【Naming】
Shan Bu: The name Si Ni Tang (Four Cold Extremities Decoction) indicates that its primary treatment is for Shao Yin disease characterized by internal and external cold, leading to coldness and rigidity in the four limbs.
【Source】
Shang Han Lun Fang (Treatise on Cold Damage Formulas)
【Composition】
(Honey-fried) Licorice, Dried Ginger, (Raw) Aconite
(3)
【Classification】
<Tonify Spleen and Middle Jiao>: Licorice
<Warm the Interior>: Dried Ginger, Aconite
【Analysis of Formula】
Yi Fang: This formula is for the Shao Yin Kidney channel. (1) When cold invades internally, it is treated with sweet and hot herbs. Therefore, ginger and aconite, which are intensely hot, are used to expand Yang energy and expel external cold. (2) Licorice is also a supplementary herb for the middle jiao and disperses cold. It also moderates the excessive potency of ginger and aconite. It must be taken cold because cold is abundant internally; drinking it hot would cause rejection and non-absorption. This aligns with the principle of “using heat to treat cold” and “treating cold with heat, administered coolly.” Shan Bu: The name Si Ni Tang indicates that it treats Shao Yin disease with internal and external cold, and cold extremities. The monarch herb is honey-fried licorice, which is sweet and warm, nourishing Yang energy. The minister herbs are ginger and aconite, which are pungent and warm, assisting Yang to overcome cold. When licorice is combined with ginger and aconite, it stimulates kidney Yang and warms the cold middle jiao, possessing the function of warming the earth with water. When ginger and aconite are combined with licorice, they unblock joints and reach the four limbs, with the power to expel Yin and restore Yang. When kidney Yang stimulates the cold, Yin disappears, and Yang energy reaches the exterior, causing the pulse to rise and the hands and feet to warm. Zhong Yi Can Xi: Dried ginger is the principal herb for warming the spleen and stomach. When combined with licorice, it softens its intense nature, making it gentle, and also prolongs its warming effect. The warmth of the spleen and stomach relies on the vigorous state of the ministerial fire. Aconite, with its black color entering the kidney, provides extraordinary heat that can supplement the ministerial fire in the kidney, thus reinforcing the source of spleen and stomach warmth. The name Si Ni Tang is indeed appropriate because the spleen governs the four limbs. In cases of spleen and stomach deficiency cold, the limbs often feel cold. After taking this medicine, the cold extremities can be restored. Han Dian: This formula is composed of licorice, dried ginger, and aconite. It can be seen as a modification of Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction) with the addition of aconite. Aconite significantly revitalizes declining metabolic functions, and thus this formula is used in situations similar to those treated by Gan Cao Gan Jiang Tang but with a pronounced decline in metabolism. It is not applicable when the metabolic function is overactive and the condition is in an expansive phase. 【Functions】
Restore Yang and save from collapse, warm the meridians and expel cold.
【Indications】
Shao Yin disease with overwhelming internal Yin cold, deficiency of Yang energy, external heat with internal cold, Yang deficiency with impending collapse, spontaneous cold sweating, cramping of the four limbs, cold hands and feet, aversion to cold, pale complexion, clear watery diarrhea, vomiting, abdominal pain, and a thready, almost imperceptible pulse. Yi Fang: (1) Treats Shang Han (cold damage) affecting the three Yin channels, with body and abdominal pain, clear watery diarrhea, aversion to cold without thirst, and cold extremities (Shang Han, Tai Yin and Jue Yin chapters). (2) May present with aversion to cold, red face, irritability, internal cold with external heat, or dry vomiting, sore throat, and a deep, thready, almost imperceptible pulse (Shang Han, Tai Yin, and Jue Yin chapters). Shan Bu: Symptoms such as a deep pulse and cold extremities.
【Applicable Symptoms】
Chronic gastroenteritis with excessive vomiting and diarrhea, diarrhea, indigestion, gastroptosis, acute vomiting and diarrhea, epidemic dysentery. Various types of collapse due to high fever and profuse sweating, and cold extremities due to excessive blood loss.
【Contraindications】
(1) This formula is for cold extremities and collapse due to Yang deficiency. It should not be used in cases not due to Yang deficiency. (2) If the symptoms of this formula present with a red face and irritability due to severe internal cold (true cold, false heat), the formula may be taken cold according to the principle “treat cold with heat, administered coolly” to prevent rejection due to hot liquid. (3) Cold stagnation in blood deficiency causing cold extremities is not suitable for this formula. It is contraindicated in cases of heat causing cold extremities.
