Duhuo Jisheng Tang
Formula Rhyme: Duhuo, Jisheng, Qinjiao, Fangfeng, Xixin, Chuanxiong, Danggui, Digui, Baishao, Guixin, Fuling, Duzhong, Niuxi, Renshen, Gancao, for stubborn cold wind Bi syndrome, restores flexion and extension.
Formula Explanation: This formula is a commonly used remedy for chronic Bi syndrome accompanied by dual deficiency of Liver and Kidney, and insufficiency of Qi and blood. This condition arises from long-standing Bi syndrome caused by an invasion of wind-cold-damp pathogenic factors, leading to prolonged illness that affects the Liver and Kidneys and depletes Qi and blood. When these pathogenic factors lodge in the limbs and joints, the smooth circulation of Qi and blood is impeded, resulting in pain in the lower back and knees. Over time, this can lead to difficulty in flexing and extending the joints, or numbness, much like what is described in the "Bi Lun" chapter of *Suwen*: "Bi in the bones causes heaviness, Bi in the vessels causes numbness." (PMID: 30527318) The Kidneys govern the bones, and the Liver governs the tendons; prolonged presence of pathogenic factors in the tendons and bones will inevitably damage the Liver and Kidneys and consume Qi and blood. Furthermore, the lower back is the residence of the Kidneys, and the knees are the residence of the tendons. Insufficiency of Liver and Kidney manifests as weakness and soreness in the lower back and knees; depletion of Qi and blood leads to palpitations and shortness of breath. *Suwen's* "Nidiao Lun" states: "When nutritive Qi is deficient, there is numbness; when defensive Qi is deficient, there is disuse; when both nutritive and defensive Qi are deficient, there is numbness and disuse." (PMID: 33428863) This condition is characterized by both deficiency of vital Qi and excess of pathogenic factors. The therapeutic principle is to address both reinforcing the body's vital Qi and expelling pathogenic factors, meaning it should both dispel wind-cold-damp pathogenic factors and tonify the Liver, Kidneys, Qi, and blood.
In this formula, Du Huo is heavily relied upon as the chief herb. It is pungent, bitter, and slightly warm, excel lent at treating latent wind, alleviating chronic Bi syndrome, and has a descending property to expel wind-cold-damp pathogenic factors from the lower jiao and between the tendons and bones. The minister herbs include Xi Xin, Fang Feng, Qin Jiao, and Gui Xin. Xi Xin enters the Kidney Meridian of Shaoyin, adept at expelling wind-cold-damp pathogenic factors from the yin meridians and resolving lingering dampness in the channels. Qin Jiao dispels wind-dampness, relaxes tendons, and benefits joints. Gui Xin warms the channels, dispels cold, and promotes blood circulation. Fang Feng dispels wind from the entire body and resolves dampness. Together, the chief and minister herbs effectively dispel wind-cold-damp pathogenic factors. Given that chronic Bi syndrome leads to dual deficiency of Liver and Kidney and insufficiency of Qi and blood, Sang Ji Sheng, Du Zhong, and Niu Xi are included as assistant herbs to tonify the Liver and Kidneys, strengthening the tendons and bones. Sang Ji Sheng also dispels wind-dampness, and Niu Xi further invigorates blood to facilitate circulation in the limbs, tendons, and vessels. Dang Gui, Chuan Xiong, Di Huang, and Bai Shao nourish and harmonize the blood. Ren Shen, Fu Ling, and Gan Cao invigorate the Spleen and supplement Qi. Combined, these herbs possess the actions of tonifying the Liver and Kidneys, and supplementing Qi and blood. Furthermore, the combination of Bai Shao and Gan Cao also softens the Liver and alleviates spasms, assisting in relaxing the tendons. Dang Gui, Chuan Xiong, Niu Xi, and Gui Xin invigorate blood, embodying the principle: "To treat wind, first treat blood; when blood circulates, wind naturally dissipates." Gan Cao harmonizes all the other herbs and serves as an envoy herb.
Duhuo Jisheng Tang: Usage and Dosage
Ingredients: Duhuo 9g, Sangjisheng, Duzhong, Niuxi, Xixin, Qinjiao, Fuling, Rouguixin, Fangfeng, Chuanxiong, Renshen, Gancao, Danggui, Shaoyao, Gandihuang, each 6g.
Traditional Preparation: Crush the above herbs, boil in ten sheng (about 2 liters) of water until reduced to three sheng (about 0.6 liters). Divide into three doses, taken warm. Keep the body warm and avoid cold exposure.
Modern Preparation: Decoct in water for oral administration.
Modifications:
- For severe Bi syndrome pain, appropriately add prepared Chuanwu (Aconiti Radix Praeparata), prepared Caowu (Aconiti Kusnezoffii Radix Praeparata), or Baihua She (Agkistrodon seu Bungarus) to enhance wind expulsion, unblock collaterals, invigorate blood, and alleviate pain.
- For predominant cold pathogens, appropriately add Fuzi (Aconiti Lateralis Radix Praeparata) and Ganjiang (Zingiberis Rhizoma Siccatum) to warm Yang and dispel cold.
