Dao Chi San: Herbal Relief for Heart Heat and Urinary Issues
Health Lab- Jan 30
- 6 min read
Updated: May 4
Dao Chi San, or Red-Guiding Powder, is a classic Chinese herbal formula from Xiao Er Yao Zheng Zhi Jue by Qian Yi, a renowned Northern Song Dynasty pediatrician. Designed for children’s delicate constitutions—prone to rapid shifts between heat, cold, strength, or weakness—this gentle blend of four herbs clears heart fire, promotes urination, and nourishes yin.
Ideal for treating heart meridian heat syndromes in children, such as restlessness or mouth sores, it also benefits adults with similar symptoms, offering timeless wisdom in traditional Chinese medicine (TCM).
What’s in Dao Chi San?
Dao Chi San combines four herbs, structured by the TCM principle of monarch, minister, assistant, and envoy, to cool the heart and regulate fluids. The ingredients and their roles are:
Monarch Herb
Rehmannia Root (Sheng Di Huang): Sweet and cold, rehmannia nourishes yin, clears heart heat, cools blood, and boosts fluids, easing chest heat and thirst.
Minister Herb
Akebia Vine (Mu Tong): Bitter and cold, akebia clears heart fire and promotes urination, flushing heat through urine to relieve painful urination.
Assistant Herb
Bamboo Leaves (Zhu Ye): Sweet and cold, bamboo leaves clear heart heat, reduce restlessness, and guide heat downward, soothing mouth sores.
Envoy Herb
Licorice Root Tip (Gan Cao Shao): Sweet and mild, licorice harmonizes the formula, protects the stomach from cold herbs, and enhances efficacy.
Preparation
Decoct equal parts (typically 6g each of rehmannia, akebia, and licorice, plus 3g bamboo leaves) in water and drink warm as a tea, adjusted for the patient’s age and condition.
How It Works
Dao Chi San targets heart meridian heat syndrome, a TCM condition where excessive heart fire disrupts the body, often in children due to their immature yin-yang balance. This heat can shift to the small intestine, causing urinary issues. The formula works by:
Clearing Heart Fire: Rehmannia and bamboo leaves cool heart heat, relieving restlessness and sores.
Promoting Urination: Akebia flushes heat via urine, easing red, painful urination.
Nourishing Yin: Rehmannia replenishes yin fluids, preventing depletion from heat.
Protecting the Stomach: Licorice ensures cold herbs don’t harm digestion.
This balanced approach, as Qian Yi envisioned, clears heat without over-drying, aligning with his principle of treating excess (heat) and deficiency (yin) simultaneously.
What Does It Treat?
Dao Chi San is used for heart meridian heat, with symptoms including:
Chest heat or discomfort
Mouth or tongue sores
Thirst or desire for cold drinks
Red, painful, or scanty urine
Red tongue and rapid pulse
Restlessness, night crying, or teeth grinding (in children)
These reflect heart fire flaring upward or shifting to the small intestine, often triggered by infections, stress, or dietary imbalances.
Pathogenesis in TCM
In TCM, the heart governs emotions and blood, while the small intestine, its paired organ, manages fluid secretion. When heart fire is excessive, it causes symptoms like mouth sores, thirst, or restlessness.
This heat can transfer to the small intestine, impairing urination and causing red, painful urine. In children, whose yin is immature, this heat progresses quickly, consuming fluids and worsening symptoms.
Dao Chi San cools the heart, guides heat downward via urine, and nourishes yin, restoring balance as described in Yi Zong Jin Jian’s phrase: “water deficiency and fire not strong.”
Modern Applications
Modern research highlights Dao Chi San’s anti-inflammatory, diuretic, and heat-clearing effects, driven by compounds in rehmannia and akebia. Clinical uses include:
Pediatric Conditions: Treats stomatitis, oral thrush, and night crying in children by clearing heart fire.
Urinary Disorders: Relieves acute urinary tract infections, cystitis, urethritis, and prostatitis by promoting diuresis and reducing inflammation.
Eye and Mouth Issues: Manages oral ulcers, keratitis, and blepharitis by cooling heat.
Cardiac Conditions: Supports viral myocarditis by reducing heart-related inflammation.
Other Uses: Treats hematuria and heat-related discomfort, enhancing patient comfort.
Its synergistic herb combination enhances efficacy while minimizing side effects, validating TCM’s scientific foundation.
Precautions
Spleen-Stomach Weakness: Use cautiously in patients with weak digestion, as cold herbs (rehmannia, akebia) may cause discomfort.
Monitoring: Watch for gastrointestinal upset in sensitive patients; adjust dosage or add spleen-supporting herbs if needed.
Contraindications: Avoid in cases of cold syndromes (pale tongue, chills) or non-heat-related urinary issues.
Professional Guidance: Consult a TCM practitioner to tailor the formula to the patient’s condition, especially for children or chronic cases.
