Clematis and Stephania Formula for Pain?
Answered by: Robert Newman, L.Ac.
Question from: Dorothy Melanson
Posted on: November 29, 2004

I have been suffering with lower back pain due to arthritis or spondylosis in lumbar 3,4,5 for about 6 months. I took 5 acupuncture treatments at an acupuncture college associated with at least two of the hospitals in our Houston Medical Center during July which helped some right after treatment. They put me on tablets for pain called Clematis and Stephania Formula, extra concentrated. I am suppose to take 2 tablets 3 times a day. They do lessen the pain, but I would like to know more about the formula. I do not seem to be having any difficulties with the formula the ingredients include: Paeoni lactiflorae root, Angelicae and on and on, written so small that I cannot read with a magnifying glass. Can it be taken long term? Has there been any ill effects with this formula? And any other information you can provide.

I have copied below some information taken from a couple of sources on the Internet about this formula. The formula you are taking can indeed be a very useful formula when prescribed for the appropriate patient with the appropriate condition. Although there are two or three herbs in the formula which have some tonifying benefits, the formula is primarily used when the patient has more of an excess state, rather than being very deficient or weak. In traditional Chinese medicine (TCM), pain is always felt to be due to a blockage of some type.

The Chinese believe that there are pathways or channels -- the same ones that are used in acupuncture treatments--which normally should carry both "Qi" and Blood (most people think that Qi is simply what we refer to in English as "energy," but it is much more than that in TCM -- for more about what Qi is, see my reply to the question, "Is There An Herb That Can Help Acid Reflux?," also in the Q & A Chinese herbs section of Richter’s website). So pain is said to be a blockage in the flow of Qi and/or Blood through these channels.

I mentioned above about this formula being mainly for conditions of excess. An excess condition that also involves some sort of pain complaint occurs when a build-up or accumulation (i.e., an excess) of some pathogenic factor has occurred in the channels and it is causing an obstruction. I will mention here that it is possible for there to be a simultaneous excess state from the accumulated pathogenic factor in the channels and a deficiency state internally from either some of the organs being weak or there being a weakness in the Qi, Blood, Yin or Yang somewhere in the body. Commonly, the internal Blood deficiency which can easily affect the musculoskeletal system comes from the Liver Blood being deficient, and the internal Qi deficiency often comes from a deficiency of the "Spleen" Qi -- this is the TCM idea of the Spleen (for more about what the Chinese idea of the "Spleen" is, see my replies the questions, "Herbs and Other Approaches for Uterine Prolapse" and "Korean Ginseng and Some Advice About Weight Loss Herbs," also in the Q & A Chinese herbs section of Richter’s website).

Now, what is considered a pathogenic factor? This can include what is known as dampness, cold, wind, heat, or a combination of some of these together (e.g., wind-cold, damp-heat, wind-damp-heat, etc.), and/or an excessive build up in one area of Qi and/or Blood (because the flow of one or both of them has become blocked or stagnant). Signs of a greater problem with the wind pathogen can include spasms, cramps, twitches, pains which can periodically move around or change location and which are worse with exposure to drafts or windy weather. Signs of the presence of more damp involve swelling, edema, a heavy sensation, and symptoms which are worse with damp weather. Signs of more heat are redness and hotter skin around the areas of pain, and symptoms that are worse with heat. Signs of more cold pathogen include sharp, fixed pains and symptoms which are worse with cold. The patterns that involve a combination of some of these pathogenic factors, e.g., wind-damp, wind-damp-cold, wind-damp-heat, and damp-heat, will show signs that are also combinations of the symptoms listed above, dependent on which combination of factors are present. You may want to check out this website for some additional information about herbs for arthritis: http://www.itmonline.org/arts/arthritis.htm

Although I obtained some of the information below from some Internet websites, I also added my descriptions of what each of the herbs is doing in the formula.

Clematis & Stephania Formula (Shu Jing Huo Xue Tang)

This formula is widely used in Japan and Taiwan for lower limb arthralgia, and for lumbago and sciatica; it clears the meridians and vitalizes blood. "Relax the Channels and Invigorate the Blood Decoction" is a traditional formula used for pain caused by wind-dampness and Qi and Blood Stagnation in the channels and collaterals.

Ingredients:

Radix Paeonia lactiflora (White Peony Root / Bai Shao) 11.3% -- this herb is in the category of herbs to tonify the Blood; it is particularly good for the Liver Blood and as such, can help to nourish the tendons and ligaments which in turn can increase flexibility help with musculoskeletal problems.

