Jiedu Jisheng Decoction for Extremity Gangrene from Waike Zhengzong

Tuo ju ("sloughing gangrene") is a TCM disease name. In its early stage the affected limb is cold and numb, with intermittent claudication and rest pain; in the later stage the toe joints necrose and slough off, turning black, decaying, and ulcerating, with wounds that long fail to heal—hence the name "sloughing gangrene." This disease corresponds to thromboangiitis obliterans (Buerger's disease) and atherosclerotic occlusive disease in modern medicine. It most often affects young and middle-aged men or the elderly, and is more common in northern than in southern China. Both hereditary and environmental/lifestyle factors contribute: smoking, abdominal obesity, prolonged sitting, prolonged standing, and chronic heavy loading predispose to the disease. It progresses slowly, has a long course, worsens in cold, and easily recurs. It also readily comorbid with popliteal cysts; patients with a concurrent popliteal cyst additionally have limited flexion and extension of the knee. In addition, cancer patients may develop such sequelae after chemotherapy. In Waike Zhengzong (Orthodox External Medicine) by the Ming-dynasty external-medicine master Chen Shigong, there is a formula called "Jiedu Jisheng Decoction" (Toxin-Resolving Life-Supporting Decoction), specifically for treating tuo ju. Its composition is: Chuanxiong (Chuanxiong Rhizoma), Danggui (Angelicae Sinensis Radix), Huangbo (Phellodendri Cortex), Zhimu (Anemarrhenae Rhizoma), Tianhuafen (Trichosanthis Radix), Jinyinhua (Lonicerae Flos), Maimendong (Ophiopogonis Radix), Yuanzhi (Polygalae Radix), Chaihu (Bupleuri Radix), Huangqin (Scutellariae Radix), Xijiao (rhinoceros horn—today replaced by water buffalo horn, used at triple the dose), and Fushen (Poriae cum Pini Radis), each 1 qian (3 g); Gancao (Glycyrrhizae Radix), Honghua (Carthami Flos), Shengma (Cimicifugae Rhizoma—add if the condition is on the fingers), and Niuxi (Achyranthis Bidentatae Radix—add if on the toes), each 5 fen (1.5 g). Use 1 bowl of water (300 ml), decoct down to eight-tenths of a bowl (240 ml), strain; before sleep add 150 ml of boy's urine and take according to the location of the disease. Chen Shigong's formula activates blood and reduces swelling, and resolves toxin and clears heat. It treats the early stage of tuo ju: aversion to cold and bodily fatigue, fever and thirst, swelling or purplish discoloration, numbness or pain, weary limbs, and a wandering, unsettled mind. In the formula, Chuanxiong, Danggui, Honghua, Shengma, and Niuxi activate blood and resolve stasis; Huangbo, Zhimu, Tianhuafen, Jinyinhua, and Xijiao clear heat and resolve toxin, reduce swelling and stop pain; Chaihu and Huangqin release the exterior; Maimendong nourishes yin; Yuanzhi quiets the heart; Gancao harmonizes the other herbs. Used together, it addresses both root and manifestation in tuo ju. This disease has a long course; some patients need long-term—even lifelong—medication. Once an initial effect is seen with this decoction, it is advisable to process the formula into pills for gentle, prolonged regulation. Medical care must be combined with lifestyle: change bad habits and control weight.