Herb Root (根 gēn)

San Qi

Notoginseng root · 三七

Panax notoginseng (Burk.) F.H. Chen · Radix et Rhizoma Notoginseng

Also known as: Tian Qi (田七), Tienchi Ginseng

San Qi (Notoginseng root) plant

Images shown are for educational purposes only

San Qi (Notoginseng) is one of the most prized herbs in Chinese medicine, sometimes called "gold that cannot be exchanged" for its remarkable ability to stop bleeding and heal injuries. It works by clearing out stagnant blood while simultaneously stopping active bleeding, making it uniquely versatile for both internal bleeding conditions and traumatic injuries. It is the principal ingredient in the world-famous Yunnan Baiyao wound medicine.

Category Hemostatic herbs (止血药) Herbs that transform stasis and stop bleeding (化瘀止血药)
Therapeutic focus Injury and Trauma Recovery Cardiovascular Health Bleeding and Bruising Pain Management

TCM Properties

Temperature

Warm

Taste

Sweet (甘 gān), Bitter (苦 kǔ)

Channels entered

Liver, Stomach

Parts used

Root (根 gēn)

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What This Herb Does

Every herb has a specific set of actions — here's what San Qi does in the body, explained in both everyday and TCM terms

Therapeutic focus

In practical terms, San Qi is primarily used to support these areas of health:

Injury and Trauma Recovery Cardiovascular Health Bleeding and Bruising Pain Management

TCM Actions

In TCM terminology, these are the specific therapeutic actions that San Qi performs to restore balance in the body:

Dispels Stasis and Stops Bleeding Invigorates Blood and Dispels Stasis Reduces Swelling and Alleviates Pain

How these actions work

'Transforms stasis and stops bleeding' is the hallmark action of San Qi and what makes it truly unique among hemostatic herbs. Most herbs that stop bleeding do so by cooling, contracting, or astringent mechanisms, which risk trapping old blood (stasis) inside the body. San Qi stops bleeding while simultaneously dispersing stagnant blood. This means it can be used for virtually any type of bleeding, whether internal (coughing blood, vomiting blood, nosebleeds, blood in the stool or urine, uterine bleeding) or external (traumatic wounds). It is especially valuable when bleeding occurs alongside signs of blood stasis. Zhang Xichun, the famous physician of the modern era, praised it as a substance that "dissolves stagnant blood without damaging new blood" (化瘀血而不伤新血).

'Activates Blood and resolves stasis' means San Qi promotes healthy circulation and breaks up accumulations of stuck or stagnant blood. This action applies broadly to conditions involving blood stasis patterns: chest pain from heart vessel obstruction, abdominal masses, blocked menstruation, painful periods, and postpartum pain from retained blood clots. It enters the Liver channel (which stores blood) and the Stomach channel (the hub of the Yang Ming, rich in Qi and blood), giving it wide reach across the body's blood system.

'Reduces swelling and alleviates pain' is why San Qi has been called the "sacred herb of traumatology" in Chinese medicine. It directly addresses the swelling and pain that follow injuries. For sprains, fractures, contusions, and other physical trauma, San Qi can be taken internally or applied as a powder directly to the affected area. This pain-relieving action extends to any condition where blood stasis causes pain, such as the stabbing chest pain of coronary artery obstruction.

Patterns Addressed

In TCM, symptoms cluster into recognizable patterns of disharmony. San Qi is used to help correct these specific patterns.

Why San Qi addresses this pattern

San Qi is one of the most effective herbs for treating Blood Stasis (blood that has become stuck or stagnant in the body). Its warm temperature and sweet-bitter taste give it the ability to both move stagnant blood and generate new blood. It enters the Liver channel, which is responsible for storing blood and ensuring its smooth flow, and the Stomach channel, which belongs to the Yang Ming system that is abundant in both Qi and Blood. By activating blood circulation and dispersing accumulations, San Qi directly addresses the core pathomechanism of Blood Stasis. Its pain-relieving action is especially relevant here, as fixed, stabbing pain is the cardinal symptom of blood stasis.

