Tongyu Jian: A Blood-Activating and Pain-Relieving Formula

"Tongyu Jian" comes from Jingyue Quanshu (Complete Works of Zhang Jingyue), an empirical formula of the Ming-dynasty physician Zhang Jingyue. It is composed of Dangguiwei (Tail of Radix Angelicae Sinensis) 2-5 qian (6-15 g), Shanzha (Fructus Crataegi), Xiangfu (Rhizoma Cyperi) and Honghua (Flos Carthami) each 2 qian (6 g), Wuyao (Radix Linderae) 1-2 qian (3-6 g), Qingpi (Pericarpium Citri Reticulatae Viride) 1.5 qian (4.5 g), Muxiang (Radix Aucklandiae) 7 fen (2 g), and Zexie (Rhizoma Alismatis) 1.5 qian (4.5 g). The method is to decoct in water.

This formula activates blood and dispels stasis, moves qi and stops pain. Jingyue Quanshu notes that it treats women with qi stagnation and blood accumulation, obstructed channels, extreme pain resisting pressure, as well as postpartum stasis pain, and blood-reversal and blood-syncope in both men and women. Nowadays it is often used for functional menstrual disorders, premenstrual syndrome, endometriosis, angina pectoris, fatty liver, and various tumors of the qi-stagnation and blood-stasis pain pattern.

Tongyu Jian has a certain analgesic effect and can relieve qi-stagnation and blood-stasis type pain caused by many diseases, including cancer pain. The Wuyao, Xiangfu and Muxiang in the formula are commonly used TCM qi-regulating painkillers; Qingpi breaks up accumulations and stops pain; Dangguiwei, Shanzha and Honghua activate blood and stop pain; Zexie promotes diuresis and drains heat, guiding the herbs downward to assist the above blood-activating and qi-regulating herbs and opening an outlet for the pathogen. This formula has a relatively strong blood-activating action; pregnant women and those at risk of bleeding should use it cautiously.

TCM holds that where there is free flow there is no pain, and where there is pain there is obstruction. As the name suggests, Zhang Jingyue's "Tongyu Jian" is used to unblock stasis obstruction and relieve the various pains caused by static and dead blood lodged in the meridians. So this formula is not only a gynecological formula; wherever there is blood-stasis obstruction, this formula applies.

Using Tongyu Jian as the base and modifying it according to the patient's symptoms can treat many kinds of pain. For pain caused by intermingled cold and stasis with cold limbs, add Rougui (Cortex Cinnamomi), Wuzhuyu (Fructus Evodiae), Aiye (Folium Artemisiae Argyi), Fuzi (Radix Aconiti Lateralis Preparata) and Ganjiang (Rhizoma Zingiberis) to warm the channels, dispel cold and stop pain. For exuberant internal fire with dry mouth and thirst, add Zhizi (Fructus Gardeniae), Mudanpi (Cortex Moutan), Xuanshen (Radix Scrophulariae), Shengdihuang (Radix Rehmanniae) and Tianhuafen (Radix Trichosanthis) to cool blood and drain heat. For severe blood stasis with intense heart-abdominal pain, add Taoren (Semen Persicae), Sumu (Lignum Sappan) and Yanhusuo (Rhizoma Corydalis) to activate blood and resolve stasis. For liver-qi stagnation, add Chaihu (Radix Bupleuri), Yujin (Radix Curcumae), Chao Zhiqiao (stir-fried Fructus Aurantii), Sheng Maiya (raw Fructus Hordei Germinatus), Meiguihua (Flos Rosae Rugosae), Chuanlianzi (Fructus Toosendan) and Yanhusuo to soothe the liver and stop pain. For accompanying constipation, add Sheng Dahuang (raw Radix et Rhizoma Rhei), Shu Dahuang (processed Rhei) and Mangxiao (Natrii Sulfas) to drain heat and unblock stasis. For pain caused by uterine fibroids, endometriosis or tumors, one may also add Sanleng (Rhizoma Sparganii), Ezhu (Rhizoma Curcumae), Ruxiang (Olibanum), Moyao (Myrrha), Shuizhi (Hirudo), Dilong (Pheretima) and Xiatianwu (Corydalis Decumbens) to strengthen the analgesic effect. For angina pectoris from coronary heart disease, add Xiebai (Bulbus Allii Macrostemi), Gualou (Fructus Trichosanthis), Danshen (Radix Salviae Miltiorrhizae), Zhiqiao and Jiegeng (Radix Platycodi).