Radix Angelica sinensis (Tang Kuei Root / Dang Gui) 9% -- this herb is also in the category of herbs to tonify the Blood; it is also very good for the Liver Blood and as such, can also help to nourish the tendons and ligaments and help with musculoskeletal problems; it also has some function of invigorating (circulating) the Blood, so it can also be useful with pain conditions: in chronic pain conditions, Blood stasis (stagnation of the circulation of Blood) in the affected area is usually present; a classic indication of Blood stasis in TCM is pain which feels sharp, stabbing, in a fixed location.

Pericarpium Citrus reticulata (Tangerine Peel / Chen Pi) 7.5% -- this herb is in the category of herbs to regulate (circulate) the Qi; it is also good for helping to reduce dampness in the system (you may recall from my above discussion that dampness is one of the pathogenic factors that can cause obstruction in the acupuncture channels)

Radix Achyranthes bidentata (Ox Knee / [Huai] Niu Xi) 7.5% -- this herb is in the category of herbs to invigorate (circulate) the Blood--this can be good for pain conditions; this herb also strongly acts on the lower back and lower body, so it can also help guide other herbs in the formula to those areas of the body; it also strengthens the Kidneys and their associated tissues, the bones, and the Liver and its associated tissues, the tendons and ligaments; it also helps to clear out one of the above-mentioned pathogenic factors that can cause obstruction and pain, the damp-heat.

Radix Clematis chinensis (Clematis Root / Wei Ling Xian) 7.5% -- this herb is in the category of herbs to dispel wind-dampness, a common pathogenic factor in musculoskeletal problems; it is said to be a very clearing herb which opens up all twelve of the main organs’ acupuncture channels -- especially in the lower limbs -- and is very good for treating pain caused by wind pathogen (wind pathogen is considered to be more Yang in nature, so it often involves problems with the back of the body and it can frequently include cramps/twitches/spasms of the muscles and/or tendons and ligaments; it usually involves problems with symptoms that change location periodically or whose pain severity or focus changes location periodically).

Radix Rehmannia glutinosa (Rehmannia Root / Sheng Di Huang) 7.5% -- this herb is in the category of herbs that clear heat and cool the blood; it is also good for tonifying the Liver and Kidney Yin (the Yin is the more fluid, material/physical aspect of the body) -- tonifying the Yin can generally be helpful for strengthening the musculoskeletal system, especially when the Liver and Kidney Yin is tonified; also, this herb is going to moisten the system, so it can help in this formula to prevent some of the herbs that are more drying (the ones to dry damp or dispel wind-damp) from creating too much dryness of the fluids or blood;

Rhizoma Atractylodes lancea (Atractylodes Rhizome / Cang Zhu) 7.5% -- this herb is in the category of herbs that are aromatic and dry dampness: so this herb can address issues of pathogenic dampness or even damp-heat that may be involved in affecting the musculoskeletal system adversely possibly involved with pain and/or swelling;

Semen Prunus persica (Peach Kernel / Tao Ren) 7.5% -- this herb is in the category of herbs that invigorate (circulate) the Blood; as such, it is useful for pain conditions where stagnation of Blood is present -- this herb will address the excess condition where there is pathogenic Blood stasis and the pain is therefore usually more sharp, stabbing and in a fixed location; as with Rehmannia, this herb is also going to moisten the system, so it can help in this formula to prevent some of the herbs that are more drying (the ones to dry damp or dispel wind-damp) from creating too much dryness of the fluids

Sclerotium Poria cocos (Hoelen, Tuckahoe / Fu Ling) 5.3% -- this herb is in the category of herbs that drain dampness, and it can be useful in musculoskeletal problems because it will help indirectly address the presence of pathogenic dampness causing obstruction in the acupuncture channels (through clearing dampness from the digestive system) and will also help the digestive system generally function a little better, thus reducing the production of dampness at its likely source;

Radix Angelica dahurica (Angelica Dahurica Root / Bai Zhi) 4.6% -- this herb is in the category of herbs that are acrid and warm and relieve the surface; it is also a very good herb for treating the dampness factor, so it is useful in this formula for addressing musculoskeletal issues that may have excess dampness as a partial or primary cause;

Radix Gentiana scabra (Gentian Root / Long Dan Cao) 4.6% -- this herb is in the category of herbs that clear heat and dry dampness, so this can be useful for treating musculoskeletal issues that may have excess dampness or damp-heat pathogen as partial or primary causes;

Radix Ledebouriella/Saposhnikovia divaricata (Siler Root / Fang Feng) 4.6% -- this herb is in the category of herbs that are acrid and warm and relieve the surface; in this formula, it is being used to help with clearing out any pathogenic wind, wind-damp and/or wind-damp-cold in the affected areas;

