Chinese Medicine Book ClubIssue 3743
One issue daily, accompanying the growth of TCM practitioners
IIntroduction：This article is very detailed and has done a lot of verification work, analyzing several controversial hot issues regarding Aconite, including the mixed use of Wu Aconite, the distinctions between warming the middle, warming the kidneys, and tonifying the kidneys, dosage issues, etc. Finally, it raises some questions that require further research, making it a guiding light for the clinical application and research of Aconite. (Introduction / Yi Yi)
—This article is approximately7400 words long, expected reading time19 minutes—
Discussion on Aconite
Author / Ye Xianchun
Biography: Ye Xianchun (1928-2009), courtesy name Shuren, from Wuwei, Anhui. He was taught by the famous TCM practitioner Zhang Zancheng and graduated from the Shanghai TCM Continuing Education Class in 1952.
Ye was deeply knowledgeable in TCM research, advocating for a balanced approach to inheriting and promoting TCM, without neglecting either aspect; he believed ancient literature should be treated with a two-part method, inheriting what is useful, discarding what is not, and improving what is insufficient. He authored over 50 influential papers, including “An Exploration of the Shennong Bencao Jing” and “On the Meridians”, which not only explored the development of Chinese medicine but also commented on various Chinese medicinal herbs, formulas, and historical figures, clarifying the correct meanings of several TCM terms.
He edited a series of textbooks on TCM foundational theories, including “Chinese Herbal Medicine”, “Commonly Used Chinese Patent Medicines”, “Ye Xianchun on Formulas”, “Practical Formula Handbook”, “Exploration of the Shennong Bencao Jing”, “Supplement to the Classics of Materia Medica”, and “Common Knowledge Q&A on Chinese Medicine”, among others.
He served as a member of the Shanghai Municipal Committee of the Chinese Democratic League, chairman of the Shanghai TCM College Committee, a member of the Shanghai Xuhui District Committee of the Chinese People’s Political Consultative Conference, and vice-chairman of the Shanghai Branch of the Chinese Pharmaceutical Association’s History Committee.
Aconite is a medicine with broad effects and significant clinical importance; it is essential for practitioners to include it in their prescriptions. It is very pungent and hot, moving quickly without retaining.
“It possesses warming and hot qi, dispersing yin cold” (from the Bencao Chongyuan)
“For all three jiao (the upper, middle, and lower burners), organs, and viscera, if there is true cold, it can treat all” (from the Bencao Zhengyi)
“For all symptoms of deep cold and chronic cold, this will be effective” (from the Bencao Qiuzhen)
Moreover, it also“has the power to expel yin and restore yang, with the ability to bring the dead back to life” (from the Shanghan Yunyao)
Although it is not suitable for all diseases and not required in every formula, it is essential for urgent treatment and can be effective in chronic diseases.Thus, it has been highly valued by practitioners throughout history, and to this day, it shows no signs of decline; current research is exploring its potential for revitalization.
However, regarding the preparation of the medicine, various schools of thought, and even clinical applications, there may be imperfections, areas that require further discussion, or aspects that have not received adequate attention. Therefore, I humbly present my views, limited as they may be, and hope that knowledgeable individuals will not hesitate to provide corrections.
1. Aconite and Wu Aconite should not be mixed
The “Dictionary of Chinese Medicinal Herbs” (compiled by Jiangsu New Medical College, October 1977, Shanghai People’s Publishing House) states:
The medicinal part of Aconite “is the lateral tuber (child root) of the Ranunculaceae plant Aconitum (cultivated variety).”
The “Bencao Gangmu” also states: “Aconite that grows with Wu Aconite is like a child attached to its mother.”
The relationship between Aconite and Wu Aconite is very clear, one being the mother root and the other the child root, and there is little disagreement in traditional and modern discussions.
However, in recent years, there have been instances of mixing in some regions, such as in the “Chinese Herbal Medicine” (Shanghai TCM College trial textbook, April 1971) which states that Aconite is “the tuber of Wu Aconite, soaked in bile water, and then cooked with tofu as a processed product.”
The “Clinical Handbook of Chinese Medicine” (compiled by the Shanghai TCM College Formula Teaching and Research Group, June 1977, Shanghai People’s Publishing House) briefly mentions in the notes: “Currently, in the Shanghai area, Wu Aconite is planted, and during harvest, the old root that was originally planted is not used, but rather the newly propagated tubers are dug up for medicinal use. The Aconite supplied in pharmacies and Wu Aconite are essentially the same, differing only in processing methods, hence they are referred to as two different medicines.”
