Chinese Medicine Book ClubIssue 3796
Daily updates to accompany the growth of TCM practitioners
IIntroduction：Ancient practitioners believed that Fuzi (Aconite) and Rougui (Cinnamon) were primarily used to expel blood stasis and eliminate diseases. The “Jinkui Yaolue” by Zhang Zhongjing outlines the principles of “disease, pulse, and syndrome treatment,” indicating that ancient practitioners diagnosed and treated based on disease identification, with each major syndrome requiring a principal herb. For any major syndrome with blood stasis, Fuzi and Rougui were essential, while the differentiation of constitution was secondary.
—This article is approximately5700 words long, expected reading time15 minutes—
Discussion on the Anti-Blood Stasis Effects of Fuzi and RouguiAuthor/Pan Huaxin
Profile:Pan Huaxin, male, professor. Born in 1938, graduated from Shanghai University of Traditional Chinese Medicine in 1979. He studied under renowned doctors such as Zhu Xiaonan, Yan Cangshan, Chen Susheng, and Qiu Peiran. He has worked at the Central Hospital of Luwan District in Shanghai, overseeing ward and outpatient services. He has authored books including “Selection of Liu’s Four Medical Cases,” “Unpublished Medical Cases of Ye Tianshi,” “Guanli Collection,” and entries in the “Encyclopedia of Traditional Chinese Medicine: Warm Disease Series,” among others. He has published nearly sixty medical papers and has a column titled “Linglan Picking Moss” in the “Xinmin Evening News.”
The historical divide in medical paradigms between ancient and modern times is evident. The medical viewpoints and thinking patterns of Zhang (Jiegu), Li (Gao), Wang (Haogu), and Zhu (Zhenheng) have left an indelible mark on the medical community from the Ming and Qing dynasties to the present.
As history evolves, so does the understanding and application of Fuzi (Aconite) and Rougui (Cinnamon). The changes around the Jin and Yuan dynasties can be seen as a microcosm of this evolution. I believe that breaking free from conventions, releasing constraints, transcending the Jin and Yuan periods, restoring the views of the Han and Tang dynasties, innovating from the ancient, and paving the way for the future is a significant responsibility bestowed upon us by the times. Thus, I humbly present the following discussion.
Section OneThe Two Major Effects of Fuzi and Rougui
In pre-Song materia medica, such as “Shennong’s Classic of Materia Medica,” “Bielu,” “Jizhu,” “Yao Xing Lun,” and “Rihua Zibencao,” the understanding and application of Fuzi (Aconite) and Rougui (Cinnamon) can be summarized into two main points: one is to expel cold and warm the Yang; the other is to break blood stasis and promote blood circulation. The latter is emphasized. For example:
“Shennong’s Classic” states that Fuzi “is indicated for wind-cold cough, warming the middle, treating traumatic injuries, breaking up masses, and blood stasis, as well as cold dampness causing pain and inability to walk.”
“Bielu” states, “It treats cold and weak feet, lumbar wind-cold, cold pain in the heart and abdomen, cholera, cramps, and can induce abortion.”
The former “breaking up masses and blood stasis” and the latter “inducing abortion” clearly indicate the effects of breaking blood stasis and promoting circulation. Traditional Chinese medicine has a fine tradition of relying on classical texts; why have we overlooked the essential discussions in “Shennong’s Classic” and “Bielu” for centuries?!
Rougui is similar.
“Shennong’s Classic” states, “It is indicated for cough with reversed qi, qi stagnation, throat obstruction, vomiting, benefits the joints, and tonifies the middle and boosts qi.”
“Bielu” adds that it treats “heart pain, flank wind, flank pain, warms the tendons and opens the meridians, stops vexation and sweating,” and “can induce abortion, strengthen bones and joints, and promote blood circulation.”
“Yao Xing Lun” states: “It is indicated for nine types of heart pain, kills three worms, breaks blood stasis, and promotes menstruation.”
“Rihua Zibencao” states, “It breaks up masses, eliminates blood stasis, treats wind-dampness, and promotes circulation, and strengthens muscles and bones.”
