Blood-Invigorating Formulas

失笑散 · Shī Xiào Sàn

Shi Xiao San

A classical focused pair for stabbing pain from blood stasis in the chest or lower abdomen.

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Last reviewed August 2026

Formula CategoryBlood-Invigorating Formulas

Primary PatternBlood Stasis

Primary FunctionInvigorate blood, transform stasis, stop pain

Primary Therapeutic PrincipleMove blood stasis and relieve stabbing pain

Main HerbsCattail Pollen · Flying Squirrel Feces

Classical SourceClassical TCM formulary

Why This Formula?

Traditionally selected for stabbing fixed pain from blood stasis in the chest or lower abdomen, when a simple, focused blood-invigorating pair is preferred over broader Qi-moving or warming formulas.

Overview

What Is Shi Xiao San?

1. Background of Origins

Shi Xiao San (失笑散), or Sudden Smile Powder, is a classical Song-dynasty formula from the Tai Ping Hui Min He Ji Ju Fang (Imperial Grace Formulary of the Tai Ping Era). It belongs to the category of formulas that invigorate Blood and transform Blood stasis.

This simple two-herb formula addresses severe pain caused by Blood stasis obstructing the vessels. The name “Sudden Smile” reflects the dramatic relief it can bring—when intense fixed pain that prevents even a smile is resolved, the patient suddenly smiles again. Typical signs include stabbing or fixed pain in the chest or abdomen that is worse with pressure and at night, postpartum abdominal pain with retained lochia, dysmenorrhea with dark clotted blood, a purple tongue possibly with stasis spots, and a choppy or wiry pulse.

Combining Wu Ling Zhi to powerfully break up Blood stasis and stop pain with Pu Huang to invigorate Blood while also stopping bleeding, Shi Xiao San effectively disperses stagnant Blood, unblocks the vessels, and relieves severe stasis-type pain.

2. Gynecological Diseases

In the field of gynecology, Shi Xiao San is frequently used to address various conditions caused by blood stasis.

Postpartum Care: It is helpful for the retention or incomplete clearing of postpartum lochia (normal postnatal discharge). For women experiencing sharp lower abdominal pain that is sensitive to pressure, the formula works to invigorate the blood, encourage the discharge, and ease the pain.
Menstrual Pain (Dysmenorrhea): It is commonly used for painful periods characterized by a poor flow and sharp, stabbing cramps in the lower abdomen caused by blocked circulation.
Irregular Cycles: For missed periods (amenorrhea) or irregular menstruation rooted in blood stagnation, the formula helps restore natural flow by regulating the body's energy and improving blood circulation.

3. Digestive System Diseases

For the digestive system, Shi Xiao San is applied to treat stomach and abdominal discomfort rooted in stagnant blood.

Stabbing Stomach Pain: It is particularly useful for sharp, fixed stomach pain that worsens when pressed. The herbs help clear the blockage in the body's pathways to stop the pain.
Abdominal and Flank Pain: The formula can also be adjusted by practitioners to treat general abdominal or side (flank) pain caused by internal blood blockages.
Supporting Digestion: By clearing out the stagnant blood, it improves local blood circulation and supports the natural recovery of healthy digestive functions.

4. Cardiovascular System Diseases

In cardiovascular care, Shi Xiao San is utilized to address chest discomfort and pain linked to poor circulation.

Chest Oppression and Pain: It is used for "chest bi" (a traditional term for a heavy, tight chest or sharp, angina-like pain), which is viewed as blood stasis blocking the heart's vital vessels.
Unblocking Vessels: The formula helps to forcefully move the blood and unblock these pathways, alleviating the sharp pain.
Palpitations and Tightness: When symptoms like palpitations or a tight chest are driven by internal blockages, this formula can help improve local circulation and support overall heart function based on traditional pattern diagnosis.

How It Works

Herb Composition (Sovereign / Minister / Assistant / Envoy)

The formula Shi Xiao San consists of a simple yet powerful two-herb combination. Here is a breakdown of their specific roles within the formula:

1. Chief Herb: Pu Huang

Pu Huang (Cattail Pollen) serves as the primary, or "chief," ingredient in this formula, driving its main therapeutic actions.

