Shi Xiao San失笑散
Sudden Smile Powder
Ingredients2 herbs
Indications
Blood stasis obstructing the vessels. Blood that has left the circulation and congealed both blocks the channel and irritates it, so the same pattern shows pain that is fixed and stabbing and bleeding that will not settle.
Clinical Manifestations
- Stabbing menstrual pain with dark clots
- Retained lochia with lower abdominal pain
- Fixed stabbing pain in the epigastrium or chest
- Irregular menstruation with stasis
- Persistent uterine bleeding mixed with clots
Health Categories
Modern Applications
Common adjustments
- Cold in the lower abdomen — add Rou Gui 肉桂 or Xiao Hui Xiang 小茴香
- Marked qi stagnation with distension — add Xiang Fu 香附 and Yan Hu Suo 延胡索
- Underlying blood deficiency — combine with Si Wu Tang so the moving does not deplete
- Bleeding predominant over pain — use Pu Huang charredand reduce the moving intent
Contraindications
Not appropriate where there is no stasis — pain from deficiency that improves with pressure, or bleeding from heat or qi collapse. Wu Ling Zhi is traditionally held to conflict with Ren Shen and the two are kept apart in one prescription. Heavy or undiagnosed uterine bleeding needs a diagnosis before any blood-moving powder is given.
For licensed practitioners’ reference only — not a self-treatment guide.
Pregnancy
Contraindicated in pregnancy. Both herbs move blood strongly and Pu Huang in particular is classically listed as unsuitable for pregnant women; the combination can provoke uterine contraction and bleeding. Use after delivery only under supervision. The pair also increases bleeding tendency alongside anticoagulant or antiplatelet medication.
Related Formulas
References
Source Tai Ping Hui Min He Ji Ju Fang 《太平惠民和剂局方》 · Song
「治心腹痛欲死，百药不效，服此顿愈。」
- Classical source (public domain) — 《太平惠民和剂局方》, Song dynasty.
2. Scheid, Bensky, Ellis & Barolet. Chinese Herbal Medicine: Formulas & Strategies, 2nd ed. — composition & dosage cross-checked.
3. 《方剂学》（全国中医药行业高等教育规划教材）— 理血剂 · 活血祛瘀, pattern and 配伍 analysis cross-checked.
Professional reference notice. Entries are scholarly references for licensed TCM practitioners and students — not medical advice, and not a recommendation to self-prescribe. Chinese herbal formulas should be used under the guidance of a qualified practitioner. Content is an original editorial compilation by Cura x Cura, cross-checked against the cited references.