Huang Lian (Coptis chinensis) is characterized by its bitter and cold properties, making it a representative herb for clearing heat and detoxifying. However, it is quite challenging to use Huang Lian effectively in clinical practice. It can treat conditions associated with heat, as well as those considered to be ‘deficient.’ Even diseases that one might think are not suitable for Huang Lian can sometimes respond positively to its use. Huang Lian exemplifies the intricacies of TCM theory.
Today, we will discuss the effects of Huang Lian from three perspectives: First, which organs can Huang Lian clear heat from? Second, why do some people experience heat symptoms after taking Huang Lian? Third, we will explore why Huang Lian can also treat certain deficiency syndromes, raising the question of whether the principle of syndrome differentiation is flawed.
1. Which organs can Huang Lian clear heat from?
Li Shizhen stated that all five zang and six fu organs can harbor heat. Huang Lian primarily enters the heart channel, making it a key herb for treating heart fire. Additionally, with different combinations, Huang Lian can also clear heat from other organs.
1. First, let’s discuss clearing heart fire. Heart fire manifests as canker sores. The heart opens to the tongue, and sores in the mouth and tongue indicate heart fire. One can use wine to decoct Huang Lian and gargle with it, or use Huang Lian with Xi Xin (Asarum) for gargling; it can also be applied topically as a powder mixed with dried ginger. Huang Lian can be combined with Aloe to make a mouthwash. Heart fire can lead to insomnia, and combining Huang Lian with Gui Zhi (Cinnamon) can quickly harmonize the heart and kidney. If heart fire descends to the small intestine, it may present as cloudy urine, which can be treated with Huang Lian and Fu Ling (Poria) made into pills with wine; for heat disturbing the heart causing agitation, Huang Lian can be taken with Han Shui Shi (Cold Water Stone). The heart governs blood, and heart fire can cause blood heat to run rampant, leading to rashes. Many infants may develop rashes or smallpox, referred to as fetal toxin. Bathing newborns in Huang Lian water can prevent or alleviate symptoms of fetal toxin.
2. Huang Lian can clear stomach fire. Stomach fire can cause toothache, treated with Qing Wei San (Clear Stomach Powder); for vomiting blood due to stomach fire, Huang Lian can be combined with a small amount of Dan Dou Chi (Fermented Soybean); for thirst due to stomach fire, there is a formula using half a jin of Huang Lian soaked in white liquor, then simmered for a long time, dried, and made into water pills. Sometimes Huang Lian is combined with Gua Lou Gen (Trichosanthes Root) and made into pills with Sheng Di Huang (Rehmannia Root) juice to clear heat and nourish yin. If we encounter a person with high blood sugar and a strong appetite, this indicates a stomach fire type of thirst disease, and we must use Huang Lian generously to reduce stomach fire to lower blood sugar; being reluctant to use Huang Lian can lead to serious consequences. If blood sugar remains high and the body develops abscesses, it will be too late to use Huang Lian. Stomach fire can also cause abdominal distension, which can be treated with Huang Lian and Zhi Shi (Bitter Orange).
3. Huang Lian can clear large intestine fire. Particularly, when damp-heat in the large intestine transforms into fire, it manifests as hemorrhoids and dysentery. Huang Lian is exceptional for treating dysentery. Liu Wansu stated that ancient formulas using Huang Lian are the best for treating dysentery. Huang Lian and Huang Bai (Phellodendron) are cold and dry, capable of clearing heat, dispelling dampness, and stopping diarrhea, thus making them the monarch in dysentery treatment. A commonly used formula is Xiang Lian Wan (Fragrant Lian Pill), which consists of four liang of Huang Lian, two liang of Mu Xiang (Aucklandia), and four liang of Sheng Jiang (Fresh Ginger). First, place the ginger at the bottom of a clay pot, then layer Huang Lian on top, followed by Mu Xiang. Add three bowls of freshly drawn well water and simmer until dry. Then remove Huang Lian and Mu Xiang to make pills, discarding the ginger. Does it retain the flavor of ginger? Certainly, it does. Does the bitterness of Huang Lian lessen? Yes, it does. After prolonged decoction, the flavors of Huang Lian, Mu Xiang, and ginger merge into one, rather than simply mixing. They intertwine to exert a concentrated effect. If you only use Huang Lian to treat dysentery, a person with a strong stomach may recover, but a person with a weak stomach may vomit because Huang Lian is bitter and cold, which can damage the stomach. Therefore, Huang Lian must be combined with supportive herbs to prevent gastric injury. This reflects the ingenuity of our ancient practitioners and their masterful application of yin-yang theory.
