Si Ni San四逆散

Frigid Extremities Powder (Bupleurum & Chih-shih Formula)

Harmonizing 和解剂Harmonize Liver and Spleen 调和肝脾

Ingredients4 herbs

HerbDosageRoleWhat it does in this formula

甘Zhi Gan Cao甘草炙Glycyrrhizae Radix Praeparata6g使 EnvoyWith Bai Shao relaxes cramping, supports the Spleen and harmonizes the four 枳Zhi Shi枳实破，水渍，炙干Aurantii Fructus Immaturus6g佐 AssistantMoves qi downward and breaks up the stagnation, paired against Chai Hu's lift 柴Chai Hu柴胡Bupleuri Radix6g君 ChiefCourses the Liver and lifts constrained yang outward

芍Bai Shao芍药Paeoniae Radix Alba6g臣 DeputyNourishes blood and softens the Liver, so coursing does not consume yin

Indications

Courses constrained yang out to the limbsCourses the Liver and regulates the SpleenRelaxes spasm and stops abdominal pain

Yang constrained in the interiorwith Liver-Spleen disharmony. Qi that cannot spread stops short of the extremities, so they go cool while heat signs may persist elsewhere. The treatment is to open the constraint, not to warm the limbs.

Clinical Manifestations

Cool hands and feet with a warm trunk, arising from tension rather than cold
Distending pain of the flanks, rib-side or epigastrium
Stress-linked abdominal pain with urgent, incomplete stools
Irritability with a wiry pulse
Gallbladder or gastric pain of Liver-Spleen disharmony

TongueRed or unremarkable, thin white or thin yellow coating

PulseWiry

Health Categories

Digestive HealthLiver Health & DetoxUrinary & Bladder HealthStress & Emotional Balance

Modern Applications

IBS Functional dyspepsia Cholecystitis Costochondritis Stress-related abdominal pain Anxiety

Common adjustments

Cough — the source adds Wu Wei Zi 五味子 and Gan Jiang 干姜
Palpitations — the source adds Gui Zhi 桂枝
Difficult urination — the source adds Fu Ling 茯苓
Abdominal pain — the source adds Fu Zi
Diarrhea with tenesmus — the source adds Xie Bai 薤白

Contraindications

The decisive distinction: cold limbs from true yang collapse — clear watery diarrhea, aversion to cold, a faint pulse — belong to Si Ni Tang 四逆汤 and must be warmed, not coursed; using this formula there would be a serious error. Zhi Shi drives qi downward, so use cautiously where qi deficiency or sinking is marked.

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

Pregnancy

Use with caution in pregnancy — Zhi Shi breaks and drives qi downward; practitioner supervision required.

Related Formulas

Chai Hu Shu Gan San柴胡疏肝散

References

Source Shang Han Lun 《伤寒论》 · Eastern Han

「少阴病，四逆，其人或咳，或悸，或小便不利，或腹中痛，或泄利下重者，四逆散主之。」
— 《伤寒论》(classical source, public domain)

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.