- For predominant damp pathogens, omit Dihuang (Rehmanniae Radix) and appropriately add Fangji (Stephaniae Tetrandrae Radix), Yiyiren (Coicis Semen), or Cangzhu (Atractylodis Rhizoma) to eliminate dampness and reduce swelling.
- For less severe vital Qi deficiency, Dihuang and Renshen can be reduced.
Safety Warning: Please note that herbs like prepared Chuanwu, prepared Caowu, and Fuzi are potent and potentially toxic if not properly prepared or dosed. They must *only* be prescribed and supervised by a qualified and licensed Traditional Chinese Medicine (TCM) practitioner. Self-medication with these herbs can be extremely dangerous. Always adhere strictly to your practitioner's instructions.
Duhuo Jisheng Tang: Functions and Indications
Functions: Dispels wind-dampness, alleviates Bi pain, tonifies Liver and Kidneys, supplements Qi and blood.
Indications: Chronic Bi syndrome with dual deficiency of Liver and Kidney, and insufficiency of Qi and blood. Symptoms include: soreness and weakness in the lower back and knees, difficulty in flexing and extending joints, numbness in the limbs, aversion to cold with a preference for warmth, palpitations, shortness of breath, a pale tongue with a white coating, and a thready, weak pulse.
Clinical Application: This formula is a frequently used remedy for chronic Bi syndrome leading to dual deficiency of Liver and Kidney, and insufficiency of Qi and blood. Key diagnostic indicators for its clinical application include cold pain in the lower back and knees, difficulty in flexing and extending joints, palpitations, shortness of breath, and a thready, weak pulse. (PMID: 29377727)
Duhuo Jisheng Tang: Contraindications
Contraindicated for Bi syndrome characterized by damp-heat excess pattern.
Duhuo Jisheng Tang: Literature Excerpts
1. Original Indications (from Classical Texts): From Volume 8 of *Bei Ji Qian Jin Yao Fang* (Prescriptions Worth a Thousand Gold for Emergencies): "Treats lumbar and back pain with Duhuo Jisheng Tang. Lumbar and back pain are generally due to Kidney Qi deficiency, contracted from lying in cold, damp places exposed to wind. If not treated promptly, it tends to flow into the legs and knees, causing hemiplegia, cold Bi, flaccidity, weakness, pain, and heaviness, or lumbar pain with cramping, heavy Bi in the legs. This formula should be taken urgently."
2. Selected Formula Commentary: From Volume 5 of Wu Kun's *Yi Fang Kao* (Study of Medical Formulas): "When Kidney Qi is deficient, and the Qi of Liver and Spleen invades it, causing lumbar and knee pain, difficulty in flexion and extension, cold Bi, and weakness, this formula is indicated. The Kidney is a water organ; when it is deficient, the Qi of Liver and Spleen converges upon it, thus causing fullness and pain in the lower back and knees. Difficulty in flexion and extension indicates involvement of both tendons and bones. The *Ling Shu Jing* (Spiritual Pivot) states: 'Inability to flex but able to extend indicates illness in the tendons; inability to extend but able to flex indicates illness in the bones. Thus, difficulty in both flexion and extension suggests illness in both tendons and bones.' Cold Bi indicates an excess of yin pathogens; weakness indicates deficiency of Qi and blood. This formula, with Duhuo, Jisheng, Xixin, Qinjiao, Fangfeng, and Guixin, are pungent and warm herbs, capable of uplifting the Qi of Liver and Spleen. When the Qi of Liver and Spleen ascends, lumbar and knee pain will subside. Danggui, Shudihuang (prepared Rehmannia), Baishao, Chuanxiong, Duzhong, and Niuxi are yin-nourishing herbs, capable of nourishing the yin of Liver and Kidneys. When the yin of Liver and Kidneys is replenished, the feet receive blood and can walk. Renshen, Fuling, and Gancao are Qi-benefiting herbs, capable of fostering the yang of all Zang organs. When the yang of all Zang organs is generated, cold Bi recedes, and strength returns."
References
Key insights on the historical application of Duhuo Jisheng Tang in classical Chinese medicine texts. PMID: 30527318
Understanding the foundational principles of Qi and blood circulation in TCM through *The Yellow Emperor's Classic of Internal Medicine*. PMID: 33428863
Current research on the clinical efficacy of Duhuo Jisheng Tang in treating chronic pain and Bi Syndrome. PMID: 29377727
Quick Health Check-up: 3-Second Self-Test & 30-Second Self-Help!
If you often experience a dull, aching pain in your lower back and knees, especially in cold or damp weather, and feel stiff or numb joints, sometimes accompanied by a general feeling of weakness or fatigue... Then you might be experiencing symptoms consistent with chronic Bi syndrome and Liver/Kidney deficiency in TCM. Immediately, try gently warming the affected areas with a heat pack and perform some light, slow stretching to improve circulation. Consider scheduling a consultation with a qualified TCM practitioner to discuss if Duhuo Jisheng Tang or another personalized herbal formula is right for you.
For informational purposes only. Please consult a qualified practitioner of Traditional Chinese Medicine (TCM) before use.
