Gui Zhi Shao Yao Zhi Mu Tang - 桂枝芍藥知母湯 - Cinnamon Twig, Peony And Anemarrhena Decoction

English:	Cinnamon Twig, Peony and Anemarrhena Decoction
Also Known As:	Cinnamon and Anemarrhena Combination

Herbs And Actions

Pharmaceutical Latin	Pin Yin	Dosage	Actions
Ram. Cinnamomi	Gui Zhi	3-12g	Releases the Exterior, warms the channels and collaterals to relieve pain, disperses Cold, unblocks Yang, transforms Qi and releases the muscle layer. With Ma Huang, for Wind-Cold-Damp Bi. With Bai Shao,for External Wind-Cold with disharmony between the Ying and Wei, with spontaneous sweating. With Zhi Fu Zi, for chills and painful extremities due to Yang Deficiency with Wind-Cold-Damp Bi and backache due to Wind-Cold Damp Bi.
Rx. Ephedrae	Ma Huang	3-9g	Disperses Cold, Promotes urination, Reduces edema, Releases the Exterior.
Rx. Aconiti Lateralis Preparata	Zhi Fu Zi	0.5-15g	Dispels Dampness, Disperses Cold., Warms the channels, Warms the Spleen. With Bai Zhu, for Wind-Damp Bi.
Rx. Anemarrhenae	Zhi Mu	3-12g	Nourishes Yin, moistens Dryness, generates Fluids and ameliorates the dryness of tonifying or warming herbs.
Rx. Paeoniae Alba	Bai Shao	3-9g	Nourishes Blood, astringes Yin and alleviates pain.
Rz. Atractylodis Macrocephalae	Bai Zhu	4-15g	Dries Dampness, Stabilizes the exterior, Tonifies Qi, Tonifies the Spleen.
Rx. Saposhnikoviae	Fang Feng	3-12g	Alleviates pain, Expels External Wind-Cold and Heat, Expels Wind-Cold-Dampness, Releases the exterior.
Rz. Zingiberis Recens	Sheng Jiang	3-15g	Strengthens the spreading and mobilizing actions of the other herbs. With Zhi Gan Cao, harmonizes and regulates the Spleen and Stomach.
Baked Rx. Glycyrrhizae	Zhi Gan Cao	1.5-6g	Moderates and harmonizes the harsh properties of other herbs.

Formula Actions

• Unblocks Yang Qi
• Promotes the movement of Qi
• Dispels Wind
• Eliminates Dampness
• Clears Heat
• Unblocks the channels and collaterals
• Stops pain

Syndromes

• Recurrent Wind-Cold-Damp Bi
• Wind-Damp Bi with formation of Heat
• Wind-Phlegm-Dampness with formation of Heat
• Recurrent painful obstruction with localized Heat (Secondary source)

Clinical Manifestations

Swollen painful joints (especially lower limbs) Joints are warm to the touch (may be burning and swollen) The pain is worse at night Reduced range of motion Chills Anhidrosis Weight loss Shortness of breath Muscular atrophy Difficulty walking and moving Thirst Hemiplegia Rigidity of the limbs

Headache Dizziness Vertigo Nausea Vomiting Edema Emaciation Swollen feet Numbness of the extremities Paralysis Fatigue T: Normal C: White and greasy or Thin, yellow and greasy P: Wiry and slippery or Slippery and rapid

Treats

Rheumatoid arthritis Connective tissue disorders Gouty arthritis Severe migratory arthralgia Chronic arthritis Periarthritis of the shoulder Deep vein thrombosis Cor pulmonare Osteoarthritis Sequelae of cerebrovascular accident Edema Arthralgia Gout

General pain Hyperpnea Numbness Paresthesia Muscular atrophy in the lower limbs Psoriasis Sciatica Erythema nodosum Sequelae of cerebrovasculitis with hemiplegia Low back pain Paralysis Painful obstruction

Contraindications And Herb/Drug Interactions

Notes

• Originally written for pan-arthralgia (Li Jie Bing, 歷節病).

