The Tiny Quzhang Tang That Treats Spasmodic Pain
In Zhang Zhongjing's Shanghan Lun there is a very small formula, Shaoyao Gancao Tang (Peony-Licorice Decoction), with only two herbs: Shaoyao (Peony) and Gancao (Licorice), each four liang; in modern use each is generally 12 g.
In the Shanghan Lun, Shaoyao Gancao Tang is used mainly for "acute spasm of the feet."
In practice, this formula has a good effect on the impaired flexion and extension of both feet caused by spasmodic pain in some patients; hence it also bears the fine name "Quzhang Tang" (Staff-Removing Decoction), describing how, after taking it, one can throw away the walking stick.
Professor Liu Duzhou held that Shaoyao Gancao Tang has the actions of sour-sweet generating yin, nourishing blood and pacifying the liver, and relieving sinew-vessel spasm; it excels at treating blood-vessel constriction pain, and is quite effective for spasmodic pain of both feet or gastrocnemius spasm due to blood deficiency that cannot straighten out.
Ke Yunbo considered Shaoyao Gancao Tang a "method of using yin to harmonize yang": it uses Gancao to generate the fluids of Yangming and Shaoyao to harmonize the fluids of Taiyin; with yin and yang harmonized, "the feet straighten out."
Professor Hu Xishu held that Shaoyao in Shaoyao Gancao Tang mainly treats contracture and spastic pain, so Shaoyao Gancao Tang can be used for acute foot spasm and weak, flaccid lower limbs, and also for abdominal pain.
The Japanese kampo physician Yoshimasu Tōdo, in his book Yakuchō, summed up the action of Shaoyao as "mainly treating firm, knotted, spasmodic conditions, and also abdominal pain, headache, numbness of the body, abdominal fullness, cough-reversal, diarrhea, and swelling/pus."
Another Japanese kampo physician, Yumoto Kyūmin, held that the indication for Shaoyao is, on palpation of the muscle, "a feeling of knotted fullness with contracture."
As for the action of Gancao, Yumoto Kyūmin thought it much like that of Shaoyao: Gancao "has a relieving action on tissues, and is especially suitable for pain arising from sudden, severe muscular contraction and for various other urgent symptoms."
So the two herbs Shaoyao and Gancao, combined, have a strong effect of relieving the pain or spasm caused by muscle contraction.
This formula has a derivative, Shaoyao Gancao Fuzi Tang. The Shanghan Lun records: "If, after promoting sweating, the disease does not resolve but there is aversion to cold, this is deficiency; Shaoyao Gancao Fuzi Tang governs it."
This formula is tiny and little discussed; many scholars pass it over in a line, which is a pity.
Many years ago I saw a cervical-cancer patient from Shanghai whose feet would not straighten after radiotherapy, making walking very hard. When she came to me for help, I prescribed Shaoyao Gancao Tang: Shaoyao 12 g, Gancao 12 g.
Getting the formula, she found it unbelievable—such a serious radiotherapy after-effect, treated with just these two herbs? Later, on my insistence, she finally tried it.
The result: after only one dose, her feet straightened; the next day she took another dose, and could go shopping in the mall happily.
This patient had thought she would be like this for the rest of her life, because her Western attending physician had tried many ways and failed to cure this after-effect, and the TCM doctors she saw could not solve it either; she never dreamed that such a simple little formula could have such good effect.
The TCM formulas she had taken before were a mixed bag—Duhuo Jisheng Tang, Huoluo Dan—the doctors all treated her as a bi-pain condition. No one was willing to treat her as a simple "acute foot spasm."
Later another Shanghai patient came to me; as I treated her, she told me her father had a strange condition: his toes stuck tightly together, impossible to pry apart, and the sole of the foot was very painful. Also untreatable by all methods.
Hearing this, I prescribed him Shaoyao Gancao Tang: Baishao (white peony) 12 g, Gancao 12 g. After five doses, he was better.
Yesterday, the daughter of that foot-spasm patient herself had spasm and discomfort in the sole, and asked me for a formula; I prescribed the same one her father had taken. She probably has not started it yet, but I expect it will solve her problem quickly too.
