Cardiovascular

The Greater Yang Version of Zhen Wu Tang (line 82)

By Gory ⋅ June 26, 2008 ⋅  Print This Post ⋅ Post a comment

The situation:

太阳病发汗，汗出不解，其人仍发热，心下悸，目眩，身瞤动，振振欲擗地也，真武汤主之。 (line 82)

The patient presents with an exterior disease, and somehow sweating doesn’t help get rid of it. Whether just due to the loss of fluids, or perhaps part of the original disease process, the guy starts palpitating (likely to be tachycardia), gets dizzy, the body goes into spasms, and he looks like he wants to fall to the ground.

Well, the second part of it looks like symptoms of low blood pressure: palpitations, dizziness and almost losing consciousness. This could be shock, probably due to dehydration from over-perspiration.

I could imagine the doctor trying his best to ‘resolve the exterior’ of his patient, believing that he could sweat out the bad guys. And by trying too hard, he gets a severely dehydrated patient.

Prescription Analysis: I believe that this prescription is a vasopressor and that fuzi (附子) is the main ingredient:

Firstly, fuzi (附子) is the main herb in the prescription, and that its properties are congruous with that of the prescription itself. The treatment principle of this formula is to “warm the yang and eliminate water (温阳利水).” With regards to “eliminating water (利水)” I do not think of it as mere diuresis. Fuzi (附子) — or aconite — is able to reverse the vicious cycle that hypovolemic shock is, where the blood vessel walls are further compromised by a messed up system, causing further fluid loss and further lowering blood pressure. Fuzi (附子) is able to help maintain an elevated arterial blood pressure — by strengthening the heart, constricting the appropriate blood vessels, and dilating the ones around the capillary bed.

Comparison of True Warrior Decoction (Zhen Wu Tang)with other formulae:

• With wu ling san (五苓散): The cause is very similar, although the guy who could use wu ling san (五苓散) is certainly not as badly hypovolemic as the guy who needs zhen wu tang (真武汤).
• With fu zi tang (附子汤): The herbs are the same except that in fu zi tang (附子汤), ginseng (人参) replaces the fresh ginger (生姜) of zhen wu tang (真武汤). There is also double the amount of fuzi (附子) and baishu (白术). With more fuzi (附子), baishu (白术) and renshen (人参), fu zi tang (附子汤) is certainly the more potent of the two.

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