Properties and Pathways: It is sweet, neutral, and has a slippery nature, primarily entering the Liver and Pericardium meridians.
Core Actions: It excels at invigorating blood, resolving stasis, and stopping bleeding.
Role in the Formula: Pu Huang is incredibly light in its physical nature, which allows it to move and disperse quickly throughout the body. It rapidly breaks up blood stasis, which is the TCM root cause of many sharp, localized pains (following the principle of "if there is free flow, there is no pain").
Unique Bleeding Control: Interestingly, while it strongly moves blood, it also helps stop bleeding. By clearing out the "old" stagnant blood, it allows "new" blood to flow properly, preventing the continuous bleeding that happens when blood is forced out of its normal pathways by blockages.

2. Deputy Herb: Wu Ling Zhi

Wu Ling Zhi (Trogopterus Feces) acts as the "deputy," strongly supporting and enhancing the actions of the chief herb.

Properties and Pathways: It is sweet, salty, and warm, and it primarily enters the Liver meridian.
Core Actions: It is highly effective at invigorating blood, stopping pain, and resolving stasis.
Role in the Formula: Wu Ling Zhi works in perfect synergy with Pu Huang. It is particularly famous for unblocking blood vessels and relieving stasis-related pain, such as chest pain, abdominal pain, and painful menstruation (dysmenorrhea). Together, these two herbs form a highly focused team that targets blood stagnation from multiple angles.

3. Assistant and Envoy Herbs

While the base formula of Shi Xiao San only contains the two herbs mentioned above (without distinct, separate assistant or envoy herbs), they naturally support each other to complete the formula's core mission. However, practitioners often add other herbs to serve these supportive roles based on a patient's specific needs:

For Qi Stagnation: If a patient also has blocked energy (qi) making the pain worse, herbs that regulate qi—such as Xiang Fu (Cyperus Rhizome) and Qing Pi (Green Tangerine Peel)—can be added to boost the blood-moving effects.
For Cold Pathogens: If the stasis is accompanied by internal cold (which slows down blood flow), warming herbs like Xiao Hui Xiang (Fennel Seed) or Pao Jiang (Roasted Ginger) are added. These act as envoys to warm the meridians and help the main herbs restore healthy circulation.

Symptoms Traditionally Associated

Clinical Presentation in TCM

1. Understanding the Pathomechanism

The primary issue that Shi Xiao San addresses is blood stasis (the accumulation of stagnant blood). Here is how it develops and affects the body:

Causes of Stagnation: Blood flow can slow down or become completely blocked due to a variety of factors, including emotional stress (which causes energy to stagnate), physical trauma, or internal cold freezing the circulation.
The "No Free Flow" Principle: In Traditional Chinese Medicine, there is a core saying: "If there is no free flow, there is pain." When stagnant blood blocks the body's pathways, it creates sharp, localized pain that usually feels worse when pressed.
Additional Complications: Beyond pain, this poor circulation can cause localized masses or lumps to form. Paradoxically, it can also lead to abnormal bleeding, as fresh blood is forced out of its natural pathways because the old blood is blocking the way.

2. Therapeutic Actions

The main goal of Shi Xiao San is to invigorate blood circulation, resolve stasis, and stop pain.

Both herbs in this formula are powerful blood-movers. By working together, they forcefully break up and clear away accumulated stasis.
Once the blockages are cleared, normal blood flow is restored. This naturally eliminates the sharp pain and allows the body's organs and tissues to function properly again.

3. Clinical Indications

Shi Xiao San is indicated for a variety of conditions where blood stasis is the root cause. Common clinical applications include:

Severe Chest and Abdominal Pain: It is highly effective for sharp, stabbing pain in the chest or abdomen that stays fixed in one specific location.
Postpartum Care: It is commonly used for the retention of postpartum lochia (when normal postnatal discharge is abnormally light or blocked), which is often accompanied by severe lower abdominal pain that is sensitive to the touch.
Menstrual Issues: The formula is widely used to treat acute lower abdominal pain during menstruation (dysmenorrhea) or missed periods (amenorrhea) caused by cold and blood stagnation in the lower body.
Broader Uses: As long as a practitioner identifies the underlying issue as blood stasis, this formula can also be applied to conditions like chronic stomach pain or specific types of chest tightness and heart pain.

