Wang Qingren's Tongqiao Huoxue Tang (Orifice-Unblocking Blood-Activating Decoction)

Tongqiao Huoxue Tang (Orifice-Unblocking Blood-Activating Decoction) is a formula created by Wang Qingren himself, from Wang Qingren's work *Yilin Gaicuo (Correction of Errors in Medical Classics)*; it is a famous formula for activating blood and resolving stasis. This formula has a certain effect in improving brain function, treating a variety of difficult and complicated ailments related to cranial nerves, and even treating brain tumors. It can also be used to treat coronary heart disease, vasculitis, and vascular disease.

The composition of Tongqiao Huoxue Tang is: Chishao (Red Peony) one qian; Chuanxiong (Ligusticum) one qian; Taoren (Peach Kernel) three qian (ground into a paste); Honghua (Safflower) three qian; old scallion three stalks (chopped); fresh ginger three qian (chopped); red jujube seven pieces (pitted); Shexiang (musk) five li (wrapped in silk gauze).

This formula is not decocted in water but in yellow rice wine (huangjiu). In *Yilin Gaicuo*, Wang Qingren explained the decocting and taking method: "Use half a jin of yellow rice wine, decoct the above seven herbs into one zhong (cup), remove the dregs, put the musk into the wine, decoct again until it boils twice, and take before going to bed. The weight of yellow rice wine in the formula differs by place; it is better to have two liang too much than too little; decoct to one zhong, by which time the wine has no flavor, so even people who cannot drink wine can take it."

Wang Qingren's *Yilin Gaicuo* was written in the Daoguang reign of the Qing dynasty. According to the conversion standards recorded in *Research on Dosage Standards of Chinese Herbal Decoction Pieces*, edited by Chinese scholars Yang Hongjun and Huang Luqi (published by Fujian Science and Technology Press), one Qing-dynasty jin is about 596.8g today; a Qing jin was sixteen liang, and a liang was ten qian. So one liang here is about 37.3g today, one qian about 3.73g, and one li is one hundredth of a qian, about 0.037g today. By the principle of rounding, this measure can be converted as one qian ≈ 4g today, and one li ≈ 0.04g today.

The five li of musk here is about 0.2g, and half a jin of yellow rice wine is about 300g. So this formula can be converted as: Chishao 4g, Chuanxiong 4g, Taoren 12g (ground into paste), Honghua 12g, old scallion 3 stalks, fresh ginger 12g, red jujube 7 pieces, musk 0.2g. Here the old scallion and fresh ginger must both be chopped when entering the medicine, and the jujubes must be broken open and pitted. A "zhong" is the wine cup used by the ancients, each holding about 20–50 ml; when we decoct the medicine we may consider reducing it to 50 ml.

In *Yilin Gaicuo*, Wang Qingren said that in this formula "musk is the most important," so he specifically urged people to buy genuine musk, and even emphasized that buying Dangmenzi (the gonads of the musk deer enveloping the musk; the musk deer is now a first-class protected animal, and trading in Dangmenzi is illegal) was even better. In the formula song compiled by Wang Qingren, the first line says: "Unblocking the orifice depends entirely on good musk."

Genuine natural musk is now very hard to buy and extremely expensive; at the price of Beijing Tongrentang, one gram of natural musk costs about 1,500–2,000 yuan (2020 price). So the 0.2g of musk in the formula is not cheap either. When decocting musk, it is wrapped in silk gauze and put into the decoction to be boiled "two times"; to save musk, Wang Qingren said the musk can be reused, decocting three batches of medicine before replacing it.

Tongqiao Huoxue Tang is the first formula in the "formula prefaces" of Wang Qingren's *Yilin Gaicuo*; Wang attached great importance to this formula, calling it "the number-one formula for unblocking the channels in both the exterior and interior." The indications of Tongqiao Huoxue Tang he listed are quite broad: hair loss; painful eyes with a red white of the eye (fundus hemorrhage); "liquor nose" (i.e., rhinophyma); long-standing deafness; vitiligo; purpura wind; purple-marked face; blue birthmark on the face like ink; gingival gan (gingival atrophy/ulceration); foul breath; female consumption; male consumptive disease; seasonal relapsing disease (blood-stasis disease); pediatric gan (infantile malnutrition), and various other diseases.