Conclusion
Dao Chi San is a gentle yet effective Chinese herbal formula that clears heart fire, promotes urination, and nourishes yin. With rehmannia, akebia, bamboo leaves, and licorice, it relieves mouth sores, urinary pain, and restlessness, particularly in children with heart meridian heat.
Widely used in modern TCM for infections and inflammatory conditions, its benefits are supported by research showing anti-inflammatory and diuretic effects. Under professional guidance, Dao Chi San offers a nurturing, balanced approach to cooling heat and restoring health, embodying Qian Yi’s pediatric wisdom for all ages.
Chinese Name | 導赤散 |
Phonetic | Dao Chi San |
English Name | Red-Guiding Powder |
Classification | Heat-clearing formulas |
Source | 《Key to Diagnosis and Treatment of Children’s Diseases》Xiao er Yao Zheng Zhi Jue《小兒藥證直訣》 |
Combination | Rehmanniae Radix (Sheng Di) 6g, Akebiae Caulis (Mu Tong) 6g, Glycyrrhizae Radix et Rhizoma (Gan Cao Shao) 6g |
Method | Grind the medicinals into a crude powder. Decoct one dose (3 qian) of the formula with one cup of water and some zhu ye, boil until the volume is reduced to half. Drink the decoction warm, after meals. (Modern use: use water to decoct the medicinals, add zhu ye 3g.) |
Action | Clears heart fire, nourishes yin, and promotes urination. |
Indication | This formula is indicated for intense heat in the heart channel. The symptoms are vexing heat in the chest, sores in the mouth and tongue, thirst, red complexion, preference for cold drinks, difficult and painful urination that is dark, a red tongue, and a rapid pulse. |
Pathogenesis | This is a pattern of intense heat in the heart channel or the transmission of heart heat to the small intestine. The heart fire flames up along the channel and causes vexing heat in the chest, sores in the mouth and tongue, and a red complexion. The intense fire consumes yin, which causes thirst and a preference for cold drinks. Since there is an interior-exterior relationship between the heart and the small intestine, heart heat transmits to the small intestine, which fails to separate the clear and the turbid and cause difficult and painful urination with dark urine. The red tongue and rapid pulse are signs of internal heat. Qian Yi said the pathogenesis of this pattern is “heart heat” or “heat of the heart qi”, without defining the nature of the pattern in terms of deficiency or excess. Later, the《Golden Mirror of the Medical Tradition》Yi Zong Jin Jian concluded this pattern is “deficient water without excessive fire”; in other words, the yin deficiency and the fire are not severe. Children, whose yin and yang are tender, are more apt to contract cold and heat. Their diseases change rapidly, and may be either deficient or excessive. According to these features, Qian Yi established the therapeutic principle: prevent deficiency when treating excess, and prevent excess when treating deficiency for children’s diseases. Since the flaming of heart fire damages kidney yin, Qian Yi also suggested clearing heart fire together with nourishing yin, and promoting urination to drain heat. |
Application | 1. Essential pattern differentiation Dao Chi San is a commonly used formula used to treat intense heat in the heart channel, and a commonly used formula that embodies the therapeutic methods of clearing heat, promoting urination, and nourishing yin. This clinical pattern is marked by vexing heat in the chest, sores in the mouth and tongue, red complexion, difficult and painful urination with dark urine, red tongue and rapid pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of intense heat in the heart channel: stomatitis, thrush, and night crying of babies; or when the patient shows signs of heart heat transmitting to the small intestine: acute urinary tract infection. 3. Cautions and contraindications Use this formula with caution in patients with spleen and stomach deficiency, as bitter-cold mu tong and cool-cold sheng di are included in the formula. |
Additonal formulae | Qing Xin Lian Zi Yin (Heart-Clearing Lotus Seed Beverage, 清心蓮子飲) [Source]《Beneficial Formulas from the Taiping Imperial Pharmacy》Tai Ping Hui Min He Ji Ju Fang《太平惠民和劑局方》 [Ingredients] Huang qin 0.5 liang (15g), mai dong 0.5 liang (15g), di gu pi 0.5 liang (15g), che qian zi 0.5 liang (15g), zhi gan cao 0.5 liang (15g), shi lian rou 7.5 qian (22.5g), huang qi (honey-fried) 7.5 qian (22.5g), ren shen 7.5 qian (22.5g) [Preparation and Administration] Prepare it as a decoction. [Actions] Clears heart fire, nourishes qi and yin, and relieves strangury with turbid urine. [Applicable Patterns] Intense heart fire, deficiency of qi and yin, and damp-heat pouring downward. Symptoms include: seminal emission, stranguria with turbid urine, profuse uterine bleeding and leukorrhea, disease onset upon tiredness, kidney yin deficiency marked by thirst, vexation, and fever. |
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