Chuanxiong Formulas for Dizziness and Headache: Xiongzhu Tang, Xiongzhi San, Xiongfu Yin, Xiongma Tang, and Xionghuang Wan
Chuanxiong (Sichuan lovage rhizome) is called "the qi medicinal within the blood" in TCM and excels at treating headache and dizziness. Paired with different medicinals, it forms different formulas with different effects. By studying how chuanxiong combines with various medicinals, we can deepen our understanding of TCM pattern differentiation and treatment. The following are several chuanxiong-containing formulas that illustrate this point.
Xiongzhu Tang comes from San Yin Ji Yi Bing Zheng Fang Lun (Systematic Treatise on Causes and Manifestations of Disease). It consists of Chuanxiong 1 liang (15 g), Baizhu (white atractylodes) 1 liang (15 g), Sheng Fuzi (raw aconite, peeled and tipped) 1 liang, Gancao (honey-fried licorice) 1.5 liang (22.5 g), and Guixin (cinnamon heart) 1.5 liang (22.5 g). Make the above into a powder. Each time take 5 qian (15 g) in 300 ml water, add 7 slices of fresh ginger and 1 jujube, and decoct to 200 ml; strain. Take warm before meals, twice daily. This formula warses the middle and transforms dampness. It treats heavy-headed vertigo caused by decline of spleen-stomach yang with external cold-damp, accompanied by a bitter mouth and loss of taste.
This formula is in fact chuanxiong combined with a half-dose of Fuzi Lizhong Tang plus cinnamon heart. In Zhang Zhongjing's Lizhong Tang and Zhenwu Tang, aconite and atractylodes are paired; this combination supports yang, strengthens the spleen, and dispels dampness. Adding cinnamon heart warms yang and unblocks the vessels to rouse yang qi; chuanxiong moves blood and qi, stops pain, and opens the orifices; licorice harmonizes the other medicinals. Hence this formula treats heavy-headed vertigo due to cold-damp. When dampness is exuberant the mouth tastes bitter; once yang is restored and phlegm-damp is eliminated, the heavy-headed vertigo and bitter mouth resolve.
Xiongzhi San comes from Gu Jin Yi Jian (Ancient and Modern Medicine Mirror). It is made of Chuanxiong and Baizhi (angelica dahurica) each 3 qian (9 g). Grind chuanxiong and baizhi to powder, then take one yellow ox brain, smear the powder onto it, place in a porcelain vessel with wine, and stew until done. Take it warm with the wine, drinking to mild intoxication; upon waking from sleep, the headache is cured. This formula expels wind and stops pain. It treats old and new unilateral or bilateral head-wind headache that is severe and unresponsive to other medicinals.
Both chuanxiong and baizhi in Xiongzhi San are common wind-expelling pain-stopping medicinals; together their analgesic effect is stronger. However, a yellow ox brain is hard to find today. This formula can be used without the ox brain by instead adding equal parts Manjingzi (vitex fruit) and making a powder together. Each time decoct in equal parts yellow rice wine and water, and take warm.
Xiongfu Yin comes from Danxi Xin Fa (Danxi's Core Traditions). It consists of Chuanxiong 2 liang (60 g) and Xiangfu (cyperus) 4 liang (120 g). Powder the medicinals; each time take 2 qian, stirred into tea. This formula regulates qi and harmonizes blood. It treats nosebleed, vomiting of blood, qi-storm headache, or postpartum headache caused by disharmony of qi and blood.
Xiangfu moves qi and stops pain, soothes the liver and resolves depression. Combined with chuanxiong, it shifts chuanxiong's action toward moving qi and stopping pain. The "qi-storm headache" here mostly refers to a problem of liver qi not freely spreading; such patients often also have qi-stagnation abdominal pain and emotional distress.
Xiongma Tang comes from Yi Zong Jin Jian (Golden Mirror of the Medical Tradition). It consists of Chuanxiong 1 qian (3 g) and Tianma (gastrodia) 2 qian (6 g). Decoct the two in water, strain, and take warm. This formula expels wind and resolves phlegm. It treats wind-phlegm headache with vertigo and nausea. This condition corresponds to modern headache from hypertension and cerebrovascular disease. TCM holds that gastrodia extinguishes wind and relieves spasms, expels wind and unblocks yang; in fact gastrodia is a fine antihypertensive. Thus gastrodia combined with chuanxiong works well for headache caused by hypertension and cerebral infarction.
Xionghuang Wan comes from Yang Shi Jia Cang Fang (Yang Family's Concealed Formulas). It consists of Chuanxiong and Jiandahuang (wine-processed rhubarb) each 2 liang (60 g). Powder finely and, with refined honey, make pills the size of a parasol tree seed. Take 20 pills each time with warm water after meals, three times daily.
This formula activates blood and expels wind, drains fire and frees the bowels. It treats exuberant wind-heat with dizzy head, red eyes, and difficult defecation. Wine rhubarb drains heat and frees the bowels; chuanxiong expels wind and stops pain. Together they dispel wind-heat and drain internal fire. Once wind-heat is gone and internal fire is subdued, the dizzy head and red eyes naturally resolve.
Zhang Zhongjing emphasized "when the pattern is present, use the corresponding medicine." Most TCM formulas are compound, made of two or more medicinals. Chuanxiong is the most commonly used medicinal for dizziness and headache, but different types of headache have different accompanying signs; which medicinal to pair with chuanxiong depends on the patient's accompanying symptoms.