Herbacy Prescription Refill Practitioner Information Practitioner must have an active Professional Account with Si Jin Bao PRO (https://www.professionals.sijinbao.com/) Type of Prescribing Professional * Eastern Physician (LAc OMD DOM AP)Western Physician (M.D. D.O. D.C. ARNP PA)Esthetician Prescribing Practitioner Name * First Last * Last Practice Name * Email * Patient Information Patient Name * First Last * Last Patient Email * Confirm Patient Email * Prescriptions to be refilled Please note, prescriptions are valid for up to 90 days unless otherwise indicated. All Professional internal decoctions are 1oz and last for eleven and a half (11 1/2) days for an adult dosage. Please refer to your SJB PRO account for more information. Prescribed Formula * PROPRIETARY FORMULAS止嗽捕蒸汽湯 A.I.R.™ - Zhi Sou Bu Zheng Qi Tang – 肺 Feì Breathe Easy Not Wheezy (Stop Cough Immune Support Decoction)板藍根湯 Ban Lan Gen Tang大肠湯Da Chang Tang (Clear Your Skin & Empty the Bin™)大止痛湯Da Zhi Tong Tang (Extra-Strength Stop Pain Decoction™)復蘇 盔甲 汤 Fu Su Kui Jia Tang (Restore the Armor Decoction™)湯San Jiao Qi Ji Tang – 三焦 San Jiao (Three Burning Spaces)酸棗仁湯 稀薟草 Suan Zao Ren Tang with Xi Xian Cao續斷湯Xu Duan Tang (Broken Bone Decoction™)枳實理中湯Zhi Shi Li Zhong Tang – 小腸 Xiao Chang (Regulate the Middle Decoction)止痛湯Zhi Tong Tang (Stop Pain Decoction™) CLASSICAL FORMULAS安眠湯An Mian Tang八昧地黃湯Ba Wei Di Huang Tang八珍湯Ba Zhen Tang- (Eight Treasure Decoction) Tonify Qi And Blood八正湯Ba Zheng Tang-Eight Rectifying Herbs (Eliminate Dampness /Restore Function to Lower Jiao)保和湯Bao He Tang- 胃 Weì Preserve Harmony Decoction保济湯Bao Ji Tang補中益氣湯Bu Zhong Yi Qi Tang- (Tonify the Middle and Augment the Qi Decoction)柴胡疏肝湯Chai Hu Shu Gan Tang柴胡加龍骨牡蠣湯Chai Hu Long Gu Mu Li Tang川穹荼調湯Chuan Xiong Cha Tiao Tang大補陰湯Da Bu Yuan Jian Tang大承氣湯Da Cheng Qi Tang大止痛湯Da Zhi Tong Tang湯Dan Qiang Tang定喘湯Ding Chuan Tang獨活寄生湯Du Huo Ji Sheng Tang獨活寄生湯Du Huo Shen Qi Tang湯Du Ji Xiao Du Tang二陳湯Er Chen Tang二妙散Er Miao San防風通聖湯Fang Feng Tong Sheng Tang防己黃芪湯Fang Ji Huang Ji Tang (Stephania & Astragalus Root)葛根湯Ge Gan Tang湯Gua Lou Xie Bai Bai Jiu Tang歸脾湯Gui Pi Tang- 心 Xīn桂枝湯Gui Zhi Tang黃連解毒湯Huang Lian Jie Du Tang藿香正氣湯Huo Xiang Zheng Qi Tang (Agastache Decoction to Rectify the Qi)湯Jian Pi Tang (Strengthen Spleen Decoction)金匱腎氣湯Jin Gui Shen Qi Tang (Tonify Kidney Qi Formula)理中湯Li Zhong Tang (Warm the Middle and Cold Tang)六昧地黃湯Liu Wei Di Huang Tang (Six-Ingredient Decoction with Rehmannia)龍膽瀉肝湯Long Dan Xie Gan Tang (Gentiana Decoction to Drain the Liver)湯Ming Mu Di Huang TangPai Qi Yin Tan (Discharge Gas Formula)平胃湯Ping Wei San (Calm the Stomach Decoction)美活勝濕湯Qiang Huo Shen Qi Tang (Notopterygium Decoction to Overcome Dampness)清氣化痠湯Qing Qi Hua Tan Tang (Clear the Qi and Transform Phlegm Decoction)入參敗毒湯Ren Shen Bai Du San Tang (Ginseng Decoction to Overcome Pathogenic Influences)湯Shao Yao Tang湯Shen Ling Bai Zhu Tang ( Ginseng, Poria, and Atractylodes Macrocephala Decoction)生隊湯Sheng Mai Tang (Generate the Pulse Decoction)十全大補湯Shi Quan Da Bu Xin Tang ( All-Inclusive Great