Si Wu Tang

Chinese: 四物汤

Pinyin: Sì Wù Tāng

Other names: Four Substances Decoction, Dang Gui Four Combination

Number of ingredients: 4 herbs

Formula category: Formulas that tonify Blood

Conditions for which it may be prescribed: Menstrual cramps Late menstruation Prolonged periods and six other conditions

Main actions:

Restores and nourishes Blood
Stimulates Blood circulation

Contraindications: Contraindicated for treating acute, severe Blood loss or other issues of blood... Contraindicated for treating acute, severe Blood loss or other issues of blood Deficiency characterized by severe weakness and labored breathing. see more

Source date: 846 AD

Source book: Secret Formulas to Manage Trauma and Reconnect Fractures Received from an Immortal

The information provided here is not a replacement for a doctor. You shouldn't use it for the purpose of self-diagnosing or self-medicating but rather so you can have a more informed discussion with a professional TCM practitioner.

Si Wu Tang is a 4-ingredient Chinese Medicine formula with Prepared Rehmannia (Shu Di huang) and White Peony Roots (Bai Shao) as principal ingredients.

Invented in 846 AD, it belongs to the category of formulas that tonify Blood. Its main actions are: 1) restores and nourishes Blood and 2) stimulates Blood circulation.

In Chinese Medicine health conditions are thought to arise due to "disharmonies" in the body as a system. These disharmonies are called "patterns" and the very purpose of herbal formulas is to fight them in order to restore the body's harmony.

In this case Si Wu Tang is used by TCM practitioners to fight patterns like Blood Deficiency, Blood Stagnation or Liver Blood Deficiency. From a Western Medicine standpoint, such patterns can give rise to a range of conditions such as late menstruation, scanty menstruation or heavy menstruation for instance.

On this page, after a detailed description of each of the four ingredients in Si Wu Tang, we review the patterns and conditions that Si Wu Tang helps treat.

The four ingredients in Si Wu Tang

Shu Di huang is a king ingredient in Si Wu Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

1. Prepared Rehmannia (Shu Di huang)

Part used: Prepared dried root tuber

Nature: Warm

Taste(s): Sweet

Meridian affinity: Kidney Liver

Category: Tonic herbs for Blood Deficiency

Shu Di huang has a very strong tonifying effect on the Liver and Kidneys and is said to nourish the Yin of the Blood.

Learn more about Prepared Rehmannia (Shu Di huang)

Bai Shao is a king ingredient in Si Wu Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

2. White Peony Roots (Bai Shao)

Part used: Dried root

Nature: Neutral

Taste(s): Bitter Sour

Meridian affinity: Spleen Liver

Category: Tonic herbs for Blood Deficiency

Bai Shao helps reduce the muscle spasms caused by Blood-Deficiency and it is particularly well-suited to treat abdominal pain. Together with Prepared rehmannia (Shu Di huang), it has a strong tonifying effect on the Blood.

Learn more about White Peony Roots (Bai Shao)

Dang Gui is a deputy ingredient in Si Wu Tang. This means it helps the king ingredient(s) treat the main pattern or it serves to treat a coexisting pattern.

3. Dong Quai (Dang Gui)

Part used: Dried root

Nature: Warm

Taste(s): Pungent Sweet

Meridian affinity: Spleen Heart Liver

Category: Tonic herbs for Blood Deficiency

In general Dang Gui's main actions are as follows: "Tonifies the Blood. Lubricates the Intestines. Relieve constipation. Promotes circulation and dispels Bi Pain. Reduce Dysmenorrhea and help with irregular menstruation."

In the context of Si Wu Tang, it is used because it enters the Liver and Heart to tonify and invigorate the Blood.

Learn more about Dong Quai (Dang Gui)

Chuan Xiong is a deputy ingredient in Si Wu Tang. This means it helps the king ingredient(s) treat the main pattern or it serves to treat a coexisting pattern.

4. Szechuan Lovage Roots (Chuan Xiong)

Part used: Dried rhizome

Nature: Warm

Taste(s): Pungent

Meridian affinity: Gallbladder Liver Pericardium

Category: Herbs that invigorate the Blood

Chuan Xiong facilitates the flow of Blood through the vessels, alleviates symptoms such as headache, dizziness, blurred vision and pain.

Learn more about Szechuan Lovage Roots (Chuan Xiong)

Conditions and patterns for which Si Wu Tang may be prescribed

It's important to remember that herbal formulas are meant to treat patterns, not "diseases" as understood in Western Medicine. According to Chinese Medicine patterns, which are disruptions to the body as a system, are the underlying root cause for diseases and conditions.

