March 2, 2011

Two Cases on the use of Si Ni San

A Collection of the Clinical Experience of He Ren
何任临床经验辑要

Case #1
On April 8 1983, a 48 year old female presented with irregular menstruation.  She was a very sceptical woman and was easily angered.  Her sleep was poor with copious dreaming, she experienced rib side pain, abdominal distension, her bowel movements alternated between hard and loose, her tongue had a thin white coat and her pulse was wiry.  In this case it is appropriate to harmonize and scatter the depression, course the liver, and regulate qi.  The following formula was prescribed;

Zhi Shi 9g
Chai Hu 9g
Sheng Gan Cao 9g
Dang Gui 9g
Bai Shao 15g
Huai Xiao Mai 30g
Zhi Xiang Fu 9g
Da Zao 7 pieces

5 packages were administered.

Follow up consultation on April 15 1983:  After taking the above formula, her sleep had improved and she felt calmer.  The abdominal distension had decreased, her bowel movements were regular, but the rib side pain was still occasionally present.  Tongue coating was still thin and the pulse was wiry.  A modified version of the original formula was prescribed.

Zhi Shi 9g
Chai Hu 9g
Sheng Gan Cao 9g
Yu Jin 9g
Bai Shao 15g
Zhi Xiang Fu 9g
Huai Xiao Mai 30g
Da Zao 7 pieces

5 packages were administered.

Commentary:  The patient in this case originally suffered from neurosis occurring alongside menopause.  Therefore we have a pattern of qi and blood disharmony with liver depression, causing rib side pain and abdominal distension.  This pattern is effectively treated with a combination of Si Ni San and Gan Mai Da Zao Tang.  On follow up after finishing the formula, the patient reported a full resolution of symptoms.


Case #2
A 41 year old male presented on August 17, 1981 with a depressed spirit, irritability and anger.  In addition he had epigastric pain, an increase in bowel movements, with occasional diarrhea, cold fingers and toes, slight sweating, fatigue, a wiry-rapid pulse, and a thin yellow tongue coat.  In this case it is appropriate to course the liver, regulate qi and resolve depression.  The following formula was prescribed;

Chai Hu 9g
Bai Shao 9g
Sheng Gan Cao 9g
Zhi Shi 9g
Chun Yang Zheng Qi Wan 3g* (separated into two doses and taken with decoction)
*Pure Yang to Rectify the Qi pills is a patent formula containing Chen Pi, Cang Zhu, Rou Gui, Ding Xiang, Huo Xiang, Bai Zhu, Fu Ling, Zhi Ban Xia, and Qing Mu Xiang.

Four packages were administered.

Commentary:  The patient in this case suffered from a depressed spirit.  He tended to think excessively and was easily angered.  This patient was initially diagnosed during the summer, and was manifesting a Si Ni San presentation.  Taking the season into consideration and the conditions of his diet with the mild reversal symptoms, we are unable to say that this is a pure case of binding depression of liver qi.  Due to these factors, Chun Yang Zheng Qi Wan was added to clear the stomach and intestines and eliminate seasonal pathogenic factors.  After taking two packages of the formula his (epigastric) pain and diarrhea had completely resolved, and he felt much calmer.

The clinical scope of Si Ni San is quite vast.  In all cases of qi stagnation, qi depression, and qi reversal the pattern and presentation of Si Ni San is often present with several opportunities for use.  The formula is applicable in cases of cholelithiasis, cholecystitis, intercostal neuralgia, weak digestive system functioning, stomatitis, panting, palpitations, colitis, neurological disorders, menopause, and several other conditions.  Generally when the pattern is correctly identified and the herbs and/or formula are matched to the presentation, our results can be 100% effective. 

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