A pill form of the classical "qing-xin li-niao yang-yin" (clear the heart, promote urine, nourish yin) formula from the Song-dynasty "Key to Therapeutics of Children's Diseases", the foundational "heart-fire" formula in TCM pediatrics.
Cultural reference - how this formula has been discussed in Chinese medical tradition. Not medical advice.
Background & origin
Compiled by Qian Yi (钱乙) in his Song-dynasty "Key to Therapeutics of Children's Diseases" (《小儿药证直诀》, 1119), one of the foundational texts of TCM pediatrics. The "pill" (丸) form is a modern production form, more common in commercial packaging. The original "导赤散" (Dōseki-san) is sold in Japan by Tsumura (ツムラ) as the standard OTC formula for "heart-fire" mouth ulcers. In Korea, similar preparations appear as 도적산 in the Kyungdong (경동) hanbang line. The formula is, in short, the most prescribed classical "heart-fire" formula in East Asia.
From the source text
This page is cultural documentation, not medical advice.
From the source text · 《小儿药证直诀》卷下·诸方·导赤散
Classical text
治小儿心热，视其睡，口中气温，或合面睡，及上窜咬牙，皆心热也。心气热则心胸亦热，欲言不能，而有就冷之意，故合面睡。
Modern Chinese rendering
本方用于小儿心热证候：睡眠时口中温度偏高（合面睡）、目上窜、咬牙、心胸烦热、欲言不能、喜就冷处。这一段方论把导赤散定位为"清心利尿养阴"思路下"心经热盛、引热下行"路径的代表方——以生地黄清热凉血、养阴生津为君;木通清心火、利小便、引热下行,竹叶清心除烦为臣;甘草梢(原方用"生甘草梢")清热解毒、调和诸药、引经至尿窍为使。四味相合,清心与利尿并用,养阴与导热共施,体现"上病下取""导心火从小肠而出"思路在中医儿科的经典应用。
Editorial translation
This formula is used for "heart-heat" patterns in children: warmth in the mouth during sleep (sleeping face-down), upward deviation of the eyes, grinding the teeth, heart-chest heat, inability to speak, and a preference for coolness. This preface positions Dǎo Chì Sǎn as the Formulary-derived "clear the heart, promote urine, nourish yin" representative formula — the canonical entry for the "heart-channel heat exuberance, drawing heat downward" register in pediatrics; it uses raw Dì Huáng as sovereign to clear heat, cool blood, and nourish yin, Mù Tōng / Zhú Yè as ministers to clear the heart, promote urine, and draw heat downward, and Gān Cǎo Shāo (raw licorice tip, in the original formula) as messenger to clear heat, resolve toxicity, and guide to the urinary orifice. The four flavours together use clearing the heart and promoting urine in combination, nourish yin and draw heat together — embodying the "treat the upper by addressing the lower" / "draw heart-fire out through the small intestine" principle as the canonical application in TCM pediatrics.
In tradition
In TCM framing, traditionally used in the context of "heart-fire flaming upward", mouth ulcers, sore throat, dark or scanty urine, irritability, crying in infants, flushed face, and a red tongue tip. The formula is named "导赤" (Heart-Draining Red) because it "drains" (导) the heart-fire (赤 represents the fire/red) downward through the small intestine channel into the urine. It is the foundational "heart-fire" formula in TCM pediatrics and is the most commonly prescribed classical OTC formula for "mouth ulcers + dark urine" patterns. In Japan, 導赤散 (Dōseki-san) is sold by Tsumura (ツムラ) as the standard OTC formula for "heart-fire" mouth ulcers. In Korea, similar preparations appear in the Kyungdong (경동) hanbang line.
Formula composition
Monarch1
- Rehmannia root, raw (Shēng Dì Huáng / 生地黄) — clears heat, nourishes yin
Minister1
- Akebia stem (Mù Tōng / 木通) — drains heart-fire downward through urine
Assistant1
- Bamboo leaf (Zhú Yè / 竹叶) — clears heart-fire
Envoy1
- Licorice tip (Gān Cǎo Shāo / 甘草梢) — harmonizes, guides to the urinary channel, stops pain
International availability
Taiwan & Hong Kong
- 順天堂OTC導赤丸Dao Chi Wan
Cautions & context
- Contains Mù Tōng (Akebia), modern pharmacy preparations use non-aristolochic substitutes; the formula should not be combined with other aristolochic-acid-containing herbs.
