Treating Musculoskeletal Disorders With Chinese Herbal Formulas - Part II: Chronic
By Jake Paul Fratkin, OMD, LAc
In my last article, Treating Musculoskeletal Disorders with Chinese Herbal Formulas: Part I, we focused on formulas for trauma and heat-bi syndromes. Now, I want to review important formulas for chronic bi syndrome.
"Bi" translates as painful-obstruction, and is applied to a variety of conditions affecting the musculoskeletal frame, including joints, muscles, bone and tendon. These conditions include chronic pain following injury, joint degeneration, or arthritis. (In Part III, the next and final installment, we will concentrate on back pain, sciatica and spinal degeneration.)
In Chinese medicine, bi syndrome includes stasis of qi and blood, and may be further differentiated by preponderance of damp, heat or cold. The etiology involves exogenous factors intruding on an underlying deficiency of qi, blood or yang. Formulas are sub-grouped into the following: wind-cold damp bi, blood stagnation bi, deficiency bi, cold bi, and heat bi.
Wind-cold-damp-bi, also called "wandering bi," is characterized by pain that moves around various locations, and is aggravated by damp weather. It is typical in arthritis, rheumatism and pain associated with aging, including joints, muscle and tendon. The accumulation of damp impedes the flow of qi and blood, causing muscular and joint numbness, pain, swelling or feelings of heaviness. The formulas use warming herbs to dispel wind-damp and invigorate blood flow.
Typical classical formulas include Juan Bi Tang and Shu Jing Huo Xue Tang. There are actually two classical formulas with the name Juan Bi Tang, and both are available in product form. The first, from 1178, is effective for chronic joint pain or sore muscles aggravated by wind-cold damp in patients with pre-existing deficiency of qi and blood. It is both warming and invigorating, containing herbs for moving blood and dispelling wind-damp, while boosting qi and blood.
The second version of Juan Bi Tang (1732) is useful for joint pain or sore muscles due to wind-cold-damp in patients with a recent onset, and more acute in nature. Lacking the qi and blood tonics of the first formula, above, this version more aggressively disperses wind and damp, while moving blood, dispersing cold and warming the channels. (Herbs commonly found in these formulas are listed in the footnotes.)
Shu Jing Huo Xue Tang is available from numerous sources. This large prescription from Gong Ting-Xian in 1587 addresses excess patterns of wind-damp bi syndrome complicated by underlying blood deficiency. Symptoms include joint pain, especially in the knees, as well as poor circulation or soreness in the muscles. While 36 percent of the formula may be considered to be addressing wind, cold and dampness, it also contains the blood-building formula Si Wu Tang as 28 percent of its composition.
Other herbal products are available that address wind-cold-damp bi syndrome.
BLOOD STAGNATION BI
Blood stagnation bi is characterized by more severe pain in the joints and muscles, with numbness and poor circulation. Pain tends to be constant and fixed in the same location, and include pain due to injury, surgery or degeneration. Locations include neck and spine, shoulder or hip pain. The tongue is dark and the pulse is choppy. The formulas use herbs that move qi and blood, and are a stronger in herbs that break blood stasis. They may be too invigorating in patients with marked deficiency, but are clinically useful in the elderly who suffer poor blood circulation. These formulas, in general, contain herbs that are prohibited during pregnancy, and prohibited when a patient is on pharmaceutical warfarin (Coumadin).
A representative classical formula that is available in product form is Shen Tong Zhu Yu Tang. Other formulas are also available. Typically, formulas combine herbs that dispel wind and dampness with blood moving herbs.
Deficiency bi formulas use herbs that move qi and invigorate blood, but also address underlying deficiencies by employing herbs that tonify qi, blood and/or yang. The pulse is weak, and may be floating or sunken. The formulas are beneficial in chronic and long-term presentations, and can also be used for numbness and tingling due to deficiency, as well as wei syndromes, which involve weakness to the point of flaccid paralysis.
Classical representative formulas vary in application. Bu Yang Huan Wu Tang addresses hemiplegia and flaccidity following stroke or spinal injury. It can also be used for numbness and tingling related to peripheral neuropathy. San Bi Tang was originally created for post-partum women contracting wind-cold-damp and developing rheumatism. It is commonly used for wind-dampness affecting patients with deficiency of qi and blood, and is more appropriate as patient age. Other formulas are also available.
Cold bi formulas include herbs that are warming and invigorating, and are particularly useful for painful limbs that are worse in cold weather. Classical formulas that are available as products include Dang Gui Si Ni Tang and Xiao Huo Lou Dan.
Dang Gui Si Ni Tang, a Shang Han Lun formula, treats cold and stiff hands and feet due to blood deficiency, or exogenous invasion of cold. It is useful for cold limbs and poor circulation due to blood deficiency, especially during or following menses.
Xiao Huo Lou Dan is used for, sequelae of stroke leading to hemiplegia, spasticity or flaccidity, numbness, etc., in the limbs. It can also be used for poor circulation aggravated by cold and damp, employing herbs that invigorate blood while warming the channels. It contains hot medicinals that dispel cold and dampness, and strong herbs to break blood stasis.
In the concluding article to this series, we will discuss formulas for back pain, sciatica and spinal degeneration.
