Four Cold Extremities
Si Ni San
Kan Traditionals
Relieves stagnant Liver Qi and regulates the Spleen, harmonizes Liver and Spleen, releases constraint.
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- Herb: White peony root, Bupleurum root, Dry fried bitter orange immature fruit, Honey fried Chinese licorice root and rhizome
- Herb (Pinyin): Bai shao, Chai hu, Chao zhi shi, Zhi gan cao
- Pattern: Liver and Spleen disharmony, Shao Yang disharmonies with constrained Qi in the Interior
- Actions: Harmonize Liver and Spleen, Regulate Liver Qi, Release constraint
- Indications: Occasional irritability, depression, agitation, Supports healthy blood circulation, Supports healthy liver function, Supports a healthy digestive system, Occasional flank discomfort, Supports healthy urinary function, Occasional coldness below the elbows and knees that can get worse with stress, Occasional sensation of warmth of the body and head with absence of sweating , Occasional emotional stress
- Contraindications: Liver Qi stagnation with underlying Yin deficiency., Occasional cold fingers and toes not due to constrained Liver Qi stagnation.
- Tongue: Red body with yellow coating
- Pulse: Wiry, possibly forceful
Four Cold Extremities addresses a variety of patterns resulting from constrained Qi in the Interior. These indications range from a very simple presentation of occasional cold extremities (below the elbows and knees), to Liver and Spleen disharmony accompanied by an excess,wiry pulse, to patterns where constrained Qi is present with contradictory signs like Hot/Cold or Dryness/Dampness. The common ground for this formula is constrained or stagnant Qi in the Interior, supported by the appearance of an excess pulse with occasional frigid or cold extremities.
The goal of the formula is to regulate Qi by venting Heat, releasing the constrained Qi. These are the two primary functions of the chief herb, Bupleurum root. It moves the Liver Qi while simultaneously venting to the Exterior. It lifts the clear Yang, which allows the turbid Yin to descend and harmonizes the Qi mechanisms.
Bitter orange immature fruit, the deputy, regulates Liver Qi stagnation and disperses accumulation, especially of the Middle Burner, supports the Spleen, and breaks up constrained Qi in the Interior of the body. White peony root, the assistant, nourishes Blood and Liver, and smooths the movement of Qi throughout the body. This herb holds things in, in contrast to the chief herb Bupleurum root, which disperses. The combination disseminates Liver Qi without injuring Liver Yin. When the Liver is nourished, so are the sinews, muscles and tendons, a direct
reflection of the interaction between the Liver (sinews and tendons) and Spleen (muscles). Honey fried Chinese licorice root and rhizome harmonizes the properties of the other herbs in the formula, but also strengthens the Spleen and Middle Burner Qi.
Four Cold Extremities disperses while also astringing and nourishing, facilitating both ascent and descent, moving Yang while supporting Yin, moving the Liver while supporting the Spleen.
While this formula is a harmonizing formula like Free and Easy Wanderer or Minor Bupleurum, it is important to differentiate them. In the case of Free and Easy Wanderer, the Spleen is deficient and the pulse will be wiry but also deficient, showing signs of Spleen Qi and Blood deficiency. Minor Bupleurum harmonizes the interior and the exterior layers whenthere are occasional alternating sensations of hot and cold, which points to a blockup of the Shao Yang layer.
Combine with Digestive Harmony Formula for occasional food stagnation. Combine with Li Dan Support for Liver and Gallbladder Damp Heat.
Origins and Development
This classical formula was first presented in the Discussion of Cold Damage around 220 A.D.