Four Subtances Decoction is used to treat patterns of ying-blood deficiency and stagnation manifesting dizziness, blurred vision, palpitations, insomnia, a lusterless complexion, menstrual irregularities, oligomenorrhea or amenorrhea, abdominal pain around the navel or mass (s) formed within the abdomen, a pale tongue, pale lips and nails, a thready, wiry pulse or thready, choppy pulse.
Four Subtances Decoction is the chief formula used to supplement the blood and regulate menstruation. It is modified from Xiong Gui Jiao Ai Tang recorded in《Essentials from the Golden Cabinet》, from which e jiao, ai ye and gan cao are removed. The pattern is caused by ying-blood deficiency with blood stagnation and deficiency of the chong mai and ren mai. Blood deficiency is closely related with the function of the heart and liver. The liver stores the blood; however, it cannot be fully nourished if there is blood deficiency. In a deficient condition, it is unable to send nutrients upward and dizziness will then occur. The heart governs the blood and stores the spirit. In case of blood deficiency, the heart-spirit would be disturbed and manifest palpitations and insomnia. Ying-blood depletion also results in malnutrition of the face, lips, tongue, and nails, so they appear pale and lusterless. The chong mai acts as the sea of blood and the ren mai is in charge of the uterus and pregnancy. Deficiency of the chong mai and ren mai, together with liver-blood insufficiency and blood stagnation, leads to menstrual irregularities such as scanty menstruation, pale menses, early or delayed menstruation, or even amenorrhea. The blood vessels are not fully-filled and blood stasis forms easily. Therefore patients with this condition suffer from abdominal pain or hard mass formation. The thready, wiry and thready, choppy pulses indicate deficiency and stagnation of ying-blood. The treatment prioritizes supplementation and nourishment of the ying-blood as the primary objective and harmonizing the blood vessels as the supportive, secondary objective.