Dampness Weighing You Down, Joints Aching, Back Feeling Heavy? Qiang Huo Sheng Shi Tang (Notopterygium Dampness-Overcoming Decoction): Doctor Li Dongyuan’s Classic Formula That Lets Wind Conquer Dampness

Today we continue with Doctor Li Dongyuan’s formulas. The one we’re looking at this time is another famous formula — Qiang Huo Sheng Shi Tang (Notopterygium Dampness-Overcoming Decoction). Strictly speaking, this formula was mentioned before, back when it came up in the hospital talks on treating dizziness.

💬 Note from Doctor Luo: The Jin-Yuan physicians like Doctor Li Dongyuan were especially skilled at using wind herbs (feng yao) — fang feng (saposhnikovia), du huo (pubescent angelica), bai zhi (Angelica dahurica) and so on. These wind herbs can dispel wind and dispel dampness. There was a theoretical foundation for their use: “wind overcomes dampness” (feng neng sheng shi). And Qiang Huo Sheng Shi Tang is the classic formula that illustrates, better than any other, how wind herbs drive out dampness — it is a representative among the succession of important formulas in the Pi Wei Lun (Treatise on the Spleen and Stomach).

When do you use this formula? — First remember these lines from the original text

This formula is used when a person has been injured by dampness, especially when it is chiefly cold-dampness or chiefly wind-dampness. Once dampness has injured the body, dampness accumulates inside, and what symptoms appear?

Doctor Li Dongyuan described it very vividly: “Ru ji tong xiang qiang” — like muscle pain and a stiff neck: the back hurts, the spine feels especially painful and aching, and the neck feels stiff; the whole back of the neck and the spine feel sore, stiff and aching. “Yao ru zhe” — the lower back feels as if it is about to snap, aching terribly. “Xiang ru ba” — the neck feels as if it has been twisted and wrenched, very painful and uncomfortable. And also “shang chong tou tong” — it feels as if a stream of qi is rushing upward, to the point that even the head aches.

💬 Note from Doctor Luo: Why do all these symptoms concentrate on the back, the neck and the lower back? Doctor Li Dongyuan explained: “Nai shi tai yang jing zhi bu xing” — it is because the Taiyang channel is not moving. The foot Taiyang Bladder channel runs along the back and travels upward, governing the yang qi of the whole body. “The Taiyang channel is not moving” means the person has been injured by dampness — dampness is obstructing the channel, and qi and blood can no longer pass through freely. So what do you use at a time like this? You use Qiang Huo Sheng Shi Tang to treat it.

What exactly is dampness? — Let’s explain the principle thoroughly first

To talk about this formula, we first have to get “dampness” (shi qi) clear. Lately people are constantly seeing talk online about “do you have heavy dampness?” — and many people compare themselves and think: my dampness really is heavy!

So what is dampness? Our bodies are roughly 70% water by weight — there is a great deal of fluid inside us. This fluid comes in every day with food and drink, and leaves through urine and sweat. Some of it is used by the body, becoming jin ye (body fluids), blood and tissue fluid circulating through the channels — that is normal. And some of it is waste, excreted with the urine.

💬 Note from Doctor Luo: So what is dampness? It is this: because of certain reasons, apart from the fluid that gets used, there is also fluid that was neither used nor excreted — it stays in the body, stagnates there, and obstructs the movement of qi and blood — that is what we call dampness. Note this: dampness, your jin ye (body fluids) and your blood all come from the same source — they are all fluid from the water you drink and the food you eat. The only difference is that one portion gets used and another portion doesn’t.

And why doesn’t it get used? The root cause is insufficient upright qi (zheng qi).

The spleen: the spleen belongs to Earth, and Earth controls Water. A person with sufficient spleen-earth can govern water — what should be used gets used, and what shouldn’t be used gets excreted;
The kidney: kidney yang is like a furnace. When the fire is strong, water can evaporate and circulate; when the fire grows cold and goes out, water stays cold inside and congeals.

So dampness has an especially close relationship with the spleen and kidney. The other organs are helpers: the lungs help circulate through the hundred vessels, the liver helps with free coursing and dredging.

