Analysis of Guizhi Zhimu Shaoyao Decoction in Synopsis of the Golden Chamber-《金匮要略》桂枝知母芍药汤解析

[Original] The limbs are painful, the body is strong, the feet are swollen like off, the head is dizzy, short of breath, warm and vomiting, Guizhi Peony Anemarrhena decoction is the main one.

[Explanation] Those who traverse the joints, the pain in the limbs refers to the pain in each joint, which is caused by rheumatic arthralgia. Due to wind dampness blocking the collaterals, poor circulation of qi and blood, and long-term physical consumption, the body is thin, weak in movement, thin limbs and swollen joints, similar to the knees of cranes, swollen feet seem to be separated from the body, numbness, and disturbance of wind evil. Yang leads to dizziness, dampness obstructs the middle focal point, chest tightness and shortness of breath, and stomach discomfort leads to nausea and vomiting. The main treatment is Guizhi Shaoyao Zhimu Decoction, which disperses wind and cold, dispels dampness and relieves pain.

[Therapeutic Law] Dispel wind and dampness, warm the meridians and dispel cold.

[Composition of prescriptions] Guizhi 4 taels, peony 3 taels, licorice 2 taels, Ephedra 2 taels, ginger 5 taels, Atractylodes 5 taels, Anemarrhena vulgaris 4 taels, Fangfeng 4 taels, and Aconite 2 taels (cannons).

[Administration and Taboos] Take seven liters of water for the top nine flavors, boil two liters, take Qihe warmly, and take three days a day.

[Theory of Classic Prescriptions] This prescription is composed of Guizhi Decoction Shaodazao, Mahuang Decoction Shao almonds plus Atractylodes, Aconite, Fangfeng and Zhimu. Take Ma and Gui in the prescription to dispel wind and cold, and relieve the cold and heat in the surface. It can be seen that when there is cold and heat in the prescription, use Atractylodes macrocephala to invigorate the spleen to dry the inner dampness, and aconite to warm the meridian to dispel cold and relieve pain. Because this syndrome is incomprehensible to heat, adding aconite but also fearing to help yang, it is used to reduce dryness, wind-proof and Guima are combined to dispel wind and cold, and the dosage of ginger is exclusively used to disperse water and dampness, and the spleen and stomach, to prevent nausea. If the prescription is to go to Zhimu, it is easy to prevent oneself, enhance the power of removing dampness and heat, and also supervise the dryness of aconite, plus astragalus for replenishing qi and removing dampness, its effect is better.

【New Use of Jing Fang】

(1) Guizhi Shaoyao Zhimu Decoction with 15 grams of Gentiana sylvestris, 30 grams of Salvia miltiorrhiza, 30 grams of Weilingxian, 8 grams of Fangji, it is effective in treating rheumatic arthralgia and joint swelling and pain.

(2) Guizhi Shaoyao Zhimu Decoction to remove ephedra, Zhimuyi ginseng 15 grams, and tangerine peel 15 grams, treat irritable bowel syndrome with strong liver and weak spleen.

[Hu Xishu’s medical records and clinical experience] Xu, male, 19 years old. The date of first visit was February 15, 1966. The left foot has been swollen and painful for five or six years, and it has worsened in the past two years. After taking X-ray film, it was confirmed to be calcaneal bone hyperplasia. Present symptoms: left foot swelling and pain, fear of cold, severe pain when walking, not thinking about drinking, thin white coating, sinking pulse. This rheumatism belongs to the syndrome of Sun Shaoyin, and it is the prescription of Guizhi Shaoyao Zhimu Decoction: Guizhi 12g, Ephedra 6g, White Peony 9g, Anemarrhena 12g, Ginger 12g, Sichuan Aconite 6g, Fangfeng 12g, Atractylodes 12g, Roasted Licorice 6g .

Result: After taking 7 doses of the medicine, the pain in the left heel was reduced, and the pain remained after walking, and the recovery was faster after rest than before treatment. Zengchuan Aconite was taken after 9g. After 1 month, the left heel swelled and the pain was not obvious.

[Interpretation and Appreciation] This prescription is mostly used for chronic rheumatism and rheumatoid arthritis with syndrome of Taiyang Shaoyin, especially those who see joint swelling and deformation accompanied by qi reversal. If rheumatic fever and joint swelling are obvious, plaster can be added.

Chen Ruichun’s medical case:

Liu ××, female, 27 years old, kindergarten teacher. First visit on April 8, 1979. When the patient saw a doctor, the joints of the two fingers were swollen, painful and deformed, and the pain was worse under cold water. The morning stiffness was obvious, the fingers could not bend, and the pain became worse in rainy days, and the local redness and swelling were obvious. Anti-“O”, normal erythrocyte sedimentation rate, positive rheumatoid factor

Positive). Others such as menstruation, diet, two stools, and sleep are the same, but the pain at night when the attack occurs, which affects sleep, the pulse is slow and stringy, the tongue is light and the blood pressure is normal.

