Guizhi Fuling Wan: A Gynecological Pill for Reducing Swelling and Dissolving Nodules
Guizhi Fuling Wan (Cinnamon Twig and Poria Pill) comes from the twentieth chapter, "On the Pulse and Treatment of Pregnancy Diseases in Women," of Zhang Zhongjing's Jingui Yaolue (Essential Prescriptions of the Golden Cabinet). It is a commonly used gynecological formula and may be applied to modern gynecological conditions such as endometritis, adnexitis, ovarian cyst, uterine fibroid, ectopic pregnancy, pelvic blood-stasis syndrome, pelvic inflammatory mass, endometriosis, and premenstrual syndrome. It may also be used for hyperlipidemia, silent myocardial ischemia, hyperviscosity syndrome, chronic glomerulonephritis, chronic prostatitis, abdominal adhesions, diabetic peripheral neuropathy, allergic nodular vasculitis of the skin, and scleroderma.
The passage in Jingui Yaolue describing the indications of Guizhi Fuling Wan reads: "A woman with an existing jiā (fixed mass) disease, who, within three months after her period has stopped, develops incessant spotting and feels fetal movement above the navel—this is caused by the fixed mass. If at six months of pregnancy there is movement, the preceding three months of regular menstruation indicate a fetus; the bleeding after three months of amenorrhea indicates a stale mass. The reason the bleeding does not stop is that the mass has not been removed; the mass should be purged, and Guizhi Fuling Wan governs it." In TCM, a zhēng (mass) is a fixed, immovable lump, corresponding to a modern cyst, inflammatory mass or tumor.
The composition and preparation of Guizhi Fuling Wan: Cinnamon twig (Guizhi), Poria (Fuling), Moutan bark (Danpi, core removed), Peony (Shaoyao), and Peach kernel (Taoren, skin and tip removed, parched), each in equal parts. The five herbs are ground to powder, refined honey is formed into pills the size of rabbit droppings. Today many manufacturers produce the Chinese-patent medicine Guizhi Fuling capsules made to the same formula, so clinicians usually prescribe Guizhi Fuling capsules.
Based on this passage from Jingui Yaolue, the main indications of Guizhi Fuling Wan are incessant spotting in women (i.e., prolonged menstrual bleeding) and lower abdominal pain—symptoms seen in many gynecological and andrological conditions localized in the pelvis.
Modern pharmacology confirms that Guizhi Fuling Wan reduces blood viscosity, markedly lowering whole-blood reduced relative viscosity, whole-blood relative viscosity, plasma relative viscosity and fibrinogen concentration, shortening red-cell electrophoresis time, improving red-cell deformability, and preventing endotoxin-induced disseminated intravascular coagulation; it also has analgesic, sedative and anti-inflammatory effects.
Because ancient obstetrics was undeveloped, Guizhi Fuling Wan was also used to induce labor or treat common obstetric conditions such as miscarriage and stillbirth. Furen Liangfang (Effective Gynecological Remedies) even renamed Guizhi Fuling Wan "Duoming Wan" (Life-Taking Pill), using it for women's miscarriage and dead fetus in utero. Jiyin Gangmu (Outline of Gynecology) converted it into a decoction renamed "Cuisheng Tang" (Labor-Inducing Decoction) for difficult labor. But all these uses were unsafe; maternal mortality in antiquity was very high, so Guizhi Fuling Wan is no longer recommended to induce labor.
Guizhi Fuling Wan can cause abortion and is contraindicated in pregnancy. But it cannot be used for medical abortion, because using it for that purpose is unsafe and not reliably effective.
As a Chinese patent medicine that activates blood, resolves stasis, reduces swelling and dissolves nodules, Guizhi Fuling Wan has some efficacy for benign gynecological tumors and cysts, though the course is long. When its modern preparation, Guizhi Fuling capsules, is used for uterine fibroids and ovarian cysts, patients often need to take it for over three months, which requires sufficient patience.