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XUEFU ZHUYU TANG
(Persica and Achyranthes Combination)
Xuefu Zhuyu Tang is a widely used formula in China designed by the medical reformer Wang Qingren (1768-1831). Wang's interest was in the correct description of the internal organs (zangfu). Chinese physicians had avoided detailed investigation of the body during the previous centuries due to proscriptions against performing autopsies (and public refusal to allow dead bodies of their relatives to be dissected) and limitations on performing internal surgery. Instead, physicians and scholars had relied upon ancient drawings of the internal organs, derived from a small number of investigations before these restrictions came to force.
Those anatomical drawings were crude, and had become a mere illustration to accompany descriptions of organ function that had been derived from theoretical considerations and a variety of observations of patients viewed from the outside. During the Song Dynasty, some new and superior drawings were made after physicians and artists were ordered to dissect and report on the internal organs of some captured bandits. But it was not until Wang Qingren published a small work of two volumes called Yilin Gaicao (Correction of Medical Errors; 1850) that Chinese anatomical studies revived. Soon after, many Chinese doctors adopted the modern anatomical texts, already highly advanced, introduced by Western physicians.
Wang wrote about the gruesome circumstances leading to his anatomical insights (1):
In the 2nd year of the reign of Jia Qing [Qing Renzong, reign: 1796-1821], about the beginning of the Spring, I happened to be traveling to Lanzhou. An epidemic of measles and dysentery was raging among the children at the time and nine-tenths of the afflicted died. Most of the poor people wrapped up their dead in mats, instead of putting them in coffins, and buried them. According to the custom of the place, the bodies were not buried deep in the ground in order that the dogs might eat them so that subsequent births might be spared [this view was derived from certain Buddhist concepts]. Thus, every day in the public burying place there were over 100 such exposed bodies. Daily I rode past on horseback. At first, I could not help holding my nose; but on thinking of the mistakes made by the ancients because they had not seen the viscera, I did not try to avoid the bad odor but, on the contrary, I went to the burying place that very morning. I closely examined the internal organs of those that were exposed. The dogs ate up the liver and heart mostly, but left the stomach and intestines. Only about three of ten bodies were complete. For ten consecutive days, I examined over 30 perfect bodies. In this way, I discovered that the ancient drawings as compared with actual human organs were entirely different, even the various parts did not agree.
It has been suggested by his contemporaries that Wang's work on anatomy had a number of errors, including observations that led to his formulation of Xuefu Zhuyu Tang. Some of his errors were considered worse than the ones he was trying to correct, so that critical commentators said: "the more Wang corrects, the more errors are made." One of the problems he encountered was the ancient Chinese correlation between blood vessels and the acupuncture meridians. The Chinese had nearly always described the flow of qi and blood as a unitary function, and had not made any distinction between the blood vessels and the acupuncture meridians that were being mapped for Chinese medical purposes. However, the meridian maps that had evolved centuries earlier did not closely follow the actual blood vessels, so that when Wang saw where the vessels actually ran, he was particularly distressed at the discrepancy. Since then, acupuncturists have been careful to claim that acupuncture meridians are different from blood vessels. Meridians have been depicted as carrying only a non-substantial qi rather than combined qi and blood, though this runs counter to virtually all the literature generated for two millennia.
Wang had condemned those who wrote about physiology based merely on guesswork-without direct observation of the body-thus raising a complaint that is scientific in nature: conclusions must be drawn from careful investigation, not simple application of dogma. He commented:
To write a book without knowing thoroughly the internal organs, is it not comparable to a man speaking in a dream? To treat a disease without knowing thoroughly the internal organs, how does it differ from a blind man groping in the dark?
Based on Wang's analysis, it has been suggested that upon carrying out his investigations of dead bodies he observed that blood was often found pooled in the chest cavity. He considered that blood stasis in the chest cavity must have been associated with disease. Modern doctors recognize that this pooling of blood most likely occurred because of changes at death, rather than having anything to do with disease.
Nonetheless, Wang designed his formula to treat blood stasis in the chest, which was designated as the "blood palace" (xue = blood; fu = residence of an official, translated as palace or mansion). The formula is comprised of two parts, one to regulate qi circulation and the other to vitalize blood. For regulating qi, he used a modification of the ancient Sini San, comprised of four herbs: bupleurum, peony, chih-shih, and licorice. Since blood vitalizing was to be an important component of therapy, he substituted red peony for peony. He also replaced chih-shih (zhishi) with chih-ko (zhiqiao). Chih-shih and chih-ko have similar properties and functions; they are the immature and mature fruit, respectively, of a type of orange. However, one difference between them has been described as their direction of action. Chih-shih is used to drain downward, thus having a vertical action. It is commonly used in formulas for treating constipation. Chih-ko has a more limited downbearing effect, but is considered valuable for spreading the qi around the central region, and is thus said to have a horizontal action; it is commonly used for problems of the stomach and lungs, and Wang used it to smooth the flow of qi in the chest. Both chih-shih and chih-ko have the shared function of preventing adverse upward rushing of qi that can cause stuffiness in the chest, which is of relevance to this formula. Wang added platycodon to this portion of the formula as an herb to direct the action of all the herbs to the chest. In particular, the combination of bupleurum, which opens the upward flow of liver qi through the liver meridian passing though the sides of the chest, and platycodon, which opens the lung qi, are considered a highly focused pair for relieving stagnation in the chest area.
