Formulas · Purge Downward 瀉下 · Cheongeum Yobang (千金要方)

Rhubarb and Moutan Decoction

Daehwangmokdan-tang

한글 대황목단탕 (옹저) · Pinyin Da Huang Mu Dan Tang

大黃牡丹湯

The Bogam leaf and the Geumgwe formula already registered as daehwangmokdanpi-tang are the same prescription under slightly different weights; the clinical entry keeps the untailed id and this leaf takes the chapter tail, so the pair stays linked. The leaf's name is 大黃牡丹湯 without 皮, read as Daehwangmokdan-tang, though the existing entry's name_ko romanizes as though 皮 were present. The transcription prints 癕 for 癰, normalized here, and 冬苽仁 for 冬瓜仁, which is left as printed. The 一方 variant substituting winter melon seed for trichosanthes seed is not counted in the ingredient list.

Composition 構成

Mokdanpi Mu Dan Pi
牡丹皮 목단피 · Moutan Bark

10 g
Chief 君
Daehwang Da Huang
大黃 대황 · Rhubarb

6 g
Chief 君
Doin Tao Ren
桃仁 도인 · Peach Kernel

10 g
Deputy 臣
Mangcho Mang Xiao
芒硝 망초 · Mirabilite

6 g
Deputy 臣
Gwaruin Gua Lou Ren
瓜蔞仁 과루인 · Trichosanthes Seed

10 g
Assistant 佐

Total 42 g per packet (첩) · representative dosage — verify against source texts.

Received this formula from your practitioner? Amounts shown here are classical reference values — granule and prepared products differ. Always follow your prescribed dosage and directions.

Actions 效能

Treats 腸癰, intestinal abscess, where the pulse is slow and tight and the pus has not yet formed
Drains the bound heat and stasis downward before the swelling suppurates
Brings down pus where there is pus and blood where there is none

Indications 主治

Pattern-based

腸癰 — intestinal abscess with a slow, tight pulse
膿未成 — pus not yet formed, so the swelling can still be drained away
Heat and blood bound in the lower abdomen refusing pressure

Biomedical correlates

Acute appendicitis and peri-appendiceal abscess (classical use; a surgical emergency today)
Pelvic inflammatory mass
Diverticular abscess

Source text 原文

Donguibogam 東醫寶鑑

治腸癰, 脉遲緊, 膿未成, 可下之. 大黃ㆍ芒硝各一錢半, 牡丹皮ㆍ桃仁ㆍ瓜蔞仁各二錢半. 右剉, 作一貼, 水煎服. 有膿卽下膿, 無膿卽下血. ○一名大黃湯. 一方, 有冬苽仁, 無瓜蔞仁, 神效. 《千金》

Translation

Treats intestinal abscess where the pulse is slow and tight and the pus has not yet formed, so that it can be drained downward. Rhubarb and mirabilite, 1 don 5 fun each; moutan bark, peach kernel and trichosanthes seed, 2 don 5 fun each. Cut the above, make one packet, decoct in water and take. Where there is pus it brings the pus down, and where there is no pus it brings blood down. Also called Daehwang-tang, the Rhubarb Decoction. One version has winter melon seed and no trichosanthes seed, and is wondrously effective. — Cheongeum 千金 (Donguibogam · Ongjeo)

Clinical commentary 臨床

The Cheongeum's version of the Geumgwe formula, and the one place in the chapter where the classical description and the modern diagnosis line up almost exactly. Rhubarb and mirabilite purge the bound heat through the bowel, moutan bark cools the blood in the vessels, and peach kernel with trichosanthes seed breaks the stasis and lubricates the passage. The whole thing is aimed at the window the leaf names: 膿未成, before the pus has formed, while the mass can still be dispersed rather than drained. 腸癰 is appendicitis and peri-appendiceal abscess. The chapter's own signs for it — a tender lower abdomen that will not take pressure, a mass, fever with chills, and the pulse turning from slow and tight to surging and rapid as the pus forms — are the signs a surgeon still looks for. Daehwang-mokdan-tang is one of the few classical formulas that has kept a real place in modern practice, used in China as adjunctive and conservative management of uncomplicated appendicitis and of appendiceal abscess, and the Geumgwe's reasoning about the window before suppuration is the same reasoning behind treating a walled-off abscess with antibiotics and interval appendicectomy. **A hot, tender right lower abdomen is a surgical emergency. Appendicitis perforates, and a purgative given to a patient with peritonitis is dangerous. This needs imaging and a surgeon, not a decoction. Contains rhubarb and mirabilite and must not be used in pregnancy.** — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.