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An Analysis of Drynaria 12 (Seven Forests)

The Drynaria 12 formula was established after several practitioners asked about Chinese herbal therapies for the common problem of osteoarthritis. This disorder involves degradation of the soft tissue (cartilage) and fluids (synovial fluid) in the joint space, especially of the knees. To a certain extent, the disorder is a common aspect of aging, but it is typically triggered by repeated injuries earlier in life, and may be worsened by certain dietary deficiencies. Osteoarthritis is usually a progressive disorder, yielding pain and, ultimately, immobility. Other degenerative conditions that affect the joints, such as avascular necrosis of the femoral head (AVN-FH), are treated by Chinese doctors using similar methods. The search of the Chinese literature for insights into their treatment of this condition reveals something about the nature of Chinese herbal approaches.

A common feature of Chinese medicinal herb reports is that for any given condition the treatment usually differs from one report to another. That is, at one hospital, the recommended herb formula(s) will differ from those administered at other hospitals, and it is often the case that only one major report on the therapy will be filed from each of these centers. This is in contrast to the situation with modern medicine where multiple studies are conducted with a certain drug, and that drug will be used in many places. Even though, as is most often the case, there are several drugs for treating a given disease, there will be many studies of each of the drugs. The difference seen in the medical literature is that the tradition of Chinese medicine has been based on individual physicians undertaking their own development of therapies and their own investigations into the clinical effects, whereas the modern medicine approach involves researchers undertaking studies to inform and influence the entire profession.

When various Chinese herbal therapies for a given condition are reported to be effective, the question becomes: which would be most suitable to use? Sometimes one of the formulas fits better the situation of a patient than another, which helps in making a selection. Most often, the differences that exist between the herbal formulations derive from the physicians' understanding of the herb ingredients and their prior experiences as to which herbs seem to work best. One means of dealing with this difficult situation is to examine several of the formulations, select the ones that are based on a common conceptual approach, and determine which ingredients might be most generally useful for that purpose (thus removing some herbs that only a single Chinese doctor might prefer but which are not used by the others). This process has been followed in devising several of the Seven Forests formulas, and Drynaria 12 is a good example. One particular journal report stood out and served as a basis for examination of the others.

Complex Chinese herb formulations, such as Drynaria 12, mainly address two therapeutic areas that are described in traditional medicine. One reflects the fact that the disorder usually appears with aging and involves degeneration of the joint, that is, a loss of the padding in the space between the bones. According to the ancient medical approach, two organ systems-the liver and kidney-are responsible for maintaining the joints, and especially those of the lower limbs. The deterioration of the joints, as seen in cases of osteoarthritis, is understood to be due to a decline in the essence and function of these organs and might be slowed, or even partly reversed, by using herbs that are said to tonify and nourish these two organs. The second therapeutic area concerns the effects of inflammation and reduced mobility, whereby the normal blood circulation in the joint is disrupted and weakened. As a result, the joint becomes painful and the ability of the body to restore it, by bringing nutrients, is impaired.

The Chinese herb approach to osteoarthritis, based on this reasoning, is to nourish the kidney and liver and revitalize the circulation of blood. The three primary herbs of Drynaria 12, which make up about one-third of the entire formula, have these properties. Drynaria (Chinese name: gusuibu, meaning the herb that "tonifies damaged bones") supplements the kidney, vitalizes blood, and alleviates pain; dipsacus, an herb commonly used to treat broken bones, supplements the kidney and liver and vitalizes blood circulation; rehmannia, used in almost every formula for disorders of aging, nourishes the kidney and liver. The remainder of the formula supports these herbs.

Drynaria 12
gusuibu Drynaria.............................. 12%
xuduan Dipsacus............................. 10%
dihuang Rehmannia.......................... 10%
huangqi Astragalus.......................... 9%
jixueteng Millettia.............................. 8%
danggui Tang-kuei........................... 8%
niuxi Achyranthes........................ 8%
duzhong Eucommia........................... 8%
lurong Deer antler.......................... 8%
chuanxiong Cnidium............................... 8%
songjie Pine node............................ 6%
duhuo Tu-huo............................... 5%

Eucommia and deer antler are examples of ingredients used to tonify the kidney and liver and strengthen the knees; millettia, tang-kuei, achyranthes, and cnidium are examples of herbs used to invigorate the blood circulation and alleviate pain; pine node and tu-huo are especially used to help relieve pain and inflammation. Astragalus is a tonic herb commonly included in formulas to improve the action of the blood vitalizing herbs and to enhance the ability of herbs to tonify the kidney. Drynaria and millettia are provided as concentrated extracts; the other herbs are ground to powder to make this formula.

A formulation like this one was used at one of the Chinese clinics and claimed to provide at least some degree of benefit for all the patients who used it. Although such claims must be viewed with due skepticism, the formulation fits traditional methods of therapy, and there are many mechanisms by which the herbs might improve joint mobility and alleviate pain. Other reports of therapies for osteoarthritis often, but not always, followed a similar pattern of therapy.

Most people with osteoarthritis have learned about the potential benefits of consuming dietary supplements containing glucosamine, the main substance used in constructing the "padding" in the joint space (see White Tiger Boswellamine, as an example of a source of this compound from ITM; it includes additional dipsacus and two herbs for vitalizing blood). The ingestion of glucosamine sulfate would be used in combination with a traditional style therapy like Drynaria 12. In China, the consumption of glucosamine-containing substances in the diet was traditionally used to benefit people with osteoarthritis; however, the Western diet is almost entirely free of glucosamine sulfate sources.

It is important to note that neither Drynaria 12 (or other Chinese herb formulations) nor glucosamine sulfate (or its polymer chondroitin) has been proven effective for osteoarthritis; the information provided here helps explain the rationale that practitioners of Chinese medicine would rely upon for recommending these substances to patients with osteoarthritis.

Method of Use

Formulas intended for nourishing kidney and liver are commonly used on a routine basis, that is, used daily over an extended period of time. A practitioner can recommend a suitable dosage, and can also provide advice about any additional formulations that might be used in conjunction with Drynaria 12.

The Herbs of Drynaria 12

Common Name Botanical Name Chinese Name Primary Indications
for Use in the
Chinese Herbal System*
Drynaria Drynaria fortunei Gusuibu pain in hips, knees, tendons, and bones; traumatic injury
Dipsacus Dipsacus asper Xuduan broken bone, traumatic injury, low back pain
Rehmannia Rehmannia glutinosa Shudihuang debilitated back and knees, fatigue, anemia
Astragalus Astragalus memranaceus Huangqi deficiency of qi and yang
Millettia Millettia nitida Jixueteng numb pain in back and knees
Tang-kuei Angelica sinensis Danggui blood stagnation and deficiency
Achyranthes Achyranthes bidentata Niushi pain of the back, knees, and bones
Eucommia Eucommia ulmoides Duzhong pain of the hips and knees
Deer antler Cervus nippon Lurong pain of the waist and knees
Cnidium Ligusticum chuanxiong Chuanxiong vitalize blood circulation, control pain
Pine node Pinus sp. Songjie alleviates pain of joints and muscles, relaxes tendons
Tu-huo Angelica pubescens Duhuo pain of the hips and knees

* These are samples of traditional applications of the herbs, selecting those uses that are relevant to osteoarthritis. Listing the applications here is not intended to imply that there is evidence for their efficacy. Some of the herbs have been subjected to pharmacology experiments supporting some of the applications; for example, analgesic and anti-inflammatory actions have been demonstrated for many of these herbs. Such laboratory results do not assure that they will have the same effects in people who consume them.