Si Ni Tang四逆汤

Frigid Extremities Decoction

Warming the Interior 温里剂Rescue Devastated Yang 回阳救逆

Ingredients3 herbs

HerbDosageRoleWhat it does in this formula

甘Zhi Gan Cao甘草炙Glycyrrhizae Radix Praeparata6g佐使 Assistant–EnvoyAugments the qi of the middle, tempers the harsh dryness of Fu Zi and Gan Jiang, and moderates Fu Zi's toxicity 干Gan Jiang干姜Zingiberis Rhizoma6g臣 DeputyWarms the middle so the restored yang has a base to hold; classically said to make Fu Zi's heat reliable

附Fu Zi (Zhi)附子生用，去皮，破八片Aconiti Radix Lateralis praeparata15g君 ChiefRestores the devastated yang of the Heart and Kidney and drives out the flood of interior cold

Indications

Rescues devastated yang and restores the collapsing qiWarms the middle and dispels interior coldStops cold-type diarrhoea and reverses cold limbs

Cold reversal from devastated Heart and Kidney yang. Yang no longer reaches the extremities or holds the spirit, and the interior is flooded with cold. It also treats yang collapse following mistaken use of sweating in a Taiyang pattern.

Clinical Manifestations

Cold limbs with aversion to cold and a curled-up posture
Listlessness verging on somnolence with a faint pulse
Watery diarrhoea containing undigested food
Vomiting and abdominal pain without thirst
Yang collapse after excessive sweating or purgation

TonguePale with a white slippery coating

PulseFaint and thin, on the verge of expiring

Health Categories

Heart & Circulation

Modern Applications

Shock Circulatory collapse Hypotension Severe dehydration Congestive heart failure Hypothermia

Common adjustments

Marked collapse with profuse sweating — add Ren Shen 人参 — the sense of Si Ni Jia Ren Shen Tang
Interior cold so severe that yang is repelled outward — increase Fu Zi and double Gan Jiang 干姜 — the sense of Tong Mai Si Ni Tang
Yang floating to the head with a red face — add Cong Bai 葱白 to unblock yang above and below
Persistent vomiting — add Sheng Jiang 生姜 and Ban Xia 半夏

Contraindications

Absolutely not for true heat with false cold — the patient whose limbs are cold but who is thirsty for cold drinks, has a foul-smelling stool, dark scanty urine, a red tongue with yellow coating and a forceful deep pulse. Giving this formula there is dangerous. Yang collapse is a medical emergency and requires urgent care alongside any herbal treatment.

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

Pregnancy

Contraindicated in pregnancy except in a life-threatening yang collapse judged by a physician. Fu Zi is a toxic aconite root: only the processed form (Zhi Fu Zi) may be used, it must be decocted first and long enough to destroy the aconitine-type alkaloids, and overdose or under-boiling causes numbness, arrhythmia and can be fatal. Dried ginger at this dose is also strongly heating. Never self-administer.

Related Formulas

References

Source Shang Han Lun 《伤寒论》 · Eastern Han

「少阴病，脉沉者，急温之，宜四逆汤。」
— 《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.