A practitioner would look for one or more of these signs

Chest Pain

Fixed, stabbing chest pain from heart vessel obstruction

Amenorrhea

Menstrual pain with dark, clotted blood

Bruising

Bruising and swelling from traumatic injury

Abdominal Pain

Postpartum abdominal pain from retained blood clots

Commonly Used For

These are conditions where San Qi is frequently used — but only when they arise from the specific patterns it addresses, not in all cases

Arises from: Blood Stasis

TCM Interpretation

In TCM, traumatic injuries cause a sudden disruption to the local flow of Qi and Blood. Blood leaves the vessels and pools in the tissues, forming stasis (瘀血). This stagnant blood blocks the channels and collaterals, producing swelling, pain, and bruising. The Liver, which governs the smooth flow of blood and the health of the sinews, is the primary organ system involved. The treatment principle is to activate blood circulation, disperse stasis, reduce swelling, and relieve pain.

Why San Qi Helps

San Qi is considered the "sacred herb of traumatology" (外伤科圣药) precisely because its actions match this condition perfectly. Its ability to activate blood and disperse stasis addresses the pooled, stagnant blood directly, while its swelling-reducing and pain-relieving properties provide symptomatic relief. It can be taken internally as a powder or applied externally to wounds. San Qi also stops bleeding from open injuries, making it doubly useful. The world-famous Yunnan Baiyao (Yunnan White Medicine), used globally as a first-aid remedy for wounds and bleeding, is built around San Qi as its principal ingredient.

Also commonly used for

Bruising

Resolves blood stasis that causes swelling and discoloration

Coughing

Coughing blood from various causes

Epistaxis (Nosebleed)

Nosebleeds, particularly recurrent or heavy

Amenorrhea

Painful menstruation due to blood stasis

Hyperlipidemia

Modern research supports a role in lowering blood lipids

Coronary Artery Disease

Used alongside conventional treatments for cardiovascular support

Cerebral Hemorrhage

Intracerebral bleeding where stasis and bleeding coexist

Herb Properties

Every herb has an inherent temperature, taste, and affinity for specific channels — these properties determine how it interacts with the body

Temperature

Warm

Taste

Sweet (甘 gān), Bitter (苦 kǔ)

Channels Entered

Liver Stomach

Parts Used

Root (根 gēn)

Dosage & Preparation

These are general dosage guidelines for San Qi — always follow your practitioner's recommendation, as dosages vary based on the formula and your individual condition

Standard dosage

3-9g (decoction); 1-3g per dose (swallowed as powder)

Maximum dosage

Up to 9g in decoction or up to 3g per dose as swallowed powder (the usual clinical ceiling). In acute traumatic injury, some practitioners may use slightly higher decoction doses short-term under supervision, but exceeding standard ranges is uncommon as San Qi is potent at low doses.

Dosage notes

San Qi is most commonly taken as powder swallowed directly (1-3g per dose, 1-3 times daily) rather than decocted, as this preserves more of its active hemostatic components. When decocted, the standard range is 3-9g. Raw San Qi (生三七) is used primarily for its Blood-moving, stasis-dispersing, and hemostatic actions: stopping bleeding, reducing swelling, and relieving pain. Cooked or steamed San Qi (熟三七) has weaker stasis-dispersing action but stronger tonifying effects, and is used for Blood deficiency, weakness after illness, or postpartum recovery. For hemostasis (stopping bleeding): 1-3g powder swallowed with warm water. For traumatic injury and pain: 3-9g in decoction, or 1-3g powder. For cardiovascular support (e.g. chest pain from Blood stasis): 1-3g powder daily, often long-term under practitioner guidance. For postpartum recovery or general tonification: use cooked San Qi, often stewed with chicken.

Preparation

San Qi is most often ground into fine powder and swallowed directly with warm water (1-3g per dose) rather than decocted, as this better preserves its hemostatic active components. When used in decoction, no special handling is required. For external use, the powder is applied directly to wounds to stop bleeding. For the tonifying (cooked) form, the root is sliced, fried in cooking oil until the surface turns brownish-yellow, then ground to powder, or it may be steamed or stewed in soup (e.g. with chicken).

