Si Wu Tang: Your Guide to a Classic Blood-Nourishing Herbal Formula
Hongji Medical- Jan 30
- 7 min read
Si Wu Tang, or "Four Substances Decoction," is a time-honored Chinese herbal formula first mentioned in a Tang Dynasty text for treating injuries and blood stagnation. Over centuries, it evolved from an earlier recipe, Xiong Gui Jiao Ai Tang, by swapping out donkey hide gelatin, mugwort, and licorice, and refining the herb mix to include cooked rehmannia, white peony, angelica, and Sichuan lovage.
Known as the "holy remedy for women’s health," Si Wu Tang is a go-to for gynecological issues, but its benefits extend to anyone with blood deficiency or poor circulation.
What’s in Si Wu Tang?
Si Wu Tang combines four herbs, each playing a key role in nourishing and regulating blood:
Rehmannia Root (Shu Di Huang): The star herb, rehmannia is sweet and warming, nourishing blood and supporting the liver and kidneys.
Angelica Root (Dang Gui): This herb both nourishes and moves blood, boosting rehmannia’s effects while clearing blockages in the meridians.
White Peony Root (Bai Shao): Sweet and soothing, white peony nourishes blood, calms spasms, and eases abdominal pain.
Sichuan Lovage (Chuan Xiong): Spicy and warming, this herb activates blood flow and qi, reaching from the head to the uterus to clear stagnation.
These herbs are typically used in equal parts, boiled into a tea or made into pills. The balance of nourishing (rehmannia and peony) and moving (angelica and lovage) herbs makes Si Wu Tang both gentle and effective.
How Si Wu Tang Works
Si Wu Tang’s main job is to "nourish blood and regulate circulation." It’s perfect for symptoms of blood deficiency, like:
Dizziness or blurred vision
Pale complexion or fatigue
Palpitations or insomnia
Irregular, scanty, or painful periods in women
It also tackles blood stagnation, which can cause pain, numbness, or menstrual discomfort. By nourishing blood, Si Wu Tang supports organs and tissues, while its circulation-boosting herbs prevent blockages, ensuring smooth flow throughout the body.
Why It’s Famous
For over a thousand years, Si Wu Tang has been the top choice for women’s health in Chinese medicine. It helps with pregnancy, postpartum recovery, and menstrual issues like irregular cycles or cramps.
But it’s not just for women—anyone with blood deficiency, from chronic fatigue to pale skin, can benefit. Its versatility has led to many variations, with herbs added or adjusted to suit specific needs.
Modern Uses
Modern research highlights Si Wu Tang’s wide-ranging benefits:
Women’s Health: Regulates menstrual cycles, eases period pain, and may improve fertility or postpartum recovery.
Skin Conditions: Helps with acne, psoriasis, or hives by improving blood flow and reducing inflammation.
Other Conditions: Shows promise for allergic rhinitis, nerve pain, headaches, diabetic foot ulcers, and even mood issues like postpartum depression.
In clinics today, Si Wu Tang is used across specialties—gynecology, dermatology, orthopedics, and more—whenever blood deficiency or stagnation is the root cause.
How It Targets the Problem
Blood deficiency starves the body of nourishment, leading to symptoms like dizziness or weakness. Poor circulation, or blood stagnation, causes pain and blockages, especially in women due to menstrual and reproductive cycles.
Si Wu Tang addresses both: rehmannia and peony rebuild blood, while angelica and lovage keep it flowing, relieving pain and restoring vitality.
Things to Keep in Mind
Si Wu Tang is powerful but requires care:
Check Your Constitution: It’s best for blood deficiency or stagnation. A practitioner can confirm if it’s right for you.
Adjust the Dose: Typically, herbs are equal, but some adjust Sichuan lovage to half the dose of angelica, or double rehmannia for extra nourishment.
Customize the Formula:
For low energy, add ginseng or astragalus.
For severe stagnation, include peach kernel or safflower, and swap white peony for red peony.
For cold hands or feet, add cinnamon or ginger.
For heat or irritability, use raw rehmannia and add skullcap.
For pregnancy issues, add donkey hide gelatin or mugwort to stabilize.
Use with Caution: Pregnant or menstruating women, or those with a "hot" constitution (like frequent flushing), should consult a doctor.
Professional Guidance: Always work with a trained herbalist to tailor the formula to your needs.
Why Si Wu Tang Matters
Si Wu Tang’s blend of nourishing and activating herbs makes it a standout for blood-related issues. Its centuries-long track record and modern applications—from women’s health to skin and nerve conditions—prove its value.
With proper guidance, Si Wu Tang can be a safe, effective way to boost vitality and ease discomfort, honoring a tradition that’s helped millions.