For the blood vitalizing portion, he selected Persica and Carthamus Combination (Tao Hong Siwu Tang), which is simply Siwu Tang (Tang-kuei Four Combination; tang-kuei, peony, cnidium, rehmannia) plus persica (taoren) and carthamus (honghua). Peony is again mentioned here, with red peony included as above. In addition, the blood vitalizing herb achyranthes, or as specified in many modern texts, the substitute herb cyathula, was added. Cyathula (chuanniuxi) is considered to be a type of achyranthes (huainiuxi); it helps drain the excess blood from the upper body to the lower body. In particular, achyranthes or cyathula with chih-ko helps prevent upward rushing of qi and blood that might result in congestion and accumulation. The formula is (2):
|Xuefu Zhuyu Tang|
|Red peony||9 g|
|Rehmannia, raw||9 g|
Its function is "to promote blood circulation and remove stasis, as well as activate the flow of qi and relieve pain." Its primary indications are headache and chest pain due to blood stasis or poor blood circulation. The chest pain is attributed to such things as coronary heart disease, rheumatic heart disease, and injury to the chest; the headaches are attributed to concussion as well as any circulation disorder. Because of its regulatory effects on the flow of qi, the formula is also recommended for persistent hiccough.
Xuefu Zhuyu Tang, regardless of its potentially flawed basis in physiology, turned out to be highly effective. It is today employed routinely in the treatment of a number of diseases and injuries and is frequently mentioned in medical journals. In a review article on its pharmacology and applications, the following effects were among those listed:
Many of these conditions do not involve the chest or upper body. Chinese doctors have come to view the formula as one that is generally suitable for blood stasis syndromes. One of the benefits of this formula, according to the Advanced Textbook is that it "removes blood stasis without consuming blood, and releases stagnant liver qi without consuming qi." This comment refers to the fact that the formula is potent, but still does not cause adverse effects. Normally, there is a concern that strong blood vitalizing formulas and strong qi regulating formulas will cause some damage (consume the blood and qi), thus limiting the duration of their use and restricting their use to persons of strong constitution.
Wang Qingren also produced two blood vitalizing formulas for the lower body that are still widely used today. One is called Shaofu Zhuyu Tang (shaofu here refers to the lower palace) and the other is called Gexia Zhuyu Tang (ge = diaphragm, xia = below). The two formulas are similar:
|Shaofu Zhuyu Tang||Gexia Zhuyu Tang|
Five of the herbs used for vitalizing blood circulation in each of the formulas match exactly, and in Gexia Zhuyu Tang, the blood vitalizing combination of carthamus and persica simply replaces bulrush in Shaofu Zhuyu Tang. The major differences between these two prescriptions are that Shaofu Zhuyu Tang includes the kidney-warming trio of cinnamon bark, dry ginger, and fennel, while Gexia Zhuyu Tang has the qi regulating trio of cyperus, lindera, and chih-ko. Both are indicated for abdominal pain due to blood stasis. Shaofu Zhuyu Tang would be selected for stasis due to cold (cold-caused congealing of blood) and Gexia Zhuyu Tang would be selected for blood stasis associated with qi stagnation.
An herb common to all these formulas by Wang Qingren is cnidium (chuanxiong). This herb is described at length in the book Chinese Herbal Medicines: Comparisons and Characteristics (5), and the explanation reveals the herb's suitability for these formulas:
Chuanxiong is pungent and warm, and enters the liver, gallbladder, and pericardium meridians. Pungency can disperse congealed blood and warmth can activate the blood circulation and dissipate the obstruction. Chuanxiong is a very effective herb for invigorating the blood and promoting its circulation. It is characterized by high moving speed and strength. It moves upwards, downwards, inwards, and outwards, and can reach every part of the body, so it is regarded as 'the herb that moves qi and blood.'
In clinical practice, it is often used to remove congealed blood and stop pain. It is particularly effective in the treatment of headache when the pain is in the sides of the head, such as in headache caused by stress or migraine. It is also used to relieve pain in intercostal neuralgia, coronary heart disease, and stenocardia, trauma, and arthritis. Since it can reach any part of the body, it can be used to treat cold and cramping pain of the fingers and toes, dysmenorrhea, amenorrhea, and irregular menstruation, which are caused by qi and blood stagnation complicated by cold. Combined with other herbs, it can be prescribed for excess, for deficiency, for cold, or for heat syndromes.