Processing Methods

In TCM, the same herb can be prepared in different ways to change its effects — here's how processing alters what San Qi does

Processing method

The raw root is either steamed until fully cooked and then sliced and dried, or stir-fried in cooking oil until the surface turns brownish-yellow, then drained and ground into powder.

How it changes properties

Processing shifts San Qi's properties from primarily blood-moving and hemostatic toward blood-nourishing and tonifying. The raw form excels at stopping bleeding and dispersing stasis ('shēng dǎ shú bǔ' — raw for attacking, cooked for tonifying). The processed form has weaker hemostatic and stasis-resolving action but gains a stronger ability to nourish and supplement blood, similar to a tonic herb. Its warming quality becomes more pronounced.

When to use this form

Use the processed (cooked) form when the goal is to nourish blood and strengthen the body rather than to stop bleeding or move stasis. Appropriate for blood deficiency after illness, postpartum blood loss, general weakness and fatigue, and conditions where the patient needs building up rather than dispersing.

Common Herb Pairs

These ingredients are traditionally combined with San Qi for enhanced therapeutic effect

Dan Shen
Dan Shen San Qi 3g (powder, swallowed) : Dan Shen 15g

San Qi is warm and activates blood while relieving pain. Dan Shen is cool and cools blood while also invigorating circulation. Together, their blood-moving and pain-relieving effects are greatly enhanced, and their temperature balance makes the pair suitable for a wider range of patients than either herb alone.

When to use: Blood stasis causing pain, particularly chest pain from heart vessel obstruction (chest obstruction/angina), as well as traumatic injuries with swelling and pain.

Bai Ji
Bai Ji 1:1 (San Qi 6g : Bai Ji 6g)

San Qi disperses stasis and stops bleeding through its blood-moving action, while Bai Ji (Bletilla) astrings and stops bleeding through its contracting, sticky nature. One disperses while the other contracts, creating a comprehensive hemostatic effect that both clears old blood and seals the wound.

When to use: Various bleeding conditions, especially coughing up blood or vomiting blood from the lungs or stomach, where both stasis dispersal and vessel-sealing are needed.

Dang Gui
Dang Gui San Qi 3g (powder) : Dang Gui 10g

San Qi transforms stasis and stops bleeding while reducing swelling and pain. Dang Gui nourishes blood and activates circulation while regulating menstruation. Together they nourish new blood while clearing away stagnant old blood, embodying the principle of 'dispelling stasis to generate the new'.

When to use: Postpartum conditions where retained blood clots cause ongoing lochia and lower abdominal pain, and for painful or blocked menstruation due to blood stasis.

Ren Shen
Ren Shen San Qi 3-6g : Ren Shen 6-10g

San Qi stops bleeding and resolves stasis while Ren Shen powerfully tonifies Qi. Since Qi is the commander of Blood, strengthening Qi helps both control bleeding and drive healthy circulation. This pair tonifies Qi while activating blood, and stops bleeding while resolving stasis.

When to use: Chest obstruction (angina) with underlying Qi deficiency, chronic or recurrent bleeding disorders with fatigue and weakness, and chronic coughing of blood in debilitated patients.

Key Formulas

These well-known formulas feature San Qi in a prominent role

Yun Nan Bai Yao 云南白药 King

Yunnan Baiyao (Yunnan White Medicine) is perhaps the most famous Chinese medicine in the world, used globally as a first-aid hemostatic and trauma remedy. San Qi is its principal ingredient, and the formula is the ultimate showcase of San Qi's dual ability to stop bleeding and resolve stasis in traumatic injuries.

