Shuiniuo Dihuang Tang: Cooling Blood and Resolving Stasis with Water Buffalo Horn and Rehmannia

The Beiji Qianjin Yaofang (Essential Prescriptions Worth a Thousand Gold) contains Xijiao Dihuang Tang, a classic for clearing heat and toxin, cooling blood, and resolving stasis. Since rhinos are endangered, rhinoceros horn is no longer used; modern TCM substitutes water buffalo horn, and the old formula is now Shuiniuo Dihuang Tang (Water Buffalo Horn and Rehmannia Decoction).

Composition: water buffalo horn 15-60 g, raw Rehmannia 30 g, Chishao (red Paeonia) 12 g, Mudanpi (Moutan) 9 g. It is a common formula for heat-toxin deeply entering the blood level, used for bleeding of various kinds, coma, purpura, a crimson tongue with prickles, and rapid pulse.

It excels at bleeding due to heat in the blood level: cerebral hemorrhage, gastric bleeding, leukemia, pediatric neuroblastoma, aplastic anemia, acute purulent meningitis, acute DIC, thrombocytopenic purpura. I also use it for low platelets with severe heat signs after targeted therapy or chemotherapy in cancer patients; adding Diyu, Huaihua, Xianhecao, Banzhilian, Baihuasheshecao, Tengligen improves results.

With modifications or combinations it addresses many bleeding problems. For cerebral or GI bleeding with constipation, combine with Zengye Chengqi Tang to cool blood, resolve stasis, stop bleeding, and free the bowels; cerebral hemorrhage can also take Angong Niuhuang Wan. For hemoptysis with heat in nutritive-blood, add Baimaogen, Baiji, Sanqi. For hematuria, add Baimaogen, Xiaoji, Shiwei, Qumai. For skin macules, add Zicao, Chantui, Fuping. For leukemia blood-heat, add Jinyinhua, Diding, Pugongying, Baitouweng, Digupi, Ceyebai, Zicao, Danshen, Qiancao.

The key is again the tongue: heat deep in the nutritive-blood level is severe, visible on the tongue—crimson-purple like pig liver, with many prickles. This heat is one level deeper than Qingying Tang's, so this formula clears heat more strongly.