Liu Wei Di Huang Wan (六味地黄丸) — Six-Ingredient Rehmannia Pill
Quick answer: Liu Wei Di Huang Wan — "Six-Ingredient Rehmannia Pill" — is the foundational Chinese herbal formula for nourishing Kidney Yin. Liu Wei Di Huang Wan combines three Yin-nourishing herbs (Shu Di Huang, Shan Zhu Yu, Shan Yao) with three gentle-draining herbs (Ze Xie, Mu Dan Pi, Fu Ling) to tonify without becoming cloying. It is used for tinnitus, night sweats, hot flushes[3], dizziness[22], lower back and knee weakness, insomnia[8], low AMH, premature ovarian failure and menopausal Kidney Yin deficiency.
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What is Liu Wei Di Huang Wan?
Liu Wei Di Huang Wan — "Six-Ingredient Rehmannia Pill" — is a Song-dynasty Chinese herbal formula (Qian Yi, 1032–1113 CE) that serves as the foundational formula for nourishing Kidney Yin at all ages, structured around the principle of "three tonifications and three drainages".
Liu Wei Di Huang Wan — Six-Ingredient Rehmannia Pill — is one of the most famous and widely used formulas in the entire history of Chinese herbal medicine. Originally formulated by the Song Dynasty physician Qian Yi (1032–1113 CE), it serves as the foundational formula for nourishing Kidney Yin at all ages and the base from which an entire family of derivative formulas is built — including Zhi Bai Di Huang Wan, Qi Ju Di Huang Wan and Jin Gui Shen Qi Wan. It is structured around the principle of “three tonifications and three drainages” — three Yin-nourishing herbs paired with three herbs that gently drain pathological byproducts to prevent the formula from becoming excessively cloying.
What TCM pattern does Liu Wei Di Huang Wan treat?
Liu Wei Di Huang Wan treats Kidney and Liver Yin deficiency — the pattern of dryness, heat from below, weakness of the lower back and knees, tinnitus, dizziness, night sweats, hot palms and soles, red tongue with little coating, and a thin rapid pulse.
Prescribed for Kidney and Liver Yin deficiency, characterised by: soreness and weakness of the lower back and knees, dizziness, tinnitus, night sweats, heat sensations in the palms, soles and chest, dry mouth and throat particularly at night, a red tongue with little or no coating, and a thin, rapid pulse.
What six herbs are in Liu Wei Di Huang Wan?
Liu Wei Di Huang Wan contains six herbs: Shu Di Huang (prepared rehmannia), Shan Zhu Yu (cornus fruit) and Shan Yao (Chinese yam) to tonify, paired with Ze Xie (alisma), Mu Dan Pi (peony bark) and Fu Ling (poria) to gently drain — the "three tonifications and three drainages" that prevent the formula from becoming cloying.
Shu Di Huang (prepared Rehmannia root, 8-30g)
the principal herb; powerfully nourishes Kidney Yin and Essence
Ze Xie (Alisma plantago-aquatica rhizome, 3-15g)
drains Kidney Dampness and Heat; prevents Shu Di Huang from becoming too cloying
Shan Zhu Yu (Cornus officinalis fruit, 4-20g)
nourishes and astringes the Liver and Kidney; prevents leakage of Essence
Mu Dan Pi (Paeonia suffruticosa root bark, 3-15g)
clears Liver Heat and invigorates Blood
Shan Yao (Dioscorea opposita rhizome, 4-15g)
tonifies Spleen, Lung and Kidney Qi
Fu Ling (Poria cocos, 3-15g)
tonifies Spleen and drains Dampness
What does Liu Wei Di Huang Wan do?
Liu Wei Di Huang Wan has two core actions: it nourishes and tonifies Kidney and Liver Yin, and clears Empty Heat — the heat that rises when Yin can no longer anchor it.
- Nourishes and tonifies Kidney and Liver Yin
- Clears Empty Heat
What conditions does Liu Wei Di Huang Wan treat?
Liu Wei Di Huang Wan is used to treat tinnitus, menopausal hot flushes and night sweats, insomnia, low AMH and premature ovarian failure, lower back pain and knee weakness from Kidney Yin deficiency, and is the parent formula for Zhi Bai Di Huang Wan, Qi Ju Di Huang Wan and Jin Gui Shen Qi Wan.