Another patient I treated had knots of sinew all over his entire left leg, lumped together and looking rather alarming.
He is also a family member of one of my cancer patients; because someone at home had a tumor, as soon as this symptom appeared he suspected he had a tumor too, was very frightened, and came to me for help.
I judged it not a tumor but merely cramping of the foot sinews. I prescribed the same Shaoyao Gancao Tang: Shaoyao 12 g, Gancao 12 g. Taken continuously for about ten days, all the sinew knots were gone.
I once saw Professor Liu Duzhou treat a similar patient: the patient had a mass in the right groin shaped like a chicken egg, not red on the surface, and no contents could be drawn out with a needle.
Only the right leg was contracted and could not straighten, the calf often cramped, and the heel could not touch the ground. Old Liu also cured this patient with Shaoyao Gancao Tang.
This formula is truly wondrous. I have also checked the Zhonghua Bencao and the Zhongyao Da Cidian; by modern pharmacological research, there is simply no way to explain why this formula treats "acute foot spasm."
I hope scholars will in future do deeper research in this area. My humble essay aims only to introduce this small formula, hoping that patients with the relevant indications may try it.
This formula has few herbs and small doses, and Baishao and Gancao are both completely non-toxic Chinese herbs, so it should not cause major side effects.
Let me introduce a few more case reports for your reference.
Professor Liu Duzhou once used this formula to treat a patient surnamed Cao, 53, whose main symptom was gastrocnemius spasm, mostly at night, with a wiry pulse and red tongue. Old Liu prescribed Shaoyao Gancao Tang; the patient recovered after four doses.
Professor Liu Duzhou also treated a 12-year-old girl whose main symptom was painful swelling after an injury to the left buttock, with the left lower limb contracted and unable to extend, plus fever of 37.8°C and a wiry, fine, rapid pulse. Western diagnosis was suppurative hip arthritis.
Professor Liu judged it liver-blood deficiency with impeded vessels and bound-up heat, and prescribed Shaoyao Gancao Tang. After three doses the patient could walk; after two more she was basically well, and was later followed up with Xianfang Huoming Yin.
Xu Dihua treated a 28-year-old man whose calf had cramped for over three months, worsening with work and improving with rest; after each episode the calf ached for days, with dizziness and fatigue and a soft, fine pulse.
Xu gave Shaoyao Gancao Tang; after only two doses the patient recovered. The formula was then modified with Huangqi, Dangshen, Danggui, and others for five days of follow-up, and there was never a recurrence.
Wang Mingru treated a 45-year-old woman with restless legs syndrome: for four months both calves had an indescribable aching, numb, heavy pain, like cramping, like electric shock, worse when sitting still and resting, relieved by patting and squeezing.
Based on the pulse, Wang also gave Shaoyao Gancao Tang: Shaoyao 60 g, Gancao 5 g. After five doses the patient was much better; continuing the original formula for a month, she was completely cured.
Liu Chinian treated a patient with acute gastric spasm, also giving Shaoyao Gancao Tang, and cured him.
Liu Guopu treated a 45-year-old migraine patient whose migraine was spasmodic pain; Western tests were all normal, so no one knew how to medicate.
Seeking TCM also failed after many treatments. Coming to Liu Guopu, he thought it over and, since it was spasmodic pain, Shaoyao Gancao Tang should be used. After twelve consecutive doses, the patient's headache was completely cured.
Chen Hanxiong treated a 64-year-old woman with trigeminal neuralgia, also using Shaoyao Gancao Tang for four days, cured.
This patient's severe pain was triggered by swallowing or speaking; during the pain she closed her eyes, wept, pouted, and gritted her teeth, lasting over ten seconds before pausing, then recurring. After blood-nourishing, wind-expelling herbs failed, she switched to Shaoyao Gancao Tang: Chao Baishao (stir-fried white peony) 30 g, Chao Gancao (stir-fried licorice) 12 g, which worked.
Overall, Quzhang Tang (Shaoyao Gancao Tang) treats mainly contractile, spasmodic pain.
Traditional TCM theory holds that Shaoyao and Gancao together are sour-sweet generating yin, with the action of soothing the liver and easing urgency. Until more convincing research appears, this is probably how to sum up its action.
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