These also indicate its treatment of blood stasis and obstruction. The clarity of reasoning in ancient texts is something we cannot avoid. The wars during the Jin and Yuan dynasties disrupted the prosperity of the Tang and Song dynasties.
In the face of military disasters, labor, famine, and grief, the contradiction of insufficient internal energy and weakness in the populace became prominent, leading to the natural use of sweet and warming tonics. This subtle change in understanding of the two major functions of Fuzi and Rougui, from a previous emphasis on breaking blood stasis to a tendency towards warming Yang, is evident.
For instance, the warming and tonifying school, represented by Guijie Zhang, emphasized that Fuzi primarily functions to “remove the cold from the organs and support insufficient Yang”, while Wang Haogu summarized Rougui as “tonifying the Mingmen fire and dispelling Yin”, which subtly misled the understanding.
In the Ming and Qing medical communities, the doctrine of warming and tonifying the spleen and stomach became dominant, leading to the association of warming Yang and dispelling cold with Fuzi and Rougui, as seen in “Bencao Beiyao” “(Fuzi) tonifies kidney Yang and expels wind-cold dampness”; “Bencao Congxin” “(Fuzi) is indicated for all cold and stubborn conditions.”
This was certainly a response to the needs of the times, but unfortunately, the valuable knowledge from the Han and Tang dynasties was lost, and the discussion of breaking blood stasis became rare.
Of course, some knowledgeable practitioners have mentioned the blood-breaking effects of Fuzi and Rougui, such as:
“Bencao Gangmu” states: “Moreover, Rougui is pungent and dispersing, able to open the uterus and break blood, hence “Bielu” mentions its ability to induce abortion.”
(Note: According to today’s research by Zhang Zhijun, “Newly Revised Materia Medica” states that “Bielu” mentions Fuzi’s ability to induce abortion, and also states that Rougui can also “induce abortion,” but “Shennong’s Classic” does not mention Rougui, only mentioning the two types of Guigui, while “Bielu” supplements Rougui. “Gangmu” states that the Rougui mentioned in “Bielu” that can induce abortion does not refer to the Guigui in “Shennong’s Classic,” but rather the Rougui from Wu Pu and Li Dang, which later merged the properties and uses of Rougui and Guigui, collectively referred to as Rougui, while Guigui was discarded.)
Zhang Jingyue’s “Bencao Zheng” also has similar statements, but the prevailing belief in the Ming dynasty that emphasized warming Yang and dispelling cold cannot be easily changed.
Continuing to the present, the “Concise Dictionary of Traditional Chinese Medicine” collectively compiled by eleven TCM colleges in 1978 and published by the People’s Health Publishing House clearly summarizes the indications for Fuzi and Rougui:
Indications for Fuzi and Rougui“Concise Dictionary of Traditional Chinese Medicine”(Fuzi) ① Yang deficiency, ② Spleen and stomach deficiency with cold, ③ Kidney Yang deficiency, ④ Wind-cold-damp obstruction;(Rougui) ① Kidney Yang deficiency, ② Cold pain in the stomach and abdomen, ③ Women’s Chong and Ren deficiency with cold, ④ Yin abscess.
Not a word is mentioned about the essence of breaking blood stasis, which shows how much the ancient understanding has faded in recent TCM academic circles!
However, the bright side is that modern laboratory research on Rougui and Fuzi has strongly supported the views of ancient practitioners.
Rougui has been shown to “inhibit platelet aggregation and has anticoagulant effects (antithrombin).” Furthermore, it has been pointed out that it can “increase the perfusion pressure of coronary and cerebral arteries, promote the opening of collateral circulation in the myocardium, thereby altering its blood supply and protecting the myocardium.”Fuzi has also been confirmed to “significantly improve the hypoxia tolerance of mice, antagonize myocardial ischemia and arrhythmia caused by posterior pituitary hormone, and reduce acute myocardial ischemic injury in anesthetized dogs. This effect of Fuzi is related to its reduction of myocardial oxygen consumption and increase in blood supply and oxygenation to ischemic myocardium.”
