Since the publication of 'Synopsis of the Golden Chamber', Guizhi Fuling Pills have undergone a long historical inheritance and development. Gui Zhi Fu Ling Wan (桂枝茯苓丸), known in English as Cinnamon Twig and Poria Pill, is one of the most important classical formulas in Traditional Chinese Medicine for treating Blood stasis in the uterus. Created by the famous physician Zhang Zhong-jing, this gentle yet effective formula moves Blood, resolves stasis, and clears mild Heat while supporting the Spleen. It is particularly indicated for dysmenorrhea (painful menstruation), uterine fibroids, endometriosis, ovarian cysts, and irregular menstruation with dark clotted blood. In modern clinical practice, Gui Zhi Fu Ling Wan is widely used in TCM gynecology for conditions involving fixed lower abdominal pain, masses, and infertility due to Blood stasis. Because it moves Blood without being overly aggressive, it is suitable for long-term use and is often combined with tonifying formulas according to the patient’s constitution.

I. Origins and History

1. Classical Source

Guizhi Fuling Wan originates from the *Jin Gui Yao Lue* (Essential Prescriptions of the Golden Cabinet), written by the Eastern Han physician Zhang Zhongjing — a classical work of Chinese medicine that has exerted a profound influence on clinical practice. In the chapter "Diseases, Pulses, Patterns, and Treatment of Pregnancy in Women" of the *Jin Gui Yao Lue*, it is recorded: "When a woman has a long-standing zheng disorder, and menstruation has not yet ceased for three months, but she experiences continuous spotting, with fetal movement above the navel, this is harm from a stubborn zheng mass. If movement occurs in the sixth month of pregnancy, and menstrual flow was normal in the preceding three months, this is the fetus moving. If bleeding occurs, and menstruation had ceased three months prior, this is old, stagnant blood. The reason the bleeding does not stop is that the zheng mass has not been removed; the zheng mass should be purged — Guizhi Fuling Wan governs this condition." This record clearly sets out the application of Guizhi Fuling Wan in treating pregnancy-related disorders in women caused by a long-standing zheng disorder.

2. Historical Evolution

Since the compilation of the *Jin Gui Yao Lue*, Guizhi Fuling Wan has undergone a long history of transmission and development. Physicians throughout history have continually applied and summarised it in clinical practice, further expanding its actions and scope of application. Across different historical periods, although the formula's herb composition has remained essentially stable, adjustments may have been made to aspects such as processing methods and dosage according to the medical understanding and clinical experience of the time. For example, as pharmaceutical technology progressed, the manufacturing process for the pill form was continually refined, to improve the herbs' efficacy and stability.

3. Cultural Influence

Guizhi Fuling Wan holds not only an important place in the medical field, but also reflects, to a certain degree, the influence of traditional Chinese culture on Chinese medicine. Chinese medicine emphasises the harmonious unity between humans and nature, and among the body's own organs; the application of Guizhi Fuling Wan embodies this holistic concept. It achieves the goal of treating disease by regulating the body's qi-blood movement, aligning with the traditional Chinese cultural ideas of "balance between yin and yang" and "harmony of qi and blood." At the same time, the formula's transmission also carries forward the continuity of Chinese medicine culture, bearing witness to several millennia of the Chinese nation's medical wisdom.

II. Herb Composition (Sovereign, Minister, Assistant, Envoy)

1. Chief Herb — Guizhi

- Nature, Flavour, and Channel Affinity

Guizhi (Cinnamon Twig) is acrid and sweet in flavour, warm in nature, and enters the heart, lung, and bladder channels.

- Actions

It has the actions of inducing sweating to release the muscle layer, warming and unblocking the channels, and assisting yang to transform qi. In Guizhi Fuling Wan, Guizhi can warm and unblock the blood vessels, propelling blood movement, making it the formula's primary active herb. It can promote the circulation of qi and blood, eliminating various disorders caused by stagnation of the blood vessels. For example, for gynaecological disorders such as dysmenorrhoea and amenorrhoea caused by cold congealing with blood stasis, Guizhi's warming, unblocking action can disperse cold pathogens and unblock the channels, allowing qi and blood to flow smoothly, thereby relieving pain symptoms.

- Dosage Characteristics

Generally used at 3 liang in the formula, a moderate dosage that fully exerts the action of warming and unblocking the blood vessels without being too fierce, avoiding depletion of righteous qi.

