Using Gui Zhi Tang in Clinic
Using Gui Zhi Tang in Clinic
By Eric Brand
Gui Zhi Tang is a formula from the Shang Han Lun (“On Cold Damage”) that was originally indicated for greater yang wind strike patterns of cold damage. The combination of medicinals within Gui Zhi Tang is very eloquent and subtle variations in additions can take the formula in several new directions. Gui Zhi Tang is essentially a formula for balancing yin and yang, and it is one of the most balanced and profound formulas within Chinese medicine
Gui Zhi Tang relies on the complementary opposition of Gui Zhi and Bai Shao. Gui Zhi is warm and outward moving, which Bai Shao is cool and constraining in action. The construction-defense disharmony that is treated in Gui Zhi Tang is essentially an imbalance of yin and yang, here expressed as an imbalance between construction and defense, or the interior and the exterior. The warm freeing action of Gui Zhi treats the yang aspect of the problem (defense) while the nourishing and consolidating action of Bai Shao treats the yin aspect of the problem (construction). Together, they balance the interior and exterior and harmonize yin and yang. Traditionally, this is explained through the use of a military analogy, with Bai Shao representing the “camp” or supply and Gui Zhi representing the “defense” or the troops at the perimeter.
Beyond Gui Zhi and Bai Shao, Gui Zhi Tang also contains a unit of earth-supplementing medicinals that appear together in many other Shang Han Lun formulas. These medicinals also rely on mutual opposition; the acrid, dispersing nature of Sheng Jiang prevents the sweet, rich nature of Da Zao from causing stagnation, while Zhi Gan Cao both supplements the spleen and harmonizes the formula.
Chinese formula texts state that Gui Zhi Tang is indicated for external contraction of wind-cold with exterior vacuity and disharmony of construction and defense. This pattern is characterized by headache, heat effusion, aversion to wind, and sweating, possibly accompanied by “noisy nose” (nasal congestion with audible breathing), absence of thirst, and/or dry retching.
Under normal physiologic conditions, defense qi moves outside the vessels and secures and protects the fleshy exterior. Construction-yin stays inside and provides nourishment to defense yang, and construction and defense are in harmony.
In the pathologic state addressed by Gui Zhi Tang, vacuity of defense qi causes the interstices to be loose. Defense yang cannot secure and protect the fleshy exterior, so there is aversion to cold. Construction-yin cannot stay in the inner body and discharges outward, causing sweating. The combination of Gui Zhi (Cinnamomi Ramulus) and Bai Shao (Paeoniae Radix Alba) both dissipates and contracts. This allows evil to be dispelled without damaging right while simultaneously nourishing yin without lodging evil.
This formula is said to “transform qi and regulate yin and yang,” and it is used for miscellaneous diseases in internal medicine that are ascribed to disharmony of yin and yang, construction and defense, or qi and blood. It is especially suitable for conditions following illness or childbirth, or for generalized weakness when the chief manifestations are aversion to wind and sweating.
Within the original Shang Han Lun, there are uses of Gui Zhi Tang that do not manifest with greater yang wind-strike. For example, it is mentioned for patients with periodic heat effusion and spontatneous sweating, in the absence of other visceral diseases. Here, it is taken prior to the onset of heat effusion to harmonize construction and defense.
Gui Zhi Tang is contraindicated in patients with greater yang cold damage signs. Because it is too mild in comparison with Ma Huang Tang (Ephedra Decoction), one will miss the best opportunity for dispelling evil.
Gui Zhi Tang is also contraindicated in interior damp-heat patterns. This is alluded to in the Shang Han Lun in a discussion of its adverse effects on “sick drinkers.” The formula is acrid and sweet, and acrid flavors reinforce heat and sweet flavors reinforce dampness, so there is a general caution against the use of Gui Zhi Tang in the interior damp-heat conditions. The original meaning of the phrase “sick drinkers” (jiu ke bing) is unclear, it may refer either to a disease name (drinker’s sickness, i.e., alcoholism) or to a drinker (jiu ke) who is sick. If it refers to the latter, it is unclear whether they are sick with greater yang wind-strike or sick from drinking. Different sources draw different conclusions about this statement.
Gui Zhi Tang is also inappropriate for patients with exuberant interior heat, as well as in greater yang disease that has been erroneously treated with purging and no exterior signs remain present.
The addition of Ge Gen (Puerariae Radix) to this formula modifies it to treat hypertonicity in the nape and back. This is a pattern of simultaneous greater yang wind strike and constrained greater yang channel qi. The fluids are damaged and cannot moisten and nourish the channels normally.
To treat variations of wind-cold with Gui Zhi Tang, consider the following modifications:
For marked insufficiency of defense yang with prominent aversion to cold, increase the quantity of Gui Zhi and Gan Cao, or add Fu Zi (Aconiti Radix Lateralis Praeparata).
For incessant leaking sweat in cases of relatively severe defense qi vacuity, add Huang Qi (Astragali Radix) and Bai Zhu (Atractylodis Macrocephalae Rhizoma).
For profuse sweating and a thin pulse from weakness of construction, increase the dose of Bai Shao and Gan Cao.
From a base of Gui Zhi Tang, several other important formulas can be created, such as Xiao Jian Zhong Tang (Minor Center-Fortifying Decoction), Huang Qi Jian Zhong Tang (Astragalus Center-Fortifying Decoction), Gui Zhi Jia Long Gu Mu Li Tang (Cinnamon Twig Decoction Plus Dragon Bone and Oyster Shell), and Ge Gen Tang (Pueraria Decoction).