Formula Analysis

The Mechanism in Classical Theory

1. Formulation Characteristics

The design of Shi Xiao San is known for being incredibly simple yet highly focused and powerful.

Simple but Precise: The formula consists of only two herbs: Pu Huang and Wu Ling Zhi. While it seems basic, it is actually a highly refined pairing.
Direct Action: Pu Huang excels at invigorating blood and moving stasis, while Wu Ling Zhi is a powerful agent for resolving stasis and stopping pain. Together, they create a synergistic effect that tackles blood blockages head-on.
Targeted Efficiency: Unlike formulas with a long list of ingredients, this straightforward combination directs its full power straight to the location of the stagnant blood, making it exceptionally effective at quickly clearing blockages and relieving pain.

2. Synergistic Effects

The two herbs in Shi Xiao San work perfectly as a team to enhance the overall therapeutic outcome:

Clearing the Blockage: Pu Huang specializes in getting the blood moving again. It helps break up and disperse the stagnant blood.
Relieving the Pain: Wu Ling Zhi shines at relieving the severe discomfort caused by the blockage.
Treating Root and Symptom: By combining these forces, the formula works faster to clear the physical stasis (the root cause) while simultaneously easing the patient's pain (the branch symptom). This comprehensive approach ensures a highly effective treatment.

3. Targeted Pathomechanism

Shi Xiao San is built entirely around addressing one specific core issue: blood stasis.

Focused Herb Selection: The choice of both Pu Huang and Wu Ling Zhi is based purely on their strong ability to invigorate blood and resolve stagnation. They directly target the pathological product (the stagnant blood itself).
Restoring Natural Flow: By clearing away these blockages from the body's channels and organs, the formula restores the healthy, free-flowing circulation of both vital energy (qi) and blood.
Precision Medicine: This highly targeted approach is a perfect example of traditional pattern differentiation, ensuring the herbs act exactly where the disease process is happening for maximum benefit.

How This Formula Compares

Clinical Comparison Table

Compare	Shi Xiao San	Jin Ling Zi San	Shao Fu Zhu Yu Tang	Xue Fu Zhu Yu Tang
Primary Function	Invigorate blood, transform stasis, stop pain	Spread Liver Qi, invigorate blood, stop pain	Invigorate Blood in lower abdomen, warm menses, stop pain	Invigorate Blood, dispel stasis, move Qi
Formula Category	Blood-Invigorating Formulas	Qi-Regulating Formulas	Blood-Invigorating Formulas	Blood-Invigorating Formulas
Typical TCM Pattern	Blood Stasis	Qi Stagnation	Blood Stasis	Blood Stasis
Main Conditions	Abdominal Pain, Dysmenorrhea	Abdominal Pain, Hypochondriac Distension	Dysmenorrhea, Abdominal Pain, Irregular Menstruation, Cold Limbs	Chest Tightness, Headache, Hypochondriac Distension, Emotional Depression, Anxiety Restlessness
Main Herbs	Cattail Pollen · Flying Squirrel Feces	Toosendan Fruit · Corydalis Rhizome	Fennel Fruit · Dried Ginger · Corydalis Rhizome · Chinese Angelica Root · Chuanxiong Rhizome · Myrrh · Cattail Pollen · Flying Squirrel Feces · Red Peony Root · Cinnamon Bark	Peach Kernel · Safflower · Chinese Angelica Root · Raw Rehmannia Root · Chuanxiong Rhizome · Red Peony Root · Achyranthes Root · Bupleurum Root · Platycodon Root · Bitter Orange · Licorice Root
Classical Source	Classical TCM formulary	Classical TCM formulary	Yi Lin Gai Cuo (Wang Qingren, Qing dynasty)	Yi Lin Gai Cuo (Corrections of Errors in Medical Classics, Wang Qingren, Qing dynasty)

How to tell them apart

Shi Xiao San, Jin Ling Zi San, Shao Fu Zhu Yu Tang and Xue Fu Zhu Yu Tang all address pain from stasis. Jin Ling Zi San spreads Liver Qi with mild blood-moving for constrained pain; Shao Fu Zhu Yu Tang warms and moves lower-abdominal stasis; Xue Fu Zhu Yu Tang moves blood in the chest. Shi Xiao San is a focused two-herb pair for stabbing pain from blood stasis.

