Shi Zao Tang (十枣汤) — Ten-Jujube Decoction

Shi Zao Tang is a classical Chinese herbal formula used primarily for severe pleural effusion — historical/hospital use only. It is prescribed for severe water-Qi excess in the chest, hypochondrium or abdomen:

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Formula actions
5. Conditions treated
6. Cautions
7. Frequently asked questions

Overview

Shi Zao Tang — the “Ten-Jujube Decoction” — is from Zhang Zhongjing’s Shang Han Lun. It is a heroic, powerful formula for severe water excess (xuan yin) — large-volume pleural effusion, ascites, or severe peripheral edema where milder approaches have failed. The name comes from the use of ten jujubes (Da Zao) cooked into the formula to soften and protect the digestion against the harsh purgatives Gan Sui, Yuan Hua and Da Ji.

This formula is rarely used in modern outpatient practice. Severe effusions are managed with diuretics, paracentesis, thoracocentesis or treatment of the underlying disease. It is included here for completeness and historical reference.

I do not generally prescribe this formula in outpatient practice.

TCM pattern

Shi Zao Tang is prescribed for severe water-Qi excess in the chest, hypochondrium or abdomen:

• Severe pleural effusion — chest pain on movement, shortness of breath
• Severe ascites
• Severe generalised edema
• Hypochondriac pain
• Shortness of breath worse on lying flat
• Strong constitution still preserved
• Tongue — slippery white coat
• Pulse — deep, wiry, forceful

Key herbs

1. Gan Sui (Euphorbia kansui, 0.5g) — powerfully purges water; toxic
2. Yuan Hua (Daphne genkwa, 0.5g) — purges water; toxic
3. Da Ji (Knoxia or Euphorbia pekinensis, 0.5g) — purges water; toxic
4. Da Zao (ten large jujubes) — protects Stomach Qi from the harsh herbs

Formula actions

1. Powerfully drives out excess water
2. Protects the middle burner from injury during purgation

Conditions treated

1. Severe pleural effusion — historical/hospital use only
2. Severe ascites — historical/hospital use only
3. Refractory edema in strong constitutions — rare modern indication

Cautions

Heroic, harsh, potentially dangerous formula. Used only by very experienced practitioners in TCM hospital settings, never in outpatient self-prescribed care.

Contains three toxic herbs (Gan Sui, Yuan Hua, Da Ji). Use only properly processed preparations.

Strictly contraindicated in pregnancy, the elderly, weak constitutions, Qi or Yin deficiency, and during acute illness or fever.

Severe pleural effusion and ascites require conventional medical investigation and management. Chinese herbs are an adjunct at most.

This page is for educational reference.

Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide.

Frequently asked questions about Shi Zao Tang

What is Shi Zao Tang used for?

Shi Zao Tang is used for severe pleural effusion — historical/hospital use only, severe ascites — historical/hospital use only, refractory edema in strong constitutions — rare modern indication. The formula targets the underlying TCM pattern producing these symptoms rather than the symptom in isolation, which is why pattern diagnosis by a qualified herbalist is essential.

How does Shi Zao Tang work?

Shi Zao Tang works through the combined action of its constituent herbs, each targeting a different aspect of the underlying TCM pattern.

How long does Shi Zao Tang take to work?

For most patients, an improvement is typically noticed within 2–4 weeks of daily granule treatment. Full benefit usually requires 6–12 weeks, depending on how long-standing the underlying pattern is. Shi Zao Tang is typically prescribed as part of an individualised treatment plan that may include other herbs or adjustments over time.

Is Shi Zao Tang safe in pregnancy?

Strictly contraindicated in pregnancy, the elderly, weak constitutions, Qi or Yin deficiency, and during acute illness or fever. As with any Chinese herbal formula, prescription in pregnancy should only be by a qualified RCHM herbalist with pregnancy training.

Who should not take Shi Zao Tang?

Heroic, harsh, potentially dangerous formula. Used only by very experienced practitioners in TCM hospital settings, never in outpatient self-prescribed care. Contains three toxic herbs (Gan Sui, Yuan Hua, Da Ji). Use only properly processed preparations. Strictly contraindicated in pregnancy, the elderly, weak constitutions, Qi or Yin deficiency, and during acute illness or fever. Severe pleural effusion and ascites require conventional medical investigation and management. Chinese herbs are an adjunct at most. This page is for educational reference. Prefer to be treated from home? Chinese herbal medicine online consultations are available throughout the UK and worldwide. Shi Zao Tang must be prescribed only after full pattern diagnosis by a qualified RCHM herbalist; self-prescription is not appropriate.