2. Deputy Herb — Fuling

- Nature, Flavour, and Channel Affinity

Fuling (Poria) is sweet and bland in flavour, neutral in nature, and enters the heart, lung, spleen, and kidney channels.

- Actions

It has the actions of promoting urination, draining dampness, strengthening the spleen, and calming the heart. Fuling in Guizhi Fuling Wan serves to strengthen the spleen and promote urination, helping to regulate the body's water-fluid metabolism. It can leach out and drain water-dampness, allowing excess water within the body to be expelled, relieving swelling and discomfort caused by water-dampness stagnation. At the same time, Fuling can also strengthen the spleen, enhancing spleen-stomach transportation and transformation function, providing a good foundation for the generation and movement of qi and blood. For example, for conditions such as increased vaginal discharge and irregular menstruation caused by spleen deficiency with dampness excess, Fuling's spleen-strengthening, urination-promoting action can improve symptoms.

- Dosage Characteristics

Used at 3 liang, working with Guizhi — one warming, one unblocking; one draining, one leaching — together regulating the body's qi-blood and water-fluid metabolism.

3. Assistant Herb — Taoren

- Nature, Flavour, and Channel Affinity

Taoren (Peach Kernel) is bitter and sweet in flavour, neutral in nature, and enters the heart, liver, and large intestine channels.

- Actions

It has the actions of activating blood, dispelling stasis, and moistening the intestines to unblock bowel movements. Taoren is a commonly used herb for activating blood and resolving stasis; in Guizhi Fuling Wan, it strengthens the formula's action of activating blood and resolving stasis. It can break blood and move stasis, dispersing stagnant blood clots, providing very good therapeutic effect for various disorders caused by blood-stasis obstruction, such as unresolved postpartum lochia and abdominal masses. At the same time, Taoren's action of moistening the intestines to unblock bowel movements also helps maintain smooth bowel movements, avoiding sluggish intestinal qi mechanism caused by internal blood-stasis obstruction.

- Dosage Characteristics

Used at 50 pieces; the dosage may be adjusted somewhat according to factors such as the condition and constitution, but overall aims to achieve the effect of activating blood and resolving stasis without excessively damaging righteous qi.

4. Assistant Herb — Mudanpi

- Nature, Flavour, and Channel Affinity

Mudanpi (Tree Peony Bark) is bitter and acrid in flavour, slightly cold in nature, and enters the heart, liver, and kidney channels.

- Actions

It has the actions of clearing heat, cooling the blood, activating blood, and resolving stasis. Mudanpi in Guizhi Fuling Wan, on the one hand, clears heat and cools the blood, preventing prolonged blood stasis from transforming into heat; on the other hand, it strengthens the action of activating blood and resolving stasis. It can cool the blood and disperse stasis, allowing blood stasis to be dissolved, while not causing adverse reactions such as bleeding from excessive blood activation. For example, for conditions of blood stasis accompanied by heat signs, such as irregular menstruation in women accompanied by fever and abdominal pain, Mudanpi's actions of clearing heat, cooling the blood, activating blood, and resolving stasis can effectively relieve the condition.

- Dosage Characteristics

Used at 2 liang, working synergistically with Taoren and the other herbs to jointly exert the formula's therapeutic efficacy.

5. Envoy Herb — Shaoyao

- Nature, Flavour, and Channel Affinity

Shaoyao (Peony Root) is bitter and sour in flavour, slightly cold in nature, and enters the liver and spleen channels.

- Actions

It has the actions of nourishing blood and regulating menstruation, astringing yin to stop sweating, softening the liver to relieve pain, and calming hyperactive liver yang. In Guizhi Fuling Wan, Shaoyao mainly serves to nourish blood, harmonise blood, and relieve urgency and pain. It can nourish blood and soften the liver, regulating liver function, allowing liver qi to move freely, and preventing liver-qi depression from worsening blood-stasis symptoms. At the same time, Shaoyao can also relieve pain caused by blood-stasis obstruction, achieving the effect of relieving urgency and pain. For example, for conditions such as dysmenorrhoea and abdominal pain in women, Shaoyao's actions of nourishing blood, harmonising blood, and relieving urgency and pain can lessen the degree of pain.

- Dosage Characteristics

Used at 4 liang, working together with the other herbs to regulate the formula's overall nature, allowing the whole formula to both activate blood and resolve stasis while also attending to nourishing blood and relieving urgency and pain.

