Si Ni Tang
Classical TCM Formula Profile
Part of the HJMEDICAL TCM Discovery Center
四逆汤 · Sì Nì Tāng
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.
Read the complete guide →Quick Facts
- Formula Category
- Yang-Tonifying Formulas
- Primary Pattern
- Yang Deficiency
- Primary Function
- Restore Yang, rescue from collapse
- Primary Therapeutic Principle
- Restore devastated Yang, rescue from collapse, and warm the Middle Jiao
- Classical Source
- Shang Han Lun (Zhang Zhongjing, Eastern Han)
- Available as Granules
- Yes
Formula Overview
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.
Therapeutic Principle
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.
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
臣MinisterReinforces the sovereign
Classical Composition
- Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 2 liang (6g)
- Zingiberis Rhizoma (Zhi Gan Jiang) 1.5 liang (6g)
- Aconiti Lateralis Radix Praeparata (Fu Zi raw; peeled; cut into eight pieces) 1 piece (15g)
Dosages follow the classical source and are shown for study, not as a prescription.
Related Conditions
Related Health Topics
Actions
- Restores yang to rescue from counterflow.
Indications
- Reversal counterflow cold of the four limbs is due to heart and kidney yang deficiency.
- This pattern is marked by reversal counterflow cold of the four limbs, aversion to cold, lying in bed curled up, debilitated spirit, desire to sleep, pale complexion, stomach pain, diarrhea, vomiting, no thirst, a white, slippery tongue coating, and a feeble, thin pulse.
Traditional Pathogenesis
Cause & mechanism
- This formula is indicated for heart and kidney yang deficiency and yin-cold excess.
- Yang and qi deficiency fails to warm the body and extremities, so there is reversal counterflow cold of the four limbs, lying in bed curled up, and averse to cold.
- It is said in《Basic Questions》, “Yang and qi in hardness can activate the spirit, and in softness can nourish the tendons”.
- In the current situation, the heart yang is weak and it cannot nourish the spirit, so there is a desire to sleep.
Clinical presentation
- Yang and qi deficiency fails to activate the blood circulation, so there is a feeble, thin pulse.
- Moreover, the kidney yang is also weak and fails to warm the spleen causing disharmony of its ascending and descending function, marked by stomach pain, diarrhea, and vomiting.
- This is considered to be a pattern of deficient yang and excessive yin, which can only be treated with strong pungent, hot medicinals of a pure yang nature to break yin-cold and rescue yang from desertion marked by reversal counterflow cold of the four limbs, severe thoracic and abdominal pain, and chronic headache.
Treatment strategy
- The treatment principle is to restore devastated Yang, rescue from collapse, and warm the Middle Jiao.
How does this formula compare?
Clinical Perspective
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.
Clinical Differentiation
- Si Ni Tang is a fundamental formula to restore yang to rescue from counterflow. This clinical pattern is marked by reversal counterflow cold of the four limbs, debilitated spirit, desire to sleep, pale complexion, feeble, thin pulse.
Safety notes: Take the decoction cold if vomiting appears. Since there is all acrid and hot medicinals in this formula, it is not suitable for long-term usage. Once the limbs become warm, this formula should not be taken anymore. It is prohibited for the pattern of true heat with false cold.
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 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.
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.
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.
Related Products
Hoi Tin Si Ni Tang (Frigid Extremities Decoction) 5:1 Concentrated Granules
Nong's Si Ni Tang (Frigid Extremities Decoction) 5:1 Concentrated Granules
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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.