Si Miao San
Classical TCM Formula Profile
Part of the HJMEDICAL TCM Discovery Center
四妙散 · Sì Miào Sàn
A classical formula for damp-heat bi of the lower limbs — red swollen joints, beriberi-like heaviness.
Read the complete guide →Quick Facts
- Formula Category
- Dampness-Draining Formulas
- Primary Pattern
- Damp-Heat
- Primary Function
- Clear heat, dry damp, ease bi pain in the lower body
- Primary Therapeutic Principle
- Clear damp-heat from the lower jiao and ease bi pain
- Classical Source
- Classical TCM formulary
- Available as Granules
- Yes
Formula Overview
A classical formula for damp-heat bi of the lower limbs — red swollen joints, beriberi-like heaviness.
Therapeutic Principle
Traditionally selected for lower-limb damp-heat bi with redness and swelling, when a compact clearing-drying approach is preferred.
Composition: Sovereign, Minister, Assistant, Envoy
Every herb in the formula, grouped by the job it does in the classical hierarchy.
君SovereignTreats the main pattern
臣MinisterReinforces the sovereign
佐/使Assistant & EnvoyTreats accompanying patterns, harmonises the whole
Classical Composition
- Cortex Phellodendri (Huang Bai) 9g
- Semen Coicis (Yi Yi Ren) 15g
- Rhizoma Atractylodis (Cang Zhu) 9g
- Radix Achyranthis Bidentatae (Niu Xi) 9g
Dosages follow the classical source and are shown for study, not as a prescription.
Related Conditions
Related Health Topics
Actions
- Clears heat
- dries dampness
- and treats damp-heat pouring downward into the sinews.
Indications
- This formula is indicated for damp-heat pouring into the lower limbs.
- Signs and symptoms include red, swollen, painful knees or feet and a greasy yellow coating.
Tongue & pulseThe pulse is slippery and rapid.
Traditional Pathogenesis
Cause & mechanism
- This pattern is caused by damp-heat brewing in the middle or lower jiao, or streaming into the channels.
Clinical presentation
- Heat and dampness together produce a heavy, burning or greasy presentation with yellow coating and a slippery rapid pulse.
- Damp-heat pouring into the lower limbs produces red, swollen, painful knees or feet and a greasy yellow coating.
Treatment strategy
- The correct method is to clear heat, drain dampness, and resolve the brewing pathogen.
- In this formula the emphasis is to clear damp-heat from the lower jiao and ease bi pain.
How does this formula compare?
Clinical Perspective
Si Miao San, Dang Gui Nian Tong Tang, Long Dan Xie Gan Tang and Wu Ling San address lower-body damp-heat or water. Dang Gui Nian Tong Tang clears damp-heat bi with more wind-dispelling; Long Dan Xie Gan clears Liver damp-heat; Wu Ling San drains water. Si Miao San is a focused four-herb formula for lower-body damp-heat bi — red swollen joints and heaviness.
Clinical Differentiation
- Si Miao San is used for damp-heat pouring into the lower limbs with red, swollen, painful knees or feet.
- It is San Miao San plus Yi Yi Ren.
- It is distinguished from Er Miao San (simpler lower-jiao damp-heat) and from Dang Gui Nian Tong Tang (damp-heat bi with more wind and blood moving).
Safety notes: This formula is bitter and drying. It is not appropriate for liver-kidney yin deficiency bi without damp-heat.
For educational reference only, based on traditional pattern differentiation — not a substitute for professional advice.
Frequently Asked Questions
What are the actions of Si Miao San?
Si Miao San has the actions of clearing Heat, drying Dampness, and unblocking the Lower Jiao. It is Er Miao San plus Niu Xi and Yi Yi Ren, used when Damp-Heat has settled in the legs, sinews, or lower orifices.
Which modern diseases is Si Miao San suited to?
Modern TCM clinical practice commonly applies it to individuals whose pattern differentiation falls within Lower Jiao Damp-Heat, including hot swollen painful knees or feet of Damp-Heat Bi type, some gout or hyperuricemia presentations of this pattern, yellow foul leukorrhea, and Damp-Heat lin or heavy aching lower limbs after medical causes have been assessed.
Is Si Miao San suitable for improving hot, heavy, aching lower limbs?
For presentations of heavy, aching, or swollen lower legs and knees that feel Hot, yellow greasy coating, dark or foul urine or discharge, and a slippery rapid pulse — in those whose pattern differentiation confirms Damp-Heat in the Lower Jiao — TCM commonly applies Si Miao San as an adjunct. It cannot replace evaluation of infection, gout crisis, or vascular disease.
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Si Miao San: Classic TCM Formula for Damp-Heat in the Lower Burner, Leg Pain & Beriberi
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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.