Objectively speaking, using modern scientific tools to study Chinese herbal medicine is still a long journey, but the preliminary conclusions above have provided convincing annotations and exciting indications for the ancient claims of Fuzi and Rougui regarding “breaking up masses, promoting blood circulation, and treating heart pain.”
Section TwoHistorical Use of Fuzi and Rougui in Treating Major Syndromes
Ancient formulas for treating major syndromes often used Fuzi and Rougui. Here, major syndromes refer to conditions such as stroke, abdominal pain, chest obstruction, joint pain, and masses. To illustrate, I will briefly mention four examples from Zhang Zhongjing’s formulas:
For “joint pain, unable to bend or stretch, with pain, use Wutou Decoction. Ingredients: Mahuang, Shaoyao, Huangqi, Gancao, Wutou, honey.”;
“For chest obstruction with urgency, use Yiyiren and Fuzi Powder. Ingredients: Yiyiren, Fuzi.”;
“For heart pain radiating to the back, use Wutou and Chishi Pill. Ingredients: Wutou, Shu Jiao, Ganjiang, Fuzi, Chishi.”;
“For intestinal abscess, with symptoms of skin mottling, tense abdomen, soft on palpation, no accumulation, no fever, rapid pulse, indicating pus in the intestines, use Yiyiren and Fuzi Baijiao Powder. Ingredients: Yiyiren, Fuzi, Baijiao.”;
All four formulas utilize Fuzi, and the academic community has traditionally believed that the crux of the above syndromes is cold obstruction, hence the use of the pungent and warming Wutou and Fuzi to expel it.
However, understanding Zhang Zhongjing’s original intent may not be so simple. First, Zhang Zhongjing based his treatment on the disease, that is, “joint pain, chest obstruction, intestinal abscess”. Under this premise, joint pain presents as inability to bend or stretch, and chest obstruction manifests as heart pain radiating to the back, which can lead to the use of Wutou.
Patients with Yang deficiency and cold congealing can use it, but those with Yin deficiency and excess heat can also use it. I believe that there were also patients with Yin deficiency and excess heat in ancient times; we cannot ignore this fact. To adapt to customs, the narrow view that Fuzi and Rougui primarily expel cold has oversimplified Zhang Zhongjing’s profound wisdom, labeling countless patients with joint pain and chest obstruction as merely suffering from cold obstruction.
In fact, many patients today with joint pain and chest obstruction exhibit symptoms of insufficient Yin fluid and excessive internal heat, such as rheumatoid arthritis with red, swollen, deformed joints, and rapid pulse; or coronary heart disease with frequent angina and dark complexion, yellow greasy tongue, and wiry pulse.
In the “Clinical Guidelines for Medical Cases: Obstruction Syndromes,” many formulas combine Chuanwu and Guizhi with Lingyangjiao and Shigao, where Wutou and Rougui break blood stasis, while Lingyangjiao and Shigao clear heat. This reflects the essence of Zhang Zhongjing’s principles, adapting to the treatment of Yin deficiency and excess heat in obstruction syndromes, which is often overlooked by later generations.
Although people and circumstances differ, the existence of Yang deficiency, Yin deficiency, Qi deficiency, blood deficiency, and organ deficiencies is an objective reality that has not changed. The only changes are in terminology; thus, scholars today must adhere to the fundamental academic attitude of seeking truth from facts. Reflecting on Zhang Zhongjing’s time, he would never abandon the treatment of patients with Yin deficiency and excess heat.
Next, let’s examine Zhang Zhongjing’s treatment of intestinal abscess, primarily using Yiyiren and Fuzi Baijiao Powder, where the symptoms indicate “pus in the intestines”. This clearly indicates heat toxin and blood stasis, yet Fuzi is used, suggesting that Zhang Zhongjing had deeper intentions, which cannot be dismissed as merely expelling cold.
