Flex (NP)™

TCM herbal formula for neuropathy and nerve-related pain, numbness, and tingling — peripheral neuropathy, diabetic neuropathy, polyneuropathy, drug-induced neuropathy, trigeminal neuralgia, postherpetic neuralgia, peripheral vascular disease — analgesic; anti-inflammatory; circulatory; invigorates blood circulation; opens channels and collaterals; relieves pain; eliminates blood stasis

⚠️ Contraindicated during pregnancy and nursing. Contains Da Huang (Radix et Rhizoma Rhei) — California Prop 65 warning: "This product contains Da Huang (Radix et Rhizoma Rhei). Read and follow directions carefully. Do not use if you have or develop diarrhea, loose stools, or abdominal pain because Da Huang may worsen these conditions and be harmful to your health. Consult your physician if you have frequent diarrhea or if you are pregnant, nursing, taking medication, or have a medical condition." Contains Dang Gui (Radix Angelicae Sinensis) and Dang Gui Wei (Extremitas Radix Angelicae Sinensis) — patients on anticoagulant or antiplatelet therapies such as Coumadin (warfarin) should use with caution or not at all. It is essential to identify and eliminate the cause(s) of neuropathy — without elimination of the offending agent, treatment will offer only symptomatic relief.

CLINICAL APPLICATIONS

* Neuropathy: peripheral neuropathy, polyneuropathy, diabetic neuropathy, drug-induced neuropathy

* Neuralgia: trigeminal neuralgia, postherpetic neuralgia

* Peripheral vascular disease

* General pain, numbness, tingling, swelling, and muscle wasting, especially in the extremities

Background: Neuropathy is a functional disturbance or pathological change in the peripheral nervous system. Symptoms include sensory loss, muscle weakness and atrophy, and pain. Etiologies include trauma, infection by micro-organisms, drugs, nutritional deficiency, metabolic disorders, malignancy, and unknown causes. Due to the wide range of causes, treatment varies. Herbal treatment focuses on relieving symptoms (pain) and the cause (poor circulation, increased cellular pressure, trauma, and infection). Optimal treatment requires identifying and eliminating the root cause — neuropathy due to nutritional deficiency requires vitamin B supplementation; diabetic neuropathy requires blood glucose control; drug-induced or toxic neuropathy requires elimination of the offending agent.

TCM differentiation: Peripheral neuropathy, polyneuropathy, diabetic neuropathy, neuralgia, and fibromyalgia have various etiologies, but all share one common factor — pain due to blood stagnation. Flex (NP) is formulated to treat nerve pain by activating blood circulation and eliminating blood stagnation. Acupuncture is sometimes more effective than herbs in cases of neuropathy and may be used concurrently — the analgesic effect of Yan Hu Suo (Rhizoma Corydalis) is increased significantly with concurrent electro-acupuncture treatment.

Key herb-level clinical data:

— Yan Hu Suo (Rhizoma Corydalis / Corydalis): one of the strongest and most potent herbs for treatment of pain; effective in both acute and chronic phases of pain and inflammation; with appropriate dosage adjustment, analgesic effect comparable to morphine; analgesic effect increased significantly with concurrent electro-acupuncture; invigorates blood circulation; relieves pain

— Dang Gui (Radix Angelicae Sinensis / Angelica Sinensis / Dong Quai): analgesic — approximately 1.7× stronger than acetylsalicylic acid; anti-inflammatory — approximately 1.1× stronger than acetylsalicylic acid; inhibits pro-inflammatory mediators including nitric oxide and prostaglandin E2 in peritoneal macrophages; treats frostbite injuries damaging both nerves and soft tissue; opens channels and collaterals to relieve pain; caution with anticoagulants

— Dang Gui Wei (Extremitas Radix Angelicae Sinensis / Angelica Sinensis Tail): opens channels and collaterals; invigorates blood circulation to the extremities; relieves pain; caution with anticoagulants

— Bai Shao (Radix Paeoniae Alba / White Peony Root): analgesic; softens the Liver and benefits tendons and sinews to relieve tightness, numbness, tingling, and pain; clinical study: Bai Shao + Gan Cao combination — marked analgesic effect, successfully treats neuralgia, trigeminal neuralgia, and sciatica