Some people grind Huang Lian and Mu Xiang into powder and make pills with roasted garlic. The roasted garlic has a special aroma that can stimulate appetite and prevent vomiting. There is a formula called Si Zhi Huang Lian Wan (Four Treatment Huang Lian Pill), which divides one portion of Huang Lian into four parts: one part is soaked in liquor and then stir-fried until dry; another part is stir-fried with ginger juice; another part is stir-fried with Wu Zhu Yu (Evodia); and the last part is stir-fried with Yi Zhi Ren (Alpinia). Then, add some Bai Shao (White Peony) and Mu Xiang to make pills. Some people use Huang Lian with a little Ai Rong (Mugwort Wool) to make a decoction. In summary, we know that Huang Lian is very cold and is excellent for treating heat diseases of the gastrointestinal tract, but the downside is that it can cause vomiting, which limits its use. Therefore, adding supportive herbs like Wu Zhu Yu, liquor, ginger, or garlic can help prevent vomiting, allowing the disease to be treated. Moreover, all these supportive herbs are, without exception, heat-clearing herbs. Li Shizhen commented that these combinations are a balance of cold and heat, yin and yang, using cold to counteract heat and vice versa, with the monarch and minister herbs supporting each other, achieving the best formulation without the risk of excessive effects. Conditions like intestinal wind bleeding, hemorrhoids, and swelling pain are all due to large intestine fire or damp-heat, and these types of combinations should not be forgotten when encountering damp-heat conditions of the large intestine, whether in acute gastroenteritis, dysentery, intestinal parasitic diseases, or malignancies. In summer, when we suffer from damp-heat, experiencing chills and fever, along with stomach pain and vomiting, Huang Lian and Xiang Ru (Elsholtzia) decoction works very well, completely eliminating the need for antibiotics.
Huang Lian can treat many diseases and can revive patients with severe dysentery. Thus, some Daoists claim that consuming Huang Lian can lead to longevity. Li Shizhen refuted this claim, stating that Huang Lian is a very bitter and cold herb, used to clear heat and dry dampness, and should not be taken for extended periods, as it would harm the body’s vital energy. However, in some cases, Huang Lian’s heat-clearing effect may not be sufficient, and it may need to be combined with Huang Qin (Scutellaria) or even Da Huang (Rhubarb) for treatment. For example, in cases of dysentery with stools resembling goose or duck liver and unbearable abdominal pain, Huang Lian and Huang Qin, or even Huang Lian Jie Du Tang (Huang Lian Detoxifying Decoction) should be used to clear heat and toxins from the gastrointestinal tract. Will using so many bitter herbs lead to vomiting? Certainly, it can, so one must find ways to support the treatment to prevent vomiting.
4. Huang Lian can treat various eye diseases. Particularly, for red, swollen, and painful eyes caused by wind-heat, or for cataracts due to internal heat, Huang Lian should be the main herb used. Li Dongyuan stated that for any eye condition with red swelling and unbearable pain, Huang Lian and Dang Gui (Angelica) should be used, soaked in wine and decocted. Su Song noted that Huang Lian has many formulas for treating eye diseases, with Yang Gan Wan (Sheep Liver Pill) being particularly unique. Modern practitioners wash the eyes with a decoction of Huang Lian, Dang Gui, and Bai Shao, using snow water or sweet water, heating it for washing, and reheating it if it cools down, which greatly benefits the eyes. Wind toxin causing red eyes and clouding can be effectively treated with this method. Eye diseases are often due to blood stagnation, so using blood-moving herbs with Huang Lian is effective. Blood flows when heated, hence the need for warm washing.
The Compendium of Materia Medica records a special Jin Huang Lian Wan specifically for treating eye diseases, made by crushing Huang Lian and soaking it in a bowl of freshly drawn well water for sixty days. The mixture is then filtered through cotton cloth, and the liquid is returned to the bowl and steamed until dry. A deep pit is dug in the ground, one foot deep, lined with tiles, and four liang of Ai Rong is placed on top and ignited. The residue of Huang Lian in the bowl is placed on the burning Ai Rong, and the pit is sealed with mud, leaving a small opening for smoke to escape. Once the Ai Rong has burned out, the bowl is dug out. The bowl contains not only Huang Lian but also some oil smoke, which is scraped off to make small pills, taken with bamboo leaf decoction. This uses extracts of Huang Lian and Ai Ye (Mugwort).
Another formula for treating acute red eye pain involves crushing Huang Lian and soaking it in egg white overnight, then filtering the egg white the next morning to create eye drops. Huang Lian is effective for eye diseases both internally and externally, as early-stage eye diseases are often due to external wind-heat or internal heat, and the eyes are considered the ‘fire orifice,’ making them susceptible to heat diseases, which Huang Lian can effectively clear.
The Compendium of Materia Medica also mentions that for children with red eye disease, applying Huang Lian powder to the soles of the feet is effective, which is much simpler than decocting or using eye drops.
