Dao Chi San
Do not self-treat with Dao Chi San
If this is an emergency
Some reactions to Dao Chi San need urgent care. Call your local emergency number or go to an emergency department straight away — do not wait to see whether it passes.
Who should avoid Dao Chi San?
- Never take any product containing Aristolochia species Mu Tong (Guan Mu Tong, Aristolochia manshuriensis) — it causes permanent kidney failure and urinary tract cancer, and there is no safe amount.
- Do not use if you cannot confirm in writing which species of Mu Tong the product contains.
- Do not use if you have kidney disease or reduced kidney function.
- Do not use if you are pregnant.
- Do not use if you are breastfeeding.
- Do not use if you have high blood pressure, because the licorice in it can push your blood pressure higher.
- Do not use if you have low potassium (a mineral your heart and muscles need) or take a water tablet that lowers it.
- Do not use if you take digoxin, a heart medicine.
- Do not use if you take lithium, a mood medicine.
- Do not use if you have heart failure or a known heart rhythm problem.
- Do not give it to a child except under a qualified practitioner who has seen the child.
- Do not use if you have loose stools, poor appetite and feel cold easily — traditional texts warn against it in this state.
When should you see a doctor?
See a doctor the same day if you have burning urination with fever, back pain, or blood in your urine, because that can be a kidney infection.
Stop the formula and get medical help urgently if you notice swelling in your legs or face, a much lower amount of urine than usual, severe muscle weakness, or a fast or irregular heartbeat.
Tell a doctor as soon as possible if you have taken any Chinese herbal product containing Mu Tong for weeks or longer, even if you feel fine. A simple blood and urine test can check your kidneys, and early aristolochic acid damage has no symptoms.
Also see a doctor if a mouth sore lasts more than three weeks, keeps coming back, or bleeds.
- What it is: Dao Chi San (Guide Out the Red Powder) is a 900-year-old Chinese herbal formula of four herbs, used traditionally for children with mouth sores, restlessness and dark, burning urine.
- Active ingredients: Catalpol and other iridoid glycosides from raw Rehmannia, Saponins from Mu Tong, Flavonoids from Lophatherum leaf, Glycyrrhizin from licorice tips
- Side effects: Usually mild (more urination, loose stools), but licorice can raise blood pressure and lower potassium, and Aristolochia-type Mu Tong can cause permanent kidney damage and cancer.
- Pregnancy & breastfeeding: Avoid in pregnancy and while breastfeeding.
Educational information, not medical advice — ask your doctor or midwife.
What is Dao Chi San?
Dao Chi San is a classic Chinese herbal formula. Another name for it is Guide Out the Red Powder. In old practice it was used mostly for children.
It was given for mouth and tongue sores, restlessness, and dark, burning urine. We list it here as one entry, not as one herb. That is because the four plants in it are always given together.
The four herbs are raw Rehmannia (Sheng Di Huang), Mu Tong, Lophatherum leaf (Dan Zhu Ye) and licorice tips (Gan Cao Shao). The name points to the idea of "guiding out" heat through the urine. "Red" stands for the red tongue and red face it was described for.
One of the four herbs brings a serious problem. Mu Tong has often been supplied as Guan Mu Tong (Aristolochia manshuriensis). That plant holds aristolochic acid, which harms the kidneys for good and causes cancer of the urinary tract.
Safe products use Chuan Mu Tong (Clematis armandii) instead. But you cannot tell the two apart by eye.
On the evidence: this formula has a long, well-recorded past in Chinese medicine for children. Even so, we could not find good human trials that test whether it works. Old use is not the same as proof of effect, and that holds for everything on this page.
How does Dao Chi San work?
In Chinese medicine terms, Dao Chi San is said to clear "heart fire". It is said to drain that heat down and out through the urine. That is a traditional frame, not an account of how the body works.
In modern terms, the parts do have some likely actions. Lophatherum and Mu Tong are mildly diuretic (they make you pass more urine). Raw Rehmannia and licorice have anti-inflammatory effects (they calm swelling) in lab tests.
None of this has been shown to explain any benefit in people. No study has traced a measured effect in humans back to one herb in this formula. So treat any story about how it works as a guess, not a finding.
What forms does Dao Chi San come in?
The old form is a decoction. The raw herbs are simmered in water, and you drink the liquid. In the classic text the herbs were ground to a powder and boiled with a little bamboo leaf.
