Shen Zhuo Tang (Gan Jiang Ling Zhu Tang): A TCM Formula for Cold-Damp Low Back Pain

Shen Zhuo Tang, also known as Gan Jiang Ling Zhu Tang (Sweet Ginger, Poria, and Atractylodes Decoction), is a classic formula from the Han Dynasty’s Essential Prescriptions from the Golden Cabinet (Jin Gui Yao Lue) by Zhang Zhongjing.

Though less well-known, it is highly effective for treating low back pain caused by cold and dampness, especially in winter. The text describes the condition in the chapter on “Five Organs’ Wind-Cold Accumulation Disorders”: “For Shen Zhuo disease, the body feels heavy, the waist is cold as if sitting in water, with a sensation like water retention, yet there is no thirst, urination is normal, appetite is unaffected, and the condition stems from the lower burner.

It arises from overexertion, sweating, and damp clothing, leading to cold-damp retention. Symptoms include cold pain below the waist and a heavy abdomen, as if carrying a belt of five thousand coins. Shen Zhuo Tang is indicated.”

Shen Zhuo Tang (Gan Jiang Ling Zhu Tang)

Formula Composition and Roles

Shen Zhuo Tang consists of four herbs, organized according to the TCM principle of “monarch, minister, assistant, and envoy”:

• Monarch: Dried Ginger (Gan Jiang)Dried Ginger, with its pungent and hot nature, disperses cold and warms the middle. As the primary herb, it quickly expels cold pathogens, restores yang qi, and relieves cold-induced low back pain.

• Ministers: Poria (Fu Ling) and Atractylodes (Bai Zhu)Poria and Atractylodes remove dampness. Poria promotes water metabolism to clear dampness, while Atractylodes strengthens the spleen and dries dampness, addressing the root cause of damp accumulation. Together, they balance the body by eliminating cold-dampness.

• Assistant: Honey-Fried Licorice (Zhi Gan Cao)Licorice harmonizes the formula, warms spleen yang, and supports Dried Ginger’s cold-dispersing and Poria and Atractylodes’ dampness-clearing actions. Its mild nature tempers Dried Ginger’s intensity to prevent excessive dispersion that could harm qi.

• Envoy: None explicitly designated, though Licorice also serves to harmonize the formula’s actions.

Shen Zhuo Tang (Gan Jiang Ling Zhu Tang)

Pathophysiology of Shen Zhuo Tang (Gan Jiang Ling Zhu Tang)

Shen Zhuo Tang targets three main pathological mechanisms:

1. Cold-Damp Obstruction；Cold-damp pathogens invade the lower body, particularly the waist, lodging in muscles and meridians. These pathogens, which are contracting and stagnant in nature, impair qi and blood flow, causing cold pain, body heaviness, and symptoms like a runny nose linked to the Bladder meridian.

2. Spleen Yang Deficiency；Weak spleen yang impairs digestion and water metabolism, worsening dampness accumulation. This leads to body heaviness, low back pain, and symptoms like normal urination and appetite despite the condition.

3. Meridian Obstruction；Cold-dampness blocks the meridians, particularly the Bladder meridian, causing impaired qi and blood flow. This results in cold pain, heaviness, and associated symptoms like a runny nose.

Shen Zhuo Tang (Gan Jiang Ling Zhu Tang)

Indications and Benefits of Shen Zhuo Tang (Gan Jiang Ling Zhu Tang)

Shen Zhuo Tang is used for Shen Zhuo disease, characterized by:

• Body heaviness and pain

• Cold, painful low back

• A heavy abdomen, as if weighed down

• No thirst

• Normal urination and appetite

• Pale tongue with white coating

• Deep, slow, or soggy pulse

The formula’s main benefits are:

• Warming the Spleen: Dried Ginger and Licorice restore spleen function to address dampness.

• Clearing Dampness: Poria and Atractylodes eliminate excess dampness to restore balance.

• Dispersing Cold: Dried Ginger expels cold to relieve low back pain.

• Resolving Dampness: Poria and Atractylodes strengthen the spleen to prevent damp accumulation.

These actions address cold-damp obstruction, spleen yang deficiency, and meridian blockage.

Shen Zhuo Tang (Gan Jiang Ling Zhu Tang)

Modern Applications

Modern research highlights Shen Zhuo Tang’s anti-inflammatory, analgesic, diuretic, and immune-regulating effects, making it effective for various conditions. It is used for:

• Rheumatoid Arthritis: Reduces joint pain and swelling.

• Lumbar Muscle Strain: Relieves low back pain by warming and dispersing cold.

• Rheumatoid Arthritis: Modulates immunity to ease joint pain and swelling.

• Thromboangiitis Obliterans: Improves circulation to reduce pain and swelling.

• Sciatica and Spinal Stenosis: Provides pain relief and reduces swelling.

Patients often experience significant improvement in low back pain, body heaviness, swelling, runny nose, and diarrhea after using the formula.

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Precautions for Use

When using Shen Zhuo Tang, consider the following:

• Pattern Differentiation: The formula is specific to cold-damp obstruction in the meridians, muscles, or joints. A TCM practitioner must confirm the diagnosis.

• Individual Variations: Adjust the formula based on the patient’s constitution, under professional guidance.

• Modifications: For severe low back pain, add Eucommia (Du Zhong) or Dipsacus (Xu Duan) to strengthen the kidneys and waist. For pronounced cold-dampness, add Cang Zhu or Magnolia Bark (Hou Po) to enhance dampness-clearing effects.

• Contraindications: Avoid in patients with damp-heat obstruction or yin deficiency with heat, as the warming nature may worsen these conditions.

Conclusion

Shen Zhuo Tang is a time-honored TCM formula that effectively treats cold-damp low back pain by warming the spleen, clearing dampness, and dispersing cold. Its simple yet powerful blend of herbs addresses conditions like rheumatoid arthritis, lumbar strain, and sciatica, offering relief from pain and heaviness. Its historical significance and modern applications highlight its value in clinical practice. Always consult a qualified TCM practitioner to ensure proper diagnosis and safe use, tailored to individual needs.