Liang Xue Di Huang Tang

Blood-Cooling Rehmannia Decoction · 凉血地黄汤

A classical decoction used to cool the Blood and stop bleeding caused by Heat, especially useful for hemorrhoids, anal bleeding, and other conditions where Heat in the Blood leads to reckless bleeding. It clears Damp-Heat from the Lower Burner and relieves pain and swelling.

Origin 《外科正宗》 (Wai Ke Zheng Zong), Volume 3 — Ming dynasty, 1617 CE
Composition 11 herbs
Di Huang
King
Di Huang
Chi Shao
Deputy
Chi Shao
Dang Gui
Deputy
Dang Gui
Di Yu
Deputy
Di Yu
Huai Jiao
Deputy
Huai Jiao
Huang Lian
Assistant
Huang Lian
Huang Qin
Assistant
Huang Qin
枳壳
Assistant
枳壳 (Zhi Qiao)
+3
more
Explore composition

Educational content Consult qualified TCM practitioners for diagnosis and treatment

Patterns Addressed

In TCM, symptoms don't appear randomly — they cluster into recognizable patterns of disharmony that reveal what's out of balance in the body. Liang Xue Di Huang Tang is designed to correct these specific patterns.

Why Liang Xue Di Huang Tang addresses this pattern

This formula directly targets Damp-Heat in the Lower Burner, especially in the Large Intestine. The herbs clear Heat, dry Dampness, and stop bleeding, addressing the root and symptoms of Damp-Heat causing hemorrhoidal bleeding and pain.

A practitioner would look for one or more of these signs

Hemorrhoids

Bleeding hemorrhoids with bright red blood

Blood in stool

Fresh blood in the stool, often spurting

Anal pain

Anal pain and swelling

Commonly Prescribed For

These conditions can arise from the patterns above. A practitioner would consider Liang Xue Di Huang Tang when these conditions are specifically caused by those patterns — not for all cases of these conditions.

TCM Interpretation

In TCM, hemorrhoids are often caused by Damp-Heat sinking down to the Lower Burner, leading to Blood stasis and swelling. When Heat enters the Blood, it forces the Blood out of the vessels, causing bleeding. This condition is marked by bright red bleeding, anal pain, and a sensation of heat.

Why Liang Xue Di Huang Tang Helps

Liang Xue Di Huang Tang cools the Blood with Sheng Di Huang, clears Damp-Heat with Huang Lian and Huang Qin, and stops bleeding with Di Yu and Huai Jiao. Zhi Qiao moves Qi to relieve distension, and Jing Jie expels Wind while stopping bleeding. Together, they address both the root (Damp-Heat) and the symptoms (bleeding, pain).

Also commonly used for

Anal fissure

Cools Blood and relieves pain to promote healing

Rectal bleeding

Directly addresses Heat-induced bleeding from the rectum

Colitis

Clears Damp-Heat to reduce inflammation and bleeding

What This Formula Does

Every TCM formula has a specific set of actions — here's what Liang Xue Di Huang Tang does in the body, explained in both everyday and TCM terms

Therapeutic focus

In practical terms, Liang Xue Di Huang Tang is primarily used to support these areas of health:

TCM Actions

In TCM terminology, these are the specific therapeutic actions that Liang Xue Di Huang Tang performs to restore balance in the body:

How It Addresses the Root Cause

TCM doesn't just suppress symptoms — it aims to resolve the underlying imbalance. Here's how Liang Xue Di Huang Tang works at the root level.

This formula addresses a pattern of Heat entering the Blood level, often combined with Dampness in the Lower Burner. When Heat invades the Blood, it forces the Blood to move recklessly, causing bleeding. In the Lower Burner, this manifests as hemorrhoidal bleeding, blood in the stool, or other bleeding signs. The Heat may be exacerbated by Dampness, which obstructs the Qi mechanism and leads to pain and swelling. The pathomechanism involves both Heat in the Blood and Damp-Heat in the Large Intestine, resulting in bleeding, pain, and local inflammation.

Formula Properties

Every formula has an inherent temperature, taste, and affinity for specific organs — these properties determine how it interacts with the body

Overall Temperature

Cold

Taste Profile

Predominantly bitter and sweet — bitter to drain Heat and dry Dampness, sweet to tonify Qi and Blood, with a subtle acridity to invigorate Blood and stop pain.

