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
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Chai Hu
| 9-12g | |
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Pinyin: Chai Hu
Chinese: 柴胡
Pharmaceutical: Radix Bupleuri
Taxonomy: Bupleurum chinense (Nan Chai Hu) seu scorzoneraefolium (Bei Chai Hu)
English: Hare's Ear Root / Thorowax Root |
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Tastes: Bitter, pungent, slightly cold
Meridians Entered: Liver and Spleen |
Actions & Indications:
- Resolves Shaoyang disorders and reduces fever (harmonizes the Exterior and Interior)
Shaoyang Stage with alternating chills and fever, a bitter taste,dizziness, tinnitus, flank pain, irritability, vomiting and a stifling sensation in the chest
Deficiency Heat (auxiliary)
Gallbladder Fire
- Spreads Liver Qi and relieves Stagnation
Liver Qi Stagnation with dizziness, vertigo, chest and flank pain, emotional instability and menstrual problems
Disharmony between the Liver and Spleen with epigastric and flank pain, a stifling sensation in the chest, abdominal bloating, nausea and indigestion
Liver/Gallbladder Disharmony
- Raises Yang Qi (specifically the Clear Qi of the Stomach and Gallbladder)
Spleen and Stomach Yang Deficiency, Qi collapse (prolapse) with hemorrhoids, vaginal discharge, bleeding or exhaustion
- Disperses Wind-Heat and resolves Phlegm and congestion
Wind-Heat
- Guides herbs to the Shaoyang aspects of the head
Shaoyang headaches
- Releases the Exterior and Drives Out Snakes
Relieves the symptoms of Gu Sydnrome while suppressing parasites (Fruehauf, 1998)
Chronic inflammatory disease (Fruehauf, 2015)
- Aids fasting
Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light brighten the eyes and boost the Essence. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
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Standard Dosage: Up to 3g to raise sinking Qi, 6-9g to relieve Liver Qi stagnation, 12-24g to release the exterior.
Cautions: Anyone who has syndromes of yin deficiency with yang hyperactivity, stirring of liver wind, yin deficiency with effulgent fire and qi going upward adversely, this herb should be used with cautions. |
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Zhi Shi
| 9-12g | |
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Pinyin: Zhi Shi
Chinese: 枳实
Pharmaceutical: Fructus Aurantii Immaturus
Taxonomy: Citrus aurantium
English: Immature Seville Orange / Immature Bitter Orange / Immature Sour Orange |
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Tastes: Pungent, bitter, slightly cold
Meridians Entered: Spleen, Stomach and Large Intestine |
Actions & Indications:
- Breaks up Stagnant Qi, reduces accumulation, descends Qi, unblocks the bowels and removes Stagnant Food
Qi Stagnation and accumulation with epigastric or abdominal pain and distention or indigestion with focal distention or gas
Food Stagnation
- Transforms Phlegm, reduces distention and resolves hardenings
Turbid Phlegm Obstructing the Qi with focal distention and fullness in the chest and epigastrium
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Standard Dosage: 3-10g in decoction.
Cautions: It should be used with cautions for pregnant women. |
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Bai Shao
| 12-24g | |
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Pinyin: Bai Shao
Chinese: 白芍
Pharmaceutical: Radix Paeoniae Alba
Taxonomy: Paeonia lactiflora
English: White Peony Root |
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Tastes: Bitter, sour, sweet, slightly cold
Meridians Entered: Spleen and Liver |
Actions & Indications:
- Nourishes the Blood and regulates menstruation
Liver Blood Deficiency with menstrual dysfunction, vaginal discharge and uterine bleeding accompanied by a pale face, a lusterless complexion and dull, lusterless nails
Anemia
Breast distention and premenstrual syndrome
- Astringes Yin and adjusts the Ying and Wei
Yin Deficiency sweating Sweating due to Yin Collapse
Disharmony between the Liver and Spleen
Disharmony between the Ying and Wei with non-productive sweating
- Calms Liver Yang and Liver Wind and alleviates pain
Liver Qi Stagnation with Liver Yang Rising
Liver Wind with Yin and Blood Deficiency
Bi syndrome due to Blood Deficiency with pain and spasms
- Softens the Liver and relieves pain
Diarrhoea, borborygmus and abdominal pain
Dysenteric disorders with tenesmus
- Tonifies the Blood while suppressing Parasites
Gu Sydnrome (Fruehauf, 1998)
Chronic inflammatory disease (Fruehauf, 2015)
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Standard Dosage: 10-30g in decoction.
Cautions: Caution with anticoagulants as it may slow clotting time. May also slow the absorption of phenytoin. |
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Zhi Gan Cao
| 6-9g | | |
Pinyin: Gan Cao
Chinese: 甘草
Pharmaceutical: Radix Glycyrrhizae
Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata
English: Liquorice Root |
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Tastes: Sweet, slightly cold
Meridians Entered: Heart, Lung and Spleen (and all 12 meridians) |
Actions & Indications:
- Tonifies the Spleen and augments Qi
Spleen Qi Deficiency with shortness of breath, lassitude and loose stools
Qi and Blood Deficiency with an irregular pulse and/or palpitations
Heart Qi Deficiency or Heart Yang Deficiency
- Moistens the Lungs, resolves Phlegm and stops coughing
Lung Heat or Cold
Productive or non-productive coughing
- Moderates spasms and alleviates pain
Painful muscle spasms of the abdomen and legs
- Clears Heat and relieves Fire Toxicity
Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung)
- Antidote for many toxic substances (internal and topical)
Poisoning
Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas)
- Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels
Often added in small doses to harmonise formulas
- Tonifies the Qi while suppressing Parasites
Gu Sydnrome (Fruehauf, 1998)
Chronic inflammatory disease (Fruehauf, 2015)
- Aids fasting
Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
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Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g.
Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium.
The NHS recommends avoiding during pregnancy. |
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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)
Most formulas are found in Scheid, Bensky, Ellis & Barolet (2009): Chinese Herbal Medicine: Formulas & Strategies and Chen & Chen (2015) Chinese Herbal Formulas and Applications. Others are from translations of primary sources. It is recommended that the original material is cross-referenced for mistakes and additional information.
Substitutions have been taken from Ken Lloyd & Prof. Leung (2004): Mayway UK Substitution List or the above publications and are intended as suggestions to help navigate the tight restrictions in the UK quickly. More applicable substitutions may be appropriate in specific situations.
Individual herb information has initially been sourced from TCM Wiki and American Dragon for basic data and then updated manually with my own notes.
These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.