According to Su Song:
“The original species is Wu Aconite, while the others, large or small, are all Aconite” (from the Gangmu)
Thus, the “Handbook” seems to imply using Aconite as Wu Aconite; while the “Chinese Herbal Medicine” suggests using Wu Aconite as Aconite.This mutual mixing of Aconite and Wu Aconite is indeed contrary to traditional applications and is a significant deviation.
Some argue that since Aconite and Wu Aconite are the same plant and have similar components, there is no need to adhere to traditional distinctions, and reform and simplification are indeed reasonable. However, to this day, insisting on differentiation seems to be a sign of stubbornness and ignorance of the times.Yet, this perspective only sees one side and not the other.
It is believed that:traditional views may have been mistakenly accepted by previous generations, but there are also many that have been validated through repeated practice and contain true knowledge; thus, further exploration and discussion are necessary before making conclusions, and one should not hastily deny what is established; reform and simplification should be based on the actual circumstances of things; if one must reform while still adhering to old rules, it will hinder development; and if one seeks to simplify while forcibly merging, it will certainly violate scientific principles, and a cautious attitude is required.
Different medicinal parts have vastly different properties, and this is not uncommon in Chinese medicine:for example, Sichuan pepper is warming while the peppercorn is cooling, cinnamon twig moves while cassia bark retains, ephedra stem can induce sweating while the nodes can stop sweating, and Polygonum multiflorum root can tonify deficiency while the vine has a calming effect. Not to mention the distinctions between the leaves, fruits, branches, and root bark of mulberry, the different treatments of the flower, leaves, whiskers, and seed pods of lotus, and the differences in the uses of the fruit and root of goji berries.
Moreover, there is further evidence: Angelica sinensis, being the same root plant, has traditional distinctions between head, body, tail, and whole, which is even closer to Aconite and Wu Aconite, thus there seems to be no need for differentiation. It has even been measured to contain 11 different metallic elements, with varying distribution in different parts (as seen in the Shanghai Journal of Traditional Chinese Medicine, 1980, Issue 1). Although the reasons for the differences in usage have not yet been clarified, it is certainly established that there are differences.
The “Gangmu” states: “Wu Aconite is like taro, Aconite is like taro seeds.”
This is only from a morphological perspective, yet both taros are common foods with similar components, but their tastes are different. This suggests that there may be a true principle in the separate use of Aconite and Wu Aconite, and the underlying mechanism still requires further research. Until a definitive conclusion is reached, it seems more appropriate to use Aconite’s medicinal part as the child root.
2. It is not a warming middle product
The properties of a medicine are derived from clinical summaries; the basis of these summaries comes from the effects observed after the medicine is used. Is Aconite an exception? In reviewing the “Chinese Herbal Medicine” (higher medical education textbook, June 1984, Shanghai Science and Technology Publishing House), it states that it can return to the heart, kidney, and spleen meridians, and claims:
“Those with weak yang qi in the kidney, spleen, and heart organs are all suitable for use.”“
This seems to imply that Aconite has warming and tonifying effects on the three organs.Thus, it cannot be without doubt.It is known that Aconite used for yin cold and yang deficiency can dispel cold to assist the recovery of yang qi, and when used for cold dampness and pain, it has the effect of dispelling cold dampness and warming the meridians to relieve pain. This is well documented and used by practitioners without question.However, the warming and tonifying effect on spleen yang seems to be a point of contention.
Research shows that the warming of the spleen by Aconite has been noted by predecessors and is not a new concept.
The “Bielu” first states: “Warming the middle and strengthening yin”;
The “Pearl Bag”:“Warming the spleen and stomach”;
The “Gangmu” also cites Wang’s “Jiu Yuan Fang”:“Warming the spleen and expelling cold.”
Various schools of thought,originating from the “Shanghan” principle of modifying the formula: treating “diarrhea without thirst… should take the Four Reversal group”, as well as the “Jinkui” Aconite and rice soup, etc., until the “Jufang” Aconite principle soup emerged, which further supports this view. These are all classic texts or famous materia medica, with significant influence, and should be respected, hence many follow this view, with few dissenting opinions.
