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TCM Book Club Issue 1440
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IIntroduction:Although both Ginseng (Ren Shen) and Codonopsis (Dang Shen) are named with “shen,” they belong to different families and have distinct effects. The author discusses the differences between the two based on literature and modern pharmacological research, which can guide clinical medication and improve usage efficiency. (Editor/Ju Ye)
Differences in the Botanical Properties of Ginseng and Codonopsis
Author/Pan Chenglian
In the herbal literature before Zhang Shiwans’ Benjing Fengyuan, there were entries for Ginseng but none for Codonopsis, or they were confused, as in the Supplementary Records which states: “Ginseng grows in the upper mountains of Dang and in Liaodong.” Li Shizhen in Compendium of Materia Medica said: “The upper Dang is now Luzhou. The people consider Ginseng to be harmful to the locality and no longer harvest it; what is used now is all Liaoginseng.” He also said: “Now Luzhou cannot produce Ginseng, and other places are even less reliable.”
This indicates that the Ginseng produced in Luzhou was not seen by Li, suggesting that Luzhou does not produce Ginseng, while Ginseng is produced in Liaodong. This may be limited by historical conditions and a lack of knowledge in pharmacognosy. Especially in modern times, due to the high price of Ginseng, Codonopsis is often used as a substitute, but the differences in family, origin, and function between the two are significant and worth clarifying.
Ginseng belongs to the Araliaceae family and is produced in the three northeastern provinces of China, with Jilin Province having the highest yield. The wild variety is called “wild mountain Ginseng,” while the cultivated variety is called “garden Ginseng.” If small wild mountain Ginseng is transplanted to fields, or small garden Ginseng is transplanted to mountains and grows, it is called “transplanted mountain Ginseng.” Its taste is sweet with a slight bitterness, and the raw form is neutral in nature, such as raw sun-dried Ginseng and white sugar Ginseng, while the cooked form is slightly warm, such as red Ginseng and Biezhi Ginseng.
Ginseng has the effects of tonifying Qi and nourishing blood, calming the spirit, and stabilizing collapse, which can enhance the body’s resistance to disease, treat various deficiencies, spleen and stomach weakness, excessive blood loss, and insufficient heart Qi. Ji Yi Dongdong in Yao Zheng states: “Ginseng is primarily used to treat distension and hardness in the heart area; it also treats loss of appetite, vomiting, preference for spitting, heart pain, abdominal pain, and palpitations.” This is based on the indications of Xiao Chai Hu Decoction and Ban Xia Xie Xin Decoction, which has its significance.
Regarding the pros and cons of using Ginseng, Xu Lingtai elaborated. In Benjing Baizhong Lu, he said: “Ginseng is powerful and potent; if used improperly, its harm is greater than that of other medicines. Nowadays, the use of Ginseng by doctors saves lives less often and causes deaths more frequently. The reason is that one in ten deaths is due to deficiency, while eight or nine in ten are due to disease. Ginseng excels in tonifying deficiency but is weak in attacking disease. Doctors do not differentiate whether the disease has been resolved or not; for chronic diseases or weak bodies, or wealthy individuals, Ginseng is always used, which is overly cautious and serves to absolve responsibility. Patients also consider using Ginseng as a way to show filial piety, not realizing that using Ginseng before the disease is resolved not only fails to replenish the vital energy but also solidifies the root of the disease, making topical treatments ineffective, leading to no recovery period, hence the saying that it causes more deaths. Some say that in Zhang Zhongjing’s formulas for cold damage, there are many instances of using Ginseng before the disease is resolved, such as in Xiao Chai Hu Decoction and Xin Jia Decoction; why is that? This is because it is a method of tonifying while purging. The ancients were meticulous in diagnosing conditions, knowing that diseases can be divided into categories. When they are combined, both evil and righteous Qi coexist, and the focus is on attacking and dispersing. When they are separated, evil and righteous Qi are apart, with both deficiency and excess; the excess should be purged, and the deficiency should be tonified. In a formula, using both is not a hindrance and can complement each other, thus using Ginseng to build the center and generate fluids, expelling evil Qi is even more effective. If evil Qi is still strong and has not separated, it must be treated specifically, and Ginseng should not be used. Moreover, it is also included in dispersing medicines, and there is no instance of it being used with cooked Rehmannia or Lycium fruit in formulas for symptoms. Understanding this, one can avoid using Ginseng to harm others.” This indeed provides enlightenment and is worth referencing.
