Si Wu Tang, Four-Substance Decoction, is Shu Di Huang, Bai Shao, Dang Gui and Chuan Xiong. The record credits it with nourishing the Blood and improving its movement. It is the base on which many later Blood formulas are built.

Herb

Amount

9 g

9 g

9 g

3 g

Actions and indications

Nourishes the Blood

Liver Blood deficiency: pale, lustreless face, pale lips and nails, and dry skin and hair
Dizziness, vertigo, blurred vision and ringing in the ears from Blood not reaching the head and eyes
Palpitations and poor sleep
Sometimes heat in the palms, soles and chest, or fever
Tongue pale, or purple or dusky; pulse thready and wiry, or thready and choppy

Regulates the Liver

Internal Wind from deficient Liver Blood: tension throughout the muscles, tremors and tics

Regulates menstruation

Deficiency of the Chong and Ren vessels: periods that are irregular, late or absent, with scanty flow
Heavy periods, spotting of pale blood, or bleeding after childbirth
Restless fetus with bleeding, and postpartum weakness
Dull, dragging pain with periods
Sometimes vaginal discharge

Improves Blood circulation

Blood stagnation arising from Blood deficiency: pain around the navel or in the lower abdomen, a firm and painful abdomen
Hard masses in the abdomen with pain that comes back
Bouts of chills and fever

Modern uses

Primary dysmenorrhea
Menstrual pain
Irregular menstruation
Early menstruation
Late menstruation
Scanty menstruation
Amenorrhea
Menorrhagia
Uterine bleeding
Premenstrual syndrome
Endometriosis
Pelvic inflammatory disease
Vaginal discharge
Vaginitis
Infertility
Ectopic pregnancy
Threatened miscarriage
Fetal restlessness
Breech presentation
Postpartum weakness
Postpartum anemia
Postpartum abdominal pain
Postpartum clots or bleeding
Puerperal fever
Lochiorrhea
Lochioschesis
Insufficient lactation
Anemia
Abdominal masses
Gastralgia
Constipation
Vascular headache
Neurogenic headache
Headache due to trauma
Unilateral pain
Dizziness
Vertigo
Tinnitus
Insomnia
Palpitations
Neurasthenia
Neurosis
Fatigue
Chronic fatigue syndrome
Hypotension
Parkinson's disease
Paresthesia
Numbness
Calf spasm
Lumbago
Sciatica
Periarthritis of the shoulder
Panarthralgia
Urticaria
Eczema
Dermatitis
Psoriasis
Rosacea
Itching
Dry skin
Dry hair
Dandruff
Allergic rhinitis
Chronic laryngitis
Chronic tonsillitis
Cataracts
Optic atrophy
Chronic nephritis
Addison's disease
Systemic lupus erythematosus
AIDS/HIV
Fever

Symptoms

Abdominal mass

Abdominal pain

Amenorrhea

Bleeding during pregnancy

Blurred vision

Chills

Delayed menstruation

Dizziness

Dry hair

Dry skin

Dysmenorrhea

Early menstruation

Fever

Five-center heat

Insomnia

Irregular menstruation

Lower abdominal pain

Menorrhagia

Metrorrhagia

Pale lips

Pale nails

Pallor

Palpitations

Restless fetus

Sallow complexion

Scanty menstruation

Spotting

Stiffness

Tics

Tinnitus

Tremor

Vaginal discharge

Modifications

Uterine or postpartum bleeding, or threatened miscarriage or restless fetus, with ongoing vaginal bleeding: + ai ye, + e jiao

Blood stasis: + tao ren, + hong hua

Heat signs: + sheng di huang, − shu di huang

Cold womb with Blood deficiency: + ai ye, + xiang fu

Alternative with no stated indication, replacing all four base herbs: + sheng di huang, + chi shao, − shu di huang, − bai shao, − chuan xiong, − dang gui

Mainly Blood stasis: + chi shao, − bai shao

Short cycle and bone-steaming fever rising toward evening: + di gu pi, + mu dan pi

Thin person with Phlegm: + zhi zi, + zhi mu, + huang bai

Painful periods, Qi stagnation: + xiang fu, + yan hu suo

Heavy periods: + huang qin, + bai zhu

Qi deficiency: + ren shen, + huang qi

Severe Qi deficiency (combined with Si Jun Zi Tang)