However, the use of Aconite in various formulas is not primarily for warming the middle, but rather for warming the kidneys, as noted in the “Selected Readings of Shanghan Lun” (compiled by the National Higher Medical College, Hubei TCM College, July 1979, Shanghai Science and Technology Publishing House) in the note after article 277:
“The so-called ‘should take the Four Reversal group’ indicates the flexibility of the practitioner, adjusting the dosage according to the condition. If it is merely a case of middle jiao deficiency and cold diarrhea, it can be combined with the principle soup to warm the middle and strengthen the spleen. If cold dampness is more severe, affecting the spleen and kidneys, then the Four Reversal soup or similar should be used to tonify fire and generate earth.”
In the same book, after stating that in the principle soup “if there is abdominal fullness, remove Atractylodes and add one piece of Aconite,” it clearly points out:
“Abdominal fullness is due to yang deficiency and cold stagnation, hence remove Atractylodes which is obstructive and add Aconite to assist yang and disperse cold.”
Furthermore, in the “Jinkui Yaolue Shiyi” (compiled by Hubei TCM College, September 1963, Shanghai Science and Technology Publishing House) under the section “abdominal rumbling and cutting pain, chest and flank fullness, vomiting, Aconite and rice soup is the main treatment,” it notes:
“Abdominal rumbling and cutting pain are caused by yang deficiency and excessive cold… This formula uses Aconite to warm yang, treating the root of the cold.”“
As for the Aconite principle soup, the “Formula Science” (TCM College trial textbook, Guangzhou TCM College, October 1974, Shanghai People’s Publishing House) states: “If there is significant deficiency and cold, and the complexion is pale, hands and feet are not warm… it can (in the principle soup) add cooked Aconite to enhance the warming yang and dispelling cold effect.”
From the above, it can be seen that if it is merely a case of spleen and stomach deficiency and cold, Aconite is not necessary; if it is deficiency and cold affecting the kidneys, then it is appropriate to use Aconite, which is reasonable and accurate.Some say that Chinese medicine has mutual assistance and compatibility, Aconite with ginseng and Atractylodes can warm the middle, and combined with ginger and cinnamon can disperse cold, thus the warming effect on the spleen cannot be denied. Based on this, Aconite is similar to ephedra in its warming effect on the lungs, and when combined with Yin Chen, it can be a medicine for warming the liver and gallbladder, right?
To attribute the effects of the entire formula to the properties of a single herb is not convincing! If one insists on categorizing Aconite as a warming middle product, it will inevitably lead to its mixing with ginger and other herbs. Alas! The difficulty of establishing a theory should not be biased; the properties of medicines must be objective, so that they can be used correctly to cure diseases.
3. Is it a kidney tonifying medicine?
Aconite has a pungent and hot nature that enters the kidneys, which is generally agreed upon; however, its function of tonifying the kidneys and benefiting fire is a point of contention among practitioners:some say it is a key medicine for warming and tonifying kidney yang, while others say it is merely an excellent remedy for dispelling cold pathogens.Since the properties of the medicine are crucial, tonifying and purging cannot be confused; with differing opinions, how should scholars proceed? If there are discrepancies, how can one accurately prescribe? Therefore, exploring the truth, distinguishing right from wrong, and clarifying understanding is of utmost importance.
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Looking through various materia medica, many support Aconite as a kidney tonifying and fire-benefiting herb.
For example, the “Pearl Bag”:“Tonifies the yang of the lower jiao that is deficient”;
The “Yongyao Method”:“Tonifies deficiency and disperses cold”;
The “Bencao Qiuzhen” goes further to say: “It is the first essential medicine for tonifying the true fire of the pre-heavenmingmen.”
Modern scholar Chen Zhongquan states: “According to ancient medical texts, Aconite is generally used to warm the spleen and tonify the kidneys.”
And Xie An states: “It is a wonderful product for reviving yang, tonifying kidney fire, and dispelling wind and cold dampness.” (The views of these two scholars are recorded in the “Dictionary of Chinese Pharmacy”)
Zhang Xichun also states: “It is a medicine for assisting the original yang.”
Based on the above views, the “Chinese Herbal Medicine” (higher medical education textbook, June 1984, Shanghai Science and Technology Publishing House) clearly states that Aconite’s effects include “tonifying fire and assisting yang,” and is used for yang deficiency syndromes. This product is good at tonifying fire and assisting yang.