The author classifies over 30 formulas composed of Ginseng from Shang Han Za Bing Lun: one category is for building the center and strengthening the spleen, such as Li Zhong Decoction and Wu Zhu Yu Decoction, generally paired with Bai Zhu (White Atractylodes), Gan Jiang (Dried Ginger), or Wu Zhu Yu (Evodia); the second category is for supporting the righteous and expelling evil, such as Bai Hu Jia Ren Shen Tang and Xiao Chai Hu Tang, generally paired with the heat-clearing Shi Gao (Gypsum) or harmonizing Chai Hu (Bupleurum) or Qin Pi (Quercus) and Lian Qiao (Forsythia); the third category is for tonifying the heart and lungs, such as Fu Mai Tang and Mai Men Dong Tang, generally paired with Mai Men Dong (Ophiopogon) or Sheng Di (Raw Rehmannia); the fourth category is for invigorating heart Yang, such as Fu Zi Tang and Si Ni Jia Ren Shen Tang, generally paired with Fu Zi (Aconite) or Gui Zhi (Cinnamon Twig); the fifth category includes others, such as Wen Jing Tang for tonifying Qi and regulating menstruation, Chai Hu Jia Long Gu Mu Li Tang for tonifying Qi and calming the spirit, and Jiu Tong Wan for tonifying Qi and alleviating pain, all aiming to achieve therapeutic goals through their Qi-tonifying and righteous-supporting effects.
This classification, though rudimentary, is beneficial for exploring the ancient methods of Ginseng’s compatibility and application as a model.
Since Ginseng is a well-recognized tonic, it is often used as a supplement outside of clinical applications. The author believes that for the elderly or those weakened after illness, if their diet is normal, they cannot endure labor, their tongue is thin and clean, and their pulse is weak, they can generally take it. However, the dosage can start at 1.5g (daily amount) and gradually increase. The author has previously treated acute leukemia patients during the interval of reduced white blood cells in combination chemotherapy, administering Biezhi Ginseng at 4.5g daily, which had a significant effect on increasing white blood cells, creating favorable conditions for continued chemotherapy.
Additionally, there is also Tai Zi Shen. In the past, small Ginseng was selected and called “Tai Zi Shen,” which was also slightly cheaper. However, the Tai Zi Shen sold in pharmacies today is often the root of the Caryophyllaceae family, which only has the effect of generating fluids and has weak Qi-tonifying power.
Western Ginseng is also a member of the Araliaceae family. Wu Yiluo’s Ben Cao Cong Xin states that it has a sweet and slightly bitter taste, is cool in nature, tonifies the lungs, reduces fire, generates fluids, and is suitable for those with fatigue and deficiency with heat. In modern clinical practice, Ginseng in Bai Hu Jia Ren Shen Tang or Zhu Ye Shi Gao Tang is often replaced with Western Ginseng, which seems to align better with heat-related diseases.
For example, a patient named Wu suffered from hemolytic anemia and previously used Biezhi Ginseng, but the heat in the blood could not be controlled, leading to dryness of the lips and tongue and confusion. The author prescribed Di Huang Tang with 3g of Biezhi Ginseng and 6g of Western Ginseng, and after two doses, the blood stopped and the spirit was clear, demonstrating that Western Ginseng’s cool nature can neutralize the warmth of Biezhi Ginseng, achieving a balance of warm and cool effects.
