Dang Gui Nian Tong Tang - 當歸拈痛湯 - Tangkuei Decoction to Pry Out Pain

Author: Li Gao / Li Dong Yuan, 李杲 / 李東垣

Year: Yuan dynasty

Source: Expounding on the Origins of Medicine

Category: Formulas that Expel Dampness

Pattern: Damp-Heat with Wind obstructing the Channels and Collaterals

Key Symptoms: Generalised body aches and pain accompanied by irritability, a heavy sensation in the shoulders and back, discomfort or a constricted sensation in the area of the chest and diaphragm, aching and painful extremities and joints with unbearable swelling and pain of the lower extremities
Secondary Symptoms: Multiple sores, carbuncles, furuncles or abscesses accompanied by redness, persistent swelling and itching, fever or thirst

Tongue: Greasy with a tinge of yellow
Pulse: Wiry and rapid, or soggy and moderate, or slippery and rapid

Ingredients

15g

Ge Gen

Pinyin: Dang Gui Chinese: 當歸 Pharmaceutical: Radix Angelicae sinensis Taxonomy: Angelica sinensis English: Chinese Angelica Root / Tang-Kuei / Dong Quai Root
Tastes: Sweet, Pungent, Warm Meridians Entered: Heart and Liver
Actions & Indications: Tonifies the Blood and regulates the menses Blood Deficiency, especially when affecting the Heart and Liver with pale, ashen complexion, lusterless nails, tinnitus, blurred vision and palpitations Blood Deficiency associated irregular menstruation, amenorrhea and dysmenorrhea Invigorates and harmonizes the Blood and disperses Cold (stops pain due to Blood Stasis) Blood Stasis causing abdominal pain and carbuncles and pain due to Blood Stasis from traumatic injury, especially when accompanied by Deficiency Cold Postpartum menstruation Pregnancy (use with caution) Blood Deficiency with chronic Wind-Damp-Bi Moistens the Intestines and unblocks the bowels Dry Intestines due to Blood Deficiency Reduces swelling, expels pus, generates flesh and alleviates pain Sores and abscess (Chuang Yung), internally and topically Stops coughing and treats dyspnea Used adjunctively for coughing Tonifies the Blood while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 6-12g in decoction. Cautions: It is contraindicated in cases of Damp-Heat stagnating in the Middle, Lung Heat with Phlegm Fire, and Yin deficiency with effulgent Yang because it is warm and sweet in properties. In addition, it should be used with caution in cases of loose stool because it can moisten intestines to smooth stool. Many sources recommend using caution, avoiding or only taking under guidance of a TCM physician during pregnancy as it can cause uterine contractions. However, there are no studies supporting this and the only scientific literature seems to suggest that Z-Ligustilide has anti-spasmodic activities that alleviate dysmenorrhoea by inhibiting uterine contractions (Du et al., 2006; Dietz et al., 2016). Caution is also advised in breast cancer patients due to its oestrogen stimulating activity. This based upon Lau et al (2005) who found it may stimulate breast cancer growth in vitro, however Yue et al, (2019) demonstrated that it is not that stimulatory in breast cancer both in vitro and in vivo through a series of tests, although they suggested it should still be used with caution in estrogen receptor-positive breast cancer. Conversely, a large population study in Taiwan by Wu et al (2014) found it reduced the subsequent risk of endometrial cancer in breast cancer survivors taking tamoxifen, especially in those of reproductive age.

Ren Shen

Gan Cao

15g

Pinyin: Gan Cao Chinese: 甘草 Pharmaceutical: Radix Glycyrrhizae Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata English: Liquorice Root
Tastes: Sweet, slightly cold Meridians Entered: Heart, Lung and Spleen (and all 12 meridians)
Actions & Indications: Tonifies the Spleen and augments Qi Spleen Qi Deficiency with shortness of breath, lassitude and loose stools Qi and Blood Deficiency with an irregular pulse and/or palpitations Heart Qi Deficiency or Heart Yang Deficiency Moistens the Lungs, resolves Phlegm and stops coughing Lung Heat or Cold Productive or non-productive coughing Moderates spasms and alleviates pain Painful muscle spasms of the abdomen and legs Clears Heat and relieves Fire Toxicity Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung) Antidote for many toxic substances (internal and topical) Poisoning Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas) Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels Often added in small doses to harmonise formulas Tonifies the Qi while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g. Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium. The NHS recommends avoiding during pregnancy.

Ku Shen

(wine washed)

Huang Qin

(dry fried)

Zhi Mu

(wine washed)

Yin Chen Hao

15g

Zhu Ling

Ze Xie

Preparation: The original text advises grinding the herbs into powder and taking a 30g in 2 cups of water, leave it to sit for a while and then boil it down to 1 cup. Strain and leave to sit again, then drink. It is more commonly prepared as a decoction today.

Actions: Resolves Dampness, clears Heat, disperses Wind, stops pain

Contraindications: Wind-Cold-Damp Bi syndromes

Notes:
The use of wine washing prior to decocting for Ku Shen and Zhi Mu but not Dang Gui is unusual and makes little sense from a modern biochemical perspective. It is widely recognised that Z-ligustilide, the main anti-inflammatory compound in Dang Gui, is not water soluable and that prior alcohol extraction increases its yield considerably (Chao & Lin, 2011). However, matrine, an opoid receptor agonist in Ku Shen, is water soluable and so does not require wine washing to release (Sun et al., 2022). Ethanol extracts of Zhi Mu meanwhile, have displayed better acetylcholinesterase inhibitory activity than water extracts, which is of use in some neurodegenerative disorders, but water and other solvents have shown equal or superior antioxidant activity (Chu et al., 2022). However, the original instruction to grind and leave to sit in water for a while could help extraction of non polar compunds from the other herbs in the formula.

From a traditional perspective, wine fried Zhi Mu guides its action upward, lessening its cold, draining qualities, and wine frying Ku Shen moderates its bitter, cold nature and helps it enter the Blood level (Bensky et al., 2004: pp. 94 & 146). This means the aim of wine treating them is to maintain their activity while reducing their cold properties, and maybe enhancing Ku Shen's affinity for the Blood, so it focuses on clearing Damp-Heat obstructing the Channels and Collaterals.

Research Links:

American Dragon

TCMWiki

Journal of Chinese Medicine

National Resource Centre for Chinese Materia Medica, China

TCM-ID Integrated Database, East China Normal University

TCM-ID Information Database, National University of Singapore

Pubmed

Science Direct

Google Scholar

Bai Du (Chinese)

A+ Medical Encyclopedia (Chinese)

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.

Herb Formulas Notebook

當 歸 拈 痛 湯  Dang Gui Nian Tong Tang

Tangkuei Decoction to Pry Out Pain