Si Shen Wan: Herbal Relief for Diarrhea and Digestive Health

Si Shen Wan, or Four Spirits Pill, is a time-honored Chinese herbal formula from Internal Medicine Abstract. Renowned for warming the spleen and kidneys, strengthening the intestines, and stopping diarrhea, it’s a trusted remedy for chronic diarrhea caused by spleen and kidney yang deficiency, often marked by early morning (“five o’clock”) diarrhea.

With its blend of warming and astringent herbs, Si Shen Wan remains a cornerstone of traditional Chinese medicine (TCM) and shows growing promise in modern applications for digestive and chronic conditions.

Si Shen Wan

What’s in Si Shen Wan?

Si Shen Wan combines four key herbs, with supporting ingredients like ginger and red dates, to warm and stabilize the digestive system. The ingredients and their roles are:

Monarch Herb

• Psoralea (Bu Gu Zhi): Warm and pungent, psoralea boosts kidney yang, warms the body, and supports spleen function, providing a steady source of internal heat to combat diarrhea.

Minister Herb

• Nutmeg (Rou Dou Kou): Warm and astringent, nutmeg warms the spleen and stomach, binds the intestines, and stops diarrhea, enhancing psoralea’s effects.

Assistant Herbs

• Schisandra (Wu Wei Zi): Sour and warm, schisandra retains yang qi, stabilizes the body, and supports the spleen to prevent fluid loss.

• Dogwood (Shan Zhu Yu): Sour and warming, dogwood nourishes the kidneys and astringes to reduce diarrhea and stabilize digestion.

Supporting Herbs

• Ginger (Sheng Jiang): Pungent and warm, ginger warms the stomach, disperses cold, and aids digestion.

• Red Dates (Hong Zao): Sweet and warm, red dates nourish the spleen, harmonize the formula, and support qi.

Preparation

To make Si Shen Wan:

1. Grind psoralea, nutmeg, schisandra, and dogwood into a fine powder and sieve.

2. Mash 120g of ginger, add water, and squeeze out the juice.

3. Mix the ginger juice with the powder, form into pills, and dry.

4. Take 9g of pills 1–2 times daily with light salt water or warm water, ideally before bed. Alternatively, decoct the herbs with ginger and red dates and drink warm.

Si Shen Wan

How It Works

Si Shen Wan targets spleen and kidney yang deficiency, a TCM condition where weak yang (warmth and energy) impairs the spleen’s ability to digest food and the kidneys’ role in fluid regulation, leading to chronic diarrhea, especially before dawn. This deficiency causes:

• Poor digestion and nutrient absorption, resulting in loose stools.

• Coldness in the body, leading to cold limbs and abdominal discomfort.

• Weakened intestinal function, causing frequent, watery diarrhea.

The formula works by:

• Warming Yang: Psoralea and nutmeg restore spleen and kidney warmth, improving digestion and fluid control.

• Astringing the Intestines: Schisandra and dogwood bind the intestines to stop diarrhea.

• Supporting Digestion: Ginger and red dates warm the stomach and boost spleen qi, enhancing nutrient absorption.

• Stabilizing Qi: The combination ensures energy flows smoothly, reducing fatigue and pain.

This approach warms, strengthens, and stabilizes, addressing both diarrhea and its underlying causes.

農本方 - 四神丸

Buy Now

What Does It Treat?

Si Shen Wan is primarily used for spleen and kidney yang deficiency diarrhea, with symptoms including:

• Early morning (“five o’clock”) diarrhea

• Loss of appetite or indigestion

• Chronic, watery stools

• Abdominal or lower back pain

• Cold hands and feet

• Fatigue or weakness

• Pale tongue with thin white coating

• Weak, slow pulse

These symptoms reflect a cold, deficient digestive system unable to properly process food or fluids.

Si Shen Wan used for spleen and kidney yang deficiency diarrhea

Modern Applications

Modern research and clinical practice have expanded Si Shen Wan’s uses, showing its effectiveness for various digestive and chronic conditions. Key applications include:

• Chronic Diarrhea: Treats spleen and kidney yang deficiency diarrhea with symptoms like loose stools, mucus, or blood, often with bloating, chills, and fatigue. Modified formulas add herbs like white peony or atractylodes for enhanced results.

