by Zhang Qi¹

Translated by Dan Bensky

Painful Obstruction Formula Number One

Radix Angelicae Pubescentis (du huo) 15g

Radix Gentianae Qinjiao (qin jiao) 15g

Radix Ledebouriellae Divaricatae (fang feng) 15g

Radix Ligustici Chuanxiong (chuan xiong) 15g

Radix Angelicae Sinensis (dang gui) 15g

Radix Rehmanniae Glutinosae Conquitae (shu di huang) 20g

Radix Paeoniae Lactiflorae (bai shao) 20g

Ramulus Cinnamomi Cassiae (gui zhi) 15g

Radix Codonopsitis Pilosulae (dang shen) 20g

Radix Astragali Membranacei (huang qi) 30g

Radix Achyranthis Bidentatae (niu xi) 15g

This method is suitable to treat painful obstruction in patients with exhaustion of both the Liver and Kidneys and insufficiency of the qi and blood who are invaded by external wind-cold-damp pathogenic influences. The presentation includes cold and painful lower back and knees, difficulty in flexing and extending the joints, and aversion to cold with attraction to heat. In some cases the limbs and joints will be aching, numb, painful while also feeling heavy. The tongue is pale and the pulse is submerged and frail (ruo) or submerged and thin (xi).

The Liver focuses on the sinews and the Kidneys focus on the bones. Both of these structures rely on the lubricating and nourishing actions of the qi and blood. When the qi and blood are insufficient then these structures lose that nourishment and external pathogenic influences take advantage of the deficiency to invade.

In treating this problem, tonification of the Liver and Kidneys along with augmentation of the qi and blood are primary. This is done here by using Radix Achyranthis Bidentatae (niu xi) along with a modification of Sage-like Healing Decoction (sheng yu tang). Radix Angelicae Pubescentis (du huo), Radix Gentianae Qinjiao (qin jiao), and Radix Ledebouriellae Divaricatae (fang feng) are added to expel wind and overcome dampness, and Ramulus Cinnamomi Cassiae (gui zhi) to warm and unblock the blood and vessels. All together this makes a prescription that both supports the normal and expels the pathogenic.

This formula is often effective in treating postpartum sore and painful joints with numbness, parasthesias, and weakness. This is because after giving birth a woman's qi and blood are insufficient, her vessels are empty and deficient, so external pathogenic influences can easily take advantage of the deficiency to invade. The clinical manifestations are sore, numb, and painful limbs and joints, with a sense of heaviness. At this time if practitioners only focus on expelling the pathogenic and do not know about supporting the normal, they will only use herbs that expel wind, cold, and dampness. Not only will they be unable to expel the pathogenic influences, but the more herbs the patients take, the more defcient they will become. Failures will be very numerous.

It is necessary to take the patient's general state into account. The practitioner must adjust the relationships between external and internal, as well as those between the normal qi and the pathogenic influences. This formula focuses on supporting the normal and secondarily expels the pathogenic. After taking it patients will feel a general increase in energy and, following that a decrease in the soreness and pain. If they continue taking it, the problem will get completely better.

Painful Obstruction Formula Number Two

Radix Gentianae Qinjiao (qin jiao) 15g

Gypsum(shi gao) 40g

Radix et Rhizoma Notopterygii (qiang huo) 10g

Radix Angelicae Pubescentis (du huo) 10g

Radix Scutellariae Baicalensis (huang qin) 10g

Radix Ledebouriellae Divaricatae (fang feng) 10g

Radix Rehmanniae Glutinosae (sheng di huang) 20g

Radix Angelicae Sinensis (dang gui) 15g

Radix Ligustici Chuanxiong (chuan xiong) 15g

Radix Paeoniae Rubrae (chi shao) 15g

Radix Angelicae Dahuricae (bai zhi) 15g

Herba cum Radice Asari (xi xin) 5g

Rhizoma Atractylodis (cang zhu) 15g

This formula is suitable for cases where wind-damp-cold painful obstruction is accompanied by interior heat.

Radix Gentianae Qinjiao (qin jiao), Radix et Rhizoma Notopterygii (qiang huo), Radix Angelicae Pubescentis (du huo), Radix Ledebouriellae Divaricatae (fang feng), Radix Angelicae Dahuricae (bai zhi), and Herba cum Radice Asari (xi xin) disperse and scatter wind from the various channels. Four-Substance Decoction (si wu tang) nourishes the blood and harmonizes the nutritive qi. Rhizoma Atractylodis (cang zhu) dries dampness. Gypsum(shi gao) and Radix Scutellariae Baicalensis (huang qin) clear heat. Internally there is clearing of heat while externally there is dispersion. In this way the wind-heat pathogenic influences is naturally released.