Show all 156 modifications

Qi stagnation: + zhi shi, + hou po, + xiang fu, + yu jin
Tidal fever, Blood deficiency: + mu dan pi, + di gu pi
Blood-deficient headache: + ju hua, + gao ben, + gou teng
Dizziness and vertigo: + qin jiao, + qiang huo
Vomiting blood or nosebleed: + ce bai ye, + qian cao gen
Overweight person with Phlegm: + zhi ban xia, + ju hong
Allergic rhinitis: + cang er zi, + xin yi hua, + xu chang qing, + ju hua, + bai zhi
Abdominal pain, mild sweating, dislike of Wind: + rou gui, + pao jiang
Vaginal discharge, white or blood-streaked: + xiang fu, + gui zhi
Other option: combine with Yu Ping Feng San
Menstrual pain: + bai zhi, + mu xiang, + xiang fu
Menstrual pain, Cold-Damp: + bai zhi, + mu xiang, + xiang fu, + ai ye, + rou gui
Menstrual pain, stagnant Qi and Blood: + bai zhi, + mu xiang, + xiang fu, + huai niu xi, + yi mu cao
Menstrual pain, stagnant Liver Qi: + bai zhi, + mu xiang, + xiang fu, + chai hu, + chuan lian zi
Menstrual pain, deficient Qi and Blood: + bai zhi, + mu xiang, + xiang fu, + huang qi, + dang shen
Very severe menstrual pain: + bai zhi, + mu xiang, + xiang fu, + xue jie, + su mu, + tu bie chong
Menstrual pain, deficient Liver-Kidney Yin: + bai zhi, + mu xiang, + xiang fu, + gou qi zi, + nu zhen zi
Menstrual pain, alternative (combined with Shi Xiao San): + dan shen, + xiang fu, + yan hu suo
Menstrual pain, underdeveloped uterus: + bai zhi, + mu xiang, + xiang fu, + zi shi ying, + yin yang huo
Irregular periods: + ai ye, + e jiao, + xiang fu
Irregular periods, Blood-level Heat before the period: + xiang fu, + fu shen, + gan cao, + huang qin, + zhi zi
Irregular periods, alternative basic set: + xiang fu, + fu shen, + gan cao
Irregular periods, Blood-level Cold after the period: + xiang fu, + fu shen, + gan cao, + huang qi, + gan jiang
Irregular, scanty periods from Blood stagnation: + xiang fu, + fu shen, + gan cao, + yan hu suo, + qing pi
Irregular, heavy periods from Qi deficiency: + huang qi, + bai zhu
Breech presentation: + bai zhu, + fu ling, − shu di huang
Uterine bleeding, Heat from Blood stagnation (combined with Shi Xiao San): + san qi
Uterine bleeding, Heat from stasis, alternative: + bai zhu, + huang qi, + zhi ke
Bi from Qi and Blood deficiency, mainly Blood: + zhi fu zi, + sang zhi, + wei ling xian, + fang feng, + jiang huang, + qin jiao, + xi xian cao
Pain in many joints (combined with Liu Wei Di Huang Wan)
Joint pain everywhere, internal Heat (combined with Liu Wei Di Huang Wan): + huang bai, + zhi mu
Joint pain everywhere, restricted movement (combined with Liu Wei Di Huang Wan): + huai niu xi, + sang zhi, + shen jin cao, + xi xian cao, + di long, + jiang can
Joint pain everywhere, weak and painful back and legs (combined with Liu Wei Di Huang Wan): + tu si zi, + du zhong, + xu duan, + di gu pi
Eczema from Dryness (combined with Liu Wei Di Huang Wan): + chi shao, + tao ren, + hong hua, + dang gui
Other option: combine with Jia Wei Xiao Yao San
Chronic eczema (combined with Xiao Feng San)
Calf spasm: + mu gua, + huai niu xi, + sang ji sheng, + xu duan, + du huo, + gui zhi, + gan cao
Other option: combine with Er Chen Tang
Calf spasm, Qi deficiency: + mu gua, + huai niu xi, + sang ji sheng, + xu duan, + du huo, + gui zhi, + gan cao, + dang shen, + da zao, + huang qi
Calf spasm with leg numbness and cramping: + mu gua, + huai niu xi, + sang ji sheng, + xu duan, + du huo, + gui zhi, + gan cao, + tian ma, + quan xie, + hu gu
Calf spasm, dry mouth: + mu gua, + huai niu xi, + sang ji sheng, + xu duan, + du huo, + gui zhi, + gan cao, + zhi mu, + mai men dong
To stop bleeding: + xue yu tan, + zong lu pi, + mu li
Late periods, deficiency Cold: + ai ye, + xiang fu, + wu zhu yu, + gui zhi
Endometriosis: + chi shao, + yi mu cao, + huang qi
Endometriosis, marked Blood stagnation: + chi shao, + yi mu cao, + huang qi, + ze lan, + shui zhi