III. Pathomechanism, Actions, and Indications

1. Pathomechanism Analysis

The pathomechanism targeted by Guizhi Fuling Wan is mainly blood-stasis obstruction. Sluggish movement of the body's qi and blood leads to internal blood-stasis accumulation, which can obstruct the uterus, channels, and other locations. In female physiology, blood stasis can affect the normal expulsion of menstrual blood, leading to conditions such as irregular menstruation, dysmenorrhoea, and amenorrhoea; blood stasis can also form masses that accumulate in the abdomen, giving rise to pathological changes such as zheng jia (abdominal masses). In other respects, blood-stasis obstruction can also cause local symptoms such as pain and swelling. Its causes are mostly related to factors such as emotional disharmony, cold-pathogen congealing, and qi deficiency with blood stasis. For example, prolonged emotional depression can lead to liver-qi stagnation, and when qi stagnates, blood becomes stagnant; invasion by cold pathogens, with cold congealing and blood stagnating, can also readily form blood stasis; and insufficient qi to propel blood movement can also lead to internal generation of blood stasis.

2. Summary of Actions

The main actions of Guizhi Fuling Wan are activating blood, resolving stasis, and gently dispersing zheng masses. Through the synergistic action of blood-activating, stasis-resolving herbs such as Guizhi, Taoren, and Mudanpi in the formula, it can promote the dispersal of blood stasis, restoring the smooth movement of qi and blood. Fuling strengthens the spleen and promotes urination, helping to improve abnormal water-fluid metabolism caused by blood-stasis obstruction. Shaoyao nourishes blood, harmonises blood, and relieves urgency and pain, able to relieve pain symptoms caused by blood stasis and prevent blood deficiency caused by excessive blood activation. The whole formula works together to achieve the goal of eliminating blood-stasis masses and regulating the body's qi-blood balance.

3. Indications

- Gynaecological Disorders

- Irregular menstruation: including symptoms such as scanty menstrual flow, unsmooth menstruation, and menstrual abdominal pain. Blood stasis obstructing the uterus prevents menstrual blood from being normally expelled, giving rise to the above manifestations of irregular menstruation. Guizhi Fuling Wan, by activating blood and resolving stasis, allows menstrual blood to flow smoothly, thereby improving symptoms of irregular menstruation.

- Dysmenorrhoea: mostly caused by cold congealing with blood stasis, or qi stagnation with blood stasis. In the formula, Guizhi warms and unblocks the channels, Taoren and Mudanpi activate blood and resolve stasis, and Shaoyao relieves urgency and pain — together effectively relieving dysmenorrhoea symptoms.

- Amenorrhoea: blood stasis obstructing the chong and ren channels prevents menstrual blood from descending, giving rise to amenorrhoea. Guizhi Fuling Wan can break blood and expel stasis, allowing blood stasis to be dispersed and the chong and ren channels to be unblocked, restoring menstruation to normal.

- Unresolved postpartum lochia: postpartum blood stasis remaining in the uterus, unable to be expelled promptly, can lead to unresolved lochia. Guizhi Fuling Wan can activate blood and resolve stasis, promoting the expulsion of lochia and restoring the uterus to normal.

- Zheng jia (abdominal masses): that is, masses in the abdomen, mostly formed from accumulated blood stasis. Guizhi Fuling Wan can gradually disperse blood-stasis masses, providing a certain therapeutic effect for conditions falling within the category of blood-stasis zheng jia, such as uterine fibroids and ovarian cysts.

- Other Disorders

- Chronic pelvic inflammatory disease: mostly caused by factors such as damp-heat stasis binding, or qi stagnation with blood stasis. Blood stasis obstructing the pelvis leads to symptoms such as local pain and bearing-down distension. The blood-activating, stasis-resolving action of Guizhi Fuling Wan can improve pelvic blood circulation, reduce inflammatory response, and relieve symptoms.

- Benign prostatic hyperplasia: Chinese medicine holds that this is related to blood-stasis obstruction. Guizhi Fuling Wan can activate blood and resolve stasis, providing a certain relieving effect for symptoms such as difficulty urinating and perineal bearing-down sensation caused by prostatic hyperplasia.

