【Benefits at the End of the Article】
Editor’s Note
Aconite (Fu Zi) is renowned in Traditional Chinese Medicine (TCM) for its role in reviving yang and countering cold. Various processed forms include salt-processed Aconite, black Aconite slices, white Aconite slices, and roasted Aconite. Do you know how to distinguish between them? Are you aware of how to apply Aconite in clinical practice?
We present the clinical experiences of Dr. Zhao Liang and Dr. He Shaoqi, which may provide some inspiration.
Discussion on the Usage and Dosage of Aconite
Author: Zhao Liang
Different Types and Processing Methods of Aconite
Aconite is a processed product of the tuber of the Aconitum plant, which is a perennial herb found in mountainous grasslands or shrub areas, distributed in southern Liaoning, Henan, Shaanxi, Gansu, Shandong, and Jiangsu. It is primarily cultivated in Sichuan, harvested from late June to early August, with the mother root, fibrous roots, and soil removed, commonly referred to as “mud Aconite.” The processed forms are as follows.
1. Salt-Processed Aconite: Select large, uniform mud Aconite, wash it, soak it in a solution of edible gallbladder water overnight, then add salt and continue soaking. Each day, take it out to dry, gradually extending the drying time until a large amount of crystalline salt (salt frost) appears on the surface, and the texture hardens, commonly referred to as “salt-processed Aconite.”
2. Black Aconite Slices: Take mud Aconite, wash it according to size, soak it in a solution of edible gallbladder water for several days, then boil it in the soaking liquid until thoroughly cooked. Remove, rinse, and cut into approximately 0.5 cm thick slices. Soak in water, dye with a coloring solution to a deep tea color, steam until an oily surface appears, then dry or continue to bake until dry, commonly referred to as “black Aconite slices.”
3. White Aconite Slices: Select uniform-sized mud Aconite, wash it, soak it in a solution of edible gallbladder water for several days, boil it in the soaking liquid until thoroughly cooked, remove the outer skin, cut into approximately 0.3 cm thick slices, soak in water, steam until cooked, dry until half-dry, then sulfur-fumigate and dry, commonly referred to as “white Aconite slices.”
4. Roasted Aconite Slices: Take clean river sand, place it in a frying container, heat with a strong fire until flexible, add clean Aconite slices, and stir-fry continuously until they puff up and slightly change color, then remove, sift out the sand, and cool.
5. Lightly Processed Aconite Slices: Take clean salt-processed Aconite, soak in clean water, changing the water 2-3 times daily until the salt is completely removed. Cook with licorice and black beans until thoroughly cooked, cut into thin slices, dry, and sift out debris. For every 100 kg of salt-processed Aconite, use 5 kg of licorice and 10 kg of black beans.
Usage of Aconite
Having understood the commonly used processed forms of Aconite in today’s medical market, let us discuss the usage and dosage of Aconite.
Generally, Aconite is toxic; the longer the cooking time, the safer it may be. However, the toxicity of Chinese herbs can sometimes be part of their therapeutic effect. As stated in the “Rites of Zhou, Tian Guan,” “Physicians manage medical orders, gathering toxic herbs for medical purposes.”
In clinical practice, Aconite is not always better with longer cooking times. For example, in the formula Si Ni Tang from the “Treatise on Cold Damage,” one piece of Aconite is used raw, boiled with three sheng of water to yield one sheng and two ge. This indicates that the cooking time for Aconite in the “Treatise on Cold Damage” is not very long.
From the boiling method, Zhang Zhongjing did not emphasize prolonged cooking in Si Ni Tang. In the Gan Cao and Gan Jiang Decoction, three sheng of water is boiled to yield one sheng and five ge, while Si Ni Tang uses three sheng of water to yield one sheng and two ge. This comparison shows that the cooking time for Si Ni Tang is not significantly longer than that of Gan Cao and Gan Jiang Decoction. This indicates that with accurate pattern differentiation and corresponding formulas, a small dose of Aconite may not need to be pre-cooked. Currently, hospitals primarily use black Aconite slices or lightly processed Aconite slices, which are already processed and have significantly reduced toxicity. However, if a large amount of Aconite is used, it is still recommended to pre-cook it to ensure clinical safety.
Dosage of Aconite
Now let us discuss the dosage of Aconite.
I do not advocate the large-scale use of Aconite for common diseases unless in emergencies to revive yang and counter cold; otherwise, one should not blindly use large doses to warm yang, such as 100g or 200g of Aconite.