Endometriosis, Yin-deficient Heat: + chi shao, + yi mu cao, + huang qi, + di gu pi, + lian qiao
Endometriosis, Qi deficiency: + chi shao, + yi mu cao, + huang qi, + bai zhu
Endometriosis, Blood deficiency: + chi shao, + yi mu cao, + huang qi, + e jiao, + he shou wu
Endometriosis, cold uterus: + chi shao, + yi mu cao, + huang qi, + ai ye, + rou gui
Endometriosis, rising Liver Qi: + chi shao, + yi mu cao, + huang qi, + xia ku cao, + dai zhe shi
Infertility, Kidney Yang deficiency: + zi shi ying, + xian mao, + yin yang huo, + tu si zi, + fu pen zi
Infertility, Kidney Yang deficiency, second set: + nu zhen zi, + mo han lian, + gou qi zi, + wu wei zi, + xuan shen, + mai men dong
Pelvic inflammatory disease: + chai hu, + huang qin, + zi hua di ding
Pelvic inflammatory disease, fever: + chai hu, + huang qin, + zi hua di ding, + jin yin hua, + lian qiao, − dang gui
Pelvic inflammatory disease, abdominal pain: + chai hu, + huang qin, + zi hua di ding, + yan hu suo, + pu huang
Pelvic inflammatory disease, poor appetite and diarrhea: + chai hu, + huang qin, + zi hua di ding, + sha ren, + mai ya, − shu di huang
Chronic nephritis (combined with Wu Ling San)
Lumbago (combined with Li Zhong Tang)
Sciatica: + wu gong, + wu shao she
Sciatica, very painful Bi: + wu gong, + wu shao she, + zhi fu zi, + rou gui
Sciatica, wandering Bi: + wu gong, + wu shao she, + du huo, + qin jiao, + fang feng
Sciatica, fixed Bi: + wu gong, + wu shao she, + fu ling, + yi yi ren, + cang zhu
Frozen shoulder: + du zhong, + jiang huang, + xi xin, + hu zhang
Frozen shoulder, Wind: + du zhong, + jiang huang, + xi xin, + hu zhang, + fang feng
Frozen shoulder, Cold: + du zhong, + jiang huang, + xi xin, + hu zhang, + zhi chuan wu
Frozen shoulder, Damp: + du zhong, + jiang huang, + xi xin, + hu zhang, + dan nan xing
Frozen shoulder, Qi deficiency: + du zhong, + jiang huang, + xi xin, + hu zhang, + dang shen
Neurogenic headache, dizziness from Liver Fire: + sang ye, + ju hua
Stabbing neurogenic headache: + tao ren, + hong hua
Neurogenic headache, dizziness and pain: + gou qi zi, + he shou wu
Neurogenic headache: + tian ma, + jiang can, + gan cao, + da zao, + shi jue ming, + wu gong
Vascular headache: + yan hu suo, + xi xin, + shi jue ming
Vascular headache, Heat: + yan hu suo, + xi xin, + shi jue ming, + xia ku cao, + ju hua
Vascular headache, Heat, second set: + yan hu suo, + xi xin, + shi jue ming, + gui zhi
Frontal vascular headache: + yan hu suo, + xi xin, + shi jue ming, + bai zhi
Occipital vascular headache: + yan hu suo, + xi xin, + shi jue ming, + qiang huo
Vertex vascular headache: + yan hu suo, + xi xin, + shi jue ming, + gao ben
Itching: + he shou wu, + bai ji li, + wu shao she
Carpal tunnel syndrome: + ji xue teng, + dan shen
Other option: combine with Ma Huang Tang: + wu shao she, + tu bie chong, + qiang huo
Carpal tunnel syndrome, Qi deficiency: + ji xue teng, + dan shen, + huang qi, + dang shen
Alternative with no stated indication: + bai xian pi, + ku shen, + da zao
Chronic fatigue, chronic laryngitis, pharyngitis, tonsillitis or long-standing sore throat: + he shou wu, + mai men dong, + e jiao
Carpal tunnel syndrome, Yang deficiency: + ji xue teng, + dan shen, + zhi fu zi, + xi xin
Blood stagnation with Phlegm: + yu jin, + bai jie zi
Nosebleed, hypertension or acute hepatitis: + sheng di huang, + bai mao gen, + chuan niu xi, + yu jin, + e jiao, + huang qin, + chuan lian zi, + gan cao, − shu di huang, − chuan xiong
Fainting after childbirth, Blood stagnation in chest, abdomen and flanks: + shui zhi, + meng chong, + mo yao, + she xiang
Headaches: + ju hua, + man jing zi, + ji xue teng, + zhi he shou wu, + zhi gan cao
Headaches, marked palpitations or insomnia: + ju hua, + man jing zi, + ji xue teng, + zhi he shou wu, + zhi gan cao, + suan zao ren, + bai zi ren, + ye jiao teng