💬 Note from Doctor Luo: If a person’s spleen and kidney are insufficient and cannot transport and transform water-dampness, the water they drink stops inside the body — this is called “internally generated dampness.” Besides internal dampness, there is also external dampness. For example, before rain the weather turns terribly muggy — I know this from experience in the Northeast: in the couple of days before rain, the dampness is especially heavy; when I turn on my dehumidifier at home, the reading is 86 or 87 — the Northeast hardly differs from Sanya in humidity anymore. If your upright qi is insufficient at such a time and you go out to work and labor, your pores open and external dampness gets in very easily; and if you get caught in rain, wade through water, or work in water, dampness injures you from outside even more readily.

Once external dampness gets in, acute conditions tend to appear: for example, a dampness-heavy cold (wind-cold-damp), and joint pain — these past couple of days your joints ache badly, your back aches badly, your lower back feels very sore. And internal dampness? All day without energy, diarrhea, an upset stomach, no appetite, a dizzy head — but it doesn’t necessarily produce much disease. When internal and external dampness join forces, that’s when it goes wrong — disease appears.

Chinese medicine actually has many roads for removing dampness

Chinese medicine is extremely resourceful when it comes to removing dampness. Doctor Zhang Zhongjing’s Shang Han Za Bing Lun (Treatise on Cold Damage and Miscellaneous Diseases) mainly centered on cold pathogen, but it discusses dampness and blood stasis excellently — there are already many formulas devoted purely to treating dampness, such as Wu Ling San (Five-Pepper Powder with Poria) and Ling Gui Zhu Gan Tang (Poria, Cinnamon Twig, Atractylodes and Licorice Decoction), and so on.

💬 Note from Doctor Luo: Let me sort out the later generations’ approaches to removing dampness for you: The first road is to support upright qi — tonify the spleen and stomach, tonify kidney yang. Zhen Wu Tang (True Warrior Decoction) mainly warms kidney yang; Ling Gui Zhu Gan Tang mainly tonifies the spleen; and throughout Doctor Li Dongyuan’s basic series of formulas you find huang qi (Astragalus), ren shen (ginseng) and bai zhu (atractylodes) — that is, huang qi plus the Si Jun Zi (Four Gentlemen) approach — this is the crucial upright-supporting line of thinking. The later the era, the more methods there were: by Doctor Zhang Xichun’s time it was basically huai shan yao (Chinese yam) leading the charge, paired with huang qi and ren shen; and there is also Doctor Chen Shiduo’s Ba Zhen Gao (Eight-Treasure Cake) — all upright-supporting approaches. The second road is bland percolation to drain dampness (dan shen li shi) — using bland percolating medicinals to promote urination from below, breaking dampness down and sending it out downward while supporting upright qi at the same time. The third road is to rouse the center, the spleen and stomach — using medicinals like bai kou ren (white cardamom seed) to help the tonics transport and transform; these medicinals already carry some of the character of wind herbs. The fourth road is the wind-herb method, the one the Jin-Yuan physicians excelled at — wind herbs can rouse the body’s upright qi, rouse the yang qi, and push the damp pathogen out from above and from the body surface. Qiang Huo Sheng Shi Tang is a classic example of using wind herbs to release dampness through the surface. Dampness in different parts of the body calls for different methods — the upper jiao (burner), middle jiao and lower jiao each have their own treatment.

Breaking down Qiang Huo Sheng Shi Tang — herb by herb

First, the suitable population: this kind of patient’s upright qi is basically still acceptable — that’s why the formula doesn’t pile on tonics at the start. It’s simply that external dampness has invaded the channels. But note: after finishing this formula, you still need to continue tonifying the spleen, otherwise the dampness will come back.

The formula starts with qiang huo and du huo — these two are classic wind-dispelling herbs, wind herbs.