IV. Formula Analysis

1. Treating Qi and Blood Together

In Guizhi Fuling Wan, Guizhi warms and unblocks the blood vessels, propelling the movement of qi and blood, creating the conditions for qi to move and blood to follow. Taoren and Mudanpi activate blood and resolve stasis, directly targeting and dispersing blood stasis. Shaoyao nourishes blood and harmonises blood, preventing excessive damage to blood during the process of activating blood and resolving stasis, ensuring the normal generation and movement of blood. Fuling strengthens the spleen and promotes urination, regulating the body's water-fluid metabolism; normal water-fluid metabolism helps qi and blood to flow smoothly. The whole formula, by regulating the movement and generation of qi and blood, achieves the goal of treating qi and blood together, restoring balance to the body's qi and blood, thereby eliminating various disorders caused by qi-blood disharmony.

2. Treating Both the Branch and the Root

From the perspective of pathomechanism, blood-stasis obstruction is the branch, while the various factors leading to the formation of blood stasis — such as emotional factors, cold pathogens, and qi deficiency — are the root. Guizhi Fuling Wan, while activating blood and resolving stasis to eliminate the branch manifestation of blood stasis, also attends to conditioning the root. For example, Guizhi's warming, unblocking action can address the root cause of cold-pathogen congealing; Fuling's spleen-strengthening action can improve insufficient qi-blood generation and abnormal water-fluid metabolism caused by spleen deficiency, reducing the likelihood of blood-stasis formation at the root. By treating both the branch and the root, the formula can not only relieve current blood-stasis symptoms but also regulate the body's overall condition, preventing disease recurrence.

3. Herb Combination and Properties

The combination of herb properties in the formula is exquisite. Guizhi is warm in nature, and combined with blood-activating, stasis-resolving herbs such as Taoren and Mudanpi, warming-unblocking is combined with blood-activating, strengthening the power of activating blood and resolving stasis, while the warming herb also prevents the blood-activating, stasis-resolving herbs from being too cold and damaging yang. Shaoyao is slightly cold in nature; combined with Guizhi, one cold and one hot mutually restrain each other, keeping the formula's overall nature balanced, neither too warming and heating so as to consume yin and stir fire, nor too cold so as to damage yang qi. Fuling is neutral in nature, and combined with the other herbs, plays a role in harmonising the herbs' properties, allowing the whole formula to exert its therapeutic efficacy more steadily.

V. Comparison with Related Formulas

1. Comparison with Shixiao San

- Composition and Actions

Shixiao San is composed of two herbs — Puhuang (Cattail Pollen) and Wulingzhi (Flying Squirrel Droppings) — with the actions of activating blood, dispelling stasis, dispersing nodules, and relieving pain. It is mainly used for the pattern of blood-stasis stagnation, such as stabbing pain in the heart and abdomen, and unresolved postpartum lochia. Compared with Guizhi Fuling Wan, Shixiao San's herb composition is simpler, with its blood-activating, stasis-resolving power concentrated relatively on Puhuang and Wulingzhi, giving a relatively pronounced pain-relieving effect, focusing on treating pain symptoms caused by blood stasis.

- Differences in Applicable Conditions

Besides its action of activating blood, resolving stasis, and relieving pain, Guizhi Fuling Wan can also regulate the body's qi-blood and water-fluid metabolism, making it suited to a variety of gynaecological disorders caused by blood-stasis obstruction, as well as certain other blood-stasis-related conditions such as zheng jia and chronic pelvic inflammatory disease. Shixiao San, on the other hand, mainly targets pain caused by blood stasis, particularly stabbing pain in the heart and abdomen region, making it more suitable for simple blood-stasis pain symptoms.

2. Comparison with Shenghua Tang

- Composition and Actions

Shenghua Tang is composed of whole Danggui (Angelica Root), Chuanxiong (Szechuan Lovage Rhizome), Taoren, Ganjiang (Dry Ginger), and Gancao (Licorice), with the actions of nourishing blood, dispelling stasis, warming the channels, and relieving pain. It is mainly used for postpartum blood deficiency with contracted cold, unresolved lochia, and cold pain in the lower abdomen. Shenghua Tang places emphasis on nourishing blood, promoting the expulsion of blood stasis through nourishing blood, while also warming the channels and dispersing cold to relieve pain.

- Differences in Applicable Conditions

Guizhi Fuling Wan focuses on activating blood and resolving stasis, providing good therapeutic effect for a variety of conditions caused by blood-stasis obstruction, not limited to the postpartum period. Shenghua Tang, on the other hand, mainly targets postpartum issues of lochia caused by blood deficiency with contracted cold, and cold pain in the lower abdomen, with its action of nourishing blood and warming the channels being more pronounced, making it a formula specifically for postpartum conditioning.

