The Prescription of Taohong Siwu Tang

→ Investigate the main indication of the formula

The original formula of Tao Hong Si Wu Tang is composed of the following individual herbs:
• Shu Di Huang (Rehmannia) (Chinese Foxglove Root), 12g
• Dang Gui (Angelica) (Chinese Angelica Root), 9g
• Bai Shao (Paeonia) (White Peony Root), 9g
• Chuan Xiong (Ligusticum) (Szechuan Lovage Root), 6g
• Tao Ren (Semen Persicae) (Peach Seed), 9g
• Hong Hua (Flos Carthami) (Safflower Flower), 3g

→ Classification of Plants (TCM Theories)

Shu Di Huang:
Nature: warm
Taste: sweet
Meridian: kidney and liver
category: Tonic herb for blood deficiency

Dang Gui:
Nature: warm.
Taste: pungent, sweet.
Meridian: heart, Spleen and liver.
Category: Tonic herb for blood deficiency.

White peony:
Nature: Natural.
Taste: bitter, Sour.
Meridian: Spleen and liver.
Category: tonic herb for blood deficiency.

Chuan Xiong:
Nature: warm.
Taste: pungent.
Meridian: gallbladder, pericardium and liver.
Category: herbs that invigorate the blood.

Tao Ren:
Nature: Natural.
Taste: bitter, sweet.
Meridian: heart, large intestine and liver.
Category: herbs that invigorate the heart.

Hong Hua:
Nature: warm.
Taste: pungent.
Meridian: heart and liver.
category: herbs that invigorate the blood.

→ Indication of formula
Taohong Siwu Tang, also known as "Peach Pit Decoction with Four Substances," is a traditional
Chinese herbal formula used in Traditional Chinese Medicine (TCM), has multiple indications,
one of its most important uses is in the treatment of gynecological disorders, particularly those
related to blood stasis and blood deficiency.
Some of the specific gynecological conditions for which Taohong Siwu Tang may be used
include:
1. Blood deficiency.
2. Menstrual disorders.
3. Postpartum recovery.
4. Blood stasis.
5. Skin conditions.
6. Dysmenorrhea.
7. Amenorrhea.
8. Uterine Fibroids.
It's important to note that the above indications are general guidelines, and the specific
prescription and dosage of Taohong Siwu Tang may vary depending on the individual's
condition and the TCM practitioner's assessment. It is always advisable to consult with a
qualified TCM practitioner or healthcare professional before using any herbal formulas.

→ Roles of Plants in Formula

Shu Di
The most common treatment for Rehmannia Root is to 'balance the yin'.
With a sweet and slightly warm nature, this enters the kidney and liver meridians to calm and
settle qi (vital energy), helping it to draw downward to allow it to rise up again in a more
natural pathway through the body.
Starting to grow in popularity worldwide, some potential Western benefits of this herb include:
1. Address autoimmune disorders, such as rheumatoid arthritis
2. Assist in repairing bones, muscle and tissue
3. Help effective cold and fever relief
4. Inflammation and dizziness
5. Prevent ulcers, wounds and bleeding
6. Hormonal balance
7. Regulate the menstrual cycle
8. Aid to reduce bleeding and headaches

Dang gui
Radix Angelica Sinensis, the dried root of Angelica sinensis (Dang gui), is a herb used in Chinese
medicine to enrich blood, promote blood circulation and modulate the immune system. It is
also used to treat chronic constipation of the elderly and debilitated as well as menstrual
disorders. Research has demonstrated that Dang gui and its active ingredients, as anti-
arthrosclerotic, anti-hypertensive, antioxidant anti-inflammatory agents which would limit
platelet aggregation, are effective in reducing the size of cerebral infarction and improving
neurological deficit scores.

Bai Shao
1. Autoimmune conditions like:
Rheumatoid arthritis
Psoriasis
2. Chronic inflammatory conditions, including:
Arthritis
Kidney disease
Liver disease
3. Improve blood flow, hyperpigmentation, mood disorders and increase estrogen levels

Chuan xiong
Can help regulate menstruation, May assist with headache, stuffy and runny nose, Can aid
hoarse voice, strong fever, body ache and profuse sputum, May reduce cholesterol levels, Can
activate blood circulation

Tao Ren
It is used for many Blood stasis syndromes, in particular those with irregular menstruation,
amenorrhoea, dysmenorrhoea, postpartum abdominal pain and abdominal masses.
Its other application is in the treatment of constipation due to Dryness.

Hong Hua
It is clinically used for the following:
• Blood-stasis syndrome with dysmenorrhoea, amenorrhoea, postpartum abdominal pain
with masses, dizziness and joint pain.
• Darkish skin eruptions due to Heat and Blood stasis such as carbuncles, dark purplish
erythema, incomplete expression of rashes.
• Painful obstruction of the chest due to Blood stasis such as angina pectoris.
→ Knowledge of Bioactive Compounds and toxicity:
Bioactive Compounds in Shu Di:
1. Catalpol: anti-inflammatory, antioxidant, and neuroprotective properties.
2. Rehmannioside A: anti-diabetic and anti-inflammatory effects.
3. Verbascoside: antioxidant and anti-inflammatory activities.
4. Aucubin: anti-inflammatory and hepatoprotective properties.
Toxicity of Shu Di:
Some studies have reported that high doses of Shu Di may lead to adverse effects on the liver
and kidneys, particularly in individuals with pre-existing conditions or those taking certain
medications.

