Frigid Extremities Powder
四逆散 · sì nì sǎn
For cold hands and feet that come with stress, tension, and a tight gut.
What it's for
Your hands and feet run cold while the rest of you feels perfectly normal, and it tends to show up alongside stress and a tense, unhappy gut. In TCM that pattern is not really about being cold. It is read as qi, the energy that moves through your body, getting stuck in the middle and never making it out to your fingers and toes. Practitioners reach for this four-herb formula to get things moving again.
Signs this formula is a fit
Cold fingers and toes plus at least one more of the 3 main signs below should sound like you.
Main signs
Cold fingers and toes, warm everywhere else
your hands and feet stay cold even when the rest of you is fine
Tight, full feeling under your ribs
pressure across the chest and upper belly that tracks with stress
Stress goes straight to your gut
cramping belly pain and sudden loose stools
Extra signs
- Irritable and on edge
- Bitter taste in your mouth
- Appetite drops off
- Red tongue with a yellow coating
- Tight, wiry pulse
Signs it isn't
- Your whole arms and legs go cold, not just the fingers and toes
- You feel cold all over, want to lie down, and have a white tongue coating
- You run dry and hot, with a dry mouth and almost no tongue coating
What's in it
Safety
- Built for cold fingers and toes with a warm body. Not for whole limbs going cold, which is a different pattern.
- Not for people who run dry and hot. Bensky rules it out when tension comes with dryness rather than stuck qi.
- Don't take while pregnant. Licorice is the reason AHPA rules it out without supervision.
- Skip if you have high blood pressure, heart failure, or kidney disease. Licorice can raise blood pressure.
- Generally well tolerated at the label dose. Bensky says bupleurum can drain you if you're run down.
- Licorice affects cortisol and can change how many prescription medications work.
- Bitter orange may inhibit CYP3A4 and affect medications processed by that pathway.
How to take it
What to get
Four Pillars Teapills
Plum Flower200 ct
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Dose
Take 8 pills, 3 times a day. Other brands and forms use different doses, so follow the label on what you buy.
How long
Follow any time limit on the product label. If it gives none, ask a qualified TCM practitioner when to reassess. Do not keep taking it unchanged if nothing improves.