si mo tang

Name: si mo tang
Creator: Bencao Index

Four Milled Herb Decoction

About si mo tang

Si Mo Tang, Four Milled Herb Decoction, is Ren Shen, Bing Lang, Chen Xiang and Wu Yao — ground rather than decocted, as the name says. The catalogue classes it among the formulas that direct rebellious Qi downward, and records it as moving Qi and opening the chest.

Ingredients

Herb	Amount
ren shen	3 g
bing lang	9 g
chen xiang	3 g
wu yao	9 g

Actions and indications

Moves Qi and relieves stagnation

Liver Qi knotted by strong emotion rebels upward into the Lungs and Stomach, with Qi clumping in the chest
Comes on suddenly after an emotional trigger, in a person whose constitution is not markedly deficient
Stifling oppression, fullness and irritability in the chest and diaphragm
Tongue normal with a white coat; pulse wiry

Directs rebellious Qi downward and opens the chest

Laboured, hurried breathing or wheezing, as if the breath were about to give out
Fullness, distention or pain of the epigastrium and abdomen, poor appetite, and at times vomiting after meals

Modern uses

Bronchial asthma
COPD
Emphysema
Anxiety-related breathlessness
Gastritis
Functional dyspepsia
Indigestion
Anorexia
Post-surgical adhesions
Gynecomastia
Globus hystericus

Symptoms

Chest fullness
Chest oppression
Epigastric distention
Epigastric pain
Poor appetite
Restlessness
Shortness of breath
Vomiting
Wheezing

Modifications

Robust patient with anger and distending pain of the abdomen and epigastrium: + mu xiang, + zhi shi, − ren shen
Robust constitution without underlying deficiency: + zhi ke, − ren shen
Constipation from Qi stagnation, with belching and a painful, distended abdomen (this version is called Liu Mo Tang): + zhi shi, + da huang
Marked Liver Qi stagnation: + chai hu, + zhi ke

Cautions

caution Not for long-term use; stop it, or shift the formula toward tonifying, once the rebellious Qi has settled
contraindication Marked Qi deficiency with fatigue and a weak pulse, without real stagnation
caution Use carefully in frail or elderly patients unless more tonifying herbs are added; Bing Lang and Chen Xiang can be hard on weak digestion
pregnancy Bing Lang strongly breaks Qi and drives it downward; use in pregnancy only under professional guidance

Preparation

Traditionally each herb is ground in water to a thick liquid, then the four are combined and briefly boiled; now usually a standard decoction with Chen Xiang added near the end

Names

Pinyin	si mo tang
English Name	Four Milled Herb Decoction

Classification

Category: Direct Rebellious Qi Downward

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