Herbal medicine

Is Xiao Yao San (Rambling Powder) over-prescribed?

Harmonizing is the central focus of the most-prescribed herbal formula (in the US) Xiao Yao San, for good reason. In both TCM and 5E, the Wood – Earth dynamic is the cog-wheel of daily life. It’s the engine that keeps it all going, the Gu qi / Spleen qi that is a foundation for every other function: building blood, circulating blood and qi, maintaining yin and yang. The Liver keeps that energy going everywhere that it needs to go, in the amount it needs to and on schedule; a smooth flow.

The Ping Wei Lun (Treatise on Spleen and Stomach) and the older 5E models put the earth element center stage. It is production and production needs distribution. That’s a foundational daily relationship, the work, done by the Wood and Earth elements.


I do not think harmonizing formulas like Xiao Yao San are overprescribed. (I may have gasped and clutched my pearls when I heard this. Seriously? I think it should be put into the water supply every spring.) Our culture is set up to tax the Earth element while giving it less than quality support (e.g. overwork, inadequate sleep, poor quality nutrition) while also taxing the Wood element (all the environmental ‘stuff’ in our systems that didn’t used to be there plus very different work environments, less physical movement, etc.)


I recently told a fellow herbalist that probably 75% of herbal formulas I prescribe over the years could or do have a foundation of Xiao Yao San, with modifications. I stand by that. If you try to do other things without making sure your central energy production and distribution isn’t fully functional, then the friction from that system can just keep standing in the way of balance, or be the source of imbalance. 


An example is the work of Will McLean, who has studied inflammation and auto-immune conditions. With inflammation there is heat, but what is the source of this mysterious heat? Clearing heat alone doesn’t work because it keeps reappearing, and often this inflammation that often shows up can be from the friction caused by the disharmony between the Wood and Earth elements. I have seen this in my practice and in life. Clearing that kind of heat doesn’t get you anywhere–you keep clearing heat and just pops back up again. But if you harmonize while you clear heat, using something like Jiao Wei Xiao Yao San, you may just need Xiao Yao San with less heat clearing after a while.


I almost always modify Xiao Yao San for the individual. I have a contentious relationship with Chai hu bupleurum, the main liver qi mover in Xiao Yao San. I think culturally our energy is too ‘vata’, too upward moving and that a better option is Xiang fu cyperus. While Chai hu moves Liver qi with a distinctly vertical, upward and outward energetic, Xiang fu moves Liver qi in a circular way, on the horizontal more than the vertical. With Wood and Earth energies in the middle jiao, to me it makes sense that the middle is where the movement needs to happen. Maybe the earth element likes that circular energetic as well? Who knows. If you need some upward and outward movement, Bo he mint is still in the formula to do that in a much lighter way.


With blood building, qi building and qi moving already built into the formula, additions can help the formula go even further. Need more blood and yin? Add in another herb like Gou qi zi goji berry or a western herb like milk thistle. Has the Liver qi stagnation distressed the heart? Add a dui yao combo to calm the shen. If heat has built up anywhere, switch to Jia Wei Xiao Yao San, also known as Dan Zhi Xiao Yao San. Mu dan pi and Zhi mu clear the heat caused by the friction and stress between the wood and earth elements.


 Xiao Yao San is a formula that can tonify qi and blood and move qi, and with easy modifications can treat other patterns of disharmony without losing the elegance of the formula. While sometimes it can be a good idea to clear out the excesses to see the real picture lying underneath, patients also like feeling the support of appropriate tonification. In a case with lots of excesses I might use Yue Ju Wan to clear for a week or two, but much more often I turn to clearing and tonifying simultaneously, with, you guessed it, a modified Xiao Yao San.


 Xiao Yao San may seem over-prescribed to some, but it is also answering the problem of how to find balance, support and ease in our modern culture. Obviously it isn’t the answer for every person, but with a complex presentation involving deficiency and stagnation, it can be a solid foundation to build on.

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