TCM Book Club Issue 1392
Daily updates to accompany the growth of TCM practitioners
IIntroduction: “For treating pain, use with Gui Zhi (Cinnamon Twig), Bai Zhu (White Atractylodes), and Fu Ling (Poria); for treating cold extremities, use with Gan Jiang (Dried Ginger); for treating aversion to cold, use with Gui Zhi, Ma Huang (Ephedra), Xi Xin (Asarum), and Gan Cao (Licorice).” (Editor/Wang Chao)
The Application of Aconite
Author/Zhu Mutong
Generally, the indications for Aconite preparations, based on the records in the “Shang Han Lun” (Treatise on Cold Damage) and “Jin Kui Yao Lue” (Essential Prescriptions of the Golden Chamber), are summarized as follows:
A. For Treating Pain (used with Gui Zhi, Bai Zhu, and Fu Ling):
1. Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction with Aconite) (Shang Han) “For Tai Yang disease, if sweating occurs and the leakage does not stop, with aversion to wind, difficulty urinating, and slight tension in the limbs, making it hard to bend or stretch.” (Tai Yang Chapter)
2. Gui Zhi Shao Yao Tang (Cinnamon Twig and Peony Decoction) (Jin Kui) “For pain in the limbs and joints, body weakness, swelling of the feet, dizziness, and shortness of breath, with a tendency to vomit.” (Wind Stroke with Joint Pain)
3. Gui Zhi Fu Zi Tang (Cinnamon Twig Decoction with Aconite) (Jin Kui).
4. Gui Zhi Jia Bai Zhu Tang (Cinnamon Twig Decoction with Atractylodes) (Jin Kui) “For cold damage on the eighth or ninth day, with wind and dampness clashing, body pain, inability to turn or lie down, no vomiting or thirst, and a floating, weak pulse… If the stool is hard and urination is smooth…” (Spasmodic Damp Heat)
5. Gan Cao Fu Zi Tang (Licorice Decoction with Aconite) (Shang Han) “For wind and dampness clashing, with joint pain, sharp pain that prevents bending or stretching, and severe pain upon approach. Sweating, shortness of breath, difficulty urinating, aversion to wind, and slight swelling of the body.” (Tai Yang Chapter)
6. Fu Zi Tang (Aconite Decoction) (Shang Han) “For Shao Yin disease, if after one or two days, the mouth feels warm and the back feels cold, moxibustion should be applied; Fu Zi Tang is indicated.” (Tai Yang Chapter)
7. Zhen Wu Tang (True Warrior Decoction) (Shang Han) “For Shao Yin disease, if it does not resolve after two or three days, and continues for four or five days, with abdominal pain, difficulty urinating, heavy and painful limbs, and diarrhea, this indicates water retention; the person may cough, have smooth urination, diarrhea, or vomiting.” (Shao Yin Chapter)
Additionally, formulas such as Yi Yi Ren Fu Zi Bai Jiang San for intestinal abscess, Yi Yi Ren Fu Zi San for chest obstruction and pain, and Da Huang Fu Zi Tang for lateral abdominal pain, all utilize the heat of Aconite to break cold accumulation.
B. For Treating Cold Extremities (used with Gan Jiang):
1. Gan Jiang Fu Zi Tang (Dried Ginger Decoction with Aconite) (Shang Han) “After purging, if sweating recurs, with daytime restlessness and nighttime calmness, no vomiting or thirst, no exterior symptoms, a deep and weak pulse, and no significant fever.” (Tai Yang Chapter)
2. Si Ni Tang (Four Reversal Decoction) (Shang Han) “For smooth urination and no thirst, this belongs to Tai Yin due to cold retention. It should be warmed.” (Tai Yin Chapter)
3. Tong Mai Si Ni Tang (Open Pulse Four Reversal Decoction) (Shang Han) “For Shao Yin disease, with clear diarrhea, internal cold and external heat, cold hands and feet, a weak pulse about to disappear, and the body does not feel cold, with a red face, abdominal pain, dry vomiting, or throat pain, or if diarrhea stops and the pulse does not come out.” (Shao Yin Chapter)
4. Fu Zi Geng Mi Tang (Aconite and Geng Rice Decoction) (Jin Kui) “For abdominal cold hernia, with thunder-like sharp pain, chest and lateral fullness, and vomiting.” (Abdominal Fullness Cold Hernia)
5. Wu Mei Wan (Mume Pill) (Shang Han) “… This indicates internal cold…” (Jue Yin Chapter)
C. For Treating Aversion to Cold (used with Gui Zhi, Ma Huang, Xi Xin, and Gan Cao):
1. Gui Zhi Qu Shao Yao Jia Fu Zi Tang (Cinnamon Twig Decoction without Peony with Aconite) (Shang Han) “For Tai Yang disease, after purging, if the pulse is rapid and the chest feels full, Gui Zhi Qu Shao Yao Tang is indicated. If there is slight aversion to cold, add Fu Zi Tang to the formula.” (Tai Yang Chapter)
2. Shao Yao Gan Cao Fu Zi Tang (Peony and Licorice Decoction with Aconite) (Shang Han) “If sweating disease does not resolve and there is a return of aversion to cold, this is due to deficiency.” (Tai Yang Middle Chapter)
3. Ma Huang Fu Zi Xi Xin Tang (Ephedra, Aconite, and Asarum Decoction) (Shang Han) “For Shao Yin disease, if it begins with fever and the pulse is deep.” (Shao Yin Chapter)
4. Gui Zhi Qu Shao Yao Jia Ma Huang Fu Zi Xi Xin Tang (Cinnamon Twig Decoction without Peony with Ephedra, Aconite, and Asarum) (Jin Kui) “For Qi stagnation under the heart, with a firm abdomen, as large as a plate, and edges like a spinning cup, caused by water retention.” (Water Retention Disease)
5. Yue Bi Jia Fu Zi Tang (Yue Bi Decoction with Aconite) (Jin Kui) “For wind water with aversion to wind, with the whole body swollen, a floating pulse, no thirst, and no sweating, with no significant fever.” (Water Retention Disease)
6. Ma Huang Fu Zi Tang (Ephedra and Aconite Decoction) (Jin Kui) “For water retention disease, if the pulse is deep and small, it belongs to Shao Yin; if it is floating, it indicates wind without water; if it is distended, it indicates water retention; sweating will resolve it.” (Water Retention Disease)
7. Fu Zi Xie Xin Tang (Aconite Heart-Draining Decoction) (Shang Han) “For fullness under the heart and a return of aversion to cold with sweating.” (Tai Yang Chapter)
The above are important Aconite preparations from the “Shang Han Lun” and “Jin Kui Yao Lue”, and are frequently used by the classical formula school. If we also consider modern formulas such as Aconite Li Zhong Tang, Shi Quan Da Bu Tang with Aconite, Da Fang Feng Tang, and Chen Xiang Tian Ma Tang, the extensive application of Aconite will be even more apparent.
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