Flex (CD) ™
* Chronic cold-type of arthritis or arthralgia that worsens with cold and damp weather
* Chronic low back pain and sciatica with underlying deficiencies
* Degenerative disorders with weakness of the lower back and knees with reduced mobility
* General aches and pains characterized by cold manifestations
* Fibromyalgia characterized by cold or numbness
WESTERN THERAPEUTIC ACTIONS
* Analgesic function to relieve pain
* Anti-inflammatory function to reduce swelling and inflammation
* Antirheumatic and antiarthritic effects to treat connective tissue disorders
* Chondroprotective and osteogenic functions to strengthen soft connective tissues and repair joints
CHINESE THERAPEUTIC ACTIONS
* Expels wind, cold and damp
* Warms channels and collaterals, disperses painful obstruction
* Tonifies Kidney yin and yang
* Invigorates the blood circulation and relieves pain
Take 3 to 4 capsules three times daily with a glass of warm water. The dosage may be increased up to 6 capsules every six hours as needed for pain.
Bai Shao (Radix Paeoniae Alba)
Chuan Niu Xi (Radix Cyathulae)
Chuan Xiong (Rhizoma Chuanxiong)
Dang Gui Wei (Extremitas Radix Angelicae Sinensis)
Di Huang (Radix Rehmanniae)
Du Huo (Radix Angelicae Pubescentis)
Du Zhong (Cortex Eucommiae)
Fang Feng (Radix Saposhnikoviae)
Ji Xue Teng (Caulis Spatholobi)
Qian Nian Jian (Rhizoma Homalomenae)
Qin Jiao (Radix Gentianae Macrophyllae)
Ren Shen (Radix et Rhizoma Ginseng)
Sang Ji Sheng (Herba Taxilli)
Wei Ling Xian (Radix et Rhizoma Clematidis)
Wu Jia Pi (Cortex Acanthopanacis)
Yan Hu Suo (Rhizoma Corydalis)
Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata)
Zhi Chuan Wu (Radix Aconiti Praeparata)
Musculoskeletal and connective tissue disorders are major causes of pain and physical disability. Causes of these bone, muscle, and joint disorders vary greatly, depending on the exact disease. Simple causes include trauma and external injuries, such as pulled muscles, strained ligaments, dislocated joints, and bone fractures. Complicated causes include infection, autoimmune disorders, crystal-induced inflammation, and non-inflammatory tissue degeneration. Optimal treatment must address the symptom (pain and inflammation) and the underlying causes. After the disorder is stabilized, physical therapy and exercise are important to maintain flexibility and strengthen surrounding muscles.
Flex (CD) is formulated specifically to treat musculoskeletal disorders characterized by cold and dampness. It contains herbs with functions to eliminate cold and dampness, tonify Kidney yin and yang, warm up channels and collaterals, activate qi and blood circulation, and relieve pain.
Du Huo (Radix Angelicae Pubescentis), Qin Jiao (Radix Gentianae Macrophyllae), and Fang Feng (Radix Saposhnikoviae) have antirheumatic, anti-inflammatory, and analgesic functions. They expel wind, dampness, and cold from the lower back, and remove painful obstruction. Du Zhong (Cortex Eucommiae), Di Huang (Radix Rehmanniae), Chuan Niu Xi (Radix Cyathulae), and Sang Ji Sheng (Herba Taxilli) replenish the vital essence of the Liver and the Kidney, which are responsible for strengthening the bones, sinews, and the muscles of the lower back and knees. Bai Shao (Radix Paeoniae Alba) has analgesic, antispasmodic, and anti-inflammatory effects. Wei Ling Xian (Radix et Rhizoma Clematidis), Yan Hu Suo (Rhizoma Corydalis), Dang Gui Wei (Extremitas Radix Angelicae Sinensis), Chuan Xiong (Rhizoma Chuanxiong), Qian Nian Jian (Rhizoma Homalomenae), Wu Jia Pi (Cortex Acanthopanacis), and Ji Xue Teng (Caulis Spatholobi) increase qi and blood circulation to the extremities to relax the muscles and the tendons. Ren Shen (Radix et Rhizoma Ginseng) and Wu Jia Pi (Cortex Acanthopanacis) tonify qi and address the underlying deficiencies. Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata) and Zhi Chuan Wu (Radix Aconiti Praeparata) restore Kidney yang, dispel cold, and warm up the channels and collaterals to relieve pain.
