Classica Sinica Medica

四逆

sì nì

Four reversals · si ni

Also rendered: Four reversals (This site) · Cold in the four limbs (Literal) · Cold extremities (Clinical, loses the reversal)

Pathology

Reviewed · 2026-10-31

At a glance

Pinyin
sì nì
Simplified
四逆
Literal
四 sì is four, meaning the four limbs; 逆 nì is to go against, to turn back from the proper direction. The phrase describes the limbs turning cold against the natural downward-and-outward warmth of the body — not a numbness but a reversal of flow, so that warmth retreats inward and the extremities go cold. It names a sign, and by extension the formulas built to reverse it.
Shuowen
**《說文》：「四，陰數也。」「逆，迎也。」** 逆本訓迎，引申為違逆、倒行；四肢當溫而反冷，是氣不達末，故曰四逆。**凡十三見**：第五篇一、第六篇三、第八篇一、第十篇一、第十一篇七。**與「厥」之别**：厥言手足逆冷之甚，可兼昏冒；四逆多指手足寒而未至昏厥。**與「厥逆」之别**：厥逆（925）為素問氣逆之目，義項不涉傷寒手足冷，不可混掛。

In brief

Cold limbs read as a reversal of qi rather than a local chill. In this chapter the sign carries two opposite meanings that must be told apart at the bedside. Where vomiting and diarrhoea have emptied the middle, vexation and restlessness follow, and the limbs go cold, the last yang is about to leave and the case is declared fatal. Where the limbs are cold but the person is not depleted — cough, palpitation, difficult urination, abdominal pain or tenesmus appearing among the options — the yang is not exhausted but stuck, and the powder of four reversals opens the obstruction. Where the pulse is deep and the cold is uncomplicated, the decoction of four reversals warms it back at once.

Senses in the classical corpus

1
少陰亡陽四逆 少陰病，吐利，燥煩，四逆者
吐利交作，陰寒內盛，四肢失温；更加燥煩，是殘陽欲脫，故主死
Vomiting and diarrhoea together, yin cold filling the interior, the four limbs losing their warmth; add dryness and vexation and the remaining yang is about to leave. The chapter calls this death.
少陰病，吐利，燥煩，四逆者，死。 — 辨少陰病脉證并治第十一
2
少陰陽鬱四逆 少陰病，四逆，其人或欬
陽氣鬱於裏而不達四末，故四逆；或欬或悸或小便不利或腹痛下重，四逆散宣通鬱陽
The yang is stuck within and does not reach the extremities, so the limbs are cold; cough, palpitation, difficult urination, abdominal pain or tenesmus may appear among the options. The powder of four reversals frees the bound yang.
少陰病，四逆，其人或欬，或悸，或小便不利，或腹中痛，或泄利下重者，四逆散主之。 — 辨少陰病脉證并治第十一
3
虚寒四逆 宜四逆湯
脉沉而四逆，陽虚寒盛，急温以四逆湯；曰急者，遲則陽亡
A deep pulse with cold limbs means yang deficiency and prevailing cold; warm it at once with the decoction of four reversals. The word urgent is used because delay lets the yang die.
少陰病，脉沉者，急温之，宜四逆湯。 — 辨少陰病脉證并治第十一

Occurrences in the classics

Passages where the term does real work, with the original, pinyin and English on the same line.

Display
4 passages
辨少陰病脉證并治第十一·辨少陰病脉證并治第十一 Read in context →
少陰病，吐利，燥煩，四逆者，死。 少阴病，吐利，燥烦，四逆者，死。
shào yīn bìng tǔ lì zào fán sì nì zhě sǐ
In shaoyin disease, vomiting and diarrhoea with agitation and reversal of the limbs is fatal.
四逆而兼吐利燥煩，是陰盛陽脫，故死；若但四逆而無吐利，未可遽斷為死。
辨少陰病脉證并治第十一·辨少陰病脉證并治第十一 Read in context →
少陰病，四逆，其人或欬，或悸，或小便不利，或腹中痛，或泄利下重者，四逆散主之。 少阴病，四逆，其人或咳，或悸，或小便不利，或腹中痛，或泄利下重者，四逆散主之。
shào yīn bìng sì nì qí rén huò kài huò jì huò xiǎo biàn bù lì huò fù zhōng tòng huò xiè lì xià zhòng zhě sì nì sǎn zhǔ zhī
In shaoyin disease with reversal of the limbs, whether the patient coughs, or has palpitations, or difficult urination, or abdominal pain, or diarrhoea with a bearing-down sensation at the anus, Four-Rebellion Powder governs.
四逆散證四逆而不厥，脉亦不微，故知為鬱而非脫。
辨少陰病脉證并治第十一·辨少陰病脉證并治第十一 Read in context →
少陰病，脉沉者，急温之，宜四逆湯。 少阴病，脉沉者，急温之，宜四逆汤。
shào yīn bìng mài chén zhě jí wēn zhī yí sì nì tāng
In shaoyin disease with a deep pulse, warm it at once; Four-Rebellion Decoction is suitable.
脉沉急温，重在脉不浮不數；若脉微欲絶，則非四逆湯所能及。
辨太陰病脉證并治第十·辨太陰病脉證并治第十 Read in context →
自利不渴者，屬太陰，以其藏有寒故也，當温之，宜服四逆輩。 自利不渴者，属太阴，以其藏有寒故也，当温之，宜服四逆辈。
zì lì bù kě zhě shǔ tài yīn yǐ qí zàng yǒu hán gù yě dāng wēn zhī yí fú sì nì bèi
Diarrhoea without thirst belongs to taiyin, because the viscus has cold; it should be warmed, and decoctions of the Four-Rebellion kind are suitable.
太陰自利不渴，藏有寒，宜四逆輩；一「輩」字，見温法有輕重進退。

Compounds built on this term

四逆湯
sì nì tāng
decoction of four reversals
辨少陰病脉證并治第十一
四逆散
sì nì sǎn
powder of four reversals
辨少陰病脉證并治第十一
通脉四逆湯
tōng mài sì nì tāng
vessel-opening four reversals decoction
辨少陰病脉證并治第十一
手足厥逆
shǒu zú jué nì
cold reversal of hands and feet
辨少陰病脉證并治第十一

How it has been translated

Every rendering below is a decision about which reader is being addressed. There is no neutral option.

This sitefour reversalskeeps the numbered limbs and the reversal
Literalthe four go againstexact, cryptic
Clinicalcold extremitiesclear, loses the mechanism

Entry status

Review pending — who reviews this?

2026-10-31

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