Zheng Tian Wan
A TCM patent remedy for Headacheby Adam Tate, 2019
Zheng Tian Wan is a TCM patent medicine for Headache. It is an OTC (over-the-counter) medicine available from various manufacturers as a general first-line remedy for Headaches and Migraine.
Some patent medicines develop a reputation for being effective for a particular disease without necessary differential diagnosis. They may achieve a high rate of efficacy regardless of the diagnosis, in some cases equal to or better than a formula written by a TCM doctor. These are Empiric remedies which often are the origin of a patent medicine.
Despite the fact that it is available as an OTC medicine it contains prepared Aconite Zhi Fu Zi and Asarum Xi Xin, both accounted toxic and forbidden in western use.
There is a great variation in the formula used by different manufacturers, and some companies have made versions marketed at the west which do not contain the above-mentioned toxic herbs.
Formula
The basic formula is usually composed of a selection of the following herbs. The formula tends to contain 7–9 herbs, usually the first 7–9 herbs of the following list., One version from 999 contains all of the following 14 herbs:
1. Paeonia Bai Shao – Nourishes Blood, settles Wind, calms Spasms, soothes the Liver
2. Ligusticum Chuan Xiong – Moves the Blood, clears Stasis, settles Wind; special for Headache
3. Angelica Dang Gui – Nourishes Blood, promotes Circulation
4. Rehmannia Shu Di – nourishes Blood and Yin
5. Angelica Bai Zhi – clear Wind-Cold, especially for Frontal/Sinus Headache
6. Saposhnikovia Fang Feng – special to clear Wind, stops Spasms
7. Carthamus Hong Hua – Moves the Blood, opens the Capillaries
8. Asarum Xi Xin – clear Wind-Cold, opens the Channels and regulates Qi and Blood
9. Prepared Aconite Bai Fu Pian (Zhi Fu Zi) – settles Wind, clears Cold and Damp, Warms Yang, eases Pain
10. Angelica Du Huo – clears Wind and Damp
11. Ephedra Ma Huang – clears Wind–Cold, opens the Channels
12. Notopterygium Qiang Huo – clears Wind-Cold
13. Persica Tao Ren – moves the Blood, opens Obstructions
14. Spatholobus Ji Xue Teng – moves the Blood, Opens the Channels
As per general Chinese convention with patent medicines, the doses or proportions are generally not given.
Following is 4 different varieties available from different manufacturers under the name Zheng Tian Wan, the first being another version from 999:
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A. Ligusticum Chuan Xiong 18.59% Dang Gui 14.11% Carthamus Hong Hua 11.89% Saposhnikovia Fang Feng 14.11% Angelica Du Huo 13.08% Paeonia Bai Shao 9.49% Rehmannia Shu Di 8.92% Persica Tao Ren 9.81% |
B. Paeonia Bai Shao Angelica Bai Zhi Ligusticum Chuan Xiong Dang Gui Rehmannia Shu Di Angelica Du Huo Uncaria Gou Teng Carthamus Hong Hua Spatholobus Ji Xue Teng Notopterygium Qiang Huo Persica Tao Ren |
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C. Angelica Dang Gui Asarum Xi Xin Saposhnikovia Fang Feng Gastrodia Tian Ma Angelica Bai Zhi Ephedra Ma Huang Carthamus Hong Hua |
D. Angelica Bai Zhi Ligusticum Chuan Xiong Dang Gui Saposhnikovia Fang Feng Angelica Du Huo Uncaria Gou Teng Carthamus Hong Hua |
Gastodia Tian Ma is not included in all versions, but is a potent addition to settle WindFunctions
1. Moves the Blood
2. Promoting Circulation, Resolve Blood Stasis
3. Nourish the Blood and calm the Liver
4. Clears External Wind
5. Settles Internal Wind
6. Clear the Channels, Relieves Pain.
Uses
1. Vascular Headache, Migraine,
2. Nervous and Tension Headaches.
3. Headaches associated with Cervical Spondylosis
4. Premenstrual Headache
5. Headache associated with Trauma
6. Headache from external Wind
7. Headache from Liver Yang
Formula analysis
The basis of this formula is Four Substance Decoction (Si Wu Tang), which is composed of herbs 1–4 being the primary Blood-tonic and circulation regulating formula of TCM. Ligusticum Chuan Xiong in particular is regarded very highly for various types of Headache. It is closely related to the western Lovage root which is used similarly.