— Gan Cao (Radix et Rhizoma Glycyrrhizae / Licorice Root): analgesic; detoxifying — one of the most effective detoxifying herbs for drug poisoning (chloral hydrate, urethane, cocaine, picrotoxin, caffeine, pilocarpine, nicotine, barbiturates, mercury, lead), food poisoning (tetrodotoxin, snake, mushrooms), and others (enterotoxin, herbicides, pesticides); harmonizes the formula and middle jiao; clinical study: Bai Shao + Gan Cao — treats neuralgia, trigeminal neuralgia, and sciatica

— Chuan Xiong (Rhizoma Chuanxiong / Ligusticum / Sichuan Lovage): improves blood circulation; increases microcirculation to peripheral parts of the body; eliminates blood stasis; anti-inflammatory — inhibits TNF-α production and TNF-α bioactivity; clinically treats trigeminal nerve pain and trigeminal neuralgia

— Tao Ren (Semen Persicae / Peach Kernel): invigorates blood circulation; eliminates blood stasis; facilitates recovery from injuries; synergistic effect with Hong Hua

— Hong Hua (Flos Carthami / Safflower): invigorates blood circulation; eliminates blood stasis; improves microcirculation to peripheral parts of the body; synergistic effect with Tao Ren

— Mu Dan Pi (Cortex Moutan / Moutan Bark / Tree Peony Root Bark): moves blood; clears heat associated with local inflammation due to blood stagnation; anti-inflammatory — inhibits prostaglandin synthesis and decreases permeability of blood vessels; reduces swelling and pressure in the periphery; antibiotic; improves blood circulation; eliminates blood stasis

— Ru Xiang (Gummi Olibanum / Frankincense / Boswellia): invigorates blood circulation; relieves pain; commonly used in treatment of trauma and sports injuries

— Mo Yao (Myrrha / Myrrh): invigorates blood circulation; relieves pain; commonly used in treatment of trauma and sports injuries

— Chuan Niu Xi (Radix Cyathulae / Cyathula Root): invigorates blood circulation; relieves pain; guides formula to lower extremities

— Er Cha (Catechu / Cutch / Black Catechu): antibiotic; promotes generation of new tissues

— Xue Jie (Sanguis Draconis / Dragon's Blood Resin): antibiotic; promotes generation of new tissues

— Lu Lu Tong (Fructus Liquidambaris / Liquidambar Fruit / Sweet Gum Fruit): opens channels and collaterals; invigorates blood circulation to the extremities; relieves pain

— Qiang Huo (Rhizoma et Radix Notopterygii / Notopterygium / Qiang Huo): analgesic; relieves pain in joints and extremities

— Qin Jiao (Radix Gentianae Macrophyllae / Large-Leaf Gentian Root): anti-inflammatory; relieves pain in joints and extremities

— Da Huang (Radix et Rhizoma Rhei / Rhubarb Root): clears heat; removes blood stasis; improves blood circulation; see California Prop 65 warning above

— Chuan Mu Xiang (Radix Vladimiriae / Vladimiria Root): invigorates qi circulation in the channels; assists overall pain-relieving effects of the formula

— Huang Jin Gui (Caulis Vanieriae): relieves pain in joints and extremities

— Mo Gu Xiao (Caulis Hyptis Capitatae): relieves pain in joints and extremities

— Liu Zhi Huang (Herba Solidaginis / Goldenrod): relieves pain in joints and extremities

— Sheng Ma (Rhizoma Cimicifugae / Cimicifuga / Black Cohosh Rhizome): channel-guiding herb; raises yang qi

— Fu Ling (Poria): strengthens middle jiao to promote absorption of the herbs

— Da Zao (Fructus Jujubae / Jujube / Chinese Red Date): harmonizes the formula and middle jiao

WESTERN THERAPEUTIC ACTIONS

* Analgesic — Yan Hu Suo (comparable to morphine, acute + chronic, enhanced by electro-acupuncture); Dang Gui (1.7× stronger than aspirin); Bai Shao + Gan Cao (neuralgia, trigeminal neuralgia, sciatica); Qiang Huo; Chuan Xiong (trigeminal neuralgia)

