The Western medical diagnosis of this condition consists of first ruling out lumbar disk herniation. The affected leg is often externally rotated when relaxed, such as when lying face down with one’s feet hanging over the edge of the bed or examination table. Various physical examination maneuvers confirm the diagnosis (e.g., Freiberg’s maneuver, Pace’s maneuver, Beatty’s maneuver, and the Mirkin test). The Western medical treatment of this condition mainly consists of stopping any offending exercises or activities. While many clinicians prescribe stretching exercises, the authors of The Merck Manual say such exercises are “rarely beneficial.”Corticosteroids are sometimes injected into the site where the piriformis muscle crosses the sciatic nerve, presumably reducing fat around the muscle.

CHINESE DISEASE CATEGORIZATION: Piriformis syndrome is categorized as bifeng, thigh wind, gu tong, thigh pain, and yao tui tong, low back and leg pain, in Chinese medicine.

DISEASE CAUSES: External injury and over-taxation combined with former heaven natural endowment insufficiency and aging

DISEASE MECHANISMS: Traumatic injury may sever the channels and vessels causing blood stasis and qi stagnation, thus resulting in pain. It is also possible for over-taxation, natural endowment insufficiency, and aging to result in malnourishment of the sinews and vessels, also causing pain. In addition, some Chinese sources also say that piriformis syndrome may be due to wind damp cold impediment hindering and obstructing the free flow of qi and blood, resulting in pain.

Treatment based on pattern discrimination:

Qi Stagnation & Blood Stasis Pattern

Liver Depression Qi Stagnation With Blood Vacuity Pattern

Liver-Kidney Yin Vacuity With Blood Stasis Pattern

Wind Cold Damp Impediment Pattern

Remarks

1. Piriformis syndrome in females is usually due to a combination of liver depression, blood not nourishing the sinews, and blood stasis, with blood vacuity in females mostly being associated with concomitant spleen vacuity. In women in their late 30s and 40s, this combination of patterns is commonly complicated by yin or yin and yang vacuity.

TREATMENT PRINCIPLES: Quicken the blood and dispel stasis, move the qi and abduct stagnation

Rx: Shun Qi Huo Xue Tang (Normalize the Flow of Qi & Quicken the Blood Decoction)

Analysis OF FORMULA: Su Geng, Zhi Ke, Hou Po, Xiang Fu, Mu Xiang, and Sha Ren all move the qi and abduct stagnation. When the qi moves, the blood moves. Dang Gui Wei, Su Mu, Chi Shao, Tao Ren, and Hong Hua all quicken the blood, dispel stasis, and stop pain. In addition, Dang Gui Wei and Su Mu free the flow of the network vessels and are empirically specific medicinals for traumatic injury.

ADDITIONS & SUBTRACTIONS: For severe pain, especially at night, subtract Zhi Ke and Sha Ren and add three grams each of Quan Xie (Scorpio) and Wu Gong (Scolopendra), six grams of Tu Bie Chong (Eupolyphaga/Steleophaga), and nine grams each of Pu Huang (Pollen Typhae) and Wu Ling Zhi (Feces Trogopterori). For pain which is worse with cold and better with warmth, add 12 grams each of Gui Zhi (Ramulus Cinnamomi) and Du Huo (Radix Angelicae Pubescentis) and three grams of Xi Xin (Herba Asari). For concomitant kidney vacuity, add nine grams of Du Zhong (Cortex Eucommiae), Xu Duan (Radix Dipsaci), and Sang Ji Sheng (HerbaTaxilli). For concomitant qi vacuity, add 15 grams of Huang Qi (Radix Astragali) and nine grams of Dang Shen (Radix Codonopsitis). If there is spasmodic pain, add 18 grams of Bai Shao (Radix Paeoniae Albae).

Acupuncture & moxibustion: Bilateral Xue Hai (Sp 10), Zhi Bian (Bl 54) on the affected side, a shi points in the affected area. If there is a visible purple vein in the area of Wei Zhong (B140), bleed this.

ANALYSIS OF FORMULA: Draining Xue Hai quickens the blood and dispels stasis. Draining Zhi Bian and Wei Zhong moves the qi and frees the flow of the network vessels in the affected area as do any local a shi points.