Contemporary scholars, after modifying and adjusting this formula, have widely used it in treating neurological diseases, ophthalmic diseases, ENT diseases, tumors (especially brain tumors, lymphoma, leukemia, and nasopharyngeal carcinoma), various thromboses, and tuberculosis.

This formula emphasizes activating blood and resolving stasis; every herb used is a blood-activating and stasis-resolving herb, so it can effectively lower the viscosity of human blood and improve blood circulation. Whatever disease is caused by obstructed blood circulation can be considered for treatment with this formula. This formula can also inhibit angiogenesis, improve tissue inflammation, and has a certain analgesic effect. Its anti-tumor effect may be related to its inhibition of angiogenesis.

This formula has a good effect on purpura caused by various diseases; what Wang Qingren called "purpura wind, purple-marked face, and blue birthmark on the face like ink" all belong to what modern medicine calls purpura, only appearing in different locations and with varying depth. Whatever such disease is caused by blood stasis, Tongqiao Huoxue Tang has a good effect.

What Wang Qingren called "gingival gan" is also called alveolar wind, i.e., severe gingival ulceration, presenting as red, swollen, ulcerated, foul, pus-discharging and painful gums, and even rotting tooth roots and loose teeth falling out.

When treating gingival gan, Wang Qingren did not use only Tongqiao Huoxue Tang. He had the patient "take one dose of Tongqiao Huoxue Tang in the evening," take one dose of Xuefu Zhuyu Tang (Blood House Stasis-Expelling Decoction) in the morning, and during the day decoct eight qian of Huangqi (Astragalus), using the Astragalus decoction in place of tea. That is, three doses of medicine a day: Xuefu Zhuyu Tang in the morning, Astragalus decoction during the day, and Tongqiao Huoxue Tang in the evening. Wang Qingren said of this treatment plan: "Effect seen in three days, great effect in ten days, complete recovery in one month. Even if five or seven teeth have fallen out, as long as the cheek is not perforated, all can be saved."

What Wang Qingren called "female dry consumption" may be female amenorrhea. Wang interpreted "female dry consumption" as: "menstrual blood absent for three or four months, or absent for five or six months, with cough and urgent panting, reduced eating, weakness of the limbs, low fever in the afternoon, worse toward evening." This symptom resembles uterine amenorrhea in women, which can cause infertility; so some physicians also use this formula to treat infertility.

The author has seen some female patients consulting physicians on a certain medical platform, mentioning that they have both amenorrhea and the symptoms of cough and low fever. Modern medicine cannot explain such a situation, but according to Wang Qingren's records, this situation is fairly common among gynecological diseases. Wang Qingren said that such patients, "if they take three or six doses of this formula, or in the most severe cases nine doses, there is none that does not recover." Because the author has not specialized in gynecology and has seen relatively few gynecological patients, I have not clinically verified the efficacy of this formula for female amenorrhea; but Wang practiced medicine for decades, and the clinical experience he wrote down should be trustworthy.

What Wang Qingren called "male consumptive disease" has the symptoms: "at first the limbs are sore, weak and without strength, gradually the muscles waste away, eating decreases, the complexion is yellowish-white, there is cough and spitting of foam, the heart is vexed and irritable, there is tidal fever in the afternoon, and much sweat at daybreak"; this is also a difficult and complicated ailment. Some tumor patients, thrombosis patients, and pulmonary embolism or lung cancer patients have such symptoms. Wang Qingren believed this was caused by blood stasis, so treatment must also activate blood and resolve stasis, using Tongqiao Huoxue Tang. For deficient patients who, after taking three doses of this formula, develop weak qi, Wang Qingren, while using this formula, also told the patient to daily decoct eight qian of Huangqi and take it in place of tea.

Tested in the clinic, Tongqiao Huoxue Tang indeed has very broad indications. The author has seen Professor Yin Huihe use Tongqiao Huoxue Tang when treating esophagitis or esophageal cancer; Professor Gan Zuwang use it when treating stubborn deafness; and Professor Zhang Xuewen use it when treating various perivascular lesions and cardiovascular and cerebrovascular diseases. As long as the physician is skilled in using it, it can have a very good effect.

In recent years some scholars have also studied the ligustrazine contained in the Chuanxiong in this formula for treating vasculitis, vascular disease, and coronary heart disease; ligustrazine injection has become a commonly used injectable drug. But the traditional TCM method of using multiple herbs together to act in concert is stronger than the action of a single herb. So we should study Wang Qingren's formula well and apply it flexibly in clinical practice.