Tongyu Jian (Stasis-Expelling Decoction): Moving Qi and Stopping Pain
The Ming-dynasty physician Zhang Jingyue recorded an empirical formula in volume 51 of his work Jingyue Quanshu (Complete Compendium of [Zhang] Jingyue). It consists of Dangguwei (tail of Angelica sinensis), Shanzha (Crataegus pinnatifida), Xiangfu (Cyperus rotundus), Wuyao (Lindera aggregata), Qingpi (unripe tangerine peel), Muxiang (Aucklandia lappa), and Zexie (Alisma orientale). It is used to treat "women with qi stagnation and blood accumulation, unsmooth channels, extreme pain refusing pressure, as well as postpartum stasis with excess pain, and blood counterflow or blood syncope in men and women." Today it is commonly used for functional menstrual disorders, irregular menstrual syndrome, endometriosis, angina pectoris, fatty liver, and various tumors presenting with pain due to qi stagnation and blood stasis. It may also be used for pelvic effusion, difficult urination, and painful urination caused by urinary or reproductive system diseases.
Tongyu Jian is composed of blood-activating and stasis-resolving herbs (Danggui tail, Crataegus, Cyperus), qi-moving and pain-stopping herbs (Cyperus, Lindera, unripe tangerine peel, Aucklandia), and water-disinhibiting and dampness-percolating herbs (Alisma); Crataegus and Alisma also lower lipids. Thus the formula activates blood, moves qi, stops pain, promotes diuresis, and lowers lipids. It can treat not only gynecological menstrual disorders and dysmenorrhea but also angina pectoris and fatty liver due to hyperlipidemia, as well as dysuria caused by prostatitis, prostate tumors, or urethral tumors.
This formula can also serve as an analgesic for cancer patients. For late-stage cancer pain due to blood stasis and qi stagnation, it may be combined with Haifu San (equal parts of Ruxiang, Olibanum, and Moyao, Myrrh), Jinlingzi San (Yuanhu, Corydalis, and Chuanlianzi, Melia toosendan), Danshen Yin (Danshen, Salvia miltiorrhiza; Tanxiang, Santalum; and Sharen, Amomum), Shixiao San (Puhuang, Typha, and Wulingzhi, Trogopterus dung), and Qili San (Xuejie, Daemonorops draco; Ruxiang; Moyao; Shexiang, Moschus; Bingpian, borneol; etc.).
The dose of each herb should be set according to the patient's condition. If the patient has difficult urination, the dose of Zexie should be larger, and one may also add Fuling (Poria), Zhuling (Polyporus), Yiyiren (Coix), and Cheqianzi (Plantago seed). If the patient also has ascites or pelvic effusion, Mabiancao (Verbena), Shiwei (Pyrrosia), and Xiaoji (Cirsium) may be added. If blood stasis is severe, shown by a purple sublingual vein, use large doses of the blood-activating, stasis-resolving Danggui tail, Crataegus, and Cyperus. If qi stagnation is severe, shown by wandering, unfixed pain, use large doses of Cyperus, Lindera, unripe tangerine peel, and Aucklandia. If the patient is vexed and irritable, add Meiguihua (Rosa rugosa), Chaihu (Bupleurum), and Yujin (Curcuma aromatica) to soothe the liver and resolve depression.
In general, adults may use 3-12 g of Danggui tail, 10-30 g of Crataegus (raw Crataegus is preferred in this formula), 6-15 g of Cyperus, 6-30 g of Lindera, 3-10 g of unripe tangerine peel, 3-10 g of Aucklandia, and 6-15 g of Alisma per day. The doses may be adjusted according to the patient's symptoms.