Radix Stephania tetrandra (Stephania Root / Han Fang Ji) 4.6% -- this herb is in the category of herbs that drain dampness; it is useful in this formula to remove excessive damp, damp-heat, wind-damp and/or wind-damp-heat pathogenic factors;

Rhizoma et Radix Notopterygium forbesii (Notopterygii Root / Qiang Huo) 4.6% -- this herb is in the category of herbs that are acrid and warm and relieve the surface; in this formula, it is helping to clear out wind-damp and/or wind-damp-cold pathogen in the musculoskeletal system;

Radix Ligusticum sinensis cv. Chuanxiong (Szechuan Lovage Root / Chuan Xiong) 3.3% -- this herb is in the category of herbs that invigorate (move/circulate) the Blood; it can be useful in this formula for treating pain from Blood stasis, and the pain is therefore usually more sharp, stabbing and in a fixed location;

Radix Glycyrrhiza uralensis (Licorice Root / Gan Cao) 3% -- this herb is in the category of herbs that tonify the Qi; it is being used in this formula to harmonize all of the other herbs in the formula to work together better; it can also help reduce any spasms and cramps that are present -- particularly in combination with Radix Paeonia lactiflora.

Chinese Medical Actions: Dispels wind-dampness, moves stagnant Blood, moves Qi, unblocks and relaxes the channels.

Indications: Back Pain, Edema, Gout, Hypertension, Joint Pain (Stiffness or Swelling), Leg pain, Movement difficulty, Muscle aches, Numbness, Pain, in lower body, Post-Partum Pain, Sciatica.

Tongue: Swollen

Pulse: Strong, choppy, superficial.

Contraindications: AVOID DURING PREGNANCY. This formula is for pain with excess; if there’s pain from deficiency, use Du Huo and Loranthus Formula.

Dorothy, you asked above if this formula can be taken long term and whether there are any ill effects possible with this formula. The main issue with this formula involves one herb -- the Han Fang Ji, listed above with its correct Latin name, Stephania tetrandra. Because of numerous reasons, a number of different species, often from different regions of China, have been used for the same herb medicine -- this is a common issue with many herbs in Chinese medicine. And this is true of the remedy known generally as "Fang Ji." For example, there is Han Fang Ji, which, as I’ve stated, is supposed to be from Stephania tetrandra. There is also Guang Fang Ji, which is supposed to be from Aristolochia fangchi, and Mu Fang Ji, which is often derived from Cocculus trilobus, and quite a few other types of Fang Ji as well. One problem that occurs with this is when dried material is simply labeled as "Fang Ji" -- no one knows which plant material is being used as the source for this when this general name is used. Also, there is not an established procedure in China for making sure that the specificity of a labeled herb is exactly correct: e.g., even if the label says it is specifically Han Fang Ji and it should therefore be from Stephania tetrandra, it may in fact be from Aristolochia fangchi or a combination of those two species, or it’s even possible that it is from other species of Stephania or Aristolochia or other genera.

This problem has arisen with more concern in the case of Fang Ji particularly because Aristolochia species have generally been found to contain enough aristolochic acid to be fairly toxic to the kidneys. Stephania species and Cocculus species are not toxic and are very safe, but one has to have a method to be sure what material is being used for this herb in order to know whether it is an Aristolochia or a non-toxic species. The way that an herb company can be sure Aristolochia is not being used is for lab testing to be done on the material for the presence of aristolochic acid.

You said you are taking tablets from a concentrate form of the formula. Since I don’t know what company is producing the herbs you are using and I can’t see the bottle for the contact information of the manufacturer, I can only guess or assume that you are taking tablets which are made from concentrated granules. A number of the companies that are the common ones making these granules and the tablets from these granules usually do testing of their raw herb material used for making the concentrates.

And with this herb, Fang Ji, most companies have now opted to simply not carry it anymore, using other herbs with similar functions as substitutes in formulas calling for Fang Ji. There is one company I am familiar with that makes concentrated granules and is very rigorous with their testing, so they offer Fang Ji which is definitely from Stephania, the true Han Fang Ji. What I would strongly suggest you do is to ask the people prescribing this formula for you to find out from the manufacturer if they are using a subsitute for the Fang Ji, or if they are testing their material to make sure it is the non-Aristolochia species, or if they are simply just not including that herb in their product or they are using a substitute for it in this material you are taking. You definitely want to make sure that the material you are using either has no Fang Ji in it or contains material that has been accurately tested.

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