Fuzi (Aconite) and Chuanwu (Chuanwu) from the previous discussion on dispelling wind, dampness, and cold originate from the same plant. Chuanwu is the main root, while the side root that grows next to it is called Fuzi. However, in commercial herbal materials, it is often sliced, so prescriptions frequently refer to it as Fuzi Pian (Fuzi slices).
During processing, a coloring solution made with vegetable oil and brown sugar is added to dye it a dark tea color, which is called Heifupian (black Fuzi slices); if sliced along the length, it is called Shunpian (longitudinal slices); if sliced across, it is called Hengpian (transverse slices).
There is a type of Huangfupian (yellow Fuzi slices) that is dyed yellow and cut transversely; while Baifupian (white Fuzi slices) is cut longitudinally, steamed, and then treated with sulfur to lighten its original color, thus called Baifupian.
Fuzi must undergo special cultivation and processing in its production area, which not only requires specific field management but also involves soaking in brine made from leftover salt, which contains many chemical elements. After soaking, it undergoes the aforementioned processing steps.
Since the Song Dynasty, Fuzi has been a well-known medicinal material from Sichuan, particularly from a place called Jiangyou, formerly known as Zhangming. This area has been the center of production, and there has been a record titled Zhangming Fuzi Ji since the Song Dynasty, indicating the fame of local Fuzi.
In the past, Fuzi was processed by individual households in small workshops, leading to various specifications for commercial competition, including yellow, white, black, longitudinally cut, transversely cut, and even thin slices made with a plane, known as Paopian (shaved slices).
In the northwest of Sichuan, during the harvesting season of Fuzi, there is often a lot of rainy weather. Some small workshops cannot keep up with processing, so similar to how Sichuan people make pickles, after digging up Fuzi and removing the outer skin and dirt, they clean it and soak it in brine. This prevents spoilage and rot, allowing it to be stored for one to two years, referred to as Yanfuzi (salted Fuzi).
When using salted Fuzi, it still needs to be sliced and soaked in water to remove the saltiness, which is called Danfupian (light Fuzi slices).
In general prescriptions, this herb is not referred to as Fuzi but rather as Fuzi Pian, Baifupian, Huangfupian, Heifupian, etc., because it is not the whole root but rather the processed and sliced herbal material, hence the term Fuzi Pian.
The reason for explaining these various specifications of commercial herbal materials, including the traditional Paofuzi (fire-processed Fuzi) which was burned in the past, and the modern Weibo Fuzi (microwave-processed Fuzi), is due to the increasing number of specifications driven by commercial competition, which has no direct correlation with their medicinal efficacy.
However, some people claim that salted Fuzi is intentionally made to “enter the kidney through salt,” but this is not the case. It is due to the inability to process it all at once, as the quantity harvested is too large. Influenced by the Sichuan method of making pickles, it is placed in large jars of brine to prevent spoilage, and it is not specifically made for “entering the kidney through salt.”
Fuzi is also a very important herb. As I mentioned when discussing Dahuang (Rhubarb), it is one of the four essential herbs. Fuzi is not only a key herb among warming herbs but also a significant medicinal substance in traditional Chinese medicine.
The effects of Fuzi mainly manifest in three aspects.
The first aspect is particularly special, called Huayang Jiuni (returning yang to rescue from reversal). This refers to its therapeutic effect on Wangyang Zheng (yang deficiency syndrome), or its therapeutic efficacy.
What is Wangyang Zheng? It is a condition where some individuals, due to prolonged illness, have their yang energy continuously depleted, leading to a complete decline of yang energy; another scenario is a sudden acute illness, such as severe vomiting, diarrhea, or profuse sweating, where yang escapes with yin, resulting in this syndrome.
The clinical manifestations of Wangyang Zheng are typically characterized by two symptoms: cold extremities and a faint pulse.
The term “Wang” literally means “none”; in ancient texts, it is explained as “Wang, meaning none.” Wangyang means that the yang energy seems to have disappeared, indicating that the person’s yang energy has been completely depleted, or is on the verge of extinction.
Why does this occur? The near extinction of yang energy is primarily due to the decline of kidney and heart yang energy. The basic function of kidney yang is to warm the body; the yang energy in the kidneys is fundamental to maintaining the body’s temperature.