* Anti-inflammatory — Dang Gui (1.1× stronger than aspirin, inhibits NO + PGE2); Chuan Xiong (TNF-α↓); Mu Dan Pi (prostaglandin synthesis↓, vessel permeability↓); Qin Jiao

* Circulatory / peripheral blood flow — Tao Ren + Hong Hua (synergistic, blood stasis elimination); Chuan Xiong (microcirculation↑, peripheral perfusion↑); Mu Dan Pi (swelling↓, cellular pressure↓)

* Antibiotic / tissue regeneration — Er Cha (antibiotic); Xue Jie (antibiotic, new tissue generation); Mu Dan Pi (antibiotic)

* Detoxifying — Gan Cao (drug poisoning, food poisoning, herbicides, pesticides, heavy metals)

CHINESE THERAPEUTIC ACTIONS

* Invigorates blood circulation; eliminates blood stasis (Tao Ren, Hong Hua, Chuan Xiong, Mu Dan Pi, Ru Xiang, Mo Yao, Dang Gui, Dang Gui Wei, Chuan Niu Xi, Da Huang)

* Opens channels and collaterals; relieves pain in extremities (Dang Gui, Dang Gui Wei, Chuan Xiong, Lu Lu Tong, Chuan Niu Xi)

* Relieves pain in joints and extremities (Qiang Huo, Qin Jiao, Huang Jin Gui, Mo Gu Xiao, Liu Zhi Huang)

* Clears heat associated with blood stagnation (Mu Dan Pi, Da Huang)

* Invigorates qi circulation in channels (Chuan Mu Xiang)

* Promotes generation of new tissues (Er Cha, Xue Jie)

* Strengthens middle jiao; harmonizes formula (Fu Ling, Da Zao, Gan Cao)

DOSAGE

Standard: 3–4 capsules three times daily on an empty stomach with warm water. May increase to 6–8 capsules three times daily if necessary.

Clinical notes: Identify and eliminate the cause of neuropathy — drug-induced or toxic neuropathy requires elimination of the offending agent; nutritional deficiency neuropathy requires vitamin B complex supplementation; diabetic neuropathy requires blood glucose monitoring and control. Acupuncture may be more effective than herbs in some neuropathy cases — consider concurrent treatment.

Supplementary formulas: Neuropathy from chronic exposure to harmful toxins and chemicals — add Herbal DTX. Diabetic neuropathy — use with Equilibrium. To potentiate pain relief — add Herbal ANG. Nerve pain in neck and shoulder — add Neck & Shoulder (AC) or Neck & Shoulder (CR). Nerve pain in arm (shoulder, elbow, wrist) — add Arm Support. Nerve pain in lower back — add Back Support (AC) or Back Support (CR). Nerve pain from herniated disk — add Back Support (HD). Nerve pain in knees — add Knee & Ankle (AC) or Knee & Ankle (CR). Chronic musculoskeletal disorder with damaged soft tissues — add Flex (MLT). Excess heat — add Gardenia Complex. Severe blood stagnation — add Circulation (SJ). Lymphedema — add Resolve (AI).

Nutrition: Maintain nutritional balance — supplement with vitamins and minerals if necessary. Increase thiamine (vitamin B₁) intake — whole grains and green vegetables maintain nerve health. Avoid white sugar and white flour products — deplete the body of B vitamins.

Lifestyle: Tight blood glucose control is essential for diabetic neuropathy — diet, exercise, and herbal treatment maintain normal blood glucose levels. Nerve pain relief: light massage with apple cider vinegar solution (½ cup apple cider vinegar + 2 cups warm water); hot wraps for 30 minutes. Avoid toxic agents and industrial poisons that cause nerve damage — carbon monoxide, heavy metals (especially lead and mercury), and chemical solvents. Avoid drugs that cause nerve damage — antibiotics (sulfonamides, nitrofurantoin, chlorobutanol), antiseizure drugs (phenytoin), sedatives (barbital, hexobarbital), and anticancer drugs (vinca alkaloids).

