In today’s fast-paced life, excessive work and life pressures leading to emotional stagnation and liver qi depression have become health concerns for many people, often presenting as chest tightness, irritability, headache and dizziness, distension and pain in the flanks and breasts, loss of appetite, and even menstrual irregularities and alternating chills and fever. At such times, Xiaoyao San becomes the “go-to remedy” for relieving depression in this population.

Xiaoyao San: The "Emotional Regulator" That Soothes the Liver and Relieves Depression

Xiaoyao San was first recorded in the Song dynasty text Taiping Huimin Hejiju Fang; its name is derived from Zhuangzi’s “Free and Easy Wandering,” meaning that by harmonizing the liver and spleen it allows the body’s qi and blood to flow freely so that the body and mind feel comfortable and at ease. Its core actions are to soothe the liver and relieve depression, strengthen the spleen and nourish the blood, and it is mainly indicated for patterns of liver qi stagnation with blood deficiency and spleen weakness.

As the "primary formula for soothing the liver and relieving depression," its combination reflects TCM wisdom: Chaihu (Bupleurum) serves as the chief herb, soothing the liver and relieving depression, unblocking liver qi; Baishao (White Peony) and Danggui (Angelica sinensis) act as deputy herbs, nourishing blood and softening the liver to counteract Chaihu's pungent-drying nature; Baizhu (Atractylodes) and Fuling (Poria) strengthen the spleen and benefit qi, enhancing middle jiao transportation and transformation; Shengjiang (fresh ginger) warms the stomach and harmonizes the middle, dispersing stagnation with a pungent action, while Bohe (mint) assists Chaihu in soothing the liver and releasing constrained heat, together functioning as assistant herbs; Zhigancao (honey-fried licorice) is the envoy, harmonizing the formula and also aiding in promoting discharge. The entire formula soothes the liver, tonifies the spleen, moves qi, and nourishes blood, capable of resolving liver qi stagnation so that qi flow is unobstructed and emotions are regulated.

Modern research corroborates its clinical efficacy: it can modulate neuroendocrine function, exert anxiolytic and antidepressant effects; improve digestive function; regulate female estrogens and progesterone, assisting in the treatment of polycystic ovary syndrome and mammary hyperplasia; inhibit inflammatory factors, delay cellular senescence, and regulate gut microbiota, showing favorable effects in the treatment of psychiatric, gastrointestinal, and gynecological diseases.

Only Truly "Carefree" When Taken for the Right Indication

Although Xiaoyao San has notable effects, it should not be used arbitrarily or abused; it must precisely match the pattern of "liver qi stagnation with blood deficiency and spleen weakness" to achieve its best therapeutic effect.

The indications for Xiaoyao San are emotional depression or irritability, fullness and distention in the chest and hypochondria, poor appetite; fatigue and lack of strength, scanty dark menstrual flow, loose and irregular stools; pale-red tongue with thin white coating, wiry and thin pulse. Correspondingly, Xiaoyao San has the following application scenarios: people in the workplace with long-term emotional suppression and high work stress; patients with premenstrual syndrome who experience breast distention and pain and mood swings 7–10 days before menstruation, accompanied by abdominal bloating and loose stools; menopausal syndrome patients presenting with hot flashes, anxiety, and dyspepsia without signs of yin deficiency with flourishing fire; individuals with chronic fatigue and gastrointestinal dysfunction—fatigue, insomnia, and GI dysregulation caused by long-term stress, after excluding organic disease; skin problems such as chloasma and acne caused by liver qi stagnation. The above populations may reasonably take Xiaoyao San under physician guidance to regulate body and mind.

Three Major Principles for the Use of Xiaoyao San

When the pattern is identified as "liver qi stagnation with blood deficiency and spleen weakness" and there are corresponding indications, Xiaoyao San (pills) may be taken under physician guidance. Use must follow three main principles: precise formula selection, dynamic timing adjustment, and synergistic enhancement.

Precise formula selection: Modify the formula according to symptoms. Xiaoyao San (pills) is suitable for isolated emotional depression with loss of appetite, accompanied by chest and hypochondriac distension, loose stools, insomnia, fatigue, tongue pale-red with teeth marks and thin white coating; Jiawei Xiaoyao Wan (plus Moutan Cortex and Gardenia) is suitable when there are concomitant heat signs (dry mouth, bitter taste in the mouth, irritability/easily angered, tongue red with thin white or yellow coating); Hei Xiaoyao San (plus raw Rehmanniae or prepared Rehmanniae) is suitable when blood deficiency is prominent (pale complexion, dizziness, weakness, tongue pale with little coating).

Dynamic timing adjustment: For regulating menstruation, start 7 days before menstruation and stop on the 2nd day of the period, continue for 3 consecutive cycles; to relieve acute stress symptoms, take continuously for no more than 2 weeks and stop when symptoms alleviate; for chronic regulation use an intermittent regimen of "take 7 days, stop 3 days," with a total course not exceeding 3 months.

Synergistic enhancement: Combine medication with lifestyle interventions, such as drinking rose tea in the morning to soothe the liver, practicing Baduanjin in the afternoon to regulate qi dynamics, and integrating psychological counseling, forming a "medication–exercise–emotion" three-in-one management plan.

Common Misconceptions About Use

Xiaoyao San is a good remedy for soothing the liver and relieving depression, but clinical use requires careful differentiation of constitution and pattern, and avoidance of cognitive misconceptions.

First, the stereotype that Xiaoyao San is “for gynecology only” must be dismantled. Although Xiaoyao San is notably effective for female menstrual disorders, TCM theory emphasizes treating different diseases with the same method and polyvalent use of formulas; it is likewise applicable to various diseases characterized by liver qi stagnation with spleen deficiency. As long as the pattern is liver qi stagnation with spleen deficiency, it is also suitable for men who present with depressed mood accompanied by dyspepsia, hypochondriac pain, abdominal distension, and other symptoms.

Second, be alert to the risk of “long-term dependence.” The formula contains Chaihu, which has dispersing and uplifting properties; continuous use for more than 3 months may deplete yin and blood, producing side effects such as dry mouth and gritty eyes. It is recommended to use it short-term under physician guidance; if long-term use is necessary, consider an intermittent regimen or combine it with Liuwei Dihuang Wan to protect yin and prevent dryness.

Finally, not all emotional problems can be treated with this formula. Misuse in those with yin deficiency and hyperactive fire (red tongue with scant coating, five-center heat) may worsen night sweating and insomnia; in those with internal damp-heat (red tongue with yellow greasy coating, bitter taste, dark urine), using it alone may promote heat from dampness; and patients with organic diseases such as hyperthyroidism or hepatitis who exhibit symptoms of liver qi stagnation with spleen deficiency must first have a clear diagnosis and standardized treatment—blind medication may delay the disease. Only with precise pattern differentiation and dynamic adjustment can its “carefree” effect be safely realized.