【Origin】

《Li Shang Xu Duan Fang》 (846 AD), 《Tai Ping Hui Min He Ji Ju Fang》 (1110 AD).

【Composition】

Prepared Rehmannia Root (Shu Di Huang), Angelica Sinensis (Dang Gui), White Peony Root (Bai Shao), Sichuan Lovage Rhizome (Chuan Xiong)

【Classification】

<Blood Tonifying>: Angelica Sinensis (Dang Gui), White Peony Root (Bai Shao), Prepared Rehmannia Root (Shu Di Huang)

<Invigorating Blood and Removing Blood Stasis>: Sichuan Lovage Rhizome (Chuan Xiong)

【Rationale】

《Yi Fang》: This formula targets the hand Shaoyin, foot Taiyin, and Jueyin meridians. (1) Angelica Sinensis (Dang Gui): Pungent, sweet, and warm, it enters the Heart and Spleen to nourish blood and acts as the sovereign herb. (2) Prepared Rehmannia Root (Shu Di Huang): Sweet and cold, it enters the Heart and Kidney to nourish blood and acts as the minister herb. (3) White Peony Root (Bai Shao): Sour and cold, it enters the Liver and Spleen to astringe Yin and nourish blood and acts as the assistant herb. (4) Sichuan Lovage Rhizome (Chuan Xiong): Pungent and warm, it moves Qi and blood throughout the upper and lower body and acts as the envoy herb. 《Shan Bu》: Ke Qin stated: The classics say that the Heart generates blood, and the Liver stores blood. Therefore, blood generation is attributed to the Heart, while blood regulation belongs to the Liver. This formula is a specialized prescription for regulating blood in the Liver meridian, not a primary formula for generating blood in the Heart meridian. Angelica Sinensis (Dang Gui) is sweet and warm, harmonizing blood; Sichuan Lovage Rhizome (Chuan Xiong) is pungent and warm, invigorating blood; White Peony Root (Bai Shao) is sour and cold, astringing blood; and Prepared Rehmannia Root (Shu Di Huang) is sweet and neutral, tonifying blood. The four substances work together to promote generation, growth, collection, and storage, thus allowing the Ying Qi (nutritive Qi) to flow smoothly through the meridians. 《Cheng Fang Bian Du》: Blood tonification should be sought from the Liver and Kidneys. Prepared Rehmannia Root (Shu Di Huang) enters the Kidney to strengthen water and nourish Yin; White Peony Root (Bai Shao) enters the Liver to astringe Yin and benefit blood; these two are the main herbs for tonifying blood. However, blood deficiency often leads to stagnation, making the meridians and channels not smooth and unobstructed. Furthermore, the purely Yin nature of Rehmannia and Peony might lack the warming and circulating function, so Angelica Sinensis (Dang Gui) and Sichuan Lovage Rhizome (Chuan Xiong), which are pungent, aromatic, warm, and moist, are added to nourish blood and move Qi within the blood, promoting circulation. In summary, this formula is excellent for treating all types of blood-related disorders. However, if the condition is purely Yin deficiency with significant blood loss, where rest is more beneficial than movement, the dispersive nature of Angelica and Chuan Xiong might not be suitable. 《Han Dian》: The Rehmannia Root and Angelica Sinensis in this formula have the effects of blood generation, sedation, and moistening. Peony Root and Chuan Xiong regulate stagnant blood and promote blood circulation. This formula is called the “holy medicine for women’s diseases.” It can invigorate blood circulation, treat anemia, and has a calming effect on neurological symptoms associated with gynecological disorders. It is not limited to women and can also be used for men. While this formula can treat anemia, due to its blood-enriching and moistening effects, it is not suitable for those with severe anemia characterized by pale lips, or those with weak digestion and loose stools. It is generally indicated for anemia with dry skin, a deep and weak pulse, a soft abdomen, and pulsations above the navel. In most cases, it is commonly used in modified formulas.

【Functions】

Tonify and regulate blood, nourish Qi and blood, regulate menstruation, invigorate blood.

