"Guifu Wan (Cinnamon and Aconite Pill)" and "Guifu Duzhong Tang (Cinnamon, Aconite and Eucommia Decoction)" for Treating Lower Back Pain

Lower back pain is a common condition, and the most common cause is herniated lumbar disc. This disease is mainly caused by degeneration of varying degrees in the parts of the lumbar intervertebral disc (nucleus pulposus, annulus fibrosus, and cartilage endplate), especially the nucleus pulposus. Under external force, the annulus fibrosus ruptures, and the nucleus pulposus tissue herniates (or prolapses) from the rupture. In severe cases surgery is required; mild cases can be treated with medication.

Because this condition worsens with cold and at night, ancient TCM mostly believed it was caused by kidney yang deficiency, and treatment should warm kidney yang and strengthen sinew and bone. The typical formula is composed of yang-warming and kidney-tonifying herbs such as Fuzi (Aconitum) and Rougui (Cinnamon). This article introduces two of them.

The first is Guifu Wan, recorded in the Classified Zhu's Proven Prescriptions (Leibian Zhushi Jiyan Fang). It is composed of: Buguzhi (Psoraleae Fructus), 2 liang (60 g); Rougui (Cinnamomi Cortex) and Pao Fuzi (processed Aconiti Radix), 1 liang each (30 g). When preparing the medicine, the above three herbs are ground together into fine powder, made into pills with wine paste, the size of a Chinese parasol tree seed (soybean size). Take 50 pills each time on an empty stomach, washed down with yellow rice wine, twice daily.

Guifu Wan warms the kidney and strengthens the lower back, and is indicated for the five types of lower back pain. Rougui and Pao Fuzi in the formula are both typical yang-supporting herbs; Buguzhi tonifies the kidney and assists yang, specifically for soreness and weakness of the lower back and legs with pain. This prescribing approach is simple and easy to understand, and the effect is excellent.

Guifu Duzhong Tang is from the Medical Mirror of Meetings (Huiyue Yijing). Its composition is: Rougui (Cinnamomi Cortex), 3 qian (9 g); Pao Fuzi (processed Aconiti Radix), 3-4 qian (9-12 g; use Sheng Fuzi, raw aconite, in urgent cases); Duzhong (Eucommiae Cortex), 2 qian (6 g). Decoct in water, strain out dregs, take warm, twice daily. If there is upper-body false heat rejecting warm medicine, take it cold. If the knees are cold and painful, add Chuanniuxi (Cyathulae Radix), 2-3 qian (6-9 g); if dampness is also present, add Cangzhu (Atractylodis Rhizoma), 2 qian (6 g).

The above two formulas both use large doses of the yang-warming Fuzi and Rougui; these two herbs address the root of conditions that worsen with cold, and with them as the chief, assisted by some herbs that have targeted therapeutic effects on lower back pain, both root and manifestation can be treated simultaneously.