Si Ni San, Frigid Extremities Powder, is Chai Hu, Zhi Shi, Bai Shao and Zhi Gan Cao. The catalogue classes it among the formulas that regulate and harmonise the Liver and Spleen, and records it as spreading a constrained Liver Qi.

Herb

Amount

9 g

9 g

12 g

6 g

Actions and indications

Spreads constrained Liver Qi and relieves stagnation

Liver Qi constrained and overacting on the Spleen and Stomach, with pain of the ribs or abdomen and menstrual complaints
Cold fingers and toes with Heat held inside: the cold stops at the wrist or ankle because constrained Qi keeps Yang from reaching the limbs
Fullness and distention below the ribs and in the chest, with irritability and fullness of the chest and epigastrium
Depression; premenstrual irritability and breast distention
A body that feels slightly warm, or hot and feverish, from disharmony of Liver Qi; fever that comes and goes; thirst

Harmonizes the Liver and Spleen

A distended, painful or blocked feeling in the Stomach, the lower abdomen or the ribs, with abdominal pain, spasm and mild bloating
Mild hardness and blockage below the Heart, sometimes with a visible white line from the navel up to the tip of the breastbone
Diarrhea, sometimes severe, with tenesmus, or dysentery; or mild constipation
Cough, palpitations, or difficult urination with dark yellow urine
Dry, swollen eyes
Painful periods
Gu syndrome

Clears Heat from the Interior

Heat at the Jue Yin or Shao Yin level
Tongue red, dusky or pale, with a thin or greasy coat that is yellow or white; pulse wiry, wiry and tight, wiry and slippery, or wiry and perhaps rapid

Nourishes Blood, softens the Liver and relieves spasmodic pain

Modern uses

Gastritis
Acute and chronic gastritis
Superficial gastritis
Gastroenteritis
Peptic ulcer
Gastric ulcer
Gastric ptosis
Gastric neuralgia
Hiatus hernia
Acid reflux
Indigestion
Nausea and vomiting
Morning sickness
Abdominal fullness and distention
Abdominal pain
Abdominal spasms
Irritable bowel syndrome
Leaky gut syndrome
Colitis
Allergic colitis
Ulcerative colitis
Smelly, painful diarrhea
Diarrhea alternating with constipation, with hard pellet stools
Giardiasis
Intestinal obstruction (adhesive)
Acute appendicitis
Encapsulated periappendicular abscess
Tubercular peritonitis
Hernia
Pancreatitis
Cholecystitis
Cholelithiasis
Biliary ascariasis
Hepatitis
Cirrhosis of the liver
Urinary calculi
Enuresis
Stress incontinence
Mastitis
Fibrocystic breast disease
Breast lumps (fibroadenoma)
Premenstrual syndrome
Dysmenorrhea
Amenorrhea
Endometriosis
Adnexitis
Blocked fallopian tubes
Infertility
Perimenopausal syndrome
Impotence
Candidiasis
Coronary heart disease
Raynaud's disease
Acrocyanosis
Syncope (due to Heat)
Epidemic hemorrhagic fever
Fever
Intercostal neuralgia
Trigeminal neuralgia
Neurogenic headache
Neck tension
Shoulder tension
Meniere's disease
Epilepsy
Depression
Neurasthenia
Neurosis
Autonomic dystonia
Chronic fatigue syndrome
Obesity
Chronic bronchitis
Pleurisy
Pertussis
Chronic tonsillitis
Otitis media
Rhinitis on one side, yellow mucus
Sinusitis on one side, yellow mucus
Gu syndrome

Symptoms

Abdominal distention

Abdominal pain

Abdominal spasms

Chest fullness

Cold limbs

Constipation

Cough

Dark urine

Depression

Diarrhea

Dry eyes

Epigastric distention

Epigastric pain

Eye swelling

Feeling of heat

Fever

Hypochondriac distention

Hypochondriac pain

Irregular menstruation

Irritability

Lower abdominal distention

Painful urination

Palpitations

Tenesmus

Thirst

Modifications

Cough: + wu wei zi, + gan jiang

Palpitations: + gui zhi

Difficult urination: + fu ling

Abdominal pain from Cold: + zhi fu zi

Epigastric pain with acid regurgitation (combined with Zuo Jin Wan)