The next group of herbs are to clear Wind from the surface of the body, in particular, Wind and Cold. This includes Angelica Bai Zhi, Saposhnikovia Fang Feng, Ephedra Ma Huang and Notopterygium Qiang Huo. These medicines settle Wind, open the capillaries to clear obstruction of the surface of the body.
Then there are the herbs that move the Blood and clear Blood stasis. This includes Ligusticum Chuan Xiong, Carthamus Hong Hua, Asarum Xi Xin and Prunus Tao Ren. This group regulates circulation and clears stasis, as well as helping relieve pain.
There are herbs that help settle wind, specifically Saposhnikovia Fang Feng and Paeonia Bai Shao.
Finally, there are special medicines to penetrate and open the channels to clear obstruction. Of course many of the herbs already mentioned help achieve this, but in particular, Carthamus Hong Hua, Asarum Xi Xin, and Prepared Aconite Bai Fu Pian (Zhi Fu Zi) potently achieve this, especially in combination.
Aconite in particular is perhaps the most essential herb of the formula. It potently regulates Qi to stop Wind, warms the Yang to promote circulation and clear Cold and Damp, is analgesic and regulates the blood circulation.
Dose
It is available either as Pills, Tablets, or as small bags of tiny pills, each bag containing 6 grams which is taken as a dose. However, due to variation in formula and strengths, individual manufacturers directions should be followed.
This can be taken 2 or 3 rimes daily for 2 or 3 weeks, then a break in treatment will often be found beneficial. Chronic cases may need to take continuously for 4–6 weeks.
Contraindications
This is generally safe and well tolerated when used as prescribed. However, it is not suitable for use during Pregnancy, in the very Young or very Old. In addition, its use should be avoided in those with serious Heart, Kidney or Liver disease.
If using a patent form of the medicine, especially from China, it should be ascertained if Aconite is included or not. If it is, ensuring the patient is aware to avoid overdose, and perhaps starting for a few days on half doses would be sensible measures to take. Ensuring the product is kept out of reach of children is also important.
The Use of Aconite
Aconite is an incredibly important and potent medicine used in the Eastern systems. It is most used in TCM and Tibetan Medicine although its use in these systems in quite different. Aconite is primarily used in TCM 1. as a potent Yang Tonic; 2. for Wind-Cold-Damp arthritic and rheumatic complaints.
In Tibetan Medicine its use in more diverse and it is especially used in various Wind diseases. Aconite has a potent effect of settling wind and regulating Qi circulation, as well as relieving pain and inflammation.
One interesting formula related to its use in chronic and obstinate Headache and Migraine is the Tibetan Pill, Red Coral 25, a compound medicines with 25 ingredients including mineral medicines such as Red Coral and Lapis Lazuli. This is one of the famous Rin Chen, or ‘Precious Jewel Pills’ of Tibetan Medicine. It also contains Aconite and this has been credited as being one of the primary effective medicines of the formula. (Click here to read more about Red Coral 25)
Warning on the use of Aconite
A few years ago this formula became well publicised in the West due to its Aconite content. The UK MHRA (medicine regulation board in the UK) released a statement claiming the medicine could be dangerous, stating that anyone who has taken it should cease immediately and contact their doctor or health practitioner.
In this media release they stated that 3 cases of suspected Aconite poisoning had come to their attention. One suffering Kidney problems, one with dizziness and paraesthesia, and a third with palpitations and shortness of breath (who recovered after ceasing). It does not state these cases were associated with taking Zheng Tian Wan, just after taking Aconite which was most likely after it was prescribed by a practitioner to use in decoction.
The media noted Aconite is known as the ‘Queen of Poisons’, but neither mentions the elaborate processing that the Aconite goes through in the Eastern systems, nor compares the percentage of side effects connected to the use of Western Medicine for similar diseases.
