Herb Formulas Notebook

Tong Mai Si Ni Tang

Unblock the Pulse Decoction for Frigid Extremities


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: Shaoyin disorder with true Cold in the Interior and false Heat in the Exterior, or severe Heart Yang deficiency

Key Symptoms: Diarrhoea with undigested food in the stool, cold extremities, no aversion to cold
Secondary Symptoms: Flushed face, dry retching, pain in the throat

Pulse: Faint, hidden or almost imperceptible.


Ingredients

Zhi Gan Cao 6g
Sheng Fu Zi 12-24g
Gan Jiang 9-12g

Subsitutions:
In modern practice Sheng Fu Zi is always replaced with the less toxic Zhi Fu Zi. In the UK both have 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: Restores the Yang and unblocks the pulse



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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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.