Ten Combinations of Fu Zi (Aconite) and Their Unique Effects

The combinations of Fu Zi (Aconite) have always been a hot topic in the field of Traditional Chinese Medicine (TCM). The first batch of national senior TCM experts, led by renowned TCM practitioner Hu Qiaowu from Anhui Province, has summarized decades of experience in using Fu Zi into ten combinations, primarily focusing on its pairing with mineral-based heavy medicines and bitter-cold, blood-activating herbs. The balance of cold and warmth, along with appropriate combinations, can yield better results for complex and difficult diseases.

Hu Qiaowu: Ten Combinations of Fu Zi

Author/Hu Qiaowu

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Introduction:Hu Qiaowu, 1915—2002, male, from She County, Anhui, was the chief physician at the affiliated hospital of Anhui University of Chinese Medicine. In 1991, he was selected as one of the first national senior TCM experts by the Ministry of Personnel, the Ministry of Health, and the State Administration of Traditional Chinese Medicine. He specialized in the diagnosis and treatment of internal injuries and exogenous febrile diseases. He authored several books including Three-Character Formula in TCM, Collection of Experiences from Senior TCM Experts: Hu Qiaowu Edition, and One Spoon of Tangerine Well: Common Seasonal Illnesses and Their Treatments, and published over 30 academic papers in domestic TCM journals.

Fu Zi is a pungent and warm herb with a wide range of clinical indications. It is commonly used in combination with warming and tonifying herbs; when paired with cold and cool herbs, it serves as a modification method. For mixed cold and heat syndromes, the medication should also be warm and cool. In the Shang Han Lun, Fu Zi is used in 20 formulas.

