Si Ni Tang: A Simple Guide to a Warming, Yang-Restoring Herbal Formula
Hongji Medical- Jan 20
- 7 min read
Si Ni Tang, or "Frigid Extremities Decoction," is a powerful Chinese herbal formula from Treatise on Cold Damage by the legendary physician Zhang Zhongjing. Designed to warm the body and restore vital energy (yang), this blend of three herbs—licorice, dried ginger, and aconite—targets severe cold conditions caused by yang deficiency in the heart and kidneys.
Widely used in traditional Chinese medicine, Sini Tang is a go-to for emergencies and chronic cold-related ailments.
What’s in Si Ni Tang?
Si Ni Tang combines three herbs to warm, energize, and balance:
Aconite (Fu Zi): The lead herb, aconite is intensely warming and spicy. It boosts kidney yang, dispels deep cold, and revives energy, reaching all parts of the body to restore vitality.
Dried Ginger (Gan Jiang): This hot herb warms the spleen and stomach, clearing internal cold and supporting aconite’s yang-boosting effects.
Roasted Licorice (Zhi Gan Cao): Licorice harmonizes the formula, softening the harsh heat of aconite and ginger to protect the body’s fluids while aiding detoxification.
These herbs are boiled in water (modern doses: ~6g licorice, 6g dried ginger, 15g aconite) until reduced, then taken warm. Stronger individuals may use slightly higher doses of aconite and ginger.
How Si Ni Tang Works
Si Ni Tang treats "yang deficiency with excess yin-cold," where the body lacks warming energy, causing symptoms like:
Cold, numb hands and feet
Chills, curling up, or aversion to cold
Fatigue, drowsiness, or depression
Pale complexion, abdominal pain, or diarrhea
Vomiting without thirst
Slippery white tongue coating, weak or deep pulse
It works by:
Restoring Yang: Aconite and ginger rekindle vital warmth, countering cold and reviving energy.
Warming the Body: Clears internal cold to relieve chills and limb coldness.
Improving Circulation: Boosts qi and blood flow, easing pain and weak pulses.
Supporting Organs: Strengthens heart, kidney, and spleen function.
What Causes These Symptoms?
Yang deficiency occurs when the body’s warming energy (yang qi) is too weak to counter excess cold (yin). This leads to:
Poor warming of limbs, causing cold hands and feet.
Sluggish blood flow, resulting in weak pulses and pain.
Organ dysfunction, triggering fatigue, diarrhea, or depression.
Sini Tang reignites yang qi, disperses cold, and restores balance, making it ideal for severe cold syndromes.
Modern Uses
Si Ni Tang shines in both traditional and modern medicine for:
Pain Relief: Eases cold-induced pain like headaches, joint aches, menstrual cramps, or testicular pain.
Systemic Symptoms: Treats fatigue, cold abdomen, diarrhea, coughing, hiccups, or frequent urination.
Medical Conditions: Used for myocarditis, hypothyroidism, chronic renal failure, low blood pressure, heart issues (e.g., myocardial infarction), depression, lung cancer, and more.
Its warming and energizing effects improve quality of life for those with cold-related chronic conditions.
Dietary Support
To enhance Si Ni Tang's effects, pair it with warming foods:
Ginger Soup: Warms the stomach and dispels cold.
Lamb Stew: Boosts yang and nourishes the body.
Red Date and Longan Tea: Supports qi, blood, and warmth.
Black Bean Soup: Nourishes kidneys and boosts yang.
Things to Keep in Mind
Si Ni Tang is potent but requires caution:
Avoid in Heat Conditions: Not for those with true heat (e.g., fever, flushing) or false cold caused by heat. It’s for yang deficiency only.
Short-Term Use: Stop once hands and feet warm up; long-term use may overheat or dry the body.
Professional Guidance: Adjust doses based on condition and consult a practitioner, as aconite is toxic if mishandled.
Why Si Ni Tang Matters
Si Ni Tang is a lifesaver in Chinese medicine, warming the body, restoring yang, and banishing cold. Its blend of aconite, dried ginger, and licorice tackles everything from icy limbs to chronic diseases with precision.
From ancient emergencies to modern heart and kidney treatments, it proves its enduring value. With careful use and dietary support, Sini Tang can help you reclaim warmth and vitality, guided by centuries of wisdom.
