导赤散合剂

4. Common modifications

• For more pronounced Heart fire: add Huang Lian (coptis rhizome) to strengthen the effect of clearing the Heart and draining fire.
• For severe painful, uncomfortable urinary dribbling: add Che Qian Zi (plantago seed) and Chi Fu Ling (red poria) to strengthen the effect of clearing heat, disinhibiting water and relieving painful urinary dribbling.
• For bloody painful urinary dribbling: add Han Lian Cao (eclipta) and Xiao Ji (field thistle herb) to cool the blood and stop bleeding.
• For more pronounced yin deficiency: add Mai Dong (ophiopogon root) and Xuan Shen (scrophularia root) to strengthen the effect of nourishing yin.

5. Cautions and clinical notes

• Contraindications:
  • Use with caution in patients with Spleen-Stomach deficiency cold, marked by reduced food intake, loose stools, and cold abdominal pain.
  • Of the Mu Tong (akebia stem/clematis stem) used in this formula, only the safe Chuan Mu Tong (clematis armandii stem) or Tong Cao (tetrapanax pith) should be used; Guan Mu Tong (aristolochia manshuriensis stem), which is associated with nephrotoxicity, is prohibited.
  • This formula is cold in nature; discontinue once the condition resolves and do not take for a prolonged period.

6. Granule conversion and dose (based on the crude herb weight of the decoction)

• Calculation of the total crude herb weight of the original formula:
  • Sheng Di Huang (rehmannia root) 15 g + Mu Tong (or Tong Cao) 6 g + Zhu Ye (lophatherum leaf) 6 g + Sheng Gan Cao Shao (raw licorice root tip) 6 g = 33 g.
• Conversion to 5:1 granules:
  • 33 g crude herb ÷ 5 = 6.6 g granules.
• Recommended dose:
  • One dose daily, taken in 2-3 doses dissolved in warm water, 2-3.5 g per dose.
  • Or as directed by a practitioner, who will modify the formula according to the relative severity of Heart fire and yin damage, in which case the total crude herb weight should be recalculated accordingly.