What Liang Xue Di Huang Tang is for
This formula treats skin that is showing Heat in the Blood: bright red spots, purpura and easy bruising, where the Heat is pushing the Blood out of the vessels. It cools the Blood, clears the Heat and stops the bleeding, so the spots stop appearing in new crops. It is an acute formula, used for a short course and then reassessed.
The lesions are bright: pinhead red spots that do not blanch when pressed, larger purpuric patches, and bruises that appear without a knock. The colour runs from fresh red to purple, the skin between the lesions may be normal or slightly warm, and the spots arrive in crops rather than one at a time. There is no scale, no greasy crust and no itch. The pattern is Heat in the Blood level, so the Heat damages the vessels and pushes the Blood out into the tissue.
Sheng Di Huang cools and nourishes the Blood so the vessels have something to hold, Chi Shao and Mu Dan Pi cool and move it so the cooled Blood does not stagnate, and Di Yu and Huai Jiao stop the bleeding. Huang Lian and Huang Qin clear the Heat that started it, Dang Gui nourishes the Blood, and Zhi Ke, Jing Jie and Sheng Ma move the Qi and lift the action so the Blood stays where it belongs. Gan Cao harmonises. The formula cools without freezing and stops the spots without leaving stasis behind.
It suits the acute hot presentation, with bright red or purpuric lesions and a sense of heat in the skin, and it is used for a short course and then reassessed. Bleeding from Cold or from deficiency is the opposite pattern: pale skin, slow bruising and cold tissue would be worsened by cooling. Unexplained bruising or bleeding needs medical assessment before treatment, because a skin formula cannot exclude a cause elsewhere in the body.
Actions
- Cools the Blood
- Clears Heat
- Stops bleeding
- Relieves red and purpuric lesions
Properties
- Taste and temperature: Predominantly bitter and sweet with a cold quality. Bitter clears Heat, sweet and cold nourish and cool the Blood.
- Organs: Heart, Liver, Stomach
- Channels: Heart, Liver, Stomach
The pattern behind it
The pattern is Heat in the Blood level. The Heat damages the vessels and pushes the Blood out, producing red lesions, purpura and bleeding, while the crimson tongue and rapid pulse confirm the level. The formula cools the Blood, clears the Heat and stops the bleeding.
Composition
The herbs in Liang Xue Di Huang Tang, with their role and dose.
| Role | Herb | Dose | Properties | Why it is there |
|---|---|---|---|---|
| King | Sheng Di Huang | 15 to 30 g | Cold, Sweet, bitter | Cools the Blood and nourishes Yin, the main cooling herb. |
| Chi Shao | 9 to 12 g | Slightly cold, Bitter | Cools and moves the Blood, addressing the congestion and the heat. | |
| Dang Gui | 6 to 9 g | Warm, Sweet, pungent | Nourishes Blood so the cooling does not leave it depleted. | |
| Di Yu | 9 to 15 g | Slightly cold, Bitter, sour | Stops bleeding and cools the Blood, the main hemostatic herb. | |
| Huai Jiao | 9 to 15 g | Cold, Bitter | Stops bleeding and clears Heat, supporting the hemostatic action. | |
| Huang Lian | 3 to 6 g | Cold, Bitter | Clears Heat from the Heart and the upper body. | |
| Huang Qin | 9 to 12 g | Cold, Bitter | Clears Heat from the upper body and cools the Blood. | |
| Zhi Ke | 6 to 9 g | Slightly cold, Bitter, pungent, sour | Moves Qi downward, supporting the movement of the formula. | |
| Jing Jie | 6 to 9 g | Slightly warm, Pungent | Disperses and vents, helping the Heat leave the Blood. | |
| Sheng Ma | 3 to 6 g | Slightly cold, Sweet, pungent | Clears Heat and lifts the action, used for bleeding of the upper body. | |
| Gan Cao | 3 to 6 g | Neutral, Sweet | Harmonises the formula. |
Patterns it treats
Heat in the Blood Level
Bright red pinhead spots that do not blanch, purpuric patches and bruises that appear without a knock, arriving in crops on skin that may feel warm. The pattern is Heat in the Blood level, so the Heat damages the vessels and pushes the Blood into the tissue.
How the formula is built
The formula cools, moves and stops at the same time. The cooling herbs address the Heat, the moving herbs prevent the cooled Blood from stagnating, and the hemostatic herbs stop the bleeding. Sheng Ma and Jing Jie add the lift that helps the Blood stay where it belongs.
Skin conditions it is used for
Where this formula appears in the skin conditions of the library.
Preparation and use
Decocted in water and taken warm, in two divided doses.
Modifications
- If the bleeding is severe, the hemostatic herbs are increased.
- If the Heat is marked, the cooling herbs are increased.
- If the person is depleted, nourishing support is added.
- If the bleeding is from Cold, this formula is not used.
Timing
Taken warm in two divided doses.
Duration
Acute use: three to seven days, reassessed.
Diet while taking it
Cool light food; avoid hot spicy food and alcohol.
Safety
Contraindications
Avoid in bleeding from Cold or deficiency, in pregnancy, and in anyone with active unexplained bleeding until it has been assessed. This is an acute formula.
Interactions
The hemostatic and Blood-moving herbs may interact with anticoagulants and antiplatelet medication, so coordination is needed.
Pregnancy
Contraindicated in pregnancy because the formula moves Blood and contains herbs that are not used in pregnancy.
Breastfeeding
Use only under professional guidance.
Children
Used only with professional supervision.
Before you use it
Recorded from the classical record and rewritten in this project's own words. Educational only: not a prescription, and unexplained bleeding or bruising needs medical assessment before treatment.
General safety references
General references for herbal hepatotoxicity and herb-drug interactions; they are not specific to this formula.
- Review article: Herbal hepatotoxicity - an update on traditional Chinese medicine preparations. Alimentary Pharmacology & Therapeutics, 2014. PMID: 24844799.
- Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs, 2009. PMID: 19719333.
- Warfarin and food, herbal or dietary supplement interactions: a systematic review. British Journal of Clinical Pharmacology, 2021. PMID: 32478963.
Origin and history
Recorded in the surgical and Blood-Heat literature as a development of the Blood-cooling approach.
The formula belongs to the Blood-Heat tradition, which recognised that some bleeding comes from Heat damaging the vessels rather than from deficiency. Its combination of cooling, moving and hemostatic herbs made it a standard treatment for purpura and heat-type bleeding.
Classical record
The formula is recorded in the Blood-Heat literature for red lesions and bleeding from Heat in the Blood, cooling the Blood and stopping the bleeding.
As recorded in the classical record for this formula.
Evidence note
No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.
Common questions
What does cooling the Blood mean?
It means clearing Heat at the deepest level, where it damages the vessels and pushes blood out. That is why the formula both cools and stops bleeding.
Can it be used for bruising?
Only where there are heat signs and a crimson tongue, and only after medical assessment of unexplained bruising.
Why does a cooling formula contain a warming herb?
Dang Gui and Jing Jie prevent the cooling from leaving the Blood stagnant and help the Heat leave. They are small parts of the whole.
How long is it used?
Three to seven days, then reassessed.