With many patients who are athletes and martial artists, I am constantly encountering patterns of pain. Consequently, I keep a healthy amount of herbal patent medicines on hand that target various patterns of pain for acute injuries, chronic injuries, surgical recovery, etc.
You may have noticed that many companies share the same patent formula names, yet use different ingredients. Sometimes these are nuanced differences and other times drastic differences. While this may seem like a frustrating situation, it also has a benefit: it can often offer an expanded palette for clinical application to more efficiently target the pattern presentation of the individual patient.
As an example, let’s focus on a recent clinical experience using the patent medicine Jin Gu Die Shang Wan that illustrates how different companies produce different formulations with the same name – highlighting both the pros and cons of this issue.
A Clinical Example
Jin Gu Die Shang Wan is a modern patent medicine based upon the formula Qi Li San – originally an eight-ingredient formula from the “Collection for the Common Pursuit of Longevity” (1762 AD) belonging to the category of formulas that invigorate blood and dispel blood stagnation. The original formula consisted of xue ji, hong hua, mo yao, ru xiang, she xiang, bing pian, er cha, and zhu sha. Modern variations of this formula typically center around an elemental structure of tian qi, dang gui, ru xiang, mo yao, xue ji, hong hua, and xu duan.
This simple herbal formulation is highly effective at invigorating the blood, dispelling blood stasis, stopping pain, and stopping bleeding. Many herbal companies manufacture different variations of this formula under the name Jin Gu Die Shang Wan, often adding herbs to clear heat and move blood, and tonifying herbs to target the liver and kidneys.
The overall actions of Jin Gu Die Shang Wan are to invigorate blood, break blood stasis, tonify the blood, stop bleeding, strengthen the sinews and bones, open the channels and collaterals, and relieve pain. In my clinic, I stock three to four different versions of Jin Gu Die Shang Wan to have the option to more effectively target various specific nuanced aspects of pain and injuries.
I recently had a patient who was suffering from chronic back pain due to a lifetime of intense martial arts and a recent acute injury. He was scheduled to have surgery in eight months and was in physical pain as well as mental anguish due to having to wait a substantial amount of time for his requested surgical intervention.
I chose a version of Jin Gu Die Shang Wan (“Great Mender Teapills”) that contained a large formulation of herbs: 25 ingredients which heavily targeted blood stasis and pain issues, as well as deeply rejuvenating and nourishing the liver and kidneys.
The formula prescribed was a traditional tea pill format, dosed on the bottle at eight pills, three times a day. I increased the dose to 16 pills, three times a day due to the patient’s larger physique and severity of the pain.
After 10 days on the formula, the patient’s self-reported pain levels had dropped almost in half and he asked if he could increase the dose. At this point, I increased the dose to 20 pills, three times a day and after two more weeks on the formula, he had experienced a dramatic reduction in pain, improved sleep and in his words, “a calmer state of mind.”
I reduced the dose to 12 pills, three times a day and instructed him to stay on this dose up until 1-2 weeks before his surgery. Three months later, I received a call from the patient stating, “The formula does not seem to be working as well.” I asked the patient to come in for a check-up; during the visit he explained that his original formula had run out and he had “ordered the same formula online.”
This “new” formula was a version with the same name, from an extremely high-quality company, but with only seven ingredients. This particular version of Jin Gu Die Shang Wan was strictly focused on blood stagnation and had no ingredients to nourish the liver and kidneys.
I showed the patient the difference in the formulas and we easily phased him back onto the more complex version, which more strongly invigorated the blood and deeply nourished the liver and kidneys – and also (in TCM vernacular) “softened the ligaments and tendons.”
After two weeks back on the original prescription, the patient once again experienced a dramatic reduction in pain and was extremely relieved. After one month back on my originally prescribed Jin Gu Die Shang Wan, the patient stated that his pain was almost completely relieved and he felt confident that he could “go the distance until his surgery.”
Clinical Pearls
This is a simple case study, but it serves as a powerful example of how different versions of the same formula can potentially cause confusion. A simpler version of Jin Gu Die Shang Wan may be highly effective for an acute injury, but for a patient with underlying kidney and liver deficiency, a larger, more complex version was needed. Both versions are highly effective depending upon the particularly needs of the patient.
As a clinician, use these situations to educate patients on the unique concept of underlying patterns and allow them see the elegant and nuanced therapeutic vision of Chinese medicine.
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