As such Si Wu Tang is used by TCM practitioners to treat eleven different patterns which we describe below.

But before we delve into these patterns here is an overview of the Western conditions they're commonly associated with:

Late menstruation Scanty menstruation Heavy menstruation Prolonged periods Absence of menstruation Low breast milk supply Menstrual cramps Irregular menstruation Postpartum weakness

Again it wouldn't be correct to say "Si Wu Tang treats late menstruation" for instance. Rather, Si Wu Tang is used to treat patterns that are sometimes the root cause behind late menstruation.

Now let's look at the eleven patterns commonly treated with Si Wu Tang.

Blood (Xue) is one of Chinese Medicine's vital subtances. Learn more about Blood in Chinese Medicine

Blood Deficiency

Pulse type(s): Choppy (Se), Fine (Xi)

Tongue color: Pale

Symptoms: Insomnia Tingling Dry skin Dry hair Dry lips Dizziness Pale lips Thin body Pale face Amenorrhea Depression Poor memory Late period Palpitations Scanty periods Blurred vision Pale complexion Slightly anxiety Tingling of limbs Pale menstrual blood Lower abdominal pain Numbness in the limbs Dull white shallow face Feeling of bearing down Withered and brittle nails

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Blood Deficiency. This pattern leads to symptoms such as dizziness, scanty periods, amenorrhea and dull white shallow face. Patients with Blood Deficiency typically exhibit choppy (Se) or fine (Xi) pulses as well as Pale, thin and slightly tongue .

A Deficiency of Blood occurs when their entire body, a part of body or a particular Organ is insufficiently nourished by Blood. This can be caused by a loss of blood, insufficient Spleen Qi to produce Blood or congealed Blood which prevents new Blood from forming.

The Organs most likely to be... read more about Blood Deficiency

Blood (Xue) is one of Chinese Medicine's vital subtances. Learn more about Blood in Chinese Medicine

Blood Stagnation

Pulse type(s): Choppy (Se), Wiry (Xian), Firm (Lao)

Tongue color: Reddish-Purple

Symptoms: Lumps Tremor Numbness Dark face Dizziness Purple lips Purple nails Blotchy skin Restlessness Itching scalp Painful period Abdominal mass Scanty periods Abdominal pain Abdominal masses Skin capillaries Hesitant periods Tendency to bleed Premenstrual pain Dark colored blood Traumatic swelling Shoulder stiffness Absence of menstruation Boring fixed stabbing pain Frequent bleeding episodes Dark clots in menstrual blood Abdominal distention and fullness

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Blood Stagnation. This pattern leads to symptoms such as dark face, purple lips, boring fixed stabbing pain and abdominal masses. Patients with Blood Stagnation typically exhibit choppy (Se), wiry (Xian) or firm (Lao) pulses as well as Purple tongue .

Blood Stagnation - also often referred to as "Blood Stasis" - is where the Blood flow is heavily restricted in all or parts of the body. It is one of the most important diagnostic conditions in Chinese Medicine because it is frequently the cause of intractable pain syndromes anywhere in the... read more about Blood Stagnation

The Liver is a so-called "Zang" Organ. Learn more about the Liver in Chinese Medicine

Liver Blood Deficiency

Pulse type(s): Choppy (Se), Fine (Xi)

Tongue color: Pale

Symptoms: Insomnia Dry hair Dry skin Pale lips Dizziness Amenorrhea Depression Joint pain Blurred vision Scanty periods Muscle weakness Floaters in eyes Tingling of limbs Dull-pale complexion Numbness in the limbs Dream disturbed sleep Feeling of aimlessness Diminished night vision Withered and brittle nails

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Liver Blood Deficiency. This pattern leads to symptoms such as blurred vision, dull-pale complexion, scanty periods and numbness in the limbs. Patients with Liver Blood Deficiency typically exhibit choppy (Se) or fine (Xi) pulses as well as Pale tongue, especially on the sides with thin, dry and white coating.

This pattern has all the general manifestation of the Blood Deficiency, such as dizziness, pale lips, dull pale face. The Liver stores Blood, that is the reason any Blood Deficiency often involves the Liver.