Comparable Ingredients

These ingredients have overlapping uses — here's how to tell them apart

Pu Huang
San Qi vs Pu Huang

Both San Qi and Pu Huang (Cattail pollen) transform stasis and stop bleeding. The key difference is that San Qi is warm, has powerful pain-relieving and swelling-reducing properties, and is the top choice for traumatic injuries. Pu Huang is neutral to slightly cool, enters the Liver and Pericardium channels, and is better suited for gynecological bleeding (uterine bleeding, postpartum conditions) and blood stasis in the lower abdomen. San Qi has broader hemostatic reach across the body, while Pu Huang excels in the lower burner.

Xue Jie
San Qi vs Xue Jie

Both San Qi and Xue Jie (Dragon's Blood resin) activate blood, stop bleeding, and are used in traumatology for injuries and wound healing. San Qi is the stronger hemostatic and is taken both internally and externally as a primary treatment herb. Xue Jie is more focused on promoting tissue regeneration and closing wounds (generating flesh), and is used more as a topical agent or in formulas for chronic non-healing sores. San Qi is the broader, more versatile choice for internal bleeding conditions.

Hu
San Qi vs Hua Rui Shi

Both are praised as 'sacred herbs for stopping bleeding and transforming stasis.' Hua Rui Shi (Ophicalcite) is sour and astringent with a neutral temperature, making it better for purely hemostatic purposes without the warming quality. San Qi is warm, has stronger pain-relieving and swelling-reducing actions, and also powerfully moves blood. The two are often paired together (as in the formula Hua Xue Dan) to complement each other: San Qi provides the active blood-moving force while Hua Rui Shi adds astringent sealing.

Identity & Adulterants

Related species and common adulterations to be aware of when sourcing San Qi

The most dangerous substitution is Tu San Qi (土三七, Gynura segetum), a Compositae (daisy family) plant whose root superficially resembles San Qi. Tu San Qi contains hepatotoxic pyrrolizidine alkaloids that cause liver failure and death. Multiple fatalities have been reported. Tu San Qi can be distinguished by its fist-shaped, knobbly rhizome with a pale yellowish cross-section, lack of bitter-then-sweet taste, and the presence of yellow flowers (unlike San Qi's yellow-green flowers). True San Qi has a characteristic greyish-green cross-section. Other adulterants include: Teng San Qi (藤三七, Anredera cordifolia, Basellaceae family), whose tuber is lighter, easier to break, with a whitish, starchy cross-section and a slightly sweet, mucilaginous taste. Zhu Jie San Qi (竹节三七/竹节参, Panax japonicus), a related Panax species with a bamboo-joint-like rhizome, which has different actions and is weaker. Shui Tian Qi (水田七, Tacca plantaginea), with a lighter body and yellowish, granular cross-section. When purchasing San Qi powder, there is a particular risk of adulteration because the characteristic morphological features are lost. It is safest to buy whole roots from reputable sources and grind them yourself.

Educational content — always consult a qualified healthcare provider or TCM practitioner before using any herb.

Toxicity Classification

Classical Chinese pharmacopoeia toxicity rating for San Qi

Non-toxic

San Qi (Panax notoginseng) itself is classified as non-toxic in the Chinese Pharmacopoeia and in classical texts such as the Ben Cao Hui Yan, which states it is 'sweet, slightly bitter, neutral, and non-toxic.' At standard doses it is well tolerated. However, there is one critical safety issue: San Qi must not be confused with Tu San Qi (土三七, Gynura segetum), a Compositae family plant that contains hepatotoxic pyrrolizidine alkaloids. Tu San Qi can cause hepatic sinusoidal obstruction syndrome (formerly called hepatic veno-occlusive disease), leading to liver failure and death. Cases of fatal liver injury from mistakenly consuming Tu San Qi in place of San Qi have been reported. The two plants are entirely different species from different families. At excessive doses, San Qi may cause nausea, vomiting, or allergic skin reactions in sensitive individuals. Rare reports mention effects on cardiac conduction. The active compound dencichine (San Qi Su, 三七素), which contributes to hemostasis, can cause nausea at high concentrations. These effects are dose-dependent and uncommon at standard therapeutic doses.

Contraindications

Situations where San Qi should not be used or requires extra caution

Avoid

Pregnancy: San Qi strongly moves Blood and disperses stasis, which can stimulate uterine contractions and increase the risk of miscarriage or premature labor. Animal studies have also shown potential teratogenic effects of ginsenosides at high doses.