In summary, the herbs in Flex (CD) dispel cold and dampness to treat various types of musculoskeletal and connective tissue disorders.
CAUTIONS & CONTRAINDICATIONS
* Side effects of this herbal formula may include nausea, vomiting, stomach discomfort and irritability. Discontinue using this formula if these adverse reactions occur.
* Do not use this formula if the patient presents with heat signs such as redness, burning or inflammation of the joints that worsens with heat.
* This formula is contraindicated during pregnancy and nursing.
* This herbal formula contains herbs that invigorate blood circulation, such as Dang Gui Wei (Extremitas Radix Angelicae Sinensis). Therefore, patients who are on anticoagulant or antiplatelet therapies, such as Coumadin (warfarin), should use this formula with caution, or not at all, as there may be a higher risk of bleeding and bruising.,,
* Patients who wear a pacemaker, take antiarrhythmic drugs or cardiac glycosides, such as Lanoxin (digoxin), and have pre-existing cardiovascular problems should not take this formula. Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata) and Zhi Chuan Wu (Radix Aconiti Praeparata) may interact with these drugs by affecting the rhythm and potentiating the contractile strength of the heart.
* Avoid exposure to rain, wind, and cold weather whenever possible.
* Always wear warm clothes and cover up the body and joints.
* Ice packs should never be used in patients with joint pain due to coldness and pain. Use heat pads instead.
Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:
* Knee and ankle joint arthritis: left yangwei pulse, which is an extra meridian pulse found distal to the cun position towards the thumb
* For herniated disk in the back with swelling and inflammation, add Back Support (HD).
* For arm pain, add Arm Support.
* For spasms and cramps, combine with Flex (SC).
* For bone fractures, injuries, and bruises, combine with Flex (TMX).
* For post-stroke numbness and atrophy, use Neuro Plus.
* For bone spurs, add Flex (SPR).
* For prevention and treatment of osteoporosis, add Osteo 8.
* For degeneration of muscles, ligaments, and tendons, add Flex (MLT).
* To potentiate the effect to relieve pain, add Herbal ANG.
* For arthritic pain with inflammation, swelling, redness and pain, use Flex (Heat) instead.
* Moxa and needle ah shi points.
Classic Master Tung’s Points:
* Needle contralateral to the pain. If the pain is in the center, needle bilaterally or the side with the more ah shi points. If the pain is bilateral, needle bilaterally.
* General arthritis: Tianhuang (T 88.13), Minghuang (T 88.12), Fugesan (T 44.30)*, Simazhong (T 88.17), Dihuang (T 77.19), Jianzhong (T 44.06), Wuhu (T 11.27). Bleed the affected area.
* Arthritis (legs): Minghuang (T 88.12), Tianhuang (T 88.13), Qihuang (T 88.14), Zhongjiuli (T 88.25), Jianzhong (T 44.06), Wuhu (T 11.27). Bleed dark veins on the legs. Bleed before needling for best result.
* Arthritis (degenerative): Wanshunyi (T 22.08), Wanshuner (T 22.09), Simashang (T 88.18), Minghuang (T 88.12), Tianhuangfu [Shenguan] (T 77.18), Wuhu (T 11.27). Bleed the affected area.
Master Tung’s Points by Dr. Chuan-Min Wang:
* Cold, damp bi zheng (painful obstruction syndrome), arthritis, fibromyalgia
§ Shoulder: Needle contralaterally Jianzhong (T 44.06), Shangjiuli (T 88.26).
§ Elbow: Needle contralaterally Cesanli (T 77.22), Cexiasanli (T 77.23). Needle ipsilaterally Huofuhai (T 33.07), Xinmen (T 33.12).
§ Wrist: Needle contralaterally Tung’s Wantong (T 66.16)*. Needle ipsilaterally Huochuan (T 33.04).
