Chinese Herbal Medicine Si Wu Tang, The Four Substance Decoction

Si Wu Tang is a basic formula that is often prescribed for women in China. By basic, I mean that the four herbs will be the principal herbs of the final prescription indicated for the patient together with other herbs specific for the patient’s condition. I think this formula is a good starting point for appreciating Chinese herbal medicine.

Students of Chinese medicine usually start by learning Ma Huang Tang and Wei Ju Tang, formulas, which are more difficult to understand and can easily be misunderstood. These formulas are commonly used to treat painful menstruation or dysmenorrhea. It is also used for amenorrhea or scanty menstruation. Chinese doctors have always paid attention to menstruation as an important indicator of women’s health and fertility.

Most texts state that Si Wu Tang was first noted in a 12th century Song Dynasty text in the pharmacopeia of the Taiping Welfare Dispensary Bureau.But it may well originally be derived from the third century formula, XiongGui Jiao Ai Tang, which appears from the Essential Prescriptions from the Golden Cabinet, written by Zhang Zhongjing.

This version of the formula has indications in line with currently accepted opinions on the actions of Si Wu Tang. Si Wu Tang has always been a popular formula and was very often prescribed by ancient Chinese doctors.

What category of formula is Si Wu Tang?

Chinese herbal medicine formulas are arranged in categories and Si Wu Tang is classified under the category of tonifying or nourishing formulas. Within the category of tonifying formulas, there are six subcategories, according to which aspect of the body will be nourished. Specifically, Si Wu Tang is a blood tonifying formula.

Si Wu Tang or the Four Substance Decoction is probably the most prosaic name of all Chinese formulas. Si means four. Wu just means a thing, substance or matter. Tang means decoction but it also means soup and indeed, a decoction is very much a soup made out of herbs that are boiled in water for a certain amount of time.

The actions of this formula are acknowledged:

1. To nourish and regulate the blood.
2. To regulate menstruation and remove stagnation.

Composition of Si Wu Tang

The formula consists of four herbs: dang gui or Chinese Angelica root, shu di huang or cooked rehmannia root, bai shao or white peony root and chuanxiong or cnidium rhizome. In China, prescriptions were written out using Chinese characters. Outside China, there is a strong movement to use the unique Latin name, which would avoid confusion, but the names tend to be very much longer.

As a matter of principle, when writing out a prescription, it is certainly better to avoid the common English name, as some common names can vary by region or apply to different plants. A typical dosage for Si Wu Tang’s 9 g each of dang gui and bai shao, 12 g of shu di huang and 6 g of chuanxiong. In general, the amount stated in formulas are indicative and it is the ratio of the ingredients that it is of the greatest importance.

Different people will respond to different decoction strengths, and experience and feedback are important in determining dosage appropriate for your patient. Once we learn the properties of the herbs, we can determine how to vary the dosages of each individual herb, depending on the patient’s condition. It is useful to note that we are using the roots and rhizomes of these plants.

This is indicative of herbs that nourish. For information, rhizome is actually an underground stem and not a root. Three herbs in this formula dang gui, bai shao and shu di huang are considered to be blood tonifying. It’s worth noting that the Chinese term buxue has been translated in a number of ways, that is to tonify, nourish, enrich, supplement, reinforce or strengthen.

It should be emphasized that we’re not talking about a direct chemical problem in the composition of the blood. Chinese medicine is not based on laboratory tests but on the sensations perceived by the doctors when they palpate the patient’s pulse. The pulse may indicate that something appears to be lacking in the blood and these herbs provide that something.

This notion of lacking is termed blood deficiency of blood vacuity and it can be determined from the pulse and the pallor of the patient’s features. This is not necessarily synonymous with anemia, as recognized in Western blood tests, although these two conditions may coincide.

Chuanxiong is considered to be a blood invigorating herb. Huoxue is often translated as invigorating, moving or quickening the blood or improving blood circulation. These herbs treats blood stagnation. This can mainly be seen from the patient’s tongue and pulse. On a cultural note, this is how Chinese students learn formulas and herbs.

There is a short poem associated with each formula. In this case, the poem is as follows:

siwushudigui shao xiong
buxuetioaxue ci fang zong
yingxuaxuzhizhuduozheng
jiajianyunyongguibiantong

Chinese education emphasizes learning texts by heart and poems such as this are a big help to Chinese students to master hundreds of formulas. This poem gives both the ingredients of the formula, its actions and under which conditions should be used. As you can see, the Chinese language is very terse, which facilitates abbreviations and enable students to learn these properties more easily.

Properties of Ingredients

So now for some more detail in the individual herbs.

Dang Gui

Dang gui is Chinese Angelica root and has been known for a while in the West under a number of spellings. It has an oily texture and tends to be cut into longer thin strips. Its properties are sweet, acrid and warm. It is associated with the heart, liver and spleen channels. From the five transformation diagram, the sweet property is associated with the spleen channel.