3. Comparison with Xuefu Zhuyu Tang

- Composition and Actions

Xuefu Zhuyu Tang is composed of Taoren, Honghua (Safflower), Danggui, Shengdihuang (Raw Rehmannia Root), Chuanxiong, Chishao (Red Peony Root), Niuxi (Achyranthes Root), Jiegeng (Platycodon Root), Chaihu (Bupleurum Root), Zhiqiao (Bitter Orange), and Gancao, with the actions of activating blood, resolving stasis, moving qi, and relieving pain. It mainly treats the pattern of blood stasis in the chest, such as chest pain and headache of long duration that do not resolve. Xuefu Zhuyu Tang, building on activating blood and resolving stasis, places greater emphasis on moving qi, promoting the dispersal of blood stasis through moving qi, and its action is relatively more fierce.

- Differences in Applicable Conditions

Guizhi Fuling Wan is mainly used for blood-stasis disorders of the lower burner, such as gynaecological irregular menstruation and zheng jia. Xuefu Zhuyu Tang, on the other hand, focuses on treating blood stasis in the upper burner, such as chest pain caused by blood stasis in the chest; its applicable conditions differ from those of Guizhi Fuling Wan in both location and pathomechanism. Xuefu Zhuyu Tang's qi-moving action makes it more effective for treating blood stasis accompanied by qi-stagnation symptoms, while Guizhi Fuling Wan relatively focuses on simple blood-stasis obstruction conditions.

VI. Clinical Applications

1. Gynaecological Clinical Applications: Activating Blood and Resolving Stasis

Irregular Menstruation

- Scanty menstrual flow, dark colour with clots: this type of irregular menstruation is mostly caused by blood stasis obstructing the uterus. Besides scanty menstrual flow, patients may also experience abdominal pain during menstruation, with pain easing after the blood clots are expelled. Guizhi Fuling Wan can activate blood and resolve stasis, allowing menstrual blood to flow smoothly, increasing menstrual flow, and improving menstrual colour and texture. Generally, after taking it for a period of time, the menstrual cycle and flow gradually return to normal.

- Amenorrhoea: for amenorrhoea caused by blood-stasis obstruction, Guizhi Fuling Wan may be rationally used based on pattern differentiation and treatment, according to the patient's specific circumstances. For patients with a relatively short duration of amenorrhoea and a reasonably good constitution, Guizhi Fuling Wan alone may be taken to activate blood and resolve stasis, promoting the onset of menstruation. If the duration of amenorrhoea is longer and the constitution relatively weak, qi-tonifying, blood-nourishing herbs may be appropriately added to the formula to strengthen therapeutic effect.

Dysmenorrhoea

- Primary dysmenorrhoea: mostly occurring within 1–2 years after menarche, with pain mostly occurring several hours before the onset of menstruation, located mainly in the lower abdomen, of a spasmodic nature, which may radiate to the lumbosacral region and inner thighs. Guizhi Fuling Wan has good therapeutic effect for cold-congealed, blood-stasis type primary dysmenorrhoea. Patients often present with concurrent symptoms such as aversion to cold with cold limbs, and pain relieved by warmth. After taking Guizhi Fuling Wan, it can warm and unblock the blood vessels, disperse cold pathogens, and relieve pain.

- Secondary dysmenorrhoea: commonly seen in conditions such as endometriosis and adenomyosis. Besides dysmenorrhoea symptoms, patients may also present with progressively worsening dysmenorrhoea, increased menstrual flow, and infertility. Guizhi Fuling Wan can improve pelvic blood circulation and reduce local blood-stasis states through activating blood and resolving stasis, thereby relieving dysmenorrhoea symptoms. However, for secondary dysmenorrhoea, comprehensive treatment combined with the specific underlying disease is still required.

Unresolved Postpartum Lochia

Postpartum lochia is generally fully expelled within around 3 weeks after delivery. If the duration of lochia is prolonged, with flow alternating between heavy and light, purplish-dark colour with clots, and accompanying abdominal pain, this is mostly unresolved lochia. Guizhi Fuling Wan can promote the expulsion of blood stasis, allowing lochia to be fully expelled as soon as possible. For postpartum patients with a relatively weak constitution, nutrition may be appropriately increased and rest attended to while taking Guizhi Fuling Wan, to promote bodily recovery.

