Si Ni Tang, Frigid Extremities Decoction, is Zhi Fu Zi, Gan Jiang and Zhi Gan Cao. The catalogue classes it among the formulas that rescue devastated Yang, and records it as restoring the pulse and warming the Middle Jiao against internal Cold.

Herb

Amount

zhi fu zi

6 g

gan jiang

4.5 g

zhi gan cao

6 g

Actions and indications

Rescues devastated Yang and restores the pulse

Yang collapse: Kidney Yang deficiency with internal Cold at the Shao Yin level, or exhausted Heart Yang (Yang Xu Jue Ni)
Yang lost after too much sweating treatment at the Tai Yang stage
Limbs icy cold with marked aversion to cold; lying curled up with the knees drawn in
Extreme fatigue, lethargy and constant sleepiness, profuse cold sweat, and in severe cases near-fainting or coma
Pale or dusky face; bluish lips and nails; sometimes a superficial fever with a red face
Tongue pale, dusky or dark purple with a slippery white coat; pulse deep and thready, deep and slow, deep and faint or minute, or floating and weak

Warms the Middle Jiao, disperses internal Cold and stops diarrhea

Cold in the Yang Ming
Vomiting without thirst, and watery stools containing undigested food
Cold and pain in the abdomen, with indigestion
Edema

Modern uses

Shock and circulatory collapse
Acute myocardial infarction
Cardiac insufficiency
Congestive heart failure
Palpitations
Cerebrovascular insufficiency
Hypopituitarism
Hypothyroidism
Adrenal insufficiency
Chronic nephritis
Chronic renal failure
Edema
Acute gastroenteritis
Vomiting and diarrhea in acute or chronic gastroenteritis
Nausea and vomiting
Diarrhea
Constipation
Cholera
Chronic colitis
Gastroptosis
Indigestion
Anorexia
Abdominal pain
Intestinal Heat
Cirrhosis of the liver
Jaundice
Chronic prostatitis
Functional uterine bleeding
Dysmenorrhea
Recurrent aphthous ulcers
Intoxication
Arthritis
Intractable arthritis
Painful obstruction
Fatigue
Weakness
Spontaneous perspiration
Sweating of the hands and feet
Influenza
Common cold
Cough
Dyspnea

Modifications

Edema or leukorrhea from Kidney and Spleen Yang deficiency: + dang shen, + fu ling, + ze xie

Red face with extreme irritability (take the decoction cold)

Stubborn arthritis from Wind-Damp: + rou gui, + bai zhu

Stubborn arthritis from Wind-Damp, as an alternative: + huang qi, + fu ling

Chronic arthritis from Cold: + gui zhi, + bai shao

Shortness of breath or fast breathing: + ren shen

Abdominal pain from Cold: + gui zhi, + bai shao

Deep coma: + ren shen

Extremely cold limbs: + xi xin, + gui zhi

Edema with palpitations: + ren shen, + fu ling

Abdominal pain from Blood deficiency (combined with Si Wu Tang)

Diarrhea with undigested food (combined with Li Zhong Tang)

Show all 25 modifications

Nausea and vomiting with a sore throat: + sheng jiang, + jie geng
Aversion to cold: + bai zhu
Diarrhea that suddenly stops: + ren shen
Palpitations and insomnia with fever: + suan zao ren, + yuan zhi
Collapse of both Qi and Yang: + hong shen
Diarrhea: + huang lian
Gastroptosis with abdominal pain: + rou gui, + zhang nao, + wu zhu yu
Gastroptosis with abdominal distention: + zhi zi, + mu xiang, + hou po
Gastroptosis with nausea: + sha ren, + zhi ban xia
Gastroptosis with belching: + shan zha, + mai ya
Low back pain from Cold-Damp in the Jue Yin: + chai hu, + du huo
Secondary dysmenorrhea (combined with Wen Jing Tang): + ai ye, + xiao hui xiang
Secondary dysmenorrhea where the face is pale and the limbs cold (combined with Wen Jing Tang): + ai ye, + xiao hui xiang, + mai men dong, + e jiao

Cautions

contraindication True Heat with false Cold: cold limbs but thirst for cold drinks, dark urine, a red tongue and a yellow coat; a hot formula would aggravate the hidden Heat

contraindication Cold limbs from Qi stagnation (as in Liver Qi constraint) or from Blood deficiency, which do not call for rescuing Yang

caution Stop at once when the hands and feet have become warm

pregnancy Contraindicated in pregnancy, because Fu Zi is acrid, hot and toxic

caution Fu Zi (aconite) is toxic and restricted: its alkaloids can poison the heart and nerves, so it must be properly processed, cooked first for a long time, and used only under a qualified, licensed practitioner

caution Heart attack, circulatory collapse and adrenal crisis are emergencies that need immediate medical care; this formula must never delay it

Pinyin

si ni tang

English Name

Fridgid Extremitites Decoction

si ni tang

About si ni tang

Ingredients

Actions and indications

Rescues devastated Yang and restores the pulse

Warms the Middle Jiao, disperses internal Cold and stops diarrhea

Modern uses

Symptoms

Modifications

Cautions

Preparation

Names

Classification