Warms the channels, disperses Cold, nourishes the Blood and unblocks the blood vessels

• Long-standing cold hands and feet that both feel very cold and are cold to the touch
• The entire hands and feet are affected, not just the fingers and toes, nor the whole limb (Interior Cold from deficiency)
• A pale tongue with a white coating
• A thin, submerged pulse, which can be so thin it’s almost imperceptible

• The formula revolves around two groups of herbs that address the issues of Blood deficiency and Cold.
• Dang Gui (chief) tonifies and invigorates Blood, and the tonifying action is strengthened by Bai Shao (deputy).
• Gui Zhi (chief) warms the channels and disperses Cold, and in combination with Xi Xin (deputy) it disperses both Internal and External Cold.
• The combination of Gui Zhi and Bai Shao harmonises the protective (Wei) and nutritive (Ying) Qi to assist in eliminating Cold from the more superficial levels of the body.
• Zhi Gan Cao and Da Zao (assistants) augment the Qi and strengthen the Spleen, thereby assisting in tonifying the Blood and facilitating the flow of Yang Qi.
• Mu Tong (envoy) promotes the flow of Qi in the channels and vessels to focus the other ingredients in these areas.

• Persistent mild headache, vertigo and tinnitus: add Bai Zhi and Fang Feng
• Vague epigastric pain, better for warmth or pressure and spitting of clear fluids: add Wu Zhu Yu, Fo Shou and Dang Shen
• Cold and pain in the lower Jiao during (scanty) menstruation: add Yi Mu Cao and Xiang Fu
• Hernial disorders due to cold: add Wu Yao, Xiao Hui Xiang and Gan Liang Jiang
• Chronic resistant sciatica: add Fu Zi, Da Huang, Xu Duan and Gou Ji

• The formula can be seen as a variation of Gui Zhi Tang and is used for a variety of conditions due to Cold invading the channels with underlying Blood deficiency.
• This is different to Yin- or Cold-type collapsing disorder (Interior Cold from deficiency) in that only the hands and feet are cold, as opposed to the whole limb, and the person does not have lethargy, a greater desire to sleep, watery diarrhoea or a submerged pulse. (Si Ni Tang)
• Compared to Yang- or Hot-type collapsing disorder (due to constrained Qi) the hands feel colder to the patient, the cold affects the entire hands and feet; not just the fingers and toes and there is no thirst, irritability, insomnia, constipation, dark urine, or red tongue with a yellow coating. (Si Ni San)
• With the appropriate presentation, the formula may be used for painful joints, irregular menstruation, abdominal pain and cold, and pain in the lower back and legs. Raynaud’s disease, rheumatoid arthritis, fibromyalgia, sciatica, peptic ulcer, chronic urticaria, frostbite and thromboangiitis obliterans.

• Use with caution in the spring and Summer or in warm climates as it can easily injure fluids.
• Contraindicated in patients with Fire from Yin deficiency. See Formula for differentiations of cold extremities.

Warms the middle Jiao and strengthens the Spleen and Stomach

Diarrhoea with watery stool, nausea and vomiting
Abdominal pain, loss of appetite and little thirst
A pale tongue with a white coating and a thin, submerged pulse

• Gan Jiang (chief) warms the Spleen and Stomach Yang and eliminates Interior Cold to fulfil the primary function of the formula.
• Dang Shen (deputy) tonifies the Spleen Qi to reinforce Yang and rectify the ascending and descending functions of the middle Jiao. Spleen deficiency causes a reduction in the ability to transform and transport water, leading to fluid accumulation and Dampness.
• Bai Zhu (assistant) aids Dang Shen in tonifying the Spleen and Stomach, it also strengthens the Spleen and dries Dampness.
• The combination of the warming, tonifying and drying herbs is effective in warming and improving the functions of the middle Jiao.
• Zhi Gan Cao (envoy) augments the Qi of the middle Jiao and harmonises the actions of the other herbs.