§ Knee: Needle contralaterally Jianzhong (T 44.06), Tongguan (T 88.01), Tongshan (T 88.02).
§ Ankle: Needle contralaterally Zhongbai (T 22.06), Xiabai (T 22.07). Needle ipsilaterally Xuanzhong (GB 39) for lateral ankle, Sizhi (T 77.20) for medial ankle.
§ Ankle not able to flex or extend: Needle contralaterally Xiaqu (T 44.15), Shangqu (T 44.16), Zhongbai (T 22.06), Xiabai (T 22.07), Wuhu 5 (T 11.27). Needle ipsilaterally Zuwujin (T 77.25).
§ Finger: Needle contralaterally Tongshan (T 88.02), Tongtian (T 88.03). Needle ipsilaterally Huochuan (T 33.04).
Balance Method by Dr. Richard Tan:
* Use Dr. Tan’s Balance Method accordingly as determined by where the pain is (use mirror or image system).
* Related joints, Adrenal Glands.
* Embed magnetic ear balls and switch ear every three days.
Auricular Medicine by Dr. Li-Chun Huang:
* Spleen, Liver, Kidney, San Jiao, Allergic Area, Endocrine, Adrenal Gland, and corresponding points to the affected area. Bleed Ear Apex.
* Sulfur helps the absorption of calcium, and adequate intake and absorption of calcium is essential for the repair and the rebuilding of bones, tendons, cartilage, and connective tissues. Patients are encouraged to consume foods high in sulfur such as asparagus, eggs, fresh garlic, and onions.
* Histidine, an amino acid, is responsible for removing the high levels of copper and iron found in arthritic patients. Patients are encouraged to consume foods high in histidine such as rice, wheat, and rye.
* Fresh pineapples are recommended as they contain bromelain, an enzyme that is excellent in reducing inflammation.
* Patients with gout should increase their intake of cherries and strawberries. Both of them are excellent in neutralizing uric acid. Increase the intake of water, as it helps to flush out uric acid.
* Foods that contain purines or uric acid, such as meat, anchovies, herring, meat gravies and broths, mushrooms, mussels, sardines, sweetbreads, and fried foods, should be avoided. Alcohol also increases the production of uric acid and should also be avoided.
* Avoid cold beverages, uncooked foods, ice cream, caffeine, sugar, tomatoes, milk, dairy products, and red meat.
* Intake of sour food, drinks or fruits (citrus) should be decreased as its nature constricts and may contribute to further stagnation in the channels and collaterals.
* Fish oil may help to alleviate pain associated with rheumatoid arthritis. It can be taken in conjunction with the herbs.
The Tao of Nutrition by Dr. Maoshing Ni and Cathy McNease:
* Recommendations: garlic, green onions, pepper, black beans, sesame seeds, chicken, lamb, mustard greens, ginger, and a small amount of rice wine (if individual does not have hypertension).
* Rub garlic or ginger on the painful areas. Or moxa could be burned on a slice of ginger over the painful areas.
* Drink scallion tea and rub it on the painful areas.
* Rub rice wine on the painful areas and drink one small glassful in the evening.
* Drink grape vine tea added to red wine.
* Make tea from parsnip, cinnamon, black pepper, and dried ginger.
* Avoid cold foods, raw foods, and cold weather elements.
* Weight loss is strongly recommended in individuals who are overweight. This lessens the pressure on the joints, which can then help in relieving pain.
* Exercise is recommended. However, sports such as swimming or skiing that expose affected joints to cold and dampness should be avoided.
* F.L., a 57-year-old female, presented with fibromyalgia. It was also noted that she had a tendency to feel cold all the time. Her TCM diagnosis was Spleen qi deficiency with damp, in addition to Kidney yin and yang deficiencies. For treatment, Flex (CD) was prescribed. The patient took the herbs with good results and continued to take the formula for two years to maintain the results. She no longer felt cold and, overall, had less pain as long as she followed the nutritional guidance as well. The patient was very pleased with the results. Submitted by V.G., Virginia Beach, Virginia.
