Guizhi Jia Zhu Fu Tang for Rheumatic Arthralgia (Arthritis, Gout, and Similar Conditions)

Guizhi Jia Zhu Fu Tang (Cinnamon Twig Plus Atractylodes and Aconite Decoction) is an important formula for treating rheumatic arthralgia. Professor Hu Xishu held this formula in especially high regard. It is also one of the two formulas I commonly use for rheumatic arthralgia; the other is Simiao Wan (Four-Miracle Pill).

Guizhi Jia Fu Zhu Tang is a commonly used formula for rheumatic arthralgia of cold-damp type, while Simiao Wan is used for rheumatic arthralgia of damp-heat type.

Rheumatic arthralgia generally presents mainly as joint pain, and most patients experience worsening on rainy, overcast days or in regions with high air humidity.

When Professor Hu Xishu himself used Guizhi Jia Zhu Fu Tang, he specifically pointed out that if the patient has unilateral sciatica, adding a small amount of Dahuang (Rhubarb) yields even better results.

The Japanese have made Guizhi Jia Zhu Fu Tang into granules that can be dissolved directly in water (also called Guizhi Jia Fu Zhu Tang granules). This medicine is used on a large scale in Japan because Japan is an island nation with a humid climate, so many Japanese people suffer from rheumatic arthralgia, and treating them with Guizhi Jia Zhu Fu Tang is very effective.

Japanese people also love hot-spring bathing, which is also related to the high prevalence of rheumatic arthralgia in Japan.

However, rheumatic arthralgia, if not treated internally and only managed with external methods, is very hard to eradicate. Therefore, external treatments such as hot-spring bathing can generally only provide temporary relief and rarely produce long-term effects. To achieve long-term efficacy, one still needs internal medicines such as Guizhi Jia Zhu Fu Tang.

In addition, I have unexpectedly found that this formula is also very effective for insomnia caused by neurasthenia. When I used this formula to treat rheumatic arthralgia in two of my own relatives, I unexpectedly resolved their stubborn insomnia as well.

Later, when I used this formula to treat neurasthenic patients who did not have rheumatic arthralgia but whose pulse was floating and deficient, it unexpectedly resolved the insomnia that had troubled them for years. This treatment experience is offered for the reference of my colleagues.

The dosages I commonly use for Guizhi Jia Zhu Fu Tang are as follows:

Guizhi (Cinnamon Twig) 15g, Baishao (White Paeony) 15g, Pao Fuzi (processed Aconite) 15g, Baizhu (Atractylodes Macrocephala Rhizome) 10–15g (Cangzhu, Atractylodes Rhizome, may also be used), Zhi Gancao (honey-fried Licorice) 10g, Shengjiang (Fresh Ginger) 20–30g, Dazao (Jujube) 5–10 pieces.

If the pain is in the legs and cannot be relieved with the above formula, Niuxi (Achyranthes) and Mugua (Chaenomeles) etc. may be added. However, Xungufeng (Radix Angelicae Pubescentis) and Tougucao (Speranskia) etc. are not recommended; prolonged use of such herbs damages the patient's liver.

So what are the medication indications for this formula?

Guizhi Jia Zhu Fu Tang evolved from Guizhi Fuzi Tang and Guizhi Qu Gui Jia Baizhu Tang. In the Shanghan Lun (Treatise on Cold Damage), the lines concerning Guizhi Jia Zhu Fu Tang and Guizhi Qu Gui Jia Baizhu Tang are as follows:

"In cold damage of eight or nine days, when wind-damp contend, the body aches pain fully and cannot turn itself, there is no vomiting and no thirst, and the pulse is floating, deficient, and rough—Guizhi Fuzi Tang governs it. If the person's stool is hard and the urination is spontaneous and free, Qu Gui Jia Baizhu Tang governs it."

First of all, the base formula is still Guizhi Tang (Cinnamon Twig Decoction), the representative formula for treating Taiyang wind-stroke. Therefore its basic pulse and symptoms are somewhat similar to those of Guizhi Tang: a floating pulse tending toward deficiency (slow, deficient, rough, thin and wiry pulses are all typical deficiency pulses), spontaneous sweating and profuse sweating, and joint pain. If it were an indication of Mahuang Tang, the pulse would instead be floating and tending toward excess.

Therefore, to use this formula the physician must first be able to take the pulse. It is appropriate for a floating pulse tending toward deficiency, but it is a grave mistake to use it for a floating-tight pulse. What formula is used for a floating-tight pulse? For rheumatic arthralgia with a floating-tight pulse, one should consider Mahuang Xingren Yiyiren Gancao Tang (Ephedra, Apricot Kernel, Coix, and Licorice Decoction). If the pulse diagnosis is wrong, the formula prescribed is wrong, and the patient's illness cannot be cured.

"The body aches pain fully and cannot turn itself" is actually a symptom of quite severe arthritis or gout. Clinically there are even more severe presentations; many patients have swollen limbs, and some experience morning stiffness—once morning comes, the limb joints become stiff. This condition can also be treated with Guizhi Jia Zhu Fu Tang.

If the swelling is severe, adding one herb, Fuling (Poria), at a dose of 15–30g to this formula is also very effective. One may even add Han Fangji (Stephania Tetrandra) and Sheng Huangqi (raw Astragalus). The modifications of the formula depend entirely on the physician's judgment of the patient's specific condition.

Generally speaking, when using this formula, Guizhi should not be removed. But if the patient has hard stool and spontaneous, free urination, then using Guizhi is no longer appropriate—continuing to use Guizhi would make the stool even harder. In that case Guizhi must be removed, and Baizhu must be raw Baizhu.

In pharmacies, Baizhu comes in charred and raw forms. Patients with loose, unformed stools do better with charred Baizhu, while patients with hard stool do better with raw Baizhu.

Thus, in a Chinese herbal decoction, changing the processing method or dosage of even one herb immediately changes the therapeutic effect. If a TCM physician wants the formulas he prescribes to have outstanding efficacy, he needs to put some effort into studying decoction formulas and the properties of medicines.

When decocting this formula, note that Pao Fuzi must be decocted first for 15–30 minutes, and the water must fully cover the aconite. If too little water is used and part of the aconite is exposed above the water, incomplete decoction can easily lead to aconitine poisoning. As long as it is thoroughly decocted, it is very safe. It is like the beans we eat: if beans are not cooked through, they are toxic.

In practice, Guizhi Jia Zhu Fu Tang can be used to treat cervical spondylosis, rheumatism, arthritis, synovitis, knee pain, gout, and various other conditions. From the Western medicine perspective these are different diseases, but from the TCM perspective, as long as the four examinations are combined and the disease mechanism is considered the same, they can be treated as the same disease. As long as the pulse diagnosis is accurate and the main symptoms match the indications of this decoction, it can be used in all such cases. We in TCM call this "treating different diseases with the same method."

Of course, when Western medicine regards a condition as the same disease, if after combining the four examinations TCM judges it not to be an indication for a certain formula, then that formula cannot be used. Therefore we cannot just match formulas according to Western diagnoses.

By the way, many people nowadays who have picked up a smattering of TCM have a bad habit of prescribing formulas without ever seeing the patient in person. As a result, sometimes the formula not only has no effect but actually causes side effects, worsens the condition, and can even lead to the patient's death.

Many patients and their families, lacking this basic common sense, also take medicine wildly without seeing a doctor, which has caused numerous medical accidents. Life is no joking matter; everyone should be careful and cautious about this.