Herb Formulas Notebook

Si Ni Tang

Frigid Extremities 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 Taiyin, Shaoyin or Jueyin disorder; Spleen and 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


Ingredients

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, stops diarrhoea

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



Notes:
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).

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Liu Lihong (2019: 485-492, Classical Chinese Medicine) discusses the importance of licorice in this formula as the Chief Herb. He argues that it's tonifying effect on Earth enables the body to store the Yang and prevent it blazing upwards, akin to using clay to fashion an oven to cook yam properly instead of burning the outside without cooking the middle.

He later (p. 547-8) compares it to the hexagram ䷗, 復 Fu, "Returning", and its associated Earthly Branch 子 Zi, 11 pm - 1 am, and the winter solstice, times when Yang re-emerges from storage. The aim of this formula is to stimulate the Yang to reemerge and it does it though tonifying the ☷Kun, Earth, with its Emperor herb, Zhi Gan Cao, while having Gan Jiang and Fu Zi serving as ministers below, with the nature of ☳ Zhen, Thunder.



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