Zhuangyao Jianshen Decoction for Bone Injury and Osteoporosis
Zhuangyao Jianshen Decoction ("Lumbar-Strengthening and Kidney-Fortifying Decoction") is from Chinese Orthopedics and Traumatology. Its composition is: shudihuang (Prepared Rehmannia) 12g, duzhong (Eucommia bark) 12g, shanzhuyu (Cornus fruit) 9g, gouqizi (Lycium fruit) 9g, buguzhi (Psoralea fruit) 9g, roucongrong (Cistanche) 9g, tusizi (Cuscuta seed) 9g, danggui (Angelica sinensis) 9g, honghua (Safflower) 6g, qianghuo (Notopterygium) 6g, duhuo (Angelica pubescens) 6g.
According to TCM theory, this formula has the effects of regulating the liver and kidney and strengthening the sinews and bones. It is primarily used for fractures and sinew injuries, osteoporosis, and related conditions. Clinically, it is used when there is a history of various fractures and sinew injuries accompanied by generalized soreness and weakness of the lower back and knees, dizziness and tinnitus, nonunion of fractures, sallow complexion, aversion to cold with cold limbs, a pale and tender tongue with white slippery coating, and a deep fine pulse. It can also be used for postmenopausal osteoporosis, lumbar disc herniation, and other patterns of liver-kidney deficiency with malnourished sinews and bones.
TCM considers soreness and weakness of the lower back and knees and pain of the sinews and bones to be related to liver-kidney deficiency, especially kidney deficiency. Kidney deficiency is further divided into kidney yang deficiency and kidney yin deficiency. Those with kidney yang deficiency present with aversion to cold, cold limbs, and obvious loose stools; for such patients, yang-warming kidney-tonifying herbs such as fuzi (Aconite), rougui (Cinnamon bark), suoyang (Cynomorium), and yangqishi (Actinolite) may be added to warm the kidney and invigorate yang. Those with kidney yin deficiency commonly present with five-center heat and night sweats; for such patients, zhimu (Anemarrhena), huangbai (Phellodendron), and guijia (Turtle shell) may be added to nourish yin and clear deficiency heat.
For patients with bone destruction and malnourished bones, gusuibu (Drynaria), maogu (cat bone), xuduan (Dipsacus), and zitong (Pyritum) may be added to strengthen bones and reconnect sinews. For local stasis swelling with a dark purplish color, sumu (Sappan wood), jixueteng (Spatholobus), taoren (Peach kernel), and dibiechong (Eupolyphaga) may be added to activate blood and disperse stasis. For qi and blood deficiency, double the dose of danggui and add chishao (Red Peony root), chuanxiong (Ligusticum), huangqi (Astragalus), and dangshen (Codonopsis) to supplement qi and nourish blood.
Removing danggui and honghua from this formula and adding nvzhenzi (Ligustrum fruit) 9g, mohanlian (Eclipta) 9g, and Shayuanzi (Astragali complanati semen) 9g can be used to relieve osteoporosis caused by endocrine therapy in breast cancer patients. Breast cancer patients undergoing endocrine therapy are prone to develop osteoporosis similar to postmenopausal osteoporosis, but such patients cannot use blood-activating and menstruation-promoting herbs like danggui and honghua. Therefore, danggui and honghua are removed and replaced with nvzhenzi, mohanlian, and shayuanzi.
This formula can also be used to relieve pain caused by bone metastases in cancer patients (especially osteolytic bone metastases), though its effect on cancer pain in end-stage patients is limited. When relieving pain in cancer patients with bone metastases, dangshen, huangqi, baizhu (Atractylodes), fuling (Poria), chuanxiong, and chishao may be added to supplement qi and nourish blood, while weilingxian (Clematis), xuchanging (Cynanchum paniculatum), ruxiang (Frankincense), moyao (Myrrh), yanhuosuo (Corydalis), xiatianwu (Corydalis decumbens), and jishiteng (Paederia) may be included to enhance pain relief.