Evils Have Entered the Channels
Wáng Xùgāo’s Treatment of Pain
I’ve been doing research on treating pain with Chinese herbal medicine, a subject about which I have posted a few times, such as here and here. Another ongoing project has been translating the Yī Xué Chú Yán (Medical Ruminations) by Wáng Xùgāo (王旭高, 1798-1862). You can read earlier sections here and here. So, this week, the two projects have merged, and I present to you my annotated working (read, rough) translation of chapter 15. As usual, the source text and translation are in block quotes and my comments and annotations are in brackets throughout.
第十五章 痛風、痹、腰痛
Chapter 15 Painful Wind, Impediment, Lumbar Pain
痛風 痛風，肢節走痛也，不外風寒濕三氣所致。痛風頭痛惡寒發熱者，宜溫散，如五積散（五積散：白芷、川芎、甘草、茯苓、當歸、肉桂、白芍、半夏各三兩，橘皮、枳殼、麻黃各六兩，蒼朮二十四兩，乾薑四兩，桔梗十二兩，厚朴四兩。為粗末，每服三錢，加姜煎服。功能解表散寒，溫中消積。《太平惠民和劑局方》方。）之類。
Painful wind
Painful wind is pain moving through the limbs and joints, it is caused by nothing more than the three qì of wind, cold and dampness. In cases of painful wind with headache, aversion to cold, and heat effusion, warm scattering is appropriate, use Wǔ Jī Sǎn [Five Accumulations Powder] (Wǔ Jī Sǎn: Bái Zhǐ [Rx Angelicae Dahuricae], Chuān Xiōng [Rx Ligusticum Chuanxiong], Gān Cǎo [Rx Glycyrrhizae], Fú Líng [Poria], Dāng Guī [Rx Angelicae Sinensis], Ròu Guì [Cx Cinnamomi], Bái Sháo [Rx Paeoniae Alba], Bàn Xià [Rz Pinelliae] each 3 liǎng; Jú Pí [Pc Citri Reticulatae], Zhǐ Ké [Fr Aurantii], Má Huáng [Hb Ephedrae] each 6 liǎng; Cāng Zhú [Rz Atractylodis] 24 liǎng; Gán Jiāng [Rz Zingiberis] 4 liǎng; Jié Gěng [Rx Platycodi] 12 liǎng; Hòu Pò [Cx Magnoliae] 4 liǎng. Grind to a coarse powder, 3 qián each dose; add Jiāng (Rz Zingiberis Recens), decoct and take. Its function is to resolve the exterior and scatter cold, warm the center and disperse accumulation. It is a prescription from the Tàipíng Huì Mín Hé Jì Jú Fāng.) and the like.
[Wǔ Jī Sǎn is not a formula that leaps to my mind in treating pain, or really anything else, for that matter. It is listed in Scheid et al (2009) under “Formulas that Release Exterior-Interior Excess.” It is indicated for exterior cold with interior accumulation of cold, dampness, phlegm, qi, and blood – the five accumulations of the name. It is a complex formula, with elements of different prescriptions:
· Píng Wèi Sǎn: Cāng Zhú, Hòu Pò, Jú Pí, Gān Cǎo, to dry dampness in the middle burner;
· Èr Chén Tāng: Bàn Xià, Fú Líng, Jú Pí, Gān Cǎo, to transform phlegm and regulate qì;
· Sì Wù Tāng: Chuān Xiōng, Dāng Guī, Bái Sháo, to nourish and quicken blood;
and three two-herb combinations:
· Má Huáng and Bái Zhǐ to warm the exterior and scatter cold;
· Ròu Guì and Gán Jiāng to warm the interior and expel cold;
· Jié Gěng and Zhǐ Ké to regulate the qì dynamic of ascending and descending.
It is produced in a granule version, Tang-kuei and Magnolia Combination, but does not appear readily available in the U.S.A. ]
輕者宜防風、當歸、秦艽、羌活、獨活、桂枝、片薑黃、牛膝、川斷、桑枝。
In less severe cases, Fáng Fēng [Rx Ledebouriellae], Dāng Guī, Qín Jiāo [Rx Gentianae Macrophyllae], Qiāng Huó [Rx Notopterygii], Dú Huó [Rx Angelicae Pubescentis], Guì Zhī [Rm Cinnamomi], sliced Jiāng Huáng [Rz Curcumae Longae], Niú Xī [Rx Achyranthis], Chuān Duàn [Rx Dipsaci Sichuanensis], Sāng Zhī [Rm Mori] are appropriate.