Recent advancements in pharmacological research on Ginseng both domestically and internationally have revealed new findings, with its main components being ginsenosides, glucose, and rhamnose. The stem and leaf components are basically the same as those of the root. The Ginseng leaf also contains the same saponins, and clinical trials have shown that it does not have a significant emetic effect and can also be used medicinally. Pharmacological experiments indicate that it can regulate the excitation and inhibition activities of the cerebral cortex; it can provide a defensive effect against various harmful stimuli to the body; and while it does not produce adrenal cortex hormone-like effects on the pituitary-adrenal cortex system, it does have some influence.
Reports indicate that Ginseng can enhance tissue respiration, promote carbohydrate glycolysis, increase energy metabolism, and enhance immune function. Other experimental studies suggest that it has a certain preventive effect on experimental gastric ulcers in rats; however, another study indicates that it exacerbates pyloric ligation ulcers in rats. The experimental results are inconsistent, which may be related to different experimental methods.
Codonopsis was first recorded in Zhang Shiwans’ Benjing Fengyuan in 1705, followed by entries in Zhao Xuemins’ Ben Cao Gang Mu Shi Yi and Wu Yiluos’ Ben Cao Cong Xin, establishing it as an independent item. Botanically classified, it belongs to the Campanulaceae family, with roots that are long and cylindrical, 1-1.7cm in diameter, with a slightly larger root tuber at the top, and the outer skin is milky yellow to light gray-brown, with many longitudinal wrinkles, distinguishable from Ginseng by its beak-like root head and many straight lines and root hairs. This product is produced in Shanxi and Gansu provinces and has the effects of clearing lung fire, strengthening the spleen, and generating fluids.
Ben Cao Feng Yuan states: “Upper Dang Ginseng, although it does not have the strong warming and tonifying effects, has the power of sweet, neutral, and clear tonification, and is not as cold as sand Ginseng, which specializes in draining lung Qi.” Zhang’s evaluation of its efficacy is quite fair. In modern times, Zhang Shanlei in Ben Cao Zheng Yi states that Codonopsis “can tonify the spleen and nourish the stomach, moisten the lungs and generate fluids, and strengthen the middle Qi, which is not far from Ginseng… but its power is relatively weak and cannot be sustained. For those with deficiency after illness, taking two or three qian (a traditional weight unit) can only temporarily invigorate their spirit for one day, which is indeed a model of moderation; however, it can support the middle and moisten the four corners… Therefore, all ancient and modern formulas that use Ginseng can be replaced with Lu Codonopsis.” It can be seen that Codonopsis has long been used as a substitute for Ginseng, but the functions of Codonopsis and Ginseng are significantly different and should be carefully distinguished in application.
Regarding the components and pharmacological research of Codonopsis, it has been reported that its root contains saponins and trace alkaloids, sucrose, glucose, and mucilage. Animal experiments indicate that Codonopsis can slightly increase red blood cells and hemoglobin, elevate blood sugar, and reduce white blood cells. The author has previously used 60g of Codonopsis as a daily amount to treat chronic myeloid leukemia, which reduced white blood cells and alleviated the condition, seemingly consistent with animal experiments.
In summary, Ginseng and Codonopsis differ in family, origin, function, and components, each having its unique effects. In recent years, Codonopsis has been used as a substitute for Ginseng in clinical practice, such as in Si Jun Zi Tang and Bu Zhong Yi Qi Tang for treating spleen and stomach deficiency.
The author believes that this is not solely relying on the power of Codonopsis, but rather on the supporting effects of Huang Qi (Astragalus), Bai Zhu (Atractylodes), or Dang Gui (Angelica). In cases of collapse or critical blood loss, relying solely on Codonopsis is insufficient. However, Codonopsis is effective in cases of recovering from heat illnesses, spleen and stomach deficiency, or insufficient lung Qi with unresolved phlegm, as it promotes phlegm expulsion, increases glycogen, and does not cause stagnation.
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