For educational reference only, based on traditional pattern differentiation — not a substitute for professional advice.

Clinical Modifications

Clinical Modifications for Shi Xiao San

Practitioners often adjust the base formula of Shi Xiao San by adding specific herbs to address a patient's unique underlying patterns.

1. Qi Stagnation and Blood Stasis

When blood stasis is accompanied by stagnant energy (qi), patients often experience bloating in the chest or sides and tend to sigh frequently.

Common Additions: Herbs that move energy, such as Xiang Fu (Cyperus Rhizome) and Qing Pi (Green Tangerine Peel), are added to the mix.
How it Works: Xiang Fu helps soothe the liver and regulate energy to relieve pain, while Qing Pi powerfully breaks through stagnation. Together with the base formula, they ensure that the active movement of "qi" helps push and break up the stagnant blood more effectively, easing both pain and a feeling of fullness.

2. Cold Coagulation and Blood Stasis

For patients where internal cold has essentially "frozen" the blood flow, symptoms usually include sharp, cold pain in the lower abdomen that feels significantly better when warmth is applied.

Common Additions: Warming herbs like Xiao Hui Xiang (Fennel Seed) and Pao Jiang (Prepared Ginger) are introduced.
How it Works: Xiao Hui Xiang disperses cold and stops pain, while Pao Jiang warms the body's channels. Combined with the blood-moving properties of the main formula, this customized blend warms the vessels to melt away cold stagnation, making it especially effective for lower abdominal pain.

3. Blood Stasis with Phlegm-Dampness

Sometimes, stagnant blood mixes with excess fluids (phlegm and dampness). This can lead to a stuffy feeling in the chest or stomach, nausea, vomiting, and a heavy feeling in the limbs.

Common Additions: Herbs that dry dampness and resolve phlegm, such as Ban Xia (Pinellia), Chen Pi (Tangerine Peel), and Fu Ling (Poria), are added.
How it Works: Ban Xia dries dampness and stops nausea, Chen Pi regulates digestion and clears phlegm, and Fu Ling helps drain excess fluids. This combination allows the body to clear out both the stagnant blood and the thick, sluggish fluids at the same time, relieving the complex mix of symptoms.

Modern Research

What the Science Suggests

1. Pharmacological Research

Modern pharmacological studies show that the traditional formula Shi Xiao San has a variety of beneficial effects. Both Pu Huang and Wu Ling Zhi have properties that help invigorate the blood and resolve stasis.

Improving Circulation: They can improve blood flow markers, reduce blood thickness, and make red blood cells more flexible, which promotes better overall circulation.
Preventing Clots: These herbs also help stop platelets from clumping together, reducing the risk of blood clots. This makes the formula meaningful for preventing and managing cardiovascular issues.
Relieving Pain: Additionally, Shi Xiao San has anti-inflammatory and pain-relieving properties. This perfectly aligns with its traditional use for treating pain and inflammation caused by blocked blood flow.

2. Expanding Clinical Applications

As modern medicine evolves, the clinical uses for Shi Xiao San have expanded well beyond its traditional roots. Modern research has found it helpful as a supportive therapy for several complex conditions:

Women's Health: For conditions like chronic pelvic inflammatory disease, uterine fibroids, and breast hyperplasia, the formula's ability to move blood and resolve stasis helps improve local blood circulation and regulate hormones. This can ease uncomfortable symptoms and significantly improve the patient's quality of life.
Cardiovascular Health: Shi Xiao San also offers supportive care for cardiovascular issues like coronary heart disease and angina. It can help improve blood flow to the heart muscle, relieving symptoms of chest pain and tightness.

3. Innovations in Dosage Forms

To maximize the benefits of Shi Xiao San and make it more practical for modern lifestyles, researchers have been innovating how the formula is prepared and taken.

Convenient Formats: Alongside concentrated herbal granules, the formula is now being developed into capsules and tablets. These modern formats are much more convenient to take, offer precise dosing, and remain stable longer, making them ideal for patients who need long-term care.
Targeted Delivery: Researchers are also exploring new ways to administer the formula, such as through suppositories and skin patches. By delivering the herbal medicine rectally or directly through the skin, the active ingredients can reach the affected area more directly. This targeted approach aims to boost effectiveness while minimizing the chance of gastrointestinal side effects.

