Bupleurum roots (Chai Hu) Immature Bitter Oranges (Zhi Shi) White peony roots (Bai Shao) Liquorice (Gan Cao)

Si Ni San

Chinese: 四逆散

Pinyin: Sì Nì Sàn

Other names: Frigid Extremities Powder, Four Rebellious Powder

Number of ingredients: 4 herbs

Formula category: Formulas that harmonize Liver-Spleen

Conditions for which it may be prescribed: ColitisEnuresisRhinitis and seventeen other conditions

  1. Regulates Liver and Spleen
  2. Eliminates Internal Heat

Contraindications: Contraindicated for Qi Stagnation associated with Yin Deficiency, which may... Contraindicated for Qi Stagnation associated with Yin Deficiency, which may also manifest with pain in the hypochondria, epigastrium, and abdomen. see more

Source date: 220 AD

Source book: Discussion of Cold Damage

Si Ni San is a 4-ingredient Chinese Medicine formula with Bupleurum Roots (Chai Hu) as a principal ingredient.

Invented in 220 AD, it belongs to the category of formulas that harmonize Liver-Spleen. Its main actions are: 1) regulates Liver and Spleen and 2) eliminates Internal Heat.

In Chinese Medicine health conditions are thought to arise due to "disharmonies" in the body as a system. These disharmonies are called "patterns" and the very purpose of herbal formulas is to fight them in order to restore the body's harmony.

In this case Si Ni San is used by TCM practitioners to fight patterns like Rebellious Liver Qi. From a Western Medicine standpoint, such patterns can give rise to a range of conditions such as cholecystitis, cholelithiasis or gastritis for instance.

On this page, after a detailed description of each of the four ingredients in Si Ni San, we review the patterns and conditions that Si Ni San helps treat.

The four ingredients in Si Ni San

Chai Hu is a king ingredient in Si Ni San. Like the name indicates, it means it has more power than other ingredients in the formula.

1. Bupleurum Roots (Chai Hu)

Part used: Dried root and rhizome

Nature: Cool

Taste(s): Bitter

Meridian affinity: GallbladderLiver

Category: Cool/Acrid herbs that release the Exterior

Chai Hu is able to disperse any kind of Qi Stagnation in the epigastrium, abdomen, Stomach, and Intestines. It is an upward rising herb that enters the Liver.

Learn more about Bupleurum Roots (Chai Hu)

Zhi Shi is a deputy ingredient in Si Ni San. This means it helps the king ingredient(s) treat the main pattern or it serves to treat a coexisting pattern.

2. Immature Bitter Oranges (Zhi Shi)

Part used: Dried unripe fruit

Nature: Cool

Taste(s): BitterPungentSour

Meridian affinity: SpleenStomachLarge intestine

Category: Herbs that regulate Qi

Zhi Shi drains Stagnation, breaks up Stagnant Qi, and reduces accumulation in the Middle Burner to facilitate the transportive and transformative functions of the Spleen and Stomach. Its descending action pairs it well with the ascending action of Chai Hu (the key herb): the effect of the different directions is to disentangle Heat in the Liver, Stomach and Spleen territories.

Learn more about Immature Bitter Oranges (Zhi Shi)

Bai Shao is an assistant ingredient in Si Ni San. This means that it either serves to reinforces the effect of other ingredients or it moderates their toxicity.

3. White Peony Roots (Bai Shao)

Part used: Dried root

Nature: Neutral

Taste(s): BitterSour

Meridian affinity: SpleenLiver

Category: Tonic herbs for Blood Deficiency

Bai Shao nourishes the Liver and preserves the Yin. Bai Shao holds things in; this is in contrast to the key herb Chai Hu, which disperses. This combination is very effective in disseminating the Liver
Qi without injuring its Yin.

Learn more about White Peony Roots (Bai Shao)

Gan Cao is an envoy ingredient in Si Ni San. This means that it directs the formula towards certain area of the body and/or harmonizes the actions of other ingredients.

4. Liquorice (Gan Cao)

Part used: Dried root and rhizome

Nature: Neutral

Taste(s): Sweet

Meridian affinity: SpleenStomachHeartLung

Category: Tonic herbs for Qi Deficiency

Gan Cao harmonizes the various actions of the other herbs in the formula and strengthens the Spleen to curb the Liver.

Learn more about Liquorice (Gan Cao)

Si Ni San is used to treat Rebellious Liver Qi

It's important to remember that herbal formulas are meant to treat patterns, not "diseases" as understood in Western Medicine. According to Chinese Medicine patterns, which are disruptions to the body as a system, are the underlying root cause for diseases and conditions.

As such Si Ni San is mostly used to treat the pattern "Rebellious Liver Qi" which we describe below.

But before we delve into Rebellious Liver Qi here is an overview of the Western conditions it is commonly associated with:

Cholecystitis Cholelithiasis Gastritis Gastric ptosis Peptic ulcers Colitis Appendicitis Pancreatis Urinary stones Dysmenorrhea Premenstrual syndrome Impotence Coronary artery disease Urinary incontinence Enuresis Perimenopausal syndrome Rhinitis Mastitis Blocked fallopian tubes Periappendical abscesses

Again it wouldn't be correct to say "Si Ni San treats cholecystitis" for instance. Rather, Si Ni San is used to treat Rebellious Liver Qi, which is sometimes the root cause behind cholecystitis.

Now let's look at Rebellious Liver Qi, a pattern that TCM practitioners commonly treat with Si Ni San.

The Liver is a so-called "Zang" Organ. Learn more about the Liver in Chinese Medicine

Rebellious Liver Qi

Si Ni San is sometimes prescribed by TCM practitioners to treat Rebellious Liver Qi. This pattern leads to symptoms such as hypochondrial distention, epigastric distension, hiccuping and frequent sighing. Patients with Rebellious Liver Qi typically exhibit wiry (Xian) pulses.

In normal times Liver Qi travels horizontally to assists the the Stomach and the Spleen's digestive functions. When it rebels its movement becomes excessive and that causes Stomach Qi to ascend instead of descend, causing belching, nausea and vomiting.

This differs from Liver Qi Stagnation which... read more about Rebellious Liver Qi

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