* P.M., an 89-year-old male, presented with chronic back pain and sciatica for the past four months. He also experienced two other episodes of the same type of pain, once after sitting outside in cold weather for a football game and the other at the funeral for his wife. The pain was in both legs and knees, down the sides of the legs and into the buttocks. Right leg pain was worse than the left. Knee pain was bilateral. Pitting edema on both ankles was noticed. His blood pressure was 130/80 mmHg and the heart rate was 80 beats per minute. Trigger points were felt at the left quadratus lumborum and glute, L3, and L4 areas. In general, he was a very healthy and active 89-year old. The diagnoses were bi zheng (painful obstruction syndrome) due to cold, Kidney qi deficiency, and qi and blood stagnation on the Gallbladder channel. Flex (CD) was prescribed at 4 capsules twice a day. He had a total of three acupuncture visits and felt 90% better. He then planned a European walking vacation so he can get better even faster to avoid seeing a physical therapist. Submitted by M.H., West Palm Beach, Florida.
* C.M., a 48-year-old female, presented with joint pain (hands, feet, knees) that worsened in cold and rainy weather. She also had a family history of arthritis and osteoporosis. She also suffered from tendonitis of both forearms. She had decreased range of motion, with calcification of joints in her fingers. Her Western diagnosis was rheumatoid arthritis; the TCM diagnosis was cold and damp obstruction. Osteo 8 and Flex (CD) were prescribed at four capsules each, twice daily. Within one day, the symptoms began improving. After one week, joints and tendons were not stiff, and almost pain free. During the winter (the season in which her condition usually deteriorated), the symptoms even improved. The patient reported later that if she stopped taking the herbs, the symptoms returned. Submitted by C.D., Phoenix, Oregon
* A 73-year-old female daycare worker presented with constant pain in the low back, right hip, and right knee due to osteoarthritis. Her pain was aggravated especially after any type of activity or prolonged sitting. Sharp pain was also elicited upon walking. Other signs and symptoms included fatigue, dizziness, and an intermittent high blood pressure. Her tongue body appeared red with a scanty tongue coating. Her left pulse was irregular, hesitant and thready at the Liver and Kidney positions. The right pulse was choppy, irregular, and weak at the Spleen position. The practitioner diagnosed her condition as Kidney and Liver yin deficiencies, qi and blood stagnation, and damp-cold bi zheng (painful obstruction syndrome) in the joints. Along with acupuncture treatment, the patient was instructed to take Flex (CD) at 3 spoonfuls, two times a day. The patient experienced a reduction in joint pain by almost 30%. Submitted by N.M., Torrance, California.
* A 63-year-old female homemaker presented with sciatica-like pain in the lumbar and left sacral region, which was worse in the evening and cold to the touch. The patient also reported swelling in her left ankle, which was also cold upon palpation and had been the source of her chronic pain for almost a year. She mentioned that her cold symptoms were relieved by warmth. A disc herniation was also diagnosed at her L3 to L4 lumbar level. Her tongue was thin, red with a thick tongue coat especially at the base. The pulse was tight and deep. The practitioner diagnosed this case as Liver and Kidney yin deficiencies, Kidney yang deficiency, and wind-damp bi zheng (painful obstruction syndrome). The patient was given Flex (CD)at 3 capsules three times daily. A significant decrease in pain level was quite evident during the initial treatment. Although the patient did experience minor indigestion in the beginning, the side effect resolved after only a short while. After taking three bottles of Flex (CD), the patient felt her pain was manageable enough that she was able to return to exercising in order to prevent further relapse. Submitted by J.T., Kingsport, Tennessee.
PHARMACOLOGICAL AND CLINICAL RESEARCH
Flex (CD) treats musculoskeletal and connective tissue disorders with cold and damp manifestations. Flex (CD) contains herbs with strong analgesic, anti-inflammatory, antirheumatic, chondroprotective, and osteogenic functions.
