与理中丸（理中汤）的区别？

理中丸药性温和，主要用于调理长期的脾胃受凉或虚寒，比如经常肚子痛、拉肚子、没胃口或吐清茶淡水。而四逆汤药性猛烈，专门用于抢救阳气极度虚弱、身体濒临虚脱的危急情况，不能当作普通的肠胃调理药来用。

与附子理中丸（附子理中汤）的区别？

附子理中丸在四逆汤基础上加了白术，药性相对平和，既能驱寒，又能更好地调理脾胃，适合慢性阳虚、经常怕冷且脾胃不好的人日常服用。四逆汤没有白术，专攻抢救危急重症，不能日常随意调理。

与通脉四逆汤的区别？

通脉四逆汤是四逆汤的加强急救版，加大了猛烈药材用量，专门应对病情极度危重、体内寒气极度深重的情况。四逆汤药性相对缓和，是应对常规危象的基础急救方。

与当归四逆汤的区别？

两者都能缓解手脚冰冷，但原因不同。当归四逆汤因气血不足且受寒导致的手脚冷（冷不过肘膝），四逆汤因严重阳气衰竭导致的冰冷（冷过肘膝）。当归四逆汤补血，四逆汤补阳，不能混用。

四逆汤的核心适用人群有哪些？

主要包括亡阳证人群（手脚极冷、脉微欲绝）、慢性阳虚体质人群（畏寒怕冷、精神萎靡）、急症人群（心肌梗死、休克等阳气虚脱者）、消化系统疾病人群（脾胃虚寒相关症状）、其他阳虚相关人群（如雷诺氏病、风湿痹痛）、术后产后及大病恢复期人群。

四逆汤的核心适应症有哪些？

包括亡阳证（四肢厥冷、冷汗自出、神衰欲寐等）、少阴寒厥证（四肢厥冷、恶寒蜷卧、呕吐腹泻等）、急症危象（心肌梗死、休克导致的阳气虚脱）、脾胃虚寒重症（腹痛剧烈、呕吐腹泻）、阳虚型慢病（雷诺氏病、冻疮等）、术后产后虚脱等。

四逆汤的现代临床拓展应用有哪些？

可用于阳虚型哮喘、白细胞减少症、食管痉挛、阳虚型月经不调、毒血症等疾病的辅助治疗，通过辨证加减，温阳散寒，缓解相关症状。

四逆汤有哪些禁忌与注意事项？

禁忌实热证、对成分过敏者、孕妇、婴幼儿以及严重慢病患者需医生指导服用。注意严格控制剂量和煎服时间，附子须久煎减毒，不可长期服用，服用期间饮食宜清淡温热，避免滋补性中药及与其他药物相互作用，出现中毒症状应立即停药就医，急症时须配合现代医学救治。

Yang-Tonifying Formulas

四逆汤 · Sì Nì Tāng

Si Ni Tang

The classic formula for Yang collapse (Si Ni syndrome). Presents with icy cold extremities, preference for lying curled up, watery diarrhoea, and a faint pulse. Strongly restores Yang.

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Last reviewed August 2026

Formula CategoryYang-Tonifying Formulas

Primary PatternYang Deficiency

Primary FunctionRestore Yang, rescue from collapse

Primary Therapeutic PrincipleRestore devastated Yang, rescue from collapse, and warm the Middle Jiao

Main HerbsPrepared Aconite Accessory Root · Dried Ginger · Honey-fried Licorice

Classical SourceShang Han Lun (Zhang Zhongjing, Eastern Han)

Why This Formula?

Traditionally selected for critical Yang collapse — icy cold extremities, faint pulse and profound exhaustion — a rescue formula rather than a maintenance one, distinct from Fu Zi Li Zhong Tang's digestion-centred Spleen-Kidney warming and from the channel-level Cold that Dang Gui Si Ni Tang addresses.

Overview

What Is Si Ni Tang?

1. Where Si Ni Tang Came From

Si Ni Tang, also known as Frigid Extremities Decoction, is a foundational classical formula from Zhang Zhongjing’s Shang Han Lun (Treatise on Cold Damage). Designed to restore devastated yang and rescue the body from collapse, it is the primary prescription for the Shao Yin cold pattern.