This pattern is not the same as hot painful obstruction and must not be confused with it. In hot painful obstruction the local area is red, swollen, and hot to the touch. In this problem externally there is an invasion of wind-cold-damp pathogenic influences; internally there is a collection of pathogenic heat. The local area is neither red nor swollen. In fact, a general look at these patients would reveal no differences between them and patients with wind-cold painful obstruction. However their tongue body is red with a dry white coating, the urine is dark, the stool dry, and the pulse slippery or rapid.

Therefore they have internal heat. Externally there is wind and internally there is heat. The wind and heat contend with each other resulting in very severe pain in the limbs. As there are no heat signs externally, it is easy to misdiagnose these patients as having wind-cold-dampness and treat them with prescriptions that expel wind-cold-dampness. As this would be using hot substances to treat a hot condition, the pain will get even more severe. This type of mistake is common.

If this type of painful obstruction is treated by using this formula to disperse wind and clear heat, you will get good results. If the stool is dry, Radix et Rhizoma Rhei (da huang) can be added to drain the heat. I once treated a young women who developed this condition soon after giving birth. She was cold throughout her body, had numbness and paresthesias, and intensely penetrating pain. She felt a stifling blockage in the epigastrium with a sense of movement upwards and she also had dizziness, distention, and pain in the head. She had been treated with over a hundred prescriptions of wind-expelling herbs without effect. On examination her tongue was red with a white, greasy coating, the pulse was floating, slippery, and slightly rapid, and the urine was dark. The diagnosis was internal heat with external wind. The wind pathogenic influence and the heat ascended and descended as they penetrated throughout the body resulting in the above presentation. I used this formula to disperse wind, nourish blood, and clear heat with the addition of 10g of Radix et Rhizoma Rhei (da huang) to drain out heat and open up areas of constraint. After six packages the disease was over halfway gone. I continued using this formula with the addition of blood-invigorating substances until she was all better.

Painful Obstruction Formula Number Three

Radix Cyathulae Officinalis (chuan niu xi) 15g

Lumbricus (di long) 15g

Radix et Rhizoma Notopterygii (qiang huo) 15g

Radix Gentianae Qinjiao (qin jiao) 15g

Rhizoma Cyperi Rotundi (xiang fu) 15g

Radix Angelicae Sinensis (dang gui) 15g

Radix Ligustici Chuanxiong (chuan xiong) 10g

Rhizoma Atractylodis (cang zhu) 15g

Cortex Phellodendri (huang bai) 15g

Excrementum Trogopterori seu Pteromi (wu ling zhi) 15g

Flos Carthami Tinctorii (hong hua) 15g

Radix Astragali Membranacei (huang qi) 20g

Semen Persicae (tao ren) 15g

This is a slightly changed version of Drive Out Blood Stasis from a Painful Body Decoction (shen tong zhu yu tang) from Corrections of Errors Among Physicians (Yi lin gai cuo). It is appropriate when the painful obstruction is of long duration and no effect has been gotten from using the various substances that expel wind, cold, and dampness. Whenever there is obstruction from the pathogenic influences wind, cold, and dampness, the vessels and collaterals are not open. There may be aching and pain throughout the trunk and extremities, swelling and pain in the joints of the hands and feet, or radiculitis from qi and blood obstruction.

Most of these substances invigorate the blood and unblock the collaterals, while some expel wind-cold-damp, and Radix Astragali Membranacei (huang qi) is used as an assistant to support the normal qi. Whenever painful obstruction persists for a long period the vessels and collaterals become obstructed and stagnant. If one simply uses substances that expel wind-cold and eliminate dampness then it will be difficult to drive the pathogenic influences out. It is necessary to invigorate the blood and unblock the collaterals to allow the qi to flow, the blood to be invigorated, and for there to be smooth and easy flow in the vessels and collaterals. Then the external pathogenic influence can be eliminated. The essential aspects of diagnosis are long-term recalcitrant painful obstruction, dark purple tonge, and a submerged pulse. Medicines that expel wind-cold-damp are ineffective and the case does not belong to a Liver and Kidney deficiency type. This includes some cases of rheumatoid arthritis, radiculitis, and chronic low back and leg pain. In these cases this formula will be effective.

