From the practitioner letters
What Xiao Yao Wan offers the patient who recovered from the event — but hasn't come back to herself.
Will Sheppy, L.Ac. · Guest contributor · August 2026
There is a patient every acupuncturist knows. The crisis is over. The specialists are satisfied. The numbers look good. And she sits down in your treatment room and tells you, quietly, that she still isn't herself. This week I want to walk through a practitioner letter about exactly that patient — and about the benefits of Xiao Yao Wan, a formula I keep on my own shelf, for the season after a stroke when the body has healed faster than the person.
Dr. Xuelan Qiu — “Dr. Lan” — Botanical Biohacking
Dr. Xuelan Qiu — Dr. Lan — is the pharmacist behind the Botanical Biohacking formulas on the Chorus shelf and in my clinic in Albany, Oregon. She writes to practitioners most weeks. Her August letter was about post-stroke depression, and it made me stop, because she named something I have watched families struggle to name: the recovery chart says finished, and the person in front of you says otherwise.
The short version
Xiao Yao Wan (Xiao Yao San, taken as tea in Purple Star) is a nine-hundred-year-old eight-herb formula traditionally used to support a smoother stress response, steadier digestion, and a mood that has bound up with both. In classical language the pattern is Liver qi constraint with Spleen depletion — common in the long tail of stroke recovery. It supports; it does not replace stroke care or psychiatric care, which continue alongside.
What Dr. Lan described
Her letter opens with a woman six months out from her stroke. Physical therapy is going well. Her neurologist is satisfied. Her family is relieved. And none of that is the whole story.
“The light has gone out of her. The things she used to enjoy no longer reach her. Sleep is heavy but not restorative. She tells you, quietly, that she does not feel like herself.”
— Dr. Lan, Botanical Biohacking practitioner letter, August 2026
Western medicine has a name for this — post-stroke depression, and it is common enough that stroke teams screen for it. Dr. Lan's point is that Chinese medicine has been describing the same patient for centuries, from the other side: not as a chemical deficit but as a pattern of qi that has knotted at the middle of the body, where digestion and mood share an axis.
The pattern behind it
The classical read is Liver qi bound up with a depleted Spleen. In plain language: the system that keeps things moving — emotions, digestion, sleep rhythms — has seized, and the system that generates energy from food has run down underneath it. Each makes the other worse. The stroke amplifies both, because a major injury disturbs the gut and the mood at the same time.
What this pattern tends to look like
- Flat, not frantic. Interest and enjoyment have dimmed rather than mood crashing dramatically.
- Sleep that doesn't restore. Plenty of hours, little repair — heavy sleep, tired mornings.
- Digestion gone cautious. Smaller appetite, heaviness after meals, food that no longer feels reliable.
- Sighing, chest tightness, irritability — the classic signs of qi that cannot move freely.
When it is not this pattern — red flags
- Any new neurological change — sudden weakness, speech change, facial droop, vision loss — is an emergency. Call 911, not an herbalist.
- Thoughts of self-harm deserve immediate human help. In the U.S., call or text 988. Herbs are not the response to a crisis.
- Depression after stroke is a medical condition. It deserves diagnosis and treatment from the stroke and mental-health team. Everything below is support alongside that care, never instead of it.
The formula — Xiao Yao San
The formula the tradition built for this pattern is Xiao Yao San, the Free and Easy Wanderer — written down in the Song dynasty and still one of the most-prescribed formulas in Chinese medicine some nine hundred years later. Eight herbs, in three working groups:
- Chai Hu and Bo He (bupleurum and mint) — release the constrained Liver, get qi moving again.
- Dang Gui and Bai Shao (angelica and white peony) — build and soften the Blood the Liver depends on.
- Bai Zhu, Fu Ling, ginger and Gan Cao (atractylodes, poria, ginger, licorice) — strengthen the Spleen and harmonize the middle.
“The texts named this as Liver-Spleen disharmony nine hundred years before the modern research described the gut-inflammation-brain path underneath it.”
