi (Gardenia jasminoides) — clears Triple Burner Heat, drains Heat through urine
3. Fang Feng (Saposhnikovia divaricata) — disperses Wind and releases the surface; here used to release the lurking Heat outward
4. Huo Xiang (Pogostemon cablin) — transforms Damp; aromatic; opens the Spleen to allow Heat to disperse
5. Gan Cao — harmonises; clears Heat

Formula actions

1. Clears lurking Spleen and Stomach Heat
2. Disperses Fire latent in the middle burner
3. Drains Heat downward through the urine
4. Releases Heat outward through the surface

Conditions treated

1. Recurrent aphthous mouth ulcers — one of the most reliable indications
2. Halitosis from Stomach Heat
3. Cracked dry lips, cheilitis, angular stomatitis
4. Gingivitis with red gums and bleeding
5. Tongue inflammation (glossitis)
6. Hyperphagia in children — constant hunger, never satisfied
7. Restless, irritable children with constant desire for food and cold drinks
8. Geographic tongue in children and adults
9. Hand-foot-and-mouth disease recovery phase
10. Acne around the mouth and chin from Stomach Heat
11. Polyphagia in early-onset diabetes (xiao ke) — particularly the middle xiao ke pattern
12. Behcet’s disease with mouth ulcers (alongside conventional care)

Comparisons with related formulas

• Qing Wei San — for Stomach Fire blazing upward with severe toothache, swollen gums, bleeding gums; more directly cold and draining than Xie Huang San.
• Yu Nu Jian — for Stomach Heat with Yin deficiency causing bleeding gums and ulceration in older patients.
• Bai Hu Tang — for vigorous, blazing Yang Ming Stomach Heat with high fever, profuse sweating and thirst; for acute presentations.
• Dao Chi San — for Heart Fire transferring to Small Intestine with mouth ulcers on the tongue tip.
• Gan Lu Yin — for Stomach Yin deficiency with empty-Heat causing recurrent mouth ulcers.

Modifications

• For severe mouth ulcers, add Huang Lian (small dose) and Lian Zi Xin
• For prominent halitosis, add Pu Gong Ying and Bai Jiang Cao
• For bleeding gums, add Sheng Di and Mu Dan Pi
• For constipation overlay, add Da Huang (small dose)
• For Yin deficiency overlay (dry mouth at night, peeled tongue), combine with Yi Wei Tang principles
• For children with restlessness and poor sleep, add Dan Zhu Ye and Bai He

Cautions

Not appropriate for cold patterns or Spleen Qi deficiency without Heat.

Not appropriate for the very early stage of acute infectious disease where exterior pathogenic factors are still present.

Use cautiously in patients with poor digestion — the cold herbs can damage Spleen Qi if used long-term. Stop and seek advice if appetite worsens, loose stools or cold feeling develops.

Recurrent mouth ulcers warrant medical investigation if accompanied by genital ulcers, eye inflammation or systemic symptoms — consider Behcet’s disease and other autoimmune causes.

Always consult a qualified Chinese herbalist registered with the Register of Chinese Herbal Medicine (RCHM). Online herbal consultations are available.

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