The theraputic principle behind this formula is stated in the adage "To treat wind first treat the blood. When the blood moves the wind will automatically be extinguished." When the blood is static for a prolonged period the tongue usually becomes dark purple. However, clinically it is not always this way. There are some patients with blood stasis whose tongues do not change. Because of this we cannot soley rely on examining the tongue. It is necessary to integrate those findings with others such as the duration of the disease or whether the pattern is one of excess or deficiency. If the examination and analysis are done from a global perspective, then this formula can hit the mark.

Painful Obstruction Formula Number Four

Rhizoma Dioscoreae Nipponicae (chuan shan long)) 50g

Lumbricus (di long) 50g

Gong teng) 50g

Semen Coicis Lachryma-jobi (yi yi ren) 50g

Rhizoma Atractylodis (cang zhu) 15g

Cortex Phellodendri (huang bai) 15g

Rhizoma Anemarrhenae Asphodeloidis (zhi mu) 15g

Radix Paeoniae Lactiflorae (bai shao) 40g

Radix Achyranthis Bidentatae (niu xi) 50g

Rhizoma Dioscoreae Hypoglaucae (bei xie) 20g

Sclerotium Poriae Cocos (fu ling) 20g

Radix Glycyrrhizae Uralensis (gan cao) 10g

This formula clears heat, resolves dampness, relaxes the sinews, and invigorates the collaterals. In the formula Rhizoma Dioscoreae Nipponicae (chuan shan long), Lumbricus (di long), and Gong teng are used to relax the sinews and invigorate the collaterals; Rhizoma Anemarrhenae Asphodeloidis (zhi mu), Cortex Phellodendri (huang bai), and Rhizoma Atractylodis (cang zhu) together clear heat and eliminate dampness; Semen Coicis Lachryma-jobi (yi yi ren), Sclerotium Poriae Cocos (fu ling), and Rhizoma Dioscoreae Hypoglaucae (bei xie) blandly leach out and resolve dampness; Radix Achyranthis Bidentatae (niu xi) strengthens the sinews and fortifies the bones; and Radix Paeoniae Lactiflorae (bai shao) treats spasms and contractions of the sinews. Together they are used to treat sore, aching, painful, and heavy limbs. This includes those with such biomedical diagonses as radiculitis and sciatica. For cases where damp-heat injures the sinews, using this will be exceedingly effective.

Damp-heat injuring the sinews gives soreness, weakness, pain, paresthesias, and heaviness of the limbs. In addition the patient will have profuse, dark urine, a white, greasy tongue coating, a lax pulse, hot palms, and other problems. Several years ago I had a patient with sciatica. There was constant pain in the right buttock that went into the thigh accompanied by aching and weakness so that he was unable to walk. Substances that dispel wind-cold, eliminate dampness, and unblock the channels and collaterals had all been tried without effect. On examination his pulse was lax but forceful, the tongue coating was greasy and white, and the color of the urine was like strong tea. The differentiation was damp-heat injuring the sinews. This formula had an immediate effect and after taking 20 packets the patient was cured. After this whenever I have came across this type of patient, I have treated them with this formula and always achieved a cure.

Painful Obstruction Formula Number Five

Radix Aconiti Carmichaeli Praeparata (zhi chuan wu) 15g

Herba Ephedrae (ma huang) 15g

Radix Paeoniae Rubrae (chi shao) 20g

Ramulus Cinnamomi Cassiae (gui zhi) 20g

Radix Astragali Membranacei (huang qi) 20g

Rhizoma Zingiberis Officinalis (gan jiang) 10g

Rhizoma Atractylodis Macrocephalae (bai zhu) 20g

Sclerotium Poriae Cocos (fu ling) 20g

Radix Glycyrrhizae Uralensis (gan cao) 10g

This formula is used for painful obstructions where there is a relative preponderance of cold and dampness. Clinical manifestations of this include cold and pain in the joints of the lower back and lower extremities, a submerged and slow or wiry and tight pulse, a moist tongue without any thirst of problems of taste, aversion to cold, and a sensation of cold in the lower abdomen and lower back. Women can have clear thin vaginal discharge and a prolonged period between menses. Men will have a cold lower abdomen, a damp scrotom and other signs of damp-cold pouring downwards.