Yin deficiency: afternoon headache, light sensitivity, weak aching low back: + ju hua, + man jing zi, + ji xue teng, + zhi he shou wu, + zhi gan cao, + gui ban, + nu zhen zi
Headaches, Qi deficiency: + ju hua, + man jing zi, + ji xue teng, + zhi he shou wu, + zhi gan cao, + huang qi, + sheng ma
Lochiorrhea: + e jiao, + huang qi, + zào xīn tŭ
Sciatica after injury: + huai niu xi, + ru xiang, + mo yao, + si gua luo, + tao ren, + hong hua, + shen jin cao, + xu duan
Urticaria, more Heat: thirst, red tongue: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao, + sheng di huang, + mu dan pi, + jin yin hua, + lian qiao, + mai men dong
Urticaria, mainly Blood deficiency with Wind-Heat: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao, + mu dan pi, + zhi zi, + jin yin hua, + lian qiao, + chan tui, + jiang can, + ku shen
Urticaria, intense itching: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao, + ku shen, + jiang can
Urticaria, robust patients: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao, + ma huang
Urticaria, marked Heat: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao, + shi gao
Urticaria: + chan tui, + wu shao she, + jiang can
Urticaria with constipation and stomach ache: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao, + da huang
Urticaria, basic alternative: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao
Urticaria, second alternative: + he shou wu, + jing jie, + fang feng, + bai ji li, + huang qi, + gan cao, + long gu, + mu li
Urticaria, weaker patients: + huang qin, + fu ping, + shan yao, + bai zhu, + he shou wu, + hong zao, + di fu zi
Palpitations: + chao suan zao ren, + long yan rou, + jiu chao dan shen, + zhi gan cao
Severe palpitations: + chao suan zao ren, + long yan rou, + jiu chao dan shen, + zhi gan cao, + duan long gu, + duan mu li
Palpitations and insomnia: + chao suan zao ren, + long yan rou, + jiu chao dan shen, + zhi gan cao, + ye jiao teng, + bai zi ren
Palpitations, poor memory: + chao suan zao ren, + long yan rou, + jiu chao dan shen, + zhi gan cao, + shi chang pu, + ye jiao teng
Scanty periods: + tai zi shen, + gou qi zi, + dang shen, + e jiao, + bai zhu
Luteal phase defect, third phase only: + chi shao, + sheng di huang
Luteal phase defect, Kidney Yang deficiency, third phase only: + chi shao, + sheng di huang, + tu si zi, + xian mao, + zi shi ying, + yin yang huo, + fu pen zi
Luteal phase defect, Kidney Yin deficiency, third phase only: + chi shao, + sheng di huang, + nu zhen zi, + wu wei zi, + gou qi zi, + xuan shen, + mai men dong
Postpartum abdominal pain: + pao jiang, + dang shen, + shu di huang
Retained lochia, weakness from overwork: + pao jiang
Blood-deficient low back pain during periods: + jiu zhi xu duan, + du zhong
Menstrual low back pain, Blood deficiency, Liver-Kidney Yin deficiency: + jiu zhi xu duan, + du zhong, + sang ji sheng, + huai niu xi
Menstrual low back pain, Blood deficiency, Qi deficiency: + jiu zhi xu duan, + du zhong, + huang qi, + dang shen
Menstrual low back pain, Blood deficiency, stagnant Stomach Qi: + jiu zhi xu duan, + du zhong, + sha ren, + mu xiang
Menstrual low back pain, Blood deficiency, Blood stasis: + jiu zhi xu duan, + du zhong, + hong hua, + tao ren
Early periods, Qi failing to hold the Blood: + dang shen, + bai zhu, + huang qi, + wu wei zi, + chen pi
Uterine bleeding, Blood deficiency and stagnation: + wu ling zhi, + pu huang, + san qi, + hai piao xiao
Uterine bleeding, stagnant Qi and Blood, full painful abdomen: + wu ling zhi, + pu huang, + san qi, + hai piao xiao, + chuan lian zi, + xiang fu
Uterine bleeding from stagnation that cannot be stopped: + wu ling zhi, + pu huang, + san qi, + hai piao xiao, + dang shen, + xian he cao, + yi mu cao, − dang gui, − chuan xiong
