Si Shen Wan
Classical TCM Formula Profile
Part of the HJMEDICAL TCM Discovery Center
四神丸 · Sì Shén Wán
A classical formula for daybreak (cock-crow) diarrhoea associated with Spleen and Kidney Yang deficiency, with early-morning loose stools, cold limbs, lumbar weakness and a deep slow pulse.
Read the complete guide →Quick Facts
- Formula Category
- Astringent Formulas
- Primary Pattern
- Yang Deficiency
- Primary Function
- Warm Spleen-Kidney Yang, astringe intestines, stop diarrhea
- Primary Therapeutic Principle
- Warm and tonify Spleen and Kidney Yang, astringe the Intestines and stop diarrhea
- Classical Source
- Zheng Zhi Zhun Sheng or traditional (Ming dynasty sources)
- Available as Granules
- Yes
Formula Overview
A classical formula for daybreak (cock-crow) diarrhoea associated with Spleen and Kidney Yang deficiency, with early-morning loose stools, cold limbs, lumbar weakness and a deep slow pulse.
Therapeutic Principle
Traditionally selected for daybreak diarrhoea from Spleen-Kidney Yang deficiency, combining warming with intestinal astringency — unlike Li Zhong Tang and Fu Zi Li Zhong Tang, which warm the Middle without securing the bowels, and distinct from Zhen Wu Tang's focus on water flooding.
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
吳茱萸Wu Zhu Yu5g
Evodia Fruit- warms the center and dissipates cold
五味子Wu Wei Zi5g
Schisandra Fruit- consolidates the kidney and astringes the intestines
Classical Composition
- Myristicae Semen (Rou Dou Kou) 2 liang (60g)
- Psoraleae Fructus (Bu Gu Zhi) 4 liang (120g)
- Schisandrae Chinensis Fructus (Wu Wei Zi) 2 liang (60g)
- Euodiae Fructus (Wu Zhu Yu dry-fried) 1 liang (30g)
- Zingiberis Rhizoma Recens (Sheng Jiang) 4 liang (120g)
- Jujubae Fructus (Da Zao) 50 pieces
Dosages follow the classical source and are shown for study, not as a prescription.
Related Conditions
Related Health Topics
Actions
- Warms the spleen and kidney
- consolidates the intestines and arrests diarrhea.
Indications
- Si Shen Wan is used to treat kidney diarrhea due to yang deficiency of the spleen and kidney.
- Chief symptoms include fifth-watch (diarrhea at dawn) diarrhea, reluctance to eat or drink, poor digestion and absorption, chronic unremitting diarrhea, abdominal pain, lumbar pain, cold limbs, mental fatigue, and lack of strength.
Tongue & pulseUsually, the tongue is pale with a white and thin coating. The pulse is deep, slow and weak.
Traditional Pathogenesis
Cause & mechanism
- This pattern is caused by ming men fire insufficiency.
- Insufficient ming men fire fails to supply the earth (spleen) with the warmth required for its transformative process.
- Kidney diarrhea, also named “fifth-watch diarrhea”, is a result.
- The fifth watch is the time of the day (before dawn) when yin qi is at its peak and the yang is beginning to rise.
- Because of kidney yang deficiency, the body’s yang qi fails to arrive.
- Yin qi is not counterbalanced and becomes pathologically overabundant.
- Ming men fire fails to warm the spleen (earth) and the spleen cannot carry out its normal transformative function.
- As a result, water and grains sink downward instead of being transformed into essence.
- This same principle can be applied to the pathomechanism of chronic diarrhea.
- As the spleen is damaged, the patient begins to display a lack of interest in food and an inability to digest what is eaten.
- Yang deficiency of the spleen and kidney in this pattern can be understood in two ways.
- First off, yin cold will congeal and cause abdominal pain, sore low back, and cold limbs.
- Second, deficient yang fails to form the essence that nourishes the spirit causing mental fatigue and lack of strength to develop.
Treatment strategy
- The therapeutic principles are to warm and supplement the spleen and to consolidate the intestines to stop diarrhea.
How does this formula compare?
Clinical Perspective
Si Shen Wan is specific for Yang-deficiency daybreak diarrhea. Li Zhong Tang and Fu Zi Li Zhong Tang warm the Middle without strong astringent action. Zhen Wu Tang addresses water flooding from Yang deficiency. Jin Suo Gu Jing Wan secures Essence rather than the bowels.
Clinical Differentiation
- Si Shen Wan is commonly used for fifth-watch diarrhea, diarrhea before dawn caused by ming men fire deficiency that fails to warm the earth (spleen), or chronic diarrhea.
- This clinical pattern is marked by fifth-watch diarrhea, reluctance to eat and drink, pale tongue with white coating, deep, slow and weak pulse.
Safety notes: This formula is warm and astringent. It is not appropriate for damp-heat or food-stagnation diarrhea.
For educational reference only, based on traditional pattern differentiation — not a substitute for professional advice.
Frequently Asked Questions
What are the actions of Si Shen Wan?
Si Shen Wan has the actions of warming the Kidney and Spleen, astringing the intestines, and stopping diarrhea. It is the classic formula for Spleen and Kidney Yang deficiency leading to chronic or early-morning diarrhea.
Which modern diseases is Si Shen Wan suited to?
Modern TCM clinical practice commonly applies it to individuals whose pattern differentiation falls within Spleen and Kidney Yang deficiency, including chronic diarrhea, diarrhea-predominant irritable bowel syndrome (IBS-D), chronic colitis, and other functional bowel disorders presenting with cold-type, early-morning or prolonged loose stools.
Is Si Shen Wan suitable for improving early-morning (daybreak) diarrhea?
For presentations of diarrhea occurring in the early morning (fifth-watch or cock-crow diarrhea), often with undigested food in the stool, cold abdominal pain relieved by warmth, poor appetite, cold limbs, lower back soreness, fatigue, a pale tongue, and a deep weak pulse — in those whose pattern differentiation confirms Spleen and Kidney Yang deficiency — TCM commonly applies Si Shen Wan as an adjunct. It cannot replace standard medical treatment.
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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.