Yan Hu Suo (Rhizoma Corydalis) is one of the strongest and most potent herbs for treatment of pain. Its effects are well documented in both historical references and modern research studies. According to classical texts, Yan Hu Suo (Rhizoma Corydalis) has been shown to treat chest and hypochondriac pain, epigastric and abdominal pain, hernial pain, amenorrhea or menstrual pain, and pain of the extremities. According to laboratory studies, the extract of Yan Hu Suo (Rhizoma Corydalis) has been found to be effective in both acute and chronic phases of inflammation. The mechanism of its anti-inflammatory effect is attributed to its effect to inhibit the release of histamine and pro-inflammatory mediators., Furthermore, it has a strong analgesic effect. With adjustment in dosage, the potency of Yan Hu Suo (Rhizoma Corydalis) has been compared to that of morphine. In fact, the analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is so strong and reliable that it has been used with satisfactory anesthetic effect in 98 out of 105 patients (93.4%) who underwent surgery. The analgesic effect can be potentiated further with concurrent acupuncture therapy. In one research study, it is demonstrated that the analgesic effect is increased significantly with concurrent treatments using Yan Hu Suo (Rhizoma Corydalis) and electro-acupuncture, when compared to a control group, which received electro-acupuncture only. Overall, it is well understood that Yan Hu Suo (Rhizoma Corydalis) has a marked effect to treat pain. Though the maximum analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is not as strong as morphine, it has been determined that the herb is much safer, with significantly fewer side effects, less risk of tolerance, and no evidence of physical dependence even with long-term use.
Flex (CD) also contains many herbs with excellent antirheumatic and anti-inflammatory effects to treat arthritic and inflammatory disorders. Du Huo (Radix Angelicae Pubescentis) and Sang Ji Sheng (Herba Taxilli), two herbs commonly used together, have antirheumatic and anti-inflammatory functions and are especially effective in treating general body aches and pains.,Wei Ling Xian (Radix et Rhizoma Clematidis) has marked antiarthritic and antirheumatic activities, as the herbs have been shown to significantly inhibit proinflammatory compounds and prevent rheumatoid arthritis. Dang Gui (Radix Angelicae Sinensis) exerts both analgesic and anti-inflammatory effects through the inhibition of pro-inflammatory mediators, including nitric oxide and prostaglandin E2 in peritoneal macrophages., In comparison with acetylsalicylic acid, the anti-inflammatory effect of Dang Gui (Radix Angelicae Sinensis) is approximately 1.1 times stronger, and its analgesic effect is approximately 1.7 times stronger.Chuan Xiong (Rhizoma Chuanxiong) illustrates an anti-inflammatory effect via an inhibitory activity on TNF-α production and TNF-α bioactivity, and shows a promising effect to treat inflammation and related diseases. Du Zhong (Cortex Eucommiae) demonstrates marked anti-inflammatory effects through its stimulating effect on the endocrine system and consequent secretion of steroids from the adrenal cortex. Fang Feng (Radix Saposhnikoviae) shows a marked effect to suppress inflammation via the inhibition of nitrite production by inducible nitric oxide synthase. Ji Xue Teng (Caulis Spatholobi) exhibits an anti-inflammatory effect through its inhibitory activities against a panel of key enzymes relating to inflammation, including cyclo-oxygenase, phospholipase, and lipoxygenase. Lastly, Di Huang (Radix Rehmanniae) has an anti-inflammatory effect to reduce swelling and inflammation. The mechanism of action is attributed to its influence on the endocrine system. It has been shown that the use of Di Huang (Radix Rehmanniae) increases the plasma levels of adrenocortical hormone, even in the presence of dexamethasone. Clinically, Di Huang (Radix Rehmanniae) was used in an herbal formula to successfully treat 12 patients with rheumatoid arthritis. 
Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata) and Zhi Chuan Wu (Radix Aconiti Praeparata) have excellent analgesic and anti-inflammatory properties and are commonly used to treat a wide variety of aches and pains. The analgesic effect of aconitine, a compound present in both herbs, is related to its effect on the central nervous system. The anti-inflammatory effect of aconitine is stronger than aspirin, and its mechanism of action is unrelated to the production of steroids from the adrenal glands.,Clinically, Zhi Chuan Wu (Radix Aconiti Praeparata) has been used successfully to treat arthritis, inflammation of the shoulder, and heel spurs., Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata) has been used in topical applications to effectively treat periarthritis of the shoulders and sciatica., Furthermore, it was demonstrated in one study of 225 patients with low back pain that the use of Zhi Chuan Wu (Radix Aconiti Praeparata) or Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata) is up to 87.4% effective in relieving pain when used on a daily basis for 10 to 15 days. Lastly, Zhi Chuan Wu (Radix Aconiti Praeparata) and Zhi Cao Wu (Radix Aconiti Kusnezoffii Praeparata) have been used topically to treat frozen shoulder. Out of 35 patients, 22 reported significant improvement, 8 reported moderate improvement, 4 reported slight improvement, and 1 reported no effect.