[More straightforward combinations here, involving warm acrid wind-cold and wind-damp medicinals, along with herbs to quicken blood as well as strengthen sinew and bone.]
痛而夜重者，屬血分，四物湯加黃耆、防風、桂枝、秦艽、紅花、桑枝、炙草；如痛久不愈，宜大補氣血，十全大補湯加虎骨、桑寄生、附子、防風、薑汁、竹瀝；
Cases of pain that are more severe at night are in the blood aspect [xuè fēn] category. Use Sì Wù Tāng [Four Substances Decoction], and add Huáng Qí [Rx Astragali], Fáng Fēng, Guì Zhī, Qín Jiāo, Hóng Huā [Fl Carthami], Sāng Zhī, Zhì Cǎo [Rx Glycyrrhizae Praeparata]; if the pain is chronic and does not resolve, it is appropriate to powerfully supplement qi and blood, use Shí Quán Dà Bǔ Tāng [Ten Complete Great Supplementation Decoction] and add Hǔ Gǔ [Os Tigris], Sāng Jì Shēng [Rm Taxilli], Fù Zǐ [Rx Aconiti Lateralis Praeparata], Fáng Fēng, Jiāng Zhī [Succus Zingiberis], Zhú Lì [Succus Bambusae];
[By the time they reach our clinics, chronic pain cases are often a mix of excess and deficiency. It is important to pay attention to restoring the upright qì and/or nourishing blood, especially when using acrid, dispersing medicinals like wind-cold and wind-damp herbs.]
溫補不效者，邪入經絡也，方中加金銀藤、木通、紅花、鉤藤、刺蒺藜、羚羊角；又久痛則鬱，鬱則生熱，熱則生痰，必加制南星、半夏、瓜蔞根、黃柏、貝母、竹瀝、薑汁；或桑寄生、虎骨。
In cases where warm supplementation is ineffective, evils have entered the channels and network vessels, so add to the prescription Jīn Yín Téng [Caulis Lonicerae], Mù Tōng [Caulis Akebiae], Hóng Huā, Gōu Téng [Rm Uncariae], Cì Jí Lí [Fr Tribuli], Líng Yáng Jiǎo [Cornus Saigae Tataricae]; also chronic pain will result from depression, depression will engender heat, and heat will engender phlegm. It is necessary to add Zhì Nán Xīng [Rz Arisaematis Praeparata], Bàn Xià, Guā Lóu Gēn [Rx Trichosanthis], Huáng Bǎi [Cx Phellodendri], Bèi Mǔ [Bulbus Fritillariae], Zhú Lì, Jiāng Zhī; or perhaps Sāng Jì Shēng and Hǔ Gǔ.
[Medicinal substance examples here include channel-unblocking herbs, wind-extinguishing antispasmodics, heat-clearing, blood-moving and phlegm-resolving, the latter of which I think helps to clear out all the stuck intercellular goo that complicates a lot of chronic muscle pain cases.]
久服辛溫藥不效，宜玉竹、黑芝麻、黃耆、甘草、阿膠、蒺藜、甘菊、歸鬚、姜蠶，乃柔肝熄風也。
If prolonged taking of acrid warm medicinals is ineffective, it is appropriate to use Yù Zhú [Rz Polygonati Odorati], Hēi Zhī Ma [Sm Sesami], Huáng Qí, Gān Cǎo, Ē Jiāo [Colla Corii Asini], Jí Lí, Gān Jú [Fl Chrysanthemi], Guī Xū [Rx Tenuis Angelicae Sinensis], and Jiāng Cán [Bombyx Batryticatus] so as to emolliate the liver and extinguish wind.
[As above, yīn-blood dissipation is a big concern in treating chronic wind-damp. When there is not enough blood to keep the network vessels filled and the sinews moist, then wind exploits the opportunity, moves in and engenders twitching and spasm.]
