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Recently, I have been considering alternatives to Aconite, especially due to complaints from office workers about the lengthy decoction time required for Aconite. However, Aconite is toxic, and when used in doses over 10 grams, I always advise a preliminary decoction of about one hour to ensure safety. So, are there any less toxic herbs that can serve as effective substitutes for Aconite?
Aconite is one of the four major herbs in Traditional Chinese Medicine (TCM) (along with Ginseng, Gypsum, and Rhubarb). It is characterized as being very hot and pungent, circulating through the twelve meridians, warming the Yang of the five organs, and has effects such as reviving Yang, warming the kidneys, assisting Yang, and dispelling cold to alleviate pain. It is primarily used for conditions like Yang deficiency leading to collapse, cold limbs with weak pulse, impotence, cold pain in the heart and abdomen, chronic cold-induced vomiting and diarrhea, water retention due to cold, Yang deficiency with external pathogens, and cold-damp obstruction, among others.
In “Yi Tong,” Han Feixia states: “Aconite revives Yang, its power is magnificent.” Moreover, Aconite circulates through the twelve meridians, reaching all areas of the body where Yang Qi is deficient. Therefore, Aconite is a commonly used herb in the Fire God school of TCM, and warming Yang generally cannot be separated from Aconite. The founder of the Fire God school, Mr. Zheng Qinan, used Aconite and dried ginger for various Yin conditions, including hemoptysis, hematochezia, hematuria, insomnia, toothache, halitosis, and constipation, with remarkable efficacy.
Any substitute for Aconite must also have a good warming Yang effect and overall efficacy similar to Aconite. I thought of three commonly used warming Yang herbs in classical formulas: Dried Ginger (Gan Jiang), Honey-fried Licorice (Zhi Gan Cao), and Cinnamon (Rou Gui).
Dried Ginger enters the Spleen, Stomach, Kidney, Heart, and Lung meridians, and has the effects of warming the middle, dispersing cold, reviving Yang, and drying dampness to resolve phlegm. It is commonly used for cold pain in the heart and abdomen, vomiting and diarrhea, cold limbs with weak pulse, cough due to cold phlegm, wind-cold-damp obstruction, and Yang deficiency with vomiting, epistaxis, and hematochezia.
“Yao Xing Lun” praises it: “Treats cold pain in the lower back and kidneys; breaks blood, dispels wind, opens the joints of the four limbs, regulates the five organs, dispels wind-cold dampness, and treats frequent urination at night; treats cough, stops persistent diarrhea, abdominal pain, and resolves cold-induced fullness and diarrhea; treats blood stasis; for patients who are weak and cold, it is advisable to add this herb.”
Dried Ginger can “open the five organs and six bowels,” indicating its penetrating nature is not weak. It is said that Dried Ginger stays in place, but in fact, it enters the Spleen, Stomach, Kidney, Heart, and Lung meridians, warming and supplementing the Yang Qi of the three burners. If combined with Honey-fried Licorice, it can further warm and circulate through the twelve meridians.
“Zheng Zhi Yao Jue” states: “Without Dried Ginger, Aconite cannot generate heat; with Licorice, its nature is gentle; with Cinnamon, it supplements the Mingmen (Gate of Life).” This shows that the heat of Dried Ginger should not be underestimated. In clinical practice, when reviving Yang and rescuing from collapse, if Aconite requires prolonged decoction and time is limited, Dried Ginger and Honey-fried Licorice can be used as substitutes.
Licorice, as stated in “Ben Cao Fen Jing”: “Its taste is sweet, it circulates through the twelve meridians, resolves the toxicity of a hundred herbs, and when used raw, it harmonizes Qi, supplements the Spleen and Stomach, and drains Heart fire to nourish Lung metal; when honey-fried, it warms and supplements the Yuan Qi of the three burners and disperses exterior cold; when added to harmonizing formulas, it supplements; in sweating formulas, it releases the muscles; in cooling formulas, it drains heat; in harsh formulas, it alleviates urgency; in nourishing formulas, it nourishes blood, and can harmonize various herbs, preventing them from clashing. It treats vomiting, resolves swelling and toxicity in the upper body; it reaches the stems and roots.”