This formula is a modified combination of two formulas from the Essentials from the Golden Cabinet (Jin gui yao lue): Aconite Decotion (wu tou tang) and Fixed Kidneys Decoction (shen zhuo tang). When damp-cold obstructs, the blood vessels become congealed and rough. The combination of Herba Ephedrae (ma huang) and Radix Aconiti Carmichaeli Praeparata (zhi chuan wu) is good for dispelling damp-cold between the bones and sinews. Ramulus Cinnamomi Cassiae (gui zhi) is acrid and warmly opens and ublocks the blood vessels. When damp-cold is expelled and the blood vessels unblocked then the painful obstruction will be cured. Sclerotium Poriae Cocos (fu ling), Rhizoma Atractylodis Macrocephalae (bai zhu), and Rhizoma Zingiberis Officinalis (gan jiang) treat damp-cold that has spread all through the three burners with a heavy sensation in the body and a cold lower back. Together with Herba Ephedrae (ma huang) and Radix Aconiti Carmichaeli Praeparata (zhi chuan wu), they all work to treat damp-cold in both the exterior and interior.

Radix Aconiti Carmichaeli Praeparata (zhi chuan wu) is a necessary herb for all cases of cold-predominant painful obstruction. Once I treated a young women whose legs were suddenly exposed to a cold wind. Even in the fierce heat of summertime her lower extremities did not feel warm. She had been treated with herbs that dispelled wind-cold to no effect. In the beginning I used 30g of Radix Lateralis Aconiti Carmichaeli Praeparata (fu zi) with wind-dispelling herbs and things began to turn around. However, it did not acheive a real cure. I changed to using 25g of Radix Aconiti Carmichaeli Praeparata (zhi chuan wu) and 10g of Herba Ephedrae (ma huang), with the aid of herbs such as Radix Angelicae Sinensis (dang gui) and Radix Astragali Membranacei (huang qi) to augment the qi and nourish the blood. The coldness of the legs was dramatically decreased and disappeared with continued use.

Herba Ephedrae (ma huang) is an important herb for cold painful obstruction as it opens the pores and expels the cold pathogenic influence from the exterior. However there are some people who experience an increased heart rate and shortness of breath for up to two hours after taking it. Therefore whenever you use Herba Ephedrae (ma huang) you must check for this phenomena. In addition, this herb should not usually be taken in large amounts. The most common dosage is 5-10g which is sufficient.

Painful Obstruction Formula Number Six

Rhizoma Atractylodis (cang zhu) 15g

Cortex Phellodendri (huang bai) 15g

Ramulus Cinnamomi Cassiae (gui zhi) 15g

Radix Clematidis (wei ling xian) 10g

Radix Aristolochiae Fangchi (fang ji) 15g

Rhizoma Arisaematis(nan xing) 15g

Semen Persicae (tao ren) 15g

Flos Carthami Tinctorii (hong hua) 15g

Radix Gentianae Longdancao (long dan cao) 10g

Radix et Rhizoma Notopterygii (qiang huo) 10g

Radix Angelicae Dahuricae (bai zhi) 10g

Radix Ligustici Chuanxiong (chuan xiong) 10g

This formula comes from a prescription by Zhu Dan-xi to treat painful wind (tong feng). It dispels wind, clears heat, invigorates the blood, eliminates phlegm, and dries dampness. In it: Semen Persicae (tao ren), Flos Carthami Tinctorii (hong hua), and Radix Ligustici Chuanxiong (chuan xiong) invigorate the blood and dispel stasis. Rhizoma Arisaematis (tian nan xing) and Rhizoma Atractylodis (cang zhu) dry dampness and dispel phlegm. Cortex Phellodendri (huang bai) and Radix Gentianae Longdancao (long dan cao) are bitter cold herbs that clear heat. Radix Aristolochiae Fangchi (fang ji), Radix Angelicae Dahuricae (bai zhi), Radix et Rhizoma Notopterygii (qiang huo), and Radix Clematidis (wei ling xian) disperse wind. This is a common formula for painful wind.

This formula is useful for treating gout or rheumatoid arthritis with painful, swollen joints and fever. The pathological mechanism of rheumatoid arthritis is complex with intertwining of wind, dampness, heat, and static blood. The vessels and collaterals are obstructed and there is a migrating intense pain throughout the joints of the body. The joints are swollen and enlarged, hot, and become deformed. Because of this simply using the method of expelling wind-cold-dampness will not be effective. This formula disperses wind, dries dampness, transforms phlegm, clears heat, invigorates the blood, and drives out stasis. It unblocks and treats problems throuhgout the upper, middle, and lower parts of the body.