Additions & subtractions: For low back pain, add Shen Shu (Bl 23) and/or Yao Yang Guan (GV 3). For pain radiating to the lateral part of the leg, add Yang Ling Quan (GB 34) and Xuan Zhong (GB 39). For pain radiating to the calf, add Cheng Shan (Bl 57). For pain in the lateral part of the feet, add Kun Lun (Bl 60) and Ba Feng (M-LE-8).

TREATMENT PRINCIPLES: Course the liver and resolve depression, supplement the qi and nourish the blood

Rx: Xiao Yao San Jia Jian (Rambling Powder with Additions & Subtractions)

ANALYSIS OF FORMULA: Within this formula, Ji Xue Teng Bai Shao, Dang Gui, Du Zhong, and Niu Xi all supplement the blood and nourish the sinews. In addition, when the liver obtains sufficient blood, it can do its duty of coursing and discharging. Dang Gui, Ji Xue Teng, and Niu Xi also quicken the blood and transform stasis. Chai Hu courses the liver and rectifies the qi. Bai Zhu, Fu Ling, and mix-fried Gan Cao fortify the spleen and supplement the qi. Sheng Jiang helps rectify the qi and harmonize the center as well as harmonizes all the other medicinals in this formula. It assists Gan Cao in this latter function.

ADDITIONS & SUBTRACTIONS: If there is marked fatigue, add 15 grams of Huang Qi (Radix Astragali) and nine grams of Dang Shen (Radix Codonopsitis). If there is depressive heat, add nine grams each of Zhi Zi (Fructus Gardeniae) and Dan Pi (Cortex Moutan). If there is damp heat, add nine grams of Huang Qin (Radix Scutellariae) and three grams of Huang Lian (Rhizoma Coptidis) and replace Sheng Jiang with six grams of Gan Jiang (dry Rhizoma Zingiberis). If there are cold hands and feet, add nine grams of Gui Zhi (Ramulus Cinnamomi). If there is constipation, add six grams of Da Huang (Radix Et Rhizoma Rhei).

Acupuncture & moxibustion: Bilateral Tai Chong (Liv 3), Ge Shu (Bl 17), and Gan Shu (Bl 18), Zhi Bian (Bl 54), and Wei Zhong (B140) on the affected side, any a shi points in the affected area. If there is a visible purple vein in the area of Wei Zhong, bleed this.

ANALYSIS OF FORMULA: When needled with even supple-menting-even draining technique, Tai Chong, Ge Shu, and Gan Shu together course the liver and nourish the blood. Draining Zhi Bian, Wei Zhong, and any a shi points moves the qi and frees the flow of the network vessels in the affected area.

Additions & subtractions: If spleen vacuity is marked, add Pi Shu (Bl 20) and Zu San Li (St 36) with supplementing method to fortify the spleen and supplement the qi. If there is depressive heat, drain Xing Jian (Liv 2) either instead of or in addition to Tai Chong. If there is heat in the yang ming, drain Nei Ting (St 44). For low back pain, add Shen Shu (Bl 23) and/or Yao Yang Guan (GV 3). For pain radiating to the lateral part of the leg, add Yang Ling Quan (GB 34) and Xuan Zhong (GB 39). For pain radiating to the calf, add Cheng Shan (Bl 57). For pain in the lateral part of the feet, add Kun Lun (Bl 60) and Ba Feng (M-LE-8).

TREATMENT PRINCIPLES: Supplement and nourish the liver and kidneys, quicken the blood and strengthen the low back

Rx: Bu Shen HuoXue Tang Jia Jian (Supplement the Kidneys & Quicken the Blood Decoction with Additions & Subtractions)

Analysis of formula: Shu Di, Niu Xi, and Gou Qi Zi enrich kidney yin and strengthen the bones. Dang Gui, Shu Di, Gou Qi Zi, and Shan Zhu Yu nourish liver blood and strengthen the sinews. Tu Si Zi, Bu Gu Zhi, Du Zhong, and Rou CongRongwarm the kidneys and strengthen the low back. In addition, Du Zhong leads the action of the other medicinals to the low back region. Mo Yao, Hong Hua, and Dang Gui quicken the blood and stop pain. Qin Jiao dispels wind dampness and treats impediment pain. Also, Qin Jiao leads the action of the other medicinals to the spinal column and limbs.