This formula is used for severe yang deficiency with internal cold, addressing symptoms such as extremely cold extremities, aversion to cold, curled-up lying posture, clear-food diarrhea, lethargy, and a faint, nearly imperceptible pulse. It remains one of the most important emergency formulas in Traditional Chinese Medicine for treating yang collapse and frigid extremities.

2. Heart and Circulation Support

In modern medicine, Si Ni Tang is often used to support the heart during critical moments like heart failure or shock. For patients who feel their heart racing, struggle to breathe, and have ice-cold hands and feet, this formula acts as a powerful tonic. It strengthens the heart's ability to pump blood and helps the body get oxygen more efficiently. In emergency situations, it can help stabilize blood pressure and improve overall circulation.

3. Digestive System Recovery

This formula is also widely used for chronic stomach and gut issues that are caused by "cold." If you suffer from chronic gastritis or stomach ulcers and find that your belly pain feels better when you use a heating pad, Si Ni Tang can help. Gan Jiang and Zhi Gan Cao help the stomach and intestines move properly again, improving your appetite and stopping chronic diarrhea. It also helps reduce inflammation and can even help the lining of the stomach heal.

4. Nervous System Support

For certain neurological issues linked to low energy, Si Ni Tang can provide a much-needed boost. For example, if someone with Parkinson’s disease feels constantly cold, moves very slowly, and has tremors, this formula can help "wake up" the nervous system by boosting the body's Yang energy. It is also effective for treating headaches or dizziness that are triggered by cold weather or a lack of internal warmth. The Zhi Gan Cao in the mix ensures the nervous system stays stable while the other herbs provide the energy.

How It Works

Herb Composition (Sovereign / Minister / Assistant / Envoy)

1. The Chief Herb — Fu Zi

Fu Zi (Aconite) is the "Sovereign" or leader of this formula. It is incredibly hot and pungent, and in Chinese medicine, it is even considered slightly toxic because it is so powerful. It targets the Heart, Kidneys, and Spleen.

Its main job is to "rescue the Yang" and jump-start the body's internal fire. It travels deep into the body to warm the "Gate of Vitality" (the root of all your energy). Modern science shows that Fu Zi contains alkaloids (like aconitine) that can actually strengthen heart contractions and raise blood pressure, which is exactly what you need when the body is in a state of shock or collapse.

2. The Deputy Herb — Gan Jiang

Gan Jiang (Dried Ginger) is the "Minister" or second-in-command. It is also very hot and targets the digestive system and lungs.

Gan Jiang works as the perfect partner to Fu Zi. While Fu Zi focuses on the deep core, Gan Jiang warms the "middle" (the Spleen and Stomach) and helps unblock the blood vessels. This ensures that the warmth provided by the Chief herb can actually reach your hands and feet. Science-wise, it contains gingerols that stimulate the gut and improve circulation, helping to wake up a sluggish system.

3. The Assistant and Envoy — Zhi Gan Cao

Zhi Gan Cao (Honey-fried Licorice) wears two hats in this formula. First, it acts as a buffer to mellow out the fierce, intense heat of Fu Zi and Gan Jiang, making sure the formula doesn't act too harshly on the body.

Second, it helps the other herbs work together harmoniously. It protects your Spleen and Stomach energy while the other "hot" herbs are doing the heavy lifting. From a modern perspective, Zhi Gan Cao contains compounds that are anti-inflammatory and immune-boosting, providing a "safety net" that helps the body recover its strength while the internal fire is being restored.

Symptoms Traditionally Associated

Clinical Presentation in TCM

1. How the Body Shuts Down (Pathomechanism)

The core issue that Si Ni Tang treats is Collapsed Yang and Internal Cold. Think of your body’s Yang Qi as the sun in the natural world—it is the essential fuel for all life and movement. When this internal "sun" fades away, your body loses its ability to stay warm and functional.