Zheng Jia

- Uterine fibroids: Guizhi Fuling Wan can be used to treat relatively small uterine fibroids. For patients with a fibroid diameter under 3cm and relatively mild symptoms, after taking Guizhi Fuling Wan, some patients' fibroids may shrink, and symptoms may also be relieved. However, for patients with larger or rapidly growing fibroids, combination with other treatment methods, such as surgical treatment, may be needed.

- Ovarian cysts: ovarian cysts, in Chinese medicine pattern differentiation, mostly fall within the category of blood-stasis zheng jia. Guizhi Fuling Wan can activate blood and resolve stasis, and may have a certain dispersing effect for certain physiological cysts or smaller benign cysts. For patients with larger cysts or those suspected of malignant tendency, surgical or other treatment measures should be taken promptly, combined with Guizhi Fuling Wan as adjunctive treatment, to prevent recurrence of the cyst.

2. Other Clinical Applications

- Chronic Pelvic Inflammatory Disease

Patients with chronic pelvic inflammatory disease commonly present with lower abdominal bearing-down distension, pain, and lumbosacral soreness, often worsening after exertion, sexual intercourse, and before and after menstruation, along with symptoms such as increased vaginal discharge. Chinese medicine holds that this is mostly caused by factors such as damp-heat stasis binding, or qi stagnation with blood stasis. The blood-activating, stasis-resolving action of Guizhi Fuling Wan can improve pelvic blood circulation, reduce local blood-stasis states, and relieve pain symptoms. At the same time, it may be combined with heat-clearing, dampness-draining herbs and other comprehensive treatment, according to the patient's specific circumstances.

- Benign Prostatic Hyperplasia

Benign prostatic hyperplasia can cause symptoms such as frequent, urgent urination and difficulty urinating. Chinese medicine holds that this is related to blood-stasis obstruction. Guizhi Fuling Wan can activate blood and resolve stasis, improving local prostatic blood circulation, reducing compression of the urethra by hyperplastic tissue, thereby relieving symptoms such as difficulty urinating. For patients with milder symptoms, Guizhi Fuling Wan may be taken alone for treatment; for patients with more severe symptoms, it may be combined with other treatment methods, such as medicated sitz baths and acupuncture, to improve therapeutic effect.

VII. Clinical Modifications for Guizhi Fuling Wan

1. Qi Deficiency with Blood Stasis

If the patient has concurrent qi-deficiency symptoms, such as shortness of breath with fatigue and a pale complexion, qi-tonifying herbs such as Huangqi (Astragalus Root) and Dangshen (Codonopsis Root) may be added to Guizhi Fuling Wan. Huangqi can tonify qi and raise yang, consolidate the exterior and stop sweating, promote urination and reduce swelling, generate fluids and nourish blood, move stagnation and unblock obstruction, expel toxin and drain pus, and promote tissue regeneration to heal sores. Dangshen can strengthen the spleen and benefit the lung, nourishing blood and generating fluids. After adding qi-tonifying herbs, the body's righteous qi can be strengthened, allowing exuberant qi to move blood, helping to disperse blood stasis while also improving the patient's qi-deficiency symptoms.

2. Cold Congealing with Blood Stasis

For patients with relatively pronounced cold congealing with blood stasis, warming herbs such as Xiaohuixiang (Fennel) and Aiye (Mugwort Leaf) may be added. Xiaohuixiang can disperse cold and relieve pain, regulating qi and harmonising the stomach. Aiye can warm the channels, stop bleeding, disperse cold, regulate menstruation, and calm the fetus. These herbs can strengthen the formula's warming, unblocking power, more effectively dispersing cold pathogens and promoting the dispersal of blood stasis, suited to conditions such as irregular menstruation and dysmenorrhoea caused by cold-pathogen congealing.

3. Damp-Heat Stasis Binding

If the patient has concurrent damp-heat symptoms, such as profuse, yellow, thick vaginal discharge with a pronounced odour, heat-clearing, dampness-draining herbs such as Huangbo (Phellodendron Bark) and Yiyiren (Job's Tears) may be added. Huangbo can clear heat, dry dampness, drain fire, resolve toxicity, and eliminate steaming bone sensation. Yiyiren can promote urination, drain dampness, strengthen the spleen, stop diarrhoea, eliminate bi obstruction, expel pus, and resolve toxicity to disperse nodules. After adding heat-clearing, dampness-draining herbs, targeting the pathomechanism of damp-heat stasis binding, the damp-heat pathogen can be eliminated and blood stasis dispersed, suited to conditions such as chronic pelvic inflammatory disease that fall within the damp-heat stasis binding pattern.

