Four Spirits Pill

Four Spirits Pill

Myristicae Semen (Rou Dou Kou) 2 liang (60g), Psoraleae Fructus (Bu Gu Zhi) 4 liang (102g), 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

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.

Warms the spleen and kidney, consolidates the intestines and arrests diarrhea.

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.

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.

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.

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.