Sì Nì Sǎn

四逆散

Frigid Extremities Powder

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Category: Harmonize ⌕ 
Subcategory: Harmonize Liver and Spleen  Source: Shang Han Lun 
Actions: disperse obstructed qi, soothe liver, regulate Spleen[31]
Diagnosis
Tongue: wiry      Pulse:    Other: 
Patterns: Liver and Spleen Qi Stagnation 
Indications: LV Qi stagnation overacting on the SP causing cold extremities (Yang Jue) [35] • 1. Yang obstructed Jue Ni Syndrome 2. Liver Spleen Qi Stagnation. cold extremities, hypochondria epigastria pain, wiry pulse [31] • Liver Qi stagnation not allowing Qi to flow to extremities, leading to cold limbs. True heat/false cold.[42]
Contraindications: 
Description
Name Variations: Si Ni San, 四逆散, Frigid Extremities Powder,
Herb List: Chai Hu(K) • Bai Shao(M) • Zhi Shi(A) • Gan Cao(E)
Commentary:
Related Formulas: Chai Hu Shu Gan San
NCCAOM: The 4 NCCAOM formulas for harmonizing the Liver and Spleen are Sì Nì Sǎn, Xiāo Yáo Sǎn, Jiā Wèi Xiāo Yáo Sǎn, and Tòng Xiè Yào Fāng. • Si Ni San is for Liver Qi stagnation overacting on Spleen causing cold extremities. • Xiao Yao San is Liver Qi stagnation with Liver Blood & Spleen Qi deficiency causing hypochondriac pain, vertigo, irregular menstruation, breast distention, wiry, fatigue, poor appetite, weak pulse. • Jia Wei Xiao Yao San is for Liver Qi stagnation with Liver Blood & Spleen Qi deficiency + Interior Heat. • Tong Xie Yao Fang is for Liver Qi stagnation overacting on the SP causing diarrhea with abdominal pain. Pulse is left side is wiry (Liver) and right side is slow (SP Qi deficiency).
Herbs Cat/Dosage Actions Attributes
Chai Hu • Thorowax • 柴胡  Release Exterior Wind Heat Harmonize interior and exterior • Reduce fevers • Reduce chills • Soothe liver Qi • Clear muscle layer heat • Tonify stomach Qi • Guide herbs to Shao Yang Jing Antibiotic • Antipyretic • Anti-inflammatory • Antibaterial • Antiviral • Analgesic • Hepatoprotective • Immunemodulatory • Chemoprotective • Anti-tumor • Cholagogic • Sedative • Immunostimulate
Zhi Zi • Gardenia • 栀子  Clear Heat Drain Fire Clear heat • Drain liver fire • Cool blood • Dry dampness • Resolve toxins • Stop bleeding • Reduce injury swelling Antibiotic • Sedative • Hypotensive • Laxative • Anti-inflammatory • Antibacterial • Antipyretic
Bai ShaoWhite Root Peony • 白芍  Tonify Blood Nourish blood • Regulate menses • Soothes liver • Relieve pain • Preserve yin • Reduce spasms • Harmonize Ying and Wei QiDao Di: Zhe Jiang • AKA Shao Yao analgesic • antibacterial • anti-inflammatory • hepatoprotective • immune system boost • sedative
Zhi Gan CaoHoney Fried Licorice • 炙甘草  Tonify Qi Increase the effectiveness of Gan Cao, particularly with: Tonify middle • Tonify Heart and Spleen Qi • Harmonize other herbs Honey is a cardiotonic. Zhi Gan Cao is different from Gan Cao in that it nourishes the heart. Hypoglycemic • Antiarrhythmic • Expectorant • Antidiarrheal • Antiulcer • Hepatoprotective • Antiulcer • Immunostimulant • Antitussive • Antiviral • Detox • Demulcent • Anti-inflammatory • Laxative • Emmenagogue • Antimicrobial • Spasmolytic
King/Chief    ♥ Minister/Deputy      Assistant     ♦ Envoy
Directions:
Modifications For
D 31
W 31
S 31

Caution

ALERT: Contraindications of each herb - use with caution under these conditions:
Chai Hu: Dries Yin and can exacerbate the Yin deficiency • Do not use as intramuscular injections • Liver fire • Hyperactive liver yang • Cytochrome P450, 2C9, 2E1, 2D6, and 3A4 • Greater than 19g may lead to liver injury
Zhi Zi: Spleen and Stomach deficiency cold • Loose stool • Poor appetite • Diarrhea
Bai Shao: Deficiency cold • Breast feeding • Pregnancy • Bleeding Disorder • Scheduled Surgery
Zhi Gan Cao:

Notes

Information in this post came from many sources, including class notes, practitioners, websites, webinars, books, magazines, and editor's personal experience.  While the original source often came from historical Chinese texts,  variations may result from the numerous English translations.   Always consult a doctor prior to using these drugs.  The information here is strictly for educational purposes. 

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