Modifications

For severe pain and restricted movement that responds to warmth:		For a heavy sensation throughout the body and worse in affected joints:
+ More Rx. Aconiti Preparata	Zhi Fu Zi	+ More Rz. Atractylodis Macrocephalae	Bai Zhu
+ More Hb. Ephedrae	Ma Huang	Or
Or		+ More Rz. Atractylodis Macrocephalae	Bai Zhu
+ More Rx. Aconiti Preparata	Zhi Fu Zi	+ More Rx. Aconiti Preparata	Zhi Fu Zi
+ More Hb. Ephedrae	Ma Huang	For Blood and Yin Deficiencies:
+ More Ram Cinnamomi	Gui Zhi	+ Rx. Rehmanniae	Sheng Di Huang
For frequent recurrence of pain due to Qi Deficiency:		+ Rx. Achyranthis Bidentatae	Niu Xi
+ Rx. Astragali	Huang Qi	For more severe Dampness:
For Damp-Heat:		+ Sm. Coicis	Yi Yi Ren
+ Gypsum Fibrosum	Shi Gao	+ Rz. Atractylodis	Cang Zhu
+ Cx. Phellodendri	Huang Bai	For Blood Stasis:
For pronounced Heat in the joints:		+ Olibanum	Ru Xiang
+ More Rx. Paeoniae Alba	Bai Shao	+ Myrrh	Mo Yao
+ More Rx. Anemarrhenae	Zhi Mu	For symptoms that worsen at night:
+ Ram Mori	Sang Zhi	- Rx. Paeoniae Alba	Bai Shao
+ Ramus Lonicerae	Ren Dong Teng	+ Rx. Paeoniae Rubra	Chi Shao
For burning pain that is less during the day and worse at night:		For Blood Deficiency:
+ More Rx. Anemarrhenae	Zhi Mu	+ Rx. Angelicae Sinensis	Dang Gui
+ Rx. More Paeoniae Alba	Bai Shao	+ Rz. Chuanxiong	Chuan Xiong
+ More Rx. Glycyrrhizae	Gan Cao	+ Rx. Rehmanniae Preparata	Shu Di Huang
For paralysis and palsy:		+ Rx. Astragali	Huang Qi
+ Rx. Stephaniae Tetrandrae	Han Fang Ji	+ Poria	Fu Ling
+ Rx. Ginseng	Ren Shen	For arthritis of the arms and shoulders:
+ Rx. Scutellariae	Huang Qin	+ Rz. seu Rx. Notopterygii	Qiang Huo
+ Rz. Chuanxiong	Chuan Xiong	+ Hb. cum Rx. Asari	Xi Xin
+ Sm. Armeniacae	Xing Ren	+ Rx. Stephaniae Tetrandrae	Han Fang Ji
For fibromyalgia due to Qi and Blood Stagnation:		+ Poria	Fu Ling
+ Ephedra, Apricot Kernel, Coicis and Licorice Decoction Ma Xing Yi Gan Tang		For rheumatoid arthritis due to mixed Heat and Cold:
+ Major Saposhnikovia Decoction Da Feng Fang Tang		- Hb. Ephedrae	Ma Huang
- Rx. Aconiti Lateralis Preparata	Zhi Fu Zi
For rheumatoid arthritis due to mixed Heat and Cold with Heat predominant:
- Rz. Atractylodis Macrocephalae	Bai Zhu
+ Less Ram. Cinnamomi	Gui Zhi
- Hb. Ephedrae	Ma Huang	- Rx. Saposhnikoviae	Fang Feng
- Rx. Aconiti Lateralis Preparata	Zhi Fu Zi	- Rz. Zingiberis Recens	Sheng Jiang
+ 20g Rx. Paeoniae Rubra	Chi Shao
- Rz. Atractylodis Macrocephalae	Bai Zhu
+ 15g Rx. Aconiti Preparata	Zhi Chuan Wu
- Rx. Saposhnikoviae	Fang Feng
- Rz. Zingiberis Recens	Sheng Jiang	+ 15g Rx. Aconiti Kusnezoffii	Zhi Cao Wu
+ 20g Rx. Paeoniae Rubra	Chi Shao
+ 15g Rx. Angelicae Sinensis	Dang Gui
+ Less than 15g Rx. Aconiti Preparata	Zhi Chuan Wu