Caution

Active bleeding without Blood stasis: San Qi is most appropriate when bleeding is accompanied by stasis. In cases of pure Blood Heat causing reckless bleeding (with signs of strong Heat such as high fever, red face, rapid forceful pulse), San Qi used alone may be insufficient or inappropriate. It should be combined with cooling Blood herbs if used at all.

Caution

Menstruation: San Qi's strong Blood-moving properties can significantly increase menstrual flow. It should generally be avoided during menstruation unless a practitioner has specifically determined it is needed for Blood stasis-type menstrual disorders.

Caution

Concurrent use of anticoagulant or antiplatelet medications (e.g. warfarin, aspirin, clopidogrel): San Qi has demonstrated antiplatelet and anticoagulant effects and may potentiate these drugs, increasing the risk of bleeding. Close monitoring is essential if combined use is necessary.

Caution

Blood deficiency without stasis: San Qi's primary action is to move and transform Blood. In cases of simple Blood deficiency without any element of stasis, it is not the appropriate herb and may further deplete an already weakened state if used alone.

Caution

Yin deficiency with internal Heat: San Qi is warm in nature. In patients with pronounced Yin deficiency signs (night sweats, five-palm heat, dry mouth), it should be used cautiously and combined with Yin-nourishing herbs to prevent aggravating the Heat.

Caution

Hormone-sensitive conditions such as breast cancer, uterine cancer, ovarian cancer, endometriosis, or uterine fibroids: some research suggests Panax notoginseng may have estrogenic activity, and caution is warranted in these conditions.

Special Populations

Important considerations for pregnancy, breastfeeding, and pediatric use

Pregnancy

Contraindicated during pregnancy. San Qi strongly invigorates Blood and disperses stasis, which can stimulate uterine contractions and increase the risk of miscarriage or premature labor. Animal studies have shown that certain ginsenosides found in Panax notoginseng can cause birth defects in animal embryos at high concentrations, though these were at doses far exceeding normal human consumption. Additionally, Panax notoginseng may have estrogenic activity, which adds further concern during pregnancy. The Chinese Pharmacopoeia and standard TCM materia medica texts list pregnancy as a contraindication for San Qi. It should not be used during any trimester unless specifically indicated by an experienced practitioner for a life-threatening postpartum condition involving Blood stasis.

Breastfeeding

There are no human studies specifically evaluating the safety of Panax notoginseng during breastfeeding. Given San Qi's Blood-moving pharmacological activity and the presence of bioactive saponins (ginsenosides) that could theoretically transfer into breast milk, caution is advised. WebMD classifies Panax notoginseng as 'likely unsafe' during breastfeeding. It is best avoided while nursing unless specifically recommended by a qualified healthcare provider. If a breastfeeding mother requires hemostatic treatment for postpartum stasis, use should be short-term and under practitioner supervision.

Children

San Qi can be used in children for appropriate indications (particularly traumatic injury with swelling and pain, or bleeding with stasis), but at reduced dosages proportional to age and body weight. A common guideline is one-third to one-half the adult dose for children over 6 years. For very young children (under 3 years), use should be minimal and only under practitioner guidance. San Qi powder is the most common pediatric form as it avoids the need for decocting. Because San Qi moves Blood strongly, it should not be used long-term in children without clear clinical indication.

Drug Interactions

If you are taking pharmaceutical medications, be aware of these potential interactions with San Qi

Anticoagulants (Warfarin): Animal studies have shown that Panax notoginseng saponins increase prothrombin time (PT) and INR when co-administered with warfarin in a dose-dependent manner, and reduce warfarin clearance. This interaction could increase the risk of bleeding. Patients on warfarin should inform their prescribing physician before taking San Qi, and INR should be closely monitored.