This pattern has an impact on areas the Liver relates to, such as the eyes, the sinews,... read more about Liver Blood Deficiency

The Heart is a so-called "Zang" Organ. Learn more about the Heart in Chinese Medicine

Heart Blood Deficiency

Pulse type(s): Choppy (Se), Fine (Xi)

Tongue color: Pale

Tongue shape: Thin

Symptoms: Anxiety Fatigue Insomnia Dizziness Pale face Pale lips Poor memory Tearfulness Palpitations Restlessness Easily scared Loss of libido Excessive dreams Feeling of guilt Dream disturbed sleep

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Heart Blood Deficiency. This pattern leads to symptoms such as easily scared, excessive dreams, palpitations and insomnia. Patients with Heart Blood Deficiency typically exhibit choppy (Se) or fine (Xi) pulses as well as Pale thin and slightly dry tongue .

This pattern is manifested by a pale face, pale lips and a pale tongue due to lack of Blood supply. Heart Blood Deficiency may eventually cause Heart Yin Deficiency because Blood is a Yin element. Dizziness is also a symptom because not sufficient Blood is able to nourish the Brain.

Heart Blood... read more about Heart Blood Deficiency

The Liver is a so-called "Zang" Organ. Learn more about the Liver in Chinese Medicine

Liver Wind agitating Internally due to Liver Blood Deficiency

Pulse type(s): Wiry (Xian), Fine (Xi)

Tongue color: Pale

Symptoms: Insomnia Dizziness Headaches No period Facial tic Dry throat Fine tremor Poor memory Hypertension Blurred vision Scanty periods Tingling of limbs Numbness in the limbs

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Liver Wind agitating Internally due to Liver Blood Deficiency. This pattern leads to symptoms such as fine tremor, facial tic, dizziness and blurred vision. Patients with Liver Wind agitating Internally due to Liver Blood Deficiency typically exhibit wiry (Xian) or fine (Xi) pulses as well as Pale and thin tongue.

If there is Liver Blood Deficiency, especially if the condition lasts a long time without being treated, the Blood vessels become 'empty' and the space is taken over by Internal Wind. Like an empty building will often get a lot of wind in its corridors, the concept here is the same.

This kind of... read more about Liver Wind agitating Internally due to Liver Blood Deficiency

The Liver is a so-called "Zang" Organ. Learn more about the Liver in Chinese Medicine

Liver Qi Deficiency

Pulse type(s): Weak (Ruo)

Symptoms: Fatigue Timidity Dizziness Indecision Depression Nervousness Irritability Easily scared Poor appetite Blurred vision Lack of courage Restless dreams Floaters in eyes Frequent sighing Abdomen distension Irregular menstruation Hypochondrial distention

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Liver Qi Deficiency. This pattern leads to symptoms such as dizziness, blurred vision, floaters in eyes and nervousness. Patients with Liver Qi Deficiency typically exhibit weak (Ruo) pulses.

It is more common to see Liver Qi Deficiency accompanying other patterns.

The most obvious one is Liver Qi Stagnation. One of Liver's main functions is to ensures the smooth flow of Qi throughout the body, in all Organs and in all directions. This function is impaired when the Qi in Liver is... read more about Liver Qi Deficiency

Qi is one of Chinese Medicine's vital subtances. Learn more about Qi in Chinese Medicine

Qi And Blood Stagnation

Pulse type(s): Choppy (Se), Deep (Chen), Fine (Xi)

Symptoms: Insomnia Dark face Moodiness Dizziness Chest pain Depression Amenorrhea Purple lips Mood swings Breast pain Hot flushes Purple nails Irritability Blotchy skin Restlessness Breast lumps Restlnessness Chest fullness Painful period Scanty periods Clots in blood Abdominal pain Abdominal masses Lochia retention Breast distention Dark colored blood Abdominal fullness Intense period pain High blood pressure Swelling of the feet Lower abdominal pain Dark menstrual blood Flooding and leaking Abdominal distension Pre-menstrual tension Black and tarry stools Irregular menstruation Boring fixed stabbing pain Pre-menstrual irritability Dark clots in menstrual blood Menstruation decreases gratually Feeling of fullness in the chest Abdominal distention and fullness Pain relief after clots discharge

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Qi And Blood Stagnation. This pattern leads to symptoms such as chest fullness, chest pain, boring fixed stabbing pain and dark face. Patients with Qi And Blood Stagnation typically exhibit choppy (Se), deep (Chen) or fine (Xi) pulses.

The typical symptoms of Qi stagnation are distension, oppression and swelling. There are also emotional issues like mood swing, depression or irritability. However, the Blood Stagnation is more on pains and purple color manifestation on skin, face, lips and nails.