When kidney yang declines, it cannot warm the body, leading to cold extremities. In milder cases, it may only affect the fingers and toes; in severe cases, it may extend to the upper limbs beyond the elbows and the lower limbs beyond the knees, eventually resulting in a cold sensation throughout the body. Cold extremities are a manifestation of kidney yang’s inability to warm the body.
The heart governs the blood vessels; when heart yang declines, it cannot propel the blood, leading to abnormal blood flow and a faint pulse. This indicates that the fundamental pathology is the decline of kidney and heart yang energy, which has reached a critical point, almost nonexistent. This is what is referred to as Wangyang Zheng in traditional Chinese medicine. In such cases, Fuzi is the first herb in traditional Chinese medicine that can “return yang to rescue from reversal.”
Because Fuzi’s effect in returning yang to rescue from reversal is the best, it cannot be replaced by other herbs. Although it is toxic, it can significantly restore the yang energy that is about to be lost, which is tantamount to restoring life. Historically, it has been an important herb for emergency treatment of Wangyang Zheng. From ancient times to the present, especially in ancient medical conditions, it has relied heavily on oral administration of Fuzi and similar herbs to treat Wangyang Zheng.
However, Fuzi requires prolonged decoction. If a patient is in a critical condition, decocting it for a long time and then allowing it to cool before administering can take a long time, which may not be timely enough. But in ancient times, there were no other medical conditions.
Currently, Fuzi has emergency preparations, such as Shenfu Injection. Even now, although comprehensive emergency measures can be taken for Wangyang Zheng, combining traditional and Western medicine, such as intravenous fluids, blood transfusions, and some Western medications for severe vomiting, diarrhea, profuse sweating, or massive bleeding, the effectiveness has greatly improved.
However, the clinical value of Fuzi in returning yang to rescue from reversal still exists. Therefore, in many hospitals, if a typical case of Wangyang Zheng occurs, while other measures are taken, the use of Fuzi-related injections remains quite widespread, achieving a significant effect in returning yang to rescue from reversal. Thus, it is the most important herb in traditional Chinese medicine for this purpose, with reliable and unique therapeutic effects for Wangyang Zheng.
Although Fuzi is the primary herb for returning yang, its strength alone may not be sufficient, as the condition may be too severe, and the yang energy may be extremely deficient. The process of restoring yang energy also takes time, which is relatively slower compared to herbs like Ganjing (Dried Ginger).
It also has certain toxicity. Therefore, in treating Wangyang Zheng, it is not simply used alone; it is often combined with Ganjing and Gancao (Licorice), which is the basis of Sijiao Tang (Four Reversal Decoction).
The combination of Fuzi with Ganjing and Gancao serves two purposes: to reduce the toxicity of Fuzi and enhance its efficacy. They have a mutual relationship where Fuzi is antagonistic to Ganjing, and vice versa; Gancao or Ganjing can reduce Fuzi’s toxicity. Secondly, it enhances the effect, as they work synergistically to strengthen the effect of returning yang to rescue from reversal. Ganjing also has a role in returning yang; modern research shows that Gancao can also enhance Fuzi’s effect in this regard.
Additionally, while Fuzi returns yang, its action is relatively slower compared to Ganjing. Some texts state that Fuzi’s nature is more conservative, while Ganjing is more active, quickly exerting its effect in returning yang. On this basis, Fuzi also begins to take effect, allowing for a more rapid and sustained medicinal effect.
Due to these multiple advantages, they are combined together. The purpose of the combination of Fuzi and Ganjing is to enhance efficacy and reduce toxicity, which is a very special and important combination.
In clinical cases of Wangyang Zheng, it is not only a simple decline of kidney and heart yang but also a depletion of vital energy, hence termed Wangyang Qi Tuo (yang energy depletion). In this case, simply using Fuzi to return yang does not address the depletion of vital energy, so Ren Shen (Ginseng) should be added. The combination of Ren Shen and Fuzi is known as Shenfu Decoction, and the current injection is based on this formula.
The Shenfu Injection is currently produced by several pharmaceutical companies nationwide and can be administered intravenously, allowing for a rapid return of yang to rescue from reversal, making this dosage form suitable for emergencies.
In summary, Fuzi’s role in returning yang to rescue from reversal is as described, but it is not easy to use effectively in clinical practice. Ancients said that Fuzi is the most useful herb, yet also the most difficult to use.
