Si Cao Tang (Four-Herb Decoction) for Stopping Bleeding and Resolving Stasis

Si Cao Tang is a decoction I devised myself: Xianhe Cao (Agrimonia, fresh 100–300 g, dried 30–100 g), Fengwei Cao (Pteris, fresh 100–200 g, dried 30–100 g), Yimucao (Motherwort, fresh 30–100 g, dried 10–30 g), and Hanlian Cao (Eclipta, fresh 30–100 g, dried 10–30 g). These four herbs are decocted in water for oral use, or the fresh herbs are juiced and drunk, 2–5 times daily or taken as a tea substitute. In severe bleeding, the patient should not take the medicine only 2–3 times a day but should increase the frequency.

This formula can be used for various bleeding disorders and in patients with low platelets. In the formula, Xianhe Cao, Fengwei Cao, and Hanlian Cao all stop bleeding. Among them, Xianhe Cao and Hanlian Cao also nourish blood. Xianhe Cao is known among the folk as "Tuoli Cao" (exhaustion-relieving herb): it not only stops bleeding but also restores the patient's strength; Xianhe Cao also stops dysentery and has antitumor activity. Hanlian Cao both cools blood to stop bleeding and nourishes the Liver and Kidney. Fengwei Cao is a folk herb commonly used to stop bleeding, stop dysentery, and relieve pain; it is effective for both hemostasis and analgesia, and in some late-stage cancer patients its pain relief even surpasses morphine. Yimucao activates blood and unblocks menstruation, and promotes diuresis and reduces swelling. Why add this blood-activating herb to a large dose of hemostatic herbs? Because stopping bleeding must not leave stasis; bleeding patients often develop thrombi because of retained stasis, so a modest blood-activating herb is needed.

These four herbs also share the action of promoting diuresis and reducing swelling. This effect not only helps prevent thrombus formation but also promotes urination, so this formula is especially suitable for patients with difficult urination or dribbling. It has good efficacy for patients with hematuria and hematochezia, and some effect for patients with bloody ascites. I often add these four herbs to the formulas of late-stage cancer patients presenting with various bleeding problems, ascites, difficult urination, and loose stools, to resolve their bleeding- and defecation-related problems.

If the patient not only bleeds but also has severe ascites, one may further add 30–50 g of Yumi Xu (corn silk, which also both promotes coagulation and promotes diuresis and reduces swelling), 30 g of Fuling (Poria), 10–30 g of Zhuling (Polyporus), 15 g of Dafupi (Areca Peel), and 15–30 g of Fangji (Stephania); for yang deficiency with impaired vaporization, add 10–30 g of Guizhi (Cinnamon Twig) or Rougui (Cinnamon Bark). If bleeding is profuse and the patient is utterly weak, it must be combined with Du Shen Tang (Single Ginseng Decoction).

This formula is mild in nature with few side effects. Even so, hemostatic herbs should not be used in large doses for too long; once the patient's bleeding improves, the dose and number of herbs should be gradually reduced. Some cancer patients (e.g., gastric, intestinal, and cervical cancer) are prone to recurrent bleeding and anemia, so in routine formulas it is appropriate to add a moderate amount of hemostatic and blood-nourishing herbs to prevent bleeding and anemia.