- Tinnitus and hearing decline from Kidney Yin deficiency
- Menopausal symptoms — the base formula for Kidney Yin deficiency menopause; modified into Zhi Bai Di Huang Wan when Empty Heat is more prominent
- Night sweats, hot flushes and afternoon heat sensations
- Insomnia from Yin deficiency leaving the Shen unanchored
- Low AMH level and premature ovarian failure from Kidney Yin and Essence depletion
- Lower back pain and knee weakness from Kidney Yin deficiency
Contraindicated in patients with significant Spleen deficiency and Dampness, Cold patterns or Yang deficiency as the primary presentation.
Are there any cautions with Liu Wei Di Huang Wan?
Liu Wei Di Huang Wan is contraindicated in patients with significant Spleen deficiency and Dampness, in Cold patterns and in Yang deficiency as the primary presentation. The rich Yin tonics in the formula can burden weak digestion if the underlying pattern is not Yin-deficient.
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References
[3] Li M, Hung A, Lenon GB, Yang AWH. Chinese herbal formulae for the treatment of menopausal hot flushes: A systematic review and meta-analysis. PLoS One. 2019 Sep 19;14(9):e0222383. https://doi.org/10.1371/journal.pone.0222383. PMID: 31536531.
[8] Hu J, Teng J, Wang W, Yang N, Tian H, Zhang W, Peng X, Zhang J. Clinical efficacy and safety of traditional Chinese medicine Xiao Yao San in insomnia combined with anxiety. Medicine (Baltimore). 2021 Oct 29;100(43):e27608. https://doi.org/10.1097/MD.0000000000027608. PMID: 34713840.
[22] Guo Z, Su Z, Wang Z, Luo X, Lai R. The effect of Chinese herbal medicine Banxia Baizhu Tianma Decoction for the treatment of vertebrobasilar insufficiency vertigo: A systematic review and meta-analysis of randomized controlled trials. Complement Ther Med. 2017 Apr;31:27-38. https://doi.org/10.1016/j.ctim.2017.01.004. PMID: 28434468.
How long does Liu Wei Di Huang Wan take to work?
Most patients with mild Kidney Yin deficiency notice improvement in night sweats, dry mouth and lower back ache within 4–6 weeks of daily granule treatment. Deeper menopausal Kidney Yin deficiency requires 3–6 months for substantial change in hot flushes and sleep architecture. The formula works by rebuilding Yin substrate, which is inherently slow — expect gradual progressive improvement rather than rapid relief.
Can Liu Wei Di Huang Wan be taken alongside HRT?
Yes — Liu Wei Di Huang Wan is widely used alongside HRT in TCM clinical practice for the residual Yin-deficient symptoms HRT alone doesn't fully resolve. No clinically significant pharmacokinetic interactions have been reported. Many patients find their HRT dose can be reduced under their GP's supervision as the herbal Yin-nourishing effect takes hold. Always coordinate medication changes with the prescriber.
What is the difference between Liu Wei Di Huang Wan and Zhi Bai Di Huang Wan?
Both are Kidney Yin tonifying formulas with the same six core herbs (Shu Di Huang, Shan Zhu Yu, Shan Yao, Ze Xie, Mu Dan Pi, Fu Ling). Zhi Bai Di Huang Wan adds Zhi Mu and Huang Bai to clear empty heat — use it when Yin deficiency presents with prominent hot flushes, night sweats, agitation or anxiety. Use plain Liu Wei Di Huang Wan when Yin deficiency presents without strong heat features.
Is Liu Wei Di Huang Wan safe long-term?
Yes — for the appropriate Kidney Yin deficient pattern, the formula can be taken daily for 6 months or longer without typical accumulation issues. For continuous use beyond 6 months, periodic review with a qualified herbalist is recommended to confirm the pattern still fits and adjust the formula as the patient changes. Avoid in cold-pattern patients (loose stools, cold extremities, low BBT) as the formula is moistening and can aggravate cold-deficient digestion.
Does Liu Wei Di Huang Wan help with male fertility?
Yes — Kidney Yin deficiency is one of the underlying TCM patterns in male factor infertility, particularly where sperm quality issues, low sperm volume, and reduced semen consistency are seen. Liu Wei Di Huang Wan is often combined with Yang-tonifying additions (Tu Si Zi, Du Zhong) for the typical male fertility formula. Treatment runs for at least one full spermatogenesis cycle (~3 months) to assess response.