Licorice, like Aconite, also has the effect of circulating through the twelve meridians, and the two have a complementary relationship. Aconite has a guiding nature, leading the treatment; while Licorice has a supportive nature, embodying the principle of “following the chicken when married to a chicken, and following the dog when married to a dog.”
Cinnamon enters the Kidney, Spleen, Heart, and Liver meridians, and has the effects of supplementing fire, assisting Yang, guiding fire back to its source, dispelling cold, and unblocking the meridians. “Ri Hua Zi Ben Cao” states: “Treats all wind conditions, supplements the five labors and seven injuries, opens the nine orifices, benefits the joints, nourishes essence, brightens the eyes, warms the lower back and knees, breaks phlegm and masses, resolves blood stasis, treats wind-damp bone and joint contractions, reconnects tendons and bones, and generates muscle.”
More importantly, Cinnamon can assist Heart fire and supplement Heart Yang, and can also aid in bladder Qi transformation. “Yi Xue Du Shu Ji” states: “The ability of the Heart, Lung, Spleen, Gallbladder, Stomach, Liver, and Kidney to transform and exchange is all dependent on the Heart’s ruling fire.” When the Qi transformation of the Heart is normal, all twelve organs are at peace.
Dried Ginger, Honey-fried Licorice, and Cinnamon are all mild in nature, non-toxic, and do not require prolonged decoction, making them ideal substitutes for Aconite. If one seeks a quick warming Yang effect, Honey-fried Licorice can also be omitted. This substitution is considered from a holistic perspective. Additionally, substitutes can be chosen based on the five organs.
Mr. He Shaoqi mentioned in “Zhu Liangchun’s Experience in Medication” that “Aconite warms the Yang of the five organs, and it must be used wisely, not excessively.” He pointed out that the efficacy of Aconite lies in warming the Yang of the five organs, and noted that Aconite can “strengthen the heart, warm Heart Yang, warm Kidney Yang, warm Spleen Yang, warm Lung Yang, and warm Liver Yang.” To strengthen the heart, one can use Cinnamon Twig (Gui Zhi), Red Ginseng (Hong Shen), or Wood Fragrance (Mu Xiang) as substitutes; to warm Kidney Yang, one can use Psoralea (Bu Guo Zhi), Xian Mao, or Agarwood (Chen Xiang); to warm Spleen Yang, one can use Red Ginseng, Dried Ginger, or Sand Ginger (Sha Ren); to warm Lung Yang, one can use Dried Ginger, Honey-fried Licorice, or Ephedra (Ma Huang); to warm Liver Yang, one can use Angelica (Dang Gui), Cinnamon, or Cyperus (Xiang Fu).
Since Aconite can also circulate through the twelve meridians, substitutes can also be considered based on the twelve meridians.
Hand Shaoyin Heart Meridian: Du Huo, Acorus (Shi Chang Pu), Longan Flesh (Long Yan Rou), etc. as substitutes;
Hand Jueyin Pericardium Meridian: Chuan Xiong, Lindera (Wu Yao), Cinnamon as substitutes;
Hand Taiyang Small Intestine Meridian: Qiang Huo, Fennel, Honey-fried Licorice as substitutes;
Foot Jueyin Liver Meridian: Qing Pi, Cinnamon, Angelica as substitutes;
Foot Shaoyang Gallbladder Meridian: Chuan Xiong, Chen Pi, Angelica as substitutes;
Foot Taiyin Spleen Meridian: Ephedra, Clove, Red Ginseng as substitutes;
Foot Yangming Stomach Meridian: Bai Zhi, Ban Xia, Bai Zhu as substitutes;
Hand Taiyin Lung Meridian: Green Onion (Cong Bai), Patchouli (Huo Xiang), Aster (Zi Wan) as substitutes;
Hand Yangming Large Intestine Meridian: Bai Zhi, Wu Zhu Yu, Nutmeg as substitutes;
Foot Shaoyin Kidney Meridian: Cinnamon, Agarwood, Epimedium (Yin Yang Huo) as substitutes;
Foot Taiyang Bladder Meridian: Qiang Huo, Sand Ginger, Alpinia (Yi Zhi Ren) as substitutes;
Hand Shaoyang Sanjiao Meridian: Chuan Xiong, Hou Po, Red Ginseng as substitutes.
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