by Bob Flaws

When the formulas for the Great Nature Classics line were chosen, we included most of the standard formulas that all Western practitioners know and use. However, we also added a few lesser known formulas that we have found to be indispensable in treating Westerners.  Over the next several weeks, I plan on writing a series of short articles on each of these formulas and why they are so useful in clinical practice.

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The first of these formulas I’d like to address is Wang Qing-ren’s famous Shen Tong Zhu Yu Tang (Body Pain Dispel Stasis Decoction). This formula comes from Wang’s 19th century classic, the Yi Lin Gai Cuo (Correcting the Errors in the Field of Medicine; available in translation from Blue Poppy) and is one of a number of Wang’s formulas which all contain the words zhu yu, dispel stasis, in their name. Wang is most famous for his emphasis on the treatment of blood stasis. In fact, our contemporary understanding of blood stasis is primarily based on Wang’s book. Wang’s key insight is that, “In enduring [i.e., chronic] diseases, [there is] lots of/mostly blood stasis.” In other words, no matter what may have been the initial precipitating disease causes, if a disease lingers and endures in the body, eventually it gives rise to blood stasis, and further, in order to cure that disease, one must primarily eliminate that blood stasis. This is exactly the rationale for Wang’s design and use of Shen Tong Zhu Yu Tang.

Rx:

Tao Ren (Semen Persicae)

Hong Hua (Flos Carthami)

Dang Gui (Radix Angelicae Sinensis)

Chuan Xiong (Rhizoma Chuanxiong)

Mo Yao (Myrrha)

Wu Ling Zhi (Faeces Trogopteri), chao (dry-fried)

Di Long (Pheretima)

Qin Jiao (Radix Gentianae Macrophyllae)

Qiang Huo (Rhizoma et Radix Notopterygii)

Xiang Fu (Rhizoma Cyperi)

Niu Xi (Radix Achyranthis Bidentatae)

Gan Cao (Radix et Rhizoma Glycyrrhizae)

Therapeutic principles: Moves the qi and quickens the blood, disinhibits the channels and frees the flow of the network vessels, dispels impediment (i.e., bi) and stops pain

Indications: Pain due to qi and blood stasis and stagnation blocking the channels and network vessels. This pain may be in in the shoulder, elbow, low back, and/or leg. It is characterized as being persistent and it may be worse at night. The words shen tong literally mean body pain but may also be translated as generalized pain. So this formula also treats generalized pain throughout the whole body. In other words, there may be more than a single site of pain. Further, this pain has typically not responded to prior treatment.

Formula rationale: Within this formula,Tao Ren, Hong Hua, Dang Gui, Chuan Xiong, and Niu Xi all quicken the blood and dispel stasis. However, Tao Ren, Dang Gui, and Niu Xi also nourish the blood and yin and, therefore, help prevent damage to the blood and yin by the quickening and attacking ingredients. This is important since long-term blood stasis prevents the engenderment of new blood and hence is commonly complicated by an element of blood vacuity. Xiang Fu rectifies the qi. It is included since the qi moves the blood. On the one hand, moving the qi helps quicken the blood. On the other, since the qi and blood move together, some element of qi stagnation usually complicates long-term blood stasis. Qin Jiao and Qiang Huo dispel wind, eliminate dampness, and free the flow of impediment. In Chinese, feng shi, wind dampness, can also be translated as rheumatic/rheumatism. In other words, these two ingredients are empirically specific for rheumatic joint pain. Qin Jiao targets joint pain in the lower body, while Qiang Huo targets joint pain in the upper body. Mo Yao, Wu Ling Zhi, and Di Long not only quicken the blood but enter and free the flow of the network vessels. A generation before Wang Qing-ren, Ye Tian-shi said, “New diseases are in the channels; enduring diseases enter the network vessels.” This means that typically the blood stasis associated with chronic, enduring diseases is located in the network vessels. In terms of Chinese medicine, this further means that one must use specific medicinals which enter and eliminate blood stasis from these vessels. Tao Ren, Hong, Hua, and Dang Gui all quicken the blood, but they are not especially good at entering the network vessels. In addition, Wu Ling Zhi and Mo Yao are empirically very effective for stopping pain. Finally, Gan Cao is in this formula in order to harmonize and balance all the other ingredients. What this really means is that it helps prevent any stomach discomfort from ingesting these medicinals.

While the standard textbook indications for this formula include bi zheng, impediment condition, and bi zheng in Chinese implies wind dampness, the emphasis in this formula is not on dispersing wind and eliminating dampness. It is on quickening the blood and freeing the flow of the network vessels. Although it does contain two wind-dampness-treating medicinals, these play a secondary role in this formula. In fact, that’s the special thing about this formula and how to use it. This formula is specifically for times when there is an obvious impediment condition but the normal wind dampness formulas and medicinals have not worked. This is because wind dampness has become complicated by blood stasis to the point that blood stasis is now the main disease mechanism at work and wind dampness is much less important. In clinical practice, this can be tricky. The patient may present all the usual signs and symptoms of wind damp impediment, and they may not present the obvious textbook signs and symptoms of blood stasis most beginners think of. In this case, it is simply the enduring nature of the condition and its failure to respond to wind-damp-eliminating treatment that indicates that blood stasis is the main disease mechanism. Don’t expect to feel a choppy pulse or see static spots or macules on the tongue. Don’t even expect to see a purple tongue. The pulse will probably simply be fine and bowstring or wiry.

Because so many of our patients come to us as caregivers of last resort (meaning that they’ve unsuccessfully tried a number of other modalities before trying acupuncture/Chinese medicine), many of our patients suffer from enduring, recalcitrant diseases. Further, since most Western patients initially think of acupuncture (and therefore Chinese medicine) as good for body pain, we see many, many patients with chronic, recalcitrant body pain. This is exactly what Wang Qing-ren designed this formula to treat, and 150 years of clinical use have documented this formula’s clinical efficacy. So, if you see lots of patients with impediment pain and you’re not currently using this formula, you need to try it. You and your patients will be happy that you did.

Copyright Blue Poppy Enterprises, Inc., 2011. All rights reserved.