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Dang Gui Si Ni Tang当归四逆汤

Dang Gui Decoction for Frigid Extremities

Warming the Interior 温里剂Warm the Channels and Disperse Cold 温经散寒

Ingredients7 herbs

Indications

Warms the channels and disperses coldNourishes the blood and frees the vesselsRelieves cold painful obstruction of the limbs

Blood deficiency with cold congealing the channels: the blood is insufficient and cold has settled in the vessels, so the extremities are cold and the pulse is nearly imperceptible — yet the whole-body signs of collapsing yang are absent.

Clinical Manifestations

  • Cold hands and feet that do not warm easily
  • Chilblains, or fingers that blanch and go numb in the cold
  • Menstrual pain relieved by warmth
  • Cold pain in the low back, hip or legs
  • Headache or lower abdominal pain from cold in the channels
TonguePale with a white coating
PulseDeep and thin, or so thin it seems about to expire

Health Categories

Women's HealthBone & Joint HealthSkin HealthHeart & Circulation

Modern Applications

Raynaud phenomenonChilblainsPeripheral circulationDysmenorrheaSciatica

Common adjustments

  • Long-standing internal cold with vomiting or headache — add Wu Zhu Yu 吴茱萸 and Sheng Jiang 生姜 — Dang Gui Si Ni Jia Wu Zhu Yu Sheng Jiang Tang
  • Menstrual pain from cold — add Ai Ye 艾叶, Xiao Hui Xiang 小茴香
  • Cold pain in the low back and legs — add Du Zhong 杜仲, Ji Xue Teng 鸡血藤
  • Marked stasis with fixed stabbing pain — add Tao Ren 桃仁, Hong Hua 红花

Contraindications

Not for cold extremities caused by heat trapped internally (true heat with false cold), and not for yang collapse with profuse sweating and diarrhea, which calls for Si Ni Tang. The warm acrid herbs are unsuitable where there is yin-deficiency heat.

For licensed practitioners’ reference only — not a self-treatment guide.

Pregnancy

Practitioner supervision required — the formula is built on warm acrid Gui Zhi and Xi Xin and is not appropriate for self-prescribing in pregnancy.

Related Formulas

References

Source Shang Han Lun 《伤寒论》 · Eastern Han

「手足厥寒，脉细欲绝者，当归四逆汤主之。」
— 《伤寒论》(classical source, public domain)
  1. Classical source (public domain), cited in the source-quote section.
    2. Scheid, Bensky, Ellis & Barolet. Chinese Herbal Medicine: Formulas & Strategies, 2nd ed. — composition & dosage cross-checked.
    3. 《方剂学》（全国中医药行业高等教育规划教材）— pattern analysis cross-checked.

Professional reference notice. Entries are scholarly references for licensed TCM practitioners and students — not medical advice, and not a recommendation to self-prescribe. Chinese herbal formulas should be used under the guidance of a qualified practitioner. Content is an original editorial compilation by Cura x Cura, cross-checked against the cited references.