Additions & subtractions: If there is marked liver depression qi stagnation, add nine grams of Chuan Lian Zi (Fructus Toosendan) and six grams of Zhi Shi (Fructus Immaturus Aurantii). If there is more pronounced blood vacuity, add 15 grams of Ji Xue Teng (Caulis Spatholobi) and nine grams of He Shou Wu (Radix Polygoni Multiflori). If there is concomitant qi vacuity, add 15 grams of Huang Qi (Radix Astragali) and nine grams each of Dang Shen (Radix Codonopsitis) and Shan Yao (Radix Dioscoreae). If there is fluid dryness constipation, add nine grams each of Huo Ma Ren (Semen Cannabis) and Tao Ren (Semen Persicae). If there is concomitant yang vacuity, add nine grams each of Ba Ji Tian (Radix Morindae Officinalis) and Suo Yang (Herba Cynomorii). If there is internal heat, add 9-12 grams of Huang Qin (Radix Scutellariae). If there is qi vacuity with muscle atrophy and weakness in the lower limbs, add 15 grams of Huang Qi (Radix Astragali) and nine grams each of Bai Zhu (Rhizoma Atractylodis Macrocephalae) and Dang Shen (Radix Codonopsitis). If there is spasmodic pain, add 18 grams of Bai Shao (Radix Paeoniae Albae).

Acupuncture & moxibustion: Bilateral Xue Hai (Sp 10), San Yin Jiao (Sp 6), and Fu Liu (Ki 7), Zhi Bian (Bl 54), Wei Zhong (Bl 40), and any locally tender a shi points on the affected side

Analysis OF FORMULA: Supplementing San Yin Jiao and Fu Liu supplements and nourishes the liver and kidneys. Even supplementing-even draining Xue Hai quickens the blood and dispels stasis, while the rest of the points move the qi and free the flow of the network vessels in the affected area.

Additions & subtractions: For pain radiating to the lateral part of the leg, add Yang Ling Quan (GB 34) and Xuan Zhong (GB 39). For pain radiating to the calf, add Cheng Shan (Bl 57). For pain in the lateral part of the feet, add Kun Lun (Bl 60) and Ba Feng (M-LE-8).

TREATMENT PRINCIPLES: Course wind and scatter cold, eliminate dampness and stop pain

Rx: Juan Bi Tang Jia Jian (Alleviate Impediment Decoction with Additions & Subtractions)

Analysis OF FORMULA: Sang Zhi, Hai Feng Teng, Qin Jiao, Qiang Huo, Du Huo, Chuan Xiong, and Gui Zhi together course wind and scatter cold, eliminate dampness and stop pain. Du Zhong courses and eliminates wind dampness and stregnthens the low back and reinforces the thigh area. Dang Gui, Chuan Xiong, Chuan Niu Xi, and Ru Xiang quicken the blood and transform stasis, free the flow of the network vessels and stop pain. Mu Xiang moves the qi to help quicken the blood and stops pain. In addition, Du Huo and Chuan Niu Xi lead the other medicinals to the lower part of the body.

ADDITIONS & SUBTRACTIONS: If there is a severe cold sensation in the affected area, add nine grams each of Zhi Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli) and Ma Huang (Herba Ephedrae). If there is restricted movement of the lower limbs, add 12 grams each of Hai TongPi (Cortex Erythiniae) and XiXian Cao (Herba Siegesbeckiae). For concomitant qi vacuity, add 15 grams of Huang Qi (Radix Astragali) and 12 grams of Dang Shen (Radix Codonopsitis). If there is concomitant blood vacuity, add 12 grams each of Bai Shao (Radix Paeoniae Albae) and Shu Di (cooked Radix Rehmanniae). For concomitant liver blood-kidney yang vacuity, add nine grams each of Wu Jia Pi (Cortex Acanthopanacis), Yin Yang Huo (Herba Epimedii), and Baji Tian (Radix Morindae Officinalis). For concomitant liver blood-kidney yin vacuity, add 12 grams each of Sang Ji Sheng (Herba Taxilli) and Shu Di (cooked Radix Rehmanniae) and replace Chuan Niu Xi with Niu Xi (Radix Achyranthis Bidentatae).