Qi Stagnation can cause the... read more about Qi And Blood Stagnation

The Kidneys is a so-called "Zang" Organ. Learn more about the Kidneys in Chinese Medicine

Kidney and Liver Yin Deficiency

Pulse type(s): Empty (Xu), Floating (Fu)

Tongue coating: Partial absence of coating

Tongue color: Red

Symptoms: Tics Vertigo Fatigue Tinnitus Insomnia Dry eyes Dry hair Dry skin Dizziness Dry mouth Sore back Headaches Dry throat Dry vagina Dry stools Amenorrhea Joint pain Infertility Hot flushes Night sweats Blurred vision Scanty periods Delayed period Lower back pain Lightheadedness Tingling of limbs Diminished hearing Vertical headaches Occipital headaches Nocturnal emissions Chronic sore throat Hot palms and soles Numbness in the limbs Withered and brittle nails Heat in vaginal and vulvar Feeling of heat in the afternoon Spontaneous and nocturnal emissions Soreness and weakness in the lower back

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Kidney and Liver Yin Deficiency. This pattern leads to symptoms such as dizziness, tinnitus, diminished hearing and lower back pain. Patients with Kidney and Liver Yin Deficiency typically exhibit empty (Xu) or floating (Fu) pulses as well as Normal-coloured without coating or with rootless coating.

The Liver stores Blood while the Kidneys store Essence.

Liver Blood depends on Essence for nourishment, while Essence depends on Blood for replenishment. Both have a common source: Grain Qi derived from the Spleen. In terms of Five Elements, the Kidneys nourish the Liver.

A long term Liver Blood... read more about Kidney and Liver Yin Deficiency

The Uterus is a so-called "Extraordinary" Organ. Learn more about the Uterus in Chinese Medicine

Cold in the Uterus

Pulse type(s): Choppy (Se), Deep (Chen), Tight (Jin)

Tongue color: Bluish-Purple, Pale

Symptoms: Sore back Sore legs Pale face Tiredness Cold limbs Late period Scanty periods Painful period Feeling of cold Frequent urination Dark colored blood Lower abdominal pain Pain relieved with heat Dark clots in menstrual blood

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Cold in the Uterus. This pattern leads to symptoms such as lower abdominal pain, pain relieved with heat, dark clots in menstrual blood and scanty periods. Patients with Cold in the Uterus typically exhibit choppy (Se), deep (Chen) or tight (Jin) pulses as well as a bluish-purple, pale tongue.

Learn more about Cold in the Uterus

Blood (Xue) is one of Chinese Medicine's vital subtances. Learn more about Blood in Chinese Medicine

Blood Deficiency and Stagnation

Pulse type(s): Choppy (Se), Wiry (Xian), Fine (Xi)

Tongue color: Pale

Symptoms: Insomnia Dizziness Amenorrhea Palpitations Blurred vision Muscle tension Lower abdominal pain Irregular menstruation Thin body lacking strength Generalized muscle tension Lusterless complexion and nails

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Blood Deficiency and Stagnation. This pattern leads to symptoms such as dizziness, blurred vision, lusterless complexion and nails and muscle tension. Patients with Blood Deficiency and Stagnation typically exhibit choppy (Se), wiry (Xian) or fine (Xi) pulses as well as a pale tongue.

Learn more about Blood Deficiency and Stagnation

Qi is one of Chinese Medicine's vital subtances. Learn more about Qi in Chinese Medicine

Blood and Qi Deficiency

Pulse type(s): Weak (Ruo), Fine (Xi)

Tongue coating: Partial absence of coating

Tongue color: Pale

Symptoms: Edema Vertigo Fatigue Anxiety Dry skin Tingling Numbness Insomnia Dry hair Dry eyes Pale face Pale lips Hair loss Tiredness Dizziness Sore back Sore knees Depression Low energy Pale tongue Watery milk Poor memory Palpitations Loose stools Poor appetite Scanty periods Blurred vision Pale complexion Pale color periods Shortness of breath Lower abdominal pain Pale menstrual blood Dull menstrual cramps Feeling of bearing down Thin and watery periods Pain relieved with massage Lethargic and withdrawn state Spontaneous flow of breast milk Menstruation decreases gratually No feeling of distension of the breasts Insufficient or absent lactation after childbirth

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Blood and Qi Deficiency. This pattern leads to symptoms such as lower abdominal pain, pale complexion, lethargic and withdrawn state and palpitations. Patients with Blood and Qi Deficiency typically exhibit weak (Ruo) or fine (Xi) pulses as well as a pale tongue with partial absence of coating.

Learn more about Blood and Qi Deficiency