Four Counterflow Combination - Si Ni San

Formula Type

Extract

TCM Pattern

While this formula is mentioned in the source text for treating a pathogen that is depressed in the shaoyin, it has come to be used to treat binding depression of liver qi that presents with warmth in the abdomen and cold in the limbs owing to lack of flow of qi to the extremities. By extension it has been used to treat a large variety of patterns of binding depression of liver qi characterized by flank pain (including a number of liver and gallbladder disorders), a wiry pulse and digestive upset (wood invading earth) expressed as diarrhea, abdominal pain and gastric pain. Since the liver channel traverses the reproductive organs, the formula can also be used to treat painful menstruation and other disorders associated with those organs.

Therapeutic Functions

Expels pathogens, resolves depressing, courses the liver and rectifies the spleen.*

Clinical Indications

This formula can treat a wide range of consequences of binding depression of liver qi including central burner disorders such as cholecystitis, cholelithiasis, gastritis, peptic ulcers, allergic colitis, adhesive intestinal obstruction, intercostal neuralgia, hepatitis, pancreatitis, and trigeminal neuralgia; and lower burner disorders such as urinary tract stones, dysmenorrhea, impotence, enuresis, blocked fallopian tubes, or encapsulated periappendical abscesses. In addition, the formula may be appropriate for other outcomes of binding depression of liver qi such as allergic rhinitis, epidemic hemorrhagic fever, coronary artery disease, premenstrual and perimenopausal syndrome, epilepsy, neurogenic headaches, or acute mastitis.

Symptoms & Signs

The patient for whom this formula is appropriate shows signs of binding depression of liver qi such as flank pain, digestive upset, anger, frustration and a wiry pulse. Note that this formula primarily addresses the branch and treatment usually involves shifting to a more nourishing formula after the relief from primary symptoms has been achieved.

Precautions

This formula is acrid and dispersing and thus inappropriate for qi constraint in patients with yin deficiency. Due to its drying and dispersing nature the formula is not appropriate for long-term use without modification

Pulse Quality

Wiry

Tongue Appearance

Varied