Guizhi Tang (Cinnamon Twig Decoction) Is an Excellent Formula for Treating Spleen-Stomach Diseases

Guizhi Tang is praised as the foremost of all TCM formulas because it is the first formula in the Shanghan Lun (Treatise on Cold Damage) and also the most widely used in clinical practice. Professor Liu Duzhou believed that Guizhi Tang, externally, harmonizes the nutritive and defensive qi; internally, it harmonizes qi and blood, and harmonizes the spleen and stomach. The five herbs in Guizhi Tang are common cooking condiments, all having stomach-fortifying effects to varying degrees. The reason Guizhi Tang has such broad effects is, in the final analysis, its action of harmonizing yin and yang.

In recent years I have quite liked using Guizhi Tang to treat gastrointestinal diseases, and have developed a series of derived formulas to treat some secondary conditions rooted in gastrointestinal disease; the results are tolerably good. I now write this article to introduce my experience using Guizhi Tang and modified Guizhi Tang to treat spleen-stomach diseases, for experts to criticize.

The composition of Guizhi Tang is: Guizhi (Cinnamon twig) 9 g, Baishao (white Paeonia) 9 g, Zhi Gancao (honey-fried licorice) 6 g, Shengjiang (ginger) 3-5 slices, Dazao (jujube) 3-5 (broken). The original text of the Shanghan Lun: Guizhi three liang (bark removed), Shaoyao three liang, Gancao two liang (honey-fried), Shengjiang three liang (sliced), Dazao twelve pieces (broken). One Han liang is roughly 15 g today, but in modern clinical practice most doctors convert one liang to 3 or 5 g, and the effect is not bad; the Japanese use even lighter doses.

Guizhi Tang is very suitable for resolving spleen-stomach disharmony, poor appetite, irregular bowel movements, hiccups, stomach pain, abdominal pain, diarrhea, nausea, and vomiting caused by excessive use of cold/cooling or raw/cold foods or medicines. Especially when long-term medicated patients develop such symptoms, Guizhi Tang is very suitable. Cancer patients, whether taking Chinese or Western medicine, will damage the spleen and stomach to varying degrees if taken for too long; giving Guizhi Tang usually resolves the spleen-stomach problem.

I recently treated a lung cancer patient from Inner Mongolia who had long taken my low-dose "attack-poison-with-poison" anti-cancer herbs; although the tumor had shrunk dramatically, he developed poor appetite, lack of appetite, and nausea. At first I suggested he use Jianpi Wei-stomach-fortifying medicines like Guipi Wan; the decoction I prescribed also included Jiao Sanxian, Jineijin, and other spleen-stomach fortifiers, but the effect was poor. Then I thought it over and decided to give the original Guizhi Tang; in just two days, the patient's appetite returned to normal.

Another patient with poor appetite after chemotherapy came to me; I likewise gave Guizhi Tang directly. In less than three days the appetite returned to normal, and the patient's hiccups and loose stools were also resolved.

This may be because whether using Western or Chinese medicine, over time both damage the patient's spleen and stomach; among these, cold-deficiency gastroenteritis and gastric ulcer are common. Guizhi Tang can resolve these problems. However, when Guizhi Tang is used to release the exterior, after taking the medicine one must eat hot thin porridge and cover up with a quilt to assist sweating; but when treating spleen-stomach diseases, these auxiliary measures are unnecessary. Because there is no exterior pattern, no need to induce sweating; just use Guizhi Tang to harmonize yin and yang and boost spleen-yang qi.

The Shennong Bencao Jing states that Guizhi can treat cough with upward qi, throat obstruction, and binding qi. The Shanghan Lun uses Guizhi Jia Gui Tang to treat ben-tun (running-pig) disease with rebellious qi surging upward. This shows Guizhi has the action of treating qi counterflow and qi stagnation; spleen-stomach diseases most easily produce qi counterflow and qi stagnation. Modern clinical TCM materia medica textbooks mostly classify Guizhi as an exterior-releasing herb, causing these effects of Guizhi to be overlooked.

For gastrointestinal diseases, if abdominal pain is severe, the dose of Shaoyao can be increased. Baishao (white Paeonia) has a very obvious pain-relieving effect; when a patient has severe pain requiring a large dose, Baishao can be used at 60 g or more.

Shaoyao Gancao Tang uses Paeonia's pain-relieving and spasm-relaxing action; the modern patent compound berberine tablet also contains Baishao, mainly for Baishao's pain-relieving effect. In my experience, for spasmodic pain of the gastrocnemius, Baishao works very well; this is probably what traditional TCM means by Baishao's "softening the liver and stopping pain."

Xiao Jianzhong Tang (Minor Center-Strengthening Decoction) is a derived formula of Guizhi Tang. Xiao Jianzhong Tang not only adds yitang (malt sugar) to relax urgency and stop pain but also uses a large dose of Baishao to treat abdominal pain due to deficiency taxation and interior urgency, with good effect. But for patients with too-high blood sugar, the yitang in Xiao Jianzhong Tang is unsuitable; then remove the yitang, and it becomes Guizhi Jia Shaoyao Tang, whose effects are comparable to Xiao Jianzhong Tang.

Guizhi Jia Gegen Tang is Guizhi Tang plus Gegen (Pueraria). Gegen has two effects: first, it can "release the muscles"; modern pharmacology confirms Gegen has a good vasodilating, antispasmodic, and analgesic effect, so Guizhi Jia Gegen Tang can treat the "stiff and rigid neck and back" (meaning spasm of the head, neck, shoulders, and back, with difficulty turning and pain) after a patient contracts wind-cold. Second, Gegen can also stop diarrhea, so Guizhi Jia Gegen Tang can also treat cold-deficiency diarrhea.

I have used Guizhi Jia Gegen Tang to treat ulcerative colitis and atrophic gastritis, with fairly good results.

One patient with ulcerative colitis had for years suffered from aversion to cold, shoulder-back discomfort, and diarrhea; his diarrhea had reached the point where he could not hold it back after eating even slightly unsuitable food, and years of Chinese and Western treatment had failed. I gave him seven doses of Guizhi Jia Gegen Tang; after five doses, this problem was completely resolved.

Another patient with atrophic gastritis also had years of spasmodic discomfort from atrophic gastritis, poor appetite, and emotional depression. Previous doctors had mostly treated him with liver-soothing and depression-relieving herbs, to no effect. He had also been suspected of depression. But after taking three doses of the Guizhi Jia Gegen Tang I prescribed, his symptoms eased greatly.

The Shanghan Lun also has Guizhi Xingren Houpo Tang, which is Guizhi Tang plus Xingren (apricot kernel) and Houpo (Magnolia bark), used for patients who have a Guizhi Tang pattern and chronic cough and wheezing. I subtracted the apricot kernel from this formula, making Guizhi Jia Houpo Tang, to treat intractable abdominal distension and poor appetite caused by gastrointestinal disease; it has some effect. This medication strategy has become a routine approach of mine for treating abdominal distension and poor appetite in cancer patients; I often combine Guizhi Jia Houpo Tang with Houpo Banxia Shengjiang Gancao Renshen Tang.

Guizhi Tang plus Fuling (Poria) can treat the pattern of retained fluid in the stomach. Some patients can clearly hear a splashing fluid sound in their stomach; such patients usually also have indigestion and loose stools. Adding spleen-fortifying, water-draining Fuling to Guizhi Tang, or adding a small amount of Baizhu, can resolve the problem of retained stomach fluid. But Baizhu may irritate the gastric mucosa and cause swelling, so if Fuling alone solves the problem, Baizhu need not necessarily be added.