Danggui Si Ni Decoction for Blood Deficiency and Cold Reversal

Chinese Medicine Book Club Issue 2366

Daily issues to accompany the growth of TCM practitioners

IIntroduction：Danggui Si Ni Decoction (当归四逆汤) is a warming interior formula that has the effects of warming the meridians, dispelling cold, nourishing blood, and unblocking the vessels. It is primarily used to treat blood deficiency with cold reversal syndrome. Symptoms include cold extremities, or pain in the waist, thighs, legs, feet, and shoulders, with no thirst, pale tongue with white coating, and a deep, thin or thin and almost imperceptible pulse. Clinically, it is often used to treat thromboangiitis obliterans, acrocyanosis, Raynaud’s disease, poliomyelitis, frostbite, dysmenorrhea, periarthritis of the shoulder, rheumatoid arthritis, and other conditions associated with blood deficiency and cold stagnation. (Editor/Tang Yichao)

Danggui Si Ni Decoction

Author/Men Chunde

【Ingredients】Danggui (当归) 12g, Guizhi (桂枝) 9g, Sheng Baishao (生白芍) 9g, Xixin (细辛) 3g, Zhi Gancao (炙甘草) 6g, Tongcao (通草) 6g, Hongzao (红枣) 4 pieces【Dosage】Decoct in water for oral administration.【Indications】Blood deficiency with cold, characterized by cold extremities, pale tongue with white coating, and a deep, thin or almost imperceptible pulse.【Formula Interpretation】The term “Si Ni” refers to the differentiation of Yang deficiency, Qi counterflow, and blood stagnation. Si Ni Decoction aims to restore Yang, while Si Ni San focuses on harmonizing. Danggui Si Ni Decoction is designed to dispel cold and unblock the vessels, thus it is formulated by modifying Guizhi Decoction by removing ginger and adding Danggui, Xixin, and Tongcao.In this formula, Danggui nourishes and invigorates the blood, Guizhi and Baishao harmonize the Ying and Wei, Xixin warms the meridians and unblocks the collaterals, and Tongcao unblocks the meridians and vessels, while Da Zao (大枣) and Gancao (甘草) tonify the middle Qi and support the Ying and blood.All the herbs work together to warm the meridians, dispel cold, nourish the blood, and unblock the vessels. This formula is widely used in clinical practice for conditions of blood deficiency with cold stagnation and dampness causing pain and spasms.【Clinical Applications】1. Paroxysmal Painful HeadacheExample:Liang, male, 32 years old.Experiences pulling pain in the head and neck, occurring intermittently, with severe pain leading to cold extremities.After seeking treatment from various sources without effect.Diagnosed at a hospital with tuberculous meningitis, repeatedly treated with streptomycin and analgesics, but headache persisted.Clinical findings:Pale complexion, sleepless nights, sensitivity to sound and light, chest discomfort, pale tongue, and thin pulse.Treated with Danggui Si Ni Decoction, prescribed for five doses.After four doses, the headache gradually ceased, but constipation occurred, so 12g of Ma Ren (麻仁) was added, and after six more doses, the patient was cured.Headaches can vary widely.This case’s headache was attributed to long-standing blood deficiency, with the liver failing to store blood, and wind-cold affecting the Jueyin channel.Common symptoms include paroxysmal pain, mental fatigue, cold body, and a deep, thin pulse, thus Danggui Si Ni Decoction is often effective.2. DysmenorrheaDysmenorrhea is commonly seen in women.It can generally be divided into two categories: one is blood stasis with Qi stagnation, and the other is blood deficiency with cold stagnation.Danggui Si Ni Decoction nourishes blood and dispels cold, effectively treating dysmenorrhea due to blood deficiency and cold stagnation.Symptoms include pale complexion, pale lips, cold extremities, lower abdominal pain, delayed menstruation, dark menstrual blood at onset, followed by lighter color, abdominal pain radiating to the lower back, along with dizziness, palpitations, and fatigue, making this formula highly effective.Example:Wang, female, 37 years old.Has experienced dysmenorrhea for over ten years, with varying severity.In recent years, menstruation has often been delayed, with increased volume and dark color, accompanied by blood clots.Before and after menstruation, she experiences unbearable lower abdominal cramping, with cold extremities and a thin pulse.Treated with Danggui Si Ni Decoction, instructed to take two doses three to five days before menstruation, continuously for three months.After treatment, the patient’s dysmenorrhea ceased, and menstrual volume returned to normal.3. Abdominal Pain due to Deficiency Cold and Cold HerniaRegardless of gender, those with cold extremities and persistent lower abdominal cramping, who do not respond to analgesics, can be effectively treated with Danggui Si Ni Decoction.If cold hernia pain has persisted for a long time, or if there is cramping pain on one or both sides of the lower abdomen, or testicular pain with scrotal swelling, Danggui Si Ni Decoction can be modified by adding 6g of Wu Zhu Yu (吴茱萸) and 9g of Sheng Jiang (生姜), with two to three doses yielding results.4. Numbness of the LimbsThose with chronic Qi and blood deficiency, leading to poor blood circulation, may experience numbness in the upper or lower limbs, a condition known as blood obstruction.If acupuncture is ineffective, Danggui Si Ni Decoction can be used for treatment.Example:Tong, female, 87 years old.Experiences numbness in the limbs, unable to get out of bed for six months.Pale complexion, thin body, cold extremities, and insensitivity upon touch, with a deep, wiry pulse.Treated with Danggui Si Ni Decoction, prescribed for three doses.After treatment, sensation returned, and limbs warmed up. Subsequently treated with Huangqi Guizhi Wuwu Decoction (黄芪桂枝五物汤) for four doses, resulting in significant improvement, and the patient was able to walk.5. Thromboangiitis ObliteransExample:Ren, male, 48 years old.Patient presents with coldness and pain in the right toe, with purple swelling for four months, diagnosed at the hospital with thromboangiitis obliterans.Treated with Danggui Si Ni Decoction, prescribed for five doses, resulting in reduced pain and warming of the lower limb.After four more doses, pain was nearly resolved, and the pulse at the Duyin point was palpable.In the early stages of thromboangiitis obliterans, symptoms often include redness, purple discoloration, numbness, and cold pain in the affected fingers or toes.Danggui Si Ni Decoction enhances Qi transformation, promotes circulation, unblocks the meridians, invigorates blood, dispels cold, and alleviates pain, thus yielding excellent results for this condition.Many similar cases have been treated, but will not be elaborated here.6. Peripheral Vascular SpasmLi, female, 35 years old.Patient has experienced cold, painful, and numb fingers for over a year, with worsening symptoms upon exposure to cold or emotional stress, and fingers turning white in cold conditions.Pale complexion, fatigue, poor appetite, and weak pulse. Initially treated with Danggui Si Ni Decoction, adding 30g of Huangqi and 20g of Jixueteng (鸡血藤), with intermittent use over half a month leading to recovery.Additionally, in clinical practice, those who are often sensitive to cold and have cold extremities may also experience palpitations and sexual dysfunction, which can be effectively treated with a few doses of this formula.

Recommended Reading:

Liu Duzhou: Lecture on Danggui Si Ni Decoction

Danggui Si Ni Decoction with Wu Zhu Yu and Sheng Jiang