Bioactive Compounds in Dang Gui:

1. Ferulic acid: antioxidant and anti-inflammatory properties.
2. Ligustilide: vasodilatory and neuroprotective effects.
3. Z-ligustilide: anti-inflammatory and anti-cancer properties.
4. Angelica polysaccharides: Polysaccharides found in Dang Gui that have immunomodulatory
and antioxidant activities.
Toxicity of Dang Gui:
Some studies have reported that high doses of Dang Gui may cause liver toxicity in certain
individuals.

Bioactive Compounds in Bai Shao (white peony root):

1. Paeoniflorin: A major bioactive compound with anti-inflammatory, antioxidant, and
neuroprotective properties.
2. Albiflorin: anti-inflammatory and analgesic effects.
3. Paeonol: A phenolic compound with antioxidant and anti-inflammatory properties.
4. Benzoylpaeoniflorin: anti-inflammatory and analgesic.
Toxicity of Bai Shao:
High doses of Bai Shao may lead to adverse effects, particularly in individuals with certain
health conditions or those taking specific medications.
Bioactive Compounds in Chuan Xiong:
1. Ligustilide: A major bioactive compound in Chuan Xiong with anti-inflammatory,
neuroprotective, and cardiovascular protective effects.
2. Ferulic acid: antioxidant and anti-inflammatory properties.
3. Senkyunolide A: A compound with potential neuroprotective and anti-inflammatory effects.
4. Coniferyl ferulate: cardiovascular protective.
Toxicity of Chuan Xiong:
Chuan Xiong is generally considered safe when used in appropriate doses.

Bioactive Compounds in Tao Ren:

1. Amygdalin: A major bioactive compound in Tao Ren with potential anti-inflammatory and
anti-cancer properties. Amygdalin is also known for its role in traditional Chinese medicine for
respiratory conditions.
2. Oleic acid: antioxidant and anti-inflammatory effects.
3. Linoleic acid: cardiovascular benefits and skin health properties.
4. Vitamin E: antioxidant that helps protect cells from damage caused by free radicals.
Toxicity of Tao Ren:
Amygdalin, a compound found in Tao Ren, can be toxic when metabolized in the body, leading
to the release of cyanide.

Bioactive Compounds in Hong Hua:

1. Carthamin: A major bioactive compound in Hong Hua that gives the herb its characteristic
red color. Carthamin has antioxidant and anti-inflammatory properties and is believed to
support cardiovascular health.
2. Linoleic acid: supports skin health and may have cardiovascular benefits.
3. Flavonoids: Hong Hua is a good source of flavonoids, such as quercetin and kaempferol,
which have antioxidant and anti-inflammatory effects.
Toxicity of Hong Hua:
Carthamin, the main bioactive compound in Hong Hua, has been reported to have mild toxicity
in high doses.
Individuals with allergies to plants in the Asteraceae family may also be at risk of allergic
reactions to Hong Hua.

→ Evidence-Based Medicine Perspective for the TCM indications

Study 1
Study Name Herbal medicine (Taohong Siwu Tang) for the treatment of primary
dysmenorrhea: A systematic review and meta-analysis.
Objectives This systematic review aimed to evaluate the efficacy and safety of Tao-
Hong Siwu Tang (TST) for the treatment of primary dysmenorrhea.
Introduction • Primary dysmenorrhea refers to lower abdominal and pelvic pain, which
occurs during menstruation without any demonstrable pelvic pathology.
• Non-steroidal anti-inflammatory drugs (NSAIDs) and oral contraceptives
(OCs) are the first-line treatment for primary dysmenorrhea. However,
the use of NSAIDs might be limited because of their possible adverse
effects.
• Therefore, the demand for complementary and alternative medicine
(CAM) for the treatment of primary dysmenorrhea has increased
worldwide.
• Tao-Hong Siwu Tang (TST) is a herbal medicine has been widely used for
the treatment of menstrual dysfunctions, such as primary
dysmenorrhea, menorrhagia, and amenorrhea in East Asia
Description Our database search identified 85 possibly relevant studies. Of these, five
of included RCTs met the quantitative synthesis and were included.
trials All RCTs were conducted in China and measured the response rate to assess
pain.

