Herb Formulas Notebook

Si Ni Jia Ren Shen Tang

Frigid Extremities plus Ginseng Decoction


Author: Zhang Zhong-Jing, 張仲景

Year: c. 220

Source: Discussion of Cold Damage (Shang Han Lun, 傷寒論)


Category: Formulas that Warm Interior Cold

Pattern: Cold Inversion Shaoyin disorder injuring the Yin and Blood and harming the Yuan Qi.

Key Symptoms: Extremely cold extremities, aversion to cold, lethargy with a constant desire to sleep, breathlessness
Secondary Symptoms: Lying down in foetal position, vomiting, 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


Ingredients

Ren Shen 3-9g
Fu Zi 5-15g
Gan Jiang 5-9g
Zhi Gan Cao 6g

Subsitutions:
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, nourishes the Yin and Qi.

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



Notes:
This formula is designed for a Si Ni Tang presentation when the diarrhoea ceases but the extremities remain cold. It is also often used for Si Ni Tang patterns with breathlessness.

---------------------------------------

One liang is taken as 3g in modern sources but in Eastern Han times it was equivalent to 13.875g. This means that the dosages in classical formulae could have been more than 4x what is given today making them far higher than recommended safe dosages today but prompts consideration of what an effective dose may be (He, 2013).



Research Links:



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.