【Chinese Name】 |
四逆散
|
【Phonetic】 |
Si Ni San
|
【English Name】 |
Frigid Extremities Powder |
【Classification】 |
Harmonizing formulas |
【Source】 |
《Treatise on Cold Damage》Shang Han Lun《傷寒論》 |
【Combination】 |
Bupleuri Radix (Chai Hu) 10 fen (6g), Paeoniae Radix Alba (Shao Yao) 10 fen (6g), Aurantii Fructus Immaturus (Zhi Shi) 10 fen (6g), Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gan Cao) 10 fen (6g) |
【Method】 |
Grind all of the medicinals into powder and mix them together. Take the powder with rice gruel three times a day. (Modern: Prepare it as a decoction.) |
【Action】 |
Moves qi, resolves the constraint, soothes the liver, and rectifies the spleen. |
【Indication】 |
1. Pattern of yang constraint and reversal counterflow cold of the limbs, marked by a lack of warmth in the extremities, abdominal pain, diarrhea, dysentery tenesmus, and a wiry pulse. 2. Pattern of disharmony of the liver and spleen, marked by distention and fullness in the rib-side, pain in the stomach cavity and abdomen, and a wiry pulse. |
【Pathogenesis】 |
Originally Si Ni San is used to treat “counterflow cold of the four limbs in a shaoyin pattern”. Counterflow cold of the four limbs here actually refers to a lack of warmth in the extremities. When the exterior pathogen invades the internal body via the channels, constraint and stagnation of the qi movement occurs. Disordered qi flow causes yang qi constraint, which results in a lack of warmth in the extremities. Later doctors broadened its scope by using it for distention and fullness in the rib-side, and pain in the stomach cavity and abdomen due to liver and spleen constraint and stagnation. The treatment is to move qi, resolve constraint, soothe the liver, and rectify the spleen. |
【Application】 |
1. Essential pattern differentiation Si Ni San treats the patterns of yang constraint and reversal counterflow cold of the limbs, which is its original indication. However, later doctors use it as a basic formula to soothe the liver and rectify the spleen. This clinical pattern is marked by lack of warmth in the extremities, pain in the rib-side, stomach cavity, and abdomen, and a wiry pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of qi constraint of liver and gallbladder, liver-spleen disharmony, or liver-stomach disharmony: chronic hepatitis, cholecystitis, cholelithiasis, biliary ascariasis, intercostal neuralgia, ulcers, gastritis, gastrointestinal neurosis, annex inflammation, tubal obstruction, and acute mastitis. |
【Additonal formulae】 |
1. Chai Hu Shu Gan San (Bupleurum Liver-Soothing Powder, 柴胡疏肝散) [Source]《Standards for Diagnosis and Treatment》Zheng Zhi Zhun Sheng《證治準繩》 [Ingredients] Chai hu 2 qian (6g), chen pi (fried with vinegar) 2 qian (6g), chuan xiong 1.5 qian (4.5g), xiang fu 1.5 qian (4.5g), zhi qiao 1.5 qian (4.5g), shao yao 1.5 qian (4.5g), zhi gan cao 5 fen (1.5g) [Preparation and Administration] Prepare it as a decoction. [Actions] Soothes the liver and moves qi, invigorates blood and relieves pain. [Applicable Patterns] Binding constraint of liver qi. Symptoms include: rib-side pain, chest oppression, frequent sighing, depression, irascibility, belching, distention and fullness in the stomach and abdomen, and a wiry pulse. 2. Zhi Shi Shao Yao San (Immature Bitter Orange and Peony Powder, 枳實芍藥散) [Source]《Essentials from the Golden Cabinet》Jin Gui Yao Lue《金匱要略》 [Ingredients] zhi shi (burned until dark) and shao yao (equal amount) [Preparation and Administration] Grind the medicinals into powder, take 1g of the powder each time, three times per day with wheat porridge. [Actions] Moves qi and harmonizes blood, relaxes spasms to relieve pain. [Applicable Patterns] Binding constraint of qi and blood. Symptoms include: postpartum abdominal pain, inability to lie flat due to vexation and fullness. It can also be used to treat abscess. |
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