Once I treated a case of rheumatoid arthritis that had over time affected the the finger, wrist, and ankle joints. The pain was piercing, the joints were swollen with accumulations of fluid and deformed. The proximal interphalangeal joints had Haygart's fusiform synovial swellings. I used six prescriptions of this formula. After this the output of urine increased, the swellings had diminished, and the the joints were much less painful. I continuted by using formulas that expelled wind, unblocked the collaterals, and nourished the blood until the person was cured.

Painful wind is another way of saying panarthralgia (li jie feng). It is usually caused by a constitutional tendency towards developing collections of internal heat such that the blood is depleted by heat. In addition the person walks through water, is caught out in the rain, or catches a draft as they lie or sit while sweating. The external pathogenic influences congeal and bind with the internal heat to clog and obstruct the vessels and collaterals do that the joints are swollen and painful and there is pain all over. This formula disperses and scatters wind and dampness, opens up the interstices and pores, transforms phlegm and unblocks the collaterals, clears heat and dissipates clumps, while invigorating the blood and dispelling stasis. It deals with all aspects of the condition and is rather effective in clinical use.

Painful Obstruction Formula Number Seven

Agkistrodon Acutus (qi she) 20g

Radix Angelicae Sinensis (dang gui) 20g

Scolopendra Subspinipes (wu gong) 2

Buthus Martensi (quan xie) 5g

Eupolyphaga seu Opisthoplatia (tu bie chong) 5g

Rhizoma Dioscoreae Nipponicae (chuan shan long) 7.5g

Herba Epimedii (yin yang huo) 15g

Radix Rehmanniae Glutinosae Conquitae (shu di huang) 25g

Radix Paeoniae Lactiflorae (bai shao) 25g

Radix Gentianae Qinjiao (qin jiao) 15g

This formula is appropriate for rheumatoid arthritis with swollen, painful joints that are deformed, stiffened, and extended resulting in the Haygart's fusiform synovial swellings of the phalanges of the hands and feet. The pain is piercing and in severe cases there is a total loss of function such some patients are crippled, emaciated, have muscular atrophy, and extremely dry skin.

Rheumatoid arthritis comes about as long term invasion of wind, cold, and damp transform into heat. The blood is dessicated and the fluids exhausted so the sinews and bones do not get sufficient nourishment. One aspect is the invasion of the external pathogen into the joint resulting in joint swelling; another aspect is the insufficiency of qi and blood manifested by a emaciation sometimes to the point of atrophy.

This formula contains most of the important substances from insects and reptiles in order to track down and root out wind. For painful obstruction disorders with injury to joints that are deformed, stiffened, and extended ordinary formulas that expel wind-dampness cannot have any effect. You must use substances from insects and reptiles to vent the pathogens from the bones, track down wind, unblock the channels and collaterals, and alleviate pain. For those who have treated many cases of rheumatoid arthritis, most of those that are severe that get better use substances from insects and reptiles. Of these substances Agkistrodon Acutus (qi she)or Bungarus (bai hua she) dispel wind-dampness, unblock the channels and collaterals. The Commentary on the Classic of the Materia Medica (Ben cao jing shu) says that its "nature is intensely penetrating and is so good at moving that there is no place that it does not reach. This is why it is able to lead the various wind herbs to get to the location of the disease, from the Organs to the skin and hair." This repeatedly speaks of its ability to track down and root out wind. Buthus Martensi (quan xie) treats wind-stroke, insensitivity from damp painful obstruction, tightness and contractions, and pain in the bones and joints. Scolopendra Subspinipes (wu gong) expels wind, suppresses tremors, and alleviates pain. Rhizoma Dioscoreae Nipponicae (chuan shan long) disperses stasis and unblocks the channels and collaterals. Eupolyphaga seu Opisthoplatia (tu bie chong) invigorates the blood, disperses stasis, and alleviates pain. When a few insect and reptile substances are combined, the result is a relatively strong combined effect of dispelling wind, suppressing pain, invigorating blood, and unblocking the collaterals. Radix Angelicae Sinensis (dang gui), Radix Paeoniae Lactiflorae (bai shao), Radix Rehmanniae Glutinosae Conquitae (shu di huang), and Herba Epimedii (yin yang huo) tonify the Liver and Kidneys and nourish the blood, to give nutitrition to the sinews and bones and benefit the joints. Combining these two groups embodies the principle of supporting the normal and dispelling the pathogenic.

