By Eric Brand

We got a request for information on formula combining with Gui Zhi Tang. Here are some ideas:

Gui Zhi Tang (Cinnamon Twig Decoction)

Gui Zhi (Cinnamomi Ramulus)
Bai Shao (Paeoniae Radix Alba)
Da Zao (Jujubae Fructus)
Sheng Jiang (Zingiberis Rhizoma Recens)
Zhi Gan Cao (Glycyrrhizae Radix Praeparata)

Gui Zhi Tang is a formula from the Shang Han Lun (“On Cold Damage”) that was originally indicated for greater yang wind strike patterns of cold damage. The combination of medicinals within Gui Zhi Tang is very eloquent and subtle variations in additions can take the formula in several new directions. Gui Zhi Tang is essentially a formula for balancing yin and yang, and it is one of the most balanced and profound formulas within Chinese medicine.

Follow up:

Gui Zhi Tang relies on the complementary opposition of Gui Zhi and Bai Shao. Gui Zhi is warm and outward moving, which Bai Shao is cool and constraining in action. The construction-defense disharmony that is treated in Gui Zhi Tang is essentially an imbalance of yin and yang, here expressed as an imbalance between construction and defense, or the interior and the exterior. The warm freeing action of Gui Zhi treats the yang aspect of the problem (defense) while the nourishing and consolidating action of Bai Shao treats the yin aspect of the problem (construction). Together, they balance the interior and exterior and harmonize yin and yang. Traditionally, this is explained through the use of a military analogy, with Bai Shao representing the “camp” or supply and Gui Zhi representing the “defense” or the troops at the perimeter.

Beyond Gui Zhi and Bai Shao, Gui Zhi Tang also contains a unit of earth-supplementing medicinals that appear together in many other Shang Han Lun formulas. These medicinals also rely on mutual opposition; the acrid, dispersing nature of Sheng Jiang prevents the sweet, rich nature of Da Zao from causing stagnation, while Zhi Gan Cao both supplements the spleen and harmonizes the formula.

Chinese formula texts state that Gui Zhi Tang is indicated for external contraction of wind-cold with exterior vacuity and disharmony of construction and defense. This pattern is characterized by headache, heat effusion, aversion to wind, and sweating, possibly accompanied by “noisy nose” (nasal congestion with audible breathing), absence of thirst, and/or dry retching.

Under normal physiologic conditions, defense qi moves outside the vessels and secures and protects the fleshy exterior. Construction-yin stays inside and provides nourishment to defense yang, and construction and defense are in harmony.

In the pathologic state addressed by Gui Zhi Tang, vacuity of defense qi causes the interstices to be loose. Defense yang cannot secure and protect the fleshy exterior, so there is aversion to cold. Construction-yin cannot stay in the inner body and discharges outward, causing sweating. The combination of Gui Zhi (Cinnamomi Ramulus) and Bai Shao (Paeoniae Radix Alba) both dissipates and contracts. This allows evil to be dispelled without damaging right while simultaneously nourishing yin without lodging evil.

This formula is said to “transform qi and regulate yin and yang,” and it is used for miscellaneous diseases in internal medicine that are ascribed to disharmony of yin and yang, construction and defense, or qi and blood. It is especially suitable for conditions following illness or childbirth, or for generalized weakness when the chief manifestations are aversion to wind and sweating.

Within the original Shang Han Lun, there are uses of Gui Zhi Tang that do not manifest with greater yang wind-strike. For example, it is mentioned for patients with periodic heat effusion and spontatneous sweating, in the absence of other visceral diseases. Here, it is taken prior to the onset of heat effusion to harmonize construction and defense.

Gui Zhi Tang is contraindicated in patients with greater yang cold damage signs. Because it is too mild in comparison with Ma Huang Tang (Ephedra Decoction), one will miss the best opportunity for dispelling evil.

Gui Zhi Tang is also contraindicated in interior damp-heat patterns. This is alluded to in the Shang Han Lun in a discussion of its adverse effects on “sick drinkers.” The formula is acrid and sweet, and acrid flavors reinforce heat and sweet flavors reinforce dampness, so there is a general caution against the use of Gui Zhi Tang in the interior damp-heat conditions. The original meaning of the phrase “sick drinkers” (jiu ke bing) is unclear, it may refer either to a disease name (drinker’s sickness, i.e., alcoholism) or to a drinker (jiu ke) who is sick. If it refers to the latter, it is unclear whether they are sick with greater yang wind-strike or sick from drinking. Different sources draw different conclusions about this statement.

Gui Zhi Tang is also inappropriate for patients with exuberant interior heat, as well as in greater yang disease that has been erroneously treated with purging and no exterior signs remain present.

The addition of Ge Gen (Puerariae Radix) to this formula modifies it to treat hypertonicity in the nape and back. This is a pattern of simultaneous greater yang wind strike and constrained greater yang channel qi. The fluids are damaged and cannot moisten and nourish the channels normally.

To treat variations of wind-cold with Gui Zhi Tang, consider the following modifications:

For marked insufficiency of defense yang with prominent aversion to cold, increase the quantity of Gui Zhi and Gan Cao, or add Fu Zi (Aconiti Radix Lateralis Praeparata).

For incessant leaking sweat in cases of relatively severe defense qi vacuity, add Huang Qi (Astragali Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma).

For profuse sweating and a thin pulse from weakness of construction, increase the dose of Bai Shao and Gan Cao.

