Spotlight on Xiao Yao San: A Stress Support Ally from TCM*

Daily stress has always existed and been experienced by all lifeforms. We cannot outrun it because it continues to evolve with us. Some would even say it drives evolution itself. In ancient times, our hunter-gatherer ancestors experienced the stress of having to run away from predatory animals to avoid being attacked or eaten. In the current technological age, we experience the daily stress of multi-tasking, managing our social media accounts and juggling work-life balance. Although each of us have varying capacities for handling daily stress, none of us are exempt from it.



How to Reduce Stress with TCM

Everyday and occasional stress not only negatively affects our mental and emotional well-being. Much research now shows that it is also detrimental to other aspects of our health, such as, but not limited to, our immune, digestive and circulatory systems. According to Traditional Chinese Medicine (TCM) theory, issues can arise from one of three origins:

  • external factors
  • internal factors
  • lifestyle

As a mental-emotional state, daily stress is internally generated, even though it may be in response to external stressors. In a stressful state, the body's qi becomes constricted and loses its ability to flow freely. Consequently, because qi is the commander of blood, the flow of blood also becomes sluggish. When the free flow of qi and blood become obstructed, countless other issues arise. Therefore, Xiao Yao San has a wide range of applications, from everyday stress management to gynecological support, and is one of the most commonly used TCM herbal formulas.* It can also be used in conjunction with TCM calming techniques, tai chi, etc.

The History of Xiao Yao San

In order to fully appreciate the spirit of this beautifully balanced formula, we must also understand its origin and history. The use of Xiao Yao San was first recorded in the medical text Tai Ping Hui Min He Ji Ju Fang (Imperial Grace Formulary of the Tai Ping Era) during the Song Dynasty (960-1279 AD). However, its name dates back to 310 AD during the period of great Taoist influence in China, when many herbalists were also alchemists who sought immortality through various practices of meditation, physical exercises that we now know as qi gong (for stress management, it’s quite helpful!) and ingestion of alchemical substances.

Xiao Yao San, also translated as “Free and Easy Wanderer,” got its name from the teachings of the great Taoist philosopher Zhuang Zi (365-290 BC). The first chapter, Xiao Yao, of his book was a collection of short stories that encouraged readers to think outside of the rigidity of the cultural norm and live in harmony with the free flow of life, the Tao.

The philosophical embodiment of this formula can best be described by Buddhist philosopher Zhi Dun (314-366 AD) in his commentary on Xiao Yao:

"Free and Easy Wandering refers to the mind of the perfected...The perfected one rides the truth of heaven, soars aloft, and wanders boundlessly in unfettered freedom. He treats beings as beings without being treated as a mere being himself. He is not self-satisfied in his wandering. Mystically one with the universe, he does not act purposefully. He is not hurried, yet moves swiftly. He goes everywhere in his freedom. He is truly a free and easy wanderer."

Though not one of the Five Emotions with a corresponding element, daily stress relates to the Wood element and the Liver organ, which govern the free flow and proper expression of all emotions. For this reason, Xiao Yao San is often prescribed for stress management, occasional anxiety and occasional low mood caused by Liver qi stagnation with blood deficiency. This herbal formula is made up of eight herbs that work synergistically to relieve the constraint of Liver qi, encourage free-flow of the Wood energy, harmonizes the functions of Liver and Spleen and nourish blood.

According to Subhuti Dharmananda, modern TCM scholar and Director of the Institute for Traditional Medicine, this formula helps one to “overcome the ingrained personal approach of clashing with, rather than flowing around, a difficulty that is encountered” and allows for the “ability to move and change to overcome obstacles.”

The Chinese Herbs for Relaxation in Xiao Yao San

The formula includes some common Chinese herbs for relaxation. The chief herb, Chai Hu, relieves constraint and spreads Liver Qi. Dang Gui (Chinese Angelica Root) and Bai Shao (White Peony Root) further assist Chai Hu in smoothing the flow of Liver qi by moistening and softening functions and nourishing the blood. The common coupling of Fu Ling (Poria) and Bai Zhu (Atractylodes Root) functions to tonify the qi of the Spleen, the organ that is responsible for proper circulation of the body's fluids and transformation of food into blood.

