by John Chen, Ph.D., Pharm.D., O.M.D., L.Ac.

Pinyin Name: Hu Qian Wan
Literal Name: Hidden Tiger Pill
Alternate Name: Phellodendron Formula
Original Source: Dan Xi Xin Fa (Teachings of [Zhu] Dan-Xi) by Zhu Zhen-Heng in 1481

COMPOSITION

Note: Hu Gu (Os Tigris) is derived from an endangered animal, and is rarely used as a medicinal substance today. Its discussion here is included primarily for academic purposes, to reflect the historical use of this substance in its original formulation. Most herbal products today have removed it completely, or replaced it with Zhu Gu (Os Porcus) which has similar functions.

DOSAGE / PREPARATION / ADMINISTRATION
Grind the ingredients into powder and form into pills with grain-based alcohol. Today, this formula is usually prepared by mixing the powdered herbs with honey to form pills, which should weigh 10g each. Take 1 pill in the morning and at night with lightly-salted water or warm water.

Chinese Therapeutic Actions

• Nourishes yin, and lowers and clears deficiency fire
• Strengthens sinews and bones

CLINICAL APPLICATIONS
Sequelae of polio or stroke with numbness, weakness, and atrophy of the extremities; atrophy and degeneration of the nervous system, atrophy and degeneration of the reproductive system, lumbago, tuberculosis of the knee, muscle atrophy, flaccidity of muscles and bones, post-stroke complications, chronic arthritis, lateral spinal sclerosis, and hypocalcemia.

EXPLANATION
Hu Qian Wan (Hidden Tiger Pill) treats wei zheng (atrophy syndrome) with severe weakness and atrophy of the sinews and bones arising from Kidney yin deficiency, Liver blood deficiency, and yin-deficient fire. The Kidney controls the bones, and the Liver controls the sinews and tendons. If the Kidney and Liver are deficient, the bones and tendons may become weak and deficient as well. Deficiency fire dries yin and blood, causing malnourishment of the sinews. Prolonged lack of nourishment of the sinews leads to stiffness and spasms of the sinews, which can eventually progress to atrophy. Weak bones and tendons may lead to soreness of the lower back and knees, as well as weak legs and weakening of the leg muscles. A red tongue body with little coating indicates deficiency fire, and a fine, weak pulse suggests that the bones and tendons are becoming deficient.

Huang Bo (Cortex Phellodendri Chinensis) and Zhi Mu (Rhizoma Anemarrhenae) clear deficiency fire and strengthen yin of the lower jiao. Gui Ban (Plastrum Testudinis) nourishes Kidney yin, and replenishes jing (essence) and marrow. Shu Di Huang (Radix Rehmanniae Praeparata) and Bai Shao (Radix Paeoniae Alba) nourish yin and tonify the blood. Hu Gu (Os Tigris) strengthens the sinews and bones. Suo Yang (Herba Cynomorii) nourishes Kidney yang and jing. Chen Pi (Pericarpium Citri Reticulatae) and Gan Jiang (Rhizoma Zingiberis) strengthen the Spleen and harmonize the middle jiao to prevent the cold and stagnating herbs from damaging the digestive system.

Modifications

• If there is more deficiency heat, use Di Huang (Radix Rehmanniae) instead of Shu Di Huang (Radix Rehmanniae Praeparata).
• With atrophy and weakness of the muscles due to blood deficiency, add Chuan Xiong (Rhizoma Chuanxiong) and Du Zhong (Cortex Eucommiae).
• With atrophy and weakness of the muscles due to qi deficiency, add Ren Shen (Radix et Rhizoma Ginseng) and Huang Qi (Radix Astragali).
• With atrophy and weakness of the muscles due to jing (essence) deficiency, add Lu Jiao Shuang (Cornu Cervi Degelatinatum) and Rou Cong Rong (Herba Cistanches).
• For seminal emissions, add Long Gu (Os Draconis) and Mu Li (Concha Ostreae).

Cautions/Contraindications
Hu Qian Wan is contraindicated in patients with atrophy caused by damp-heat invasion.