From a base of Gui Zhi Tang, several other important formulas can be created, such as Xiao Jian Zhong Tang (Minor Center-Fortifying Decoction), Huang Qi Jian Zhong Tang (Astragalus Center-Fortifying Decoction), Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction Plus Dragon Bone and Oyster Shell), and Ge Gen Tang (Pueraria Decoction).

Xiao Jian Zhong Tang (Minor Center-Fortifying Decoction)

Gui Zhi (Cinnamomi Ramulus)
Bai Shao (Paeoniae Radix Alba)
Da Zao (Jujubae Fructus)
Sheng Jiang (Zingiberis Rhizoma Recens)
Zhi Gan Cao (Glycyrrhizae Radix Praeparata)
Yi Tang (Maltosum)

The profound nature of Gui Zhi Tang is readily apparent because of the dramatic change in indications achieved by subtle modifications, in this case the simple addition of Yi Tang (Maltosum). While Gui Zhi Tang is a formula for external contraction, Xiao Jian Zhong Tang is a major formula for internal medicine. Specifically, Xiao Jian Zhong Tang is a representative formula for vacuity cold patterns of abdominal pain, among other indications.

Yi Tang is a sweet medicinal that supplements the center and “relaxes tension.” The action of “relaxing tension” (huan ji) only appears in three common items in the Chinese materia medica: Yi Tang, Bai Shao, and Gan Cao. All three of these medicinals are used together in the formula Xiao Jian Zhong Tang, which accounts for its profound ability to treat cramping pain in vacuity patterns. The warm nature of Gui Zhi allows the formula to be suitable for cold patterns, and the sweet, supplementing action of the other medicinals makes Xiao Jian Zhong Tang suitable for vacuity patterns.

For cases with more significant qi vacuity, Huang Qi (Astragali Radix) may be added to Xiao Jian Zhong Tang. This forms the formula Huang Qi Jian Zhong Tang (Astragalus Center-Fortifying Decoction), which is also an important formula for qi vacuity patterns of abdominal pain.

Ge Gen Tang (Pueraria Decoction)

Gui Zhi (Cinnamomi Ramulus)
Bai Shao (Paeoniae Radix Alba)
Da Zao (Jujubae Fructus)
Sheng Jiang (Zingiberis Rhizoma Recens)
Zhi Gan Cao (Glycyrrhizae Radix Praeparata)
Ge Gen (Puerariae Radix)
Ma Huang (Ephedrae Herba)

Ge Gen Tang is a major formula for common cold. In fact, it is the most commonly used OTC herbal formula in Japan for treating common cold. Ge Gen Tang can be formed from Gui Zhi Tang by simply adding Ma Huang and Ge Gen, and it combines the principles of both Ma Huang Tang (Ephedra Decoction) and Gui Zhi Tang. It is also sometimes used in Chinese medical traumatology to treat muscular pain of the upper back and neck (Gui Zhi Tang plus Ge Gen alone can be used here as well).

Ge Gen Tang promotes sweating and resolves the exterior, engenders liquid and soothes the channels. By combining Gui Zhi with Ma Huang, its ability to enhance sweating is accentuated. This makes it applicable for repletion patterns of wind-cold. The addition of Ge Gen also makes the formula suitable for treating stiff neck and diarrhea.

Ge Gen Tang has several main applications. It is indicated for greater yang (tai yang) disease with “stretched stiff nape and back,” absence of sweating, and aversion to wind. Stretched stiff nape and back refers to hypertonicity of the neck and back and discomfort when looking up and down, as if the neck were forcefully stretched, a condition that is considered more severe than simple stiffness and pain in the neck).

Ge Gen Tang is also used for greater yang (tai yang) and yang brightness (yang ming) combination disease, manifesting with diarrhea. The original text describes this as “spontaneous diarrhea,” meaning that it is diarrhea that occurs without any known natural or iatrogenic cause (such as inappropriate purging). This pattern is one of simultaneous disease in the interior and exterior, with the exterior aspect being the most significant.

Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction Plus Dragon Bone and Oyster Shell)

Gui Zhi (Cinnamomi Ramulus)
Bai Shao (Paeoniae Radix Alba)
Da Zao (Jujubae Fructus)
Sheng Jiang (Zingiberis Rhizoma Recens)
Zhi Gan Cao (Glycyrrhizae Radix Praeparata)
Long Gu (Mastodi Ossis Fossilia)
Mu Li (Ostreae Concha)

Gui Zhi Jia Long Gu Mu Li Tang is a formula that is created by adding Long Gu (Mastodi Ossis Fossilia) and Mu Li (Ostreae Concha) to Gui Zhi Tang. This formula harmonizes yin and yang, subdues with heavy settling and secures and astringes. This formula is based on the concept of harmonizing yin and yang that underlies most of the Gui Zhi Tang derivative formulas. Gui Zhi Jia Long Gu Mu Li Tang is particularly concerned with promoting interaction of the heart (fire) and kidney (water).
If yin depletion affects yang, there will be dual vacuity of yin and yang. Kidney and heart cannot interact; in men there will be seminal emission or seminal efflux, in women there is dreaming of intercourse with ghosts. There may be hypertonicity of the lesser abdomen, cold pain of the genitals, dizziness and loss of hair, spontaneous sweating or night sweating, heart palpitations and insomnia, pale red tongue with thin white fur, and a thin weak or thin slow pulse. Gui Zhi Jia Long Gu Mu Li Tang is indicated in such conditions.