As we learn from the “Huangdi Neijing,” “A little fire generates qi, while a strong fire consumes qi,” meaning that small doses of warming yang can replenish yang qi, while large doses, although effective in the short term, will inevitably deplete the body’s yang qi over time. Once Aconite is stopped, yang qi will be even more deficient. It is like a child’s growth; if parents do everything for them (large doses of warming yang), they will inevitably achieve nothing when they grow up. However, if they receive slight guidance when they go astray (small doses of warming yang), they can achieve great things in the future.
Moreover, every medication has its safe dosage range, with effective and toxic doses. Once you understand Chinese culture, you will naturally comprehend that TCM often treats diseases by adapting to circumstances, using a little to achieve a lot. In emergencies, one can use a heavier dose to revive yang, but once yang qi is restored, do not continue with large doses of warming yang; instead, follow up with small doses of tonifying formulas to maximize the benefits.
Clinical Experience with Aconite
Next, I will share my experiences with the dosage and usage of Aconite in clinical practice.
1. Dosage: In my unit’s pharmacy, we use black Aconite slices, and my usual dosage is 5~20g, with rare cases of severe yang deficiency reaching up to 30g, such as in some acute left heart failure patients where I use 20~30g, yielding excellent results.
2. Cooking Time: I usually prescribe Aconite to be boiled vigorously until boiling, then simmered for over 1 hour, so I rarely require pre-cooking in my prescriptions.
3. Aconite Indications: Cold extremities, joint pain, undigested stools, and overall body weakness.
4. Aconite Combinations: For exterior yang deficiency, Aconite is combined with Ma Huang; for interior yang deficiency, Aconite is combined with Gan Jiang.
【Appendix】 He Shaoqi: A Discussion on Aconite
Author: He Shaoqi
From Zhang Zhongjing to Myself: Experiences with Aconite
It is said that people from Sichuan favor Aconite due to the region’s humid climate and terrain. However, this overlooks the fact that Aconite was first effectively used and promoted by Zhang Zhongjing. Zhang Zhongjing used Aconite:
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In combination with Gan Jiang and Gan Cao (Si Ni Tang) as the primary formula for reviving yang and countering cold;
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In combination with Fu Ling, Bai Zhu, Bai Shao, and Sheng Jiang (Zhen Wu Tang) to treat edema;
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In combination with Ren Shen, Bai Zhu, Fu Ling, and Bai Shao (Aconite Decoction) to warm and tonify the original yang;
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In combination with Ma Huang and Xi Xin (Ma Huang Aconite Xi Xin Decoction) to warm the meridians and release the exterior;
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In combination with Bai Zhu (Gui Zhi Aconite Decoction) to treat wind-damp joint pain (Bai Zhu is a sacred herb for removing dampness);
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In combination with Ban Xia, Jing Mi, Da Zao, and Sheng Jiang (Aconite Jing Mi Decoction) to warm the spleen and stop diarrhea;
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In combination with Da Huang and Xi Xin (Da Huang Aconite Decoction) to warm and eliminate cold accumulation;
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In combination with Da Huang, Huang Qin, and Huang Lian (Aconite Xie Xin Decoction) to support yang and resolve phlegm;
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In combination with Sheng Di, E Jiao, Huang Tu, Bai Zhu, Gan Cao, and Huang Qin (Huang Tu Decoction) to warm the spleen and stop bleeding;
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In combination with Yi Yi Ren and Bai Jiao Cao (Yi Yi Aconite Bai Jiao San) to treat intestinal abscess;
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In combination with Wu Mei, Huang Lian, Huang Bai, and Chuan Jiao (Wu Mei Wan) to treat roundworm convulsions and chronic diarrhea;
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In combination with Di Huang, Shan Zhu Yu, Shan Yao, Dan Pi, Fu Ling, Ze Xie, and Gui Zhi (Shen Qi Wan) as a foundational formula for tonifying the kidneys…
It can be said that he has maximized the use of Aconite, and Zhang Zhongjing was not from Sichuan.
Since Zhang Zhongjing, the clinical application of Aconite has become even more widespread, such as:
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In “Ancient and Modern Records of Efficacy,” Aconite is combined with Ma Huang, Gui Zhi, Dan Shen, Ren Shen, Fang Feng, Xing Ren, Fang Ji, Huang Qin, Sheng Di, and Gan Cao (Xiao Xu Ming Tang) to treat unbearable wind-cold joint pain, and severe back pain that cannot be turned at night.
