[Source]

Shang Han Lun

 [Composition]

Licorice, Dried Ginger, Aconite
(3)

 [Category]

<Tonify Spleen and Middle Jiao>: Licorice

<Warm the Interior>: Dried Ginger, Aconite

[Analysis]

Shan Bu: Yin is abundant internally, causing Yang to be obstructed externally. This formula is used to open the channels. Therefore, it can be known that Si Ni Tang circulates Yang Qi, Aconite tonifies and warms Yang Qi, Bai Tong circulates Yang Qi up and down, and Tong Mai circulates Yang Qi internally and externally. If the pulse is weak and about to disappear, with interior cold and exterior heat, it indicates that Yin is abundant in the Kidney, causing Yang to be obstructed externally, hence this formula is indicated. Doubled Dried Ginger with added Licorice to assist Aconite, renamed Tong Mai Si Ni Tang, because it can greatly strengthen original Yang, govern the interior and exterior, and collectively call back the exterior heat to the interior. At this time, vital Qi is already departing, and extinction is imminent. If mild and slow Licorice is used as the monarch, how can it quickly summon exterior Yang? Thus, it is replaced by Dried Ginger. However, Licorice and Dried Ginger are added in equal parts, for fear that after dispersion, the ferocity of ginger and aconite cannot nourish original Qi, which is known as a controlled army. Gu Jin Ming Yi Fang Lun: Tong Mai Si Ni is to warm the earth in water. Interior cold and exterior heat, entirely Kidney’s internal cold forcing Yang outward, hence the monarch is Dried Ginger, establishing a banner in the Middle Jiao; the minister is the “State Elder” (Licorice), governing the interior and exterior; additionally, Aconite greatly strengthens original Yang, collectively calling back the exterior heat to the interior. At this time, vital Qi is departing, and survival is momentary. If mild and slow Licorice is used as the monarch, how can it quickly summon exterior Yang? Thus, it is replaced by Dried Ginger. However, Licorice and Dried Ginger are added in equal parts, for fear that after the loss, the ferocity of ginger and aconite cannot nourish original Qi, which is known as a controlled army. In the section on modification, if the facial complexion is red, scallions are added. Later generations then use Scallion White for Tong Mai Si Ni, not knowing that Yang is lost externally, and using scallions to assist its dispersion will cause Qi to escape with sweat, and Yang will have no way to return internally, which is a mistake! Bai Tong is named because of diarrhea and a weak pulse, where Scallion White is used to circulate Yang up and down. This formula addresses interior cold and exterior heat, using Tong Mai to circulate Yang internally and externally, hence the main formula does not use scallions. This should be carefully distinguished. Gu Fang Xuan Zhu: Tong Mai Si Ni, Shao Yin Yang obstruction, red face, Yang excess and imminent departure, urgently use Dried Ginger, raw Aconite enter through the gate and drive away the阴霾 (yin haze), Licorice moderates the ferocity of ginger and aconite, stays in the Middle Jiao, and supports primordial Harmony Qi. Using Scallion White to enter the Ying and open channels may help Yang return internally. Inferring from Zhongjing’s intention, it only aims to open channels and return Yang, with no other meaning. Li Dai Ming Yi Liang Fang Zhu Jie: This formula has the same three herbs as Si Ni Tang, but with increased Dried Ginger. The formula name is Tong Mai Si Ni Tang, indicating that its method of “opening” lies entirely in Dried Ginger, which is undoubtedly correct. However, Dried Ginger is persistent and does not move; how can it “open”? This “opening” is because when grain enters the Stomach, the channels move, and the Middle Jiao’s pulsations are the basis for moving the channels. If the lower Jiao channels are severed, it is incurable. But if it is merely due to cold evil congealing and blocking, and the channels are not open, then add Dried Ginger to warm the Middle Jiao’s Qi to stimulate it, invigorate bodily function, and from the center to the extremities, the channels can be restored. The “unblocking” (bu tong) is more subtle than “unblocking” (tong). Zhongjing’s divine use of Dried Ginger is thus. Pulses are born from the Middle Jiao’s grain Qi. This formula has already reached the source of sustenance, making this formula’s channel opening, compared to strengthening the heart to restore pulses, even more profound.

 [Functions]

Revive Yang and open channels, disperse Yin and overcome cold.

 [Indications]

Shao Yin disease, with Yin abundant internally, causing Yang to be obstructed externally, profuse watery diarrhea, interior cold and exterior heat, paradoxically no aversion to cold, hands and feet cold, pulse weak and about to disappear, body paradoxically not aversion to cold, facial complexion is red, or abdominal pain, or dry retching, or sore throat, or diarrhea stops but pulse is not palpable, used for severe cases of Si Ni Tang indications. Shan Bu: Treats Shao Yin profuse watery diarrhea, interior cold and exterior heat, hands and feet cold, pulse weak and about to disappear, body paradoxically not aversion to cold, facial complexion is red, or abdominal pain, or dry retching, or sore throat, or diarrhea stops but pulse is not palpable. Treats Jue Yin profuse watery diarrhea, interior cold and exterior heat, sweating and cold extremities.

 [Mnemonic]

Ni shi jiang fu chao tong xiao (You and your father argued, ginger, aconite, licorice, open all night)

 [Modifications]

Shan Bu: (1) If facial complexion is red, add 9 stalks of scallions. (2) If there is abdominal pain, remove scallions and add 2 liang of White Peony. (3) If there is vomiting, add 2 liang of Fresh Ginger. (4) For sore throat, remove White Peony and add 1 liang of Platycodon. (5) If diarrhea stops but pulse is not palpable, add 2 liang of Ginseng.