Shaoyao-Gancao-Tang (“Shang Han Lun”)/芍藥甘草湯 「傷寒論」
By Ju Bong Kang, KMD
Actions and Diagnosis
This prescription treats pain caused by tension in the muscles and joint ligaments of the limbs or waist due to coldness or lack of qi and blood. According to abdominal diagnosis theory, Shaoyaogancao-Tang can be effective when Shaoyao’s abdominal hypertonicity appears. But the pain itself should be caused by muscle tension. The formula is still effective even if there is no hypertonicity for abdominal examination. In the case of severe knee joint pain, it is required to use a large dose of 40~80g at a time for a better and faster treatment effect. If joint pain is severe and swollen, this prescription relaxes ligament tension, relieves inflammation, reduces swelling, and relieves pain without a diuretic.
Taking more than 40g of Shaoyao promotes intestinal movement. However, some patients could suffer from diarrhea or liquid-like stool. To prevent loose stool formation or diarrhea, Baizhu and Fuling are added to control the stool condition.
Suppose knee joint pain is concomitant with liquid stasis in the joint. This prescription can be combined with Fangji-Huangqi-Tang. But for joint pain and deformation caused by rheumatism, use Guishao-Zhimu-Tang made by adding Mahuang. Patients with pain in their finger joints due to repetitive manual work are improved with Shaoyao-Gancao-Tang. But when the joints are painful, swollen, and deformed, it is necessary to use Guishao-Zhimu-Tang, even if there is no sign of rheumatism. Shaoyao-Gancao-Tang is also effective in various pains in the digestive tract without headache and joint pain due to a wind-cold pathogen. Combined with Juling-Tang, it relieves the pain of kidney stones and facilitates the release of stones.
Many methods and prescriptions have been used to treat joint pain, but if it does not work, this prescription often results in a good effect. Since there are only two drugs in Shaoyao-Gancao-Tang, it is not expected but rather has a good effect quickly. This prescription may not work if the dose is small. Therefore, care should be taken because 30g or 40~80g may be required even if Buyin-Tang or Duho-Jisheng-Tang is applicable for back pain or knee joint pain due to a deficiency of yin-blood. When the joint pain is more severe, the treatment effect is improved using 20 to 30 grams of Shaoyao.
Contents of Source Text
Even if the pulse floats, spontaneous sweating, and there is a heart-vexation, it is the wrong treatment to attack with Guizhi-Tang, the superficies in a little cold and a tight leg. When attacked with Guizhi-Tang, Jue-syndrome occurs, so the throat is dry, the chest is uncomfortable, and vomit appears, then Gancao-Ganjiang-Tang is given. As a result, when Yang is recovered, Jue-syndrome healed, and the feet are warm, then Shaoyao-Gancao-Tang is given again. Although the foot is stretched out, the stomach-qi is not yet harmonious, so if nonsense-talking is issued, then a little Tiaowei-Chengqi-Tang(調胃承氣湯) is given. If sweated again and hot-needle(燒鍼) was applied again, treat it with Sini-Tang(四逆湯). (“Shang Han Lun”)
Application
- Symptoms include the inability to stand up and walk due to severe knee, ankle, and hip joint pain.
- Severe pain due to stomach cramps, urinary stones or gallstones, hemorrhoid pain, urination pain, and severe local pain.
Differential Diagnosis
Guishao-Zhimu-Tang: This prescription is used effectively for joint pain caused by rheumatism. Shaoyao-Gancao-Tang is not used for rheumatism. However, suppose the pain in the joint is severe due to rheumatism. In that case, the dose of Shaoyao in Guishao-Zhimu-Tang is increased and often used as a combination of the two prescriptions.