- Not appropriate for "spleen yang deficiency" presentations (loose stools, cold limbs, severe fatigue), the formula is "cold and draining" in nature.
- Sudden, severe, or rapidly progressing symptoms (high fever, severe mouth pain, inability to eat or drink) should be evaluated by a clinician, these are not within the scope of self-treatment.
- Pregnant or breastfeeding people should consult a qualified practitioner before use.
Related formulas
Other formulas from this text· "Key to Therapeutics of Children's Diseases"
Other formulas by this contributor· Qian Yi
Related concerns
Concern · digestion
Digestion
Upper-abdominal heaviness, bloating, sour reflux, loose stools, traveler's stomach, and the aftermath of a meal that was richer, spicier, or larger than usual.
Editorial note
Compiled from "Key to Therapeutics of Children's Diseases" (1119).
Last reviewed: July 18, 2026
Three layers of evidence
Classical source
≈ 900 years · "Key to Therapeutics of Children's Diseases" (1119)
Pharmacopoeia indication
"Clear heat and drain fire, promote urination and relax the bowels. Used for mouth and tongue sores, sore throat, irritability and chest heat, scanty dark urine, and constipation caused by internal exuberance of fire and heat."
Modern research status
As of 2026-07-18, a PubMed search using the formula name and the Latin / Korean / Japanese transliterations together with "systematic review" and "meta-analysis" did not identify a dedicated systematic review for this formula. Any clinical evidence that does exist is fragmented across small individual trials or covered in broad herbal-medicine umbrella reviews, which do not allow a per-formula evidence assessment; the absence of a dedicated SR is itself the relevant editorial fact here.
References
References reviewed on July 18, 2026 · PubMed search on 2026-07-18
- 01ClassicalQián Yǐ (钱乙), 《小儿药证直诀》 (Xiǎo Ér Yào Zhèng Zhí Jué / Key to Therapeutics of Children's Diseases), Northern Song dynasty, compiled ca. 1119, vol. 3 (卷下), the "formulas" (诸方) section, the entry for Dǎo Chì Sǎn (导赤散), the foundational "clear the heart, promote urine, nourish yin" (清心利尿养阴) representative formula in TCM pediatrics; the present-day Dǎo Chì Wán (丸 / pill form) is the modern industrial production form of the classical decoction (散) formula; the citation above follows the editorial choice to attribute the modern pill dosage form to the classical pediatric-lineage origin.
- 02TextbookDuan Fuqin (段富津) et al. (eds.), 《方剂学》 (Fāngjìxué / Science of Formulas), 2nd edition, Shanghai Scientific and Technical Publishers, 2011, the standard modern university-level formula textbook in mainland China, with Dǎo Chì Sǎn (and the related Wán / Sǎn / Kē Lì dosage forms) analysed in the "heat-clearing formulas" (清热剂) chapter as the representative "clear the heart, promote urine, nourish yin" formula, the canonical entry for the "heart-channel heat exuberance" register in pediatrics.
- 03TextbookTsumura & Co. (ツムラ), Dōseki-san (導赤散) product documentation, Japan's leading Kampo manufacturer, the standard Japanese Kampo OTC formula for "heart-fire" mouth ulcers in children, sold in Japanese drugstores, used in Japanese Kampo clinical practice for "heart-channel heat" patterns, listed in the Japanese Kampo formulary as a foundational "heart-fire" pediatric formula.
- 04PharmacopoeiaPharmacopoeia Commission of the PRC, 《中华人民共和国药典》 2020 edition, vol. 1 (Zhōnghuá Rénmín Gònghéguó Yàodiǎn, Pharmacopoeia of the People's Republic of China, 2020 ed., vol. 1), China Medical Science Press, 2020, the official national monograph for Dǎo Chì Wán (丸 / 散), "functional indication" reads "clear heat and drain fire, promote urination and relax the bowels, used for mouth and tongue sores, sore throat, irritability and chest heat, scanty dark urine, and constipation caused by internal exuberance of fire and heat".