Tong Mai Si Ni Tang — Unblock the Vessels Decoction for Frigid Extremities
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Overview
Tong Mai Si Ni Tang is from Zhang Zhongjing’s Shang Han Lun and is a more powerful variation of the foundational Yang-collapse formula. It uses larger doses of Fu Zi (prepared aconite), Gan Jiang (dried ginger) and Gan Cao than its base — with the specific indication of severe Yang collapse where the Yin has also been damaged, producing the dangerous “true Cold with false Heat” picture: a patient with cold extremities, weak pulse, but flushed face, sore throat or other apparent Heat signs.
This is a hospital-grade emergency formula. It is presented here for educational completeness.
TCM pattern
Tong Mai Si Ni Tang is prescribed for severe Yang collapse with Yin damage (true Cold, false Heat):
- Cold extremities, possibly past the knees and elbows
- Pallor
- Severe diarrhoea with undigested food
- Cold sweat
- Paradoxical flushed face (“false Heat”)
- Sore dry throat (“false Heat”)
- Aversion to cold despite the flushed face
- Very feeble pulse, possibly “hollow”
- Tongue — pale, possibly cyanosed
Key herbs
- Fu Zi (large dose) — rescues Yang
- Gan Jiang (large dose) — warms the middle
- Zhi Gan Cao — harmonises and protects
Formula actions
- Rescues collapsed Yang
- Unblocks vessels and restores warmth
- Stops cold diarrhoea
Conditions treated
- Severe gastroenteritis with Yang collapse — cholera-type presentations historically
- Cardiogenic shock
- End-stage chronic illness with Yang collapse
- Severe postpartum collapse
Cautions
Hospital emergency formula. Only used by very experienced practitioners alongside conventional emergency medicine. Call 999 for acute shock.
Contains large dose of Fu Zi (prepared aconite) — toxic herb requiring correct processing.
Strictly contraindicated in pregnancy and any condition other than acute Yang collapse.
This page is for educational reference only.
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