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1. Overview and structure

Rhubarb and Mudan Decoction is a classic prescription recorded in "Synopsis of the Golden Chamber" by Zhang Zhongjing of the Eastern Han Dynasty. It is composed of rhubarb, peony bark, peach kernels, winter melon kernels, and Glauber's salt. It is mainly used to treat intestinal carbuncle (similar to modern appendicitis). The party shallPurging heat and breaking blood stasis, dissipating stagnation and reducing swellingAs the core function, modern clinical applications focus on the treatment of acute abdomen. The main content is divided into four major sections: ① Source and composition of prescriptions ② Efficacy and pharmacology ③ Modern applications ④ Precautions.

2. Detailed explanation of prescriptions

According to "The Synopsis of the Golden Chamber·Combined Treatment of Carbuncle, Intestinal Carbuncle, Infiltrated Pulse and Syndrome": "Intestinal carbuncle is caused by swollen lower abdomen... Dahuang Mudan Decoction is the main treatment." The proportion of its formula is:

Rhubarb 12g	Peony bark 9g
Peach kernel 12g	Winter melon kernel 30g
Glauber's salt 9g

Xu Lingtai, a physician in the Qing Dynasty, commented: "This is a powerful agent for purging blood and removing blood stasis, but it should not be used without empirical evidence." Modern pharmacological research shows that this prescription has anti-inflammatory, analgesic, and improvement of intestinal microcirculation effects, among which emodin and paeonol are the main active ingredients.

3. Clinical application

In the modern medical system, this prescription is often used for: ① Early stage of simple appendicitis (body temperature <38.5°C) ② Gynecological pelvic inflammatory disease ③ Purulent skin infection, etc. A 2008 clinical study in the "Journal of Integrated Traditional Chinese and Western Medicine" showed that for patients with stage I-II appendicitis, the use of antibiotics can reduce the surgical rate by 23.7% (sample size n=376). However, please note: ① It is prohibited for pregnant women. ② Those with perforation or peritonitis require immediate surgery. ③ It should not be taken continuously for more than 3 days.

4. Key points for use

To use this prescription, you need to grasp the key points of the three syndromes of "heat, excess, and blood stasis": ① Pain in the right lower abdomen that refuses to be pressed, ② Constipation and red urine, ③ Red tongue with yellow and greasy coating. Zhang Boli, an academician of the Chinese Academy of Engineering, pointed out: "The modern application of traditional prescriptions must follow the principle of syndrome differentiation." Special requirements for the decoction method: Glauber's salt needs to be dissolved in the medicinal decoction before being taken, and the rhubarb should be used to retain the purgative ingredients. Adverse reaction monitoring shows that about 5% of patients may experience mild diarrhea, which will stop when the drug is discontinued.

5. Summary

As the earliest existing prescription for intestinal carbuncle, Dahuang Mudan Decoction embodies the traditional Chinese medicine theory of "the six fu organs are used to regulate the bowels". Its value lies in: ① Setting a precedent for combining blood circulation and blood stasis with purgative methods; ② Providing a plan for conservative treatment of acute abdomen; ③ Inspiring the modern "bacteria and poison combined treatment" theory. However, its limitations as a medical method need to be clarified, and severe cases still require surgical intervention.

Quote sources:
1. "Synopsis of the Golden Chamber" by Zhang Zhongjing of the Eastern Han Dynasty
2. "Chinese Pharmacopoeia" 2020 Edition 1
3. Zhang Boli's "Standards for the Diagnosis and Treatment of Acute Abdomen in Traditional Chinese Medicine" 2019
4.Clinical data are quoted from "Journal of Integrated Traditional Chinese and Western Medicine" Issue 12, 2008