Antiplatelet drugs (Aspirin, Clopidogrel): San Qi has demonstrated antiplatelet activity through inhibition of platelet aggregation. Combining it with antiplatelet medications may produce additive effects. A meta-analysis of 20 RCTs found that Panax notoginseng preparations combined with aspirin produced greater platelet inhibition than aspirin alone. While this may be therapeutically beneficial in some contexts, it also increases potential bleeding risk and requires clinical oversight.

CYP450 interactions: Most available evidence suggests that Panax notoginseng does not significantly affect the activity of major CYP450 enzymes (CYP3A4, CYP2C9, CYP2C19, CYP2B6, CYP2E1), indicating a low risk of pharmacokinetic interactions with drugs metabolized by these pathways. However, individual variation exists, and caution is still warranted with narrow-therapeutic-window drugs.

Hypoglycaemic agents: San Qi may have blood glucose-lowering effects. Diabetic patients on insulin or oral hypoglycaemic medications should monitor blood sugar levels if taking San Qi concurrently.

Dietary Advice

Foods and dietary considerations when taking San Qi

Avoid consuming cold or cooling foods (such as bitter melon, pears, crab) concurrently with San Qi, as these may counteract its warm nature and reduce its effectiveness. Avoid heavily spicy or greasy foods while taking San Qi, as combining two warming influences may lead to excessive internal Heat (symptoms like mouth sores or irritability). Tea and coffee should be avoided around the time of taking San Qi, as tannins and caffeine may interfere with absorption of its active constituents.

Botanical Description

Physical characteristics and morphology of the San Qi source plant

Panax notoginseng (Burk.) F. H. Chen is a perennial herbaceous plant in the Araliaceae (ginseng) family, growing 30 to 60 cm tall. The stem is erect, smooth, and hairless. At the top of the stem, 3 to 6 palmately compound leaves are arranged in a whorl, each leaf bearing 3 to 7 leaflets. The leaflets are elliptical to obovate-oblong, 5 to 15 cm long and 2 to 5 cm wide, with finely serrated margins and sparse bristly hairs along the veins.

A single umbel inflorescence emerges from the stem apex, bearing 80 to 100 or more small, pale yellow-green flowers that bloom from June to August. The fruit is a fleshy, nearly kidney-shaped drupe that turns bright red when ripe, maturing from August to October, and typically contains 1 to 3 seeds.

The medicinal root is a fleshy, inverted-conical or spindle-shaped taproot. San Qi is a shade-loving plant that prefers warm, moist, semi-shaded environments at elevations of 1,200 to 1,800 metres. It thrives in loose, humus-rich, slightly acidic sandy loam soils, and cannot tolerate extreme cold, strong heat, or waterlogging. The plant requires 3 to 7 years of growth before the root is ready for harvest.

Sourcing & Harvesting

Where San Qi is sourced, when it's harvested or collected, and how to assess quality

Harvesting season

Autumn, before flowering, typically after 3 to 7 years of growth (most commonly harvested at 3 to 4 years).

Primary growing regions

The premier dao di (terroir) region for San Qi is Wenshan Prefecture (文山州) in Yunnan Province, China, which is recognized as the origin and finest production area for this herb. Wenshan is called 'The Home of San Qi in China.' The region's low latitude, high elevation (1,200-1,800m), ample rainfall, and unique red laterite soils create ideal growing conditions. Key producing counties include Wenshan, Yanshan, Maguan, Xichou, Guangnan, Malipo, Funing, and Qiubei. Guangxi Province (especially Tianyang, Jingxi, Tiandong, and Baise) is the historical original production area, where the herb was traditionally called 'Tian Qi' (田七). However, Yunnan Wenshan has since overtaken Guangxi as the primary and highest-quality source. More recently, production has expanded to Honghe Prefecture (Yunnan) and smaller amounts are grown in Qujing, Yuxi, and other Yunnan regions.