Acupuncture & moxibustion: Bilateral Qu Chi (LI 11) and Yin Ling Quan (Sp 9), Zhi Bian (Bl 54), Wei Zhong (Bl 40), and any locally tender a shi points on the affected side

ANALYSIS OF FORMULA: Draining Qu Chi and Yin Ling Quan is a special combination for coursing wind, scattering cold, eliminating dampness, and stopping pain wherever there is impediment pain. Draining Zhi Bian and Wei Zhong courses and eliminates wind and dampness, diffuses impediment and frees the flow of the network vessels in the affected area as do any local a shi points. Draining method and moxibustion should be used for all points.

Additions & subtractions: For pain radiating to the lateral part of the leg, add Yang Ling Quan (GB 34) and Xuan Zhong (GB 39). For pain radiating to the posterior part of the calf, add Cheng Shan (Bl 57). For pain in the lateral part of the foot, add Kun Lun (Bl 60) and Ba Feng (M-LE-8).

Because peripheral neuropathy is a symptom complex rather than a disease in its own right, the Western medical diagnosis and treatment of Peripheral neuropathy primarily revolve around that of the primary disease. However, electromyography and nerve conduction velocity tests may be used to help confirm neuropathy. Treatment of the underlying systemic disorder may halt the progression of this condition and even improve symptoms, but recovery tends to be slow at best. Various experimental drug therapies, such as the antidepressant amytriptilline (Elavil), have shown mixed results in clinical trials.

CHINESE DISEASE CATEGORIZATION: Peripheral neuropathy is categorized as wei zheng, wilting condition, in Chinese medicine. Numbness and tingling are referred to as ma mu, tingling and woodenness. Insensitivity is bu ren, no feeling. Since Peripheral neuropathy associated with systemic disease tends to affect the lower extremities first, this condition may also be referred to as xia zhi ma mu, lower extremity numbness and tingling, or xia zhi teng tong, lower extremity aching and pain.

DISEASE CAUSES: The six environmental excesses, the seven affects, unregulated eating and drinking, taxation fatigue, enduring disease, aging, poisoning, and iatrogenesis

DISEASE MECHANISMS: The disease mechanisms of Peripheral neuropathy are nothing other than the disease mechanisms of wilting, pain, and numbness and tingling. Any evil qi, whether externally invading or internally engendered may lodge in the channels and network vessels, thus obstructing the flow of qi and blood. On the one hand, lack of free flow may cause pain. On the other hand, malnourishment may result in insensitivity and wilting. Lack of nourishment may also be due to A) anything which damages the spleen, the latter heaven root of qi and blood engenderment and transformation, B) enduring evil heat damaging and consuming blood and fluids, C) over or erroneous use of windy, dispersing medicines and recreational drugs, and D) the debility and decline of aging.

Treatment based on pattern discrimination:

Damp Heat Invasion & Excessiveness Pattern

Lung-Stomach Fluid Damage Pattern

Spleen-Stomach Vacuity Weakness Pattern

Liver-Kidney Insufficiency Pattern

Spleen-Kidney Insufficiency With Cold Dampness Pouring Down Pattern

Remarks

1.  Because Peripheral neuropathy is usually seen in enduring, chronic diseases, there will be liver depression qi stagnation even though none of the above patterns mention it. One can also count on fatigue due to spleen vacuity. Further, as the majority of the above formulas imply, there will also be concomitant blood stasis. Qi and yin vacuity with damp heat and qi and blood stasis and stagnation is a commonly seen combination of patterns in patients with Peripheral neuropathy due to diabetes, SLE, RA, and AIDS. If yin vacuity reaches yang, there may also be concomitant yang vacuity.

2.  If blood stasis has entered the network vessels, worm and insect ingredients should be used, such as Di Long (Pheretima), Jiang Can (Bombyx Batryticatus), Quan Xie (Scorpio), Wu Gong (Scolopendra), Shui Zhi (Hirudo), and Tu Bie Chong (Eupolyphaga/Steleophaga). Most of these medicinals also track down and extinguish wind, thus relieving tingling and itching.