【Indications】

All types of blood deficiency with weakness, stagnation of Ying blood, anemia, sallow complexion, dizziness, insomnia, pale lips, pale tongue, and weak pulse. Irregular menstruation in women, abdominal pain around the navel, excessive vaginal bleeding, hard abdominal masses, pale tongue with white coating. Also used for abdominal pain and bleeding during pregnancy, retained blood clots after childbirth, persistent lochia, and generally for conditions of blood deficiency or poor blood circulation. 《Yi Fang》: All blood deficiency and gynecological disorders related to menstruation. It is generally suitable for all blood disorders. 《Shan Bu》: All conditions of blood deficiency, blood heat, and blood dryness.

【Indications】

Dysmenorrhea, irregular menstruation, leucorrhea, miscarriage, infertility, malposition of fetus, mastitis, pelvic inflammatory disease, nephritis, vasospastic headache, various anemias, autonomic nervous system dysfunction, sciatica, urticaria, dry skin, itchy skin diseases. Various postpartum conditions such as foot qi from blood stasis, tongue erosion after childbirth, postpartum paralysis, as well as blood channel disorders, stroke, skin diseases, and various anemias can be treated.

【Contraindications】

(1) If there is excessive bleeding from above or below, and the patient is critically ill, Si Wu Tang should not be administered. (2) Contraindicated for individuals who are obese, prone to phlegm-dampness, experience vomiting, have poor appetite, or loose stools.

【Mnemonics】

(1) Sister-in-law and younger brother return with a bow and arrow. (2) Turtle grandfather and father come to sweep the ground (Gui, Xiong, Shao, Di). (3) Local area lacks poor people (Di, Dang, Shao, Qiong).

