Prepared aconite (Zhi Fu Zi) Dried ginger (Gan Jiang) Liquorice (Gan Cao)

Chinese: 四逆汤

Pinyin: Sì Nì Tāng

Other names: Four Rebellious Decoction, Frigid Extremities Decoction

Number of ingredients: 3 herbs

Formula category: Formulas that rescue devastated Yang

Conditions for which it may be prescribed: CirrhosisGastroenteritisChronic colitis and two other conditions

  1. Rescues devastated Yang
  2. Warms the Middle Burner
  3. Stops diarrhea

Contraindications: This formula is contraindicated in cases with true Heat and false Cold... This formula is contraindicated in cases with true Heat and false Cold characterized by cold extremities, thirst with a desire to drink cool beverages, dark urine, and a red tongue with a yellow coating. see more

Source date: 220 AD

Source book: Discussion of Cold Damage

Si Ni Tang is a 3-ingredient Chinese Medicine formula with Prepared Aconite (Zhi Fu Zi) as a principal ingredient.

Invented in 220 AD, it belongs to the category of formulas that rescue devastated Yang. Its main actions are: 1) rescues devastated Yang and 2) warms the Middle Burner.

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 Tang is used by TCM practitioners to fight patterns like Lesser Yin Cold Transformation. From a Western Medicine standpoint, such patterns can give rise to a range of conditions such as acute cardiac insufficiency, cerebrovascular insufficiency or gastroenteritis for instance.

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

The three ingredients in Si Ni Tang

Zhi Fu Zi is a king ingredient in Si Ni Tang. Like the name indicates, it means it has more power than other ingredients in the formula.

1. Prepared Aconite (Zhi Fu Zi)

Part used: Processed daughter root

Nature: Hot

Taste(s): PungentSweet

Meridian affinity: HeartKidneySpleen

Category: Herbs that warm the Interior and/or expel Cold

Zhi Fu Zi breaks through the Yin and revives the Yang. It is especially effective in warming and stimulating the Fire at the Gate of Vitality so that it disseminates throughout the body and reaches the extremities.

Learn more about Prepared Aconite (Zhi Fu Zi)

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

2. Dried Ginger (Gan Jiang)

Part used: Dried rhizome

Nature: Hot

Taste(s): Pungent

Meridian affinity: HeartKidneyLungStomach

Category: Herbs that warm the Interior and/or expel Cold

Gan Jiang warms the Middle Burner and eliminates Cold, which strengthens the Spleen's functions of transforming and transporting food and fluids.

Learn more about Dried Ginger (Gan Jiang)

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

3. Liquorice (Gan Cao)

Part used: Dried root and rhizome

Nature: Neutral

Taste(s): Sweet

Meridian affinity: HeartLungSpleenStomach

Category: Tonic herbs for Qi Deficiency

Gan Cao augments the Qi, strengthens the Spleen, reduces the toxicity and moderates the drying properties of the other herbs.

Learn more about Liquorice (Gan Cao)

Si Ni Tang is used to treat Lesser Yin Cold Transformation

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 Tang is mostly used to treat the pattern "Lesser Yin Cold Transformation" which we describe below.

But before we delve into Lesser Yin Cold Transformation here is an overview of the Western conditions it is commonly associated with:

Acute cardiac insufficiency Cerebrovascular insufficiency Gastroenteritis Chronic colitis Cirrhosis

Again it wouldn't be correct to say "Si Ni Tang treats acute cardiac insufficiency" for instance. Rather, Si Ni Tang is used to treat Lesser Yin Cold Transformation, which is sometimes the root cause behind acute cardiac insufficiency.

Now let's look at Lesser Yin Cold Transformation, a pattern that TCM practitioners commonly treat with Si Ni Tang.

'Cold' as a body pattern in Chinese Medicine is one of the so-called "Eight Principles". Learn more about Cold pattern in Chinese Medicine

Lesser Yin Cold Transformation

Si Ni Tang is sometimes prescribed by TCM practitioners to treat Lesser Yin Cold Transformation. This pattern leads to symptoms such as feeling of cold, diarrhea, no thirst and chills. Patients with Lesser Yin Cold Transformation typically exhibit deep (Chen), slow (Chi) or weak (Ruo) pulses.

This is one of the two patterns of the Lesser Yin stage, the second Yin stage of the Six Stages theory

The Lesser Yin stage is where the disharmony mainly affects the Kidney Channel.

The Kidneys are considered the root of Yin and Yang in the body. As such, this stage has two patterns, called... read more about Lesser Yin Cold Transformation

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