Gui Shao Di Huang Wan — Angelica, Peony & Rehmannia Decoction

归芝地黄丸 | Guī Sháo Dì Huáng Wán

Overview

Gui Shao Di Huang Wan is a modification of the classical Liu Wei Di Huang Wan (Six Flavour Rehmannia Pill) with the addition of Dang Gui (Angelica sinensis) and Bai Shao (white peony root). It is one of the most important formulas in Chinese medicine for fertility and gynaecology and is widely used as a follicular-phase formula in TCM fertility cycle therapy — the approach of prescribing different formulas at different points in the menstrual cycle to match the physiological demands of each phase.

The formula nourishes Kidney Yin and Liver Blood, gently clears Empty Heat, and gives the body the yin substance it needs to produce a mature, high-quality follicle. It is particularly well suited to women with low AMH, high FSH, thin endometrial lining, or irregular cycles with light or delayed periods.

I prescribe pharmaceutical-grade granules from Sun Ten in Taiwan, tested to the highest international quality and safety standards, and dose-adjusted across the menstrual cycle.

Composition

The formula comprises the six herbs of Liu Wei Di Huang Wan with two additions:

Shu Di Huang (wine-prepared Rehmannia root) — the chief herb; powerfully nourishes Kidney Yin, Jing and Blood
Dang Gui (Angelica sinensis root) — the first named addition; nourishes and moves Blood
Bai Shao (white peony root) — nourishes Liver Blood, preserves Yin, softens the Liver
Shan Yao (Chinese yam) — tonifies the Kidney, Spleen and Lung; supports Jing
Shan Zhu Yu (Cornus fruit) — astringes the essence and nourishes Liver and Kidney
Fu Ling (Poria) — supports the Spleen and balances the richness of the Yin tonics
Mu Dan Pi (Moutan bark) — clears Empty Heat and invigorates Blood
Ze Xie (Alisma rhizome) — drains Dampness and prevents the Yin tonics from creating stagnation

The three cooling/draining herbs (Mu Dan Pi, Ze Xie, Fu Ling) balance the three tonifying herbs (Shu Di Huang, Shan Yao, Shan Zhu Yu) — the classical "three tonifications, three drainings" structure of Liu Wei Di Huang Wan — with Dang Gui and Bai Shao adding Blood nourishment and movement that makes the formula particularly suited to gynaecology and fertility.

Actions

Nourishes Kidney Yin and Jing
Nourishes Liver Blood
Gently moves Blood
Clears Empty Heat
Softens the Liver

TCM Pattern Treated

Gui Shao Di Huang Wan is designed for Kidney Yin deficiency with Liver Blood deficiency, frequently with mild Empty Heat and Liver Qi stagnation. In reproductive terms, this is the pattern underlying many of the most common causes of subfertility in women in their late 30s and 40s — declining egg quality, diminishing ovarian reserve, thin endometrial lining and irregular menstruation with short or absent follicular-phase bleeding.

Clinical Indications

The characteristic presentation includes:

Declining ovarian reserve — low AMH, rising FSH, short follicular phase
Light or delayed periods, scanty menstrual flow
Spotting before or after the period
Thin endometrial lining on scan
Irregular or short cycles with difficulty conceiving
Hot flushes, particularly in perimenopause or after fertility medication
Night sweats, five-palm heat, a sensation of heat in the afternoon
Dry skin, dry hair, dry eyes
Dizziness, tinnitus, lower back ache
Insomnia, particularly difficulty falling asleep with restless mind
Tongue: red or pale with thin coating, often with scalloped edges
Pulse: thready, sometimes rapid or wiry

Conditions Commonly Treated

Gui Shao Di Huang Wan is a cornerstone formula in my fertility practice, particularly for the follicular phase of the cycle:

Low AMH and diminished ovarian reserve
High FSH and poor follicle development
Thin endometrial lining in natural cycles and IVF
Luteal phase defect arising from follicular-phase deficiency
Preparation for IVF — particularly for women over 38 and for those with a poor response to stimulation
Perimenopausal symptoms with reproductive involvement
Post-pill amenorrhoea with Yin depletion
Unexplained infertility with Kidney Yin and Liver Blood deficiency pattern

Use in Fertility Cycle Therapy

In TCM fertility cycle therapy, different formulas are prescribed in different phases of the menstrual cycle to match the physiological demands of each phase. Gui Shao Di Huang Wan is the classical follicular-phase formula — typically prescribed from day 6 to day 11 (approximately from the end of menstruation until a few days before ovulation). This is when the body is building Yin, Blood and Essence to mature the follicle and thicken the endometrial lining, and when Yin-nourishing formulas have their greatest impact.

The formula is then typically succeeded by an ovulation-phase formula (moving Qi and Blood to support ovulation itself) and by a luteal-phase formula (tonifying Yang to support implantation and early pregnancy). This phase-based approach produces consistently better results than a single formula used throughout the cycle, in my clinical experience.

Research Evidence

A 2021 in vitro study using human uterine microvascular endothelial cells demonstrated that Gui Shao Di Huang Wan significantly promotes angiogenesis — the formation of new blood vessels — and regulates oestrogen receptor α and progesterone receptor β expression in endometrial cells. This provides a biomedical mechanism for its observed clinical effect on endometrial lining thickness and receptivity. A 2015 Australian meta-analysis of Chinese herbal medicine in fertility (1,851 women) found pregnancy was 3.5 times more likely with Chinese herbs combined with conventional medicine over four months, compared to conventional medicine alone; Gui Shao Di Huang Wan is one of the formulas most commonly cited in this literature.

Prescribing Notes

Where Yang deficiency is significant alongside the Yin deficiency — cold hands and feet, low basal body temperature in the luteal phase, frequent pale urination — I combine with Yang-tonifying herbs such as Tu Si Zi (cuscuta seed) and Du Zhong (eucommia). Where Liver Qi stagnation dominates with premenstrual irritability, breast tenderness and cycle irregularity, I often alternate or combine with Xiao Yao San. For women with significant Blood stasis (dark clots, fixed pelvic pain, endometriosis), blood-moving herbs are added in the luteal phase rather than the follicular phase when the formula is used.

Cautions

Gui Shao Di Huang Wan is rich and moistening. It is not appropriate during acute illness (colds, flu, fever) or in patients with strong Spleen Qi deficiency with significant Damp accumulation (loose stools, heavy abdomen, thick greasy coating). Like all Chinese herbal formulas it should only be taken under the supervision of a qualified practitioner, particularly in the context of fertility treatment and IVF.

Online Consultation

For patients unable to attend the clinic in person, I offer online herbal consultations, including full cycle-based protocols for fertility. After a detailed assessment of your cycle, blood work and any imaging available, pharmaceutical-grade granules from Sun Ten are dispensed phase-by-phase and posted directly to your home.

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