Qiang huo (notopterygium): sweet and bitter in nature. Doctor Zhang Yuansu (the Old Man of Jie Gu) called it pure yang, entering the Taiyang channel (the foot Taiyang Bladder channel); it is especially effective for Taiyang-channel headaches. Doctor Zhang Yuansu said: for expelling bone-and-joint pain, without this herb it cannot be removed (fei ci bu neng chu) — bone-and-joint pain means dampness has gotten in, and without qiang huo it probably won’t be removed. Moreover, qiang huo can enter the liver and gallbladder channels and remove cold-dampness. Wind herbs can also course the liver — helping the liver channel flow freely — and there is real reasoning behind this. Why did Doctor Zhang Yuansu insist on speaking of “Taiyang-channel wind herbs”? This is their hallmark: although these are all wind herbs, they were extremely precise about which channel each one enters — wherever you hurt, whichever part of the body hurts, you use the herb that enters that channel. That is the ancients’ experience. The back is where the foot Taiyang Bladder channel runs, so qiang huo is used specifically to unblock it.
Du huo (pubescent angelica): this herb moves downward and enters the Shaoyin channel; in fact it also circulates through the whole body, entering all three yin channels. Doctor Zhang Yuansu called it yang within yin (yin zhong zhi yang), entering the Shaoyin channel to treat pain along the Shaoyin channels. The original text says “tou xuan yun mu xuan, fei ci bu neng chu” — for dizziness and vertigo, without this herb it cannot be removed: when heavy dampness obstructs the channels, you get dizziness and vertigo, and du huo removes the dampness and solves the problem. But why use du huo — a herb that moves downward — for an illness of the upper body? Because the foot Taiyang Bladder channel and the foot Shaoyin Kidney channel are interior-exterior paired channels — treating only one and not the other won’t do; and if there is dampness in the kidney, dampness in the lower jiao, the impact on the body is considerable. So du huo is used to remove the dampness from the Shaoyin kidney channel — you have disease above, but I treat the root below — this is a very ingenious maneuver inside the formula.

💬 Note from Doctor Luo: Speaking of this, I remember when I was studying kidney-disease treatment with Doctor Zhao Shaoqin at the Beijing University of Chinese Medicine — the wind herbs made a deep impression on me. Doctor Zhao specialized in kidney disease. Many kidney patients have very thick tongue coating — damp-heat inside the body; it is damp-heat and blood stasis in the kidney that cause kidney disease. Most people would think of warming yang and dispelling dampness, but warming yang runs directly against the root of kidney disease damp-heat. Doctor Zhao excelled at wind herbs — “wind overcomes dampness” — he used fang feng (saposhnikovia), jing jie tan (charred schizonepeta), and also bai zhi (Angelica dahurica) and du huo; whenever the coating was very thick, he would usually pair in huo xiang (patchouli), pei lan (eupatorium), bai zhi and du huo. It made a deep impression on me at the time — bai zhi and du huo sank deep into my mind. What does du huo do? It removes dampness — on one side it helps remove your dampness, and on the other it helps unblock your channels — don’t you have blood stasis? It helps open your channels. After using it, the patient’s tongue coating quickly and gradually recedes; and then when you go in with the cooling-blood, quickening-blood medicinals, they begin to take effect — the patient recovers very quickly.

Now the remaining herbs:

Honey-fried gan cao (licorice): tonifies the center, specifically tonifying the spleen and stomach. The ancients had people who greatly revered this formula, saying the most ingenious thing in it is the honey-fried gan cao — it tonifies the center for you. This is the consistent approach of Doctor Li Dongyuan and his school.
Gao ben (Chinese lovage): also a surface-releasing wind herb. Doctor Zhang Yuansu judged it slightly yin within yang (yang zhong wei yin) — a herb of the Taiyang channel, returning specifically to the Taiyang channel. It has the actions of dissipating cold and releasing the surface, dispelling wind and dispersing dampness. And it has one special talent: it can treat vertex (top-of-head) pain — its ability to circulate is strong, and it can ascend all the way to the vertex. The vertex is related to the foot Jueyin Liver channel, so gao ben is also very effective for cold-dampness of the liver channel. Strictly speaking, all these wind herbs unblock the liver channel and the liver-gallbladder channels — the old books may not say so, but you should keep this awareness.
Fang feng (saposhnikovia): a herb of the Taiyang channel, pure yang, with the actions of coursing wind and dispersing cold, dispersing pathogen and moving qi, and dispelling wind. It is especially good at dispelling wind of the upper body, and removes a little wind of the lower body — that is Doctor Zhang Yuansu’s judgment. And in the Qiang Huo Sheng Shi Tang pattern, the upper-body symptoms are especially pronounced (head, neck, back), so fang feng dispels wind and disperses dampness with excellent effect.
Man jing zi (vitex fruit): many people may not know this one. It too dispels wind — whether wind-cold or wind-heat. Its nature is light and clear, floating upward, and it can especially reach the head; it can free the joints, open the nine orifices, and it also has dampness-dispelling action. Some physicians call it a fine herb that can disperse wind-heat and disperse wind-heat of the head and eyes. Its chief action is dispelling wind — its wind-dispelling and channel-freeing action is especially strong, and for pain caused by damp pathogen clinging to the channels it is a very good analgesic — especially suited to disorders of the head and face.
Chuan xiong (ligusticum): harmonizes qi and blood. Dispelling wind alone won’t do — once you’ve removed the wind and removed the dampness, the qi and blood have to be regulated so they fill the channels again; hence chuan xiong to circulate and unblock the channels.

