Frigid Extremities Decoction

Frigid Extremities Decoction

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)

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.)

Restores yang to rescue from counterflow.

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.

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.

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.

1. Tong Mai Si Ni Tang (Channel-Unblocking for Frigid Extremities Decoction 通脈四逆湯)