Ingredients

11 herbs

The herbs that make up Liang Xue Di Huang Tang, organized by their role in the prescription

King — Main ingredient driving the formula
Deputy — Assists and enhances the King
Assistant — Supports or moderates other herbs
Envoy — Directs the formula to its target
King — Main ingredient driving the formula
Di Huang

Di Huang

Rehmannia root

Dosage 15 - 30g
Temperature Cold
Taste Sweet (甘 gān), Bitter (苦 kǔ)
Organ Affinity Heart, Liver, Kidneys

Role in Liang Xue Di Huang Tang

Cools the Blood, nourishes Yin, and extinguishes Heat in the Blood level. Addresses the root of bleeding due to Heat.
Deputies — Assists and enhances the King
Chi Shao

Chi Shao

Red peony root

Dosage 9 - 12g
Temperature Slightly Cool
Taste Bitter (苦 kǔ), Sour (酸 suān)
Organ Affinity Liver

Role in Liang Xue Di Huang Tang

Invigorates Blood and dispels stasis, preventing the cold herbs from congealing Blood. Also cools Blood and relieves pain.
Dang Gui

Dang Gui

Chinese Angelica root

Dosage 6 - 9g
Temperature Warm
Taste Sweet (甘 gān), Acrid / Pungent (辛 xīn)
Organ Affinity Liver, Heart, Spleen

Role in Liang Xue Di Huang Tang

Nourishes and invigorates Blood, guiding other herbs to the Blood level and preventing stasis. The tail part specifically moves Blood.
Di Yu

Di Yu

Garden Burnet Root

Dosage 9 - 15g
Temperature Slightly Cool
Taste Bitter (苦 kǔ), Sour (酸 suān), Astringent (涩 sè)
Organ Affinity Liver, Large Intestine, Stomach
Preparation Stir-fried until charred (地榆炭)

Role in Liang Xue Di Huang Tang

Cools Blood and stops bleeding, especially for intestinal bleeding and hemorrhoidal bleeding. Charred to enhance hemostatic effect.
Huai Jiao

Huai Jiao

Pagodatree Pod

Dosage 9 - 15g
Temperature Cold
Taste Bitter (苦 kǔ)
Organ Affinity Liver, Large Intestine

Role in Liang Xue Di Huang Tang

Clears Heat from the Large Intestine and stops bleeding. A key herb for hemorrhoidal bleeding.
Assistants — Supports or moderates other herbs
Huang Lian

Huang Lian

Coptis rhizome

Dosage 3 - 6g
Temperature Cold
Taste Bitter (苦 kǔ)
Organ Affinity Heart, Liver, Stomach, Large Intestine, Gallbladder, Spleen

Role in Liang Xue Di Huang Tang

Clears Heat and dries Dampness, especially from the Lower Burner. Assists in treating the root of Damp-Heat.
Huang Qin

Huang Qin

Baical skullcap root

Dosage 9 - 12g
Temperature Cold
Taste Bitter (苦 kǔ)
Organ Affinity Lungs, Gallbladder, Spleen, Large Intestine, Small Intestine, Heart, Stomach

Role in Liang Xue Di Huang Tang

Clears Heat and dries Dampness, particularly from the Large Intestine. Supports Huang Lian in clearing Damp-Heat.
枳壳

枳壳 (Zhi Qiao)

Dosage 6 - 9g

Role in Liang Xue Di Huang Tang

Moves Qi in the Large Intestine, relieves distension and pain, and helps guide the herbs to the affected area.
Jing Jie

Jing Jie

Schizonepeta

Dosage 6 - 9g
Temperature Slightly Warm
Taste Acrid / Pungent (辛 xīn), Aromatic (芳香 fāng xiāng)
Organ Affinity Lungs, Liver
Preparation Stir-fried until charred (荆芥炭)

Role in Liang Xue Di Huang Tang

Charred to enter Blood and stop bleeding. Also expels Wind, addressing the Wind component in hemorrhoidal bleeding.
Envoys — Directs the formula to its target
Sheng Ma

Sheng Ma

Cimicifuga rhizome

Dosage 3 - 6g
Temperature Slightly Cool
Taste Acrid / Pungent (辛 xīn), Sweet (甘 gān)
Organ Affinity Lungs, Spleen, Stomach, Large Intestine

Role in Liang Xue Di Huang Tang

Raises Yang and directs the formula to the Lower Burner. Also clears Heat and resolves toxins.
Gan Cao

Gan Cao

Licorice root

Dosage 3 - 6g
Temperature Neutral
Taste Sweet (甘 gān)
Organ Affinity Heart, Lungs, Spleen, Stomach

Role in Liang Xue Di Huang Tang

Harmonizes the actions of all herbs and moderates the cold nature of the formula.