• Severe vomiting: add Sheng Jiang
• Bleeding due to Yang deficiency: swap Gam Jiang for Pao Jiang and add Huang Qi, Dang Gui and E Jiao
• Palpitations: add Fu Ling

• The formula addresses middle Jaio Cold due to Yang deficiency; when Spleen Yang is deficient, the clear Yang cannot ascend (causing watery stools) and the turbid Yin cannot descend (causing nausea and vomiting). Cold causes contraction and pain, and the lack of thirst, a pale tongue with a white coating indicate Cold.
• The source text mentions it twice: (i) sudden turmoil disorder with cold, (ii) spitting of fluids due to cold during the recovery from chronic illness.
• It’s now used for a wide variety of disorders including chronic bleeding, chronic childhood convulsions (characterised by emaciation, cold hands and feet, vomiting and diarrhoea).
• It’s also used for painful obstruction in the chest due to Yang Qi deficiency in the upper Jiao with the upward rising of Cold (Yin) that causes Qi to clump and obstruct the chest. Symptoms include rigid focal distension in the heart region, a feeling of chest fullness and pain in the hypochondrium that shoots towards the heart.
• Hou Po Wen Zhong Tang (Magnolia Bark Decoction for Warming the Middle) also treats diarrhoea due to Cold in the middle Jiao, but it strongly dries Dampness and moves Qi, but it does not tonify.
• With the appropriate presentation, the formula may be used for acute or chronic gastritis, gastric or duodenal ulcers, gastroptosis, irritable bowel syndrome (IBS), chronic colitis, chronic bronchitis, oral herpes and functional uterine bleeding.

• Because the formula has warm and dry ingredients it should not be used for externally contracted conditions with fever, or Yin deficiency.
• When used for sudden turmoil disorder it should be discontinued once the vomiting and diarrhoea cease.

Rescues devastated Yang, warms the middle Jiao and stops diarrhoea

Lesser (Shao) Yin-Stage disorder

• Extremely cold extremities, aversion to cold
• Sleeping with the knees drawn up
• A lethargic state with a constant desire to sleep
• Abdominal pain and coldness, a lack of thirst
• Vomiting, diarrhoea with undigested food particles
• A pale tongue with a slippery white coating
• A thin or submerged faint pulse

• Fu Zi (chief) very hot and acrid, resuscitates devastated Yang by warming and stimulating Kidney Yang so it spreads through the body and reaches the extremities.
• Gan Jiang (deputy) warms the middle Jiao and eliminates Cold, strengthening the Spleen’s transforming and transporting function.
• These two herbs work synergistically to strengthen and warm the Kidney and Spleen Yang.
• Zhi Gan Cao (assistant) augments Qi, strengthens the Spleen, reduces the toxicity of the chief herb and modifies the drying properties of both the other herbs.

• Intractable arthritis due to Wind-Dampness: add Rou Gui and Bai Zhu
• Oedema or leukorrhoea due to Spleen and Kidney Yang deficiency: add Dang Shen, Fu Ling and Ze Xie

• The crucial aspect of this formula is its ability to strengthen both the Spleen and Kidney Yang without injuring Yin (which can easily be injured by vomiting or diarrhoea.)
• This is a Lesser (Shao)-Yin pattern which can arise in two ways: (i) chronic Yang deficiency leads to devastated Yang (ii) excessive sweating, which may be due to an externally-contracted illness, or improper treatment of a Greater (Tai) Yang-Stage disorder.
• Both are Lesser (Shao)-Yin disorders in which pathogenic Cold enters the Lesser Yin and attacks the Kidneys. Symptoms can develop very quickly, as happens with shock.
• With the appropriate presentation, the formula may be used for acute myocardial infarction, cardiac insufficiency, vomiting and diarrhoea due to acute or chronic gastroenteritis, hypopituitarism, hypothyroidism, adrenal insufficiency, and intractable arthritis.

Contraindicated in cases with True Heat and False Cold with cold extremities, thirst with a wish for cold drinks, dark urine and a red tongue with a yellow coating. See Discussion in Dang Gui Si Ni San