3.  When needling either the Ba Feng (M-LE-8) or Ba Xie (M-UE-22) points, it is necessary to needle deeply into theinterosseous spaces, taking care not to needle into the periostreum on either side. By deep needling, we mean at least 1-1.5 cun. In order to do this, one should spread the ringers or toes apart manually while inserting and guiding the needle to its right depth and position.

4. The majority of published research from China on Peripheral neuropathy is on the oral administration of Chinese medicinals, not acupuncture. Since Peripheral neuropathy tends to be a root vacuity (commonly qi and yin vacuity) with a branch repletion (blood stasis and/or damp heat impediment), acupuncture alone is not generally considered the standard of care for this condition. Nevertheless, it may be an effective adjunctive therapy.

5.  In order to treat blood stasis and damp heat impediment locally more effectively, it is possible to use Chinese medicinal hot foot soaks. One such formula consists of: XiXian Cao (Herba Siegesbeckiae), 100g, Ji Xue Teng (Csailis Spatholobi), Ren Dong Teng (Caulis Lonicerae), and Ai Ye (Folium Artemisiae Argyii), 60g each, Wu Jia Pi (Cortex Acanthopanacis) and Tou Gu Cao (Herba Impatientis), 30g each, and Hong Hua (Flos Carthami), Ku Shen (Radix Sophorae Flavescentis) and Mo Yao (Myrrha), 20g each. These medicinals are boiled twice—the first time in seven times more water than the medicinals for 1.5 hours, the second time in five times as much water for one hour. The resulting two batches of medicinal liquid are combined. This should result in aproximately one liter of medicinal liquid. Bottle and reserve for use. Each time, use 30ml of this liquid in three liters of hot water (40-50° C), soaking both feet for 30 minutes each time, four times per day if possible.

6.  Restless leg syndrome, which is also seen in diabetics and hypertensives, is treated according to basically the same pattern discrimination as above with an emphasis on qi and yin vacuity, dampness or damp heat, wind, and blood stasis.

TREATMENT PRINCIPLES: Clear heat and disinhibit dampness

Rx: Si Miao San Jia Wei (Four Wonders Powder with Added Flavors)

Analysis OF FORMULA: Bei Xie, Huang Bai, Yi Yi Ren, Fu Ling, and Cang Zhu together clear heat and dry or seep dampness. Sang Zhi, Mu Gua, Du Huo, Wei Ling Xian and also Cang Zhu, Yi Yi Ren, and Bei Xie disinhibit dampness and free the flow of impediment. Dan Shen, Niu Xi, and Ji Xue Teng quicken the blood and transform stasis.

ADDITIONS & SUBTRACTIONS: For muscle and flesh aching and pain, add nine grams each of Ru Xiang (Olibanum) and Mo Yao (Myrrha). For chest fullness, glomus, and oppression, add 12 grams each of Hou Po (Cortex Magnoliae Officinalis) and Zhi Ke (Fructus Aurantii) and nine grams of Qing Pi (Pericarpium Citri Reticulatae Viride). For deviation of the face, mouth, or eyes, add 15 grams of Jiang Can (Bombyx Batryticatus), 12 grams of Zhi Bai Fu Zi (Rhizoma Praeparata Typhonii), and six grams of Quan Xie (Scorpio). For severe heaviness and swelling of the limbs, add nine grams of Ze Xie (Rhizoma Alismatis).

Acupuncture & moxibustion: Xue Hai (Sp 10), Yin Ling Quan (Sp 9), San Yin Jiao (Sp 6), Zu San Li (St 36), local points depending on the area of pain or discomfort

Analysis OF FORMULA: Xue Hai is the meeting point of the blood. Draining it quickens the blood and dispels stasis. Draining Yin Ling Quan clears heat and eliminates dampness, especially from the lower half of the body. When San Yin Jiao is combined with Yin Ling Quan, it strengthens the function of clearing and eliminating dampness and heat from the lower limbs. Zu San Li is a main point for treating all diseases of the lower limbs.