Furthermore, the three conditions of joint pain, chest obstruction, and intestinal abscess share a common pathological mechanism, namely blood stasis. Joint pain is due to stasis in the meridians, chest obstruction is due to stasis in the heart vessels, and intestinal abscess is due to pus formation and stasis. The use of Wutou and Fuzi, with their pungent and warming properties, serves to break blood stasis, promote circulation, and relieve obstruction, emphasizing the principle of treating the disease first and breaking stasis urgently, reflecting the essence of the “Neijing” “Addressing the main issue first, then addressing the cause”.
“When Chen Zhuo is removed, the intestines and stomach are clean, and when masses are eliminated, the Ying and Wei flourish.”
This also highlights the characteristic of ancient methods of treating diseases by focusing on expelling pathogens.
However, related textbooks (“Interpretation of Jinkui Yaolue” published by Shanghai Science and Technology Press) assert that the above syndromes, such as chest obstruction and heart pain, are caused by “Yin-cold obstruction,” hence using Wutou to “harshly expel Yin pathogens” is a misinterpretation of Zhang Zhongjing’s original intent, and it causes countless patients with Yin deficiency and excess heat to miss out on treatment.
It is not difficult to see that Zhang Zhongjing’s use of Fuzi in the above four formulas aligns with the discussions in “Shennong’s Classic” and “Bielu” regarding breaking blood stasis and promoting circulation, as well as modern laboratory research. Recognizing this point serves as a warning for us.
We diligently seek ancient teachings, yet we are not truly ancient; we merely follow the Ming and Qing traditions; we advocate for the modernization of TCM, yet we ignore the clear conclusions of modern laboratory research, remaining fixated on cold obstruction!
Outside of Zhang Zhongjing’s formulas, ancient treatments for one of the major syndromes, stroke, are also thought-provoking. Before the Song dynasty, treatments for wind primarily used major and minor life-saving decoctions, all of which included Mahuang (Ephedra), Fuzi, and Rougui as the main ingredients, using their pungent properties to promote circulation, relieve obstruction, and restore blood supply to damaged tissues, targeting the disease of stroke, which is about eliminating the disease.
After the Song dynasty, Liu, Li, and Zhu each proposed different theories, focusing on heart fire, Qi deficiency, or phlegm-heat, emphasizing the body, which is beneficial to the body (for discussions on form and body, refer to Zhang Jingyue’s theories on form and the “Clinical Guidelines for Medical Cases” on body enhancement).
The theories from the Jin and Yuan dynasties have been confused and mixed over the ages, leading to distinctions between similar and dissimilar conditions, resulting in the emergence of misleading theories.
It is worth noting that the ancient formulas of Mahuang, Fuzi, and Rougui, with their pungent flavors, were developed to promote blood circulation in the treatment of stroke, which resonates with the recent clinical use of aspirin to prevent and treat “cerebral infarction” and “myocardial infarction.” If one believes in the anticoagulant effects of aspirin, how can one disregard the blood-circulating properties of Mahuang, Rougui, and Fuzi? To put it bluntly, is this not a case of forgetting one’s roots? (Refer to my article “Exploring the Original Intent of Major Life-Saving Decoction for Stroke” in the December 2001 issue of Zhejiang Journal of Traditional Chinese Medicine.)
Due to space limitations, I can only briefly mention the use of Fuzi and Rougui in treating major syndromes by later practitioners after Zhang Zhongjing.
