Herb Formulas Notebook

Si Ni Tang

Frigid Extremities Decoction

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Source: Discussion of Cold Damage (c. 220)
Author: Zhang Ji / Zhong-Jing

Category: Formulas that Warm Interior Cold

Pattern: Cold inversion Shaoyin disorder (Kidney Yang deficiency with internal Cold), Shaoyin type disharmony of Yin Wei Mai and Ren Mai.

Key Symptoms: Extremely cold extremities, aversion to cold, lethargy with a constant desire to sleep
Secondary Symptoms: Lying down in foetal position, vomiting, diarrhoea with undigested food particles, painful and cold abdomen, increased urination, absence of thirst

Tongue: Pale, little or thin white coating
Pulse: Thin, submerged, faint
Abdomen: Weak muscle tone, skin folds can be easily lifted up, splashing sounds

Fu Zi 5-15g
Gan Jiang 5-9g
Zhi Gan Cao 6g

In the UK Fu Zi has to be replaced although no useful substitute can be made in this context making the inclusion of this formula for reference only. For a less severe presentation using the maximum amount of Gan Jiang to warm the middle and adding Gui Zhi to warm the extremities may be possible but this would not be a Shaoyin Cold Inversion pattern.

Preparation: Decoction.

Actions: Rescues devastated Yang, warms the middle Jiao, stops diarrhoea

Contraindications: True heat and false cold (Si ni san presentations)

Research Links:
Science Direct
Google Scholar
Journal of Chinese Medicine
American Dragon

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.