— Dr. Lan, August 2026
A note on names, because readers ask me this constantly: Xiao Yao Wan and Xiao Yao San are the same formula in different preparations — wan means pill, san means powder. On the Chorus shelf it lives as Purple Star, brewed as a daily tea, with one thoughtful adjustment: the Bo He dose is calibrated to soften the headaches Chai Hu can produce in patients with yin or blood deficiency, and the Chai Hu itself is wildcrafted from the Tibetan plateau.
What I see in clinic
When I think about Xiao Yao Wan, I think stress — and I think wiry pulse. Sometimes that strong, stagnant, excess picture is covering up a deficiency underneath, which is very often the case with stroke. That's the part I'd add to Dr. Lan's letter. She describes the pattern as Liver qi bound with a depleted Spleen, and I agree — but the patients I see after a stroke usually walk in looking excessive. Tight. Held. And before you tonify, you have to move that excess. Reach for the tonic first and you can end up feeding something that has nowhere to go.
Which is also how I decide between the two formulas on this shelf. A wiry pulse and a held, tight presentation is a Xiao Yao picture — something to move. If what's actually in front of me is deficiency, with nothing much to move, then Neurogene is the more tonifying choice. Same patient, different month, sometimes different formula.
So with this pattern I think about moving points first. And here I'd part ways with the standard answer: I don't reach for Liver 3 and Large Intestine 4 — the Four Gates — as my blood mover. I use PC 6 with Liver 5 to open the Jue Yin collaterals, and Spleen 6 to nourish. PC 6 and Liver 5 are the connecting points of the two Jue Yin channels, arm and leg, so pairing them opens that layer rather than just pushing qi through it — and Spleen 6 builds underneath while the other two move. It's the more tonifying combination, which is what this patient actually needs. With neurological deficits, the yin channels are curled in and excessively tight, and PC 6 doesn't just stimulate the median nerve and help release that tension — it's a good neurological point in its own right.
Here's what I tell people about the first two weeks. Sometimes you feel like you have more energy. That is not caffeine — there's nothing like that in the formula. It's that when you move more freely and more easily, it feels like more energy, because you're not clenching all the time.
One thing I wrote in my own piece on this formula, and stand by: prescribe the formula and prescribe the conversation. Patients holding this much rarely have anyone in their week who simply asks how they are doing. The formula creates the physiological space; the conversation gives it somewhere to go. I've written more about the everyday version of this pattern — the tired that sleep doesn't fix — on the clinic blog, and about the cyclic edge the Liver pattern often carries in my Glow Tea post.
What the research adds — and what it doesn't
Dr. Lan's letter says published work on Xiao Yao San in post-stroke depression has documented effects on the gut microbiome and gut-to-brain inflammatory signals, and that "in the trial the formula reached the depression at the level a standard antidepressant reached it." I went looking for that trial. Here is what the indexed literature actually holds — it is close to her description, but the pieces live in separate studies, and honesty about that matters more to me than a tidy citation.
- In post-stroke depression specifically, a meta-analysis of seven randomized trials (607 patients) found Xiao Yao formulas improved response rates and depression scores when added alongside antidepressants, with no serious adverse events reported — add-on support, not replacement.1
- The head-to-head result is real but comes from general depression, not stroke: a randomized, double-blind trial of 210 outpatients with mild-to-moderate depression found a Jiawei Xiao Yao preparation performed equivalently to sertraline on the Hamilton depression scale, with faster improvement in anxiety and sleep measures.2
- The gut-microbiome mechanism is laboratory work, not yet human trials: a 2026 multi-omics study found Xiao Yao San reshaped the gut microbiota of stressed mice, and that transplanting the treated microbiota reproduced the antidepressant effect — direct causal evidence for the gut-brain route, in animals.3
How Dr. Lan recommends using it
For the patient who has come back from the stroke but not back to herself, her letter recommends “Purple Star at two bags daily for the first month, then one bag daily for months two and three,” with mood, sleep, and enjoyment re-evaluated at the three-month mark. She pairs it with daily Microgard — her gut-ground formula, which Chorus doesn't currently carry — because the same gut-brain path the formula works on responds to steadier ground underneath.
