Prepared rehmannia (Shu Di Huang) White peony roots (Bai Shao) Dong quai (Dang Gui) Szechuan lovage roots (Chuan Xiong)

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 crampsLate menstruationProlonged periods and six other conditions

  1. Restores and nourishes Blood
  2. 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

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: KidneyLiver

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): BitterSour

Meridian affinity: LiverSpleen

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): PungentSweet

Meridian affinity: HeartLiverSpleen

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: GallbladderLiverPericardium

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 twelve 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 twelve 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

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

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), firm (Lao) or wiry (Xian) 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

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

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

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

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

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 Interior in Chinese Medicine is one of the so-called "Eight Principles". Learn more about Interior in Chinese Medicine

Interior Wind

Si Wu Tang is sometimes prescribed by TCM practitioners to treat Interior Wind. This pattern leads to symptoms such as convulsions, tremor of limbs, dizziness and paralysis. Patients with Interior Wind typically exhibit fine (Xi), rapid (Shu) or wiry (Xian) pulses.

Interior Wind is mostly referred to be the Liver Wind. There are 4 types of Interior Liver Wind due to the original causes:

1. Liver Wind agitating Internally due to Liver Fire

2. Liver Wind agitating Internally due to extreme Heat

3. Liver Wind agitating Internally due to Liver Yang Rising

4. read more about Interior Wind

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

Kidney and Liver Yin Deficiency

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

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

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), fine (Xi) or wiry (Xian) pulses as well as a pale tongue.

Learn more about Blood Deficiency and Stagnation

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