Dang Gui Si Ni Tang — Tangkuei Decoction for Frigid Extremities

Overview

Dang Gui Si Ni Tang is the principal Chinese herbal formula for warming the channels of the extremities and nourishing Blood to treat cold hands and feet from Blood deficiency with Cold invading the channels. It originates from Zhang Zhongjing’s Shang Han Lun and is specifically designed for the situation where cold extremities arise not from constitutional Yang deficiency but from insufficient Blood in the channels leaving them vulnerable to Cold invasion.

TCM pattern

Prescribed for Blood deficiency with Cold obstructing the channels of the extremities, characterised by: persistently cold hands and feet (even in warm weather), possible blue or white discolouration of the fingers or toes, a pale tongue with white coating, and a thin, deep pulse. This is distinct from the Yang deficiency cold pattern where coldness affects the whole body.

Key herbs

Dang Gui (Angelica sinensis root) — nourishes Blood and invigorates circulation in the channels; the principal herb
Gui Zhi (Cinnamomum cassia twigs) — warms the channels, expels Cold and promotes circulation to the extremities
Bai Shao (Paeonia lactiflora root) — nourishes Blood and works with Dang Gui to build Blood in the channels
Xi Xin (Asarum sieboldii herb) — powerfully warms the channels and expels Cold from the interior
Tong Cao (Tetrapanax papyriferus pith) — promotes circulation in the channels and collaterals
Da Zao (Ziziphus jujuba fruit) — nourishes Blood and harmonises the formula
Zhi Gan Cao (honey-fried Glycyrrhiza root) — harmonises and moderates the formula

Conditions treated

Raynaud’s disease — the primary formula for cold-sensitive digital vasospasm from Blood deficiency with Cold obstruction
Chilblains (pernio) — painful, itchy inflammatory lesions from cold exposure
Cold hands and feet in women with Blood deficiency, especially with scanty or irregular periods
Peripheral nerve pain from Cold obstruction in the channels with Blood deficiency