My additions: work with a practitioner rather than self-prescribing after a stroke — medication interactions are real, and if you take psychiatric or sedative medication, blood thinners, or you're pregnant, that conversation happens first. This is a formula for a pattern, not a diagnosis, and three months is the honest timescale.
Related formulas from the letter: Dr. Lan's footer also names Neurogene Tea — the modified Bu Yang Huan Wu Tang she calls “the recovery base under the mood layer” after stroke — and Microgard and Microgard Plus for the gut ground (not currently on the Chorus shelf). For daily gut ground from the Chorus line itself, Chorus Gut Harmony is the house formula built for that job — a different blend than Microgard, chosen for the same reason Dr. Lan pairs a gut formula under a mood formula. I've also written about Neurogene's pattern on the clinic blog.
References
- Jin X, Jiang M, Gong D, Chen Y, Fan Y. Efficacy and safety of Xiaoyao formula as an adjuvant treatment for post-stroke depression: a meta-analysis. Explore (NY). 2018;14(3):224–229. doi:10.1016/j.explore.2017.12.007
- Su R, Fan J, Li T, et al. Jiawei Xiaoyao capsule treatment for mild to moderate major depression with anxiety symptoms: a randomized, double-blind, double-dummy, controlled, multicenter, parallel-treatment trial. J Tradit Chin Med. 2019;39(3):410–417. PMID 32186013
- Chen Q, Li S, Fu S, et al. Xiaoyao San exerts antidepressant effects via the gut microbiota-brain axis: an integrative fMRI and multiomics study. J Pharm Biomed Anal. 2026;282:117695. doi:10.1016/j.jpba.2026.117695
- Zhang Y, Han M, Liu Z, Wang J, He Q, Liu J. Chinese herbal formula Xiao Yao San for treatment of depression: a systematic review of randomized controlled trials. Evid Based Complement Alternat Med. 2012;2012:931636. doi:10.1155/2012/931636
- Further reading from Valley Health Clinic: Purple Star: For the Tired That Sleep Doesn't Fix · Neurogene Tea · Glow Tea
Questions readers ask
What is Xiao Yao Wan used for?
Traditionally, for the pattern called Liver qi stagnation with Spleen depletion — low mood bound up with stress, unrestorative sleep, and digestion that has gone cautious. It is one of the most-prescribed formulas in Chinese medicine, used to support a smoother stress response rather than to treat any diagnosed disease.
What's the difference between Xiao Yao Wan and Xiao Yao San?
Same eight-herb formula, different preparation: wan is the pill form, san the powder. Purple Star delivers the formula as a brewed daily tea.
How long does Xiao Yao Wan take to work?
Dr. Lan's protocol runs three months, with a re-evaluation of mood, sleep, and enjoyment at the end — and she notes patients often notice sleep improving before the days feel lighter. Classical formulas work in weeks and months, not days.
Does Xiao Yao Wan have side effects?
It is generally well tolerated in the published trials, but Chai Hu can produce headaches in some blood-deficient patients (Purple Star's mint dose is adjusted partly for this reason). If you take psychiatric or sedative medication or blood thinners, are pregnant, or are recovering from a stroke, talk with your practitioner before starting — and never stop a prescribed medication in favor of an herb.
Adapted with permission from a Botanical Biohacking practitioner letter by Dr. Xuelan Qiu (“Dr. Lan”). Will Sheppy, L.Ac., practices at Valley Health Clinic in Albany, Oregon.
These statements have not been evaluated by the Food and Drug Administration. This product is not intended to diagnose, treat, cure, or prevent any disease. Information is educational and does not replace care from your own practitioner.