Internal Freeze: Without Yang, cold takes over. This causes your limbs to become ice-cold (a condition called "cold reversal").
Organ Failure: As the fire goes out, your organs struggle. A weak Heart leads to palpitations; a weak Spleen leads to abdominal pain and diarrhea; and weak Kidneys lead to deep exhaustion and a constant feeling of being chilled to the bone.

This state is usually caused by severe illness, excessive exposure to cold, or long-term depletion of the body's energy.

2. Actions: What the Formula Does

The primary action of Si Ni Tang is to Rescue Yang and Reverse Collapse.

Reigniting the Fire: Using the intense heat of Fu Zi and Gan Jiang, it rapidly refills the body's energy reservoirs (Heart, Spleen, and Kidney Yang) and drives out the deep internal cold.
Warming the Center: It also warms the digestive system, helping to stop pain and diarrhea by restoring the Spleen’s ability to process fluids.
Restoring Balance: Once the "internal sun" is shining again, the cold disappears, and the body's natural functions return to a state of balance.

3. When to Use It (Indications)

This is an emergency formula for when the body is in a state of shock or severe depletion. Symptoms include:

Extreme Cold: Ice-cold hands and feet, and a strong desire to curl up in a ball under blankets.
Vitality Loss: Looking pale, feeling mentally foggy or extremely sleepy (like a dying battery), and having no thirst.
Digestive Collapse: Sharp abdominal pain, watery diarrhea, or vomiting.
Pulse & Tongue: A pulse that is nearly invisible (very thin and weak) and a tongue with a slippery white coating.

In modern clinics, it is used for critical conditions like heart failure or shock. It is also used as a support for chronic diseases (like chronic gastritis or arthritis) when the patient shows signs of being severely "cold" and depleted.

Formula Analysis

The Mechanism in Classical Theory

1. The Power Duo: Fu Zi and Gan Jiang

In this formula, Fu Zi and Gan Jiang work together as a high-powered team to save the body's energy.

The Strategy: Fu Zi is the "fire starter"—it goes deep to warm the Kidneys (the root of energy). Gan Jiang is the "stoker"—it warms the Spleen (the engine of energy).
The Result: When the root and the engine are both warmed, the body starts producing energy again. Gan Jiang also helps keep the heat from Fu Zi lasting longer. Modern research confirms this: the alkaloids in Fu Zi and the oils in Gan Jiang combine to boost heart strength and improve circulation much better than either herb could do alone.

2. The Peacemaker: Zhi Gan Cao

Zhi Gan Cao (Honey-fried Licorice) has the vital job of "Harmonizing."

Smoothing the Edge: Because Fu Zi and Gan Jiang are so incredibly hot and fierce, they could be harsh on the body. Zhi Gan Cao mellows them out, ensuring the energy boost is steady rather than a sudden, damaging explosion.
Protecting the Core: It also supports the Spleen and Stomach, acting as a shield to make sure the body’s healthy energy isn't "burned off" while the formula is fighting the internal cold. It acts as the bridge that helps the body absorb and use the powerful medicine effectively.

How This Formula Compares

Clinical Comparison Table

Compare	Si Ni Tang	Si Ni San	Dang Gui Si Ni Tang	Huang Qi Gui Zhi Wu Wu Tang
Primary Function	Restore Yang, rescue from collapse	Course Liver Qi, resolve constraint, harmonize	Warm channels, nourish Blood, disperse Cold	Tonify Qi, warm channels, relieve numbness
Formula Category	Yang-Tonifying Formulas	Harmonising Formulas	Blood-Tonifying Formulas	Qi-Tonifying Formulas
Typical TCM Pattern	Yang Deficiency	Qi Stagnation	Blood Deficiency	Qi Deficiency
Main Conditions	Cold Limbs, Abdominal Pain, Stomach Discomfort, Fatigue & Low Energy, General Lethargy	Cold Limbs, Hypochondriac Distension, Bloating, Emotional Depression, Chest Tightness	Cold Limbs, Joint Discomfort, Low Back Pain	Cold Limbs, Numbness in Limbs, Joint Discomfort
Main Herbs	Prepared Aconite Accessory Root · Dried Ginger · Honey-fried Licorice	Bupleurum Root · Immature Bitter Orange · White Peony Root · Honey-fried Licorice	Chinese Angelica Root · Cinnamon Twig · White Peony Root · Asarum / Wild Ginger · Tetrapanax Pith · Jujube / Chinese Date · Honey-fried Licorice	Astragalus Root · Cinnamon Twig · White Peony Root · Fresh Ginger · Jujube / Chinese Date
Classical Source	Shang Han Lun (Zhang Zhongjing, Eastern Han)	Shang Han Lun (Zhang Zhongjing, Eastern Han)	Shang Han Lun (Zhang Zhongjing, Eastern Han)	Jin Gui Yao Lue (Zhang Zhongjing, Eastern Han)