Painful Obstruction Formula Number Eight

Gypsum(shi gao) 50g

Flos Lonicerae Japonicae (jin yin hua) 50g

Radix Aristolochiae Fangchi (fang ji) 20g

Rhizoma Dioscoreae Hypoglaucae (bei xie) 20g

Radix Gentianae Qinjiao (qin jiao) 15g

Semen Coicis Lachryma-jobi (yi yi ren) 30g

Ramulus Cinnamomi Cassiae (gui zhi) 30g

Cortex Phellodendri (huang bai) 30g

Rhizoma Atractylodis (cang zhu) 30g

Caulis Mutong (mu tong) 30g

This formula treats hot painful obstruction and is appropriate for the acute arthritis of rheumatic fever with red, swollen, burning hot, and painful joints. There is dark red urine, erythema of the trunk and extremities, a dark red tongue with a white, greasy coating, and a pulse which is floating and slippery or slippery and rapid.

The pathological mechanism of hot painful obstruction is wind-damp-cold being accompanied by heat or turning into heat after a prolonged period clogging and trapping the blood vessels such that the circulation of qi and blood is obstructed. This leads to red, swollen, hot, and painful joints. Heat entering the blood and collaterals is the reason of the erythema and nodules.

In this formula Radix Aristolochiae Fangchi (fang ji), Radix Gentianae Qinjiao (qin jiao), and Ramulus Cinnamomi Cassiae (gui zhi) dispel wind and unblock the collaterals. Gypsum(shi gao), Flos Lonicerae Japonicae (jin yin hua), and Cortex Phellodendri (huang bai) clear heat. Rhizoma Atractylodis (cang zhu), and Semen Coicis Lachryma-jobi (yi yi ren) eliminate dampness. Put together they have the effect of dispelling wind and eliminating dampness.

For patients with aversion to wind and other exterior symptoms one can add 10g of Herba Ephedrae (ma huang).

For scanty, dark urine add Talcum (hua shi), Rhizoma Alismatis Orientalis (ze xie), and Herba Lophatheri Gracilis (dan zhu ye) to clear heat and promote urination.

For erythema and nodules add Cortex Moutan Radicis (mu dan pi), Radix Paeoniae Rubrae (chi shao), and Radix Rehmanniae Glutinosae (sheng di huang) to cool the blood and invigorate the blood.

For rather large joint effusions add Sclerotium Poriae Cocos (fu ling) and Sclerotium Polypori Umbellati (zhu ling) to blandly leach out dampness.

I have observed clinically that there is an increase in the erythema in some patients treated with this formula plus herbs that invigorate the blood and those that cool the blood. This is a positive sign that the wind, damp, and heat pathogens are being externally vented to the qi level from the blood level, from the interior going out through the exterior. This points out that the pathogen is being released through the exterior and that the disease is taking a turn for the better. I once treated a patient with rheumatic fever who had many areas of severe erythema on their lower extremities. When given cortisone the erythema would recede, but it returned when the medication was stopped. This went on for a long time with no resolution. After I gave them this formula with the addition of Cortex Moutan Radicis (mu dan pi), Radix Paeoniae Rubrae (chi shao), and Radix Rehmanniae Glutinosae (sheng di huang) the erythmema extended throughout the entire lower extremities, the pain was greatly reduced, and they began to recover.

It is necessary to use Gypsum(shi gao) in the treatment of any hot painful obstruction. It is cold, releases the muscular layer, and clears heat. Whenever treating any type of painful obstruction due to wind-dampness combined with heat, one must combine Gypsum(shi gao) with herbs that dispel wind. In theCase Histories of Wu Ju-Tong(Wu Ju-Tong yi an) whenever a hot type of paobis treated, large dosages of Gypsum(shi gao) are used to ensure effectiveness. Note that both "Painful Obstruction Formula Number 2" and this one combine herbs that dispel wind-damp with shi gao. It really is quite effective.

Usually in acute rheumatic fever both the ESR the ASO titer are high reflecting the rheumatic activity. As the wind-damp-heat pathogen retreats, these tests return to normal. I recently treated a woman who had rheumatic fever with a fever that would nt recede. I treated her with over 50 packets of this formula and she was cured.

