Herb Formulas Notebook

Si Ni San

Frigid Extremities Powder


Author: Zhang Zhong-Jing, 張仲景

Year: c. 220

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


Category: Formulas that Harmonise

Pattern: Shaoyang Heat inversion due to internal constraint of Qi

Key Symptoms: Cold and clammy fingers and toes while the body and head are warm, anxiety and irritability, abdominal distention and pain
Secondary Symptoms: Fullness in the chest and epigastrium, palpitations, insomnia, fatigue, frequent sighing or taking deep breaths, depressive moods, cough, alternating constipation and diarrhoea, nausea, urinary difficulty

Tongue: Red with yellow coating
Pulse: Wiry
Abdomen: Focal distention in the epigastrium, noticeable tension in rectus abdominis muscle, fullness and distention in hypochondrium


Ingredients

Chai Hu 9-12g
Zhi Shi 9-12g
Bai Shao 12-24g
Zhi Gan Cao 6-9g


Preparation: Source text advises to grind into a powder and take in 6-9g doses three times a day. Normally prepared as a decoction today.


Actions: Vents pathogenic Qi, releases constraint, spreads Liver Qi, regulates the Spleen

Contraindications: Qi constraint associated with Yin deficiency, long term use



Notes:
Si Ni San contains Shao Yao Gan Cao Tang which is used to help with cramps and spasms of skeletal and smooth muscle, with the addition of Zhi Shi that assists its action to move Qi downwards through the digestive tract and break up stagnation in the channels, and Chai Hu that raises Qi helps with stifling sensations in the chest and irritability. This upward and downward motion of these two extra herbs help to reinstate the Qi mechanism.

A review by Ling et al. (2015) found that Si Ni San helped multiple GI disorders through several common mechanisms: maintaining the normal function of the sphincters, preventing reflux and subsequent dysbiosis; alleviating emotional irritation that leads to gut irritation through the gut-brain axis and hormonal mechanisms; and improvement of GI microcirculation.

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Ploberger (2017), in Westliche und traditionell chinesische Heilkräuter, offers the following alternative using western herbs:

Herba Alchemillae(Lady's Mantle)3g(Emperor)
Herba Millefolii(Yarrow)3g(Emperor)
Pericarpium Citri ret.(Orange peel)3g(Minister)
Radix Paeoniae alba(White Peony)3g(Assistant)
Radix Glycyrrhizae(Licorice root)3g(Envoy)



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.