Frigid Extremities Powder

Sayeok-san

한글 사역산 · Pinyin Si Ni San

四逆散

The source gives equal parts and a dose of 2 don, so each drug is about 2 g per dose; the grams here record that per-dose share. 芍藥 is unspecified and is registered as white peony.

Composition 構成

Siho Chai Hu
柴胡 시호 · Bupleurum

2 g
Chief 君
Baekjagyak Bai Shao
白芍藥 백작약 · White Peony

2 g
Deputy 臣
Jisil Zhi Shi
枳實 지실 · Immature Bitter Orange

2 g
Assistant 佐
Gamcho Gan Cao
甘草 감초 · Licorice

2 g
Envoy 使

roasted

Total 8 g per packet (첩) · representative dosage — verify against source texts.

Received this formula from your practitioner? Amounts shown here are classical reference values — granule and prepared products differ. Always follow your prescribed dosage and directions.

Actions 效能

Frees the yang trapped in the interior
Harmonizes the liver and spleen

Indications 主治

Pattern-based

Limbs warm at first and then turning cold as the evil passes through the channels
Yang constrained within with cold extremities

Biomedical correlates

Functional abdominal pain with cold hands and feet
Irritable bowel syndrome with stress

Source text 原文

Donguibogam 東醫寶鑑

治傷寒病, 手足自熱而至溫, 從溫而至厥, 乃傳經之邪也, 宜用此. 柴胡ㆍ芍藥ㆍ枳實ㆍ甘草(灸) 各等分. 右爲末, 每二錢, 淡米飮調服, 日二. 《入門》

Translation

Treats cold damage disease in which the hands and feet pass from hot to warm, and from warm to reversal cold; this is an evil passing through the channels, and this should be used. Bupleurum, peony, unripe bitter orange and roasted licorice, in equal parts. Powder, and take 2 don per dose stirred into thin rice water, twice a day. — Immun 入門 (Donguibogam · Han, upper)

Clinical commentary 臨床

Cold hands and feet that the other Frigid Extremities formulas would answer with aconite, and here the answer is a cooling, freeing one instead — because the cold is not from a want of yang but from yang that cannot get out. The progression in the indication, hot to warm to cold, is the tell: the yang was there and has been shut in. Bupleurum and bitter orange open the way out, peony and licorice relax what is gripping. Two drugs of this formula are the whole of Peony and Licorice Decoction, and the four together are the parent of Bupleurum Liver-Soothing Powder and much of the later qi-regulating repertoire. — Eui Young (Justin) Chung, L.Ac., Dipl. O.M.