Prescription: 10g of Guizhi, 15g of Radix Paeoniae Alba, 10g of Attached Tablets, 6g of Raw Ephedra, 15g of Anemarrhena, 10g of Atractylodes Macrocephalae 10g, 10g of Fangfeng, 10g of Qinguang, 6g of Sichuan and Caowu each, 5g of Roasted Licorice and 3 Pieces of Ginger. Take 1 dose a day and decoct for 1 hour. Decoction 2 times in divided doses.

Second visit, April 20. After taking the above 10 doses, I felt that the pain in the joints of the fingers was relieved, the morning stiffness disappeared, the pain and pain of washing with cold water were alleviated, and the others were still normal. Ask the original prescription to enter again.

Third visit, November 5. The patient took the medicine at the unit and took more than 40 doses successively. The redness and swelling of the finger joints basically subsided, the deformation did not increase, and the others were all normal. The pulse is slow and the tongue is soft. Guard the top before entering. Add another party and take the two alternately.

Recipe: 10g of Alone, 20g of Parasite, 10g of Gentiana, 3g of Asarum, 10g of Parsnip, 15g of Rehmanniae Rehmanniae, White

Peony root 10g, Chuanxiong 5g, Angelica 10g, Guizhi 10g, Poria 15g, Eucommia 10g, Achyranthes bidentata 15g, Codonopsis 15g, Raw Astragalus 15g, Mulberry Branch 15g. Decoction 1 dose a day, decocted 2 times in divided doses.

After that, the patient went to another place for medical treatment and was treated with insect medicine in a specialist hospital, but the symptoms were not improved. Sometimes I come to follow-up and use the first two alternately.

On October 15, 2001, he came back for a follow-up visit. The patient complained: After receiving the above treatment, the finger joints remained stable in their original appearance, the deformation did not aggravate, and he was able to take care of himself and insisted on going to work.㔾Menopausal for more than a year, full body, keep exercising, and retire at home. The above two prescriptions are still taken alternately.

Note: Rheumatoid arthritis is similar to Lijie wind pain in the “Golden Chamber”. Clinically, Guizhi Shaoyao Zhimu Decoction can be used to control symptoms. After treating many cases, the effect of relieving symptoms can be achieved. The author has the following experience:

(1) Rheumatoid arthritis should be detected, diagnosed and treated early. A worker who once treated a female seal engraving, when he found pain and swelling in his right index finger joint, came to see a doctor, and immediately gave Guizhi Shaoyao Zhimu Decoction. After taking 15 doses, he has not relapsed. Therefore, it should be controlled as soon as possible, because the disease is expensive in early treatment.

(2) For the treatment of rheumatoid arthritis, Guizhi Shaoyao Zhimu Decoction is the effective first choice. It should be added to this prescription to make Chuancaowu to enhance the curative effect of Wentong, and it should be taken for a long time, 40 doses, 50 doses or more. Until the symptoms are controlled, it is still necessary to consolidate from the upper side, but if the yin is weak, the medication will be very difficult. It will not work without warming, and it will hurt the yin with warming. There is no better way.

(3) The problem of using Duhuojijie Decoction. Originally, Duhuojijietang was a recipe for invigorating qi and blood, nourishing liver and kidney, but for patients with rheumatoid arthritis, after pain relief and symptom relief, it should be used in conjunction to make it nourishment, nourishment, and beneficial.

(4) The problem of using insect medicine. Many doctors use the method of searching wind to dry blood, which has no obvious effect on rheumatoid arthritis, and the reaction to dry blood is obvious after taking a lot of long-term use, so it is recommended to use less or not.

(5) The problem of using hormones to relieve pain. In the case of unbearable pain, use it for a period of time to relieve it. But just accept it when you see it. Long-term use is prone to cause osteoporosis, and at best, the gains and losses are mixed. In other words, the losses are greater than the gains. At present, there are tripterygium wilfordii drugs on the market. These drugs may be effective for some patients for a while, but long-term use of liver damage should not be ignored.

In short, both Chinese and Western medicines were not ideal for the treatment of this disease. The traditional Chinese medicine uses Guizhi Shaoyao Zhimu Decoction to add flavor, no toxic side effects are seen, and long-term use is also worry-free. Other hormone treatments, such as Tripterygium wilfordii and insect drugs, have found toxic side effects, which are worthy of further exploration and discussion.

Author: Wu Xiufei