Chinese: 四逆散
Pinyin: Sì Nì Sàn
Other names: Frigid Extremities Powder, Four Rebellious Powder
Number of ingredients: 4 herbs
Formula category: Formulas that harmonize Liver-Spleen
Conditions for which it may be prescribed: ColitisEnuresisRhinitis and seventeen other conditions
- Regulates Liver and Spleen
- Eliminates Internal Heat
Contraindications: Contraindicated for Qi Stagnation associated with Yin Deficiency, which may... Contraindicated for Qi Stagnation associated with Yin Deficiency, which may also manifest with pain in the hypochondria, epigastrium, and abdomen. see more
Source date: 220 AD
Source book: Discussion of Cold Damage
The information provided here is not a replacement for a doctor. You shouldn't use it for the purpose of self-diagnosing or self-medicating but rather so you can have a more informed discussion with a professional TCM practitioner.
Si Ni San is a 4-ingredient Chinese Medicine formula with Bupleurum Roots (Chai Hu) as a principal ingredient.
Invented in 220 AD, it belongs to the category of formulas that harmonize Liver-Spleen. Its main actions are: 1) regulates Liver and Spleen and 2) eliminates Internal Heat.
In Chinese Medicine health conditions are thought to arise due to "disharmonies" in the body as a system. These disharmonies are called "patterns" and the very purpose of herbal formulas is to fight them in order to restore the body's harmony.
In this case Si Ni San is used by TCM practitioners to fight patterns like Rebellious Qi, Phlegm in Kidneys or Gallbladder or Rebellious Liver Qi. From a Western Medicine standpoint, such patterns can give rise to a range of conditions such as cholecystitis, cholelithiasis or gastritis for instance.
On this page, after a detailed description of each of the four ingredients in Si Ni San, we review the patterns and conditions that Si Ni San helps treat.
The four ingredients in Si Ni San
Chai Hu is a king ingredient in Si Ni San. Like the name indicates, it means it has more power than other ingredients in the formula.
1. Bupleurum Roots (Chai Hu)
Chai Hu is able to disperse any kind of Qi Stagnation in the epigastrium, abdomen, Stomach, and Intestines. It is an upward rising herb that enters the Liver.
Zhi Shi is a deputy ingredient in Si Ni San. This means it helps the king ingredient(s) treat the main pattern or it serves to treat a coexisting pattern.
2. Immature Bitter Oranges (Zhi Shi)
Part used: Dried unripe fruit
Nature: Cool
Meridian affinity: SpleenStomachLarge intestine
Category: Herbs that regulate Qi
Zhi Shi drains Stagnation, breaks up Stagnant Qi, and reduces accumulation in the Middle Burner to facilitate the transportive and transformative functions of the Spleen and Stomach. Its descending action pairs it well with the ascending action of Chai Hu (the key herb): the effect of the different directions is to disentangle Heat in the Liver, Stomach and Spleen territories.
Bai Shao is an assistant ingredient in Si Ni San. This means that it either serves to reinforces the effect of other ingredients or it moderates their toxicity.
3. White Peony Roots (Bai Shao)
Part used: Dried root
Nature: Neutral
Meridian affinity: LiverSpleen
Category: Tonic herbs for Blood Deficiency
Bai Shao nourishes the Liver and preserves the Yin. Bai Shao holds things in; this is in contrast to the key herb Chai Hu, which disperses. This combination is very effective in disseminating the Liver
Qi without injuring its Yin.
Gan Cao is an envoy ingredient in Si Ni San. This means that it directs the formula towards certain area of the body and/or harmonizes the actions of other ingredients.
4. Liquorice (Gan Cao)
Part used: Dried root and rhizome
Nature: Neutral
Taste(s): Sweet
Meridian affinity: HeartLungSpleenStomach
Category: Tonic herbs for Qi Deficiency
Gan Cao harmonizes the various actions of the other herbs in the formula and strengthens the Spleen to curb the Liver.
