A Blue Poppy blog post by Bob Quinn
Gui zhi fu ling wan (GZFLW) is one of those formulas I studied in my TCM education but did not see often prescribed in our college clinic, so I graduated without much of a feel for it. Now, however, not a week goes by without me giving this formula to at least one patient. It is in my category of “tried and true” remedies. I credit Heiner Fruehauf, Ph.D. and Nigel Dawes with opening my eyes to this formula.
Blood stasis is a common element in many American patients. Chinese medicine has numerous formulas that can deal with this, ranging from very strong ones with insects to milder ones. GZFLW would have to be placed on the mild and extremely safe side of the spectrum. It was actually developed to treat breakthrough bleeding in pregnancy, so we know it is safe.
I have learned that palpating the abdomen is not that common in US acupuncture-herbal practice, but here I will again make the point that important information is being missed when we fail to assess the abdomen. The lower abdomen is key here when we discuss blood stasis, as it seems to settle there. Dr. Manaka also noted that the skin texture on the upper back between the shoulder blades can lead us to suspect blood stasis. If the skin texture there is dry and rough, there is likely blood stasis.
As it turns out GZFLW is a great remedy for blood stasis, even as mild as it is. It really delivers results. In unmodified tablet form (Great Nature brand) it offers convenience for the patient. The dose can be started at three tabs, two times a day and increased if necessary.
If one is using granules, this formula can be made stronger by adding a little san leng, e zhu, and da huang. (I learned this modification working at Heiner Fruehauf’s clinic.) I am reminded of two interesting cases for this sort of modification.
In 2008 on one of my supervisory shifts we had a patient who had been seen on other shifts in the college clinic. She was in her late 30s and had complaints of hypothyroid (cold, low energy) and lifelong constipation. She also mentioned that her hair had not grown a millimeter for months. She had been placed on Shen qi wan for three months and nothing had changed for the better. When I assessed her abdomen I could see this was not likely a good match for what she needed. I put her on GZFLW with added da huang. She came weekly for treatment. After ten weeks her hair had grown a quarter inch, and she had daily bowel movements for the first time in her life. Her energy was much improved as well (except when she went on a sugar binge). She reported feeling like a new person.
As an interesting side note, I can add that this patient, due to scheduling could not continue under my care. I saw her some moths later sitting in our waiting room. I snuck a peek at her chart and saw she was back on Shen qi wan. We really can get stuck in our thinking, although it has to be noted that maybe by then it was a better match for her. I suspect though it was simply a matter of rigid thinking that says: Hypothyroid patients are cold and need Shen qi wan in all cases. That kind of thinking strikes out as often as it makes a hit.
The other case was a big man in his late 60s. He had a horribly blotchy red face, so much so that he avoided the embarrassment of going out in public. He came to his first appointment in the middle of the winter dressed in a short sleeve shirt and shorts! He was about 260 pounds. His lower abdomen was a tough-boggy mess of stasis of all sorts. He was put on GZFLW with added san leng, e zhu, and da huang. He stayed on that for three months. At the end of that time his lower abdomen’s true picture was revealed: It was as deficient as one could only imagine. There was no tone at all to his tissue. He had been in a traveling rock and roll career that burned the candle at both ends, and this lifestyle had taken its toll. After the three months of GZFLW he had to move on to more building- nourishing formulas, but GZFLW had worked its important magic. The restoring stage could not be engaged properly without the initial clearing action of GZFLW.
I mention these cases to make the case that GZFLW is an important formula for us all to be comfortable prescribing.
Best wishes to all,
Bob Quinn