Si Shen Wan, Four-Miracle Pill, is Bu Gu Zhi, Wu Zhu Yu, Rou Dou Kou and Wu Wei Zi. The catalogue classes it among the formulas that restrain leakage from the Intestines, and records it as warming Kidney and Spleen Yang to stop diarrhoea.

Herb

Amount

12 g

3 g

6 g

6 g

Actions and indications

Warms and tonifies Kidney and Spleen Yang

Spleen and Kidney Yang deficiency with diarrhea at daybreak: loose stools that come in the hours before dawn and often wake the person, preceded by rumbling of the bowels
Cold, sore or weak low back and knees, cold limbs, tiredness and lethargy, and a liking for warmth
Poor appetite, food passing undigested, and pain around the navel or in the abdomen

Astringes the Intestines and stops diarrhea

Chronic early-morning diarrhea from Cold and deficiency, not from Damp-Heat or food stagnation
Tongue pale with a thin white coat; pulse deep, slow and weak

Modern uses

Daybreak diarrhea
Chronic colitis
Allergic colitis
Ulcerative colitis
Crohn's disease
Irritable bowel syndrome
Chronic dysentery
Tuberculosis of the colon
Intestinal autonomic dystonia
Celiac disease
Chronic pancreatitis
Diarrhea
Constipation
Abdominal Cold
Abdominal fullness and distension
Anorexia
Spermatorrhea
Enuresis
Lumbago
Fatigue
Hepatitis C
AIDS/HIV
Alzheimer's disease
Tabes dorsalis

Modifications

Marked Yang deficiency: backache, severe cold abdominal pain, cold limbs: + zhi fu zi, + rou gui

Rectal prolapse: + huang qi, + sheng ma, + dang shen

Other option: combine with You Gui Wan

Lower abdominal pain: + xiao hui xiang, + mu xiang, − wu wei zi, − wu zhu yu

Other option: combine with Bu Zhong Yi Qi Tang

Uncontrollable diarrhea: + ying su ke, + he zi

Spleen-Kidney Yang deficiency, poor appetite, long unremitting diarrhea (combined with Li Zhong Wan): + bai zhu, + shan yao

Diarrhea that will not stop: + lian zi, + qian shi

Aching, weak low back and knees: + ba ji tian, + gou ji

Impotence: + xian mao, + yin yang huo

Night urination or dribbling: + yi zhi ren, + fu pen zi

Diarrhea: + pao jiang, + bai zhu, + huang qi, + zhi fu zi, + rou gui

Show all 34 modifications

Dysentery (combined with Tong Xie Yao Fang): + mu xiang, + huang lian, + gan cao
Early-stage colitis: + pao jiang, + da huang, + hou po, + zhi fu zi, − rou dou kou, − sheng jiang
Other option: combine with Shen Ling Bai Zhu San
Middle-stage colitis: + huang bai, + cang zhu, + huang lian
Late-stage colitis: + he zi, + ying su ke
Enuresis: + yi zhi ren
Seminal emission: + shan zhu yu, + bai shao
Constipation: + chuan jiao, + liu huang
Spleen-Kidney Yang deficiency (combined with Li Zhong Tang): − sheng jiang, − da zao
Spleen-Kidney Yang deficiency, marked abdominal pain (combined with Li Zhong Tang): + chao xiao hui xiang, + gao liang jiang, − sheng jiang, − da zao
Elderly or very ill, unremitting diarrhea, perhaps hemorrhoids or prolapse, no pathogen left (combined with Li Zhong Tang): + zhì huáng qí, + he zi, + chi shi zhi, − sheng jiang, − da zao
Spleen-Kidney Yang deficiency, severe Cold (combined with Li Zhong Tang): + zhi fu zi, − sheng jiang, − da zao
Spleen-Kidney Yang deficiency, Jing deficient (combined with Li Zhong Tang): + lu rong, − sheng jiang, − da zao
Qi deficiency in the elderly: + huang qi, + gan jiang
Hepatitis C (combined with Li Zhong Tang)
Hepatitis C, severe Yang deficiency (combined with Li Zhong Tang): + zhi fu zi
Hepatitis C, severe Qi deficiency, long-standing diarrhea (combined with Li Zhong Tang): + huang qi, + chen pi, + sheng ma, + chai hu
Hepatitis C, weak and painful low back and knees (combined with Li Zhong Tang): + xu duan, + gou ji
Hepatitis C, scanty urine and edema (combined with Li Zhong Tang): + gui zhi, + ze xie, + che qian zi
Hepatitis C, pain over the liver (combined with Li Zhong Tang): + chi shao, + dan shen, + chai hu
Hepatitis C, severe Kidney Yang deficiency (combined with Li Zhong Tang): + shu di huang, + shan yao, + shan zhu yu, + sha ren, + zhi fu zi
Ulcerative colitis: + zhi fu zi, + dang shen, + bai zhu, + chi shi zhi, + zhi gan cao

Cautions

contraindication Stagnation in the Stomach or Intestines

contraindication Diarrhea or dysentery from Damp-Heat, with fever, burning, tenesmus or foul-smelling stools: warming and binding may lock the Heat in

contraindication Acute diarrhea from food stagnation, such as after overeating, which should be cleared rather than astringed

contraindication Diarrhea with an active external pathogen still present

caution Avoid raw and cold food while taking it

caution Bu Gu Zhi has been linked in case reports to drug-induced liver injury; longer courses should be supervised by a practitioner

caution Rou Dou Kou (nutmeg) is toxic in large amounts, causing nausea, a racing heart or hallucinations; do not exceed the formula amount

caution Long-standing diarrhea, altered bowel habits or bloody stools call for medical assessment to exclude cancer or inflammatory bowel disease; tuberculosis of the intestines must be treated medically

pregnancy Use with caution and only under a qualified practitioner, because Wu Zhu Yu is warming, descending and moves the Blood

Pinyin

si shen wan

English Name

Four-Miracle Pill

si shen wan

About si shen wan

Ingredients

Actions and indications

Warms and tonifies Kidney and Spleen Yang

Astringes the Intestines and stops diarrhea

Modern uses

Symptoms

Modifications

Cautions

Preparation

Names

Classification