【Chinese Name】 |
四逆湯
|
【Phonetic】 |
Si Ni Tang
|
【English Name】 |
Frigid Extremities Decoction |
【Classification】 |
Warming interior formulas |
【Source】 |
《Treatise on Cold Damage》Shang Han Lun《傷寒論》 |
【Combination】 |
Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 2 liang (6g), Zingiberis Rhizoma (Zhi Gan Jiang) 1.5 liang (6g), Aconiti Lateralis Radix Praeparata (Fu Zi raw; peeled; cut into eight pieces) 1 piece (15g) |
【Method】 |
Decoct these three medicinals with three sheng of water, boil them until one sheng and two ge of water is left, remove the dregs, and take the warm decoction two times a day. Patients with a strong constitution can take a larger piece of fu zi and double the amount of gan jiang (3 liang). (Modern use: prepare as a decoction.) |
【Action】 |
Restores yang to rescue from counterflow. |
【Indication】 |
Reversal counterflow cold of the four limbs is due to heart and kidney yang deficiency. This pattern is marked by reversal counterflow cold of the four limbs, aversion to cold, lying in bed curled up, debilitated spirit, desire to sleep, pale complexion, stomach pain, diarrhea, vomiting, no thirst, a white, slippery tongue coating, and a feeble, thin pulse. |
【Pathogenesis】 |
This formula is indicated for heart and kidney yang deficiency and yin-cold excess. Yang and qi deficiency fails to warm the body and extremities, so there is reversal counterflow cold of the four limbs, lying in bed curled up, and averse to cold. Yang and qi deficiency fails to activate the blood circulation, so there is a feeble, thin pulse. It is said in《Basic Questions》, “Yang and qi in hardness can activate the spirit, and in softness can nourish the tendons”. In the current situation, the heart yang is weak and it cannot nourish the spirit, so there is a desire to sleep. Moreover, the kidney yang is also weak and fails to warm the spleen causing disharmony of its ascending and descending function, marked by stomach pain, diarrhea, and vomiting. This is considered to be a pattern of deficient yang and excessive yin, which can only be treated with strong pungent, hot medicinals of a pure yang nature to break yin-cold and rescue yang from desertion marked by reversal counterflow cold of the four limbs, severe thoracic and abdominal pain, and chronic headache. |
【Application】 |
1. Essential pattern differentiation Si Ni Tang is a fundamental formula to restore yang to rescue from counterflow. This clinical pattern is marked by reversal counterflow cold of the four limbs, debilitated spirit, desire to sleep, pale complexion, feeble, thin pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of debilitated yang and yin exuberance: myocardial infarction, cardiac failure, severe vomiting or diarrhea due to acute gastroenteritis, and profuse sweating due to acute disease resulting shock. 3. Cautions and contraindications Take the decoction cold if vomiting appears. Since there is all acrid and hot medicinals in this formula, it is not suitable for long-term usage. Once the limbs become warm, this formula should not be taken anymore. It is prohibited for the pattern of true heat with false cold. |
【Additonal formulae】 |
1. Tong Mai Si Ni Tang (Channel-Unblocking for Frigid Extremities Decoction 通脈四逆湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Zhi gan cao 2 liang (6g), fu zi one big piece (raw, peeled, cut into eight pcs) (20g), gan jiang 3 liang, 4 liang for strong people (9~12g) [Preparation and Administration] Decoct the three medicinals with 3 sheng of water until 1.2 sheng left, remove the remainder and take the warm decoction two times a day. [Actions] Breaks yin and restores yang to connect the interior and exterior. [Applicable Patterns] Shaoyin pattern, exuberant yin repelling yang. Symptoms include: diarrhea with undigested food, internal cold and external heat, reversal counterflow cold of limbs, feeble, impalpable pulse, aversion to cold, red complexion, bellyache, nausea or vomiting, sore throat, diarrhea stops but the pulse is still impalpable. 2. Si Ni Jia Ren Shen Tang (Frigid Extremities Decoction Plus Ginseng 四逆加人參湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Zhi gan cao 2 liang (6g), fu zi 1 piece, (raw, peeled, cut into eight pcs) (15g), gan jiang 1.5 liang (9g), ren shen 1 liang (6g) [Preparation and Administration] Decoct the four medicinals with 3 sheng of water until 1.2 sheng left, remove the remainder and take the warm decoction two times a day. [Actions] Restores yang to rescue from counterflow, boosts qi, and rescues from desertion. [Applicable Patterns] Shaoyin pattern. Symptoms include: aversion to cold, fever, reversal counterflow cold of the four limbs, lying in bed curled up, a feeble pulse and diarrhea, diarrhea stops while other symptoms remains. 3. Bai Tong Tang (Scallion Yang-Freeing Decoction 白通湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Cong bai 4 pcs, gan jiang 1 liang (6g), fu zi 1 pc (raw, peeled, cut into eight pieces) (15g) [Preparation and Administration] Decoct the four medicinals with 3 sheng of water until 1 sheng left, remove the remainder and take the warm decoction two times a day. [Actions] Breaks yin and restores yang to connect the upper and lower. [Applicable Patterns] Shaoyin pattern, exuberant yin repelling yang. Symptoms include: reversal counterflow cold of the hands and feet, diarrhea, a feeble pulse, and a red complexion. Treatise on Cold Damage says: For continuous diarrhea, reversal counterflow cold of the limbs, severe thoracic and abdominal pain, chronic headache, impalpable pulse, nausea, and vexation, add 1 he (5 ml) of pig bile and 5 he (25 ml) of human urine, called Bai Tong Tang with pig bile. 4. Shen Fu Tang (Ginseng and Aconite Decoction 參附湯) [Source]《Categorized Synopsis of the Whole》Zheng Ti Lei Yao《正體類要》 [Ingredients] Ren shen 4 qian (12g), fu zi (processed, remove rind and hilum) 3 qian (9g) [Preparation and Administration] Decoct the four medicinals with 2 zhan of water and 10 pieces of sheng jiang until 8 fen left, remove the remainder and take the warm decoction three times a day. [Actions] Boosts qi to consolidate and restore yang. [Applicable Patterns] Yang and qi collapse. Symptoms include: reversal counterflow cold of the four limbs, continuous cold sweating, shallow breathing, and a feeble and impalpable pulse. |
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