BUPLEURUM & CITRUS
Si Ni San

 

‘Frigid Extremities Powder’
Source: Treatise on febrile diseases caused by Cold (Shang Han Lun, 200)

Keywords
Base formula for Liver qi stagnation patterns

Ingredients
Bupleurum chinense (Chai Hu, bupleurum)
Paeonia alba (Bai Shao, white peony)
Citrus aurantium (Zhi Shi, aurantium)
Glycyrrhiza uralensis (Gan Cao, liquorice)

Major therapeutic action
Promotes circulation, harmonises the Liver and digestion.

 Biomedical action
antispasmodic, alleviates depression and emotional distress, benefits digestion, carminative.

Indications
*  This is the base formula for all liver patterns with the following symptoms, especially when the digestion is also involved. It is the basis for most moving formulas.
*  With the appropriate key symptoms, this formula can be used to treat other biomedical conditions such as irritable bowel syndrome with alternating constipation and diarrhoea, gastrointestinal pain and bloating from spasm, gas build-up or ulceration, gastritis, peptic ulcers, cholecystitis, gallstones, biliary spasm, chronic hepatitis, breast swelling and lumps, fibrocystic breast disease, headaches associated with the menstrual cycle, irregular menstruation, ovarian cysts, dysmenorrhoea, poor peripheral circulation, pleurisy, intercostal neuralgia, depression and nervous bladder.

Key symptoms for use
*  symptoms worse with emotional turmoil or stress
*  epigastric and abdominal pain, bloating or ‘knots’, hypochondriac pain
*  premenstrual syndrome, tension headaches
*  irritability, depression, moodiness, generally uptight
*  cyclical symptoms in an otherwise robust patient (usually young)
*  chronic cold fingers and toes (but the extremities and body are warm)

Combinations
*  For Damp-Heat leucorrhoea with abdominal pain, add Cang Zhu & Huang Bo.
*  With episodic sharp pain, add Jin Ling Zi San.
*  With acid reflux, heartburn, add Huang Lian & Wu Zhu Yu.
*  For gallstones, cholecystitis, combine with Yin Chen Hao Tang.
*  For fibrocystic breast disease, add Qing Pi & Xiang Fu or combine with Xiao Luo Wan.
*  For intercostal neuralgia, add Jin Ling Zi San. 		Dosage
The typical dose is three grams twice daily, before meals. In severe cases or the early stages of treatment
(the first two weeks), a 50-100% increase in dose may be used, then reduced as the treatment takes effect.
May be used as an enema for ulcerative bowel disorders.

Cautions and contraindications
Not suitable (unless modified) for very weak or run down patients.
Care should be taken in those with a tendency to abdominal bloating, loose stools or general digestive weakness.
Caution in patients on anti-coagulant drug therapies. May potentiate Coumarin (Warfarin sodium) and aspirin.
Contraindicated during pregnancy, in nursing mothers and when there is an acute cold or flu.

Differentiation
Xiao Yao San:  For similar patterns with the additional symptoms of pale face and lips, dry hair, tiredness, poor memory, insomnia, scanty menses or amenorrhoea, and a pale tongue. Xiao Yao San is an excellent alternative moving formula for women.
Xue Fu Zhu Yu Tang:  Powerfully moving. This formula is built from Si Ni San and Tao Hong Si Wu Tang.
For more severe and localised pain syndromes.