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However, there are also many who hold opposing views.
For instance, “Zhu Danxi states that it is fierce and does not tonify, but rather kills…” (as seen in the “Bencao Qiuzhen”)
The “Bencao Chongyuan” states: “Aconite possesses a strong and hot nature, thus it is highly toxic. The “Bencao” lists it as a lower-grade medicine, and many toxic substances are found in lower-grade medicines. The “Suwen” states that toxic medicines attack pathogens, and attacking the pathogens is how one tonifies.”
The “Bencao Jingdu” further supplements this by stating: “The “Suwen” states that using toxic medicines to attack pathogens is a miraculous method of revival; later generations established tonifying and nourishing methods, which are ambiguous and clever techniques. Ultimately, attacking the pathogens and restoring the vital energy is the way to tonify.”
Some believe that toxic substances inherently lack tonifying properties, and if it can tonify, it is merely attacking pathogens and restoring the vital energy, which is an indirect effect, not a direct efficacy.
The above two views are held by different scholars. However, contemporary practitioners mostly adhere to the former view, thus whenever Aconite is discussed, it is praised as a top herb for tonifying kidney yang and benefiting the life fire, used for symptoms of kidney yang deficiency.
However, to explore its essence, the function of Aconite in tonifying yang and benefiting fire is merely through its ability to disperse cold; when the true yang is submerged due to excessive yin, dispelling the yin cold allows the original yang to recover… Symptoms of kidney yang deficiency are numerous, such as feeling cold in the body and limbs, shortness of breath and wheezing, weakness in the lower back and knees, impotence and nocturnal emissions, frequent urination, morning diarrhea, and a slow and deep pulse, with many clinical cases showing one or two symptoms more prominently, without needing to list them all.
Aconite is pungent and hot, dispersing cold and warming yang, and should be suitable for those with obvious cold symptoms; if other symptoms are predominant, it can be used in combination, but it is not an essential herb. The “Tangye Bencao” states that “it should not be used if the body is cool and the limbs are cold.” This is what it means.
As for Aconite not being a tonifying product, there are two views from predecessors.
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One is as stated in the “Hundred Kinds Record”:
“It is a toxic medicine… with a hot and rapid nature, entering the blood and qi, fierce and violent, how can it not be harmful to delicate organs? Therefore, it must be used with caution.”
Being toxic and harmful to the vital energy, how can it be said to be tonifying for deficiency?
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The other is as stated in the “Tangye”:
“It floats and sinks without limit, with a pungent and hot taste, being the yang among yangs, thus it moves and does not stop, unlike ginger which can stop and not move.”
Zhu Zhenheng also states: “Aconite moves quickly and does not retain, only taking its fierce and rapid nature to descend.”
It is noted that ginger can both move and retain, which is still uncertain; however, Aconite’s nature of moving without retaining is undoubtedly clear. Comparing this to Zhang Shanlei’s discussion on Salvia miltiorrhiza, “Moving and dispersing products are certainly not tonifying products.” Why should Aconite be any different? Some argue that the Right Return Pill and the Cinnamon Aconite Eight Flavor Pill use Aconite not for its tonifying kidney and benefiting fire properties? Furthermore, the “Jingdu” states that “attacking the pathogens and restoring the vital energy”, how can it also state that “mixed with Poria, Peony, and Glycyrrhiza, or mixed with Rehmannia and Alisma, like a beloved winter day, is a method of tonifying deficiency?” Is this not contradictory?
Thus, it is known that this is likely the effect of mutual compatibility, and certainly not the effect of Aconite alone. Zhu Danxi has long stated: “Zhongjing’s Eight Flavor Pill uses Aconite as a guide for the Shaoyin, its tonifying effect is primarily from Rehmannia, and later generations mistakenly regard Aconite as a tonifying medicine, which is erroneous.”
The “Bencao Xuan Zhi” also states: “However, Aconite must be combined with tonifying medicines to cultivate the original yang, warm the meridians, and disperse cold; it does not mean that Aconite itself is a tonifying medicine.”
If one uses examples of compatibility to prove Aconite’s efficacy, then as Yu Bo stated: “It can… guide tonifying blood medicines into the blood to nourish the insufficient true yin; it can also guide dispersing medicines to open the pores to dispel exterior wind and cold.”