How to tell them apart

Si Ni Tang is for critical Yang collapse. Fu Zi Li Zhong Tang addresses severe Spleen-Kidney Yang deficiency with digestive focus. Dang Gui Si Ni Tang and Huang Qi Gui Zhi Wu Wu Tang address channel/Blood patterns rather than systemic Yang collapse.

For educational reference only, based on traditional pattern differentiation — not a substitute for professional advice.

Clinical Modifications

Clinical Modifications for Si Ni Tang

1. When You Also Have a Cold or Flu (Surface Symptoms)

If you have collapsed internal energy but also catch a seasonal chill—showing symptoms like fever, no sweating, and an intense dislike of cold—we add Ma Huang (Ephedra) and Xi Xin (Asarum). Ma Huang helps you sweat to push the cold out from the surface, while Xi Xin clears deep-seated chills and stops pain. Together with Si Ni Tang, they treat both the "inside" (warming your core) and the "outside" (clearing the flu symptoms) at the same time.

2. When You Feel Bloated or Stagnant (Qi Stagnation)

If you feel tight in the chest, bloated in the belly, or are burping frequently alongside your low energy, we add Mu Xiang (Aucklandia Root) and Hou Po (Magnolia Bark). Mu Xiang is great for settling the stomach and stopping pain, while Hou Po clears fullness and moves stagnant energy downward. Adding these ensures that while we warm your system, your energy stays moving and doesn't get "clumped up" in your digestive tract.

3. When Your Circulation is Blocked (Blood Stasis)

If you notice signs of poor circulation—like a dull or dark complexion, purple-looking lips or nails, and sharp body pains—we add Dang Gui (Angelica Root) and Chuan Xiong (Ligusticum). Dang Gui builds and moves the blood, and Chuan Xiong is a specialist at moving energy and blood together to stop pain. This modification helps the formula better reach your extremities and clears out the "traffic jams" in your blood vessels caused by the internal cold.

Modern Research

What the Science Suggests

1. What Science Says Today (Pharmacological Research)

Modern science has taken a close look at how Si Ni Tang works, and the results are impressive. Research shows it has several key benefits for the body:

A Power Boost for the Heart: It strengthens the heart's pumping power and increases blood flow to the heart itself. It also helps the heart handle a lack of oxygen better and can even help regulate irregular heartbeats.
Getting the Gut Moving: For the digestive system, Si Ni Tang helps move food through the gut more efficiently. It boosts stomach acid and digestive enzymes, which clears up indigestion. It also acts as a shield for the stomach lining, reducing inflammation and helping with issues like ulcers and gastritis.
General Protection: Beyond the heart and gut, this formula helps balance the immune system and acts as an antioxidant. This means it helps protect your cells from damage and may even help slow down the aging process. The different chemicals in the herbs work as a team to protect and regulate your whole body.

2. Real-World Results (Clinical Research)

In recent years, many clinical studies have confirmed that Si Ni Tang is highly effective in treating serious conditions:

Heart Failure and Shock: When used alongside standard modern medical treatments, Si Ni Tang significantly improves heart function. Patients often feel much better, have a higher quality of life, and in severe cases, the formula has been shown to help lower mortality rates.
Chronic Gut Issues: For people struggling with long-term stomach inflammation or diarrhea, this formula provides safe and effective relief. It helps stop abdominal pain and gets the digestive system back to a normal, healthy state.
New Horizons: Doctors are also finding that Si Ni Tang works well for "tricky" or hard-to-treat cases where a patient’s energy is severely depleted. It offers a unique way to combine ancient wisdom with modern care. As research continues, we are discovering even more ways this formula can help people stay healthy and recover from illness.

