What Dang Gui Si Ni Tang is for
This is the formula for skin that has gone cold and dusky at the edges: hands and feet that turn white, blue or purple, crack in winter and heal slowly, because the Blood is too thin and the Cold too settled to keep the periphery supplied. It warms the channels and builds the Blood together, so warmth and colour return.
The change sits at the edges. Fingers and toes go white, then blue or dusky, and stay cold to the touch; the tissue feels numb, tight or painful, and cracks and chilblains appear where the cold has settled. Healing is slow, and the same areas break down again each winter. Erythema multiforme belongs to this page where the pattern is depleted Blood with Cold in the channels, and the lesions sit on skin that is cold rather than hot.
Blood that is thin reaches the extremities poorly, and Cold congeals what does arrive, so the tissue at the edges is both under-supplied and chilled. Dang Gui and Bai Shao nourish and move the Blood, Gui Zhi and Xi Xin warm the channels and disperse the Cold, Tong Cao keeps the channels flowing so the warming does not congest, and Da Zao with Gan Cao support the middle and the Blood. It warms the channels while it builds the Blood, meeting both needs in one formula.
It is not for Yin deficiency with empty heat. Flushing, night heat and a red dry tongue mean the skin is hot, and warming herbs would make it worse; the cold, pale, dusky periphery is the opposite picture. It is used through the cold months, and any skin that is blackening, ulcerating or losing sensation needs urgent medical assessment, since cold injury is not always simple Cold.
Actions
- Warms the channels and disperses Cold
- Nourishes and moves Blood
- Restores warmth to the extremities
- Relieves pain and numbness from Cold
Properties
- Taste and temperature: Predominantly sweet and pungent with a warming quality. Sweet nourishes Blood, pungent and warm disperses Cold and opens the channels.
- Organs: Liver, Heart, Spleen
- Channels: Liver, Heart, Spleen
The pattern behind it
The pattern is Blood deficiency with Cold in the channels. Thin Blood does not reach the extremities well, and Cold congeals what does arrive, so the hands and feet become cold, dusky, numb and painful. The formula warms the channels and builds the Blood at the same time, so the periphery is both supplied and warmed.
Composition
The herbs in Dang Gui Si Ni Tang, with their role and dose.
| Role | Herb | Dose | Properties | Why it is there |
|---|---|---|---|---|
| Dang Gui | 9 to 12 g | Warm, Sweet, pungent | Nourishes and moves Blood, restoring what the periphery is lacking. | |
| King | Gui Zhi | 9 g | Warm, Pungent, sweet | Warms the channels and disperses Cold, the main action for the cold extremities. |
| Bai Shao | 9 g | Slightly cold, Bitter, sour | Nourishes Blood and softens the tissue, supporting the nourishing side. | |
| Xi Xin | 3 g | Warm, Pungent | A strong warming herb that disperses Cold from the channels and relieves pain; used in small dose. | |
| Tong Cao | 6 g | Slightly cold, Sweet, bland | Opens the channels and helps the flow, preventing the warming herbs from congesting. | |
| Envoy | Da Zao | 8 to 25 g | Warm, Sweet | Nourishes the middle and the Blood, supporting the whole formula. |
| Gan Cao | 6 g | Neutral, Sweet | Harmonises the formula and supports the middle. |
Patterns it treats
Blood Deficiency with Cold in the Channels
Cold, white, blue or dusky hands and feet that crack and heal slowly, with numbness or pain in the cold. Thin Blood does not reach the periphery and Cold congeals what arrives.
How the formula is built
The formula warms and builds together. Gui Zhi and Xi Xin disperse the Cold that is congealing the channels; Dang Gui and Bai Shao build the Blood that is too thin to warm the extremities; Tong Cao keeps the flow open; Da Zao and Gan Cao support the source. That is why it is used for chronic cold extremities rather than for an acute chill.
Skin conditions it is used for
Where this formula appears in the skin conditions of the library.
Preparation and use
Decocted in water and taken warm, in two or three divided doses.
Modifications
- If the Cold is severe, warming herbs are increased.
- If the Blood deficiency dominates, the nourishing herbs are increased.
- If pain is marked, Blood-moving herbs are added.
- If there is Heat, the formula is not used.
Timing
Taken warm in two or three divided doses.
Duration
Three to seven days for an acute cold-limb episode, and longer for chronic cold extremities with reassessment.
Diet while taking it
Warm cooked food; avoid cold and raw food which add to the Cold.
Safety
Contraindications
Avoid in Yin deficiency with empty fire: flushing, night sweats, a red dry tongue and a rapid fine pulse. Avoid in Heat patterns. Xi Xin is used only in the classical small dose.
Interactions
Dang Gui and Gui Zhi may add to anticoagulant effects. Xi Xin contains aristolochic acid in some species and must come from a safe source; only the approved species and dose should be used.
Pregnancy
Use with caution in pregnancy. Gui Zhi promotes circulation and Xi Xin is strongly dispersing, so professional guidance is needed.
Breastfeeding
Use only under professional guidance.
Children
Used in children with reduced dose for cold extremities.
Before you use it
Recorded from the classical record and rewritten in this project's own words. Educational only: not a prescription, and cold, painful, discoloured extremities or non-healing skin need medical assessment.
General safety references
General references for herbal hepatotoxicity and herb-drug interactions; they are not specific to this formula.
- Review article: Herbal hepatotoxicity - an update on traditional Chinese medicine preparations. Alimentary Pharmacology & Therapeutics, 2014. PMID: 24844799.
- Interactions between herbal medicines and prescribed drugs: an updated systematic review. Drugs, 2009. PMID: 19719333.
- Warfarin and food, herbal or dietary supplement interactions: a systematic review. British Journal of Clinical Pharmacology, 2021. PMID: 32478963.
Origin and history
Shang Han Lun (伤寒论, Treatise on Cold Damage) by Zhang Zhongjing, Eastern Han dynasty, around 220 CE.
Zhang Zhongjing recorded the formula in the Treatise on Cold Damage for cold extremities in a Blood-deficient person, distinguishing it carefully from the cold extremities of Qi constraint. That distinction is the reason two formulas with similar names, Si Ni San and Dang Gui Si Ni Tang, treat two entirely different patients.
Classical record
The Treatise on Cold Damage records the formula for cold hands and feet with a fine pulse in a person whose Blood is insufficient, treated by warming the channels and nourishing the Blood together.
Shang Han Lun (伤寒论, Treatise on Cold Damage), Zhang Zhongjing, Eastern Han dynasty.
Evidence note
No controlled trial of this treatment in skin conditions was identified for this entry. What is described here rests on the classical and later materia medica record and on traditional clinical use, not on controlled trial evidence, and it is not a prediction of benefit. Where skin-specific research does exist it is linked above.
Common questions
How is it different from Si Ni San?
Si Ni San is for cold hands and feet from Qi constraint in a robust person. Dang Gui Si Ni Tang is for cold extremities from Blood deficiency and Cold in a pale, thin person.
Can it help chilblains?
Yes, where the pattern is cold with Blood deficiency. Chilblains also call for avoiding cold exposure and, if severe, medical assessment.
Is Xi Xin safe?
Only at the classical small dose and from a safe source, since some species of the plant contain a harmful compound.
When should cold fingers be investigated?
Colour change on cold exposure, pain, ulceration or one-sided coldness needs medical assessment, especially where autoimmune disease is possible.