💬 Note from Doctor Luo: Remember the ratios of the formula: qiang huo and du huo, one qian each (roughly 3 g each — a little more than the rest), honey-fried gan cao, gao ben and fang feng, five fen each (very small amounts), man jing zi three fen, chuan xiong two fen. Grind the herbs to powder for one dose: decoct two cups of water down to one cup, strain out the dregs and take warm — be sure to take it after meals, so the medicinal power moves upward. This formula is extremely classic: it gathers these wind herbs, unblocks the channels, lets the body’s upright qi start circulating, and pushes the dampness out from the body surface and from above.

Modifications — Doctor Li Dongyuan left many variations

Doctor Li Dongyuan went on to describe many modifications. For example, if there is damp-heat, add a little huang bai (phellodendron bark) together with a little fu zi (aconite) — notice, cold and heat are placed together: huang bai clears the damp-heat, but you mustn’t injure the yang qi, so a little fu zi is matched in. Sometimes you are also told to add ren shen (ginseng) to support the upright qi.

How to use it today — the three most common scenarios

💬 Note from Doctor Luo: Today our main theme is the “wind overcomes dampness” approach. In modern practice, there are three most common scenarios for this formula:

First, joint-type disorders. As long as your back hurts, your head hurts, your neck hurts — as long as it is caused by dampness — the tongue coating is rather thick and greasy, you’re always sleepy and weak, with a dizzy, heavy feeling — this method can be used. Some people’s joints ache whenever it turns cloudy; it hurts badly, and there is certainly dampness in the body. With this approach, of course you can also pair in some qi-tonifying, upright-nourishing, blood-nourishing herbs for an even better effect.

Second, dampness colds. You catch a cold when the weather is especially humid. The characteristics: joint soreness is very obvious, especially the back aching badly; no energy; the head feels as if a big hat has been put over it (head heavy as if wrapped); almost no appetite; feeling muddled, weary and unwilling to move — all of this is related to dampness, and this formula works just as well.

Third, fifth-watch diarrhea (wu geng xie). The old TCM master, the great physician Doctor Ding Guangdi, used it specifically to treat fifth-watch diarrhea — in the early morning a gust of cold wind blows and diarrhea follows; no amount of spleen tonifying does any good. He held that this comes from relatively heavy dampness in the body, and used the dampness-dispelling wind-herb method to rouse the body’s yang qi — sometimes adding a little bai zhu (atractylodes) and some spleen-tonifying, stomach-tonifying herbs to the formula, with very good results.

Why can wind herbs dispel dampness? — The mechanism is actually simple

💬 Note from Doctor Luo: Why can wind herbs remove dampness? Because they increase the permeability inside your body — the permeability of the channels — promoting the circulation of qi and blood inside the body and rousing the body’s functions. Once qi and blood start carrying the body’s substances (including turbid dampness) through circulation, there are more chances to discharge them. Moreover, wind herbs have an inherent tendency to move upward and outward — they can make you sweat, and once you sweat, the dampness garbage is excreted with the sweat. This is an especially important idea in Chinese medicine.

The lineage of wind herbs: how Chinese medicine enriched itself step by step

At the very beginning of Chinese medicine, the medicinals used in Doctor Zhang Zhongjing’s Shang Han Za Bing Lun were basically ma huang (ephedra) and gui zhi (cinnamon twig) — the medicinals were rather simple back then. As Chinese medicine developed in later generations — by the time of the Wei-Jin period — wind herbs began to be used more and more; by the Jin-Yuan era, the Jin-Yuan physicians were already using these wind herbs widely. Famous physicians like Liu Hejian were all skilled with wind herbs, adding a broader range of approaches to Chinese medicine and enriching the “wind overcomes dampness” theory through practice.