痹 痹證與痛風相似，痹則著而不行，風則走痛無定。《內經》云：風勝為行痹，即痛風也；寒勝為痛痹；濕勝為著痹。是則痹證屬寒濕也。治法不外溫通以祛寒濕，宜五積散、黃耆桂枝五物湯。
Impediment (Bì)
Impediment (bì) patterns and painful wind are similar to one another. Impediment causes affliction but does not move, wind results in moving pain that is not fixed [in location]. Inner Canon says: Prevailing wind causes moving impediment, meaning painful wind; prevailing cold causes painful impediment; prevailing dampness causes fixed impediment. Thus impediment patterns are categorized as cold and dampness. The treatment method is nothing more than to warm and free so as to dispel cold and dampness; it is appropriate to use Wǔ Jī Sǎn, or Huáng Qí Guì Zhī Wǔ Wù Tāng [Astragalus and Cinnamon Twig Five Substances Decoction].
[Huáng Qí Guì Zhī Wǔ Wù Tāng is a variation of Guì Zhī Tāng with Huáng Qí added.]
腰痛 暴痛實者，宜溫散，如羌活、秦艽、桂枝、白朮、杜仲、當歸、乾薑、茯苓、防風。腰久痛虛者，宜補腎，六味丸或八味丸加鹿角膠、霜、杜仲、牛膝、補骨脂。瘀傷腰痛，痛如刺，輕者鹿角磨沖酒服；重者桃仁承氣湯。腰重痛者，濕也，苓薑朮桂湯。
陳修園（陳修園：陳念祖，字修園，清代醫家。）治腰痛久不愈，用白朮一兩為主，佐牛膝、淫羊藿；若火虛者，加附子、當歸、肉桂、杜仲；或加乾薑，治寒濕；或加苡仁，治濕者夾熱，據云神效。
旭高治一腰痛，其人咳嗽，大便秘，或時痛甚不可行動，諸藥不效，用滾痰丸而愈。是痰亦有腰痛者。
Lumbar pain
In cases of acute pain from repletion, it is appropriate to warm and scatter, such as with Qiāng Huó, Qín Jiāo, Guì Zhī, Bái Zhú [Rz Atractylodis Macrocephalae], Dù Zhòng [Cx Eucommiae], Dāng Guī, Gán Jiāng, Fú Líng, Fáng Fēng. In cases of chronic lumbar pain from deficiency, it is appropriate to supplement the kidney, use Liù Wèi Wán [Six-Ingredient Rehmannia Pill] or Bā Wèi Wán [Eight Ingredient Rehmannia pill] adding Lù Jiǎo Jiāo [Cornu Cervi Gelatinum], [Lù Jiǎo] Shuāng [Cornu Cervi Degelatinatum], Dù Zhòng, Niú Xī, Bǔ Gǔ Zhī [Fr Psoraleae]. Stasis injury lumbar pain, with stabbing pain, in mild cases, grind Lù Jiǎo [Cornu Cervi], drench in wine and take; in severe cases use Táo Rén Chéng Qì Tāng [Persica Seed Order the Qì Decoction] .
Cases with aching lumbar pain are dampness, use Líng Jiāng Zhú Guì Tāng [Poria, Ginger, Atractylodes And Cinnamon Decoction].
Chén Xiūyuán (Chén Niànzǔ, courtesy name Xiūyuán, Qīng era physician): To treat chronic unresolving lumbar pain use Bái Zhú 1 liǎng as chief; assisted by Niú Xī, and Yín Yáng Huò [Hb Epimedii]; in cases where [life gate] fire is deficient, add Fù Zǐ, Dāng Guī, Ròu Guì, Dù Zhòng; or add Gan Jiāng to treat cold-dampness; or add Yǐ Rén [Sm Coicis], in cases of dampness mixed with heat, it is said this has a miraculous effect.
Xùgāo treated one case of lumbar pain, the person had a cough, and fecal block, at times the pain was such they could not move. Various medicinals were ineffective, so Gǔn Tán Wán [Vaporize Phlegm Pill] was used and the patient recovered. Lumbar pain cases can also involve phlegm.
[Typically when we think of back pain with underlying deficiency, we reach for Dú Huò Jì Shēng Tāng, which is not mentioned by name in this chapter. The influence of warm supplementation strategies from the Míng period are very much in evidence here. Anyway, that’s all for now. As always, thanks for reading.]
Note: this newsletter is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Scheid, V., Bensky, D., Ellis, A., & Barolet, R. (2009). Chinese herbal medicine: Formulas & strategies (2nd ed.). Eastland Press.
Wáng, X. (1862). Yī xué chú yán. https://jicheng.tw/tcm/book/%E9%86%AB%E5%AD%B8%E8%8A%BB%E8%A8%80/index.html
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