Introduction: Yanghe Decoction is "used to treat crane's knee wind, bone-attaching abscess, and all types of yin abscesses. It is like sunlight shining, dissolving all cold congealing, hence the name Yanghe." The author of this article applies it to bi syndrome where pathogenic factors invade the muscles, meridians, and joints, causing qi and blood stagnation and obstruction, belonging to deficiency-cold type. Adding herbs such as Astragalus, Angelica, Pangolin Scales, Earthworm, Achyranthes Root, and Chaenomeles Fruit yields significant therapeutic effects.

Yanghe Decoction Treats Deficiency-Cold Type Bi Pain

Yuan Jinqi

Xinjiang is located in the northwestern border region, where winters are excessively long and the climate is severely cold, resulting in a high incidence of arthralgia syndrome. The *Suwen·Bi Lun* states: "What is referred to as 'bi'... is the result of repeated exposure to wind, cold, and dampness." "Bi" means obstruction. Pathogenic factors invade the skin, meridians, and joints, causing stagnation of qi and blood, leading to obstruction and impediment. Regardless of whether wind, cold, or dampness predominates, all can cause joint pain, restricted flexion and extension, and numbness. In severe cases, the condition becomes unbearable, recurs repeatedly, and leads to joint deformities, often accompanied by a pale complexion, aversion to cold with cold limbs, and exacerbation during winter, exposure to cold, or overexertion. These manifestations are purely due to blood deficiency and cold congealing in the bones and sinews. If prolonged, the condition often becomes stubborn and difficult to treat.

For the treatment of patients with deficiency-cold arthralgia, some use modified Duhuo Jisheng Tang, others use modified Bazhen Tang combined with Wutou Tang, and still others combine the aforementioned formulas with insect-based herbs to expel wind and unblock collaterals. The methods vary, each with its own merits.

In exploring the treatment of this condition, revisiting the Yanghe Tang formula from *Waike Zhengzhi Quansheng Ji*, based on observations of over a hundred cases, it is believed that this formula is not only a surgical prescription for treating all chronic deficiency-cold ulcers but also an excellent formula with proven efficacy for deficiency-cold arthralgia.

Mr. Zhang, a male irrigation worker on a farm, presented with cold pain in the lumbar spine radiating to the left leg, accompanied by numbness and soreness for three years. He had sought medical treatment extensively. A hospital diagnosed him with rheumatic spondylitis and sciatica, but treatments such as physical therapy, nerve blocks, and acupuncture proved ineffective.

Due to chronic low back pain, he experienced limited mobility, difficulty walking, and exacerbation of pain with exposure to wind or cold, often accompanied by sweating and moaning. The patient had previously sought treatment at his own expense, taking blood-activating and collateral-dredging medications containing aconite and strychnine. Although the pain temporarily subsided, it recurred upon discontinuation of the medication or during overcast weather. In October 1982, he consulted me. Examination revealed a pale complexion, fatigue, reluctance to speak, aversion to cold, low back pain as if beaten with a stick, aggravated by touch, a dull and dark tongue, and a deep, thready, and weak pulse.

The syndrome was identified as deficiency-cold type arthralgia. I prescribed Yanghe Decoction supplemented with astragalus, angelica, pangolin scales, and earthworm, decocted with 50 ml of white wine. After ten consecutive doses, the patient's low back pain significantly improved. Another ten doses were administered, and he regained the ability to bend forward and backward. However, numbness and soreness persisted in the left leg. To the original formula, papaya and achyranthes root were added, and ten more doses were prescribed. At this stage, the patient's complexion showed slight improvement, he reported a sensation of warmth throughout the body, and approximately 70–80% of the symptoms had resolved.

Subsequently, he was advised to take a paste prepared by combining Yanghe Decoction with Bazhen Decoction and honey, gradually and consistently. After half a year of continuous use and a two-year follow-up, the patient was confirmed to have fully recovered.

The Yanghe Decoction from "Complete Collection of External Medicine Syndromes and Treatments" consists of 30 grams of cooked rehmannia root, 9 grams of deer antler glue, 3 grams of cinnamon bark, 1.5 grams of ephedra, 6 grams of white mustard seed, 1.5 grams of charred ginger, and 3 grams of raw licorice root. It is decocted with one cup each of water and wine. The dosage can be adjusted as appropriate.

This formula is used to treat crane's knee wind, deep-seated abscesses, and all types of yin abscesses. It is like sunlight shining, completely dispelling cold stagnation, hence the name Yanghe (Harmonizing Yang).

Based on this understanding, I first explored the formula's principles and then applied it clinically to treat deficiency-cold type arthralgia, with almost universal effectiveness. This formula tonifies without causing greasiness, warms without causing dryness, and combines opening and tonifying. It truly possesses the effects of warming yang, tonifying blood, dispelling cold, and unblocking stagnation.

The formula heavily uses cooked rehmannia root to warmly tonify the nutritive blood. Deer antler glue, a substance with affinity for flesh and blood, nourishes blood, assists yang, replenishes essence, fills marrow, and strengthens tendons and bones. Cinnamon bark and charmed ginger warm the channels, unblock the vessels, break up yin, and harmonize yang. Raw licorice root is used to detoxify and harmonize the various herbs. Particularly, ephedra and white mustard seed unblock yang and disperse stagnation to resolve phlegm accumulation.

The ancients said: Warming and tonifying without opening the pores—how can the cold-accumulated toxins find a path to disperse? Moreover, if the toxin is severe, it may instead be aided, like providing grain to bandits. Therefore, this formula warms and tonifies without causing stagnation. Blood deficiency often accompanies qi deficiency; when applying this formula, qi-tonifying herbs must be added, such as Dangshen and Huangqi. Add an appropriate amount of white wine and decoct with water, utilizing the wine's ability to warm the meridians, dispel cold, activate blood, and unblock the collaterals.