【Modifications】

《Yi Fang》: (1) Cooling blood: Heart: add Coptis Chinensis (Huang Lian). Liver: Scutellaria Baicalensis (Huang Qin). Lung: Dried Scutellaria Baicalensis (Ku Qin). Large Intestine: Scutellaria Baicalensis (Huang Qin). Gallbladder: Coptis Chinensis (Huang Lian). Kidney, Bladder: Phellodendron (Huang Bai). Spleen: Prepared Rehmannia Root (Di Huang). Stomach: Rhubarb (Da Huang). San Jiao: Root of Spatholobus (Di Gu Pi). Pericardium: Moutan Cortex (Dan Pi). Small Intestine: Gardenia Fruit (Shan Zhi Zi), Akebia (Mu Tong). (2) Clearing Qi: Heart and Pericardium: add Ophiopogon Japonicus (Mai Dong). Lung: Aurantii Fructus Immaturus (Zhi Ke). Liver: Bupleurum (Chai Hu), Citri Aurantii Pericarpium (Qing Pi). Spleen: White Peony Root (Bai Shao). Stomach: Pueraria Root (Gan Ge), Gypsum (Shi Gao). Large Intestine, San Jiao: Forsythia Suspensa (Lian Qiao). Small Intestine: Poria Cocos (Chi Fu Ling). Bladder: Talcum (Hua Shi), Amethyst (Hu Po). (3) Blood deficiency: add Turtle Shell (Gui Ban). (4) Blood dryness: add human milk. (5) Blood stasis: add Persica Seed (Tao Ren), Carthamus Tinctorius (Hong Hua), Allium Tuberosum juice, and virgin boy’s urine. (6) Acute bleeding: add Mentha Haplocalyx (Bo He), Scrophularia Ningpoensis (Xuan Shen) to disperse. (7) Persistent bleeding: add fried Typha Pollen (Chao Pu Huang), Carbonized Ink (Jing Mo). (8) Chronic bleeding: add Cimicifuga Rhizoma (Sheng Ma) to guide blood back to the meridians. (9) Women with purple-black menstrual blood and rapid pulse (heat): add Scutellaria Baicalensis (Huang Qin), Coptis Chinensis (Huang Lian). (10) Pale blood with slow pulse (cold): add Cinnamon Bark (Gui Zhi), Prepared Aconite (Fu Zi). (11) Obese individuals with phlegm: add Pinellia Ternata (Ban Xia), Arisaema Cum Bile (Nan Xing), Pericarpium Citri Reticulatae Viride (Ju Hong). (12) Thin individuals with heat: add Coix Seed (Hei Zhi), Anemarrhena Asphodeloides (Zhi Mu), Phellodendron (Huang Bai). (13) Stagnation: add Vladimiria Root (Mu Xiang), Amomum Villosum (Sha Ren), Atractylodes Lancea (Cang Zhu), Massa Fermentata Medicinalis (Shen Qu). (14) Blood stasis and obstruction: add Persica Seed (Tao Ren), Carthamus Tinctorius (Hong Hua), Corydalis Tuber (Yan Hu), Cinnamomum Cassia (Rou Gui). (15) Qi deficiency: add Ginseng (Ren Shen), Astragalus (Qi). (16) Qi excess: add Aurantii Fructus Immaturus (Zhi Ke), Magnoliae Officinalis Cortex (Po). 《Han Dian》: For postpartum foot qi with blood stasis, add Atractylodes Lancea (Cang Zhu), Chaenomelis Fructus (Mu Gua) 30g each, Coix Seed (Yi Yi Ren) 6.0g. For postpartum paralysis, add Turtle Shell (Gui Ban), Ostreae Concha (Shi Jue Ming) 30g each. (1) This formula with Phellodendron (Huang Bai) and Anemarrhena Asphodeloides (Zhi Mu) is called Zhi Bai Si Wu Tang. Further adding Scrophularia Ningpoensis (Xuan Shen) creates Zhi Yin Jiang Huo Tang, for Yin deficiency with heat. Zhi Bai Si Wu Pills are called Kan Li Wan, for Yin deficiency with consumptive cough. (2) This formula with Coptis Chinensis (Huang Lian), Coptis Chinensis (Huang Lian) is called Er Lian Si Wu Tang, for chronic deficiency with blood loss, heat entering the blood chamber, and fever at night. (3) This formula with Phellodendron (Huang Bai), Scutellaria Baicalensis (Huang Qin), Glycyrrhiza (Gan Cao) is called San Huang Si Wu Tang, for Yin deficiency with tidal fever. (4) For blood deficiency with cold, add Cinnamon Bark (Rou Gui), Prepared Ginger (Pao Jiang) to warm the middle and tonify Yang. (5) For dysmenorrhea, add Cyperus Rotundus (Xiang Fu), Corydalis Tuber (Yan Hu Suo) to move Qi, relieve depression, regulate menstruation, and stop pain. (6) For women with purple-black menstrual blood and rapid pulse, add Scutellaria Baicalensis (Huang Qin), Coptis Chinensis (Huang Lian) to clear heat. (7) This formula uses both raw and prepared Rehmannia Roots, adding Astragalus (Huang Qi), Moutan Cortex (Dan Pi), Cimicifuga Rhizoma (Sheng Ma), Bupleurum (Chai Hu) to create San Huang Bu Xue Tang. It tonifies blood with the two Rehmannia Roots, cools blood with Moutan Cortex, tonifies Qi with Astragalus, and lifts Yang with Sheng Ma and Chai Hu. Strong Qi generates blood, and Yang generates Yin, thus treating blood loss and deficiency, and conditions with large, empty pulses. (8) This formula with Persica Seed (Tao Ren), Carthamus Tinctorius (Hong Hua) is called Yuan Rong Si Wu Tang, also known as Tao Hong Si Wu Tang, for constipation due to internal organ binding and bruising. (9) This formula with Notopterygium Root (Qiang Huo), Saposhnikovia Root (Fang Feng) is called Zhi Feng Liu He Tang, for wind-induced dizziness and constipation, and difficult bowel movements. Its honey pills are called Bu Gan Wan. (10) This formula with Vladimiria Root (Mu Xiang), Areca Catechu (Bing Lang) is called Zhi Qi Liu He Tang, for blood deficiency with Qi stagnation or Qi and blood rushing upwards. (11) This formula with Notopterygium Root (Qiang Huo), Gastrodia Elata (Tian Ma), honey pills is called Shen Ying Yang Zhen Dan, for paralysis and contractures due to wind-cold, dampness, and heat in the Jue Yin meridian, speech impediment, and blood deficiency with foot qi. (12) This formula with Persica Seed (Tao Ren), Carthamus Tinctorius (Hong Hua), bamboo shavings, and ginger juice, treats hemiplegia, especially on the left side, attributed to blood stasis. (13) This formula removes White Peony Root (Bai Shao) and adds Saposhnikovia Root (Fang Feng) to create Fang Feng Dang Gui San, for conditions following excessive sweating leading to厥證 (jue zheng – cold limbs, convulsive rigidity), characterized by wind and blood deficiency. (14) This formula removes Rehmannia Root (Di Huang) and adds Dried Ginger (Gan Jiang) to create Si Shen Tang, for abdominal pain in women due to blood deficiency. (15) This formula with Colla Corii Asini (E Jiao), Artemisiae Argyi Folium (Ai Ye), Glycyrrhiza (Gan Cao) is called Jiao Ai Tang, for deficiency of Chong and Ren meridians, persistent menstrual bleeding, and blood deficiency with diarrhea. (16) This formula with Artemisiae Argyi Folium (Ai Ye), four-processed Cyperus Rotundus (Xiang Fu) (soaked in virgin boy’s urine, salt water, wine, and vinegar for three days) as vinegar pills is called Ai Fu Nuan Gong Wan, for cold uterus and irregular menstruation. Adding Colla Corii Asini (E Jiao) creates Fu Bao Dan, for cold-induced irregular menstruation. (17) This formula with Moutan Cortex (Dan Pi), Root of Spatholobus (Di Gu Pi) treats steaming bone disorder in women. (18) This formula removes White Peony Root (Bai Shao) and Rehmannia Root (Di Huang), and adds Ligusticum Striatum (Chuan Xiong) and Angelica Sinensis (Dang Gui) to create Chuan Gui Tang, or Buddha’s Hand Powder (Fo Shou San), also known as Yi Qi San Shi Jun Chen San. It treats postpartum headache due to blood deficiency and threatened miscarriage. Taking this formula will stabilize the pregnancy; for fetal death in utero, it will induce expulsion and is a miraculous labor inducer. (19) This formula combined with Si Jun Zi Tang (Four Gentlemen Decoction) creates Ba Zhen Tang (Eight Treasures Decoction), for deficiency of Heart and Lung, and Qi and blood deficiency. Adding Astragalus (Huang Qi) and Cinnamon Bark (Rou Gui) creates Shi Quan Da Bu Tang (Ten Complete Great Tonifying Decoction), which also helps Yang and consolidates the protective Qi. Shi Quan Da Bu Tang removing White Peony Root (Bai Shao) and adding Cornus Officinalis (Shan Zhu Yu), Schisandra Chinensis (Wu Wei Zi), Saposhnikovia Root (Fang Feng), Cynanchum Wilfordii (Rou Cong Rong), simmered with ginger and jujube, is called Da Bu Huang Qi Tang, for deficiency of both Qi and blood with spontaneous sweating and Yang deficiency leading to厥證 (jue zheng). (20) Si Wu Tang, Si Jun Zi Tang, and Xiao Chai Hu Tang combined create San He San, for chronic weakness after childbirth. (21) This formula with seven qian each of the four Si Wu herbs, plus one liang of Saposhnikovia Root (Fang Feng), and three qian each of Gardenia Fruit (Zhi Zi), Astragalus (Huang Qi), and Coptis Chinensis (Huang Lian). Taking five qian per dose. If the pulse is strong, add Rhubarb (Da Huang). This is called Di Sheng Huang Lian Tang, for women’s wind-blood disorders with excessive blood loss, leading to dryness, picking at bedding, closing eyes and raising hands and feet, incoherent speech, and a floating, wiry, and empty pulse. (22) This formula with Ginseng (Ren Shen) and Astragalus (Huang Qi) is called Sheng Yue Tang, for premature menstruation with heavy, pale flow, limb weakness, fatigue, and diminished spirit.

【Pharmacology】

It has effects on improving anemia, anti-radiation damage, anti-platelet aggregation, anti-thrombosis, anti-hypoxia, anti-free radical damage, inhibiting granuloma proliferation, inhibiting uterine activity, regulating immune function, and supplementing trace elements, phospholipids, and vitamins.