However, it is true that Aconite is related to most of the serious side effects and fatalities that occur in modern TCM in China. But this is in Decoction where the dose maybe 10–20 or more grams per day (sometimes far higher), and also using Wild forms of Aconite which are known to be far more potent that the cultivated forms. In Pill form where the amount is only a fraction of the formula, no side effects would be expected when used in therapeutic doses.
It does remind us to be aware of the use of such formulas and patent remedies. Some people can think that ‘herbs are not as strong as western pharmaceuticals, I therefore should take more than directed’.
If recreated for the western clinic, the Aconite can be omitted.
You can read about the release by the MHRA in the Pharmaceutical Journal (18 April, 2013), and in The Daily Mail (18 April, 2013)
Research
Details of available research are sketchy and only available in Chinese. However, according to some clinical trials, there has been up to 98% efficacy (efficacy meaning some relief, not necessarily a cure). There is plenty of anecdotal reports of it being very effective in some patients.
Use with Other Formulas
1. For stress and anxiety related Headache, it can be combined with Xiao Yao San.
2. For Headache related to menstruation or PMS, it can also be combined with Xiao Yao San or Dan Zhi Xiao Yao San.
3. Headache from Liver Heat, it can be combined with Long Dan Xie Gan Wan
4. Headache from deficiency, it can be taken with Gui Pi Wan or Bu Zhong Yi Qi Tang
5. Headche from Heart Fire, with Palpitations, Insomnia etc., combine with Tian Wan Bu Xin Dan.
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Right: Ligusticum Chuan Xiong (Chinese Lovage) is an important Chinese Medicine to move the Blood, resolve stasis and ease Pain. It is particularly indicated for various types of Headache. |
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A proposed version for the Western Clinic
Ligusticum Chuan Xiong 20 grams
Gastrodia Tian Ma 15 grams
Angelica Dang Gui 15 grams
Mistletoe 15 grams
Paeonia Bai Shao 15 grams
Saposhnikovia Fang Feng 15 grams
Feverfew 15 grams
Carthamus Hong Hua 10 grams
Powder or form honey Pills.
Dose of the powder: half–1 teaspoonful, 2–3 times daily.
Feverfew (Tanacetum parthenium) is an obvious addition in the Western clinic as it is cheap, readily available, and has a lot of research to show its effectiveness in various types of Headache including Migraine.
Mistletoe and Peony were always combined in the Western tradition for Wind diseases of the Head. This combination settles Wind, regulates Blood as well as being nourishing to Yin and Blood. Along with Gastrodia, this combination powerfully settles internal Wind.
Additions
1. If permitted, 10 grams of prepared Aconite Bai Fu Pian (Zhi Fu Zi) can be added. If Aconite is added, an equal dose of Licorice should be added to counteract any potential toxicity.
2. If there is Blood deficiency, double the doses of Dang Gui and Paeonia Bai Shao and add Rehmannia Shu Di.
3. For acute Headache, double the dose of Fang Feng and add Angelica Bai Zhi.
4. Chronic Blood-stagnation type Headache with fixed pain, add Persica Tao Ren, increase the doses of Dang Gui and Ligusticum Chuan Xiong to 30 grams, and the dose of Asarum Xi Xin can be increase to 15 grams.
5. If there is excess Heat with stress, anxiety and insomnia, Red Coral and Pearl may be added.
6. To make it more penetrating to open up the network channels and open the orifices of the Brain, a little Borneol Bing Pian can be added.
7. Headache associated with Depression, St. Johns and Balm wort can be added.
8. This will be much stronger if 3–5 grams of Saffron is used in place of Safflower.
This formula is also well suited to being made into a tincture which will be absorbed more quickly and enter the blood vessel more effectively. The Tincture can then be applied on a cotton ball or gauze and applied topically to the pain as well as being taken internally.
Conclusion
Each Traditional Medicine system has numerous empirical formulas for the treatment of specific conditions, often being formulas that have proven their efficacy over generations. These are often quite different from formulas used by practitioners which are based on differential diagnosis. However, there is no reason why they cannot be incorporated into the modern clinic. These formulas can also serve as a basis for inspiration in the creation of individual formulas.
Resources & Bibliography
1. Product notes gathered in China
2. Bensky, Chinese Herbal Medicine, Materia Medica, 3Ed., 2004