Quality indicators

Traditional quality assessment of San Qi uses the phrase 'copper skin, iron bone, lion's head' (铜皮铁骨狮子头). This describes the ideal root: a greyish-brown or greyish-yellow surface with a waxy sheen ('copper skin'), an extremely hard and dense body that is heavy for its size ('iron bone'), and a rounded top with knobby protuberances around the stem scar ('lion's head'). The cross-section should be greyish-green, yellowish-green, or greyish-white, with fine brownish resin dots in the bark and a faintly radial wood pattern. The root should feel heavy and solid when held. The aroma is faint, and the taste is bitter at first, then turns slightly sweet. Quality grading is based on 'head count' (头数): the number of roots per 500g of dried material. Fewer heads per 500g means larger individual roots. First grade is typically 20 heads or fewer per 500g. Roots that are large, heavy, solid, smooth-surfaced, and show a clean greyish-green cross-section are considered best. Avoid roots that are lightweight, hollow, dark, fibrous, or shrivelled.

Classical Texts

Key passages from the classical Chinese medical texts that describe San Qi and its therapeutic uses

《本草纲目》 (Ben Cao Gang Mu) — Li Shizhen, Ming Dynasty

Original: 止血散血定痛，金刃箭伤、跌扑杖疮、血出不止者，嚼烂涂，或为末掺之，其血即止。亦主吐血衄血，下血血痢，崩中经水不止，产后恶血不下，血运血痛，赤目痈肿，虎咬蛇伤诸病。

Translation: It stops bleeding, disperses Blood, and relieves pain. For wounds from blades, arrows, falls, or blows where bleeding will not stop, chew it and apply the paste, or sprinkle it as powder, and the bleeding stops at once. It also treats vomiting blood, nosebleeds, bloody stool, bloody dysentery, uterine flooding, unceasing menstrual flow, postpartum retention of lochia, dizziness and pain from Blood stasis, red eyes, abscesses, and injuries from tigers or snakes.

《本草纲目拾遗》 (Ben Cao Gang Mu Shi Yi) — Zhao Xuemin, Qing Dynasty

Original: 人参补气第一，三七补血第一，味同而功亦等，故称人参三七，为中药之最珍贵者。

Translation: Ren Shen (Ginseng) is foremost for supplementing Qi; San Qi is foremost for supplementing Blood. Their flavours are similar and their merits equal, hence it is called 'Ren Shen San Qi' and is the most precious of Chinese medicines.

《本草新编》 (Ben Cao Xin Bian) — Chen Shiduo, Qing Dynasty

Original: 三七根，止血之神药也，无论上中下之血，凡有外越者，一味独用亦效，加入补血补气药之中则更神。盖止药得补而无沸腾之患，补药得止而有安静之休也。

Translation: The root of San Qi is a miraculous medicine for stopping bleeding. Regardless of whether the bleeding is from the upper, middle, or lower body, used alone it is effective; combined with Blood- and Qi-tonifying herbs it becomes even more wondrous. For hemostatic herbs gain stability through tonification, and tonifying herbs gain calm through hemostasis.

《玉楸药解》 (Yu Qiu Yao Jie) — Huang Yuanyu, Qing Dynasty

Original: 三七和营止血，通脉行瘀，行瘀血而敛新血。

Translation: San Qi harmonizes the Ying (Nutritive) level and stops bleeding, opens the vessels and moves stasis, dispersing old stagnant Blood while preserving fresh new Blood.

Historical Context

The history and evolution of San Qi's use in Chinese medicine over the centuries

San Qi holds a distinguished place in Chinese medical history as one of the most valued herbs for Blood disorders. Its earliest known textual references appear in the Ming Dynasty. The earliest recorded medicinal use may be in the Die Sun Miao Fang (跌损妙方, c. 1523), which contains some 40 formulas using 'Shen San Qi.' The Yi ethnic medicine manuscript Nie Su Nuo Qi (聂苏诺期, 1566) records its use for stopping bleeding from knife wounds. Li Shizhen's Ben Cao Gang Mu (1578) was the first major materia medica to include San Qi, recording it as originating in the deep mountains of Guangxi.