We are not particularly skilled in ophthalmology, so if one wishes to treat eye diseases, it is essential to read more specialized texts on the subject. We have a preliminary understanding that the eyes are the ‘fire orifice,’ and Huang Lian is good for treating eye diseases. I ask you, is it better to use a larger or smaller dose of Huang Lian? This again refers to the later saying, “To treat the upper jiao like a feather, it must be lifted lightly.”
2. Long-term use of Huang Lian can lead to heat
This issue is not new; ancient scholars have already analyzed it thoroughly. The Compendium of Materia Medica cites Wang Bing, stating that sour enters the liver as warmth, bitter enters the heart as heat, pungent enters the lungs as clearing, salty enters the kidneys as cold, and sweet enters the spleen as the ultimate yin, encompassing all four qi. Therefore, long-term use of Huang Lian and Ku Shen (Bitter Root) can lead to heat due to fire transformation. Li Shizhen provides an example: Jin Duan Wang Su had many heat diseases and took many bitter cold medicines like Jin Hua Wan (Golden Flower Pill) for years, which only exacerbated his heat, eventually leading to cataracts and blindness. This illustrates that bitter cold medicines not only do not promote longevity but can also increase the body’s heat when taken for extended periods, ultimately harming health. Thus, prolonged use of Huang Lian can stimulate the heart’s fire, leading to an explosive outbreak of heat.
The bitter flavor transforming into heat is an extreme situation that we should be aware of. Generally, short-term use of Huang Lian, if not appropriate, often leads to damage to the spleen and stomach’s yang qi. The emergence of the Yi Shui school is somewhat related to the indiscriminate use of Huang Lian.
3. Why can Huang Lian treat deficiency syndromes?
Why is it that in some deficiency syndromes, tonic herbs do not work, but Huang Lian can instead be effective? For example, in treating dysentery, Huang Lian is certainly used for excess conditions. However, in cases of prolonged dysentery where the body becomes very weak and cold, this indicates a yang deficiency syndrome. If you use Huang Tu Tang (Yellow Earth Decoction), Li Zhong Tang (Regulate the Middle Decoction), or Zhen Ren Yang Zang Tang (True Man Nourishing the Organs Decoction), will they work? The answer is no. Some folk doctors still prescribe Huang Lian because it is specifically for treating dysentery, and it may actually help. Can you replicate this experience? If you use Huang Lian for both the beginning and end of dysentery, you may find that it makes the patient weaker. This is incorrect. Why is this? Dysentery is caused by damp-heat. Sometimes we can see that the large intestine is damp-heat, and naturally, using Huang Lian as the main herb is appropriate. However, sometimes the evil and the righteous have been in conflict for a long time, and on the surface, it may seem that the righteous qi is insufficient, with both qi and yang deficiency, but the damp-heat evil has not transformed into cold. It remains damp-heat, so using Huang Lian is still effective. However, in some patients, whether weak or not, they have already transformed into cold, and using Huang Lian will only worsen their condition. The apparent weakness may not be true weakness; this is called ‘great excess with a weak appearance.’ My mentor from Zhangjiakou, Teacher Wang Taoyao, understood this deeply. Many diseases, such as stomach issues, are treated by other doctors with warming tonics like Ren Shen (Ginseng) and Bai Zhu (Atractylodes), but they do not improve. My teacher used Huang Qin and Huang Lian to treat them. He said if they could be cured with Ren Shen and Bai Zhu, they wouldn’t need to find you. They are not getting better, so you must go against the grain and think in reverse. Why are they weak? It is because they have evil qi in their bodies, which makes them weak and unable to recover. Why are they particularly cold? Is it yang deficiency? No, it is because of internal fire stagnation, which causes cold extremities. Therefore, as TCM practitioners, it is challenging; what you see may not be the truth. Diagnosing an excess or deficiency syndrome is not something you can determine at a glance; it requires analysis.
4. Conclusion
We will conclude our discussion on Huang Lian here. Huang Lian is a classic herb with a long history, and Zhang Zhongjing used it extensively in his formulas. Sometimes it is used for exterior conditions, and more often for interior conditions, even in mixed conditions of cold and heat. Historically, those who were adept at using Huang Lian include Zhang Zhongjing and Liu Hejian, and I aspire to learn from them. The Inner Canon states, “All heat-related conditions belong to fire”; “All conditions of agitation and restlessness belong to fire”; “All conditions of reversal and counterflow belong to fire”; “All conditions of swelling and pain belong to fire”; “All conditions of abdominal distension belong to heat”; “All conditions with sound, like a drum, belong to heat”; “All conditions of reversal and murky fluids belong to heat”; “All conditions of vomiting and urgent diarrhea belong to heat”… all are related to these diagnoses. When used appropriately, Huang Lian can treat many critical and complex conditions. However, improper use or blind imitation can harm patients. Therefore, to use Huang Lian effectively, one must accurately differentiate syndromes and skillfully combine herbs, standing on the shoulders of our ancient predecessors.