Tong Mai Si Ni Tang通脉四逆汤
Unblock the Pulse Decoction for Frigid Extremities
Ingredients3 herbs
Indications
Exuberant interior cold repelling the yang outwardin a Shaoyin pattern. The interior is frankly cold while a false warmth appears at the surface; the treatment is to break the cold, not to address the surface signs.
Clinical Manifestations
- Watery diarrhoea with undigested food and cold limbs
- A flushed face in a patient who is otherwise cold and collapsing
- Absence of aversion to cold despite an obviously cold interior
- A pulse so faint it can barely be found, or absent after diarrhoea stops
- Dry retching, abdominal pain or sore throat accompanying yang collapse
Health Categories
Modern Applications
Common adjustments
- Face flushed red — add Cong Bai 葱白 to lead the floating yang back down
- Abdominal pain — add Bai Shao 白芍 to relax and stop pain
- Dry retching — add Sheng Jiang 生姜
- Diarrhoea stopped but the pulse does not return — add Ren Shen 人参
Contraindications
Absolutely not for true heat masquerading as cold, where a red face reflects real heat rather than displaced yang — the distinction rests on thirst, stool odour, urine colour, tongue and pulse strength. This pattern is a medical emergency; herbal treatment does not replace urgent care.
For licensed practitioners’ reference only — not a self-treatment guide.
Pregnancy
Contraindicated in pregnancy. The doses of prepared Fu Zi and dried ginger here are larger than in Si Ni Tang, so the toxicity margin is narrower still: only processed Fu Zi may be used, it must be pre-decocted long enough that the broth no longer numbs the tongue, and use outside a life-threatening emergency assessed by a physician is not appropriate.
Related Formulas
References
Source Shang Han Lun 《伤寒论》 · Eastern Han
「少阴病，下利清谷，里寒外热，手足厥逆，脉微欲绝，身反不恶寒，其人面色赤……通脉四逆汤主之。」
- 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.