Why This Combination Works

How the herbs in Liang Xue Di Huang Tang complement each other

Overall strategy

The formula cools the Blood to stop bleeding, clears Heat and dries Dampness to address the root cause, and moves Qi and Blood to relieve pain and swelling.

King herb

Sheng Di Huang enters the Blood level to cool Blood and nourish Yin, directly addressing the reckless movement of Blood due to Heat.

Deputy herbs

Chi Shao and Dang Gui Wei invigorate Blood and prevent stasis from the cold herbs. Di Yu and Huai Jiao specialize in cooling Blood and stopping bleeding in the Lower Burner, especially for hemorrhoidal bleeding.

Assistant herbs

Huang Lian and Huang Qin clear Heat and dry Dampness from the Large Intestine. Zhi Qiao moves Qi to relieve distension and pain. Jing Jie, charred, enters the Blood to stop bleeding and expel Wind.

Envoy herbs

Sheng Ma raises Yang and directs the formula to the Lower Burner, while Gan Cao harmonizes the formula and moderates the cold nature.

Notable synergies

The pairing of Di Yu and Huai Jiao creates a potent cooling and hemostatic effect specific to the Large Intestine. The combination of Chi Shao and Dang Gui Wei ensures that Blood stasis is prevented while cooling Blood.

How to Prepare

Traditional preparation instructions for Liang Xue Di Huang Tang

Combine all ingredients in a pot with 1000–1200 mL of water. Bring to a boil over high heat, then reduce to a simmer for 30–40 minutes. Strain the liquid, retaining the herbs. Add another 600–800 mL of water to the herbs and simmer again for 20–30 minutes. Strain and combine both decoctions. Divide into 2–3 doses and take orally, warm, throughout the day.

Common Modifications

How practitioners adapt Liang Xue Di Huang Tang for specific situations

Added
Huang Bai (黄柏) 6–9g: strongly dries Dampness and clears Heat

Huang Bai is added to reinforce the Damp-Heat clearing effect, especially when heat signs are prominent.

Educational content — always consult a qualified healthcare provider or TCM practitioner before using any herbal formula.

Contraindications

Situations where Liang Xue Di Huang Tang should not be used or requires extra caution

Avoid

Contraindicated in Spleen-Stomach deficiency cold (脾胃虚寒) with symptoms such as abdominal cold pain, loose stools, and poor appetite.

Avoid

Contraindicated in cases of Qi and Yang deficiency with pronounced cold signs (aversion to cold, cold extremities).

Caution

Use with caution during pregnancy — contains blood-moving herbs (e.g., Chuan Xiong, Dang Gui).

Caution

Use with caution in elderly or debilitated patients, and those with low blood pressure or compromised cardiovascular function.

Caution

Use with caution in patients with liver or kidney dysfunction — adjust dosage under professional guidance.

Special Populations

Important considerations for pregnancy, breastfeeding, and pediatric use

Pregnancy

Contraindicated during pregnancy. The formula contains blood-moving herbs such as Chuan Xiong (川芎) and Dang Gui (当归) which may stimulate uterine contractions. Should only be considered under strict professional supervision if absolutely necessary.

Breastfeeding

No specific safety data on breastfeeding. Caution is advised due to lack of evidence; use only when clearly needed and under guidance of a qualified practitioner. It is not known whether the active compounds are excreted in breast milk.

Children

Use with caution in children. Dosage must be reduced and adjusted by a qualified practitioner based on age and weight. Not recommended for infants without professional guidance.