The most useful aspect refers to its application in Wangyang Zheng, where it can save lives in critical conditions, holding significant clinical value; yet it is also considered the most difficult to use because it treats acute and severe conditions and is toxic. The requirements for the method of use, dosage, and combinations must be very precise; any slight negligence may lead to unimaginable consequences, hence it is regarded as difficult to use. However, the utility of Fuzi should be fully acknowledged.
The second effect is to Bu Huo Ji Yang (tonify fire and rescue yang), which refers to tonifying the Mingmen Fire (gate of vitality fire). This actually refers to the body’s Yuan Yang (original yang), which is kidney yang. Here, Fuzi’s role in tonifying fire and assisting yang is to replenish Yuan Yang, thus it can be used for all forms of yang deficiency.
Therefore, in the applications mentioned in texts, it is stated that it is used for various yang deficiency syndromes.
Among yang deficiency syndromes, the first is kidney yang deficiency. Due to the multiple physiological functions of the kidneys, kidney yang deficiency can manifest in various clinical symptoms, and Fuzi can generally be used. Kidney yang deficiency primarily leads to an inability to warm the body, resulting in cold intolerance and cold limbs, as well as lower back and knee pain.
Additionally, it can cause delayed growth and development, leading to premature aging; or kidney dysfunction can lead to edema, frequent clear urination, and nocturia; in elderly individuals, it may even cause incontinence; kidney governs reproduction, and kidney yang deficiency can lead to reduced reproductive function and sexual dysfunction; the kidneys also govern the reception of qi, and when they fail to do so, it can lead to shortness of breath, with more exhalation than inhalation, known as Xu Chuan (deficiency asthma); kidney also warms the spleen yang, and in cases of spleen and kidney yang deficiency, it can lead to persistent diarrhea, all of which can be treated with Fuzi.
However, the most effective and useful effect is likely in improving kidney yang deficiency’s inability to warm the body. As for the symptoms caused by kidney yang deficiency in other aspects, further research may be needed to determine Fuzi’s efficacy.
However, from ancient to modern clinical applications, Fuzi has been widely used for all forms of kidney yang deficiency, regardless of the symptoms presented, and it likely has varying degrees of effect. For instance, it is used for generalized edema due to kidney yang deficiency, and for frequent clear urination and nocturia, it is also used. It is a widely applicable herb for kidney yang deficiency, and future discussions on yang tonifying herbs should emphasize the manifestations of yang deficiency and how to optimally select and combine them.
The second application is for Spleen Yang Deficiency. Spleen yang deficiency can lead to abdominal cold pain, loose stools, and poor appetite. It can tonify both spleen and kidney, so it can be used for both spleen and kidney deficiency, and it can also be used when spleen yang deficiency is predominant.
Spleen yang deficiency is generally a further development of spleen qi deficiency, so it often needs to be combined with qi tonifying herbs, such as Ren Shen and Bai Zhu (White Atractylodes), which is the guiding principle of Li Zhong Tang (Regulate the Middle Decoction) that combines with Ren Shen and Bai Zhu.
It can also be used for Heart Yang Deficiency. Wangyang Zheng already includes heart yang deficiency; general heart yang deficiency can present with symptoms such as spontaneous sweating and palpitations; in severe cases, it may lead to chest pain with cold symptoms. When using Fuzi, it is often combined with blood-activating herbs or warming herbs like Rougui (Cinnamon) and Guizhi (Cinnamon Twig).
For example, in treating yang deficiency colds, Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction) also uses Fuzi to tonify yang energy. Additionally, for Wei Yang Bu Gu (defensive yang instability), which leads to persistent spontaneous sweating, Qi Fu Tang (Aconite and Astragalus Decoction) can be used, which combines Fuzi with Huangqi (Astragalus) to stabilize the exterior and stop sweating.
In summary, Fuzi can be used for almost all forms of yang deficiency, and it can be used to tonify fire and assist yang for any deficiency-cold syndrome.
The third effect is to San Han Zhi Tong (disperse cold and stop pain). This brings us back to the general overview; when we broadly say disperse cold and stop pain, it means that this herb can warm the interior and warm the meridians, having a relatively broad effect of warming the interior and dispersing cold, or warming the interior and stopping pain.
For Fuzi’s effect in dispersing cold and stopping pain, it can first warm the interior, making it suitable for stomach cold or spleen-stomach deficiency cold. If it is a yang deficiency condition, it can be used, as already mentioned in the yang tonifying section. If it is not a yang deficiency condition but a real condition, such as excessive cold evil leading to abdominal cold pain, Fuzi can still be used.
