Zhenwu Decoction (真武汤) stands as one of the core prescriptions in classical Chinese medicine — a powerful formula for warming yang and promoting diuresis. I have used it to treat various patterns of yang deficiency with fluid overflow, and the results have been remarkable. One might truly say the patient recovers as soon as the cup is set down.
An important indication for using Zhenwu Decoction is edema, particularly lower limb swelling that worsens in the morning and subsides by midday. The tongue coating in most cases presents with an enlarged tongue body — it may be red or pale white, but that distinction is of little consequence.
From a Western medical perspective, edema caused by circulatory impairment due to heart failure is precisely where Zhenwu Decoction demonstrates its greatest efficacy. The Zhenwu Emperor, as the deity of the North and the celestial god of water, holds absolute dominion over what the ancients called “the cold, stagnant waters of the north.” Fluid overflow resulting from yang deficiency — especially heart yang deficiency — is overwhelmingly cold and stagnant in nature. Invoking the celestial water god under these circumstances is entirely appropriate.
Classical Formula: Fuling (Poria) 3 liang, Shaoyao (Peony Root) 3 liang, Shengjiang (Fresh Ginger) 3 liang, Fuzi (Prepared Aconite) 1 piece, Baizhu (White Atractylodes) 2 liang. Boil in 8 sheng of water to obtain 3 sheng, remove the dregs, and take 7 ge warm, three times daily.
This dosage is suitable for a single administration. Generally speaking, the dose of Fuzi should not be too small — at least 15 grams — otherwise the effect will not be swift.
I have used this formula to treat many elderly patients with severe heart failure. Their presentations were strikingly similar: bedridden, semi-comatose, with a dark purplish complexion and faint breathing. Their lower limbs were diffusely swollen, sometimes involving the entire body. Their feet were so swollen they could not wear shoes. Urine output was scanty. The overall impression was one of profound yin cold. Most had already received Western cardiac strengthening therapy with limited results. Some were in the CCU; others were essentially at home waiting to die.
In such cases, provided no other serious comorbidities are present, the original Zhenwu Decoction alone suffices. One dose, and within two hours the patient will produce copious urine. The edema then begins to subside. By the following day, systemic symptoms improve markedly, and many patients can get out of bed and move about. At this point, 2–3 additional doses for consolidation are needed, after which treatment can be adjusted according to the presenting pattern. This formula rescues the critically ill from the brink of death.
Sometimes even simple lower limb edema can be treated with this formula. If qi deficiency is present, raw Huangqi (Astragalus) should be added. When selecting and modifying the formula, one must carefully observe the patient’s specific condition. It is contraindicated in cases with obvious heat-toxin patterns, but in most other situations, appropriate modifications can be made.
中文原文 / Chinese Original
真武汤作为中医经典中的核心处方，效专力宏，是一张温阳利水的良方，我用他治疗各种阳虚水泛证效果极佳，可谓覆杯而愈。
我用真武汤的一个重要指征是水肿，尤其是下肢水肿，晨起肿甚，午间消散。其舌苔大部分是胖大的，可能红可能白，无关紧要。
从西医的角度讲，心力衰竭导致循环障碍引起的水肿正是真武汤发挥作用的最佳位置，真武大帝作为北方之神，为天鬼水神，对所谓的北方寒凉止水具有完全掌控的权利，而因阳虚，特别是心阳虚造成的水泛大多是寒凉之水，这时祭出天鬼水神是完全正确的。
茯苓三两、芍药三两、生姜三两、附子(炮)一个，白术二两。以水八升，煮取三升，去滓，温服七合，日三服。
这个量喝一次应该是可以的，一般来说附子的量不能太少，至少应该15克，否则效果不会很快。
我曾用此方治疗多位心衰重症的老年人，情况很相似，都已不能下床，基本处于半昏迷状态，脸色紫暗，呼吸微弱，下肢漫肿甚至浑身肿胀，脚肿大严重，无法穿上鞋，尿量少，一派阴寒的感觉。他们大部分都经过了西医强心治疗，效果一般，有些是在CCU，有些就在家里等死。这种情况如果没有其他严重疾病，只需要真武汤原方，一剂下去，两小时内必大量排尿，水肿随即好转，第二天全身症状明显好转，很多患者都可以下床活动，此时需要再巩固2-3剂，随后即可随证治之，救人于危难之中。
有时一些单纯的下肢水肿也可用此方治疗，若气虚应该加生黄芪，这时选方用药要注意观察患者的具体情况，如为明显热毒者不可用，其他情况均能酌情加减。
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