Safety

Safety Considerations

1. Safety with Fu Zi

Fu Zi is the powerhouse of this formula, but it contains natural alkaloids that can be toxic if not handled correctly.

The Golden Rule: Always ensure Fu Zi is properly prepared and boiled long enough.
Watch for Signs: If you feel numbness in your tongue or mouth, dizziness, or a racing heart after taking it, stop immediately and contact a professional.
Pregnancy: Pregnant women should generally avoid this formula because the intense moving and warming properties of Fu Zi could be risky for the pregnancy.

2. What to Avoid in Your Diet

While taking this formula, stay away from "stressful" foods that fight against the warming effect:

No Raw or Cold Foods: Avoid ice-cold drinks, salads, or raw fish.
No Greasy or Spicy Foods: Stay away from fried foods, heavy fats, or extreme spices like hot chili, which can irritate a weak stomach.
Stick to the Basics: Choose warm, easy-to-digest meals like rice porridge, warm noodles, and cooked vegetables to help your body absorb the medicine.

3. Drug Interactions

Si Ni Tang (specifically the Fu Zi in it) does not get along with certain other herbs. According to traditional rules, it should not be mixed with herbs like Ban Xia, Gua Lou, Bei Mu, Bai Lian, or Bai Ji, as they can cause bad reactions or cancel each other out. If you are taking any other medications or supplements, always check with a specialist first to avoid any unwanted interactions.

Available Products

Where to Get It

HJMEDICAL Hoi Tin Si Ni Tang (Frigid Extremities Decoction) 5:1 Concentrated Granules $24.93

HJMEDICAL Nong's Si Ni Tang (Frigid Extremities Decoction) 5:1 Concentrated Granules $54.46

Nong's Dang Gui Si Ni Tang Extract Granules

HJMEDICAL Nong's Dang Gui Si Ni Tang (Angelica Frigid Extremities Decoction) 5:1 Concentrated Granules $67.30

HJMEDICAL Hoi Tin Dang Gui Si Ni Tang (Angelica Warming Circulation Decoction) 5:1 Concentrated Granules $29.10

FAQ

Questions About Si Ni Tang

Q1: What are the actions of Si Ni Tang?

Si Ni Tang has the actions of restoring devastated Yang, warming the Middle Jiao, and dispelling Cold. It is primarily used for Shao Yin cold patterns or Yang collapse, characterized by cold extremities, aversion to cold, and a faint pulse.

Q2: Which modern diseases is Si Ni Tang suited to?

Modern TCM clinical practice commonly applies it (under close professional supervision) to individuals whose pattern differentiation falls within Yang collapse or severe Yang deficiency, including supportive care in shock, heart failure, severe gastroenteritis with cold signs, and certain chronic cold-type conditions with clear Yang failure features.

Q3: Is Si Ni Tang suitable for improving cold extremities and exhaustion?

For presentations of ice-cold hands and feet (often extending toward the elbows and knees), strong aversion to cold, desire to curl up, mental fatigue or drowsiness, watery diarrhea, and a faint or thready pulse — in those whose pattern differentiation confirms Yang collapse or Shao Yin cold — TCM may apply Si Ni Tang as an emergency adjunct. It cannot replace standard medical treatment.

Q4: Who should not take Si Ni Tang?

Those with true Heat presenting as false Cold, Yin deficiency with Heat, excess Heat patterns, or who are pregnant are generally not suitable. Because the formula contains Fu Zi, it must only be prescribed and monitored by a qualified TCM physician.

Q5: How does Si Ni Tang differ from Fu Zi Li Zhong Tang?

Si Ni Tang is a more focused Yang-rescue formula aimed at critical Yang collapse with cold extremities and faint pulse. Fu Zi Li Zhong Tang emphasizes warming the Middle Jiao and strengthening the Spleen for severe digestive deficiency-cold, and is generally less intense as an emergency rescue formula.

Q6: Why is proper preparation of Fu Zi critical in Si Ni Tang?