Uterine bleeding from stagnation, long-lasting: + wu ling zhi, + pu huang, + san qi, + hai piao xiao, + tao ren, + da huang tan, + yi mu cao, + mu xiang, + guan zhong
Uterine bleeding, stasis and Heat: dry mouth, bitter taste, heavy bright red flow: + wu ling zhi, + pu huang, + san qi, + hai piao xiao, + di yu, + qian cao gen, + xia ku cao
Insufficient lactation: + wang bu liu xing, + mu tong, + gua lou ren
Lupus erythematosus (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, − shu di huang
Lupus, severe Qi deficiency (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, + huang qi, + xi yang shen, − shu di huang
Lupus, marked night or spontaneous sweating (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, + long gu, + mu li, − shu di huang
Lupus, Qi deficiency with poor appetite (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, + shan yao, + fu ling, + bai zhu, − shu di huang
Lupus, clear tidal fever and heat in palms, soles and chest (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, + shan yao, + fu ling, + mu dan pi, + shan zhu yu, + ze xie, − shu di huang
Lupus, Blood stagnation with prominent skin lesions (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, + tao ren, + hong hua, + dan shen, + chi shao, + bai mao gen, − shu di huang
Lupus, skin lesions, alternative (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, + di gu pi, + xuan shen, + tian hua fen, + qing hao, + ou jie, − shu di huang
Lupus, marked Kidney Yin deficiency: sore weak back and knees, dizziness, tinnitus (combined with Da Bu Yin Wan): + sheng di huang, + bie jia, + gou qi zi, + tu si zi, + fu pen zi, + rou cong rong, + huai niu xi, + he shou wu, − shu di huang
Joint pain everywhere, Blood deficiency with stagnation: + sheng di huang, + tao ren, + huai niu xi, + chen pi, + fu ling, + bai zhi, + long dan cao, − shu di huang
Upper-body joint pain, Blood deficiency with stagnation: + sheng di huang, + tao ren, + huai niu xi, + chen pi, + fu ling, + bai zhi, + long dan cao, + qiang huo, + gui zhi, + wei ling xian, − shu di huang
Lower-body joint pain, Blood deficiency with stagnation: + sheng di huang, + tao ren, + huai niu xi, + chen pi, + fu ling, + bai zhi, + long dan cao, + guang fang ji, + mu tong, + huang bai, − shu di huang
Joint pain everywhere, Blood deficiency, stagnation and Phlegm: + sheng di huang, + tao ren, + huai niu xi, + chen pi, + fu ling, + bai zhi, + long dan cao, + dan nan xing, + zhi ban xia, + sheng jiang, − shu di huang
Parasitic vaginitis, swelling and pain: + chai hu, + long dan cao, + zhi zi
Headache from Blood deficiency: + man jing zi, + ju hua
Blood-deficient headache with dizziness: + man jing zi, + ju hua, + tian ma, + gou teng
Blood-deficient headache with palpitations: + man jing zi, + ju hua, + dan shen
Blood-deficient headache with poor appetite: + man jing zi, + ju hua, + chen pi, + shan zha
Blood-deficient headache with insomnia: + man jing zi, + ju hua, + suan zao ren, + wu wei zi
Blood-deficient headache with dry stools: + man jing zi, + ju hua, + xuan shen, + he shou wu

Cautions

contraindication Sudden, severe loss of blood; its moving herbs, Dang Gui and Chuan Xiong, do not suit bleeding that must be stopped first

contraindication Collapse of Blood or Qi

contraindication Extreme weakness or laboured breathing

contraindication Dehydration

contraindication Blood Heat or purely excess patterns with no underlying deficiency

caution Weak Spleen and Stomach, or Spleen Qi or Yang deficiency with Damp (loose stools, poor appetite, abdominal fullness, greasy coat): the rich Shu Di Huang and Bai Shao are hard to digest and can worsen these; modify when the Spleen Yang is constitutionally weak

pregnancy Use with caution; because Dang Gui and Chuan Xiong move the Blood, use only under professional guidance and usually in a modified form

Pinyin

si wu tang

English Name

Four-Substance Decoction