Finally, Flex (CD) incorporates herbs to repair cartilages and rebuild bones, since chronic musculoskeletal and connective tissue disorders are often associated with wear and tear of the joints. Chuan Niu Xi (Radix Cyathulae) shows great chondroprotection against cartilage-degrading disorders. It is an excellent herb to protect the cartilage from repetitive and stress-induced injuries.Wei Ling Xian (Radix et Rhizoma Clematidis) has an excellent chondroprotective effect. One study showed that the saponin fraction from Wei Ling Xian (Radix et Rhizoma Clematidis) is effective in ameliorating joint destruction and cartilage erosion in subjects with osteoarthritis, protecting articular cartilage by preventing extracellular matrix degradation and chondrocyte injury. Dang Gui (Radix Angelicae Sinensis) is an effective herb to promote the generation of bones. According to one study, the water extract of Dang Gui (Radix Angelicae Sinensis) was found to contribute to the formation of bones and treatment of bone injuries. It directly stimulates the proliferation, alkaline phosphatase activity, protein secretion, and particularly type I collagen synthesis of human osteoprecursor cells in a dose-dependent manner. Du Zhong (Cortex Eucommiae) has significant osteogenic and antiosteoporotic effects that promote generation of new bones and prevent osteoporosis. According to a bone cell culture experiment, administration of Du Zhong (Cortex Eucommiae) shows a potential effect to increase the proliferation and differentiation of osteoblasts without affecting osteoclast activity. The researchers conclude that these herbs can effectively increase the rate of tissue regeneration of damaged bones.
In summary, Flex (CD) is an empirical herbal formula with excellent function to treat musculoskeletal and joint disorders characterized by cold and damp.
Pain is a basic bodily sensation induced by a noxious stimulus that causes physical discomfort (such as pricking, throbbing, or aching). Pain may be of acute or chronic state, and may be of nociceptive, neuropathic, or psychogenic origin.
Non-steroidal anti-inflammatory agents (NSAID), such as Motrin (ibuprofen), Naprosyn (naproxen), and Voltaren (diclofenac) are very frequently used to treat mild to moderate pain characterized by inflammation and swelling. Clinical applications include headache, arthritis, dysmenorrhea, and general aches and pain. Though effective, they may cause such serious side effects as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. Furthermore, the newer NSAIDs, also known as COX-2 inhibitors [such as Celebrex (celecoxib)], are associated with significantly higher risk of cardiovascular events, including heart attack and stroke. In fact, these side effects are so serious that two COX-2 inhibitors have already been withdrawn from the market [Vioxx (rofecoxib) and Bextra (valdecoxib)]. In brief, it is important to remember that while drugs offer reliable and potent symptomatic pain relief, they should only be used if and when needed. Frequent use and abuse leads to unnecessary side effects and complications.
Treatment of pain is a sophisticated balance of art and science. Proper treatment of pain requires a careful evaluation of the type of disharmony (excess or deficiency, cold or heat, exterior or interior), characteristics (qi and/or blood stagnations), and location (upper body, lower body, extremities, or internal organs). Furthermore, optimal treatment requires integrative use of herbs, acupuncture, and tui-na therapies. All these therapies work together to tonify the underlying deficiencies, strengthen the body, and facilitate recovery from chronic pain. TCM pain management targets both the symptom and the cause of pain, and as such, often achieves immediate and long-term success. Furthermore, TCM pain management is often associated with few or no side effects.
For treatment of mild to severe pain due to various causes, TCM pain management offers similar treatment effects with significantly fewer side effects.
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