ADDITIONS & SUBTRACTIONS: If there is pain in the heel, needle Kun Lun (Bl 60). If there is tingling or burning on the sole of the foot, add Yong Quan (Ki 1). If there is pain, tingling, or numbness of the toes, needle the Ba Feng (M-LE-8).

TREATMENT PRINCIPLES: Clear heat, engender fluids, and moisten dryness

Rx: Qing Zao Jiu Fei Tang (Clear Dryness & Rescue the Lungs Decoction) & Yi Wei Tang (Boost the Stomach Decoction)

Analysis OF FORMULA: Shi Gao clears heat and drains fire, while Sheng Di clears heat and cools the blood. Mai Men Dong, Sha Shen, and Sheng Di enrich yin, engender fluids, and moisten dryness. Sang Ye clears heat from the lungs, while Pi Pa Ye clears heat from the stomach. Huo Ma Ren moistens the intestines and frees the flow of the stools. Shan Yao, TaiZi Shen, and Gan Cao boost the qi and engender fluids.

Additions & subtractions: If stomach fluid damage is severe, add nine grams each of Shi Hu (Herba Dendrobii), Yu Zhu (Rhizoma Polygonati Odorati), and Tian Hua Fen (Radix Trichosanthis). If heat evils are severe, add 12 grams each of Dan Zhu Ye (Herba Lophatheri) and Lu Gen (Rhizoma Phragmitis).

If oral thirst leads to drinking and there’s a surging, large, vacuous, or scallion-stalk pulse due to summerheat heat damaging qi and yin, replace Qing Zao Jiu Fei Tang and Yi Wei Tang with Bai Hujia Ren Shen Tang (WhiteTiger Plus Ginseng Decoction): Shi Gao (Gypsum Fibrosum), 30g, JingMi (Semen Oryzae), 20g, Zhi Mu (Rhizoma Anemarrhenae), 12g, and Ren Shen (Radix Ginseng) and mix-fried Gan Cao (Radix Glycyrrhizae), 6g each.

Acupuncture & moxibustion: Nei Ting (St 44), Zu San Li (St 36), Zhi Gou (TB 6), Zhao Hai (Ki 6), Da Zhui (GV 14), local points according to the affected areas

ANALYSIS OF FORMULA: Draining Nei Ting clears heat and engenders fluids. Draining Zu San Li frees the flow of the qi and blood in the lower extremities as well as frees the flow of the stools. Draining Zhi Gou clears heat from the three burners and frees the flow of the stools. Supplementing Zhao Hai supplements the kidneys and engenders fluids. The kidneys are the water viscus and, therefore, control the fluids and humors of the entire body. Da Zhui is the intersection point of the six yang channels and the governing vessel. Draining it clears heat from the entire body and recedes or abates fever.

Additions & subtractions: Add the Ba Feng (M-LE-8) if there is numbess and tingling in the toes. Add Yong Quan (Ki 1) if there is burning pain on the sole of the foot. If there is heel pain, add Tai Xi (Ki 3) needled through to Kun Lun (Bl 60). Add Tian Shu (St 25), Da Chang Shu (Bl 25), and He Gu (LI 4) if there is constipation. Add Lie Que (Lu 7) if there is marked lung dryness. Add the Ba Xie (M-UE-22), He Gu (LI 4), and Qu Chi (LI 11) if there is numbness and tingling of the fingers. Add He Gu (LI 4) and Qu Chi (LI 11) if there is fever.

TREATMENT PRINCIPLES: Fortify the spleen and boost the qi

Rx: Shen Ling Bai Zhu San Jia Jian (Ginseng, Poria & Atractylodes Powder with Additions & Subtractions)

Analysis OF FORMULA: Dang Shen, Fu Ling, and Shan Yao supplement the spleen and boost the qi. Chen Pi transforms dampness and rectifies and regulates upbearing and down-bearing. Gui Zhi warms the spleen at the same time as it quickens the blood and frees the flow in the extremities. In particular it leads yang qi to move back downwards. Qiang Huo frees the flow of impediment and stops pain by moving the qi. Mu Gua soothes the sinews and frees the flow of the channels as well as guides the other medicinals to the lower legs. Dan Shen quickens the blood and transforms stasis. In addition, Shan Yao and Xu Duan supplement the kidney qi and yang respectively. These last three medicinals are included in this formula because enduring disease typically includes blood stasis and enduring spleen disease reaches the kidneys.

