Si ni san (constipation)

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On March 10, 1986, A 28 year male presented with dry stools like sheep’s feces, evacuating once every 2-3 days, which had been going on for for nearly 1 year. He also had abdominal distension, fullness, and pain, and cold hands. His tongue was red with a thin and yellow coat. His pulse was wiry and rapid. The pattern belonged to qi constipation.

Treatment was to regulate the qi, unlock the yang, moisten the intestines, and unblock the bowels.Frigid Extremities Powder (sì nì sân) with modifications was given:

  • Bupleuri Radix (chái hú)12g
  • Aurantii Fructus immaturus (zhî shí)9g
  • Paeoniae Radix alba (bái sháo)9g
  • Allii macrostemi Bulbus (xiè bái)9g
  • Cannabis Semen (huô má rén)30g
  • Glycyrrhizae Radix (gän câo)3g

Four packets were given whereby the stools were unblocked and normal.

Source: (陕西中医 1993;〈7〉 : 324 )

Translated by: Jason Blalack

Jason’s Commentary:
Since I came across this case years ago I have used this idea and base formula multiple times with success. “Qi constipation” is an ancient disease name that comes about from yang qi constraint and clumping, qi stagnation not outthrusting, and a sluggish Large Intestine. Cold limbs and a wiry pulse are the key signs/symptoms for diagnosing this pattern. In the book, Book to Safeguard Life Arranged According to Pattern (1108), it says, “cold extremities with constipation, urination that is reddish” is a “yang pattern resembling symptoms of yin.” Use Frigid Extremities Powder (si ni san) to dredge and outthrust the constrained and trapped yang qi and free the qi dynamic. Allii macrostemi Bulbus (xie bai) is added to aid in unblocking the stool whereas Cannabis Semen (huo ma ren) is added moisten the stool/dryness.

Original Chinese:

安少先医案 : 傅某 ,男 ,28 岁, 1986 年 3 月 10 日 就诊。大便干燥如羊矢, 2~3 日 1 行近 1年, 脘腹胀满疼痛, 两手发凉, 舌红、苔薄黄, 脉弦数。证属气秘, 治宜理气通阳, 润肠通便, 投四逆散加味 :柴胡 12g, 积实、白芍、薤白各 9g, 火麻仁 3Og, 甘草 3g。服 4 剂便通如常。

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  • Caroline

    Hi Jason,
    Thank you very much for sharing your case. I just wonder : in the SHL, line 318 says “diarrhea” instead of constipation for the use of Si Ni San. What is your expertise about this? TIA!

    • Jason Blalack

      That is a good question. When we understand the pattern / mechanism / dynamic then we do not have to be tied to the exact symptoms. Also notice the modifications addressing the constipation. Does that make sense? I have used this formula idea many many times in the clinic with success.

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