Pain below the ribs: + yan hu suo, + yu jin

Abdominal pain from food stagnation: + shan zha, + mai ya, + ji nei jin

Blood deficiency with pain below the ribs and irregular periods: + bai zhu, + fu ling, + dang gui, − zhi shi

Fixed, pinpoint pain from Blood stasis: + dan shen, + wu ling zhi, + pu huang

Painful periods: + dang gui, + wu yao, + xiang fu, + yan hu suo

Leukorrhea from Damp-Heat, with lower abdominal pain and an aching low back (combined with Er Miao San)

Disorders of the biliary tract: + yin chen hao, + dan shen, + yu jin, + chi shao, + jin qian cao

Show all 119 modifications

Breast abscess: + qing pi
Jaundice: + yin chen hao, + yu jin
Intercostal neuralgia: + gua lou pi, + xie bai, + yu jin
Roundworms: + wu mei, + ku lian pi
Intestinal obstruction: + da huang
Acute icteric hepatitis (combined with Yin Chen Hao Tang)
Heat in the Spleen and Stomach: + bing lang, + xiang fu
Indigestion and no appetite, with cold limbs and a wiry, smooth pulse: + lian qiao, + shen qu
Severe pain below the ribs: + yu jin, + xiang fu, + chuan xiong
Severe Liver Qi stagnation: + xiang fu, + yu jin
Scanty urine: + mu tong, + sheng di huang
Nausea and vomiting: + huang lian, + sheng jiang
Diarrhea with tenesmus (combined with Tong Xie Yao Fang)
Constipation: + da huang, + mang xiao
Accumulated Heat (or combined with Chai Hu Qing Gan Tang instead): + zhi zi, + chuan lian zi
Food stagnation or indigestion (or combined with Bao He Wan instead): + mai ya, + ji nei jin
Spleen deficiency: + dang shen, + bai zhu
Hypertension: + zhe shi (duan), + long gu, + mu li, + huang qin
Dysmenorrhea (combined with Shi Xiao San): + xiang fu, + yan hu suo
Liver problems: + yin chen hao, + jin qian cao, + yu jin, + dan shen
Gu syndrome: + zi su ye, + bo he, + bai zhi
Phlegm-Heat obstruction with insomnia, irritability and a tendency to anger (combined with Xiao Xian Xiong Tang)
Distention after meals, belching and no appetite (combined with Ping Wei San)
Red face, marked irritability and insomnia (combined with Huang Lian Jie Du Tang)
Amenorrhea: + zhi ke, − zhi shi
Mastitis: + lu jiao jiao, + chuan shan jia
Used together with Gui Zhi Fu Ling Wan; placement unclear: + fu ling pi, + xiang fu, + hong hua, + wu yao, + chong wei zi, − fu ling
Hepatitis: + yan hu suo, + hou po, + yu jin, + dan shen
Hepatitis with jaundice: + yan hu suo, + hou po, + yu jin, + dan shen, + yin chen, + zhi zi
Hepatitis with constipation: + yan hu suo, + hou po, + yu jin, + dan shen, + da huang
Hepatitis with diarrhea: + yan hu suo, + hou po, + yu jin, + dan shen, + bai zhu, + fu ling, + yi yi ren
Hepatitis with no appetite: + yan hu suo, + hou po, + yu jin, + dan shen, + mai ya, + shan zha, + chen pi
Hepatitis with low fever: + yan hu suo, + hou po, + yu jin, + dan shen, + di gu pi, + qing hao
Hepatitis with enlarged liver and spleen: + yan hu suo, + hou po, + yu jin, + dan shen, + bie jia, + mu li, + qing pi
Hepatitis with constant fatigue: + yan hu suo, + hou po, + yu jin, + dan shen, + dang shen
Liver cirrhosis: + huang qi, + dan shen, + bie jia
Qi stagnation in liver cirrhosis: + huang qi, + dan shen, + bie jia, + xiang fu, + yan hu suo
Liver cirrhosis with Heat: + huang qi, + dan shen, + bie jia, + yu jin, + huang qin
Yin deficiency in liver cirrhosis: + huang qi, + dan shen, + bie jia, + gou qi zi, + sheng di huang
Blood stagnation in liver cirrhosis: + huang qi, + dan shen, + bie jia, + dang gui, + e zhu
Spleen deficiency in liver cirrhosis: + huang qi, + dan shen, + fu ling, + yi yi ren
Cholecystitis: + chuan lian zi, + mu xiang
Cholecystitis with Qi stagnation: + chuan lian zi, + mu xiang, + yu jin, + yan hu suo
Cholecystitis with gallstones: + chuan lian zi, + mu xiang, + jin qian cao, + da huang
