Si Sheng Wan — Four-Fresh Pill
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Overview
Si Sheng Wan — the “Four-Fresh Pill” — is from the Song-dynasty Fu Ren Da Quan Liang Fang. The four herbs are all used fresh (sheng), which preserves their cooling action. The formula addresses bleeding from Blood Heat in the upper body — nosebleeds, blood-streaked sputum, vomiting of bright blood, or heavy menstrual bleeding with bright red blood.
I prescribe Si Sheng Wan as part of bespoke herbal formulas from pharmaceutical-grade granules sourced from Sun Ten in Taiwan.
TCM pattern
Si Sheng Wan is prescribed for bleeding from Blood Heat in the upper burner:
- Nosebleed (epistaxis) with bright red blood
- Coughing up blood (haemoptysis)
- Vomiting blood (haematemesis) — bright red
- Heavy menstrual bleeding with bright red blood
- Skin bleeding (purpura)
- Red face, thirst
- Restlessness, irritability
- Tongue — red, possibly dry
- Pulse — rapid, forceful
Key herbs
- Sheng Di Huang (fresh rehmannia) — nourishes Yin and cools Blood
- Sheng He Ye (fresh lotus leaf) — clears Heat and stops bleeding
- Sheng Ai Ye (fresh mugwort) — warm; balances the cold action
- Sheng Ce Bai Ye (fresh biota leaf) — cools Blood and stops bleeding
Formula actions
- Cools Blood
- Stops bleeding
- Resolves Blood Heat in the upper burner
Conditions treated
- Acute epistaxis from Blood Heat
- Haemoptysis from Lung Blood Heat (alongside investigation of cause)
- Haematemesis from Stomach Blood Heat (alongside gastroenterology assessment)
- Heavy menstrual bleeding with bright red blood — see menstrual problems
- Acute idiopathic thrombocytopenic purpura (alongside conventional care)
- Coagulation disorder with Blood Heat picture (alongside haematology)
Cautions
Acute significant bleeding requires medical assessment to identify the cause. Severe haemoptysis, haematemesis or rectal bleeding can be a medical emergency — call 999 or attend A&E.
Not appropriate for cold-deficient bleeding (pale, watery blood, cold extremities).
Use cautiously in pregnancy.
Always consult a qualified Chinese herbalist registered with the RCHM.
Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide.
