September 1, 2010

Hu Xi-Shu’s commonly used formulas for impediment syndrome (痹证 Bi Zheng)

Dr. Hu was a master at utilizing classical formulas for the treatment of a wide array of syndromes. The following is a list of his most commonly used formulas and their specific patterns for the treatment of pain.

I. Ge Gen Jia Zhu Tang (Kudzu Decoction plus Atractylodes Decoction)(葛根加术汤):
Neck and nape tightness and pain, heat effusion, aversion to cold, lumbar soreness, generalised heaviness, white tongue coating, wiry-slippery pulse.

Ge Gen 4 qian (Radix Puerariae)
Ma Huang 3 qian (Ephedrae, Herba)
Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)
Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)
Bai Shao 2 qian (Paoniae Lactiflorae, Radix)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)
Da Zao 4 pieces (Zizyphi Jujubae, Fructus)
Cang Zhu 5 qian (Atractylodis, Rhizoma)

This formula is used in both acute and chronic inflammatory joint problems, especially when manifesting with heat effusion, an absence of sweating and aversion to cold. The use of this formula is still warranted in cases of acute joint inflammation without the presence of neck and nape pain. This formula may be utilised in treating cases of lumbar muscular injury, hyperosteogenesis, ankylosing spondylitis and chronic arthritis.


II. Ma Xing Yi Gan Tang (Ephedra, Apricot Kernel, Coicis, and Licorice Decoction)
(麻杏薏甘汤):

Whole body joint pain, late afternoon heat effusion, body heaviness or swelling of the joints in the four extremities, harmony in the mouth* or sticky taste in the mouth, greasy-white tongue coating, deep-wiry-slippery pulse.

Ma Huang 3 qian (Ephedrae, Herba)
Xing Ren 2 qian (Pruni Armeniacae, Semen)
Yi Yi Ren 6 qian (Coicis Lachryma-jobi, Semen)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)

This formula pattern is commonly seen in cases of chronic and acute rheumatoid arthritis with a tendency towards damp heat.

*Harmony of the mouth is described as a normal taste in the mouth without any dryness, stickiness or thirst, and is commonly observed in relatively healthy individuals or in mild conditions.


III. Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony, and Anemarrhena Decoction) (桂枝芍药知母汤):
Whole body joint pain, joint swelling in the extremities or knees, stiffness and/or deformities in the extremities, fingers or toes, dizziness, shortness of breath, white tongue coating, wiry pulse.

Gui Zhi 4 qian (Cinnamomi Cassiae, Ramulus)
Ma Huang 2 qian (Ephedrae, Herba)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Sheng Jiang 5 qian (Zingiberis Officinalis Recens, Rhizoma)
Bai Zhu 5 qian (Atractylodis Macrocephalae, Rhizoma)
Zhi Mu 4 qian (Anemarrhena Asphodeloidis, Rhizoma)
Fang Feng 4 qian (Ledebouriellae, Radix)
Pao Fu Zi 2 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)
Gan Cao 2 qian (Glycyrrhizae Uralensis, Radix)


This formula pattern is commonly seen in chronic rheumatic cases such as damp-heat type rheumatoid arthritis and is classified as a combination of the Shao-Yin and Tai-Yin disease stages. This formula is especially indicated in cases of swelling with joint deformities accompanied by upward rising qi and nausea. In cases where redness, swelling and heat are significant, Sheng Shi Gao (Gypsum) may be added to the above formula.


IV. Gui Zhi Jia Ling Zhu Fu Tang (Cinnamon Twig plus Poria, Atractylodis, and Aconite Decoction) (桂枝加苓术附汤):
Lumbar, knee or shoulder joint pain, head, neck and nape pain, possibly accompanied by palpitations, epigastric pain, sweating, aversion to wind, cold extremities, harmony of the mouth, white tongue coating, wiry pulse.

Gui Zhi 2 qian (Cinnamomi Cassiae, Ramulus)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Zhi Gan Cao 3 qian (Glycyrrhizae Radix Preperata)
Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)
Da Zao 4 pieces (Zizyphi Jujubae, Fructus)
Cang Zhu 3 qian (Atractylodis, Rhizoma)
Fu Ling 3 qian (Poriae cocos, Sclerotium)
Pao Fu Zi 3 qian (Aconiti Carmichaeli Preparata, Radix Lateralis)


This was one of Dr. Hu’s most commonly used formulas. If joint pain was more evident on one side of the body, he would consider this obstruction and stasis of blood and would add a small dose of Da Huang (Radix Rhubarb) in order to quicken the blood and free the collaterals.



V. Gui Zhi Jia Huang Qi Tang (Cinnamon Twig plus Astragali Decoction)
(桂枝加黄芪汤):

Enduring joint pain, obvious sweating and aversion to wind, cold extremities, with perhaps a warm body and numbness in the extremities. Thin-white tongue coating, moderate pulse.

Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Sheng Jiang 3 qian (Zingiberis Officinalis Recens, Rhizoma)
Da Zao 4 pieces (Zizyphi Jujubae, Fructus)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)
Huang Qi 3 qian (Astragali Membranacei, Radix)

This formula is used in cases of exterior vacuity combined with water-damp evils seen in cases of impediment pain, numbness and sores.



VI. Chai Hu Gui Zhi Gan Jiang Tang combined with Dang Gui Shao Yao San (Bupleurum, Cinnamon Twig, and Ginger Decoction, plus Tangkuei and Peony Powder)
(柴胡桂枝干姜汤合当归芍药散):

Lumbar and/or pelvic pain, neck and back pain, weak knees, palpitations, fullness below the heart, spontaneous or night sweating, lower extremity oedema, white tongue coating, deep-thin-wiry pulse.

Chai Hu 4 qian (Bupleuri, Radix)
Gui Zhi 3 qian (Cinnamomi Cassiae, Ramulus)
Gan Jiang 2 qian (Zingiberis Officinalis, Rhizoma)
Huang Qin 3 qian (Scutellariae Baicalensis, Radix)
Hua Fen 4 qian (Trichosanthis Kirilowii, Radix)
Sheng Mu Li 5 qian (Ostreae, Concha)
Dang Gui 3 qian (Angelicae Sinensis, Radix)
Bai Shao 3 qian (Paoniae Lactiflorae, Radix)
Chuan Xiong 2 qian (Ligustici Chuanxiong, Radix)
Bai Zhu 3 qian (Atractylodis Macrocephalae, Rhizoma)
Ze Xie 5 qian (Alismatis Orientalis, Rhizoma)
Fu Ling 4 qian (Poria cocos, Sclerotium)
Zhi Gan Cao 2 qian (Glycyrrhizae Radix Preperata)


This formula is commonly used in the treatment of lumbar and cervical hyper-osteogenesis, osteoporosis, ankylosing spondylitis and wind-damp type rheumatic disorders. The location of this disease is found in both the Jue-Yin and Tai-Yin levels and is a pattern of blood vacuity with damp exuberance therefore treatment involves resolving the two Yin’s nourishing the blood and disinhibiting water.
According to numerous recorded cases studies, Dr. Hu commonly employed this formula in the treatment of Systemic Lupus erythematosus (SLE).