4. More Severe Blood Stasis

When blood-stasis symptoms are relatively severe, such as larger abdominal masses and intense pain, the dosages of Taoren and Honghua (Safflower) may be appropriately increased, or herbs with stronger blood-breaking, stasis-expelling power such as Sanleng (Bur-Reed Rhizome) and Ezhu (Zedoary Rhizome) may be added. Sanleng can break blood, move qi, and reduce accumulation to relieve pain. Ezhu can break blood, move qi, and reduce accumulation to relieve pain. However, when using blood-breaking, stasis-expelling herbs, care should be taken to control the dosage and course of treatment, to avoid excessive attack causing damage to righteous qi.

VIII. Dosage and Preparation (Traditional Method and Modern Concentrated Granules)

1. Traditional Method

The traditional dosage form for Guizhi Fuling Wan is a pill, generally prepared as a honey-bound pill or a water-bound pill. The honey-bound pill is prepared by mixing fine herb powder evenly with refined honey to form pills. The water-bound pill is prepared by forming pills from fine herb powder with an appropriate amount of water or yellow wine.

- Dosage

Generally 6–9 grams per dose, twice daily. The specific dosage may be adjusted according to factors such as the patient's condition and constitution. For example, those with milder conditions may appropriately reduce the dosage, while those with more severe conditions may increase the dosage as advised by a physician.

- Method of Administration

Taken with warm boiled water. When taking honey-bound pills, the pill may be divided into smaller portions and taken in divided doses; when taking water-bound pills, they may be taken directly with warm boiled water.

2. Modern Concentrated Granules

Modern concentrated granules are a granule preparation produced from Chinese herbs through extraction, concentration, and other processing methods, offering advantages such as convenience of administration and confirmed efficacy.

- Dosage

The dosage for the modern concentrated granule form of Guizhi Fuling Wan generally varies according to different manufacturers' product instructions. A common dosage is one sachet per dose, twice daily. However, the specific dosage should still be individually adjusted by a physician according to the patient's specific circumstances.

- Method of Administration

Taken by dissolving in boiled water. Pour the granules into a cup, add an appropriate amount of boiled water, stir evenly, and take. Compared with the traditional pill form, modern concentrated granules are easier to dissolve and absorb, with a relatively better taste, more suited to the fast pace of modern life.

IX. Precautions and Contraindications

1. Contraindicated in Pregnancy

Guizhi Fuling Wan has an action of activating blood and resolving stasis; if taken by a pregnant woman, it may lead to adverse outcomes such as fetal restlessness and miscarriage. During pregnancy, a woman's physiological state is special, with qi-blood movement relatively slowed, prioritising the nourishment of the fetus. Blood-activating, stasis-resolving herbs may disrupt this physiological balance, affecting the fetus's normal development. Pregnant women should therefore strictly avoid using Guizhi Fuling Wan.

2. Use with Caution During Menstruation

During menstruation, a woman's qi and blood are in a state of outward discharge, and the body is relatively weak. The blood-activating, stasis-resolving action of Guizhi Fuling Wan may lead to conditions such as excessive menstrual flow and prolonged menstrual period. For women with normal menstrual flow, or scanty flow with symptoms of blood-stasis obstruction, Guizhi Fuling Wan may be appropriately taken for conditioning outside the menstrual period, under a physician's guidance, according to specific circumstances. However, during menstruation, particularly for women with heavy menstrual flow, it should be used with caution or discontinued.

3. Use with Caution in Those with a Weak Constitution

Those with a weak constitution, such as populations with qi-blood insufficiency or spleen-stomach weakness, have relatively weak righteous qi. The blood-activating, stasis-resolving action of Guizhi Fuling Wan may, to a certain degree, deplete righteous qi. Such populations should consult a physician's opinion before using Guizhi Fuling Wan. If use is genuinely necessary, qi-tonifying, blood-nourishing or spleen-strengthening, stomach-benefiting herbs may be appropriately added to the formula, to strengthen the constitution and reduce damage to righteous qi from the medication.