The Medical Canon states that it can “guide tonifying Qi herbs through the twelve meridians to restore the dispersed Yang; guide blood tonifying herbs into the blood to nourish the insufficient true Yin; promote dispersing herbs to open the pores and expel exterior wind-cold; and guide warming herbs to the lower jiao to eliminate internal cold-damp.” Huang Gongxiu praised it as: “the primary agent for tonifying the true fire of the congenital Mingmen.” Zhang Xichun stated: “Fu Zi is the main herb for assisting the Yuan Yang, its power can ascend and descend, can reach internally and disperse externally; for all cold and stagnant conditions in the viscera, muscles, and meridians, ‘none fail to be effective when taking this.’”In modern times, Xu Xiaopu proposed that Fu Zi can “guide fire back to its source and subdue false heat.”Although Fu Zi is a key herb for dispelling cold and tonifying, it has certain toxicity. When used appropriately, its effects are remarkable; however, if used improperly, it can lead to severe consequences. Therefore, ancient practitioners often combined it with other herbs.As Zhang Jingyue said: “Fu Zi is aggressive and difficult to handle alone; it must be paired with large sweet herbs, such as Ren Shen (Ginseng), Shu Di Huang (Rehmannia), and Zhi Gan Cao (Honey-fried Licorice), which can temper its harshness and enhance its efficacy.” He created many famous formulas combining Fu Zi with warming and tonifying Qi and blood herbs. Based on the principles of mutual necessity and mutual assistance in herbal combinations, ancient practitioners also created effective formulas combining Fu Zi with Gan Jiang (Dried Ginger), Rou Gui (Cinnamon), Ma Huang (Ephedra), and Xi Xin (Asarum), but reports on its combination with mineral-based heavy medicines and bitter-cold, blood-activating herbs are still rare. The author, with over 40 years of experience using Fu Zi in combination with the aforementioned herbs to treat difficult diseases, summarizes them into ten combinations for clinical trial.1Combination with Shi Gao (Gypsum) for treating wind-water, cough, asthma, and rashes that are difficult to resolve In the Jin Kui, there is a record stating “for those with aversion to wind, add one piece of Fu Zi,” which opened the way for the combined use of these two herbs in later generations. Shu Chiyuan in Six Meridians Differentiation combined the two herbs, and one dose cured a case of stubborn dysentery; Zhao Yangkui combined the two herbs to treat a severe case of diabetes, which also yielded immediate results. The Sun Zhao’s Formula introduced the combination of the two herbs for treating wind-heat headache. Some have used Da Qing Long Tang (Major Blue Dragon Decoction) with Fu Zi to treat epidemic meningitis. Although the two herbs have different properties and functions, the author has found that whether for seasonal or miscellaneous diseases, whenever there is a combination of deficiency and excess or mixed cold and heat presenting one of the following three conditions, they can be used freely: ① Lung meridian with heat accumulation and kidney Qi deficiency with cold; ② Excessive internal heat with exterior deficiency and spontaneous sweating; ③ Wind-heat affecting the upper body with cold water impacting the lower body.2Combination with Dai Zhe Shi (Hematite) for treating metrorrhagia For those with a constitution of deficiency-cold or yin diseases and metrorrhagia with heat in the blood, if using hemostatic agents yields little effect, one can try using Dai Zhe Shi combined with Fu Zi. Zhang Xichun stated: Dai Zhe Shi “can generate blood and cool blood, its quality is heavy and sinking,” bitter and slightly cold, primarily entering the lung meridian, and when paired with the warm and moving Fu Zi, it creates a balance of cold and heat, stillness and movement, thus regulating Yin and Yang and solidifying the Chong and Ren meridians. Recent practitioners have also reported using the two herbs together with Gan Song (Sweet Woodruff), Li Lu (Veratrum), Ling Xiao Hua (Campsis Grandiflora), and Shi Chang Pu (Acorus) to treat epilepsy.3Combination with Shi Jue Ming (Abalone Shell) for treating palpitations and headaches The imbalance of water and fire can often lead to palpitations and anxiety, while liver Yang with phlegm-heat can also cause headaches. The two herbs can be used together as the main treatment; the former addresses the relationship between the heart and kidney, while the latter addresses the relationship between the upper and lower body. Shi Jue Ming can calm the rebellious liver Yang, allowing it to descend, while Fu Zi can invigorate the Yang of the Mingmen, evaporating kidney water to assist the upward flow. The combination of cold and heat, and the interaction of water and fire, can promote the balance of Yin and Yang. This is effective for treating insomnia and manic disorders caused by kidney Yang deficiency and excessive liver fire. Xu Xiaopu used Fu Zi combined with Ci Shi (Magnetite) and Long Chi (Dragon’s Tooth) to nourish Yin and subdue Yang, which is similar to this method.4Combination with Da Huang (Rhubarb) for treating hemoptysis, chest pain, and diarrhea For persistent hemoptysis due to cold obstructing the vessels; for chest pain from external injury; and for abdominal diarrhea due to deep cold, Da Huang combined with Fu Zi can be used in different formulas to achieve warming and unblocking effects. According to treatment principles, warming agents should not be used for purging, and purging agents should not be used for warming. The combination of Fu Zi and Da Huang, one hot and one cold, can work together to achieve their respective effects despite their opposing properties. Zhang Zhongjing had Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) and Fu Zi Xie Xin Tang (Aconite and Heart-Draining Decoction), and later practitioners also created Wen Pi Tang (Warming the Spleen Decoction), which are all excellent formulas using both herbs. Recent practitioners have also reported using the two herbs together to treat acute kidney failure caused by epidemic meningitis and to treat appendicitis lumps and chronic cholecystitis.5Combination with Huang Lian (Coptis) for treating damp-heat diarrhea in the later stages In the later stages of damp-heat, when the middle Yang is not functioning properly, it often leads to dampness obstructing heat, causing lingering symptoms. Due to heat being trapped in dampness, fever often persists; dampness obstructs the middle jiao, leading to disharmony in the bowels and