The name 'San Qi' has a colorful etymology. Li Shizhen proposed it derives from 'Shan Qi' (山漆, 'mountain lacquer'), because it seals wounds as lacquer binds objects. Others relate the name to the plant's morphology: 'three branches with seven leaves.' Modern linguistic research suggests the name may trace to the Miao ethnic language word 'chei' for the plant, combined with the Chinese word for mountain. The herb also carries the poetic aliases 'Jin Bu Huan' (金不换, 'Worth More Than Gold') and 'Xue Shen' (血参, 'Blood Ginseng'), testifying to its high esteem.

The modern physician Zhang Xichun (1860-1933) famously praised San Qi in his Yi Xue Zhong Zhong Can Xi Lu, marvelling at its seemingly contradictory ability to both stop bleeding and dissolve stasis, describing it as being like a 'divine dragon whose transformations cannot be fathomed.' San Qi is the principal ingredient of the world-renowned Yunnan Bai Yao (云南白药), whose hemostatic properties were famously noted during the Vietnam War era when it was carried by soldiers to treat combat wounds in the field.

Modern Research

5 published studies investigating the pharmacological effects or clinical outcomes of San Qi

1

Panax notoginseng preparation plus aspirin versus aspirin alone on platelet aggregation and coagulation: A meta-analysis of RCTs (2022)

Dai L, Zhang Y, Jiang Y, Chen K. Frontiers in Pharmacology, 2022, 13:1015048.

This meta-analysis of 20 randomized controlled trials (2,216 patients) evaluated whether adding Panax notoginseng saponin preparations to aspirin improved antiplatelet and anticoagulant outcomes in coronary heart disease and ischemic stroke. The combination showed enhanced inhibition of platelet aggregation and improved coagulation markers compared to aspirin alone, with a favorable safety profile regarding bleeding risk.

2

Efficacy and safety of Panax notoginseng saponins in the treatment of adults with ischemic stroke in China: A randomized clinical trial (2023)

JAMA Network Open, 2023, 6:e2317574.

A randomized clinical trial published in JAMA Network Open evaluated the efficacy and safety of Panax notoginseng saponins (PNS) for ischemic stroke in Chinese adults. The study provided evidence supporting PNS as a treatment option, contributing to the evidence base for San Qi-derived preparations in cerebrovascular disease.

3

Effects and mechanism of action of Panax notoginseng saponins on the pharmacokinetics of warfarin (2022)

Qian J, Chen W, Wu J, et al. European Journal of Drug Metabolism and Pharmacokinetics, 2022, 47(3):331-342.

This animal study found that co-administration of Panax notoginseng saponins (PNS) with warfarin increased prothrombin time (PT) and INR in a dose-dependent manner. Medium and high doses of PNS significantly reduced warfarin clearance and increased systemic exposure, suggesting a clinically relevant pharmacokinetic interaction that warrants caution when combining San Qi with warfarin.

4

Herb-drug interactions between Panax notoginseng or its biologically active compounds and therapeutic drugs: A comprehensive review (2023)

Xie Y, Wang C, et al. Journal of Ethnopharmacology, 2023, 306:116156.

This comprehensive review systematically examined pharmacodynamic and pharmacokinetic interactions between Panax notoginseng and conventional drugs from studies published 2005-2022. While most CYP450 enzyme interactions were found to be negligible, pharmacodynamic synergism with anticoagulant and antiplatelet agents was confirmed, highlighting the need for clinical vigilance in combination therapies.

PubMed
5

Antiplatelet and anticoagulant effects of Panax notoginseng: comparison of raw and steamed forms with Panax ginseng and Panax quinquefolium (2009)

Lau AJ, et al. Journal of Ethnopharmacology, 2009, 125(3):380-386.

This comparative study found that both raw and steamed Panax notoginseng significantly inhibited platelet aggregation and prolonged plasma coagulation times, with steamed P. notoginseng showing the greatest antiplatelet and anticoagulant effects among the three Panax species tested. This confirms the traditional understanding that processed (steamed/cooked) San Qi has different properties from the raw form.

PubMed

Research on individual TCM herbs is growing but still limited by Western clinical trial standards. These studies provide emerging evidence and should be considered alongside practitioner expertise.