Si Ni San — Frigid Extremities Powder

On this page

1. Overview
2. TCM pattern
3. Key herbs
4. Conditions treated
5. Cautions

Overview

Si Ni San — Frigid Extremities Powder — is a deceptively simple but clinically profound formula from Zhang Zhongjing’s Shang Han Lun. Despite its name, it does not treat cold from Yang deficiency but cold extremities arising from Liver Qi stagnation preventing the smooth flow of Qi and Yang to the limbs. It serves as the structural ancestor of many important derivative formulas, including Xiao Yao San and Chai Hu Shu Gan San.

TCM pattern

Prescribed for Liver Qi stagnation with Yang Qi not reaching the extremities, characterised by: cold hands and feet (despite normal body temperature), hypochondriac or abdominal pain, irritability, a wiry pulse, and symptoms that worsen with emotional stress.

Key herbs

1. Chai Hu (Bupleurum chinense root) — spreads Liver Qi and releases constraint; raises Yang to reach the extremities
2. Bai Shao (Paeonia lactiflora root) — nourishes Blood, softens the Liver and alleviates pain
3. Zhi Shi (Citrus aurantium immature fruit) — breaks up Qi stagnation and reduces distension
4. Zhi Gan Cao (honey-fried Glycyrrhiza root) — harmonises the formula and moderates pain

Conditions treated

1. Cold hands and feet from Liver Qi stagnation — the patient feels generally warm but the hands and feet are cold
2. IBS with abdominal pain, cramping and bloating from Liver invading the Spleen
3. Hypochondriac pain and chest tightness from Liver Qi stagnation
4. Stress and emotional tension producing physical symptoms

Cautions

Always consult a qualified Chinese herbalist registered with the Register of Chinese Herbal Medicine (RCHM). Online herbal consultations are available. See the prices page for costs.