Jiedu Dihuang Tang (Detoxifying Rehmannia Decoction): Clearing Heat, Resolving Toxin, Cooling Blood, and Dispersing Swelling
Jiedu Dihuang Tang is a famous external-medicine formula from the Waike Jinjing (Golden Mirror of External Medicine). It combines Xijiao Dihuang Tang (Rhinoceros-Horn Rehmannia Decoction) and Huanglian Jiedu Tang (Coptis Detoxifying Decoction) into one. This formula clears heat and resolves toxin, cools blood and disperses swelling, and stops bleeding and pain. The Waike Jinjing used it to treat the hanging abscess of the hard palate, roughly equivalent to today's acute tonsillitis and pharyngitis.
For external-medicine ailments caused by exuberant heat-toxin, presenting with macules and papules, bleeding (hematemesis, epistaxis, bloody stool), agitation and delirium, coma and convulsions, a purplish-red tongue, and a rapid fine or wiry rapid pulse, one may consider choosing Jiedu Dihuang Tang. Leukemia and aplastic anemia presenting as exuberant heat-toxin may also use this formula; cancer patients with fever and heat and bleeding may also use it to stop bleeding.
This formula consists of raw Rehmannia (Sheng Di Huang) 30 g, red peony (Chi Shao) 12 g, Moutan bark (Mu Dan Pi) 12 g, buffalo horn (Shui Niu Jiao) 30 g, Scutellaria (Huang Qin) 9 g, cape jasmine (Zhi Zi) 9 g, Phellodendron (Huang Bai) 6 g, Coptis (Huang Lian) 6 g, and licorice (Gan Cao) 3 g. The first four are the components of Rhinoceros-Horn Rehmannia Decoction (because rhinoceros is a protected animal, buffalo horn is now used as a substitute), and the middle four are the components of Coptis Detoxifying Decoction. Because all the above herbs are cold-cooling or bitter-cold, a small amount of licorice is added to fortify the spleen and harmonize the stomach, and licorice also clears heat and resolves toxin.
If the patient has constipation, restlessness, or even mania, one may add 3-30 g of raw rhubarb (Sheng Da Huang) to the above to drain heat and open the bowels. Rhubarb should be added later in decoction, and the dose should follow the principle of starting small and gradually increasing. Because rhubarb is a laxative and patients vary, some need only a small dose to open the bowels while others need a larger dose. Physicians have historically been cautious with rhubarb, mostly using 3-10 g. But I have used 30 g on several occasions, because for some patients a small dose does not achieve bowel movement; especially when cancer patients develop intestinal obstruction, too small a dose of rhubarb has little effect.
This formula is often used to treat leukemia and lymphoma. When treating leukemia, it must be combined with heat-clearing, blood-cooling herbs such as isatis leaf (Da Qing Ye), honeysuckle (Jin Yin Hua), forsythia (Lian Qiao), dandelion (Pu Gong Ying), wolfberry bark (Di Gu Pi), cogongrass root (Bai Mao Gen), agrimony (Xian He Cao), and bird's-foot fern (Feng Wei Cao). When treating lymphoma, it must be combined with herbs such as Scrophularia (Xuan Shen), Zhejiang fritillary (Zhe Bei Mu), tuberous oat (Tu Bei Mu), oyster shell (Mu Li), seaweed (Hai Zao)—although seaweed and licorice are among the eighteen incompatible pairs, they are often used together in famous tumor formulas, such as Seaweed Jade Pot Decoction (Haizao Yuhu Tang)—kelp (Kun Bu), Dioscorea bulbifera (Huang Yao Zi), and momordica (Mu Bie Zi). If purpura appears on the skin, one may appropriately add gromwell (Zi Cao), indigo naturalis (Qing Dai), duckweed (Fu Ping), and cicada slough (Chan Tui). Patients with heavier bleeding may add notoginseng (San Qi), cattail pollen (Pu Huang), burnet (Di Yu), bletilla (Bai Ji), pagoda tree flower (Huai Hua), biota leaf (Ce Bai Ye), and human hair charcoal (Xue Yu Tan) to strengthen the hemostatic effect. This formula has also been used to treat psoriasis; when treating psoriasis, one may add dictamnus root bark (Bai Xian Pi) and tribulus (Ci Ji Li).
Many people, constrained by the theory of the yang-supporting school, fear using cold-cooling and bitter-cold herbs, believing that bitter-cold harms the stomach; this is a great prejudice. I once saw a patient with severe fire-toxin whose condition rapidly worsened after a yang-supporting TCM physician treated him with aconite-type formulas. I urgently used Jiedu Dihuang Tang, and only after taking it frequently did the heat subside and the swelling disperse. TCM treats disease on the principle of "cold patterns are treated with heat, heat patterns with cold"; people's constitutions are entirely different. If one only knows how to use yang-supporting formulas, one has literally chopped TCM in half. For patients with exuberant heat-toxin, one must use these heat-clearing, blood-cooling herbs without hesitation.
This formula has a fever-reducing effect and can treat persistent high fever in Japanese encephalitis patients. I have also used it to treat some cancer-fever patients whose syndrome was reckless blood heat, with effect. But if the patient is febrile and unconscious and this formula alone is ineffective, it must be combined with Purple Snow Pellet (Zi Xue Dan) or Calming the Palace Pill (Angong Niuhuang Wan).
I have also used this formula to treat acute gastroenteritis and dysentery in summer, with cures that come as quickly as drinking a cup. This formula can also be used to treat allergic purpura, especially with good effect in those whose condition worsens with heat. When using it, I often add anemarrhena (Zhi Mu) and raw gypsum (Sheng Shi Gao) to strengthen the heat-clearing effect.
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