Juan bi tang, "Remove Painful-Obstruction Decoction"; author: Yang Tan; source text, Yang Shi Jia Cang Fang, 1178, "Yang Family Depository (of) Formulas". It is available as Chianghuo & Turmeric Combination (extract granules); Notopterygium & Turmeric Combination (extract granules); Graceful Branches (Kan); and Juan Bi Tang (Herbal Times, Blue Poppy).
Juan bi tang, "Remove Painful-Obstruction Decoction"; author Cheng Guo-Peng; source text Yi Xue Xin Wu, 1732, "Medical Studies Mind Awakening". It is available as Clear Channels Teapills (Plum Flower) and Juan Bi Formula (Golden Flower).
Commonly used herbs for wind or wind-damp include du huo (Radix Angelicae Pubescentis); fang feng (Radix Saposhnikoviae/Ledebouriellae); and qiang huo (Radix Notopterygii).
Commonly used herbs for blood stagnation include chi shao (Radix Paeoniae Rubra); chuan niu xi (Radix Cyathulae); chuan xiong (Rhizoma Ligustici Chuanxiong); dan shen (Radix/Rhiz. Salviae Miltiorrhizae); hong hua (Flos Carthami); ji xue teng (Caulis Spatholobi/Millettiae); jiang huang (Rhizoma Curcumae Longae); mo yao (Myrrha); ru xiang (Olibanum); tao ren (Semen Persicae); xue jie (Sanguis Draconis); and yan hu suo (Rhizoma Corydalis). Herbs for warming the channels include gui zhi (Ramulus Cinnamomi); hai feng teng (Caulis Piperis Kadsurae); cao wu (Radix Aconiti Kusnezoffii; and chuan wu (Radix Aconiti).
Shu jinhuo xue tang ("Dredge Channels, Invigorate Blood Decoction". Author, Gong Ting-Xian; source text, Wan Bing Hui Chun, 1587, "Thousand Diseases Restored to Life (Returned to Spring)". Available as Clematis & Stephania Combination (extract granules); Course and Quicken Formula (Golden Flower); Mobility 2 (Health Concerns); and Shu Jing Huo Xue Wan (Herbal Times). The Herbal Times version changes the original formula by removing tao ren, wei ling xian, and fang, and adding du huo and ji xue teng.
Si Wu Tang, "Four Substance Decoction". Author, Lin (dao ren, Daoist priest). Source text, Xian Shou Li Shang Xu Duan Mi Fang, 846, "Immortal Teaching (to) Manage Injury, Reconnect Fractures, Secret Formulas".
The following formulas address wind-cold-damp bi syndrome: AC-Q (Health Concerns); Chase Wind, Penetrate Bone Formula (Golden Flower); Chiang-Huo 13 (Seven Forest); Drynaria 12 (Seven Forest); Flex-CD (Evergreen); Meridian Comfort (Kan); and Mobility 3 (Health Concerns).
Shen tong zhu yu tang, "Body Pain Expel Stasis Decoction". Author, Wang Qing-ren; source text, Yi Lin Gai Cuo, 1830, "Physicians’ Circle, Correction (of) Errors". Available in product form as Cnidium & Notopterygium Combination or Ligusticum & Notopterygium Combination (extract granules); Great Invigorator Teapills (Plum Flower); Meridian Passage (Kan); Shen Tong Zhu Yu Wan (Herbal Times); and Sappan 12 (Seven Forest).
Other formulas that address blood-stasis bi include Bone & Sinew Formula (Golden Flower); Channel Flow (Health Concerns); Feng Shi Xiao Tong Wan (Tanglong); and Invigorate The Collaterals (Kan).
See herb list, footnote 3, above.
Bu yang huan wu tang, "Tonify Yang, Return Five (50%) Decoction". Author, Wang Qing-ren; source text, Yi Lin Gai Cuo, 1830, "Physicians Circle Correction (of) Errors". It is available as Astragalus & Peony Combination (extract granule); Bu Yang Huan Wu Tang (Blue Poppy); Bu Yang Huan Wu Wan (Herbal Times, Tanglong); and Great Yang Restoration Teapills (Plum Flower).
San bi tang, "Three Painful-Obstruction Decoction". Author, Chen Zi-Ming; source text, Fu Ren Liang Fang, "Women’s Fine Formulas", 1237. Available as San Bi Tang Teapills (Plum Flower) and Tuhuo & Astragalus Combination (extract granule).
Other formulas and products for deficiency bi syndrome include Major Siler Combination (extract granule); Acanthopanax 10 (Seven Forest); Chui Feng Tou Gu Wan (Plum Flower); Mobility 3 (Health Concerns) and Sea-Q (Health Concerns).
Dang gui si ni tang, "Angelica Dang Gui, Four (Limb) Counterflow Decoction". Author, Zhang Zhong-Jing; source text, Shang Han Lun, "Injury (by) Cold, Discussion", 220. Available as Dang Gui Si Ni Teapills (Plum Flower); Dang Gui Si Ni Wan (Herbal Times); and Tangkuei & Jujube Combination (extract granule).
Xiao huo luo dan, "Minor Invigorate Luo Channel Elixir". Author, Chen Shi-Wen (1080); source text, Tai Ping Hui Min He Ji Ju Fang, 1107, 1148 and 1151, "(Era of) Great Peace, Benefit People Harmonious Medicines, Office (of) Formulas". It is available as Myrrh & Aconite Formula (extract granule); Xiao Huo Luo Dan Teapills (Plum Flower); and Xiao Huo Luo Wan (Herbal Times)
See footnote 3, above.
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