The Health Benefits of Xiao Yao Wan

Xiao yao wan is an herbal blend used for centuries in traditional Chinese medicine (TCM) to improve mood, reduce stress, and ease digestion. Also known as xiao yao san, Free and Easy Wanderer, and Relaxed Wanderer, the blend is a popular dietary supplement.

Xiao yao wan blends can vary from brand to brand, though the formula commonly studied contains the following:

• Bupleurum (chai hu)
• Dong quai (dang gui)
• White peony root (bai shao)
• White atractylodes (bai zhu)
• Poria (fu ling)
• Peppermint (bo he)
• Ginger root (sheng jiang)
• Licorice root (zhi gan cao)

Another variation called jia wei xiao yao san contains all eight herbs with the addition of peony bark and gardenia fruit.

Health Benefits

Although xiao yao wan has a long history of use in Eastern medicine, there is limited research proving its effectivenes.

In TCM, xiao yao wan is believed to work by clearing liver stagnation to improve qi (energy flow). Stagnant liver qi is said to affect the blood and may contribute to mood swings, pain, irritability, constipation, abdominal pain, premenstrual syndrome (PMS), and irregular menstrual periods.

Depression

In TCM, xiao yao wan is used for depression and other mood disorders, but there is limited research in humans to support this. An animal study published in Phytotherapy Research suggests that xiao yao wan may help relieve depression by improving amino acid metabolism and altering gut microflora.

A review published in Evidence-Based Complementary and Alternative Medicine included 26 randomized control trials involving 1,837 people with depression. The studies compared xiao yao wan to a placebo, different antidepressants, or as an adjunct to antidepressants.

According to the study authors, the current research is poorly designed and more rigorous trials are needed before xiao yao wan can be recommended to treat depression.

PTSD

A handful of studies have looked into the effect of the xiao yao wan blend Free and Easy Wanderer on post-traumatic stress disorder (PTSD), but so far, the research is limited. 

In 2009, researchers discovered the blend decreased anxiety behaviors in stress-induced rats. A later study linked these anti-PTSD effects to the neurosteroid allopregnanolone, a natural hormone derived from progesterone that was previously identified as a key player in the development of PTSD. Again, using stress-induced rats, researchers found Free and Easy Wanderer not only reduced anxiety behaviors, but it also increased brain levels of allopregnanolone. 

Xiao yao wan's anti-inflammatory compounds, including paeoniflorin and isoliquiritin, may be the key to its beneficial impact on PTSD, according to a 2017 study. Researchers found these compounds, previously shown to relieve depression, impact neurobiological pathways associated with PTSD symptoms.

In addition, a 2017 study found the blend counteracts oxidative stress using similar pathways as the antidepressant fluoxetine, a common PTSD treatment. 

While it is too early to say for certain that xiao yao wan can be used to treat PTSD, the current research suggests it is promising.

Stress

Research investigating xiao yao wan's effect on stress is limited to rodent studies. The stress hormone cortisol impacts neurons in the hippocampus responsible for concentration, memory, and mood. One study on rats found xiao yao wan appears to protect against these negative effects of stress.

Although the herbal blend is sometimes touted as a stress reliever, more evidence is needed to support this claim.

Indigestion

Xiao yao wan is used traditionally to soothe a sour stomach. Current research suggests the herbal blend helps to relieve functional dyspepsia, also known as chronic indigestion.

According to a review of 14 studies published in the Journal of Gastroenterology and Hepatology, xiao yao wan may help to relieve stomach discomfort, nausea, bloating, and belching associated with indigestion.

Investigators noted that the herbal preparation appears to work as well as prokinetic drugs—medications that increase intestinal motility, such as Motilium (domperidone) and Reglan (metoclopramide).

A 2018 review of Chinese herbal medicine remedies for indigestion also confirmed these results and suggested xiao yao wan was more effective than prokinetic medications.

Possible Side Effects

Xiao yao wan is generally regarded as safe and non-toxic. Reported side effects from individual herbs in the blend include: 

• Cramps (licorice root) 
• Dizziness (licorice root)
• Edema (licorice root)
• Headache (licorice root)
• High blood pressure (licorice root)
• Low blood sugar (poria)
• Lactation in non-lactating women (licorice root)
• Numbness (licorice root)
• Stomach discomfort (dong quai)
• Weakness (licorice root)

Contraindications

Each herb in the blend is considered safe, though some contraindications apply for individual ingredients at certain doses. If you have any of the following conditions, talk to your doctor before taking xiao yao wan: 

• Pregnancy: Dong quai can stimulate uterine contractions and should not be taken during pregnancy except under the guidance of a doctor or midwife trained in TCM.
• Cardiovascular disease: Two ingredients in xiao yao wan are not recommended for people with cardiovascular disease—licorice root, which raises blood pressure, and poria, which has a diuretic effect.
• Kidney disease: Similarly, licorice root and poria are not recommended for people with kidney disease.
• Diabetes: Poria should not be taken at the same time as blood-sugar-lowering medications such as insulin as it can cause low blood sugar.

In addition, licorice root is not recommended in people over the age of 65. Longterm use of the herb can cause high blood pressure and lower potassium levels, potentially leading to heart and muscle problems.

Selection, Preparation & Storage

Sold as Free and Easy Wanderer, Relaxed Wanderer, xiao yao san, and xiao yao wan, the herbal blend is available as capsules, tinctures, and teapills (pea-sized balls of compressed herbal formulas used in Chinese medicine) and can be found at natural-food stores, stores specializing in herbal remedies, and online.

Ingredient labels and supplement facts labels may be provided on the bottle that you buy, however, many brands list only a proprietary blend or list ingredients in Chinese.

Dietary supplements are largely unregulated and the content of any product may differ from what is specified on the product label. In some cases, the product may have doses different from the specified amount for each herb.

Other Questions

What are teapills and how are they taken? 

Xiao yao wan and other Chinese herbal medicines are often sold as teapills, which are a combination of herbal extracts compressed into small, pea-sized balls. Teapills are swallowed whole, but because they are so small, a standard dose commonly comprises multiple teapills taken three times a day. Always follow the manufacturer's instructions when taking teapills or other herbal supplements. 

Does xiao yao san relieve PMS? 

Commonly marketed as a remedy for premenstrual syndrome (PMS) symptoms, there is currently no evidence to support its use. One study published in the journal BMC Complementary and Alternative Medicine found jia wei xiao yao san is the most prescribed herbal formula for PMS in Taiwan. However, the study authors note there is a lack of published research on its safety or effectiveness in treating PMS.

A Word From Verywell

Currently, there is not enough research to support the use of xiao yao wan as a treatment for any medical condition. If you're considering taking xiao yao wan, consult your health care provider. More and more primary care physicians are becoming familiar with herbal medicine, however, it may be advised to consult a licensed TCM practitioner.