Can it then be directly stated that it has the effect of tonifying blood and nourishing yin, as well as dispersing and relieving the exterior? I believe there are no such people in the world, especially among wise and discerning individuals.
From the above, it can be seen that Aconite is not a tonifying kidney yang medicine; its use for kidney yang deficiency is to dispel the lower jiao’s yin cold, assisting in the recovery of the original yang. Therefore, it is appropriate to state that Aconite functions to warm the kidneys and disperse cold, or to warm the kidneys and assist yang (through warming the kidneys and dispersing cold, assisting the recovery of kidney yang), but to call it a tonifying kidney and benefiting fire medicine is not accurate.
4. Dosage must be appropriate
Accurate diagnosis, careful selection of medicines, yet there are still cases where effects are not seen, and adverse outcomes occur, which are often related to inappropriate dosages.In severe cases, if the dosage is light, even if the disease is present, it is difficult to cure; if the dosage is heavy for a light disease, it may remove the disease but harm the vital energy.Thus, practitioners must pay attention to the dosage of medicines; Aconite is a fierce and toxic product, and clinical use must be cautious, and should not be taken lightly.
According to the “Shanghan” and “Jinkui”, there are a total of thirty-six formulas that use Aconite, excluding six overlapping formulas (Four Reversal Soup, Tongmai Four Reversal Soup, Cinnamon Aconite Soup, Remove Cinnamon Add Atractylodes Soup, Licorice Cinnamon Soup, Ephedra Aconite Licorice Soup), five formulas that are used in pills and powders (Kidney Qi Pill, Coix Aconite Powder, Wu Aconite and Red Stone Fat Pill, Coix Aconite and Baijiao Powder, Wu Mei Pill), and one formula for external use (Toufeng Mo Powder); the remaining twenty-four formulas are taken as decoctions:
Eight formulas of the Four Reversal Soup type (Four Reversal Soup, Four Reversal Soup with Ginseng, Tongmai Four Reversal Soup, Tongmai Four Reversal Soup with Pig Gallbladder, White Tong Soup, White Tong Soup with Pig Gallbladder, Poria Four Reversal Soup, Dried Ginger Aconite Soup) all use one piece.
The remaining sixteen formulas are all processed, with nine formulas using one piece (Cinnamon Aconite Soup, Aconite Soup, Peony Licorice Aconite Soup, Aconite Xiexin Soup, Zhenwu Soup, Ephedra Aconite and Xixin Soup, Ephedra Aconite Licorice Soup, Aconite and Rice Soup, Bamboo Leaf Soup).
Three formulas use two pieces (Licorice Aconite Soup, Aconite Soup, Peony Aconite and Zhi Mu Soup).
Four formulas use three pieces (Cinnamon Aconite Soup, Remove Cinnamon Add Atractylodes Soup, Dahuang Aconite Soup, Huangtu Soup).
According to the Song Dynasty “Jufang”, the use of “one piece, weighing six qian” and Ming Dynasty Miao Xiyong’s “Paozhi Dafa” states “one piece weighing one liang, is the standard for use.”Referring to the “Dictionary of Chinese Medicinal Herbs” ancient and modern measurement comparison table, since the Tang and Song Dynasties, 1 liang equals 1.19 liang (37.3 grams) in the current system (16 liang system), it can be seen that the amount of Aconite used in the Han Dynasty was small, ranging from 22 to 37 grams, and large amounts could exceed 78 to 100 grams, which cannot be considered small.
Subsequently, although the formulas recorded still use pieces, they have gradually changed to weight measurements.For example, in the Jin Dynasty “Xiaopin Fang”, the Yaozi Soup (1 liang), the Four Shun Soup (2 liang), in the “Zhouhou Fang” for treating various wind and acute joint pain (1 liang), and the bone joint pain formula (2 liang), in the Tang Dynasty “Qianjin Fang” for Angelica Soup (1 liang), warming the spleen soup (2 liang), and treating wind body pain (3 liang), in the Song Dynasty “Jufang” for San Sheng Yin (half a liang), in the “Jisheng Fang” for treating cold hernia (1 liang), and in the “Shengji Zonglu” for treating chronic diarrhea (half a liang), etc.
