Si Sheng Wan
Quick Facts
- What it is: Si Sheng Wan, or Four-Fresh Pill, is a Chinese herbal formula of four fresh plants, used in tradition for bleeding.
- Main uses: Nosebleeds, Coughing up blood, Blood in vomit or stool, Heavy menstrual bleeding
- Best for: Short-term traditional use for a bleeding spell, guided by a trained herbalist
- Active ingredients: Fresh Rehmannia root, Fresh lotus leaf, Fresh biota leaf, Fresh mugwort leaf, Tannins and flavonoids, Thujone (from mugwort leaf)
- Forms: Pill, Dried powder, Loose herbs for tea, Liquid extract
- Time to effect: Not known; no trial has measured it.
- Side effects: Mostly loose stools, cramps and chills; allergy and, at very high mugwort doses, fits are rare but serious.
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What is Si Sheng Wan?
Si Sheng Wan is an old Chinese herbal formula. The name means Four-Fresh Pill. It is one named formula made of four plants, not a single herb.
Healers gave it for bleeding that Chinese medicine calls "heat in the blood". That covers nosebleeds, coughing up blood, blood in vomit, and blood in the stool.
Long use in a tradition is not proof that a remedy works. We say this once here, and you will not see it repeated in every section below.
The short verdict: it is a well-known staple of Chinese herbal medicine, but human trial evidence is missing, so we cannot say it helps.
How does Si Sheng Wan work?
In Chinese medicine the four fresh plants are seen as cool or cold in nature. Cold herbs were thought to cool "hot" blood and stop it leaking from the vessels. That is a traditional idea, not a proven body process.
Lab tests on single herbs from the formula hint at effects on clotting. Biota leaf and mugwort leaf are the two most studied this way. What happens in a dish or in a rat may not happen in you.
No one has shown, in people, that the whole formula stops a bleed.
What forms does Si Sheng Wan come in?
You will most often find it as a small pill or a dried powder.
Other forms are loose dried herbs for a tea, and a liquid extract. Some herbalists still mix the fresh leaves, but fresh stock is hard to get.
Most products on sale use dried herbs. The classic text asks for fresh ones. No study has checked whether dried and fresh forms act the same way.
Where it comes from:
Si Sheng Wan first appears in Furen Liangfang, a Chinese book on women's health from 1237.
It has stayed in use in China since then, and it is still taught and listed today. Herbalists use it for a short bleeding spell, not for long-term care.
It is a set formula with a fixed list of four herbs, which is why it is treated as one item here.
If this is an emergency
Some reactions to Si Sheng Wan need urgent care. Call your local emergency number or go to an emergency department straight away — do not wait to see whether it passes.
Who should avoid Si Sheng Wan?
- Do not use if you are pregnant: this ban has no exceptions, because mugwort leaf can act on the womb.
- Do not use if you are breastfeeding.
- Do not use if you are bleeding and a doctor has not yet found the cause.
- Do not use if you take warfarin, heparin, apixaban, rivaroxaban or any other blood thinner (a drug that stops clots), unless your own doctor agrees.
- Do not use if you take aspirin or another antiplatelet drug (a pill that stops blood cells sticking together), unless your own doctor agrees.
- Do not use if you have epilepsy or any other condition that causes fits.
- Do not use if you have a bleeding disorder such as haemophilia (an illness in which blood does not clot properly).
- Do not use if you have surgery or dental surgery booked within the next two weeks.
- Do not use if you are allergic to mugwort, ragweed, daisies or other plants in that family.
- Do not use if you have long-term loose stools, a weak stomach, or feel cold all the time, since this formula is cold in nature.
- Do not use if you have liver or kidney disease, unless your doctor says it is safe for you.
- Do not give it to a child unless a doctor is guiding the treatment.
When should you see a doctor?
Call emergency services now if you vomit blood, cough up a lot of blood, pass black tarry stools, feel faint, or your heart races. These can mean a fast, heavy bleed inside the body.
See a doctor the same day if you cough up any blood, see blood in your stool or urine, or a nosebleed will not stop after 20 minutes of firm pressure.
Stop the formula and get help if you get a rash, swelling of the lips or face, trouble breathing, or a fit. Book a routine visit if bleeding keeps coming back, or if your periods are heavy enough to leave you tired and pale.
Evidence grades and traditional-use labels are explained in our methodology. Nothing here is medical advice.
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