A "soothe the liver, move qi, harmonize the center" formula from the Ming dynasty, the formula of choice for "liver qi stagnation" presentations with chest and flank distension.
Cultural reference - how this formula has been discussed in Chinese medical tradition. Not medical advice.
Background & origin
Compiled in the Ming dynasty text "Comprehensive Medicine" (《医学统旨》) as the standardized "liver qi stagnation" formula, historically a refinement of the earlier Sini San tradition. In Japan, Saiko-sokan-san (柴胡疏肝散) is sold by Tsumura and Kracie as the standard OTC for "chest and flank fullness, irritability, premenstrual tension". In Korea it appears as Siho-sogan-hwan (시호소간환) in the Kyungdong hanbang line. The formula is the primary TCM treatment for what is described in the tradition as "the liver governs the free flow of qi", when that flow is impeded, this formula is meant to restore it.
From the source text
This page is cultural documentation, not medical advice.
From the source text · 《医学统旨》内·胁痛门·柴胡疏肝散条
Classical text
据《医学统旨》：柴胡疏肝散，治肝气郁结，胁肋疼痛，寒热往来。柴胡、白芍、枳壳、香附、川芎、陈皮、甘草。
Modern Chinese rendering
本方用于"肝气郁结、胁肋疼痛"系列证候：情志不舒所致的两胁胀痛走窜、胸闷叹气、烦躁易怒、食欲不振、咽部异物感（梅核气），或妇女经前乳房胀痛。方以柴胡疏肝解郁为君；香附、川芎行气活血、止痛为臣；白芍养血柔肝、缓急止痛；枳壳、陈皮理气宽中、导滞；甘草调和诸药。整体上，是明代"疏肝理气、调和肝脾"思路下"气滞 + 血瘀"同治代表方，临床用于"肝气郁结"为主之胸胁胀痛、月经不调、情志抑郁证候。
Editorial translation
This formula is used for "liver-qi stagnation with flank pain" patterns: emotional distress causing distension and wandering pain in both flanks, chest oppression with frequent sighing, irritability and easy anger, poor appetite, a "plum-pit" sensation in the throat (plum-pit qi), and premenstrual breast distension in women. The Chái Hú Shū Gān Sǎn uses Chái Hú to soothe the liver and resolve constraint as sovereign; Xiāng Fù and Chuān Xiōng move qi, activate blood, and stop pain as minister; Bái Sháo nourishes blood, softens the liver, and eases urgency pain; Zhǐ Ké and Chén Pí regulate qi, widen the middle, and guide stagnation; Gān Cǎo harmonizes the formula. It is, in short, the Ming-dynasty representative formula for "qi stagnation + blood stasis simultaneous treatment" of the "liver-qi stagnation" register.
In tradition
In TCM tradition, associated with "liver qi stagnation" patterns: chest and hypochondriac distension and pain, irritability, mood swings, frequent sighing, poor appetite, a sensation of "a lump in the throat" (plum-pit qi), and premenstrual or perimenstrual mood and breast changes. It is the formula of choice when the dominant complaint is "everything feels stuck in my chest and I can't relax" rather than a clearly defined physical symptom.
Formula composition
Monarch3
- Bupleurum root (Chái Hú / 柴胡) - sovereign, soothes the liver and raises yang
- Bitter orange, bran-fried (Fū Chǎo Zhǐ Ké / 麸炒枳壳) - sovereign, regulates qi and widens the middle
- Cyperus rhizome, vinegar-processed (Cù Xiāng Fù / 醋香附) - sovereign, soothes the liver and regulates qi
Other ingredients22
- Poria (Fú Líng / 茯苓) - minister, fortifies the spleen and leaches dampness
- Cardamom (Dòu Kòu / 豆蔻) - minister, transforms dampness and moves qi
- White peony root, wine-processed (Jiǔ Bái Sháo / 酒白芍) - minister, nourishes blood and softens the liver
- Licorice root (Gān Cǎo / 甘草) - envoy, harmonizes the formula
- Scutellaria root (Huáng Qín / 黄芩) - assistant, clears heat and dries dampness
- Tangerine peel (Chén Pí / 陈皮) - assistant, regulates qi and transforms dampness
- Platycodon root (Jié Gěng / 桔梗) - assistant, opens the lungs and guides qi upward
- Magnolia bark, ginger-processed (Jiāng Hòu Pò / 姜厚朴) - assistant, dries dampness and descends qi
- Hawthorn fruit, stir-fried (Chǎo Shān Zhā / 炒山楂) - assistant, digests food and disperses stagnation
- Saposhnikovia root (Fáng Fēng / 防风) - assistant, dispels wind and regulates qi
- Medicated leaven, stir-fried (Chǎo Liù Shén Qū / 炒六神曲) - assistant, digests food and harmonizes the stomach
- Mentha (Bò He / 薄荷) - assistant, disperses wind-heat and soothes the liver
- Perilla stem (Zǐ Sū Gěng / 紫苏梗) - assistant, regulates qi and widens the chest
- Aucklandia root (Mù Xiāng / 木香) - assistant, moves qi and stops pain
- Betel nut, stir-fried (Chǎo Bīng Lang / 炒槟榔) - assistant, directs qi downward and disperses stagnation
- Sparganium rhizome, vinegar-processed (Cù Sān Léng / 醋三棱) - assistant, invigorates blood and disperses accumulation
- Rhubarb, wine-processed (Jiǔ Dà Huáng / 酒大黄) - assistant, clears heat and purges accumulation
- Green tangerine peel, stir-fried (Chǎo Qīng Pí / 炒青皮) - assistant, soothes the liver and breaks qi
- Dong quai (Dāng Guī / 当归) - assistant, nourishes blood and invigorates blood
- Pinellia, ginger-processed (Jiāng Bàn Xià / 姜半夏) - assistant, dries dampness and transforms phlegm
- Lindera root (Wū Yào / 乌药) - assistant, warms the kidney and moves qi
- Curcuma rhizome, vinegar-processed (Cù É Zhú / 醋莪术) - assistant, invigorates blood and disperses accumulation
International availability
Taiwan & Hong Kong
- 順天堂OTC柴胡疏肝散Chai Hu Shu Gan San
Cautions & context
- A qi-moving formula, generally safe for short-term use, but not appropriate for active fever or acute infection.
