Si Wu Tang (四物汤) — Four-Substance Decoction
Quick answer: Si Wu Tang is the foundational Blood tonic formula of Chinese herbal medicine. Si Wu Tang combines four herbs — Shu Di Huang, Bai Shao, Dang Gui and Chuan Xiong — to nourish Liver Blood and gently invigorate it. Si Wu Tang is prescribed for Blood deficiency presenting as irregular or scanty periods, pale complexion, dizziness, dry skin and hair, anaemia and post-partum recovery, and is the parent formula for Ba Zhen Tang, Tao Hong Si Wu Tang and many other classical formulas.
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What is Si Wu Tang?
Si Wu Tang — literally "Four-Substance Decoction" — is the foundational Chinese herbal Blood tonic formula, first recorded in the Tang Dynasty (618–907 CE) in the Xian Shou Li Shang Xu Duan Mi Fang.
Si Wu Tang — Four-Substance Decoction — is the foundational Blood tonic formula in the entire canon of Chinese herbal medicine. First recorded in the Tang Dynasty (618–907 CE) in the Xian Shou Li Shang Xu Duan Mi Fang, it consists of just four herbs that together nourish Blood, invigorate Blood and regulate the Liver. It is the most important and most widely prescribed formula for Blood deficiency in women and forms the base from which many other important formulas are derived, including Ba Zhen Tang (Eight Treasure Decoction), Tao Hong Si Wu Tang and Gui Zhi Fu Ling Wan variants. Its classical name — Si Wu (Four Substances) — simply reflects its composition of four herbs.
What TCM pattern does Si Wu Tang treat?
Si Wu Tang treats Liver Blood deficiency — the pattern of pale complexion, dizziness, blurred vision, palpitations, insomnia, dry skin and hair, numb limbs, and irregular or scanty periods, with a pale tongue and a thin choppy pulse.
Si Wu Tang is prescribed for Liver Blood deficiency, characterised by: pale or sallow complexion, pale lips and fingernails, dizziness and blurred vision, palpitations, insomnia, dry skin and hair, numbness or tingling of the limbs, irregular or scanty menstruation, delayed menstrual cycle, a pale tongue, and a thin, choppy pulse. The formula also has a mild Blood-invigorating action, making it suitable for Blood deficiency with a mild stasis component.
What four herbs are in Si Wu Tang?
Si Wu Tang contains four herbs: Shu Di Huang (prepared rehmannia), Bai Shao (white peony), Dang Gui (Chinese angelica) and Chuan Xiong (ligusticum). Two nourish and contain Blood (Shu Di Huang, Bai Shao); two invigorate and move it (Dang Gui, Chuan Xiong).
- Shu Di Huang (prepared Rehmannia root, 4-21g) — the principal herb; powerfully nourishes Blood and Yin; fills the Essence; the most important Blood tonic in TCM
- Bai Shao (Paeonia lactiflora root, white, 4-15g) — nourishes Blood and preserves Yin; calms the Liver and relieves spasm; softens the Liver’s interaction with the formula
- Dang Gui (Angelica sinensis root, 4-12g) — nourishes and invigorates Blood simultaneously; regulates menstruation and relieves pain; the leading herb for women’s Blood conditions
- Chuan Xiong (Ligusticum chuanxiong rhizome, 3-9g) — invigorates Blood and moves Qi; prevents the nourishing herbs from causing stagnation; the chief Blood-moving herb for headache and menstrual pain
The elegance of this formula lies in the pairing of tonic and moving herbs: Shu Di Huang and Bai Shao nourish and contain Blood, while Dang Gui and Chuan Xiong invigorate and move it. This balance tonifies without causing stagnation and moves without damaging Blood.
What does Si Wu Tang do?
Si Wu Tang nourishes Blood, regulates the Liver, gently invigorates Blood circulation, and regulates menstruation — the four core actions that make it the parent formula for the entire family of Chinese herbal Blood tonics.
- Nourishes the Blood
- Regulates the Liver
- Improves Blood circulation
- Regulates menstruation
What conditions does Si Wu Tang treat?
Si Wu Tang is the foundational formula for irregular menstrual cycle, scanty or delayed periods, dysmenorrhoea, amenorrhoea, post-partum recovery, anaemia, dry skin and hair loss from Blood deficiency, and IVF support to thicken the endometrium.
- Irregular menstrual cycle — delayed, scanty or pale periods from Blood deficiency; the foundational formula for menstrual Blood deficiency
- Dysmenorrhoea (painful periods) with Blood deficiency and mild stasis
- Amenorrhoea from Blood deficiency
- Post-partum recovery — rebuilding Blood after childbirth and blood loss
- Anaemia and chronic Blood deficiency with pallor, fatigue and dizziness
- Insomnia and palpitations from Liver Blood deficiency failing to anchor the Mind
- Dry skin, hair loss and brittle nails from Blood deficiency
- Support during IVF and fertility treatment to nourish Blood and support endometrial development
Are there any cautions with Si Wu Tang?
Si Wu Tang should be used with caution during pregnancy (Chuan Xiong and Dang Gui have uterotonic activity) and is not suitable as the sole formula where significant Blood stasis, excess Heat, Damp-Phlegm or Yang deficiency dominates.
Use with caution during pregnancy (Chuan Xiong and Dang Gui have uterotonic properties). Not suitable as the sole formula where significant Blood stasis, excess Heat, Damp-Phlegm or Yang deficiency is the primary pattern. Shu Di Huang can burden digestion in patients with Spleen deficiency — in such cases, the formula may be modified by adding Sha Ren or Chen Pi to assist digestion.
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