Tonifying Decoction)十灰湯Si Huang Tang (Ten Partially-Charred Substances)四金湯Si Jin Tang (Stone)四君子湯Si Jun Zi Tang- (Tonify Qi Formula)四逆湯Si Ni Tang (Frigid Extremities Decoction)四物湯Si Wu Tang (Four-Substance Decoction)酸棄仁湯Suan Zao Ren Tang (Sour Jujube Decoction)蘇子降氣湯Su Zi Jiang Qi Tang (Perilla Fruit Decoction for Directing Qi Downward)桃花湯Tao Hua Tang天麻鉤藤飲Tian Ma Gou Teng Tang ( Gastrodia and Uncaria Decoction)天王袖心丹湯Tian Wang Bu Xin Dan (Calm Insomnia Heart And Kidney)溫膽湯Wen Dan Tang (Warm the Gallbladder Decoction)葦茎糖Wen Jing Tang (Reed Decoction)五苓湯Wu Ling Tang (Five Ingredient Decoction with Poria)吳茱英湯Wu Zhu Yu Tang ( Evodia Decoction)香砂六君子湯Xiang Sha Liu Jun Zi Tang ( Six Gentlemen Decoction with Aucklandia and Amomum)小柴胡湯Xiao Chai Hu Tang- 肝 Gān ( Minor Bupleurum Decoction)小承氣湯Xiao Cheng Qi Tang ( Minor Order the Qi Decoction)小 湯Xiao Ke Tang逍遁湯Xiao Yao Tang (Rambling Decoction)血府逐瘀湯Xue Fu Zhu Yu Tang (Drive Out Stasis in the Mansion of Blood Decoction)銀翹湯Yin Qiao Tang ( Honeysuckle and Forsythia Decoction)右歸湯You Gui Tang- 腎 Shèn Restore the Right (Kidney) Decoction左歸湯Zuo Gui Tang- 腎 Shèn Restore the Left (Kidney) Decoction TOPICAL FORMULASRevive Gel™Revive Cream™Schmoove Gel™Schmoove Cream™Wonderful Gel™Wonderful Cream™Trauma Paste™ Dosage Instructions * 2x Daily3x Daily4x Daily5x Daily6x Daily7x Daily8x Daily Prescription Expiration Date * Add Formula Remove Formula Prescriptions to be refilled Please note, prescriptions are valid for up to 90 days unless otherwise indicated. All Professional internal decoctions are 1oz and last for eleven and a half (11 1/2) days for an adult dosage. Please refer to your SJB PRO account for more information. Prescribed Formula * PROPRIETARY FORMULAS止嗽捕蒸汽湯 A.I.R.™ - Zhi Sou Bu Zheng Qi Tang – 肺 Feì Breathe Easy Not Wheezy (Stop Cough Immune Support Decoction)復蘇 盔甲 汤 Fu Su Kui Jia Tang (Restore the Armor Decoction™) CLASSICAL FORMULAS保和湯Bao He Tang- 胃 Weì Preserve Harmony Decoction清氣化痠湯Qing Qi Hua Tan Tang (Clear the Qi and Transform Phlegm Decoction)銀翹湯Yin Qiao Tang ( Honeysuckle and Forsythia Decoction) TOPICAL FORMULASRevive Gel™Revive Cream™Schmoove Gel™Schmoove Cream™Wonderful Gel™Wonderful Cream™ Dosage Instructions * 2x Daily3x Daily4x Daily5x Daily6x Daily7x Daily8x Daily Prescription Expiration Date * Add Formula Remove Formula Prescriptions to be refilled Please note, prescriptions are valid for up to 90 days unless otherwise indicated. Prescribed Formula * TOPICAL FORMULASRevive Gel™ PRORevive Cream™ PROSchmoove Gel™ PROSchmoove Cream™ PROWonderful Gel™ PROWonderful Cream™ PROYucca'b'Cool™Yucca'b'Energized™A Wonderful Mask™ Dosage Instructions * 2x Daily3x Daily4x Daily5x Daily6x Daily7x Daily8x Daily Prescription Expiration Date * Add Formula Remove Formula Special Instructions / Additional Details Please include the requested size (2oz or 4oz) if you have prescribed Revive, Schmoove or Wonderful. Signature Clear Today's Date Admin Section Add Remove Prescription Orders Add Remove Captcha If you are human, leave this field blank. Submit