+ 15g Zaocys	Wu Shao She
+ Less than 15g Rx. Aconiti Kusnezoffii	Zhi Cao Wu	+ 9g Rx. Rehmanniae	Sheng Di Huang
+ 9g Bombyx Batryticatus	Jiang Can
+ 15g Rx. Angelicae Sinensis	Dang Gui
+ 9g Pheretima	Di Long
+ 15g Zaocys	Wu Shao She	For rheumatoid arthritis due to mixed Heat and Cold with Yin Deficiency and Internal Heat:
+ 9g Rx. Rehmanniae	Sheng Di Huang
+ 9g Bombyx Batryticatus	Jiang Can	- Hb. Ephedrae	Ma Huang
- Rx. Aconiti Lateralis Preparata	Zhi Fu Zi
+ 9g Pheretima	Di Long
+ 9g Rz. Polygoni Cuspidatae	Hu Zhang	- Rz. Atractylodis Macrocephalae	Bai Zhu
+ 9g Glauberitum	Han Shui Shi	- Rx. Saposhnikoviae	Fang Feng
+ 9g Hb. Humuli	Lu Cao	- Rz. Zingiberis Recens	Sheng Jiang
+ 15g Cx. Phellodendri	Huang Bai	+ 20g Rx. Paeoniae Rubra	Chi Shao
For rheumatoid arthritis due to Wind-Cold-Damp with Internal Heat and a fever:
+ 15g Rx. Aconiti Preparata	Zhi Chuan Wu
+ Gypsum Fibrosum	Shi Gao
For rheumatoid arthritis due to Wind-Cold-Damp with Internal Heat and Blood Deficiency:		+ 15g Rx. Aconiti Kusnezoffii	Zhi Cao Wu
+ Caulis Spatholobi	Ji Xue Teng	+ 15g Rx. Angelicae Sinensis	Dang Gui
For rheumatoid arthritis due to Wind-Cold-Damp with Internal Heat and severe Dampness with swelling of the limbs:
+ 15g Zaocys	Wu Shao She
+ 9g Rx. Rehmanniae	Sheng Di Huang
+ Rx. Stephaniae Tetrandrae	Han Fang Ji	+ 9g Bombyx Batryticatus	Jiang Can
+ Rx. Dioscoreae Hypoglaucae	Bei Xie	+ 9g Pheretima	Di Long
+ 30-40g Rx. Rehmanniae	Sheng Di Huang
For rheumatoid arthritis due to Wind-Cold-Damp with Internal Heat and Qi Deficiency:
+ Rx. Astragali	Huang Qi	For mental and physical fatigue:
For Yin Deficient and intense Internal Heat:		+ Rx. Astragali	Huang Qi
+ Rx. Rehmanniae	Sheng Di Huang	For a poor appetite:
For a fever:		+ Per. Citri Reticulatae	Chen Pi
+ Gypsum Fibrosum	Shi Gao	+ Massa Medicata Fermentata	Shen Qu
+ Cx. Phellodendri	Huang Bai
For Blood Deficiency with swelling in the joints of the limbs:		For pronounced Dampness with swelling of the joints:
+ Caulis Spatholobi	Ji Xue Teng	+ Rz. Dioscoreae Hypoglaucae	Bei Xie
+ Hb. Pyrolae	Lu Xian Cao
For rheumatoid arthritis with a fever:		+ Rz. Alismatis	Ze Xie
+ Gypsum Fibrosum	Shi Gao	+ Rx Aristolochiae Fangji	Guang Fang Ji
+ Sm. Coicis	Yi Yi Ren	+ Sm. Coicis	Yi Yi Ren
For rheumatoid arthritis due to Blood Deficiency with a joint swelling:		For rheumatoid arthritis due to Excess Dampness with a joint swelling:
+ Caulis Spatholobi	Ji Xue Teng	+ Rz. Dioscoreae Hypoglaucae	Bei Xie
+ Hb Pyrolae	Lu Xian Cao
+ Rx. Angelicae Dahuricae	Bai Zhi	+ Rz. Alismatis	Ze Xie
+ Rx. Stephaniae Tetrandrae	Han Fang Ji
For rheumatoid arthritis with Qi Deficiency:
+ Rx. Astragali	Huang Qi