“Zhouhou Fang” treats common heart pain with Wutou Pill (Wutou, Chuan Jiao, Ganjiang, Rougui);
“Fan Wang Fang” treats severe blood pain in the waist with single Rougui;
“Zhang Wenzhong” treats sudden waist pain with Rougui, Mudanpi, and Fuzi;
“Biyou Fang” uses Lianzhong Pill, indicated for heat and pain in the lower ribs, using Dahuang, Poxiao, Shaoyao, and Rougui;
“Guangji” treats abdominal masses with hard lumps under the ribs, painful on palpation, using Bie Jia Pill (Bie Jia, Niuxi, Xiong Huang, Dahuang, Danggui, Ganjiang, Rougui, Xixin, Fuzi, Gancao, Ba Dou);
“Shenshi Fang” uses Wutou Pill to treat abdominal distension and pain, using Wutou, Ganjiang, Zaojia, Rougui, Chaihu, Fuzi, Ren Shen, Houpo, Huanglian, Fuling, Shu Jiao, Wuyuyu, and Jiegeng;
“Biyou Fang” treats tooth pain with Fangfeng, Fuzi, Shu Jiao, and Mangcao (held in the mouth without swallowing, rinsed with wine);
“Yannian Fang” treats heart pain with Zhuyou Pill (Wuyou, Ganjiang, Rougui, Baizhu, Ren Shen, Jupi, Jiao, Gancao, Huangqin);
“Zhang Wenzhong” uses Shu Jiao Pill to treat chest fullness and heart pain radiating to the back (Shu Jiao, Banxia, Fuzi);
“Gujin Luyanzhi” uses Xiaocao Pill to treat chest obstruction and heart pain (Xiaocao, Rougui, Shu Jiao, Ganjiang, Xixin, Fuzi) and so on.
A wealth of ancient experience in treating pain is presented before us, and it is clear that the above syndromes cannot be summarized merely as cold obstruction. Cold is just one of the six excesses that can cause disease; other pathogenic factors can also cause disease and pain, and various pathogenic factors can lead to stasis, and obstruction leads to pain. This is absolute.
It is evident that the use of Fuzi and Rougui is not merely for dispelling cold and warming Yang. It is intriguing that many formulas clearly exhibit heat symptoms yet still use Fuzi and Rougui.
For instance, in the aforementioned “Biyou Fang” Lianzhong Pill, the symptoms also include “deficiency heat, dry mouth, thick saliva, dry eyes, intermittent headaches, and painful urination”, which can be seen as a manifestation of Yin deficiency and excess heat, yet the ancients still used Rougui.
Clearly, the “Biyou Fang” targets the disease, which is the pain and stasis, and in the context of dispelling pathogens and promoting blood circulation, it treats both the disease and the body. The combination of Rougui with Dahuang and Shaoyao balances the side effects of Rougui’s pungent and warming nature, making it a well-considered approach.
The aforementioned syndromes share a common pathological mechanism, namely blood stasis and obstruction, and the ancient purpose of using Fuzi and Rougui was primarily to break blood stasis and promote circulation, not merely to dispel cold and warm Yang. Although the relationship between cold and stasis is close, cold invasion can easily lead to stasis, as stated in the “Suwen” “When cold remains, blood coagulates, and when coagulated, the pulse does not flow.”
However, when stasis becomes an organic disease, it becomes the primary contradiction, and cold evil becomes a secondary pathological mechanism. Many major syndromes such as stroke, chest obstruction, masses, and joint pain are all like this. The dual functions of Fuzi and Rougui in dispelling cold and breaking blood stasis have been overshadowed and replaced by the concept of dispelling cold, leading to their disappearance from discussions. This transformation is something we must be acutely aware of.
In the 1950s, I studied under the renowned doctor Yan Cangshan in Shanghai, practicing Ding’s methods for over a decade. Although I occasionally heard of the common use of Fuzi and Rougui in Sichuan medicine, I did not pay much attention.
At that time, the famous old TCM doctor Chen Susheng, a disciple of the renowned doctor Zhu Weiju, was known for his adept use of Fuzi and Rougui. I observed him using Fuzi and Rougui to treat severe illnesses and frequently sought his advice. However, due to his advanced age and hearing difficulties, communication was challenging. Moreover, during that time, many things were in disarray, and I regrettably did not delve deeper into this matter. Nevertheless, the effectiveness of Fuzi and Rougui in Chen’s practice made me question my established beliefs.
In 1979, I began teaching at Shanghai University of Traditional Chinese Medicine, guided by Mr. Qiu Peiran. Under the leadership of Shi Yunyuan, I spent over a decade sifting through ancient texts, which opened my eyes to the profound insights of Chen and Qiu regarding the use of Fuzi and Rougui, which is not limited to warming Yang and dispelling cold but emphasizes breaking blood stasis and promoting circulation.
