Tong Mai Si Ni Tang
Star通脉四逆汤 (Unblock the Pulse Decoction for Frigid Extremities)
Source: Shang Han Lun — Zhang Zhong-Jing (Eastern Han, c. 220)
Last updated October 1, 2026
Description
Tong Mai Si Ni Tang (Unblock the Pulse Decoction for Frigid Extremities), from the Shang Han Lun (Discussion of Cold-Induced Disorders) by Zhang Zhong-Jing — a variation of Si Ni Tang.
Presentation: Shaoyin syndrome with severe yang deficiency, yang on the verge of separating from yin (true cold, false heat): cold extremities without aversion to cold, red face, cold sensation inside and warm sensation outside, abdominal pain, sore throat, no diarrhea or diarrhea with undigested food, and a fainting pulse.
Composition: Same ingredients as Si Ni Tang at larger doses of Fu Zi and Gan Jiang.
Fu Zi: The Shang Han Lun original used raw Sheng Fu Zi; modern practitioners always use prepared Zhi Fu Zi (Radix Aconiti Lateralis Praeparata).
Source: Chen JK, Chen TT. Chinese Herbal Formulas and Applications: Pharmacological Effects & Clinical Research. Art of Medicine Press, 2009, p. 488.
Composition
| Herb | Amount | % | Role | Function |
|---|---|---|---|---|
|
Gan Cao
as printed: Radix et Rhizoma Glycyrrhizae Praeparata cum Melle (zhi gan cao) 6 g
|
6g | 23.08% | — | |
|
Zhi Fu Zi
as printed: Radix Aconiti Lateralis Praeparata (fu zi) 20 g
|
20g | 76.92% | — | |
|
Gan Jiang
dose printed as 9–12 g; as printed: Rhizoma Zingiberis (gan jiang) 9–12 g
|
g | — | — |
Energetics dose-weighted
The formula's overall nature, taste balance and channel reach, weighted by each herb's dose. Classical formulas often pair warm and cool herbs on purpose, so a net figure summarises the mix — it doesn't describe every herb in it.
Nature
Net hot (+1.54)
From 100% of the weighed grams.
Grams by band: neutral 23%, hot 77%.
Taste
- pungent 39%
- sweet 62%
From 100% of the weighed grams.
Channels reached
- Spleen 100%
- Heart 100%
- Kidney 77%
- Lung 23%
- Stomach 23%
Share of the grams entering each channel, from 100% of the weighed grams.
1 herb without a dose in grams, so left out of every figure above: Gan Jiang.
Dose-weighted from each herb's recorded nature, taste and channels (missing values are left out, never counted as neutral). It describes the composition — it is not a recommendation.
Preparation
Cook in 3 cups [600 mL] water to 1.2 cups [240 mL]; take warm in two doses daily; today use bracketed doses.
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Formula family
Each entry reads as the larger formula written out: “+” adds its other catalogue cores, then the herbs none of them hold. A catalogue formula counts as a core only when at least 80% of its herbs are present, no more than 1 is absent, and the absent herb is not its chief.
Similar Formulas by composition
Match score combines dosage-weighted composition (cosine, 70%) with shared-herb overlap (Jaccard, 30%).
Traditional formula information is for educational purposes only. Herbal formulas should be prescribed by a qualified practitioner — dosages and combinations are individualized and can interact with medications.
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