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In “Qian Jin Fang,” Aconite is combined with Xi Xin, Fang Feng, Gan Jiang, Shan Zhu Yu, and Fu Ling (San Wu San) to treat severe cold in the wind palace, with urgent headaches and tight neck muscles.
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In “Jin Xiu Fang,” Aconite is combined with Bai Zhu, Gan Cao, Da Zao, and Sheng Jiang (Zhu Fu Tang) to treat wind deficiency with heavy dizziness.
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In “Zhou Hou Fang,” Aconite is combined with Tian Xiong and Chuan Wu (San Jian Tang) to treat original yang deficiency with cold evil entering, resulting in a submerged pulse.
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In “Tai Ping Sheng Hui Fang,” Aconite is combined with Du Huo, Niu Xi, Gui Xin, Chuan Xiong, Chi Shao, Dang Gui, and Tao Ren (Du Huo San) to treat cold stagnation and wind attacking, causing limb pain.
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In “San Yin Fang,” Aconite is combined with Gan Jiang, Gan Cao, Ren Shen, Shao Yao, Fu Ling, Gui Xin, and Bai Zhu (Aconite Eight Herbs Decoction) to treat joint pain in the limbs, as if being hammered.
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In “Ju Fang,” Aconite is combined with Cao Wu, Quan Xie, Tian Ma, Cang Zhu, and Walnut Meat (Shan Shen San) to treat kidney qi deficiency, causing pain in the waist and joints, and inability to bend the knees;
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In combination with Lu Rong, Rou Cong Rong, Ren Shen, Shu Di, Rou Gui, Shi Hu, Wu Wei Zi, Huang Qi, Fu Ling, Bai Shao, Bai Zhu, Ban Xia, and Gan Cao (Lu Rong Da Bu Tang) to treat various deficiencies in pregnant women;
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In combination with Ren Shen, Gan Jiang, Gan Cao, Rou Gui, Wu Zhu Yu, Mai Ya, Shen Qu, Zhi Shi, Jie Geng, and Xi Xin (Da Wen Pi Wan) to treat spleen and stomach deficiency cold, causing food not to digest, with little intake and much damage.
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In “Chi Shui Xuan Zhu,” Aconite is combined with raw Aconite, raw Ban Xia, and raw Sheng Jiang (San Sheng Yin) to treat phlegm dizziness.
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In “Zhang’s Medical Communication,” Aconite is combined with Bai Guo, Ju Hong, Sheng Jiang, and Gan Cao (Leng Xiang Yin Zi) to treat abdominal pain and diarrhea in the summer months.
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In “Medical Insights,” Aconite is combined with Gan Jiang, Bai Zhu, Gan Cao, and Yin Chen (Yin Chen Zhu Fu Tang) to treat jaundice.
The above famous formulas are just a few examples, and there are countless more from the Tang and Song dynasties to the Ming and Qing dynasties, from official formula books to personal writings, demonstrating the extensive use of Aconite! Recently, the esteemed physician Zhu Wei Ju has also used Aconite combined with Zao Ren to treat tachycardia and premature contractions; combined with Zhi Mu to treat febrile diseases with thirst; and combined with magnetic stone to treat insomnia due to neurasthenia. Mr. Jiang Chunhua believes that many chronic and difficult diseases, especially chronic inflammation, do not respond to conventional methods of clearing heat and detoxifying, because the body is weak from prolonged illness, and damp-heat fire toxins are unresolved. He draws inspiration from Zhang Zhongjing’s Wu Mei Wan and Yi Yi Aconite Bai Jiao San, breaking conventions by using warming and clearing methods together, tonifying and purging simultaneously, treating the body and the disease together. For example, he treats Behçet’s disease by combining Aconite with Dang Shen, Huang Qi, Gan Cao, Yin Yang Huo, Huang Lian, Huang Qin, Dan Pi, Pu Gong Ying, and Ban Zhi Lian, achieving effective results.