4. Dietary Precautions

While taking Guizhi Fuling Wan, raw, cold, greasy, and spicy irritating foods should be avoided. Raw and cold foods, such as ice cream and cold drinks, may damage spleen-stomach yang qi, affecting spleen-stomach transportation and transformation function, thereby being unfavourable for the absorption and efficacy of the herbs. Greasy foods, such as fried foods and fatty meat, are difficult to digest and increase the burden on the spleen and stomach. Spicy foods, such as chili peppers and Sichuan peppercorns, readily stir fire and generate heat, potentially conflicting with the properties of Guizhi Fuling Wan, leading to disordered qi-blood movement within the body.

X. Modern Research

1. Pharmacological Research

Blood-Activating, Stasis-Resolving Action

Guizhi Fuling Tang and Guizhi Fuling Wan are widely applied clinical formulas for activating blood and resolving stasis, mainly treating gynaecological disorders such as dysmenorrhoea, uterine fibroids, ovarian cysts, and adnexitis, and are suited to conditions attributable to blood stasis such as chronic prostatitis, varicose veins, acne, thrombosis, melasma, renal insufficiency, diabetic nephropathy, ovarian cancer, thyroid cysts, bronchial asthma, and fetal calming, having the actions of dilating blood vessels and activating blood to resolve stasis.

Modern research shows that Guizhi Fuling Wan has a marked action of activating blood and resolving stasis. Its herbal constituents such as Guizhi, Taoren, and Mudanpi can improve blood rheology indicators, lower blood viscosity, increase red blood cell deformability, and promote blood circulation. By improving microcirculation, blood supply to areas of blood stasis is improved, thereby helping to disperse blood stasis. For example, in some animal experiments, after administering Guizhi Fuling Wan, animals showed widened vascular diameter, increased blood flow speed, and markedly increased blood flow in areas of stasis.

Endocrine-Regulating Action

Guizhi Fuling Wan has a certain regulatory effect on the female endocrine system. It can regulate hormone levels within the female body, improving symptoms such as irregular menstruation caused by endocrine disorders. Research has found that Guizhi Fuling Wan can regulate the function of the hypothalamic-pituitary-ovarian axis, bringing hormone levels such as oestrogen and progesterone toward balance. For certain gynaecological disorders caused by hormonal imbalance, such as polycystic ovary syndrome, Guizhi Fuling Wan may, by regulating the endocrine system, improve symptoms and enhance patients' fertility.

Anti-Inflammatory Action

This formula also has a certain anti-inflammatory action. It can reduce inflammatory response, providing adjunctive therapeutic benefit for certain inflammatory diseases. In inflammation model experiments, Guizhi Fuling Wan was found to inhibit the release of inflammatory mediators, reduce exudation and oedema at the inflammatory site, and reduce tissue damage. For example, in research on the treatment of chronic pelvic inflammatory disease, Guizhi Fuling Wan can, through its anti-inflammatory action, improve the inflammatory state of pelvic tissue, relieving symptoms such as pain and bearing-down distension.

2. Clinical Research Findings

Applications in Treating Gynaecological Disorders

Clinical research has confirmed the effectiveness of Guizhi Fuling Wan in treating gynaecological disorders. For conditions such as irregular menstruation, dysmenorrhoea, amenorrhoea, and unresolved postpartum lochia, its overall effective rate is relatively high. For example, in a clinical study targeting scanty menstrual flow, patients were divided into a treatment group and a control group; the treatment group took Guizhi Fuling Wan, while the control group received other conventional treatment methods. The results showed that the treatment group's menstrual flow noticeably increased, and the menstrual cycle returned to normal, with therapeutic effect significantly better than the control group. In terms of treating dysmenorrhoea, multiple studies have shown that Guizhi Fuling Wan can effectively relieve dysmenorrhoea symptoms, improving patients' quality of life.

Exploration in Treating Other Conditions

Besides gynaecological disorders, there are also related research reports on Guizhi Fuling Wan in treating certain other conditions. For example, in the treatment of benign prostatic hyperplasia, some clinical observations have found that after taking Guizhi Fuling Wan, patients' symptoms of difficulty urinating improved, and prostate volume decreased to a certain degree. In the treatment of chronic pelvic inflammatory disease, combining Guizhi Fuling Wan with antibiotics and other medications can improve treatment outcomes, shorten the course of illness, and reduce recurrence rate. These research findings provide a basis for the further clinical application of Guizhi Fuling Wan, and have also broadened its scope of application in the field of modern medicine.