Drug Interactions

If you are taking pharmaceutical medications, be aware of these potential interactions with Liang Xue Di Huang Tang

  • Anticoagulants / Antiplatelets (e.g., warfarin, aspirin, clopidogrel): Chuan Xiong and Dang Gui in this formula have blood-moving properties, which may increase bleeding risk when combined with these drugs.
  • Diuretics & Corticosteroids: Gan Cao (licorice) can cause sodium retention and potassium loss; concurrent use with diuretics may exacerbate hypokalemia, and with corticosteroids may alter fluid balance.
  • Antihypertensives: Gan Cao may raise blood pressure in susceptible individuals, potentially reducing the effect of antihypertensive medications.
  • CYP3A4 substrates: Huang Lian inhibits certain cytochrome P450 enzymes and may alter the metabolism of drugs such as some antibiotics, antivirals, and immune modulators.

No well-documented clinical interactions are available; these potential interactions are based on constituent herb pharmacology. Always consult a healthcare provider before concurrent use with prescription medications.

Usage Guidance

Practical advice for getting the most out of Liang Xue Di Huang Tang

Best time to take

30 minutes before meals (as per classical instruction: 食前服).

Typical duration

Acute hemorrhoidal bleeding: 7–14 days. Chronic conditions may require longer courses under professional supervision.

Dietary advice

Avoid spicy, greasy, fried, and irritative foods. Prefer a light, bland diet. Cold or raw foods should also be limited as they may further weaken Spleen Yang already challenged by the formula's cold nature.

Liang Xue Di Huang Tang originates from 《外科正宗》 (Wai Ke Zheng Zong), Volume 3 Ming dynasty, 1617 CE

Classical Texts

Key passages from the classical Chinese medical texts that first described Liang Xue Di Huang Tang and its clinical use

《外科正宗》卷三(Ming Dynasty, 1617 CE)

原文:凉血地黄汤,治脏毒已成未成,或肿不肿,肛门疼痛,大便坠重。方用川芎、当归、白芍、生地、白术、茯苓各一钱,黄连、地榆、人参、山栀、天花粉、甘草各五分。水二钟,煎八分,食前服。

English: Liangxue Dihuang Decoction treats rectal abscesses whether formed or not, with or without swelling, anal pain, and a bearing-down sensation in the anus. Prescription: Chuan Xiong, Dang Gui, Bai Shao, Sheng Di Huang, Bai Zhu, Fu Ling, each one qian; Huang Lian, Di Yu, Ren Shen, Shan Zhi Zi, Tian Hua Fen, Gan Cao, each five fen. Simmer in two cups of water to eight-tenths, take before meals.

Historical Context

How Liang Xue Di Huang Tang evolved over the centuries — its origins, lineage, and place in the broader tradition of Chinese medicine

凉血地黄汤 first appears in the Ming dynasty surgical manual 外科正宗 (The Orthodox Manual of Surgery, 1617 CE) by Chen Shigong, where it treats rectal abscesses and anal pain with bleeding. During the Qing dynasty, several modified versions emerged: 外科大成 (The Great Compendium of Surgery) adapted the formula to target hemorrhoidal bleeding with a stronger cooling-blood focus, while 医宗金鉴 (The Golden Mirror of Medicine) recorded a similar version for blood-heat hemorrhagic conditions. These variations highlight the formula's foundational role in TCM proctology, blending the Qi-tonifying Si Jun Zi Tang and Blood-nourishing Si Wu Tang with cold herbs to address both deficiency and heat — a strategy that remains influential in modern anorectal practice.

Modern Research

A published study investigating the pharmacological effects or clinical outcomes of Liang Xue Di Huang Tang

1

Modified Liangxue Dihuang Decoction combined with snap needles for postoperative pain and wound edema in mixed hemorrhoids (Damp-Heat syndrome): a randomized controlled trial (2024)

Zhang WJ, Xu J. (2024), Journal of Clinical Personalized Medicine, 3(4), 2102-2106.

In a randomized trial of 70 patients undergoing mixed hemorrhoid surgery, the combination of modified Liangxue Dihuang Decoction with snap needles significantly reduced postoperative pain and perianal edema compared to the decoction alone. The total effective rate was higher in the treatment group (P < 0.05), and both groups showed no adverse reactions, indicating good safety.

Link

Research on TCM formulas is growing but still limited by Western clinical trial standards. These studies provide emerging evidence and should be considered alongside practitioner expertise.