Discussion The quality of the included evidence was moderate because of the unclear
risk of bias. The number of RCTs and total sample size analyzed in our
review were not sufficient to reach an obvious conclusion.
Study 2
Study Name Effect of Tao-Hong-Si-Wu-Tang, A Traditional Chinese Herbal Medicine
Formula, on Physical Fatigue in Mice.
Material and 1. Plant materials
Methods Bai Shao
Chuan Xiong
Hong Hua
Dang Gui
Tao Ren
2. Animals
Male Kun-Ming strain mice weighing 20 ± 2 g
3. Preparation of THSWT solutions
4. Animals grouping and treatment
5. Forced swimming test.
The physical fatigue was induced by forcing animals to swim until
exhaustion. Exhaustion was determined by observing loss of
coordinated movements and failure to return to the surface within 7 s .
6. Biochemical parameters assay
After the forced swimming test, the mice were taken out and the blood
were collected.
Several biochemical parameters, such as blood lactic acid, BUN, liver
glycogen and muscle glycogen, were determined.
7. Statistical analysis
The data are expressed as means ± S.D.
Results 1. THSWT prolonged the exhaustive swimming time of mice.
2. THSWT increased liver glycogen and muscle glycogen contents of mice
after exhaustive swimming.
3. THSWT decreased blood lactic acid and blood urea nitrogen contents
after exhaustive swimming.
Discussion • Fatigue is one of the most frequent physiological reactions.
• The anti-fatigue activity of Tao-Hong-Si-Wu-Tang (THSWT) is still poorly
understood. Therefore, the present study is to investigate the effect of
THSWT, a traditional Chinese herbal medicine formula, on physical
fatigue-induced stress models in mice, which would provide scientific
evidence for traditional Chinese herbal medicine formula for prevention
and treatment of diseases related to fatigue.
Conclusion The results supported that THSWT had anti-physical fatigue effect. Further
study is necessary to better understand the mechanism involved in the
action of THSWT on physical fatigue, and to assess the optimum dose.
 Evidence based medicine (Clinical trials)

→ Study indirect relationship between the plants and the indications

In vitro:
• In vitro studies can uncover the specific bioactive compounds present in each herb, their
pharmacological effects, and how they may work together synergistically.
• For example, studies on Taoren (Peach Kernel) may focus on its anti-inflammatory and
anticoagulant properties, which can contribute to promoting blood circulation and reducing
blood stagnation. Honghua (Safflower) is known for its vasodilatory effects and ability to
improve blood flow, which complements the actions of other herbs in the formula.
• In vitro investigations into Danggui (Chinese Angelica) and Chuanxiong (Ligusticum) can
elucidate their roles in regulating menstruation, relieving pain, and enhancing blood
circulation. These studies may reveal the underlying mechanisms of action, such as their
effects on platelet aggregation, hormone regulation, and antioxidant activity.

In vivo interactions:
1. Taoren (Semen Persicae): Known for its ability to invigorate blood circulation and remove
blood stasis. It is commonly used to alleviate pain, promote menstruation, and address
conditions related to stagnant blood.
2. Honghua (Flos Carthami): Also promotes blood circulation and dispels blood stasis. It is
often used to relieve menstrual disorders, promote healthy blood flow, and address conditions
associated with poor circulation.
3. Danggui (Radix Angelicae Sinensis): TCM considers Danggui to be a blood tonic with the
ability to regulate blood circulation, nourish blood, and invigorate the vital energy. It is
frequently used for conditions such as blood deficiency, irregular menstruation, and pain
related to blood stagnation.
4. Chuanxiong (Rhizoma Chuanxiong): Known for its ability to invigorate blood circulation and
promote the smooth flow of Qi. It is often used to alleviate pain, particularly headaches and
menstrual discomfort, as well as to address conditions related to stagnant Qi.
5. Shu Di Huang (Rehmannia glutinosa) – nourishes blood.
6. Bai Shao (Paeonia lactiflora) – nourishes blood, regulates menstruation, and alleviates pain.

In the context of Taohong Siwu Tang, the combination of these plants is designed to harmonize
blood circulation, nourish the blood, and regulate Qi flow. The synergistic effects of these
plants work together to address conditions related to blood stasis, deficiency, and circulation
issues, such as menstrual irregularities, pain, and other related symptoms.

Molecular Targets
The active components within the herbs of Taohong Siwu Tang interact with a wide range of
molecular targets, such as enzymes, receptors, and signaling molecules involved in blood
circulation, inflammation, and pain signaling. For example, certain compounds might inhibit
the expression or activity of pro-inflammatory cytokines, or they might modulate estrogen
receptors, contributing to the formula's effectiveness in treating menstrual-related disorders.

→ Provide references:
• Article Category: 2017, Articles, Herbal Formula Spotlight
• Beebe S. Tao Hong Si Wu Tang (Four-Substance Decoction with Safflower and Peach Pit).
• https://pubmed.ncbi.nlm.nih.gov/32723605/
• Bokelmann J. Medicinal Herbs in Primary Care: An Evidence-Guided Reference for
Healthcare Providers. Philadelphia: Elsevier; 2022.
• https://herbpathy.com/Uses-and-Benefits-of-Shu-Di-Huang-Cid2877