Classic formula · Harmonize
Si Ni San
四逆散 Frigid Extremities Powder
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.
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.
Also sold as: Si Ni Wan · Bupleurum and Chih-shih Formula
Who Si Ni San is for
This formula is chosen for 2 patterns. Match your own picture before you match the name.
Signs it is classically given for
- 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
- Tongue
- Normal or a little red at the sides.
- Pulse
- Wiry.
What is in Si Ni San
Amounts are the classic decoction range in grams. Patent pills use the same herbs in the same proportion, so read the box for these names.
| Herb | Amount | Role | Job in the formula |
|---|---|---|---|
| Chai Hu Chinese Thorowax Root Use caution | 6 g | Chief | Bupleurum spreads the Liver qi and lets the warmth out. |
| Bai Shao White Peony Root | 9 g | Deputy | White peony softens the Liver and relaxes cramping. |
| Zhi Shi Immature Bitter Orange Fruit Use caution | 6 g | Assistant | Immature bitter orange breaks up stagnation in the chest and gut and pulls qi downward. |
| Zhi Gan Cao Honey-Fried Licorice Root Use caution | 6 g | Envoy | Honey-fried licorice harmonizes and, with peony, eases spasm. |
How Si Ni San 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.
Actions in classic terms
- Spreads Liver qi and releases constrained yang
- Harmonizes the Liver and Spleen
Common changes to Si Ni San
A practitioner rarely gives the bare formula. These are the classic additions for a specific picture.
- Loose stools with cramping add Bai Zhu, Fang Feng Toward Tong Xie Yao Fang.
- Rib pain add Xiang Fu, Chuan Xiong Toward Chai Hu Shu Gan San.
Cautions with Si Ni San
- 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 and typical dose
Sold as teapills, granules, decoction.
- Teapills
- 8 pills, three times a day, the usual label dose
- Course
- One to four weeks.
Follow the label of the brand you buy. Pill sizes differ between makers.
Buying Si Ni San
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.
Brand comparisons for formulas live on Supplements Apothecary, the buying side of this library.
Formulas often confused with Si Ni San
- Xiao Yao San 逍遥散 Adds blood and Spleen tonics for the tired, stressed person.
- Chai Hu Shu Gan San 柴胡疏肝散 Stronger qi moving for rib and chest pain.
Conditions where Si Ni San comes up
Sources
- Bensky, Scheid, Ellis and Barolet, Chinese Herbal Medicine: Formulas and Strategies, 2nd edition Composition, actions, indications, and cautions.
Important Note
Formula pages describe classic use so you can read a label, ask a better question, and find the right monographs. They are education, not a prescription. A formula that fits the wrong pattern can make things worse, so match the picture first.