resulting in loose stools. These two conditions can be quite challenging for physicians. At this time, using Fu Zi combined with Huang Lian in the formula can yield unexpected effects. Huang Lian is bitter and dries dampness, cooling and draining heat, making it an excellent remedy for dampness obstructing heat, which is not matched by other herbs. Fu Zi is pungent and warm, which can invigorate the middle Yang, expel heat outward, and also assist Huang Lian in solidifying the stomach and stopping diarrhea. Xu Xiaopu often used the two herbs together to treat damp-heat with both Qi and Yin deficiency, where residual pathogens linger, presenting with fever, sweating, and a rapid pulse, as well as children with summer heat presenting with thirst, frequent urination, cold limbs, and no sweating. His self-formulated treatment for summer heat, Qing Shang Wen Xia Tang (Clear Above and Warm Below Decoction), uses these two herbs as the main ingredients.6Combination with Huang Qin (Scutellaria) for treating prolonged chills and fever For individuals with a generally weak constitution, after an external invasion, the righteous Qi often cannot withstand the evil, leading to prolonged exterior pathogens that gradually transform into heat. Persistent fever is due to insufficient sweating, making it difficult for the pathogens to be expelled. If pungent and warm dispersing agents are used, they can easily injure Yin; if pungent and cool dispersing agents are used, they may hinder Yang. Therefore, it is advisable to use Xiao Chai Hu Tang (Minor Bupleurum Decoction) for harmonizing, with a small amount of Fu Zi to stabilize the middle and expel the pathogens, which is the best approach. Although Huang Qin clears lung heat, its bitter and cold nature is not suitable for those with a pale tongue and cold limbs, but Fu Zi can invigorate Yang Qi and assist in clearing heat while also promoting the expulsion of pathogens.7Combination with Shan Zhi Zi (Gardenia) for treating abdominal pain Chest and abdominal pain often present with mixed cold and heat symptoms. For example, a thin and rapid pulse with a pale white tongue, bitter mouth, and clear urination, with pain that is relieved by pressure, and internal heat with cold limbs, etc. Ancient practitioners often used oppositely flavored herbs together, and the combination of the warm and dispersing Fu Zi with the bitter and cold Jiao Zhi (焦栀) is particularly suitable for these symptoms. Its efficacy can relieve pain and resolve stagnation, similar to the combination of Gan Jiang (Dried Ginger) with Jiao Zhi for treating stomach pain.8Combination with Pao Jia (Pangolin Scales) for treating bone pain, masses, and lumps The medicinal use of Pao Jia was first recorded in Shennong’s Herbal Classic. Since the Song and Yuan dynasties, it has been used for external symptoms such as sores and for promoting lactation and regulating menstruation. Li Shizhen used it in Ben Cao Gang Mu to treat rheumatic cold pain, where the entire body is stiff and cannot bend, with unbearable pain, emphasizing its ability to open the meridians. However, it is often feared for its harshness and rarely used, but modern practitioners such as Long Zhi Zhang, Zhang Xichun, and Zhang Ci Gong have effectively utilized this herb. Long praised it as a gentle general, stating that its efficacy surpasses that of Da Huang and Ba Dou, as Ba Dou and Da Huang only break down solid accumulations, while Pao Jia can also penetrate and resolve hidden accumulations. Zhang stated: “The penetrating nature of Pao Jia is thorough, thus it can open the viscera, pass through the meridians, and reach the joints; all blood clots and accumulations can be resolved. It can also treat masses, paralysis, urinary obstruction, and abdominal pain.”9Combination with Xi Xian Cao (Siegesbeckia) for treating wind-damp pain The Compendium of Materia Medica states: “Xi Xian Cao is effective for liver and kidney wind, four limbs numbness, bone pain, and knee weakness, as well as wind-damp sores.” Commonly used wind-damp dispelling herbs tend to be pungent and warm, while this herb has the unique ability to dry dampness with its bitterness, eliminate heat with its coldness, and disperse wind with its pungency. For those with chronic wind-damp, kidney Yang deficiency, and evil entering the meridians causing heat, presenting with widespread joint pain, muscle soreness, and a red tongue with a slightly rapid pulse, if using pungent and warm wind-dispelling agents yields little effect, one can often use Fu Zi combined with Xi Xian Cao to treat both the root and the branch, solidifying the right and dispelling the evil. However, Xi Xian Cao must be prepared with wine and honey, steamed and dried nine times to eliminate its turbid and Yin qualities for best results.10Combination with Dan Shen (Salvia) for treating chest obstruction, palpitations, and pulse irregularities Ancient practitioners stated: “The chest is the position of Yang, a place of clarity and openness, difficult to bear even a trace of shadow; if obstructed, Yang Qi cannot circulate, leading to pain.” This clearly indicates that the pathogenesis of chest obstruction and pain is related to the failure of chest Yang to thrive, with phlegm and turbidity rising, leading to blood stasis in the heart vessels. Thus, palpitations and irregular pulses also arise due to the obstruction of Qi and blood. Therefore, patients presenting with a pale complexion, cold extremities, blue-green eyes, a pale and swollen tongue with purple spots, or a white greasy or light yellow tongue, with a pulse that is deep, thin, wiry, or intermittent, along with chest tightness and pain, can use Fu Zi combined with Dan Shen (Salvia) as the main agents. Huang Gongxiu stated: “Dan Shen has a bitter taste and red color, is neutral and descending, and can enter the heart and break blood stasis,” while Fu Zi is a key herb for strengthening the heart, thus the combination of the two can directly address the pathological stasis in the heart. Among all blood-activating and stasis-resolving herbs, Dan Shen is particularly adept at treating heart diseases, and there are many reports of using Dan Shen combined with other herbs to treat coronary heart disease or acute myocardial infarction, which beginners should pay attention to. Ding Ganren often used Dan Shen combined with Fu Zi to treat joint pain due to cold stagnation and dampness, also utilizing the warming and blood-activating properties of both herbs.

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