I soon broke free from the constraints of Ding’s methods, using Fuzi and Rougui to treat major syndromes of blood stasis in clinical practice. Unexpectedly, the results were remarkable, as seen in the treatment of coronary heart disease with angina, using Gua Lou, Xie Bai, Fuzi, and Rougui as the main herbs (refer to my article in “Chinese Clinical Doctors” 2004, Volume 32, “Exploring the Han and Tang Legacy in Treating Coronary Heart Disease and Angina”), where the efficacy was significantly different from those who did not use Fuzi and Rougui, and this efficacy can be replicated and withstand objective scientific verification.
Conclusion
In summary, ancient practitioners held that Fuzi and Rougui were primarily used to expel blood stasis and eliminate diseases. Zhang Zhongjing’s “Jinkui” outlines the principles of “disease, pulse, and syndrome treatment”, indicating that ancient practitioners diagnosed and treated based on disease identification, with each major syndrome requiring a principal herb. For any major syndrome with blood stasis, Fuzi and Rougui were essential, while the differentiation of constitution was secondary. The “Qianjin Fang,” “Wai Tai Mi Yao,” “Sheng Hui Fang,” and “Sheng Ji Zong Lu” are all rich sources for treating diseases.
If we can revive the ancient understanding of Fuzi and Rougui’s ability to combat blood stasis today, I would consider it a contribution to the ongoing discourse, as “the wise are like carpenters drilling holes, having reached nine-tenths of the way, I am merely providing the final touch.” With the enlightenment and education from Chen Susheng and Qiu Peiran, and the assistance of Shi Yunyuan, I have contributed this final touch, which is significant not only for its revival of ancient knowledge but also for clarifying doubts and innovating, paving a promising path for the clinical treatment of difficult major syndromes.
Reflecting on the historical twists and turns of Fuzi and Rougui, the blame lies in the changes during the Jin and Yuan dynasties, where various schools shifted focus from disease to constitution, emphasizing the body. Li Gao emphasized Qi deficiency, while Danxi pointed to Yin deficiency. Various Ming scholars picked up the remnants, and the so-called differentiation of syndrome and treatment became a differentiation of constitution and treatment.
In fact, the current landscape of TCM is based on the teachings of the Jin, Yuan, Ming, and Qing dynasties, with the study of the “Neijing” and Zhang Zhongjing’s teachings as the ultimate goal. Simplifying and distancing from the ancient teachings, the key point is to exclude the profound medical heritage of the Tang and Song dynasties, which is akin to discarding a priceless treasure. The invaluable medical legacy of the Tang and Song dynasties has also faded, leading to the prevalence of shallow and vulgar studies and the rise of unfounded speculations. How can we not feel regret in the face of the achievements of our predecessors!
Transcending the Jin and Yuan dynasties and delving into the Tang and Song dynasties is an important task that we cannot choose to ignore. The four profound medical texts: “Qianjin Fang,” “Wai Tai Mi Yao,” “Sheng Hui Fang,” and “Sheng Ji Zong Lu” are the authentic sources of TCM scholarship, the overall framework of clinical TCM, the culmination of Qin and Han medicine, and the academic roots of the Jin, Yuan, Ming, and Qing scholars. They represent a broad avenue for revitalizing TCM.
TCM is not lacking successors, but rather talents who are willing to study diligently and forge ahead. “On the side of the sunken boat, a thousand sails pass; in front of the sick tree, ten thousand trees spring forth.” I firmly believe that a new generation will emerge to inherit the profound knowledge.
—Copyright Statement—• Article excerpt from “Journal of Shanghai University of Traditional Chinese Medicine” | Author/Pan Huaxin• Edited by/Wang Qinyi | Recommended by/Han Xing | Typeset/Shisan | Reviewed by/Ju Ye | Proofread by/Yang Ye.• This article is copyrighted by the rights holder. For educational exchange only, please do not use it casually.