Major Saposhnikovia Decoction (Da Fangfeng Tang) for Expelling Cold and Stopping Pain
Major Saposhnikovia Decoction comes from the Song dynasty Prescriptions from the Imperial Pharmacy (Heji Jufang). The original formula: Chuanxiong (Fujian chuanxiong excluded), prepared Aconite (Pao Fuzi, peeled), each 1.5 liang; prepared rehmannia (Shu Di, washed), white atractylodes (Baizhu), Saposhnikovia (Fangfeng, rootlets removed), Angelica (Danggui, washed, rootlets removed, soaked in wine, roasted), white Peony (Baishao), Eucommia (Duzhong, coarse bark removed, stir-fried until fibers break), each 2 liang; Notopterygium (Qianghuo, rootlets removed), ginseng (Renshen, rootlets removed), honey-fried licorice (Zhi Gancao), Achyranthes (Niuxi, rootlets removed, soaked in wine, sliced, lightly stir-fried), each 1 liang. The above are pounded into a coarse powder; take 5 qian each time with one and a half zhong of water, seven slices of ginger, and one jujube, decocted to eight fen; strain and take warm on an empty stomach before meals.
This formula expels wind and smooths qi, activates the vessels, strengthens the sinews and bones, expels cold-dampness, and drives out cold qi. It treats, after dysentery, painful, weak, paralyzed legs unable to walk—called "dysentery wind" (li feng); or swollen, painful knees with the thighs and shins shriveled like dried flesh, leaving only skin and bone, with contracture preventing bending or stretching—called "crane's-knee wind" (he xi feng).
This formula is a modification of Four-Agent Decoction (Si Wu Tang: prepared rehmannia, Chuanxiong, Angelica, white Peony). In Orthodox External Medicine (Waike Zhengzong), Chen Shigong slightly modified it: ginseng 2 qian, plus Saposhnikovia, stir-fried white atractylodes, Astragalus, Achyranthes, Eucommia, Angelica, prepared rehmannia, white Peony, Chuanxiong, Notopterygium, licorice, and Aconite, each 1 qian, decocted. Chen Shigong's modified version combines Jade Screen Powder (Yu Ping Feng San) with Four-Agent Decoction and adds ginseng, Eucommia, Achyranthes, Notopterygium, Aconite, and licorice. Its effect is to supplement and boost qi and blood, strengthen sinews and bones, simultaneously expel cold-dampness, and restore lower-limb function.
The "crane's-knee wind" treated by this formula is tuberculous arthritis in modern medicine: patients have swollen, painful knee joints with wasted muscles of the thigh and shin, resembling a crane's knee, hence the name. The ancients described that after taking Major Saposhnikovia Decoction, qi and blood flow smoothly, flesh gradually grows, and the patient can walk as before.
Besides treating crane's-knee wind, the ancients held this formula also treats "dysentery wind"—when dysentery persists and the patient gradually develops leg pain as if paralyzed and unable to walk. Thanks to advances in medical care, dysentery patients rarely become this severely ill today.
This formula suits paralyzed patients. The author used it to some effect for a breast-cancer patient with osteolytic fracture following bone metastasis. The author further modified Chen Shigong's version: ginseng 6g, Saposhnikovia 3g, stir-fried white atractylodes 3g, raw Astragalus 3g, Huai Achyranthes 3g, Eucommia 3g, Angelica 3g, prepared rehmannia 3g, white Peony 3g, Chuanxiong 3g, Notopterygium 3g, honey-fried licorice 3g, Aconite 3g, deer-horn gelatin (Lujiaojiao) 3g, teasel (Xuduan) 3g, Drynaria (Gusuibu) 3g, malaytea scurfpea (Buguzhi) 3g, and Chaenomeles (Mugua) 3g.
Some cancer patients, long ill and frail, have sore, weak legs, pain below the waist, even paraplegia, with aversion to cold, cold limbs, clear long urine, no thirst, and pale, colorless lips. Western examination shows anemia; TCM pattern differentiation reveals qi-blood deficiency and decline of kidney yang. Such patients may be treated mainly with this formula, modifying the herbs according to their specific condition. If prolonged bed rest causes constipation, add 3–15g of Cistanche (Roucongrong); if spleen-kidney yang deficiency causes diarrhea, do not use Cistanche but add 3g nutmeg (Roudoukou), 3g evodia (Wuzhuyu), and 3g schisandra; if the patient's appetite is poor, add charred hawthorn and medicated leaven to aid digestion.