Clinical Studies and Research

1. Muscle atrophy and lateral spinal sclerosis: It has been reported that Hu Qian Wan plus
   Ren Shen (Radix et Rhizoma Ginseng) and Huang Qi (Radix Astragali) is effective in treating muscle atrophy and lateral spinal sclerosis, especially if the conditions are characterized by yin and yang deficiencies1.
2. Hypocalcemia: Use of modified Hu Qian Wan was associated with good therapeutic effect in treating 15 patients with low plasma calcium levels following thyroidectomy. The formula contained Huang Bo (Cortex Phellodendri Chinensis) 12g, Zhi Mu (Rhizoma Anemarrhenae) 6g, Suo Yang (Herba Cynomorii) 6g, Shu Di Huang (Radix Rehmanniae Praeparata) 9g, Bai Shao (Radix Paeoniae Alba) 9g, Gui Ban (Plastrum Testudinis) 10g, Chen Pi (Pericarpium Citri Reticulatae) 10g, Gan Jiang (Rhizoma Zingiberis) 15g, Long Gu (Os Draconis) 18g, Mu Li (Concha Ostreae) 30g, E Jiao (Colla Corii Asini) 30g, and lamb 15g. Additional modifications were made if necessary. Of 15 cases, the study reported complete recovery in 8 cases, improvement in 4 cases, and no change in 3 cases2

• Gan Jiang (Rhizoma Zingiberis) counters the bitter and cold effects of Huang Bo (Cortex Phellodendri Chinensis).
• Gan Jiang (Rhizoma Zingiberis) assists Chen Pi (Pericarpium Citri Reticulatae) in warming the middle jiao, strengthening the Spleen, regulating qi, and harmonizing the Stomach. Together, these two herbs prevent the yin tonics from creating stagnation in the middle jiao.
• Gan Jiang (Rhizoma Zingiberis) facilitates the generation of blood. According to Master Zhu Dan-Xi, it enters the Lung to benefit Lung qi, and enters the Liver channel to assist blood tonics in generating blood.3

Hu Qian Wan and Da Bu Yin Wan (Great Tonify the Yin Pill) both tonify Kidney yin, sedate fire, and contain
Shu Di Huang (Radix Rehmanniae Praeparata), Gui Ban (Plastrum Testudinis), Huang Bo (Cortex Phellodendri Chinensis), and Zhi Mu (Rhizoma Anemarrhenae). Their differences are:

• Hu Qian Wan nourishes yin, sedates fire, and strengthens tendons and bones to treat yin-deficient heat in the Liver and Kidney, with jing (essence) and blood deficiencies causing atrophy or degeneration of the bones, tendons, and connective tissues.
• Da Bu Yin Wan treats Liver and Kidney yin deficiencies with deficiency fire symptoms of steaming bones sensation, tidal fever, cough with blood, a red tongue body with a scanty tongue coating, and a rapid, forceful pulse.4

About the Author

Dr. John Chen is a recognized authority in both western pharmacology and Chinese Herbal Medicine. He teaches at the USC School of Pharmacy, Emperors College, Yo San University of TCM, OCOM, Five Branches, AOMA and ACTCM. Dr. Chens most recent published work is Chinese Medical Herbology and Pharmacology (2003, AOM Press) and Chinese Herbal Formulas and Applications (2008, AOM Press) for which he was lead author.

To learn more about the above formula and how to use and combine 30 primary herbal formulas for the best clinical results, Dr. Alex Chen is speaking on the following topic for Lotus Institute. All classes are approved for 8 CEUs/PDAs by the CA, IL, FL Acupuncture Boards, and by NCCAOM.

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REFERENCES
1Shang Hai Zhong Yi Yao Za Zhi (Shanghai Journal of Chinese Medicine and Herbology) 1985;11:32.
2Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine) 1995;30(11):495.
3Wang MZ, et al. Zhong Yi Xue Wen Da Ti Ku (Questions and Answers on Traditional Chinese Medicine: Herbal Formulas).
4Wang MZ, et al. Zhong Yi Xue Wen Da Ti Ku (Questions and Answers on Traditional Chinese Medicine: Herbal Formulas)..