You may also see granules that melt in hot water, pills, or a liquid extract. Labels usually say Dao Chi San or Guide Out the Red Powder.
Whatever the form, ask the seller in writing which Mu Tong species is used. Ask too if the batch is tested for aristolochic acid. If they cannot answer, do not buy it.
Where it comes from:
Dao Chi San first appears in a Song dynasty book from 1119. The title is Xiao Er Yao Zheng Zhi Jue ("Key to Therapeutics of Children's Diseases"). It was written by Qian Yi, a doctor for children.
The formula has been in steady use in Chinese medicine for about 900 years. Schools still teach it today, and most modern formula books list it. Its standing rests in one tradition, Chinese herbal medicine, not across several.
What does Dao Chi San help with?
- Mouth and tongue sores in children (canker sores): This is the classical main use, and Qian Yi described it for exactly this in 1119. Chinese practitioners still prescribe it for red, painful sores on the tongue tip with a fretful child. We could not find published human trials testing whether it heals these sores faster than doing nothing.
- Painful or burning urination: Traditional texts use it for hot, difficult, burning urination with dark urine. Two of the herbs increase urine output in animal studies. Burning urination can be a urinary infection, which may need antibiotics, so this is a symptom to have checked rather than self-treat.
- Dark, scanty urine: Traditionally read as a sign of internal heat and treated by "draining" it through the urine. In plain terms, dark urine is most often simple dehydration. Drinking more water is the first thing to try.
- Restlessness and poor sleep in young children: Classically given to an irritable, hot, restless child who sleeps badly. This use rests entirely on traditional case reports and teaching texts. No controlled human trial supports it.
- Red face and thirst described in TCM as "heart fire": "Heart fire" is a traditional pattern name, not a medical diagnosis, and it does not correspond to any measurable finding. The formula is chosen for this pattern rather than for a named disease. There is no modern evidence base for it.
What are the side effects of Dao Chi San?
- Passing urine more often
- Loose stools or mild diarrhoea
- Stomach upset or nausea
- Fluid retention and puffy ankles, from the licorice
- Raised blood pressure, from the licorice
- Low potassium (a mineral your heart and muscles need), from the licorice, which can cause muscle weakness and an irregular heartbeat
- Allergic rash
- Kidney damage and urinary tract cancer if the product contains Aristolochia species Mu Tong
Good to know:
Most reported effects are mild and settle when you stop: extra urination, loose stools, a little stomach upset.
The licorice effects matter more than people expect. Regular glycyrrhizin intake can push blood pressure up and potassium down, and that combination can cause dangerous heart rhythms.
The serious risk is not the formula itself but the Mu Tong in it. Aristolochic acid has caused irreversible kidney failure, dialysis, urinary tract cancer and deaths. That harm builds silently over months and is not reversed by stopping.
Options to discuss with a clinician
For every reason people reach for this formula, there are routes with better evidence behind them — and each one is a conversation with a doctor, pharmacist or qualified herbalist, not a straight swap you make at home.
**Painful or burning urination, dark or scanty urine.** This is the one to get looked at rather than treated from a shelf. Burning on passing urine can mean a urinary tract infection (a bacterial infection of the bladder or kidneys), which usually needs testing and prescribed treatment; blood in the urine, fever or back pain means urgent same-day assessment. Ask a clinician what is actually causing it before anything else is considered.
**Mouth and tongue sores, including in children.** Things worth raising with a GP, dentist or pharmacist include Saltwater Rinse, Aloe Vera Topical, Hyaluronic acid gels, and Licorice root (Glycyrrhiza glabra) — licorice in particular needs a clinician's sign-off, as it affects blood pressure and potassium. Repeated mouth ulcers in a child can point to low iron, B12 or Vitamin D, which a simple blood test can check.
**Restlessness and broken sleep in young children.** Worth a paediatric review rather than a herbal product: sleep routine, pain, reflux and iron levels are the usual starting points a clinician will work through with you.
Graded pages for the options named above:
- Licorice root (Glycyrrhiza glabra) — evidence grade B, traditional tier T3
- Aloe Vera Topical — evidence grade B, traditional tier T3
- Hyaluronic acid — evidence grade A, traditional tier T0
- Saltwater Rinse — evidence grade A, traditional tier T3
- Potassium — evidence grade A, traditional tier T0
- Vitamin D — evidence grade A, traditional tier T0
Review status
This page has not been signed off by a pharmacist and is not published. It is shown here for a policy decision only.