- Contains chuanxiong, which is generally considered inappropriate during pregnancy unless under qualified guidance.
- Long-term daily use may over-move qi in some constitutions, periodic breaks are typically recommended.
- Persistent chest pain, especially with shortness of breath or radiation to the arm or jaw, requires immediate medical evaluation before any herbal remedy is considered.
Related formulas
Browse by Pattern
Related concerns
Concern · stress
Stress & Mood
Everyday tension, low mood, irritability, the sense of being "wound up but tired". The cluster of complaints that brings many Chinese adults to the family 中成药 drawer before they ever see a doctor.
Concern · digestion
Digestion
Upper-abdominal heaviness, bloating, sour reflux, loose stools, traveler's stomach, and the aftermath of a meal that was richer, spicier, or larger than usual.
Editorial note
Compiled from "Comprehensive Medicine" (1556).
Last reviewed: July 18, 2026
Three layers of evidence
Classical source
≈ 500 years · "Comprehensive Medicine" (1556)
Pharmacopoeia indication
"Soothe the liver and regulate qi, disperse distension and stop pain. Used for liver qi stagnation: hypochondriac pain, chest and abdominal fullness, vomiting of sour fluid, and lack of desire to eat."
Modern research status
A 2016 PRISMA-compliant meta-analysis (PMID 27858863) of 30 RCTs (2,599 cases) evaluated adjunctive treatment with "liver-soothing-oriented method" medications for post-stroke depression; Chai Hu Shu Gan Wan is a representative liver-soothing formula, and the meta-analysis found the class improved overall effective rates, HAMD scores, and quality-of-life measures compared with non-liver-soothing conventional therapy, though the authors called for larger prospective trials; no formula-specific systematic review for Chai Hu Shu Gan Wan alone was identified. [5]
References
References reviewed on July 18, 2026 · PubMed search on 2026-07-18
- 01ClassicalYè Wénlíng (叶文龄), 《医学统旨》 (Yī Xué Tǒng Zhǐ / Comprehensive Medicine), Ming-dynasty physician, compiled ca. 1534 (early Jiajing reign), the "flank pain" (胁痛) section, the entry for Chái Hú Shū Gān Sǎn (柴胡疏肝散), the representative "soothe the liver and regulate qi + move qi and blood" formula of the "liver-qi stagnation" register; editorial adaptation from the 1534 edition, pending scholarly verification of exact textual wording.
- 02TextbookDuān Fùjīn (段富津) et al. (eds.), 《方剂学》 (Fāngjìxué / Science of Formulas), 2nd edition, Shanghai Scientific and Technical Publishers, 2011, the standard modern university-level formula textbook in mainland China, with Chái Hú Shū Gān Sǎn analysed in the "qi-regulating formulas" (理气剂) chapter as the canonical "liver-qi stagnation" formula, the standard entry for the "soothe the liver" register.
- 03TextbookTsumura (ツムラ) and Kracie (クラシエ), Saiko-sokan-san (柴胡疏肝散) prescription family product documentation, Japan's leading Kampo manufacturers, the standard Japanese Kampo "liver-qi stagnation" OTC formula derived from the late-Ming 《医学统旨》 line, sold in Japanese drugstores for "chest and flank fullness, irritability, premenstrual tension"; mirrored in Korean hanbang Siho-sogan-hwan (시호소간환) preparations in Kyungdong (경동) product line.
- 04PharmacopoeiaPharmacopoeia Commission of the PRC, 《中华人民共和国药典》 2020 edition, vol. 1 (Zhōnghuá Rénmín Gònghéguó Yàodiǎn, Pharmacopoeia of the People's Republic of China, 2020 ed., vol. 1), China Medical Science Press, 2020, the official national monograph for Chái Hú Shū Gān Wán (丸 / 水丸), "functional indication" reads "soothe the liver and regulate qi, disperse distension and stop pain, used for liver qi stagnation: hypochondriac pain, chest and abdominal fullness, vomiting of sour fluid, and lack of desire to eat".
- 05