Fu Zi contains toxic alkaloids. Only properly processed Fu Zi should be used, and it typically requires prolonged pre-decoction to reduce toxicity. Incorrect preparation or dosage can lead to serious adverse effects, which is why professional supervision is mandatory.

Q7: When should Si Ni Tang be stopped?

Classical guidance emphasizes discontinuing the formula once the limbs begin to warm and Yang shows signs of recovery. Continued use after the crisis is resolved is not appropriate and may cause excess Heat.

Q8: Can Si Ni Tang be used for chronic cold conditions?

In modern practice it is sometimes adapted for chronic Yang deficiency with clear cold signs under careful professional guidance. However, its classical strength is for acute or severe Yang collapse rather than mild long-term cold patterns.

Q9: What are the main ingredients of Si Ni Tang?

The classical formula consists of three herbs: Fu Zi (prepared Aconite) to restore Yang and dispel Cold, Gan Jiang (dried Ginger) to warm the Middle and assist Yang, and Zhi Gan Cao (honey-fried Licorice) to harmonize the formula and moderate the intensity of the other herbs.

Q10: Is Si Ni Tang an emergency formula?

Yes, it is classically regarded as a key Yang-rescue formula for critical cold patterns. In modern settings it should only be used alongside appropriate medical care and never as a substitute for emergency treatment when shock or severe circulatory failure is present.

FAQ

General Questions

How do I choose the right formula?

TCM formulas are traditionally selected according to individual pattern differentiation rather than by symptom alone. If you're not sure which formula fits your presentation, take our AI Assessment below for a personalized starting point, then confirm with a qualified TCM practitioner.

What are concentrated herbal granules?

Concentrated herbal granules are made by decocting raw herbs, then extracting and concentrating the resulting liquid into a fine granule or powder form. This preserves the same active compounds as a traditional decoction while making the herbs far easier to store, measure, and prepare.

How should I take these products?

Dissolve the recommended amount of granules in hot water, stir until fully dissolved, and drink while warm — following the dosage and frequency advised by your TCM practitioner or as stated on the product packaging.

Are concentrated herbal granules equivalent to traditional decoctions?

Concentrated granules are produced from the same herbs and processed to retain their active compounds, so they are traditionally regarded as a convenient alternative to decoctions rather than a different remedy. Some practitioners note subtle differences in strength or absorption between the two forms, so your TCM practitioner may adjust dosage accordingly.

Are your products authentic?

Yes. HJMEDICAL sources its concentrated granules exclusively from established, reputable manufacturers such as Nong's and Hoi Tin, both long-standing names in the TCM granules industry, with GMP compliance stated directly on their packaging.

Are HJMEDICAL products manufactured under GMP standards?

HJMEDICAL sources its concentrated granules from established, reputable manufacturers such as Nong's and Hoi Tin, both long-standing names in the TCM granules industry. GMP compliance for these products is stated directly on their packaging.

Do you ship internationally?

Yes — we ship worldwide! Every order goes out via Hong Kong Post, and your exact shipping cost and estimated delivery time for your address are calculated and shown right at checkout, so there are never any surprises. We also offer free shipping once your order reaches our free-shipping threshold, so it's easy to stock up on your favorite formulas and save.

Can I take more than one formula at the same time?

Some formulas are traditionally combined, while others overlap or counteract each other. We recommend checking with a qualified TCM practitioner before combining formulas, especially if you are already taking other medication.

Are these products suitable during pregnancy or breastfeeding?

Some TCM formulas are not suitable during pregnancy or breastfeeding. Please consult a qualified TCM practitioner or your doctor before use if you are pregnant, trying to conceive, or nursing.

Do these products replace medical treatment?

No. These products are traditional herbal supplements intended to support wellbeing according to TCM principles — they are not a replacement for professional medical diagnosis or treatment. Please consult a qualified TCM practitioner or licensed healthcare provider before starting, stopping, or combining any treatment, especially if you have a chronic condition.

Medical Disclaimer

For general TCM education only — not medical advice. Consult a qualified TCM practitioner or licensed healthcare provider before use, especially if pregnant, nursing, on medication, or managing a chronic condition.

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