Si Ni San
Classical TCM Formula Profile
Part of the HJMEDICAL TCM Discovery Center
四逆散 · Sì Nì Sǎn
Classic formula for Liver Qi constraint causing cold extremities (true heat with false cold appearance) and hypochondriac/epigastric distension. Differs from Si Ni Tang which addresses true Yang collapse.
Read the complete guide →Quick Facts
- Formula Category
- Harmonising Formulas
- Primary Pattern
- Qi Stagnation
- Primary Function
- Course Liver Qi, resolve constraint, harmonize
- Primary Therapeutic Principle
- Course the Liver, regulate Qi, resolve constraint and harmonize the Middle
- Classical Source
- Shang Han Lun (Zhang Zhongjing, Eastern Han)
- Available as Granules
- Yes
Formula Overview
Classic formula for Liver Qi constraint causing cold extremities (true heat with false cold appearance) and hypochondriac/epigastric distension. Differs from Si Ni Tang which addresses true Yang collapse.
Therapeutic Principle
Traditionally selected when cold extremities arise from constrained Yang unable to reach the limbs rather than true Yang deficiency — a coursing formula, unlike Si Ni Tang, which rescues genuine Yang collapse, and simpler than the later Chai Hu Shu Gan San and Xiao Yao San developments.
Composition: Sovereign, Minister, Assistant, Envoy
Every herb in the formula, grouped by the job it does in the classical hierarchy.
君SovereignTreats the main pattern
佐AssistantTreats accompanying patterns
Classical Composition
- Bupleuri Radix (Chai Hu) 10 fen (6g)
- Paeoniae Radix Alba (Shao Yao) 10 fen (6g)
- Aurantii Fructus Immaturus (Zhi Shi) 10 fen (6g)
- Glycyrrhizae Radix et Rhizoma Praeparata cum Melle (Zhi Gan Cao) 10 fen (6g)
Dosages follow the classical source and are shown for study, not as a prescription.
Related Conditions
Related Health Topics
Actions
- Moves qi
- resolves the constraint
- soothes the liver
- and rectifies the spleen.
Indications
- 1.
- Pattern of yang constraint and reversal counterflow cold of the limbs, marked by a lack of warmth in the extremities, abdominal pain, diarrhea, dysentery tenesmus, and a wiry pulse. 2.
- Pattern of disharmony of the liver and spleen, marked by distention and fullness in the rib-side, pain in the stomach cavity and abdomen, and a wiry pulse.
Traditional Pathogenesis
Cause & mechanism
- Originally Si Ni San is used to treat “counterflow cold of the four limbs in a shaoyin pattern”.
- Counterflow cold of the four limbs here actually refers to a lack of warmth in the extremities.
- When the exterior pathogen invades the internal body via the channels, constraint and stagnation of the qi movement occurs.
- Disordered qi flow causes yang qi constraint, which results in a lack of warmth in the extremities.
- Later doctors broadened its scope by using it for distention and fullness in the rib-side, and pain in the stomach cavity and abdomen due to liver and spleen constraint and stagnation.
Clinical presentation
- 1.
- Pattern of yang constraint and reversal counterflow cold of the limbs, marked by a lack of warmth in the extremities, abdominal pain, diarrhea, dysentery tenesmus, and a wiry pulse.
- 2.
- Pattern of disharmony of the liver and spleen, marked by distention and fullness in the rib-side, pain in the stomach cavity and abdomen, and a wiry pulse.
Treatment strategy
- The treatment is to move qi, resolve constraint, soothe the liver, and rectify the spleen.
How does this formula compare?
Clinical Perspective
Si Ni San addresses Liver Qi constraint with cold extremities from constrained Yang. Si Ni Tang is for true Yang collapse. Chai Hu Shu Gan San and Xiao Yao San are later developments for broader Liver constraint patterns. Wen Jing Tang focuses on cold in the Chong and Ren with Blood deficiency.
Clinical Differentiation
- Si Ni San treats the patterns of yang constraint and reversal counterflow cold of the limbs, which is its original indication.
- However, later doctors use it as a basic formula to soothe the liver and rectify the spleen.
- This clinical pattern is marked by lack of warmth in the extremities, pain in the rib-side, stomach cavity, and abdomen, and a wiry pulse.
Safety notes: This formula is not appropriate for true cold inversion from shaoyin yang collapse, which requires Si Ni Tang rather than Si Ni San.
For educational reference only, based on traditional pattern differentiation — not a substitute for professional advice.
Frequently Asked Questions
What are the actions of Si Ni San?
Si Ni San has the actions of venting constraint and resolving stagnation, spreading Liver Qi and regulating the Spleen. It is primarily used for Yang constraint causing cold extremities or for Liver-Spleen disharmony with hypochondriac or abdominal pain.
Which modern diseases is Si Ni San suited to?
Modern TCM clinical practice commonly applies it to individuals whose pattern differentiation falls within Liver Qi constraint or Liver-Spleen disharmony, including functional dyspepsia, irritable bowel syndrome, chronic hepatitis or cholecystitis (supportive), stress-related abdominal pain, and mild depression with Qi stagnation.
Is Si Ni San suitable for improving cold hands and feet with chest or abdominal discomfort?
For presentations of cold extremities (often limited to the hands and feet), hypochondriac or epigastric pain/distension, possible diarrhea or irregular stools, and a wiry pulse — in those whose pattern differentiation confirms Yang constraint or Liver-Spleen disharmony rather than true Yang deficiency — TCM commonly applies Si Ni San as an adjunct. It cannot replace standard medical treatment.
Related Products
Hoi Tin Si Ni San (Frigid Extremities Powder) 5:1 Concentrated Granules
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Chai Hu Shu Gan San: Classic TCM Formula for Liver Qi Stagnation & Rib-Side Pain
Si Ni Tang: Classic TCM Formula for Yang Collapse, Cold Extremities & Shock
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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.