Cholecystitis with Damp-Heat: + chuan lian zi, + mu xiang, + huang qin, + jin yin hua
Gallstones: + yu jin, + ji nei jin, + jin qian cao
Biliary ascariasis (combined with Jin Ling Zi San): + zhi ke, + shi jun zi, + bing lang, − zhi shi
Superficial gastritis with Qi stagnation of the Liver and Stomach: + zhe bei mu, + huang qin, + xiang fu
Biliary ascariasis, as an alternative: + wu mei, + ku lian pi
Stomach channel stagnation in superficial gastritis: + san leng, + e zhu, + yan hu suo, + san qi, + chuan lian zi
Gastritis: + pu gong ying, + chen pi, + huang lian
Upper abdominal pain in gastritis: + pu gong ying, + chen pi, + huang lian, + chuan lian zi, + yan hu suo
Gastritis with constipation: + pu gong ying, + chen pi, + huang lian, + da huang
Peptic ulcer: + hou po, + shi hu, + mai men dong
Epigastric pain: + hou po, + mai ya, + yu jin
Ulcerative colitis from Damp-Heat: + bai jiang cao, + hong teng, + yi yi ren
Ulcerative colitis from Spleen deficiency: + dang shen, + shan yao, + chao bai zhu
Ulcerative colitis from Kidney Yang deficiency (combined with Si Shen Wan)
Infertility: + zhi ke, + chi shao, + dan shen, + chuan lian zi, − zhi shi, − bai shao
Infertility with Qi stagnation: + zhi shi, + chi shao, + dan shen, + chuan lian zi, − bai shao
Infertility with Blood stagnation: + zhi ke, + chi shao, + dan shen, + chuan lian zi, + shui zhi, − zhi shi, − bai shao
Adnexitis with Damp-Heat: + mu tong, + ze xie
Adnexitis with Cold-Damp: + gui zhi, + xiao hui xiang
Adnexitis with severe pain: + chuan lian zi, + yan hu suo
Adnexitis with heavy leukorrhea: + hai piao xiao, + tu fu ling
Impotence: + wu gong
Impotence with pain below the ribs: + wu gong, + chuan lian zi
Impotence with a dry mouth and bitter taste: + zhi zi, + mu dan pi
Impotence with insomnia and many dreams: + yuan zhi, + suan zao ren
Impotence with dizziness and a swollen feeling in the head: + ju hua, + tian ma
Impotence with cold and pain in the limbs and lower abdomen: + gou qi zi, + yi zhi ren, + ba ji tian
Heat signs with nausea and vomiting: + huang lian, + wu zhu yu
Vomiting of bile: + zhi ke, + yu jin, + jin qian cao
Severe nausea and vomiting: + xuan fu hua, + dai zhe shi
Constipation together with nausea and vomiting: + da huang
Food stagnation causing nausea and vomiting: + shan zha, + mai ya, + ji nei jin
Acid reflux from stagnant Heat, with nausea and vomiting: + huang lian, + wu zhu yu
Long-standing nausea and vomiting that has damaged Yin: + chai hu, + sha shen, + shi hu
Severe pain between the ribs: + xiang fu, + qing pi, + chuan xiong
Spleen disorders with a greasy tongue coat (combined with Ping Wei San)
Coughing up thick Phlegm: + gua lou
Deficiency Cold of the Spleen and Stomach presenting as acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion: + hai piao xiao, + huang lian, + wu zhu yu
Severe cases of acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion from deficiency Cold of the Spleen and Stomach: + hai piao xiao, + huang lian, + wu zhu yu, + wa leng zi, + zhe bei mu
Severe cases of acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion from deficiency Cold of the Spleen and Stomach, with a sharp burning feeling: + hai piao xiao, + huang lian, + wu zhu yu, + pu gong ying
Deficiency Cold of the Spleen and Stomach with epigastric pain, in acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion: + hai piao xiao, + huang lian, + wu zhu yu, + yan hu suo, + yu jin
Deficiency Cold of the Spleen and Stomach with nausea, in acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion: + hai piao xiao, + huang lian, + wu zhu yu, + zhi ban xia, + sheng jiang
