四逆散

4. Granule conversion and dose

Calculation of the total raw herb weight of the original formula:

Chai Hu (bupleurum root) 6 g + Bai Shao (white peony root) 6 g + Zhi Shi (immature bitter orange) 6 g + Zhi Gan Cao (honey-fried licorice root) 6 g = 24 g.

Converted to 5:1 granules:

24 g raw herbs ÷ 5 = 4.8 g granules.

Granule dose: Dissolve in warm water and take twice daily, morning and evening, about 2.5 g per dose. Take between meals.

5. Cautions and clinical notes

• Contraindications:
  1. The "reversal cold" (si ni) treated by this formula arises from yang constraint that cannot extend outward, which is entirely different from cold-type reversal due to yang decline with yin excess; therefore it should not be used in patients with yang deficiency cold reversal.
  2. It is not suitable for use alone in patients with Liver yin deficiency where qi stagnation has transformed into fire.
• Characteristics: This formula is a foundational formula for dispersing the Liver and regulating qi; many later well-known formulas, such as Xiao Yao San (Rambling Powder) and Chai Hu Shu Gan San (Bupleurum Powder to Spread the Liver), evolved from this formula.
• Modern applications: Widely used for chronic hepatitis, cholecystitis, cholelithiasis, pancreatitis, gastritis, gastrointestinal neurosis, intercostal neuralgia, and menstrual irregularity where the pattern is identified as Liver qi stagnation with Liver-Spleen disharmony.
• Duration of use: This formula regulates qi movement and may be taken for a course of use as directed. When used for regulation in chronic conditions, it may be taken over a longer term, with attention to monitoring changes in constitution.