• Non-Specific Colitis: Achieves a 96.7% effective rate in treating colitis, reducing inflammation and stabilizing bowel function, with a 36.4% cure rate in 100 cases.

• Irritable Bowel Syndrome (IBS): A modified formula with bupleurum, tangerine peel, and saposhnikovia relieves IBS symptoms like diarrhea and abdominal pain, taken as a 7-day decoction course.

• Diabetes with Diarrhea: Combined with Shen Ling Bai Zhu San, Si Shen Wan reduces diarrhea and edema in diabetic patients, using herbs like Chinese yam, lentils, and poria.

• Cold Constipation: A specialized formula with Sichuan pepper and sulfur treats constipation due to cold and deficiency, formed into pills with jujube pulp.

• Dawn Diarrhea: A decoction with extra ginger and red dates effectively stops early morning diarrhea, improving quality of life.

Studies also suggest potential for Si Shen Wan in treating intestinal tuberculosis, enuresis, spermatorrhea, and other yang-deficient conditions, with ongoing research exploring its mechanisms and new dosage forms.

農本方 - 四神丸

Buy Now

Pathogenesis in TCM

In TCM, spleen and kidney yang deficiency underlies “five o’clock diarrhea,” triggered by:

• Chronic illness or overexertion weakening yang energy.

• Cold diet or environment impairing spleen function.

• Aging or constitutional weakness reducing kidney yang.

This leads to poor spleen digestion, fluid leakage (diarrhea), and coldness, worsened at night when yang is lowest. Si Shen Wan warms and tonifies, restoring digestive strength and intestinal stability.

Precautions

• Contraindications: Avoid in cases of diarrhea from damp-heat (yellow, foul-smelling stools) or stagnation (bloating, fullness), as the formula’s warming nature may worsen these conditions.

• Special Populations: Use cautiously in patients with hypertension, heart disease, diabetes, allergies, fever, pregnancy, or the elderly, under medical supervision.

• Short-Term Use: Discontinue after symptoms resolve to avoid overuse, as Si Shen Wan is not a general health supplement.

• Professional Guidance: Consult a TCM practitioner for accurate diagnosis and tailored dosing, as diarrhea has multiple causes requiring specific treatments.

Conclusion

Si Shen Wan is a powerful Chinese herbal formula that warms the spleen and kidneys, strengthens the intestines, and stops diarrhea. With herbs like psoralea, nutmeg, schisandra, and dogwood, it effectively treats early morning diarrhea and related symptoms of yang deficiency.

Modern applications extend its benefits to chronic colitis, IBS, diabetes-related diarrhea, and more, with research supporting its efficacy. When used under professional guidance, Si Shen Wan offers natural, holistic relief, blending ancient TCM wisdom with contemporary health solutions to restore digestive vitality and comfort.

Chinese Name	四神丸
Phonetic	Si Shen Wan
English Name	Four Spirits Pill
Classification	Astringent formulas
Source	《Summary of Internal Medicine》Nei Ke Zhai Yao《內科摘要》
Combination	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
Method	Grind all of the medicinals, except sheng jiang, into a fine powder. Smash 120g of sheng jiang and collect the juice by adding a little water. Mix the powder and the juice together, shape the mixture into pills, and let dry. Take 9g of the pills once or twice per day. At least one dose should be taken at bedtime with lightly salted or warm water that has been boiled. It can also be prepared as a decoction by adjusting the medicinal quantities based on the original ratios.
Action	Warms the spleen and kidney, consolidates the intestines and arrests diarrhea.
Indication	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. Usually, the tongue is pale with a white and thin coating. The pulse is deep, slow and weak.
Pathogenesis	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. The therapeutic principles are to warm and supplement the spleen and to consolidate the intestines to stop diarrhea.
Clarification	According to《Medical Formulas Collected and Analyzed》, this formula should be taken with lightly salted or boiled water before bedtime. This follows good reason, as Wang An explained, “if the formula is taken in the early morning, the medicinal effect will be spent and at its lowest point of efficacy by the time night comes. It, therefore, will not be able to protect the body from yin-cold at night.” For this reason, it has been suggested to the patient to take it just before bedtime in order to offer optimal results.
Application	1. Essential pattern 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. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of deficiency-cold of the spleen and kidney: chronic colitis, intestinal tuberculosis, and irritable bowel movement syndrome.

Si Shen Wan