San Huang Xie Xin Tang (三黄泻心汤) — Drain the Epigastrium with Three Yellows

San Huang Xie Xin Tang is the classical Chinese herbal formula from Zhang Zhongjing’s Jin Gui Yao Lue for Excess Fire in the upper three burners — severe agitation, Fire-type bleeding (nosebleed, haematemesis), red face, hypertensive crisis and acute febrile illness. Three powerful cold-bitter herbs — Da Huang, Huang Lian and Huang Qin (the three “yellows”) — combine to drain Fire downward through the bowels, cool the Blood and resolve severe agitation. Reserved for short-term acute use; strictly contraindicated in pregnancy.

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions
7. Frequently asked questions

Overview

San Huang Xie Xin Tang — the “Three Yellows Drain the Epigastrium Decoction” — is from Zhang Zhongjing’s Jin Gui Yao Lue. Three powerful cold draining herbs — Da Huang, Huang Lian, Huang Qin (the three “Huangs” or yellows) — combine to drain Excess Fire throughout the upper three burners, with particular use for Fire-type bleeding (nosebleed, haematemesis) and severe agitation.

I prescribe San Huang Xie Xin Tang as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.

TCM pattern

San Huang Xie Xin Tang is prescribed for Excess Fire in the upper three burners:

• Restlessness, agitation, severe irritability
• Red face, possibly red eyes
• Bleeding from upper body — epistaxis, haematemesis, haemoptysis
• Bitter taste, foul breath
• Severe constipation^[11]
• Possible delirium or insomnia^[8] from Fire disturbing the Shen
• Severe acute mouth ulcers
• Hot, painful, swollen face or neck
• Tongue — red, yellow coat
• Pulse — rapid, forceful, possibly slippery

Key herbs

1. Da Huang (Rx. et Rz. Rhei, 1-15g) — purges Fire downward through bowels
2. Huang Lian (Rz. Coptidis, 1-9g) — clears Heart and Stomach Fire
3. Huang Qin (Rx. Scutellariae, 1-15g) — clears Lung and upper-burner Fire

Formula actions

1. Drains Fire from the three burners
2. Cools Blood and stops Fire-type bleeding
3. Resolves severe agitation and delirium from Fire
4. Purges accumulation

Conditions treated

1. Severe acute hypertensive crisis with red face and headache (alongside conventional care)
2. Acute haemorrhage from Fire — epistaxis, haemoptysis, haematemesis
3. Severe acute hyperthyroidism^[6] with marked agitation
4. Severe acute mania or psychosis with Fire pattern
5. Severe acute conjunctivitis with red eyes
6. Severe acute oral toxicity with mouth ulcers and bleeding gums
7. Acute toxic febrile illness

Cautions

Contains Da Huang — strictly contraindicated in pregnancy.

Not appropriate for cold-deficient or Yin-deficient patterns — the cold draining herbs damage Yang and depleted Yin.

For short-term acute use only; not for chronic use.

Acute hypertensive crisis, severe bleeding or severe psychiatric emergency require urgent medical care.

Always consult a qualified Chinese herbalist registered with the RCHM.

Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide.

Frequently asked questions about San Huang Xie Xin Tang

What is San Huang Xie Xin Tang used for?

San Huang Xie Xin Tang is used for Excess Fire in the upper three burners — severe acute hypertensive crisis with red face, Fire-type bleeding (epistaxis, haematemesis, haemoptysis), severe acute hyperthyroidism with marked agitation, severe acute mania or psychosis with Fire pattern, acute conjunctivitis, severe acute mouth ulcers and acute toxic febrile illness. Used alongside, never instead of, conventional emergency care.

How does San Huang Xie Xin Tang work?

The three cold-bitter herbs each target different aspects of Fire. Da Huang purges Fire downward through the bowels (the “drain” mechanism); Huang Lian clears Heart and Stomach Fire to settle agitation and stop bleeding; Huang Qin clears Lung and upper-burner Fire. Together they produce a rapid, bowel-mediated drainage of severe Heat from the upper body.

Is San Huang Xie Xin Tang safe in pregnancy?

No — strictly contraindicated. The formula contains Da Huang, which is a Blood-moving purgative that can stimulate uterine contraction and threaten the pregnancy. It is also generally inappropriate for any cold-deficient or Yin-deficient pattern.

How quickly does San Huang Xie Xin Tang work?

For acute Heat patterns the effect is rapid — agitation and bleeding can settle within hours to a day or two of dosing. The formula is used for short-term acute treatment only, typically 2–7 days. It is not appropriate for chronic conditions; prolonged use damages Yang and depletes Yin.

Who should not take San Huang Xie Xin Tang?

Avoid in pregnancy, cold-deficient constitutions, Yin-deficient patterns and any non-Heat presentation. Severe hypertensive crisis, major haemorrhage and acute psychiatric emergencies need urgent conventional medical care — this formula is supportive within a TCM treatment plan, not a substitute for emergency care.

References

[6] Liu Y, Cheng L, Yan G, Gu J, Lyu Z, Ding J. Effectiveness and potential mechanism of Jiawei-Xiaoyao-San for hyperthyroidism: a systematic review. Front Endocrinol (Lausanne). 2023 Sep 18;14:1241962. https://doi.org/10.3389/fendo.2023.1241962. PMID: 37780612.

[8] Hu J, Teng J, Wang W, Yang N, Tian H, Zhang W, Peng X, Zhang J. Clinical efficacy and safety of traditional Chinese medicine Xiao Yao San in insomnia combined with anxiety. Medicine (Baltimore). 2021 Oct 29;100(43):e27608. https://doi.org/10.1097/MD.0000000000027608. PMID: 34713840.

[11] Lyu Z, Fan Y, Bai Y, Liu T, Zhong LL, Liang HF. Outcome of the efficacy of Chinese herbal medicine for functional constipation: A systematic review and meta-analysis. World J Clin Cases. 2022 May 26;10(15):4856-4877. https://doi.org/10.12998/wjcc.v10.i15.4856. PMID: 35801027.