A gentle, five-ingredient formula from the Han dynasty, originally used for "masses below the waist" in women, and now one of the most commonly prescribed gynecological formulas in both Chinese and Japanese kampo practice.
Cultural reference - how this formula has been discussed in Chinese medical tradition. Not medical advice.
Background & origin
Recorded by Zhang Zhongjing in the "Essential Prescriptions of the Golden Cabinet" (《金匮要略》) as the foundational formula for "women's masses below the waist" (妇人癥病). In Japan, Keishibukuryogan (桂枝茯苓丸) is the most prescribed gynecological kampo formula, produced by every major manufacturer (Tsumura, Kracie, Kotaro) and routinely used in obstetric and gynecologic clinics. In Korea it appears as Gyejibokryeong-hwan (계지복령환) in the Kyungdong hanbang line. It is a rare formula that is essentially used identically across the three traditions.
From the source text
This page is cultural documentation, not medical advice.
From the source text · 卷下·妇人妊娠病脉证并治·第 2 条
Classical text
妇人宿有癥病，经断未及三月，而得漏下不止，胎动在脐上者，为癥痼害。妊娠六月动者，前三月经水利时，胎也。下血者，后断三月，衃也。所以血不止者，其癥不去故也，当下其癥，桂枝茯苓丸主之。
Modern Chinese rendering
妇人素有癥病（旧有的腹中包块），停经不到三个月，又见漏下不止、脐上觉有胎动的，这是癥病痼疾妨害胞胎之故。若停经六个月才觉胎动，且受孕前三个月月经通利的，那是胎。若停经前三个月月经紊乱而下血的，是瘀血内停（衃）。漏下不止的原因是癥病未去，应当先消其癥，用桂枝茯苓丸主治。这是"妇人癥病"思路下"活血化瘀、缓消癥块"的代表性条文，也是后世"癥瘕积聚"治法的源头。
Editorial translation
When a woman has long suffered from an abdominal mass disorder (zheng), her menses have ceased for less than three months, and she develops unceasing spotting with fetal stirring felt above the umbilicus, this is the harm of an entrenched mass disorder (zheng gu hai) obstructing gestation. If fetal stirring is only felt in the sixth month of gestation, and the three preceding months of menstruation had been regular, then it is a fetus. If there was bleeding in the three months prior to cessation, then it is a static mass (pei). The reason the bleeding does not stop is that the mass disorder has not been removed, and so the mass must be drained, with Cinnamon and Poria Pills as the formula of choice. This is the canonical clause for the "invigorate blood, transform stasis, and gently disperse abdominal masses" line of reasoning in gynecology, and the historical source of the later "zheng-jia ji-ju" (mass and accumulation) treatment tradition.
In tradition
In TCM tradition, traditionally associated with patterns described as "blood stasis" in the lower abdomen: menstrual pain that is fixed and sharp, dark menstrual clots, irregular cycles, a feeling of heaviness or palpable lumps in the lower abdomen, and menopausal hot flashes with irritability. It is also commonly discussed in the context of postpartum recovery and, in some modern Chinese uses, of benign gynecological masses. The Japanese indication (Keishibukuryogan) is the most frequently prescribed gynecological kampo formula in Japan.
Formula composition
Monarch2
- Cinnamon twig (Guì Zhī / 桂枝) — warms and unblocks the vessels
- Persica kernel (Táo Rén / 桃仁) — invigorates blood and dispels stasis
Minister2
- Poria (Fú Líng / 茯苓) — leaches dampness and fortifies the spleen
- Moutan tree bark (Mǔ Dān Pí / 牡丹皮) — cools the blood and disperses stasis
Assistant1
- White peony root (Bái Sháo / 白芍) — nourishes blood and softens the liver
International availability
Cautions & context
- Considered unsuitable during pregnancy in most TCM and kampo guidance, the formula is classified as "invigorating blood and breaking stasis" and is contraindicated in early pregnancy.
- People on anticoagulant therapy (warfarin, aspirin, clopidogrel) are typically advised to use it only under medical guidance, persica kernel and cinnamon twig have documented antiplatelet activity.
- Heavy menstrual bleeding (menorrhagia) is a traditional contraindication, the formula may worsen blood loss.
- If a lower-abdominal mass grows rapidly or is accompanied by weight loss or postmenopausal bleeding, medical evaluation is required before continuing use.
Related formulas
Other formulas from this text· "Essential Prescriptions of the Golden Cabinet"
Other formulas by this contributor· Zhang Zhongjing
Browse by Pattern
Related concerns
Concern · womens-health
Women's Health
The cluster of complaints that Chinese households often frame around the menstrual cycle: premenstrual mood shifts, breast tenderness, irregular cycles, and post-partum recovery.
Editorial note
Compiled from "Essential Prescriptions of the Golden Cabinet" (200).
Last reviewed: July 18, 2026
Three layers of evidence
Classical source
≈ 1800 years · "Essential Prescriptions of the Golden Cabinet" (200)
Pharmacopoeia indication
"Invigorate blood and resolve stasis, disperse abdominal masses. Used for women with pre-existing abdominal masses, or blood-stasis amenorrhea, menstrual pain, and incomplete lochial discharge after childbirth."
Modern research status
As of 2026-07-18, a PubMed search using the formula name and the Latin / Korean / Japanese transliterations together with "systematic review" and "meta-analysis" did not identify a dedicated systematic review for this formula. Any clinical evidence that does exist is fragmented across small individual trials or covered in broad herbal-medicine umbrella reviews, which do not allow a per-formula evidence assessment; the absence of a dedicated SR is itself the relevant editorial fact here.
References
References reviewed on July 18, 2026 · PubMed search on 2026-07-18
- 01ClassicalZhang Zhongjing, 《金匮要略》 (Jǐn Guì Yào Lüè / Essential Prescriptions of the Golden Cabinet), Eastern Han dynasty, c. 200 CE, with the base formula appearing in clause 2 of the "women's pregnancy" section, the canonical text for the "invigorate blood, transform stasis, gently disperse abdominal masses" approach in gynecology.
- 02TextbookDuan Fuqin (段富津) et al. (eds.), 《方剂学》 (Fāngjìxué / Textbook of Formulas), Shanghai Scientific and Technical Publishers, 1995, the standard modern university-level formula textbook in mainland China, with Gui Zhi Fu Ling Wan analysed as the representative "invigorate blood and dispel stasis" formula for "static blood in the lower jiao" patterns.
- 03PharmacopoeiaChinese Pharmacopoeia Commission, 《中华人民共和国药典》 2020 年版一部 (Zhōnghuá Rénmín Gònghéguó Yàodiǎn, Pharmacopoeia of the People's Republic of China, 2020 Edition, Vol. I), China Medical Science Press, 2020, the official monograph for Gui Zhi Fu Ling Wan / Gui Zhi Fu Ling Jiao Nang dosage forms.