abstracted & translated by

Bob Flaws, Lic. Ac., Dipl. Ac. & C.H., FNAAOM, FRCHM

Keywords: Chinese medicine, Chinese herbal medicine, osteoporosis

Tang Hua, in issue #4, 2003 of the Yun Nan Zhong Yi Zhong Yao Za Zhi (Yunnan Journal of Chinese Medicine & Chinese Medicinals) published an article titled, "An Analysis of the Therapeutic Efficacy of Treating Osteoporosis with Self-composed Yu Tong Zhuang Gu Tang (Cure Pain & Strengthen the Bones Decoction). This article appeared on page 18 of that journal. A precis of that article is given below.

Cohort description

There were 64 patients enrolled in this clinical trial, 18 males and 46 females aged 49-70 with an average age of 58 years. All met the 1994 diagnostic criteria for osteoporosis, and endocrine diseases, rheumatoid arthritis, and multiple myeloma were ruled out.

Treatment method

The basic formula used in this study consisted of: cooked Radix Rehmanniae Glutinosae ( Shu Di ), 20g, Cortex Eucommiae Ulmoidis ( Du Zhong ), 15g, Fructus Psoraleae Corylifoliae ( Bu Gu Zhi ), 15g, Rhizoma Drynariae ( Gu Sui Bu ), 15g, Herba Epimedii ( Xian Ling Pi ), 6-10g, Radix Salviae Miltiorrhizae ( Dan Shen ), 15g, Lignum Sappan ( Su Mu ), 10g, Rhizoma Corydalis Yanhusuo ( Yan Hu Suo ), 12g, Rhizoma Cyperi Rotundi ( Xiang Fu ), 10g, Semen Cuscutae Chinensis ( Tu Si Zi ), 15g, Fructus Rosae Laevigatae ( Jin Ying Zi ), 15g, Fructus Euryalis Ferocis ( Qian Shi ), 15g, and uncooked Radix Glycyrrhizae Uralensis ( Gan Cao ), 5g. If there was more of a tendency to yang vacuity, Qian Shi and Gu Sui Bu were subtracted and Du Zhong was increased to 20 grams. In addition, 15 grams of Cornu Degelatinum Cervi ( Lu Jiao Shuang ) were added. If there was more of a tendency to yin vacuity, 15 grams each of Fructus Lycii Chinensis ( Gou Qi Zi ) and Herba Dendrobii ( Shi Hu ) and 10 grams of Plastrum Testudinis ( Gui Ban ) were added. If there was insomnia, 10 grams of Fructus Schisandrae Chinensis ( Wu Wei Zi ) and 20 grams of Semen Zizyphi Spinosae ( Suan Zao Ren ) were added. If sweating was severe, 30 grams of Fructus Klevis Tritici Aestivi ( Fu Xiao Mai ) and 20 grams of Concha Ostreae ( Mu Li ) were added. If there was a white, lusterless facial complexion, superificial edema, fatigue, and scanty stirring, Xian Ling Pi and Qian Shi were removed and 20 grams of Gelatinum Corii Asini ( E Jiao ) and 15 grams each of Fructus Mori Albi ( Sang Shen Zi ) and Rhizoma Alismatis ( Ze Xie ) were added. One packet of these medicinals was decocted in water and administrered per day warm in three divided doses. Twelve days equaled one course of treatment, and outcomes were assessed after three successive courses.

Treatment outcomes

Cure was defined as complete disappearance of symptoms. Marked effect was defined as marked improvement in symptoms. Some effect was defined as partial improvement in symptoms. No improvement meant that there was no improvement or reduction in symptoms. Based on these criteria, two patients were judged cured, 30 got a marked effect, 20 got some effect, and 12 got no effect. Therefore, the total effectiveness rate was listed as 82.77%.

Discussion

Like many contemporary Chinese formulas for the treatment of senile osteoporosis, the above formula is based on the idea that the kidney govern the bones and, therefore, osteoporosis primarily has to do with kidney vacuity, either yin or yang. This formula also takes into account that pain is always an indication of lack of free flow. Thus it contains medicinals to move the qi and quicken the blood. In general, I like and agree with the modifications Dr. Tang suggests. However, it is my experience that this formula would likely have gotten a better therapeutic effect in more patients if it had also included medicinals to fortify the spleen and supplement the qi. The spleen is the latter heaven root, while the kidneys are the former heaven root, and former and latter heavens are mutually rooted. It is spleen vacuity that leads to kidney vacuity as part of the aging process. In that case, spleen vacuity does not go away. Rather, it gives rise to spleen-kidney dual vacuity. Therefore, I would recommend adding Radix Panacis Ginseng ( Ren Shen ), Radix Astragali Membranacei ( Huang Qi ), Radix Dioscoreae Oppositae ( Shan Yao ), and/or Rhizoma Atractylodis Macrocephalae ( Bai Zhu ) to the above formula. Although it is important to remember such key statements of fact in Chinese medicine as, "At seven [times] seven in women, the tian gui is exhausted, the kidneys are vacuous, and the essence is depleted," it is also important to truly understand the mechanisms behind such statements. Other voices within the contemporary Chinese literature suggests that it is not sufficient to only supplement the kidneys and quicken the blood in the treatment of senile osteoporosis, but that fortification of the spleen and supplementation of the qi must also be given their appropriate weight. This certainly is corroborated by my own clinical experience.

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