Si Ni Tang

Si Ni Tang (Frigid Extremities Decoction), from the Shang Han Lun (Discussion of Cold-Induced Disorders) by Zhang Zhong-Jing.

Actions: Restores depleted yang; Rescues from counterflow cold.

Presentation: 1. Shaoyin syndrome: severely cold extremities, aversion to cold, preference to curl up when lying down, lassitude, drowsiness, vomiting, absence of thirst, abdominal pain, diarrhea, a white, slippery tongue coating, and a faint, fine pulse. 2. Depletion of yang due to excessive sweating in taiyang syndrome.

Cautions:

• Extremely hot; contraindicated in true-heat/false-cold conditions
• Stop immediately once the hands and feet have warmed

Fu Zi: The Shang Han Lun original used raw Sheng Fu Zi; modern practitioners always use prepared Zhi Fu Zi (Radix Aconiti Lateralis Praeparata).

Toxicology (studies on raw Sheng Fu Zi): With Sheng Fu Zi:Gan Jiang:Gan Cao at 4:3:3, mouse LD50 was 5.821 g/kg intraperitoneal and 71.78 g/kg oral, versus 17.42 g/kg oral for Sheng Fu Zi alone; Gan Cao and Gan Jiang reduced Sheng Fu Zi toxicity without changing alkaloid concentration.

Pharmacological effects reported:

• Cardiovascular: in rabbits increased cardiac contractile force and blood pressure and restored normal rhythm
• Immunostimulant: rats immunosuppressed with hydrocortisone kept higher IgG when also given the decoction
• Analgesic and anti-inflammatory: marked effects in rats by intraperitoneal injection
• Half-life: 5.8 hours in a two-compartment pharmacokinetic model

Source: Chen JK, Chen TT. Chinese Herbal Formulas and Applications: Pharmacological Effects & Clinical Research. Art of Medicine Press, 2009, p. 486.

Cook in 3 cups [600 mL] water to 1.2 cups [240 mL]; take warm in two doses daily. The original text allowed a large piece of raw Sheng Fu Zi for strong constitutions. Today use the bracketed doses with prepared Zhi Fu Zi, decocted first for 30–60 minutes before adding the other herbs.