Safety

Safety Considerations

1. Pregnancy and Deficiency of Qi and Blood

Shi Xiao San should be used cautiously during pregnancy because its blood-invigorating and stasis-dispersing effects may cause fetal restlessness or even miscarriage. Pregnant patients should use it only under medical supervision after carefully weighing the benefits and risks.

Patients with qi and blood deficiency should not take it alone, as its strong blood-moving action may further weaken the body. If treatment is necessary, it should be combined with qi- and blood-nourishing herbs under professional guidance.

2. Processing and Compatibility Precautions

The processing of Pu Huang and Wu Ling Zhi should be selected according to the condition: raw Pu Huang has a stronger blood-invigorating effect, while roasted Pu Huang is more hemostatic.

Wu Ling Zhi should not be combined with Ren Shen (ginseng), and other potential compatibility conflicts should also be considered. Use the formula according to standard traditional medicine principles to ensure safe and effective treatment.

Available Products

Where to Get It

HJMEDICAL Hoi Tin Shi Xiao San (Traditional Blood-Moving Formula) 5:1 Concentrated Granules $27.71

HJMEDICAL Nong's Shi Xiao San (Sudden Smile Powder) 5:1 Concentrated Granules $52.32

HJMEDICAL Nong's Jin Ling Zi San (Melia Toosendan Powder) 5:1 Concentrated Granules $37.34

HJMEDICAL Hoi Tin Shao Fu Zhu Yu Tang (Cold-Type Abdominal Pain) 5:1 Concentrated Granules $27.71

Nong's Shao Fu Zhu Yu Tang Extract Granules | Traditional Herbal Balance Series HJMEDICAL

HJMEDICAL Nong's Shao Fu Zhu Yu Tang (Fennel Seed & Corydalis Combination) 5:1 Concentrated Granules $44.83

FAQ

Questions About Shi Xiao San

Q1: What are the actions of Shi Xiao San?

Shi Xiao San has the actions of invigorating Blood, dispelling Blood stasis, and stopping pain. It is a simple yet potent formula for fixed, stabbing pain caused by Blood stasis, and its name “Sudden Smile” reflects the rapid relief of pain that often follows its use.

Q2: Which modern diseases is Shi Xiao San suited to?

Modern TCM clinical practice commonly applies it to individuals whose pattern differentiation falls within Blood stasis, including dysmenorrhea with dark clots, endometriosis or adenomyosis pain of stasis type, postpartum abdominal pain from retained lochia, irregular menstruation with clotting, and certain cases of chest or epigastric stabbing pain due to Blood stasis.

Q3: Is Shi Xiao San suitable for improving fixed stabbing pain in the lower abdomen or chest?

For presentations of fixed, stabbing pain in the lower abdomen or chest, dysmenorrhea with dark menstrual blood and clots, postpartum pain with retained lochia, a dark or purplish tongue possibly with stasis spots, and a choppy or wiry pulse — in those whose pattern differentiation confirms Blood stasis — TCM commonly applies Shi Xiao San as an adjunct. It cannot replace standard medical evaluation of pain or abnormal bleeding.

Q4: Who should not take Shi Xiao San?

Pregnant women, those with heavy bleeding without stasis signs (such as Qi-deficiency bleeding), and those with pure Blood deficiency without stasis are generally not suitable. The formula strongly moves Blood and can stimulate the uterus. It is traditionally incompatible with Ren Shen (ginseng). Use should be assessed by a qualified TCM physician.

Q5: Why is this simple two-herb powder so effective for Blood-stasis pain?

Wu Ling Zhi and Pu Huang both invigorate Blood and stop pain, yet they complement each other: Wu Ling Zhi is particularly strong at dispersing stasis and relieving pain, while Pu Huang invigorates Blood while also having a mild astringent quality that helps regulate bleeding. Taken together (often with vinegar or wine to enhance the Blood-moving effect), they rapidly disperse stagnant Blood and alleviate the resulting fixed pain.

Q6: Can Shi Xiao San be used for both menstrual pain and postpartum abdominal pain?

Yes. Both conditions frequently involve Blood stasis in the uterus or lower abdomen. When the pain is fixed and stabbing and the blood is dark with clots (or lochia is retained), the formula’s Blood-invigorating and stasis-dispelling action addresses the common underlying pattern.