CASE STUDIES

— F.T., 44-year-old female marathon runner: Baker's cyst on left knee (MRI confirmed, 4 cm diameter); pain and swelling limiting walking and running; qi and blood stagnation in channels with heat toxin and phlegm accumulation. Resolve (AI) + Flex (NP) 3g 3x daily at 2:1 ratio. Result at 1 month: cyst almost completely resolved. Formula modified for residual inflammation and stagnation. Patient resumed long-distance running without further problems. Also eliminated coffee and started eating anti-inflammatory foods during treatment.

— D.A., 55-year-old female: Extreme pain in both heels radiating up the calf; night sweats; difficulty staying asleep; low energy; depression; weak thin pulse; red tongue with thin white coating; Liver qi stagnation and Kidney yin deficiency. Flex (NP) + Circulation (SJ). Result: less pain (still present in morning and after prolonged standing); sleep improved to waking only once per night. Continued improvement with patient effort.

— J.B., 55-year-old female: Right foot pain; numbness and tingling along neck; pain shooting down back of legs; hot flashes and night sweating; pain on palpation of joints; red cheeks; qi and blood stagnation with yin deficiency / RSD (reflex sympathetic dystrophy). Flex (NP) 2–3 caps 2x daily. Result: less arm and neck pain; right foot pain still present; slight stomach discomfort — directed to increase dosage if tolerable.

— L.L., 52-year-old female: Body aches over entire body; leg swelling; low-grade fever; sore throat; low energy; thin weak pulse; pale dull tongue with thin white coating; Lyme disease / general qi and blood stagnation with Spleen qi deficiency. Resolve (AI) + Flex (NP) + acupuncture + lymphatic massage. Result: energy increased; pain lessened; sore throat resolved.

— J.R., male: Intolerable neuropathy after chemotherapy and radiation for throat cancer. Flex (NP) self-tested in alternating weeks. Result: week without Flex (NP) was "nearly intolerable"; with Flex (NP) he is "in the zone" and able to sleep; neuropathic symptoms reduced by approximately 50%.

— 59-year-old male: Sea urchin sting to hand while diving in Hawaii 4 months prior; spines entered hand; black markings gone but limited finger and hand movement; dusky swollen tongue with sticky coat; wiry slippery pulse. Flex (NP) + Astringent Complex for 15 days + acupuncture. Result: completely healed.

— 36-year-old female (Type 1 diabetic): Severe neuropathy of hands; chronic fungal and bacterial infections; sores over lower limbs; feet numbness; severe fatigue, malaise, and weakness; kidney failure (post-transplant); immune deficiency from immunosuppressants; severe Kidney jing (essence) deficiency with Spleen qi deficiency, damp-heat, and qi and blood stagnation. Flex (NP) 3–4 caps 3x daily + customized formula to tonify Spleen qi, move blood, and circulate qi. Result at 2–3 days: relief from hand pain; stinging sensations reduced in occurrence and intensity; sores and warts improved and less visible.

— M.F., 57-year-old female: Leg and big toe pain with pressure; metallic taste; absence of thirst; heat sensations except in hands and feet; upper body sweating; 6-month toxic chemical and pesticide exposure; yin deficiency with heat, damp-heat and toxic heat accumulation, and bi zheng (painful obstruction syndrome) of the legs. Liver DTX + Balance (Heat) + Flex (NP) for 6 weeks. Result: less leg pain; decreased sweating; subsiding heat sensations; warmer hands. Metallic taste still present. Also advised to increase carrot juice and cucumber intake.

Related Reading

Also see: Herbal DTX – for neuropathy from toxic chemical exposure | Equilibrium – for diabetic neuropathy | Herbal ANG – to potentiate pain relief | Flex (MLT) – for chronic musculoskeletal disorder with soft tissue damage | Circulation (SJ) – for severe blood stagnation | Resolve (AI) – for lymphedema and nodules | Neck & Shoulder (AC) – for acute neck and shoulder nerve pain | Neck & Shoulder (CR) – for chronic neck and shoulder nerve pain | Back Support (HD) – for herniated disk nerve pain | Gardenia Complex – for excess heat | Pain & Musculoskeletal Support Collection.