Malfunction of the Spleen results in the accumulation of pathological fluids, also called dampness, and blood deficiency. Zhi Gan Cao (Honey-fried Licorice Root) is a slightly sweet and mild tonic, which is often used to harmonize the actions of the other herbs in the formula. In this formula specifically, it harmonizes the Liver and the Spleen. The last two herbs, Bo He (Mint Leaf) and Wei Jiang (Roasted Ginger Root) serve as envoys to support the functions of the Liver and Spleen, respectively. Bo He is slightly bitter and cool, so can disperse depressive Liver heat, and enhances Chai Hu’s ability to spread Liver qi.

Wei Jiang is hotter and more drying than Sheng Jiang, so enhances the Spleen’s ability to resolve dampness and harmonizes the qi of the Stomach to arrest rebellious qi. If there is external qi constraint, Sheng Jiang (Fresh Ginger Root) can be substituted for Pao Jiang. The combination of Chai Hu, Bo He, and Sheng Jiang relieves the constrained qi at the body’s surface.

Variations on Xiao Yao San

Another way to view Xiao Yao San is as a variation of Si Ni San (Frigid Extremities Powder), which contains three herbs that can be found in Xiao Yao San, with the addition of Zhi Shi (Unripe Bitter Orange) to relieve qi stagnation in the middle burner and strengthens the functions for the Spleen. Similarly to Xiao Yao San, Si Ni San is prescribed for the pattern of Liver qi stagnation. The differentiating factor is that Si Ni San is indicated when the Liver qi constrains the yang from spreading to the extremities, so the hands and feet will feel cold when the body feels warm of even hot. It also has a stronger ability to disperse qi than Xiao Yao San, but lacks the blood nourishing properties of the larger formula.

The most common variation of Xiao Yao San is Jia Wei Xiao Yao San (Augmented Free and Easy Wanderer). Sometimes also called Dan Zhi Xiao Yao San, due to the addition of Mu Dan Pi (Moutan Root Bark) and Zhi Zi (Gardenia Fruit), this formula is indicated when depressive heat is also present. Not surprisingly, the two added herbs clear heat that has been generated by Liver qi constraint. Chi Shao (Red Peony Root) is often substituted for Bai Shao because it has a stronger ability to clear heat.

This augmented formula is more commonly used than Xiao Yao San in Japan. The renowned Japanese Kampo physician Shiro Hosono explains its popularity through the relationship between blood deficiency, dryness, and heat:

“The well-nourished blood (the yin aspect) can restrain heat (the yang aspect); in return, the well-directed heat circulates the blood and prevents it from coagulating. In this case, the blood is insufficiently nourished and the heat is agitated and alternately constrained or rushing out without direction. Thus, the blood and heat (yin and yang) are in conflict rather than harmony. From the philosophical viewpoint, the heat represents the struggling with obstacles while the blood deficiency represents the failure to cultivate wise ways. The two are interconnected; wisdom releases one from struggling; relaxing the struggle gives one a chance to cultivate wisdom.”

Another common variation of Xiao Yao San is Hei Xiao Yao San (Black Free and Easy Wanderer), named for the addition of Shu Di Huang (Prepared Rehmannia) due to its black color. This formula is indicated when there is more severe blood deficiency than exists in Xiao Yao San. The original modification called Sheng Di Huang (Raw Rehmannia), but this form is rarely used unless heat is also present. The two envoy herbs, Bo He and Sheng Jiang are also now omitted.

Due to its efficacy and broad range of application for many health conditions, Chinese herbal medicine has gained popularity in throughout the world. To stay current with the times, many herbal formulas have been adapted from their original form to suit the preferences and conveniences of the consumers. Although Xiao Yao San and its variations were first formulated as medicinal powders (san), they can now be consumed as decoctions (tang) and pills (wan). However, these offerings are not unique to Xiao Yao San, but also apply to other Chinese herbal formulas as well. So, as the demands of the modern world continue to exert stress upon us each day, TCM will continue to evolve alongside it in order to help us maintain health and wellness.


Natha Surinsuk, born and raised in Thailand, received a B.S. in Psychobiology from the University of California, Los Angeles. Passionate about Eastern Medicine and helping others, Natha went on to complete her Masters of Science in Traditional Oriental Medicine at the Pacific College of Oriental Medicine (now Pacific College of Health and Science). She currently practices in the South Bay area of southern California.