Gui Zhi Fu Ling Wan (桂枝茯苓丸) — Cinnamon Twig and Poria Pill
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Overview
Gui Zhi Fu Ling Wan is the classical Chinese herbal formula for invigorating Blood and resolving Blood stasis in the uterus and lower abdomen. Originating from Zhang Zhongjing’s Jin Gui Yao Lue, it is one of the most precisely targeted Blood-moving formulas in TCM, specifically for masses, pain and abnormalities arising from Blood stasis accumulating in the Chong and Ren channels that govern the uterus. In contemporary clinical practice it is the most widely prescribed Chinese herbal formula for gynaecological Blood stasis conditions.
TCM pattern
Prescribed for Blood stasis in the Uterus, characterised by: fixed abdominal masses, painful periods with dark clotted blood, persistent lower abdominal pain that is fixed and worsened by pressure, a purple or dusky tongue, and a deep, choppy (Se) or wiry pulse.
Key herbs
- Gui Zhi (Cinnamomum cassia twigs, 2-12g) — warms the channels and invigorates Blood circulation in the Chong and Ren channels
- Fu Ling (Poria cocos, 2-15g) — tonifies Spleen and resolves Dampness
- Mu Dan Pi (Paeonia suffruticosa root bark, 2-12g) — clears Blood Heat, invigorates Blood and disperses stasis
- Chi Shao (Paeonia lactiflora root, red, 2-12g) — invigorates Blood, disperses stasis and alleviates pain
- Tao Ren (Prunus persica seed, 2-12g) — the most potent Blood-moving herb in the formula; breaks up Blood stasis and softens hardness
Formula actions
- Invigorates Blood
- Transforms Blood stasis
- Reduces fixed abdominal masses
TCM patterns and conditions where it is used
The formula is used for the TCM pattern of Blood stasis in the Uterus with fixed abdominal masses. The presentations within that pattern include:
- Uterine fibroids — systematic review of 38 RCTs (n=3,816) reported that Guizhi Fuling Formula plus mifepristone was associated with greater reductions in fibroid volume than mifepristone alone in the trials studied[1]
- Endometriosis-pattern Blood stasis with fixed-position pain and menstrual irregularity
- Dysmenorrhoea with dark, clotted blood from Blood stasis in the Uterus
- Ovarian cyst pattern from Blood stasis accumulation
- PCOS-pattern presentations with Blood stasis component — in TCM, this overlay can present with irregular cycles and follicular cysts
- Post-partum Blood stasis — retained lochia or post-partum fixed abdominal pain
Contraindicated in pregnancy. Use with caution in patients with significant Qi or Blood deficiency without Blood stasis.
Cautions
Always consult a qualified Chinese herbalist registered with the Register of Chinese Herbal Medicine (RCHM). Online herbal consultations are available. See the prices page for costs.
Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide. After a full video consultation, Dr (TCM) Attilio D'Alberto formulates a bespoke herbal prescription and posts your Chinese herbs directly to your door.
References
[1] Chen NN, Han M, Yang H, Yang GY, Wang YY, Wu XK, Liu JP. Chinese herbal medicine Guizhi Fuling Formula for treatment of uterine fibroids: a systematic review of randomised clinical trials. BMC Complement Altern Med. 2014 Jan 2;14:2. https://doi.org/10.1186/1472-6882-14-2. PMID: 24383676.
How does Gui Zhi Fu Ling Wan work for fibroids?
Gui Zhi Fu Ling Wan targets the underlying Blood stasis pattern that drives fibroid formation. The formula combines warming Yang-supporting herbs (Gui Zhi, Mu Dan Pi) with Blood-moving herbs (Tao Ren) and Damp-resolving herbs (Fu Ling), addressing the stagnation-and-accumulation pattern that classical TCM identified as the root of fixed abdominal masses. Modern research has documented reductions in fibroid volume when the formula is combined with mifepristone, alongside symptom improvements in heavy bleeding and dysmenorrhoea.
How long until Gui Zhi Fu Ling Wan reduces fibroid size?
Substantial fibroid volume reduction typically requires 6–12 months of consistent treatment combining Gui Zhi Fu Ling Wan with weekly acupuncture and lifestyle measures. Symptom improvement (reduced bleeding, less dysmenorrhoea, less abdominal pressure) usually appears within 2–3 menstrual cycles. For large or rapidly growing fibroids, gynaecological assessment for surgical or pharmacological intervention may still be needed alongside the herbal treatment.
Can Gui Zhi Fu Ling Wan help endometriosis?
Yes — endometriosis shares the Blood-stasis pattern that Gui Zhi Fu Ling Wan targets. The formula is one of the most frequently prescribed Chinese herbal formulas for endometriosis-related pain and infertility. It works alongside (not instead of) the gynaecology team's medical or surgical management. Most patients see meaningful pain reduction within 8–12 weeks of daily treatment.
Is Gui Zhi Fu Ling Wan safe in pregnancy?
No — Gui Zhi Fu Ling Wan is contraindicated in pregnancy because of its Blood-moving action which can theoretically increase bleeding and miscarriage risk. The formula is used pre-conception for fibroids and endometriosis but stopped at positive pregnancy test, replaced with pregnancy-safe Yin-and-Blood-nourishing formulas like Tai Shan Pan Shi San (Mount Tai Stability Powder).
Can Gui Zhi Fu Ling Wan be taken alongside hormonal medication for fibroids?
Yes — the formula has been studied in combination with mifepristone (RU486) in fibroid trials and showed enhanced volume reduction compared with mifepristone alone. Combination with GnRH analogues (Zoladex) and other hormonal therapies appears safe with no documented clinically significant interactions. Always disclose all herbs to your gynaecologist for coordinated care.