💬 Note from Doctor Luo: Later physicians kept enriching Chinese medicine with their own experience and completing the theories of the Huang Di Nei Jing (Yellow Emperor’s Inner Classic) — the Nei Jing mainly discusses theory and says little about clinical practice, and later physicians kept adding to it. So when we think about how to remove dampness from the body, we know there is one more method available: you can tonify the spleen, tonify the kidney, tonify upright qi, tonify yang qi; you can blandly percolate to drain dampness from below; you can rouse the spleen and stomach of the middle jiao; and you can use wind herbs to release the damp pathogen from above and from the body surface. With more and more approaches, we are better equipped to regulate the body.

Epilogue: classic formulas still sleeping in the books

Having come this far, what I find especially regrettable is: Doctor Li Dongyuan’s formulas have not all been turned into ready-made Chinese patent medicines. A formula this classic — most of them are still sleeping in the books. A formula like Qiang Huo Sheng Shi Tang, made into a patent medicine, paired with some spleen-tonifying herbs and some bland percolating dampness-draining herbs — combined just a little, its dampness-removing effect would be even better. There really are many people who, once injured by dampness, have no idea what medicine to use — it’s a great pity.

💬 Note from Doctor Luo: I think this is a problem with both the management and the commercial operation of Chinese medicine. Approving classic formulas like this would be extremely beneficial to the health of ordinary people, yet very few people do it. Go to Japan and look: Doctor Zhang Zhongjing’s formulas, and these later formulas too — the Japanese have produced them all; on our side, approving medicines is extremely difficult, almost nothing gets approved. Actually, for classic formulas like this, you just make them following the original — with doctors guiding their use — and I think it is entirely feasible. Many classic formulas are still sleeping, while the common people have so many health problems left unsolved — making them into patent medicines, into granules, into capsules — all of it works. The wisdom of the ancients sits right there, and the road ahead is truly long and heavy.

My dear friends, today I’ve told you about this classic formula. The idea this formula inspires in us is: wind overcomes dampness — using these wind-dispelling herbs, you can conquer dampness. Once you’ve learned the idea and broadened your thinking, when you meet a related problem in the future, you’ll have one more approach: remember there’s a formula that may work. Next I’ll talk about more of Doctor Li Dongyuan’s formulas — thank you all for listening!

What to take away

Wind overcomes dampness (feng neng sheng shi). This is the core idea of Qiang Huo Sheng Shi Tang — and of the whole Jin-Yuan wind-herb tradition. Wind herbs such as qiang huo, du huo, fang feng, gao ben and man jing zi rouse the yang qi, increase the body’s permeability, move qi and blood, and drive dampness out from the body surface and through sweat.
When to reach for it. Dampness injury — especially cold-dampness or wind-dampness: aching back and spine, stiff painful neck, lower back feeling as if it will snap, a rushing sensation with headache. The pattern is “the Taiyang channel is not moving”: the foot Taiyang Bladder channel runs along the back, so symptoms concentrate on the back, neck and lower back.
The formula in brief. Qiang huo (notopterygium) and du huo (pubescent angelica) one qian each (about 3 g) as the wind-dispelling leaders — qiang huo unblocks the Taiyang channel of the back, du huo reaches the paired Shaoyin kidney channel to treat the root below; honey-fried gan cao, gao ben (Chinese lovage) and fang feng (saposhnikovia) five fen each; man jing zi (vitex fruit) three fen; chuan xiong (ligusticum) two fen. Ground to powder, decocted from two cups to one, taken warm after meals so the power moves upward. After the course, keep tonifying the spleen or the dampness will return.
Doctor Li Dongyuan’s modifications. For damp-heat, add a little huang bai (phellodendron bark) plus a little fu zi (aconite) — clear the damp-heat without injuring yang; sometimes add ren shen (ginseng) to support upright qi.
Three modern uses. (1) Joint pain caused by dampness — e.g. joints that ache whenever the weather turns cloudy; (2) dampness colds — heavy head like a hat, sore back, no appetite, weariness; (3) fifth-watch diarrhea (dawn diarrhea) — Doctor Ding Guangdi’s specialty: wind herbs to rouse yang, sometimes with bai zhu and spleen tonics.

Compiled from Doctor Luo Dalun’s lecture series on Doctor Li Dongyuan. Qiang Huo Sheng Shi Tang comes from Doctor Li Dongyuan’s Pi Wei Lun (Treatise on the Spleen and Stomach).