In addition to warming the interior, Fuzi can also warm the meridians, widely used for cold pain in the limbs and headaches caused by cold in the meridians. A particularly unique warming and dispersing cold effect of Fuzi is its similar action to Wutou (Aconite) in dispelling wind-dampness, making it a good herb for dispelling wind-dampness and stopping pain, especially for wind-damp cold bi syndrome, particularly when accompanied by yang deficiency symptoms.
In terms of treating interior cold syndrome, it is a real condition; in terms of the second application, it is also an interior cold syndrome, but for deficiency. Therefore, the ancients said that Fuzi can be used whenever there is cold, regardless of deficiency or excess; one is for deficiency-cold syndrome, and the other is for excess-cold syndrome. The excess condition is to warm the interior, disperse cold, and stop pain, while the deficiency condition is to warm and tonify yang energy. Fuzi’s effects mainly focus on these three aspects, which correspond directly and are easy to remember.
There are also some noteworthy issues regarding the usage, dosage, and precautions of Fuzi. Firstly, the dosage is generally 3-9 grams. The dosage of Fuzi varies greatly across the country; in some coastal areas of Jiangnan, the general dosage tends to be lower due to the hot climate, where people are more prone to heat and sweating, often leading to fluid damage. Doctors are particularly cautious with Fuzi, especially in hot weather, so using a few grams is common.
However, in the southwestern region, many clinical doctors feel that a few grams may not be effective, so it is common to use Fuzi up to 30 grams, especially in Sichuan and Yunnan. In the 1950s and 60s, a famous doctor in Yunnan known as “Fire God” Wu Peiheng often prescribed 100-500 grams of Fuzi, which was not uncommon. The key is the duration of decoction; if Fuzi is used at 3-5 grams but not decocted for long, it can easily lead to toxicity. If a large amount is used, decocting for 3-5 hours, sometimes from morning to afternoon or overnight, can make using 100-200 grams of Fuzi safe without toxic reactions.
The key is whether such a large amount should be used; in reality, it may not be fully utilized. I want to clarify that I am not advocating for everyone to use more or heavier doses, especially for beginners. The textbook dosage should be a feasible amount, and one should start with this amount. After gaining experience, if necessary, one can increase the dosage slightly.
Most of the time, the solvent in decoctions is limited; even if a large amount of medicine is used, its solubility is limited, and its content does not infinitely increase. We should treat the dosage correctly; excessive dosages can be unsafe and wasteful, while excessive caution can also affect efficacy.
Fuzi requires prolonged decoction, so within a certain range, using a bit more should be quite safe.
Its warming and drying properties are not as intense as those of Ganjing or pepper, so in southwestern folk medicine, Fuzi is often used as a food therapy ingredient in winter, with larger amounts used when stewing lamb. Many people do not have obvious yang deficiency but do not experience adverse reactions after using it, indicating that Fuzi should be considered safe as long as it is used reasonably. The key is prolonged decoction until there is no numbness, similar to Wutou.
Although the combinations and processing of Fuzi can reduce toxicity, the most effective method is to heat and decoct it. Therefore, Fuzi in pill or powder form must be used cautiously; without water and high heat to hydrolyze it, its toxicity is significant.
I have seen a case of Fuzi poisoning where a person ate a lot of Fuzi stewed with meat without any reaction, but after eating a piece of Fuzi that was not submerged in water, they immediately felt uncomfortable, first experiencing numbness, followed by heart-related adverse reactions, such as arrhythmias. This was caused by that piece of Fuzi that was not cooked in water, which I witnessed firsthand. This illustrates the importance of thorough decoction in water for detoxification.
Additionally, the issues of dryness and heat damaging yin, assisting heat, and contraindications for yin deficiency and pregnancy are common to this category of herbs and are not special contraindications.
All content regarding Fuzi is as stated in our textbooks. It is mentioned that Fuzi is one of the eighteen counteracting herbs. Our “Clinical Chinese Herbal Medicine” does not affirm or deny this; in the sixth edition of the textbook, it was included as one of the eighteen counteracting herbs because the original pharmacopoeia listed a category of Wutou herbs that should not be used with Banxia, Guo Lou, Beimu, Bai Lian, and Bai Ji. Since Fuzi is also a Wutou herb, it is important to be aware of this.
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