当归拈痛汤

3. Tongue and pulse

• Tongue: White, greasy coating with a slight yellow tinge, or yellow, greasy coating.
• Pulse: Wiry and rapid, or soft (ru) and rapid.

4. Common modifications

• Marked swelling and pain of the feet and knees: Add Fang Ji (stephania root) and Mu Gua (chaenomeles fruit) to dispel dampness and reduce swelling.
• Marked generalized body pain: Add Jiang Huang (turmeric rhizome) and Hai Tong Pi (erythrina bark) to invigorate blood, unblock the channels, and relieve pain.
• Severe damp-heat with red, swollen, and hot joints: Add Jin Yin Hua (honeysuckle flower), Lian Qiao (forsythia fruit), and Huang Bai (phellodendron bark) to strengthen the clearing of heat and resolving of toxin.
• Modern applications: This formula is widely used for rheumatic arthritis, rheumatoid arthritis, gout, eczema, and beriberi in patients presenting with a pattern of internal damp-heat accompanied by wind pathogen.

5. Cautions and clinical notes

• Contraindications:
  • Not to be used for cold-damp painful obstruction (cold pain of the joints that worsens with exposure to cold).
  • Use with caution in patients with yin deficiency and fluid depletion.

6. Granule conversion and dose

• Calculation of the total raw herb weight in the original formula:
  • Qiang Huo (notopterygium rhizome) 15 g + Yin Chen (virgate wormwood) 15 g + Zhu Ling (polyporus sclerotium) 9 g + Ze Xie (alisma rhizome) 9 g + Huang Qin (scutellaria root) 9 g + Ku Shen (sophora root) 6 g + Bai Zhu (white atractylodes rhizome) 6 g + Cang Zhu (black atractylodes rhizome) 9 g + Dang Gui (Chinese angelica root) 9 g + Ren Shen (ginseng root) 6 g + Sheng Ma (cimicifuga rhizome) 6 g + Ge Gen (kudzu root) 9 g + Zhi Mu (anemarrhena rhizome) 9 g + Zhi Gan Cao (honey-fried licorice root) 15 g = 138 g.
• Conversion to 5:1 granules:
  • 138 g raw herbs ÷ 5 = 27.6 g granules.
• Recommended dose:
  • One dose daily, divided into two servings taken in the morning and evening, dissolved in warm water, about 14 g per serving.
  • Or as directed by a practitioner, who will modify the formula according to the predominance of dampness, heat, or wind pathogen and the location of disease; the total raw herb weight should then be recalculated accordingly.