Shi Pi San
Do not self-treat with Shi Pi San
Practitioner-prepared only. How much poison is left depends on how that one root was processed, so the same named formula is not the same strength twice.
If this is an emergency
Some reactions to Shi Pi San need urgent care. Call your local emergency number or go to an emergency department straight away — do not wait to see whether it passes.
Who should avoid Shi Pi San?
- Never take this formula while pregnant: aconite is toxic to an unborn baby and can cause miscarriage.
- Do not use if you are breastfeeding.
- Never give it to a child.
- Never prepare it yourself from raw or unprocessed aconite root, and never take a product that does not state how the aconite was processed.
- Do not use if you have any heart-rhythm problem (an irregular or abnormally fast or slow heartbeat), or if you have had one in the past.
- Do not use if you take digoxin, amiodarone, sotalol, flecainide or any other drug for heart rhythm.
- Do not use if you take diuretics (water pills), corticosteroids (steroid medicines) or lithium.
- Do not use if you have high blood pressure or low potassium (hypokalaemia), because the licorice in it makes both worse.
- Do not use if you have moderate or advanced kidney disease or liver disease, unless a doctor who knows your case is supervising you.
- Do not use if you have a fever, a hot flushed feeling, thirst with a dry red tongue, or swelling that a practitioner has called a heat pattern.
- Do not use if you are taking warfarin or another blood thinner.
- Do not drink alcohol while taking it.
- Do not use if you are about to have surgery: stop at least two weeks beforehand and tell your surgeon.
- Do not use if you have unexplained new swelling that has not been checked by a doctor.
When should you see a doctor?
Stop taking it and get emergency help straight away if you notice tingling or numbness in your lips, tongue, face or fingers, a racing or irregular heartbeat, chest pain, vomiting, severe dizziness or trouble breathing. These can be signs of aconite poisoning, which can be fatal. Take the packet or the leftover herbs with you so the medical team can see what you took.
See a doctor promptly, without waiting, if your swelling gets worse or spreads, if you gain weight quickly over a few days, if you become breathless when lying flat, if you pass much less urine, or if your legs feel weak or crampy.
Book an ordinary appointment if the swelling has not clearly improved after two weeks, if your blood pressure rises, or if you feel generally unwell on the formula.
- What it is: A 13th-century Chinese herbal formula, also called Bolster the Spleen Powder (Decoction), used by practitioners for cold-type swelling from fluid build-up.
- Active ingredients: Prepared aconite root (Fu Zi), Dried ginger (Gan Jiang), White atractylodes (Bai Zhu), Poria (Fu Ling), Magnolia bark (Hou Po), Chinese quince (Mu Gua), Tsaoko fruit (Cao Guo), Areca husk (Da Fu Pi), Costus root (Mu Xiang), Roasted licorice (Gan Cao)
- Side effects: Usually mild stomach upset or dry mouth, but tingling lips, vomiting or an irregular heartbeat mean possible aconite poisoning and need emergency care.
- Pregnancy & breastfeeding: Avoid in pregnancy and while breastfeeding.
Educational information, not medical advice — ask your doctor or midwife.
What is Shi Pi San?
Shi Pi San is a classical Chinese herbal formula. Practitioners use it for long-lasting swelling from fluid build-up (edema). It suits people who also feel cold and tired, with bloating and loose stools.
This entry covers a single drug (TCM formula). It is also known as Bolster the Spleen Powder (Decoction). Another name for it is Shi Pi Yin.
It is a mix of many herbs. One of them is prepared aconite root (Fu Zi), which is toxic if it is not processed and cooked well. That one fact drives most of the safety advice below, and it is why this is not a self-care product.
Now the evidence. This is a well-known traditional formula with centuries of recorded use. But we could not find good published human trials for it.
Long traditional use is not proof that something works. We do not repeat that point in each section below.
How does Shi Pi San work?
In traditional Chinese medicine, the formula is said to warm the "spleen and kidney yang". It is also said to move stuck water, so fluid stops pooling in the legs and belly. That is a traditional model of the body, not a biological explanation.
In modern terms, some herbs have effects you can measure in the lab. Poria is a mild diuretic (it makes animals pass more urine). Aconite alkaloids act strongly on the heart and nerves, and licorice changes salt and potassium balance.
No one has joined this up into a proven mechanism for the whole formula in people. Treat the account above as a working idea, not a fact.
What forms does Shi Pi San come in?
In the past, the herbs were ground to a coarse powder. A set amount was then boiled with fresh ginger and jujube to make a drink. That is where the name "powder" comes from, even though you swallow it as a liquid.
Today you may meet it in a few forms. You may get raw herbs to decoct (boil) at home, under guidance. You may also get a ready-made granule or powder that melts in hot water, or pills and capsules.
Ready-made goods vary a lot in strength. They also vary in how the aconite was processed. Only use a product from a regulated supplier that lists every herb and its amount.