Painful Obstruction Formula Number Nine

Radix Angelicae Sinensis (dang gui) 15g

Sclerotium Polypori Umbellati (zhu ling) 15g

Rhizoma Atractylodis (cang zhu) 15g

Radix Sophorae Flavescentis (ku shen) 15g

Herba Artemisiae Yinchenhao (yin chen hao) 15g

Radix Paeoniae Rubrae (chi shao) 15g

Rhizoma Anemarrhenae Asphodeloidis (zhi mu) 10g

Radix et Rhizoma Notopterygii (qiang huo) 10g

Radix Ledebouriellae Divaricatae (fang feng) 10g

Rhizoma Alismatis Orientalis (ze xie) 10g

Radix Scutellariae Baicalensis (huang qin) 10g

Radix Glycyrrhizae Uralensis (gan cao) 10g

This formula treats the struggle between wind, dampness, and heat with irritability and pain in the joints of the extremities or generalized body pain. There may be rheumatic nodules that are hard, red, swollen, and painful or an extremely itchy erythema with yellow urine, a white, greasy tongue coating, and a floating, slippery pulse.

In this formula Radix et Rhizoma Notopterygii (qiang huo) and Radix Ledebouriellae Divaricatae (fang feng) dispel wind; Rhizoma Alismatis Orientalis (ze xie) and Sclerotium Polypori Umbellati (zhu ling) resolve dampness; and Radix Sophorae Flavescentis (ku shen), Radix Scutellariae Baicalensis (huang qin), Rhizoma Anemarrhenae Asphodeloidis (zhi mu), and Rhizoma Atractylodis (cang zhu) clear heat and eliminate dampness. Together they treat wind-dampness and heat which are clogging the muscles, flesh, and joints. Subcutaneous nodules, edema, and a white, greasy tongue coating are all signs of wind-damp pathogens hanging around and refusing to leave. The special characteristics of this formula is that it separately reduces what is above and what is below such that the external pathogen is dispersed and scattered, the damp-heat is removed and eliminated, and the clogging and stagnation of the qi and blood are disbanded and unblocked. When this happens the various symptoms are resolved.

Painful Obstruction Formula Number Ten

Radix Astragali Membranacei (huang qi) 75g

Radix Paeoniae Lactiflorae (bai shao) 20g

Radix Glycyrrhizae Uralensis (gan cao) 10g

Rhizoma Zingiberis Officinalis Recens (sheng jiang) 10g

Fructus Zizyphi Jujubae (da zao) 5 pieces

Radix Achyranthis Bidentatae (niu xi) 15g

Semen Persicae (tao ren) 15g

Flos Carthami Tinctorii (hong hua) 15g

Ramulus Cinnamomi Cassiae (gui zhi) 15g

This formula is for insufficiency of protective (wei) qi marked by upper and lower extremities (or just the hands and feet) that feel numb, sore, and aching with a sense of being heavy, cumbersome, and weak, or a sensation of crawling ants. The pulse is lax or frail, the whole body is weak, and there is shortness of breath.

This formula focuses on tonifying the qi. As "the qi is the commander of the blood" when the qi moves, the blood moves also. This formula adds some herbs to Astragalus and Cinnamon Twig Five-Substance Decoction (huang qi gui zhi wu wu tang). The main herb is Radix Astragali Membranacei (huang qi) which augments the qi; Ramulus Cinnamomi Cassiae (gui zhi) unblocks the yang; Radix Paeoniae Lactiflorae (bai shao) preserves the yin and eliminates painful obstruction; Rhizoma Zingiberis Officinalis Recens (sheng jiang) and Fructus Zizyphi Jujubae (da zao) regulate and harmonize the nutritive and the protective;and Semen Persicae (tao ren) and Flos Carthami Tinctorii (hong hua) invigorate the blood and unblock the collaterals. They work together to augment the qi, unblock the yang, and promote movement in areas affected by painful obstruction. I treated a sixty year-old woman named Wang who had sore and achy numbness and parasthesias affecting her feet and hands that was difficult for her to endure. Her pulse was lax and forceless. After taking over 30 packets of this formula the soreness, aching, numbness, and paresthesias were completely eliminated and the the pulse also followed by becoming more forceful. This type of disease is not uncommon and requires large dosages of Radix Astragali Membranacei (huang qi) to treat effectively.