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Counterflow Cold Decoction

四逆汤 〔四逆湯〕sì nì tāng

Source: Shāng Hán Lùn 伤寒论

Ingredients:

Action: Returns yáng and stems counterflow.

Indication: Lesser yīn disease with debilitation of yáng qì, characterized by reversal cold of the limbs, generalized cold sweating, clear-grain diarrhea, cold pain in the abdomen, and vomiting. Tongue fur: White and glossy. Pulse: Sunken and fine, on the verge of expiration. The formula also treats yáng collapse caused by profuse sweating or diarrhea.

Category: Interior-warming formulas / Yáng-returning desertion-stemming formulas

Method: Decoct with water.

Warnings: Contraindicated in yīn vacuity and in true heat and false cold.

Rationale: Fù zǐ is very hot and very acrid agent that warms and supplements kidney yáng. Although it acts swiftly, its effect is not long-lasting. Hot acrid Gān jiāng warms and supplements spleen yáng. Its effect last longer than that of Fù zǐ, although it is slower acting. These two agents are therefore mutually complementary in their action. Zhì gān cǎo is sweet and warm. Combined with Fù zǐ, it resolves the latter's toxicity and warms and invigorates heart yáng. Combined with Gān jiāng, it softens the harshness of ginger. The formula as a whole provides yáng-returning and counterflow-stemming action that is both quick-acting and long-lasting without side effects.

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