Chinese Name | 四物湯 |
Phonetic | Si Wu Tang |
English Name | Four Substances Decoction |
Classification | Tonic formulas |
Source | 《Secret Prescriptions for Orthopedics and Traumatology from Immortals》Xian Shou Li Shang Xu Duan Mi Fang《仙授理傷續斷秘方》 |
Combination | Angelicae Sinensis Radix (Dang Gui jiu chao; wine-fried) 9g, Chuanxiong Rhizoma (Chuan Xiong) 6g, Paeoniae Radix Alba (Bai Shao) 9g, Rehmanniae Radix Praeparata (Shu Di Huang jiu zheng; wine-steamed) 12g |
Method | Grind the medicinals into a coarse powder. For each dose, combine 15g of the powder with about one and a half zhan (three hundred milliliters) of water. Decoct until the total volume has reached eight fen (160 ml). Take the decoction while it is warm, before meals. (Modern use: prepare and take as a decoction). |
Action | Supplements and regulates the blood. |
Indication | Si Wu Tang is used to treat patterns of ying-blood deficiency and stagnation manifesting dizziness, blurred vision, palpitations, insomnia, a lusterless complexion, menstrual irregularities, oligomenorrhea or amenorrhea, abdominal pain around the navel or mass (s) formed within the abdomen, a pale tongue, pale lips and nails, a thready, wiry pulse or thready, choppy pulse. |
Pathogenesis | Si Wu Tang is the chief formula used to supplement the blood and regulate menstruation. It is modified from Xiong Gui Jiao Ai Tang recorded in《Essentials from the Golden Cabinet》, from which e jiao, ai ye and gan cao are removed. The pattern is caused by ying-blood deficiency with blood stagnation and deficiency of the chong mai and ren mai. Blood deficiency is closely related with the function of the heart and liver. The liver stores the blood; however, it cannot be fully nourished if there is blood deficiency. In a deficient condition, it is unable to send nutrients upward and dizziness will then occur. The heart governs the blood and stores the spirit. In case of blood deficiency, the heart-spirit would be disturbed and manifest palpitations and insomnia. Ying-blood depletion also results in malnutrition of the face, lips, tongue, and nails, so they appear pale and lusterless. The chong mai acts as the sea of blood and the ren mai is in charge of the uterus and pregnancy. Deficiency of the chong mai and ren mai, together with liver-blood insufficiency and blood stagnation, leads to menstrual irregularities such as scanty menstruation, pale menses, early or delayed menstruation, or even amenorrhea. The blood vessels are not fully-filled and blood stasis forms easily. Therefore patients with this condition suffer from abdominal pain or hard mass formation. The thready, wiry and thready, choppy pulses indicate deficiency and stagnation of ying-blood. The treatment prioritizes supplementation and nourishment of the ying-blood as the primary objective and harmonizing the blood vessels as the supportive, secondary objective. |
Application | 1. Essential pattern differentiation According to《Secret Prescriptions for Orthopedics and Traumatology》from Immortals, Si Wu Tang is used to relieve pain from blood stasis caused by trauma. However, the《Beneficial Formulas from the Taiping Imperial Pharmacy》says that it is able to treat all kinds of women’s diseases. It serves as a basic formula to supplement blood and regulate menstruation. This clinical pattern is marked by lusterless complexion, pale lips and nails, pale tongue, thready pulse. 2. Modern applications Si Wu Tang is useful in the treatment of the following biomedical disorders and diseases which are caused by ying-blood stagnation due to blood deficiency: menstrual irregularities, pregnancy and postpartum issues, chronic skin problems like urticaria, allergic pupura, and neurogenic headaches. It also has some additional uses for diseases encountered in the orthopedics and traumatology department. 3. Cautions and contraindications It is inappropriate for the treatment of fever due to yin deficiency, profuse uterine bleeding, and qi desertion. |
Additonal formulae | 1. Tao Hong Si Wu Tang (Peach Kernel and Carthamus Four Substances Decoction 桃紅四物湯) [Source]《Usage of Medicinals Like That of Military Forces》Yi Lei Yuan Rong《醫壘元戎》 [Ingredients] Si Wu Tang, tao ren 9g, hong hua 6g [Preparation and Administration] Prepare it as a decoction. [Actions] Nourishes and invigorates blood. [Applicable Patterns] Blood deficiency and blood stasis. Symptoms include: early menstruation, copious amount of menses filled with clots, thick purple, sticky menses, and abdominal pain. 2. Jiao Ai Tang (Donkey-Hide Gelatin and Mugwort Decoction 膠艾湯) [Source]《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 [Ingredients] Chuan xiong 2 liang (6g), e jiao 2 liang (6g), gan cao 2 liang (6g), ai ye 3 liang (9g), dang gui 3 liang (9g), shao yao 4 liang (12g), gan di huang 6 liang (18g) [Preparation and Administration] Decoct the six medicinals with 5 sheng of water and 3 sheng of wine until 3 sheng left, remove the remainder and add e jiao to melt over a mild flame. Take 1 sheng of warm decoction three times a day. [Actions] Nourishes blood, stanches bleeding, regulates menstruation, and calms the fetus. [Applicable Patterns] Deficiency of chong mai and ren mai, blood deficiency and cold exposure. Symptoms include: flooding and spotting, menorrhagia, constant vaginal dripping, postpartum persistent bleeding or after abortion, abdominal pain or vaginal bleeding during pregnancy. 3. Sheng Yu Tang (Sage Healing Decoction 聖愈湯) [Source]《Golden Mirror of the Medical Tradition》Yi Zong Jin Jian《醫宗金鑒》 [Ingredients] Shu di 7.5 qian (20g), bai shao 7.5 qian (20g), chuan xiong 7.5 qian (8g), ren shen 7.5 qian (dang shen 20 g is also commonly used), dang gui 5 qian (15g), zhi huang qi 5 qian (18g) [Preparation and Administration] Prepare it as a decoction. [Actions] Supplements qi and blood, and contains blood. [Applicable Patterns] Weakness of qi and blood where qi fails to contain blood. Symptoms include: early menstruation, menorrhagia, light colored menses, weak limbs, mental and spiritual fatigue. |