I also have some insights on Aconite. In addition to what has been mentioned:
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For kidney issues, I use Gan Jiang Ling Zhu Tang with Aconite, which is more effective;
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For shoulder periarthritis, I often use Huang Qi, Dang Gui, Bai Zhu, Yin Yang Huo, Wei Ling Xian, Xi Xian Cao, Gui Zhi, Jiang Huang, and Hai Tong Pi, but Aconite must be used heavily; otherwise, it will not be effective;
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For those with weak constitutions, I use Yu Ping Feng San with Aconite, ginger, and dates;
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For acute nephritis onset, with chills, no sweating, and edema, I use Ma Huang Aconite Xi Xin Tang;
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For chronic nephritis edema, I use Zhen Wu Tang and Shi Pi Yin, both with Aconite as the main herb;
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For persistent diarrhea, early morning diarrhea, and elderly incontinence, I use Li Zhong He Si Shen with added Rou Gui and Aconite to warm and tonify the life fire;
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For oral ulcers that do not respond to cooling herbs, it is often due to excess yin and floating yang; Aconite with ginger can break yin and revive yang, ensuring that the yin haze dissipates and the fire stabilizes;
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For chronic pharyngitis, I use a piece of Aconite honey-fried, cut into small pieces to swallow;
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For dysmenorrhea with cold symptoms, Aconite combined with Dang Gui is used.
In summary, based on ancient and modern experiences with Aconite, it is a versatile herb that can be used for various purposes, whether to attack or tonify, to warm or cool, to promote or stop, and for internal or external applications. Its effects are remarkable when used appropriately, and it holds an irreplaceable role among herbs, justifying its title as the “leader of all herbs.”
The Issues of Aconite Dosage, Cooking Methods, and Compatibility with Ban Xia
The dosage of Aconite has always been a topic of great debate. In Zhang Zhongjing’s formula, one piece of Aconite is used, processed into eight pieces, resulting in approximately 60g per dose. A large piece of Aconite weighs about 6-8g, and when processed, it is referred to as “processed Aconite,” which has a stronger effect. Therefore, when using Aconite, there is no need to be overly cautious; starting with 10-15g is acceptable, and if there are no issues, it can be increased to 30g or more.
For treating bi syndrome with yang deficiency and cold intolerance, I typically use dosages above 30g, but I have often faced refusals from pharmacies, requiring me to sign a waiver. However, there have been instances where they still refused to dispense the medication. I once treated a patient with rheumatoid arthritis using 30g of Aconite per dose, but the pharmacy refused to dispense it. Fortunately, a relative of the patient worked at a pharmacy in Haidian, allowing me to obtain it, and after taking over a hundred doses, the patient recovered, having used several tens of kilograms of Aconite. I also treated another patient with cold-damp bi syndrome, using 30g per dose, which was ineffective, so I increased it to 60g. To save time, he cooked two doses together, resulting in an actual dosage of 120g. I do not mean to suggest that larger doses are always better, but for severe cases, using only a few grams is akin to scratching the surface and will not resolve the issue.
Aconite should be pre-cooked; for small doses (9g or so), pre-cook for half an hour; for medium doses (15g or so), pre-cook for 1 hour; for large doses (30g or more), pre-cook for 2 hours. After the initial cooking, simmer on low heat for 40 minutes. When cooking Aconite, adding a piece of ginger (about 30g, smashed) and 1 tael of honey is better, as it can reduce the toxicity of Aconite.
Using Aconite will not lead to toxic accumulation. A patient with ankylosing spondylitis in Shenyang has taken over 400 doses, each with a heavy use of Aconite at 30g, totaling several tens of kilograms of Aconite, and has been able to maintain work and has essentially recovered.
Historically, there have been claims that Aconite is incompatible with Ban Xia, Gua Lou, Bei Mu, Bai Ji, and Bai Lian, which are part of the “eighteen incompatibilities.” However, there is no mention of Ban Xia being incompatible with Aconite. Chuan Wu is the mother plant of Aconite, but these are two different herbs. If one claims that Aconite is incompatible with Ban Xia and Gua Lou, it would be a misrepresentation. Moreover, the combination of Aconite and Ban Xia has been pioneered by the medical sage Zhang Zhongjing.
There are many opportunities for using Ban Xia and Aconite together. If you require proof, I can provide over 100 medical cases and prescriptions from ancient and modern times as evidence. Once, when I prescribed a combination of Ban Xia and Aconite, a pharmacy worker scoffed at the prescription, questioning which quack doctor wrote it, showing a lack of common knowledge. I found it amusing rather than angering. Renowned contemporary physicians such as Jiang Chunhua, Zhu Liangchun, and Yan Dexin have all published serious articles refuting the claim that Ban Xia is incompatible with Aconite. Interested readers may wish to look them up.
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