The characteristics of dang gui are that it both tonifies and invigorates the blood with more emphasis on tonification. And it also regulates menstruation and alleviates or stops pain. You should be careful about using dang gui if the patient suffers from diarrhea or abdominal fullness. The patient may show a tongue with a thick coating, which would imply dampness.

You’ll also need to be careful about using dang gui if the patient is taking certain Western medicines are supplements.

Shu Di Huang

Shu di huang is Chinese foxglove root that is prepared by mixing with the rice wine and screaming until the roots are black and moist. The herbs are then dried in the sun. The herb is sweet and moist, slightly warm in nature and very cloying. It has a characteristic overbaked look and is associated with the heart, kidney and liver channels.

The characteristics of shu di wang are that it tonifies blood, enriches yin, generates essence and augments the marrow. It should be underlined that shu di wang is a very cloying and rich substance and can on the body like a heavy dessert. It can aggravate dampness and impede digestion. It should be used carefully in case of Chi stagnation and excessive phlegm.

Bai Shao

Bai shao is white peony root. It is produced from the roots of cultivated paeonialactea flora with the skin removed. It’s properties are bitter, sour and mildly cold and it is associated with the liver and spleen channels. From the five transformations diagram, the sour flavor is associated with the liver. The actions of bai shao are that it tonifies blood and regulates menstruation.

It conserves Yin and and stops sweat. It alleviates pain, nourishes and softens the liver and stabilizes liver yang. Because bai shao is called inhibiting, you should be careful about prescribing it to a patient who has a weak stomach or who suffers from diarrhea. It should not be prescribed for very long periods.

ChuanXiong

Chuanxiong is cnidium root or lovage root. Each one in its name is associated with the province Szechuan. It has a characteristic irregular shape with a darker margin. Its properties are acrid and warm and it is associated with the liver, gallbladder and pericardium channels. Its key characteristics are that it invigorates the blood, promotes the movement of Chi and expels wind.

It is very often used to treat headaches. Chuanxiong should be used with great care during pregnancy or if the patient bleeds easily or has profuse menses. It should not be used in cases of Yin deficiency where there is general dryness and the patient has a red dry tongue.

If we look at a summary of the herbs in the formula, we see that the mixture of herbs is mildly warming and has two herbs that are sweet and two that are acrid contributing to its blood nourishing and blood moving characteristics. If we look at the organs and channels associated with the herbs, we see that all the herbs are associated with the liver.

We can look at dang gui and chuanxiong as paired herbs. Dang gui is mainly associated with blood tonification and nourishment and chuanxiong is mainly associated with blood movement or invigoration. Dang gui is somewhat oily in texture and tends to moisturize. The dryness of chuanxiong balances the somewhat greasy texture of dang gui.

Actions and use of Si Wu Tang

Si Wu Tangis said to nourish and regulate or harmonize the blood. It also regulates menstruation and moves or transforms stagnation. We can look at this through the metaphor of a boat on a river that is running dry. The shallow water represents blood deficiency in this will impede the boat’s movement. Also, if the water does not flow, will not move easily.This represents blood stagnation.

So it is important that there should be enough water or the patient’s case, blood in that it should be free to move. It’s interesting to compare the properties of Si Wu Tang as a formula with that of one of its constituent herbs, dang gui. Even though one of dang gui’s properties is to invigorate blood, this action is minor compared to its function of nourishment.

By looking at the functions of all the herbs in the formula, we can see that the other herbs help to modulate the nourishment and the integration of blood in this helps us to see that the formula is appropriate for a syndrome of blood deficiency and stagnation. The syndrome can be identified by the following signs and symptoms:

The patient complains of a feeling of weakness and fatigue and if the patient is a woman, she’ll be having menstrual problems.

Patient has pale features, which may include their face, eyes, lips, nails and especially their tongue.

Their pulse is thin and rough or thin and tight. Menstrual problems may include dysmenorrhea, amenorrhea, irregular menstruation or spotting.

Other symptoms may include dizziness are blurred vision, heart palpitations and insomnia.

Western Evidence

One of the most respected forms of Western evidence are Cochrane reviews. Cochrane reviews are systematic of primary research in human health care and health policy and are internationally recognized as the highest standard of evidence-based health care resources. A 2008 Cochrane review supported the use of formulas based on Si Wu Tang on dysmenorrhea.

There are some circumstances when Si Wu Tang should not be used. This is especially the case when the patient has a body constitution that indicates dry heat or internal fire. This would be indicated by red eyes, dry mouth and tongue, swollen gums, a tendency to have acne and a feeling of being easily constipated.

To summarize, Si Wu Tang:

• Treats menstrual problems: dysmenorrhea

• Treats blood deficiency and stagnation syndrome

• Nourishes and regulates blood

• Regulates menstruation and moves stagnation

Blue Mountain Acupuncture
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Walla Walla, WA 99362
Phone: (509) 876-4597
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