Wuji San (Five-Accumulations Powder): A TCM Formula for Resolving Accumulations and Relieving Pain
Wuji San comes from the Xian Shou Li Xu Duan Duan Mi Fang (Secret Recipes from the Immortal for Treating Trauma and Mending Fractures), a classic of TCM orthopedics and traumatology. Wuji San was originally created for traumatic injuries, but because of its striking clinical efficacy, later practitioners also used it for miscellaneous internal-medicine conditions; with proper pattern differentiation, it often produces remarkable effects.Wuji San is composed of: Cangzhu (Atractylodis Rhizoma) and Jiegeng (Platycodi Radix), each 20 liang (600 g); Zhiqiao (Aurantii Fructus) and Chenpi (Citri Reticulatae Pericarpium), each 6 liang (180 g); Shaoyao (Paeoniae Radix), Baizhi (Angelicae Dahuricae Radix), Chuanxiong (Chuanxiong Rhizoma), Chuan-gui (i.e., Danggui, Angelicae Sinensis Radix), Gancao (Glycyrrhizae Radix), Rougui (Cinnamomi Cortex), Fuling (Poria), and Banxia (Pinelliae Rhizoma), each 3 liang (90 g); Houpo (Magnoliae Officinalis Cortex) and Ganjiang (Zingiberis Rhizoma), each 4 liang (120 g); Mahuang (Ephedrae Herba) 6 liang (180 g).Preparation: apart from Zhiqiao and Rougui, grind all the above herbs into a coarse powder, stir-fry over low heat until the color changes, spread out to cool, then add the powdered Zhiqiao and Rougui and mix evenly. For each dose take 3 qian (9 g), add 3 slices of fresh ginger, decoct, and take warm after meals. For traumatic headache or common cold with aversion to cold, in addition to ginger, an appropriate amount of scallion white (Congbai) should also be added.In the Wuji San entry of the Xian Shou Li Xu Duan Duan Mi Fang, it is said to treat five consumptions and seven impairments, headache from injury, and colds with chills. Later generations prepared this formula in proportion as a decoction, named Cangzhu Jiegeng Tang (Atractylodes-Platycodon Decoction), because Cangzhu and Jiegeng are the sovereign herbs. Cangzhu Jiegeng Tang is also used for generalized body pain caused by various infectious diseases.Wuji San has three major effects: first, pain relief—it eases pain from many causes (including cancer pain); second, fever reduction—it induces sweating to lower fever and also has some effect on cancer fever; third, promotion of digestion—modern pharmacology confirms that this formula accelerates gastric and intestinal emptying and small-intestinal propulsion, improving gastrointestinal motility disorders.However, this formula has a drawback: its nature is too warm and drying. Ganjiang, Mahuang, Rougui, Banxia, and other ingredients are all strongly acrid and hot, so patients with yin deficiency or with phlegm-dampness that has transformed into heat will not only fail to get relief but may worsen.Wuji San is the representative formula for the five accumulations—of cold, dampness, qi, blood, and phlegm—caused by external contraction of wind-cold and internal injury from raw, cold food. Such patients commonly have fever and aversion to cold, no sweating, indigestion, poor appetite, epigastric distending pain, chest and abdominal fullness, headache, body pain, stiffness of the neck and back, and pain in the chest and abdomen. This formula may also be used for menstrual irregularity and dysmenorrhea in women when these present as cold patterns.Today this formula is often used for body pain and headache after trauma; sciatica and low-back-leg pain from chronic strain; thromboangiitis obliterans; intercostal neuralgia; frozen shoulder; stomach pain; hiccups; crane’s-knee wind; deep-source nodules; cancer fever; cancer pain; leukorrhea; dysmenorrhea; rheumatic pain; and arthritis, provided the pattern is cold-evil congelation.In Wuji San, Cangzhu (which strengthens the spleen and dries dampness) and Jiegeng (which resolves phlegm and expels pus) together serve as sovereign herbs, drying dampness and resolving phlegm; phlegm and dampness causing disease often produce heavy, aching body pain, so the first task is to resolve phlegm and dry dampness. Fuling, Houpo, and Banxia assist the sovereign herbs, reinforcing phlegm-resolving and dampness-drying. Mahuang, Ganjiang, and Rougui are all acrid-hot herbs that dispel cold throughout the body; once cold is gone and yang arises—like the weather turning from overcast to clear—the phlegm-dampness loses its foundation, and this resolves the cold accumulation. Zhiqiao, Chenpi, and Houpo move qi, resolving the qi accumulation. Shaoyao, Baizhi, Chuanxiong, and Danggui activate blood and relieve pain; used together, these four resolve the blood accumulation. Once all five accumulations are resolved, the patient recovers.Wuji San can also relieve cancer pain and cancer fever in patients with advanced cancer, but it suits only those of cold-damp constitution, not those with yin deficiency and exuberant fire. Because this formula has the side effect of assisting heat and engendering fire, anyone with dry mouth, constipation, or scanty, dark urine should not take it.