Source: Shanghan Lun (Treatise on Exogenous Febrile Diseases).

Ingredients:
No.1  Zhigancao (Radix Glycyrrhizae Praeparatae) 6 g
No.2  Zhishi (Fructus Aurantii Immaturus) 6 g
No.3  Chaihu (Radix Bupleuri) 6 g
No.4  Shaoyao (Radix Paeoniae) 6 g

Administration:
Grind the above drugs into fine powder, take 3 g twice daily with warm boiled water. Or decoct them with dosages in proportion to those of the original recipe.

Actions:
Soothing the liver and regulating the spleen.

Clinical Application:
This recipe is used to treat syndrome of disharmony between the liver and spleen, marked by hypochondriac distention and fullness, epigastric and abdominal pain, thin whitish fur, and taut pulse. It is applicable to chronic hepatitis, cholecystitis, cholelithiasis, gastric ulcer, gastritis, gastrointestinal neurosis and other diseases, which pertain to syndrome of stagnated qi in the liver and gallbladder and disharmony between the liver and spleen (or between the gallbladder and stomach). Baishaoyao (Radix Paeoniae Alba) is used clinically as ingredient No. 4.

In case of severe hypochondriac pain, add Chuanxiong (Rhizoma Ligustici Chuanxiong) and Xiangfu (Rhizoma Cyperi) to sooth the liver and regulate qi. In case of heat transformed from the stagnated qi manifesting bitter and dry mouth, add Zhizi (Fructus Gardeniae) and Chuanlianzi (Fructus Meliae Toosendan) to expel heat from the liver.

Elucidation:
Originally this recipe is used to treat inward shift of pathogenic heat, accumulation and obstruction of yang-qi, causing cold limbs. Physicians of later generations have expanded its application and used it to deal with various syndromes due to disharmony between the liver and spleen. Ingredient No. 3 is monarch drug with the action of releasing the stagnated liver-qi. The last ingredient functions as minister drug to preserve yin with astringent and nourish blood and the liver. Ingredient No. 2 can regulate liver-qi to remove stagnation and regulate qi movement of the liver and spleen when in compatibility with ingredient No. 3, acting as adjuvant drug.

The first ingredient serves as guiding drug, which can relieve spasm in combination with ingredient No. 4, and regulate the middle-energizer in combination with ingredient No. 2, and coordinate the properties of other drugs. The last two in compatibility is meant to regulate the liver, while the first two to regulate the spleen. And all together constitute the result of regulating the middle-energizer as well as the flow of qi.

Sini San, Sini Tang and Danggni Sini Tang are all used in the treatment of cold limbs, but they are different in pathogeneses and therapeutic principles. The syndrome of cold limbs treated with Sini Tang is caused by excessive yin-cold in the interior due to exhaustion of yang-qi with manifestations as coldness extending from hands to elbows and from feet to knees concomitant with deficiency cold syndrome of the body. For this reason, the recipe focuses on recuperating the depleted yang.

As for Danggui Sini Tang, deficient yang and blood cause cold to retain in the vessels, which manifests milder coldness compared with that in Sini Tang and is accompanied by such symptoms showing deficiency and obstructed circulation of blood as pain of the limbs, pale tongue and thready pulse. That’s why the principle of warming the meridians to dispel cold and nourishing the blood to remove obstruction is adopted in this case. In terms of Sini San, cold limbs are the result of heat invading inward and causing yang-qi to be stagnated and fail in warming the limbs. This is characterized by coldness of only the fingers and toes with feverish body and taut pulse. Thus the therapeutic principle aims at dispersing heat to relieve stagnancy.