Additions & subtractions: If there is muscular cramping and pain, add nine grams each of Ru Xiang (Olibanum) and Mo Yao (Myrrha) and three grams oiXiXin (Herba Asari). If there is swelling and distention of the hands and feet, add 12 grams of Luo Shi Teng (Rhizoma Trachelospermi) and Bi Xie (Rhizoma Dioscoreae Hypoglaucae). If the tongue is red with scanty fur or the fur is dry and yellow with oral thirst, delete Chen Pi, Gui Zhi, and Qiang Huo and add 30 grams each of ShengDi (uncooked Radix Rehmanniae), Sang Zhi (Ramulus Mori), and Shi Gao (Gypsum Fibrosum), 12 grams each of Mai Men Dong (Tuber Ophiopogonis) and Bei Sha Shen (Radix Glehniae), and nine grams of Qin Jiao (Radix Gentianae Macrophyllae).

Acupuncture & moxibustion: San Yin Jiao (Sp 6), Xue Hai (Sp 10), Zu San Li (St 36), Pi Shu (Bl 20), Wei Shu (Bl 21), local points depending on the area of pain or discomfort

Analysis of formula: San Yin Jiao, Zu San Li, Pi Shu, and Wei Shu together supplement the spleen and boost the qi. Xue Hai quickens the blood and dispels stasis. In addition, Zu San Li frees the flow of the qi and blood in the lower extremities.

ADDITIONS & SUBTRACTIONS: If there is pain in the heel, needle Kun Lun (Bl 60). If there is tingling or burning on the sole of the foot, add Yong Quan (Ki 1). If there is pain, tingling, or numbness of the toes, needle the Ba Feng (M-LE-8). If there is downward falling of the central qi with dizziness, fatigue, and lack of strength, moxa Bai Hui (GV 20).

NOTE: In actuality, this is a qi and yin vacuity pattern.

TREATMENT PRINCIPLES: Supplement and boost the liver and kidneys, foster yin and clear heat

Rx:   Hu   Qian   Wan Jia Jian (Hidden Tiger  Pills  with Additions & Subtractions)

ANALYSIS OF FORMULA: Gui Ban, Shu Di, He Shou Wu, Dang Gui, and E Jiao nourish liver blood and enrich kidney yin. In addition, Gui Ban strengthens the sinews and reinforces the bones. Huang Bai and Zhi Mu clear and descend vacuity heat. Huang Qi fortifies the spleen and boosts the qi. Sang Zhi and Qiang Huo dispel wind, eliminate dampness, and free the flow of impediment. Chuan Niu Xi, Dang Gui, and Chi Shao quicken the blood and free the flow of the network vessels.

ADDITIONS & SUBTRACTIONS: If yin vacuity has reached yang with chilled limbs, a pale tongue, and a deep, fine pulse, add nine grams each of Lu Jiao Jiao (Gelatinum Cornu Cervi), Bu Gu Zhi (Fructus Psoraleae), Rou Gui (Cortex Cinnamomi), and Zhi Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli).

Acupuncture & moxibustion: San Yin Jiao (Sp 6), TaiXi (Ki 3), Fu Liu (Ki 7), Zu San Li (St 36), Xue Hai (Sp 10), local points depending on the site of pain or discomfort

Analysis of formula: Supplementing San Yin Jiao, Tai Xi, and Fu Liu supplements the kidneys and enriches yin. Supplementing San Yin Jiao and Zu San Li supplements the spleen and boosts the qi. Zu San Li frees the flow of qi and blood in the lower extremities. Draining Xue Hai quickens the blood and dispels stasis.

Additions & subtractions: For more marked spleen qi vacuity, add Pi Shu (Bl 20) and Wei Shu (Bl 21). For marked kidney vacuity, add Shen Shu (Bl 23). If there is concomitant yang vacuity, moxa Shen Shu (Bl 23) and Ming Men (GV 4). If there is tingling or burning on the sole of the foot, add Yong Quan (Ki 1). If there is pain, tingling, or numbness of the toes, needle the Ba Feng (M-LE-8).