{
    "slug": "si-ni-san",
    "names": {
        "pinyin": "Si Ni San",
        "chinese": "四逆散",
        "english": "Frigid Extremities Powder",
        "alternate": [
            "Si Ni Wan",
            "Bupleurum and Chih-shih Formula"
        ]
    },
    "category": "harmonize",
    "source": {
        "text": "Shang Han Lun (Discussion of Cold Damage)",
        "author": "Zhang Zhong-jing",
        "dynasty": "Han",
        "year": "c. 220"
    },
    "summary": "Four herbs for cold fingers and toes on a warm body. The warmth is there, but stuck Liver qi stops it reaching the hands and feet. Also for tight ribs, a knotted stomach, and loose stools with cramping that follow stress. Small, old, and surprisingly broad.",
    "picture": "A house with the furnace on and the vents closed. The rooms at the end of the hall go cold. Si Ni San does not add heat. It opens the vents.",
    "patterns": [
        {
            "slug": "liver-qi-stagnation",
            "role": "with cold hands",
            "_links": {
                "self": "https://www.naturalherblibrary.com/api/v1/pattern/liver-qi-stagnation",
                "html": "https://www.naturalherblibrary.com/pattern/liver-qi-stagnation"
            }
        },
        {
            "slug": "liver-overacting-on-spleen",
            "role": "with cramping",
            "_links": {
                "self": "https://www.naturalherblibrary.com/api/v1/pattern/liver-overacting-on-spleen",
                "html": "https://www.naturalherblibrary.com/pattern/liver-overacting-on-spleen"
            }
        }
    ],
    "indications": [
        "Cold hands and feet with a warm trunk",
        "Tightness or pain under the ribs",
        "A knotted or crampy stomach",
        "Loose stools with cramping and urgency that follow stress",
        "Irritability, a feeling of being wound tight",
        "Painful periods with cold hands"
    ],
    "signs": {
        "tongue": "Normal or a little red at the sides.",
        "pulse": "Wiry."
    },
    "ingredients": [
        {
            "pinyin": "Chai Hu",
            "grams": "6",
            "role": "chief",
            "job": "Bupleurum spreads the Liver qi and lets the warmth out.",
            "herb_slug": "root-of-chinese-thorowax",
            "english": "Chinese Thorowax Root",
            "chinese": "柴胡",
            "latin": "Radix Bupleuri",
            "_links": {
                "herb": "https://www.naturalherblibrary.com/api/v1/herb/root-of-chinese-thorowax",
                "html": "https://www.naturalherblibrary.com/herb/root-of-chinese-thorowax"
            }
        },
        {
            "pinyin": "Bai Shao",
            "grams": "9",
            "role": "deputy",
            "job": "White peony softens the Liver and relaxes cramping.",
            "herb_slug": "white-peony-root",
            "english": "White Peony Root",
            "chinese": "白芍",
            "latin": "Radix Paeoniae Alba",
            "_links": {
                "herb": "https://www.naturalherblibrary.com/api/v1/herb/white-peony-root",
                "html": "https://www.naturalherblibrary.com/herb/white-peony-root"
            }
        },
        {
            "pinyin": "Zhi Shi",
            "grams": "6",
            "role": "assistant",
            "job": "Immature bitter orange breaks up stagnation in the chest and gut and pulls qi downward.",
            "herb_slug": "immature-fruit-of-seville-orange",
            "english": "Immature Bitter Orange Fruit",
            "chinese": "枳实",
            "latin": "Fructus Aurantii Immaturus",
            "_links": {
                "herb": "https://www.naturalherblibrary.com/api/v1/herb/immature-fruit-of-seville-orange",
                "html": "https://www.naturalherblibrary.com/herb/immature-fruit-of-seville-orange"
            }
        },
        {
            "pinyin": "Zhi Gan Cao",
            "grams": "6",
            "role": "envoy",
            "job": "Honey-fried licorice harmonizes and, with peony, eases spasm.",
            "herb_slug": "prepared-liauorice-root",
            "english": "Honey-Fried Licorice Root",
            "chinese": "炙甘草",
            "latin": "Radix Glycyrrhizae Praeparata",
            "_links": {
                "herb": "https://www.naturalherblibrary.com/api/v1/herb/prepared-liauorice-root",
                "html": "https://www.naturalherblibrary.com/herb/prepared-liauorice-root"
            }
        }
    ],
    "actions": [
        "Spreads Liver qi and releases constrained yang",
        "Harmonizes the Liver and Spleen"
    ],
    "how_it_works": "Bupleurum lifts and spreads; bitter orange pushes down and out. Between them the stuck qi starts moving again and the warmth reaches the limbs. Peony and licorice are the classic pair for cramping, which is why the formula also settles a stress-knotted gut.",
    "modifications": [
        {
            "for": "Loose stools with cramping",
            "add": [
                "Bai Zhu",
                "Fang Feng"
            ],
            "note": "Toward Tong Xie Yao Fang."
        },
        {
            "for": "Rib pain",
            "add": [
                "Xiang Fu",
                "Chuan Xiong"
            ],
            "note": "Toward Chai Hu Shu Gan San."
        }
    ],
    "cautions": [
        "Not for cold hands from true cold: a pale face, a cold trunk, a wet pale tongue. That is yang deficiency and needs warming.",
        "Pregnancy: use only under a qualified practitioner."
    ],
    "forms": [
        "teapills",
        "granules",
        "decoction"
    ],
    "typical_dose": {
        "teapills": "8 pills, three times a day, the usual label dose",
        "course": "One to four weeks."
    },
    "cousins": [
        {
            "slug": "xiao-yao-san",
            "difference": "Adds blood and Spleen tonics for the tired, stressed person."
        },
        {
            "slug": "chai-hu-shu-gan-san",
            "difference": "Stronger qi moving for rib and chest pain."
        }
    ],
    "commerce": {
        "store": "supplementsapothecary.com",
        "store_name": "Supplements Apothecary",
        "store_slug": "si-ni-san",
        "store_url": "https://www.supplementsapothecary.com/supplement/si-ni-san",
        "status": "planned",
        "label_check": "The box reads Si Ni San with the characters 四逆散. Four ingredients: Bupleurum, White peony, immature Bitter orange, and Licorice. Not to be confused with Si Ni Tang, which contains aconite."
    },
    "conditions": [
        "hypochondriac-pain",
        "liver-qi-stagnation",
        "abdominal-pain",
        "diarrhea",
        "dysmenorrhea",
        "stress"
    ],
    "sources": [
        {
            "title": "Bensky, Scheid, Ellis and Barolet, Chinese Herbal Medicine: Formulas and Strategies, 2nd edition",
            "note": "Composition, actions, indications, and cautions."
        }
    ],
    "meta": {
        "status": "published",
        "last_updated": "2026-10-12",
        "reviewed_by": null
    },
    "_links": {
        "html": "https://www.naturalherblibrary.com/formula/si-ni-san",
        "self": "https://www.naturalherblibrary.com/api/v1/formula/si-ni-san",
        "index": "https://www.naturalherblibrary.com/api/v1/formulas"
    }
}