Chinese Name | 四逆湯 |
Phonetic | Si Ni Tang |
English Name | Frigid Extremities Decoction |
Classification | Warming interior formulas |
Source | 《Treatise on Cold Damage》Shang Han Lun《傷寒論》 |
Combination | Glycyrrhizae Radix et Rhizoma (Zhi Gan Cao) 2 liang (6g), Zingiberis Rhizoma (Zhi Gan Jiang) 1.5 liang (6g), Aconiti Lateralis Radix Praeparata (Fu Zi raw; peeled; cut into eight pieces) 1 piece (15g) |
Method | Decoct these three medicinals with three sheng of water, boil them until one sheng and two ge of water is left, remove the dregs, and take the warm decoction two times a day. Patients with a strong constitution can take a larger piece of fu zi and double the amount of gan jiang (3 liang). (Modern use: prepare as a decoction.) |
Action | Restores yang to rescue from counterflow. |
Indication | Reversal counterflow cold of the four limbs is due to heart and kidney yang deficiency. This pattern is marked by reversal counterflow cold of the four limbs, aversion to cold, lying in bed curled up, debilitated spirit, desire to sleep, pale complexion, stomach pain, diarrhea, vomiting, no thirst, a white, slippery tongue coating, and a feeble, thin pulse. |
Pathogenesis | This formula is indicated for heart and kidney yang deficiency and yin-cold excess. Yang and qi deficiency fails to warm the body and extremities, so there is reversal counterflow cold of the four limbs, lying in bed curled up, and averse to cold. Yang and qi deficiency fails to activate the blood circulation, so there is a feeble, thin pulse. It is said in《Basic Questions》, “Yang and qi in hardness can activate the spirit, and in softness can nourish the tendons”. In the current situation, the heart yang is weak and it cannot nourish the spirit, so there is a desire to sleep. Moreover, the kidney yang is also weak and fails to warm the spleen causing disharmony of its ascending and descending function, marked by stomach pain, diarrhea, and vomiting. This is considered to be a pattern of deficient yang and excessive yin, which can only be treated with strong pungent, hot medicinals of a pure yang nature to break yin-cold and rescue yang from desertion marked by reversal counterflow cold of the four limbs, severe thoracic and abdominal pain, and chronic headache. |
Application | 1. Essential pattern differentiation Si Ni Tang is a fundamental formula to restore yang to rescue from counterflow. This clinical pattern is marked by reversal counterflow cold of the four limbs, debilitated spirit, desire to sleep, pale complexion, feeble, thin pulse. 2. Modern applications This formula may be used in the following biomedically defined disorders when the patient shows signs of debilitated yang and yin exuberance: myocardial infarction, cardiac failure, severe vomiting or diarrhea due to acute gastroenteritis, and profuse sweating due to acute disease resulting shock. 3. Cautions and contraindications Take the decoction cold if vomiting appears. Since there is all acrid and hot medicinals in this formula, it is not suitable for long-term usage. Once the limbs become warm, this formula should not be taken anymore. It is prohibited for the pattern of true heat with false cold. |
Additonal formulae | 1. Tong Mai Si Ni Tang (Channel-Unblocking for Frigid Extremities Decoction 通脈四逆湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Zhi gan cao 2 liang (6g), fu zi one big piece (raw, peeled, cut into eight pcs) (20g), gan jiang 3 liang, 4 liang for strong people (9~12g) [Preparation and Administration] Decoct the three medicinals with 3 sheng of water until 1.2 sheng left, remove the remainder and take the warm decoction two times a day. [Actions] Breaks yin and restores yang to connect the interior and exterior. [Applicable Patterns] Shaoyin pattern, exuberant yin repelling yang. Symptoms include: diarrhea with undigested food, internal cold and external heat, reversal counterflow cold of limbs, feeble, impalpable pulse, aversion to cold, red complexion, bellyache, nausea or vomiting, sore throat, diarrhea stops but the pulse is still impalpable. 2. Si Ni Jia Ren Shen Tang (Frigid Extremities Decoction Plus Ginseng 四逆加人參湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Zhi gan cao 2 liang (6g), fu zi 1 piece, (raw, peeled, cut into eight pcs) (15g), gan jiang 1.5 liang (9g), ren shen 1 liang (6g) [Preparation and Administration] Decoct the four medicinals with 3 sheng of water until 1.2 sheng left, remove the remainder and take the warm decoction two times a day. [Actions] Restores yang to rescue from counterflow, boosts qi, and rescues from desertion. [Applicable Patterns] Shaoyin pattern. Symptoms include: aversion to cold, fever, reversal counterflow cold of the four limbs, lying in bed curled up, a feeble pulse and diarrhea, diarrhea stops while other symptoms remains. 3. Bai Tong Tang (Scallion Yang-Freeing Decoction 白通湯) [Source]《Treatise on Cold Damage》Shang Han Lun《傷寒論》 [Ingredients] Cong bai 4 pcs, gan jiang 1 liang (6g), fu zi 1 pc (raw, peeled, cut into eight pieces) (15g) [Preparation and Administration] Decoct the four medicinals with 3 sheng of water until 1 sheng left, remove the remainder and take the warm decoction two times a day. [Actions] Breaks yin and restores yang to connect the upper and lower. [Applicable Patterns] Shaoyin pattern, exuberant yin repelling yang. Symptoms include: reversal counterflow cold of the hands and feet, diarrhea, a feeble pulse, and a red complexion. Treatise on Cold Damage says: For continuous diarrhea, reversal counterflow cold of the limbs, severe thoracic and abdominal pain, chronic headache, impalpable pulse, nausea, and vexation, add 1 he (5 ml) of pig bile and 5 he (25 ml) of human urine, called Bai Tong Tang with pig bile. 4. Shen Fu Tang (Ginseng and Aconite Decoction 參附湯) [Source]《Categorized Synopsis of the Whole》Zheng Ti Lei Yao《正體類要》 [Ingredients] Ren shen 4 qian (12g), fu zi (processed, remove rind and hilum) 3 qian (9g) [Preparation and Administration] Decoct the four medicinals with 2 zhan of water and 10 pieces of sheng jiang until 8 fen left, remove the remainder and take the warm decoction three times a day. [Actions] Boosts qi to consolidate and restore yang. [Applicable Patterns] Yang and qi collapse. Symptoms include: reversal counterflow cold of the four limbs, continuous cold sweating, shallow breathing, and a feeble and impalpable pulse. |