Where it comes from:
Shi Pi San first appears in the Ji Sheng Fang ("Formulas to Aid the Living"). Yan Yong-he wrote it in 1253, during China's Song dynasty. It was set down as a treatment for "yin edema", a cold-type swelling that does not clear with cooling or draining methods.
It has stayed in the standard Chinese formula teaching ever since. Teachers and doctors still use it in China, Japan and Korea today. It is a staple of one tradition, not a remedy shared across many.
What does Shi Pi San help with?
- Long-standing swelling of the legs, ankles or face (edema) with a cold, tired feeling: This is the formula's main traditional use. It was written for swelling that feels cold and heavy. That picture also brings tiredness, loose stools and a pale tongue. We could not find published human trials of Shi Pi San against a dummy treatment for edema. Swelling that lasts more than a few days is a sign of something else. Heart, kidney, liver or vein problems can all cause it, so you need a diagnosis before any herb.
- Fluid build-up in the belly (ascites) linked to liver disease: Practitioners in China use this formula for ascites, usually in a changed form. They add it to normal medical care. Small hospital studies exist in Chinese-language journals, but we cannot verify a trial number for it. Ascites is a serious sign of advanced liver disease. Care means medical drainage, diuretics (water pills) and less salt. Herbs should never take the place of that care.
- Swelling linked to long-term heart failure: Some Chinese practitioners add this formula to standard heart failure care. They use it for cold-type swelling. We cannot point to reliable trial evidence in people. This use carries a real hazard. Aconite alkaloids affect heart rhythm. Licorice can lower potassium, which also affects heart rhythm and can make digoxin (a heart drug) dangerous.
- Swelling linked to long-term kidney disease: Old texts describe the formula for swelling that comes with weak digestion and cold. That picture can overlap with kidney disease. We can cite no dependable human trial evidence. Damaged kidneys clear drugs and plant compounds poorly. So this is one of the riskier places to use a formula that holds aconite.
- Bloating, poor appetite and loose stools with a feeling of cold: Several herbs in the formula are used for bloating and slow digestion. They are magnolia bark, costus root, tsaoko and dried ginger. This use is traditional. Evidence here is traditional and lab-level only. Milder formulas exist for digestive trouble alone. A practitioner would not normally reach for an aconite formula just for bloating.
What are the side effects of Shi Pi San?
- Numbness or tingling of the lips, tongue or fingers: an early warning sign of aconite poisoning; stop at once and get medical help
- Nausea, vomiting or stomach pain
- Palpitations (a racing, pounding or irregular heartbeat)
- Dizziness, blurred vision or feeling faint
- Rising blood pressure, puffy face or ankles, and low potassium from the licorice on longer courses
- Muscle weakness or cramps (a sign of low potassium)
- Dry mouth, thirst or constipation
- Loose stools or extra trips to pass urine
- Allergic rash or itching
Good to know:
Mild digestive upset and dry mouth are the common, minor effects. The serious ones are not common at correct doses of properly processed herbs, but they are severe when they happen.
Aconite poisoning has caused deaths, and cases still occur from wrong processing, overdose, or home-made brews. Tingling or numbness around the mouth, vomiting, or an irregular heartbeat after a dose is an emergency, not a side effect to wait out.
Options to discuss with a clinician
Better-studied routes exist for each of the problems this formula is reached for, and every one of them starts as a conversation with a doctor, pharmacist or qualified herbalist rather than a straight swap.
**Bloating, poor appetite and loose stools.** Options worth raising at that appointment include Peppermint Oil, Ginger, Fennel, a trial of a Low-FODMAP Diet (a short-term eating plan that cuts certain fermentable carbohydrates), Probiotics (Lactobacillus plantarum P8), Bacillus Coagulans, or a Digestive Enzyme Complex. Which of these fits depends on what is actually driving the symptoms, so ask for the cause to be identified first.
**Fluid in the belly (ascites) from liver disease, or swelling of the legs, ankles or face linked to heart failure or long-term kidney disease.** These are not self-treatment problems. New or worsening swelling needs same-week medical assessment, and sudden breathlessness or rapid weight gain needs urgent care. Standard treatment — prescribed diuretics (water tablets), salt and fluid guidance, and treatment of the underlying organ disease — is the route with real evidence behind it. Ask your clinician what gentle Exercise is safe for you alongside that.
Tell whoever you see about every herbal product you are already taking.
Graded pages for the options named above:
- Probiotics (Lactobacillus plantarum P8) — evidence grade C, traditional tier T0
- Digestive Enzyme Complex — evidence grade C, traditional tier T0
- Bacillus Coagulans — evidence grade B, traditional tier T0
- Low-FODMAP Diet — evidence grade A, traditional tier T0
- Peppermint Oil — evidence grade A, traditional tier T2
- Exercise — evidence grade A, traditional tier T3
- Fennel — evidence grade B, traditional tier T0
- Ginger — evidence grade A, traditional tier T3
Review status
This page has not been signed off by a pharmacist and is not published. It is shown here for a policy decision only.