【Mnemonic】
是你將父吵 (Shì shì nǐ jiāng fù chǎo) – You, your father, scold (Ginger, Aconite, Licorice) #
【Modifications】
Yi Fang: (1) If the face is red, indicating Yang uprising: Add 9 stalks of scallion to promote Yang. (2) If there is abdominal pain, indicating true Yin deficiency: Add peony to astringe Yin. (3) If there is a sore throat, indicating Yin energy congealing upwards: Add Platycodon to benefit the throat. (4) If diarrhea stops but the pulse is absent: Add Ginseng to assist Yang and replenish Qi and blood. (5) For vomiting: Add Fresh Ginger to disperse rebellious Qi. Han Dian: Tong Mai Si Ni Tang (Circulating Vessels Si Ni Tang) is a modification of Si Ni Tang where the amount of dried ginger is increased, used for severe symptoms of Si Ni Tang. Si Ni Jia Ren Shen Tang (Si Ni Tang with Ginseng Added) is Si Ni Tang with ginseng added, used for severe conditions due to excessive fluid loss from significant bleeding. Fu Ling Si Ni Tang (Si Ni Tang with Poria Added) is Si Ni Jia Ren Shen Tang with poria added, used for Si Ni Jia Ren Shen Tang conditions that also present with irritability, palpitations, and edema. (1) If it is due to externalization of cold-dampness, with symptoms of yellowing of the skin, greasy gray tongue coating, and cold extremities, combine with Artemisia capillaris and Atractylodes macrocephala to warm Yang, expel cold, and promote dampness elimination. (2) If it is due to spleen and kidney Yang deficiency with downward-flowing cold-dampness, presenting with edema and whitish vaginal discharge, combine with Codonopsis, Atractylodes macrocephala, and Poria cocos to warm the spleen, tonify the kidney, and dispel cold and promote urination. (3) This formula with added Atractylodes macrocephala and Jujube is named Shu Fu Tang, treating rheumatic pain of the body due to the combination of wind and dampness, or cold damage leading to heart pain and cold extremities. (4) This formula without licorice is Gan Jiang Fu Zi Tang (Dried Ginger and Aconite Decoction), which treats symptoms after purgation followed by sweating, restlessness during the day and calmness at night, without vomiting or thirst, no external symptoms, a deep and thready pulse, and no significant fever. It also treats internal cold with cold extremities, dizziness, and absence of sweating or profuse sweating, i.e., external heat with irritability, and Yin overcoming Yang. (5) This formula without licorice and with the addition of 4 stalks of scallion is Bai Tong Tang (White Penetrating Decoction) to restore Yang and unblock vessels. If human urine and pig bile are added, it becomes Bai Tong Jia Ren Niao Zhu Dan Zhi Tang, used for Shao Yin disease with diarrhea and a thready pulse. For Bai Tong Tang indications, if diarrhea does not stop, with cold extremities, no pulse, dry vomiting, and irritability, a sudden reappearance of the pulse after taking this decoction indicates death, while its continuation indicates survival. (6) This formula with added Ginseng is Si Ni Jia Ren Shen Tang (Si Ni Tang with Ginseng Added), treating aversion to cold, thready pulse, diarrhea, and blood loss after diarrhea stops. If Poria is added, it becomes Fu Ling Si Ni Tang (Si Ni Tang with Poria Added), treating restlessness after unremitting disease following sweating and purgation. (7) This formula without dried ginger and with the addition of peony is Shao Yao Gan Cao Fu Zi Tang (Peony, Licorice, and Aconite Decoction), treating Shang Han with unremitting sweating and subsequent aversion to cold, indicating deficiency. (8) This formula without aconite, using licorice and dried ginger, is named Gan Cao Gan Jiang Tang (Licorice and Dried Ginger Decoction), treating Shang Han with a floating pulse, spontaneous sweating, frequent urination, vexation, slight aversion to cold, and leg cramps. If <a href='https://whatsintcm.com/dt_articles/Cinnamon Twig/’>Cinnamon Twig Decoction was mistakenly used to attack the exterior, leading to cold extremities, dry throat, vexation, and vomiting, this decoction is used to restore Yang. If the cold extremities resolve and the feet become warm, Shao Yao Tang is then used to harmonize Yin, and the legs will extend. Peony and licorice are each 4 liang. (9) This formula with added Angelica sinensis and Akebia is named Dang Gui Si Ni Tang (Angelica Sinensis Si Ni Tang), treating cold hands and feet due to cold exposure, thready pulse almost imperceptible, and cold疝 (hernia) in men and women, with coldness below the navel radiating to the lower back and hips, causing pain. (10) This formula with added Artemisia capillaris is named Yin Chen Si Ni Tang (Artemisia Capillaris Si Ni Tang), treating dark yellow jaundice.
【Pharmacology】
It has effects such as strengthening the heart, antioxidant, anti-shock, enhancing immune function, and improving hypoxia tolerance.