Conditions and patterns for which Si Ni San may be prescribed
It's important to remember that herbal formulas are meant to treat patterns, not "diseases" as understood in Western Medicine. According to Chinese Medicine patterns, which are disruptions to the body as a system, are the underlying root cause for diseases and conditions.
As such Si Ni San is used by TCM practitioners to treat three different patterns which we describe below.
But before we delve into these patterns here is an overview of the Western conditions they're commonly associated with:
Cholecystitis Cholelithiasis Gastritis Gastric ptosis Peptic ulcers Colitis Appendicitis Pancreatis Urinary stones Dysmenorrhea Premenstrual syndrome Impotence Coronary artery disease Urinary incontinence Enuresis Perimenopausal syndrome Rhinitis Mastitis Blocked fallopian tubes Periappendical abscesses
Again it wouldn't be correct to say "Si Ni San treats cholecystitis" for instance. Rather, Si Ni San is used to treat patterns that are sometimes the root cause behind cholecystitis.
Now let's look at the three patterns commonly treated with Si Ni San.
Qi is one of Chinese Medicine's vital subtances. Learn more about Qi in Chinese Medicine
Rebellious Qi
Pulse type(s): Wiry (Xian)
Tongue color: Normal (light red), Red sides
Symptoms: Nausea Asthma Belching Vomiting Coughing Diarrhea Insomnia Hiccuping Headaches Restlnessness
Si Ni San is sometimes prescribed by TCM practitioners to treat Rebellious Qi. This pattern leads to symptoms such as hiccuping, belching, nausea and vomiting. Patients with Rebellious Qi typically exhibit wiry (Xian) pulses as well as a normal (light red), red sides tongue.
Rebellious Qi is an Excess/Full condition and it is another form of Qi Stagnation. In this case, Qi flows in the wrong direction from the normal physiological one for a given Organ or Channel.
The Organs whose Qi should descend are Stomach, Lungs, Heart, Small Intestine, Large Intestine, Kidneys... read more about Rebellious Qi
The Kidneys is a so-called "Zang" Organ. Learn more about the Kidneys in Chinese Medicine
Phlegm in Kidneys or Gallbladder
Pulse type(s): Slippery (Hua), Wiry (Xian)
Tongue coating: Sticky coating, Thick coating
Tongue shape: Swollen
Symptoms: Back pain Gallstones Bloody urine Abdomen pain Kidney stones Epigastric pain Urinary difficulty Frequent and urgent urination
Si Ni San is sometimes prescribed by TCM practitioners to treat Phlegm in Kidneys or Gallbladder. This pattern leads to symptoms such as frequent and urgent urination, urinary difficulty, bloody urine and gallstones. Patients with Phlegm in Kidneys or Gallbladder typically exhibit slippery (Hua) or wiry (Xian) pulses as well as Swollen tongue with yellow sticky coating.
According to Chinese medicine, gallstones or Kidney stones are a form of Phlegm. It is the consequence of Phlegm left untreated in the Gallbladder and the Kidneys.
Over a long period of time, stagnant Dampness can give rise to a large amount of Heat which then dries up Body Fluids and solidify read more about Phlegm in Kidneys or Gallbladder
The Liver is a so-called "Zang" Organ. Learn more about the Liver in Chinese Medicine
Rebellious Liver Qi
Pulse type(s): Wiry (Xian)
Symptoms: Belching Hiccuping Headaches Dizziness Irritability Frequent sighing Breast distention Nausea or vomiting Epigastric distension Hypochondrial distention Churning feeling in the stomach
Si Ni San is sometimes prescribed by TCM practitioners to treat Rebellious Liver Qi. This pattern leads to symptoms such as hypochondrial distention, epigastric distension, hiccuping and frequent sighing. Patients with Rebellious Liver Qi typically exhibit wiry (Xian) pulses.
Most Organs' normal physiological Qi goes in one direction (up or down) and their pathological Qi normally goes toward the opposite direction.
The Liver is an exceptional one as its Qi goes in all directions, especially upwards. It is because it's responsible for ensuring the smooth flow of Qi... read more about Rebellious Liver Qi
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