Q7: What are the main ingredients of Shi Xiao San?

The classical formula consists of equal parts of Wu Ling Zhi (flying squirrel feces) to invigorate Blood, dispel stasis, and stop pain, and Pu Huang (cattail pollen) to invigorate Blood and stop bleeding. It is traditionally prepared as a powder and taken with vinegar or yellow wine to enhance the Blood-moving effect.

Q8: Is Shi Xiao San suitable for long-term use?

No. It is intended for short-course use to resolve acute or episodic Blood-stasis pain. Once the pain and stasis signs improve, the formula should be stopped or modified. Continuous Blood-invigorating treatment is not appropriate without professional supervision.

Q9: How does Shi Xiao San differ from stronger Blood-breaking formulas?

Stronger formulas containing San Leng, E Zhu, or large doses of Tao Ren and Hong Hua more aggressively break up solid masses and severe chronic stasis. Shi Xiao San is milder and more focused on relieving pain from Blood stasis; it is especially suitable for menstrual, postpartum, or fixed stabbing pain where rapid symptomatic relief of stasis pain is needed without heavy attacking.

Q10: What lifestyle advice supports the use of Shi Xiao San?

Keeping the lower abdomen warm, avoiding cold foods and exposure during menstruation, gentle movement to promote circulation, and managing emotional stress that constrains Qi and Blood help the formula disperse stasis. Severe or persistent pain, abnormal bleeding, or postpartum complications require proper medical evaluation.

FAQ

General Questions

How do I choose the right formula?

TCM formulas are traditionally selected according to individual pattern differentiation rather than by symptom alone. If you're not sure which formula fits your presentation, take our AI Assessment below for a personalized starting point, then confirm with a qualified TCM practitioner.

What are concentrated herbal granules?

Concentrated herbal granules are made by decocting raw herbs, then extracting and concentrating the resulting liquid into a fine granule or powder form. This preserves the same active compounds as a traditional decoction while making the herbs far easier to store, measure, and prepare.

How should I take these products?

Dissolve the recommended amount of granules in hot water, stir until fully dissolved, and drink while warm — following the dosage and frequency advised by your TCM practitioner or as stated on the product packaging.

Are concentrated herbal granules equivalent to traditional decoctions?

Concentrated granules are produced from the same herbs and processed to retain their active compounds, so they are traditionally regarded as a convenient alternative to decoctions rather than a different remedy. Some practitioners note subtle differences in strength or absorption between the two forms, so your TCM practitioner may adjust dosage accordingly.

Are your products authentic?

Yes. HJMEDICAL sources its concentrated granules exclusively from established, reputable manufacturers such as Nong's and Hoi Tin, both long-standing names in the TCM granules industry, with GMP compliance stated directly on their packaging.

Are HJMEDICAL products manufactured under GMP standards?

HJMEDICAL sources its concentrated granules from established, reputable manufacturers such as Nong's and Hoi Tin, both long-standing names in the TCM granules industry. GMP compliance for these products is stated directly on their packaging.

Do you ship internationally?

Yes — we ship worldwide! Every order goes out via Hong Kong Post, and your exact shipping cost and estimated delivery time for your address are calculated and shown right at checkout, so there are never any surprises. We also offer free shipping once your order reaches our free-shipping threshold, so it's easy to stock up on your favorite formulas and save.

Can I take more than one formula at the same time?

Some formulas are traditionally combined, while others overlap or counteract each other. We recommend checking with a qualified TCM practitioner before combining formulas, especially if you are already taking other medication.

Are these products suitable during pregnancy or breastfeeding?

Some TCM formulas are not suitable during pregnancy or breastfeeding. Please consult a qualified TCM practitioner or your doctor before use if you are pregnant, trying to conceive, or nursing.

Do these products replace medical treatment?

No. These products are traditional herbal supplements intended to support wellbeing according to TCM principles — they are not a replacement for professional medical diagnosis or treatment. Please consult a qualified TCM practitioner or licensed healthcare provider before starting, stopping, or combining any treatment, especially if you have a chronic condition.

Medical Disclaimer

For general TCM education only — not medical advice. Consult a qualified TCM practitioner or licensed healthcare provider before use, especially if pregnant, nursing, on medication, or managing a chronic condition.

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