Deficiency Cold of the Spleen and Stomach with vomiting, in acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion: + hai piao xiao, + huang lian, + wu zhu yu, + dai zhe shi, + shi di
Deficiency Cold of the Spleen and Stomach with irritability or tension, in acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion: + hai piao xiao, + huang lian, + wu zhu yu, + he huan pi, + zhi zi
Deficiency Cold of the Spleen and Stomach with insomnia or restless nights, in acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion: + hai piao xiao, + huang lian, + wu zhu yu, + mu li, + zhen zhu mu, + yu jin
Deficiency Cold of the Spleen and Stomach with gallstones, in acid reflux, hiatus hernia, gastritis, peptic ulcer or indigestion: + hai piao xiao, + huang lian, + wu zhu yu, + jin qian cao, + yin chen hao, + ji nei jin
Peptic ulcer, larger Qi-moving herb set: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, − zhi shi
Peptic ulcer with a cold feeling in the Stomach and a liking for warm drinks: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + wu zhu yu, + gan jiang, − zhi shi
Bouts of severe pain from a peptic ulcer: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + dan shen, − zhi shi
Peptic ulcer with severe distention of the Stomach: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + qing pi, − zhi shi
Spasmodic pain of a peptic ulcer: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + bai shao, + gan cao, − zhi shi
Food stagnation with a peptic ulcer: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + shen qu, + mai ya, − zhi shi
Liver Blood deficiency with a peptic ulcer: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + dang gui, + shu di huang, − zhi shi
Spleen Qi deficiency with a peptic ulcer: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + bai zhu, + dang shen, + fu ling, − zhi shi
Frequent belching with a peptic ulcer: + zhi ke, + wa leng zi, + xiang fu, + chuan lian zi, + zi su geng, + yan hu suo, + chen pi, + mu xiang, + fo shou, + xuan fu hua, − zhi shi
Raynaud's disease with pain of the chest, breasts or flanks: + yan hu suo, + yu jin
Blood deficiency and irregular periods in Raynaud's disease: + bai zhu, + fu ling, + dang gui, − zhi shi
Food stagnation in Raynaud's disease: + shan zha, + mai ya, + ji nei jin
Raynaud's disease with painful periods: + dang gui, + wu yao, + xiang fu, + yan hu suo
Intercostal neuralgia in Raynaud's disease: + gua lou pi, + xie bai, + yu jin
Constipation in Raynaud's disease: + da huang
Endometriosis from Qi and Blood stagnation where Qi stagnation predominates (combined with Xiao Yao San)
Coronary heart disease: + chuan xiong, + jiang xiang, + xiang fu, + dan shen, + yu jin

Cautions

contraindication Cold limbs from any other cause, including plain Yang or Qi deficiency without Qi constraint

caution Do not confuse with Si Ni Tang: Yang collapse, an emergency this formula does not treat, shows cold rising above the elbows or knees, deep exhaustion, profuse sweat, watery stools containing undigested food and a pulse that can barely be felt

pregnancy Zhi Shi breaks Qi and directs it downward; use with caution in pregnancy

caution Intestinal obstruction, pancreatitis and cholecystitis can be surgical emergencies with severe abdominal pain, and hernia, breast lumps and hepatitis need medical assessment; the formula does not replace that care

Pinyin

si ni san

English Name

Fridgid Extremities Powder

si ni san

About si ni san

Ingredients

Actions and indications

Spreads constrained Liver Qi and relieves stagnation

Harmonizes the Liver and Spleen

Clears Heat from the Interior

Nourishes Blood, softens the Liver and relieves spasmodic pain

Modern uses

Symptoms

Modifications

Cautions

Preparation

Names

Classification

Support