It can be seen that the dosage in the Jin and Tang Dynasties was still large, and by the Song Dynasty, it was often used in powdered form, with reduced dosages.
Since the Ming and Qing Dynasties, practitioners have set their own formulas, and the dosage of Aconite has generally been two qian, no longer measured by pieces, and even the original formulas recorded in the “Shanghan” and “Jinkui” have been changed to weight measurements, such as the “Bihua Yijing” Four Reversal Soup and White Tong Soup with Pig Gallbladder both using 5 qian, etc.
At this time, the dosage of Aconite, such as in the “Jingyue Quanshu” Right Return Drink, is one, two, or three qian, and in the Zhenyin Decoction, it is used in five, seven, or one, two, or three qian, and in the “Bihua Yijing” Aconite Principle Soup, it is used in five qian, and in the Yin Chen Ginger Decoction, it is used in five fen, etc., which is basically the same as current clinical applications.
The evolution of Aconite’s dosage is indeed a result of its toxicity and the long-term practical experience of practitioners. Aconite used raw is particularly toxic, hence it is rarely used in decoctions today; even processed products have reduced toxicity, but it has not been completely eliminated, so it is still not advisable to use it in large quantities.
Currently, the general clinical dosage is 3 to 9 grams, as stated in the “Dictionary of Chinese Medicinal Herbs” and “Chinese Herbal Medicine” (higher medical education textbook), which both state “one to three qian.” However, the “Pharmacopoeia” (1977 edition) considers that “3 to 15 grams” can be used, thus for symptoms of deep cold and chronic cold, using up to 15 grams is also acceptable; even for yang collapse, administering 30 grams is also appropriate.
However, it is necessary to observe carefully during use, just as the “Medical Comprehensive Notes” states in the “Three Yin Treatment Principles”:
“Do not overuse cinnamon and Aconite to prevent toxicity.”
Recently, medical journals have reported that some experienced TCM practitioners treating bi syndrome have used 2 to 4 liang (60 to 125 grams), resulting in cases of poisoning and even fatalities, which should serve as a cautionary tale.
Some suggest that prolonged boiling for 2 to 4 hours may prevent toxicity, which is also a method.However, research on the pharmacology of Chinese medicine indicates that Aconite contains aconitine, which has analgesic effects, and prolonged boiling decomposes aconitine, reducing its toxicity.
Based on this, using a large amount to seek quick effects may lead to prolonged boiling, which destroys its analgesic properties; thus, how can one achieve the goal of pain relief while avoiding toxicity? Therefore, the method of using a large amount and prolonged boiling is not advisable and should not be promoted.
Conversely, there are those who fear the severe toxicity of Aconite and dare not use it, even if they do, they only use 1 to 3 grams (3 fen to 1 qian) at most, as seen in the “Selected Compilation of Experiences from Shanghai Old TCM Practitioners” which records using 2.4 grams for treating yang deficiency and cold symptoms, praised for its lightness and effectiveness, having the ability of “four ounces to move a thousand pounds,” yet its efficacy can be imagined.
In summary, the dosage of medicines, whether excessive or insufficient, is not correct; it should be adjusted according to the severity of the disease. Otherwise, adhering to a fixed dosage to address the myriad changes in disease conditions, how many can be fortunate enough to hit the mark? In ancient times, it was said: as a physician, one must act with the desire for precision and wisdom, be bold yet meticulous; the use of Aconite is such, and the same applies to other medicines.
5. Further in-depth research is needed
Aconite is a commonly used medicine in clinical practice, thus widely used and researched, with numerous writings and reports emerging continuously.However, its functions still require clarification to ensure understanding and mastery; aside from my superficial observations mentioned earlier, the following several truths seem to require further in-depth research to enhance academic clarity.
1. On the issue of raw and cooked differentiation
Modern scholar Chen Zhongquan states: “The same medicine, whether raw or cooked, has different strengths and main treatments; Aconite is one such example.”(“Dictionary of Chinese Pharmacy”) In examining the differentiation of raw and cooked Aconite, it was first noted in Zhang Zhongjing’s writings, and Chen’s summary of various formulas from the “Shanghan” states:
“Using cooked Aconite to tonify kidney yang is one aspect; its main use is ultimately in warming and tonifying; using raw Aconite to restore yang and rescue from reversal is another aspect; its main use is ultimately in rescue from reversal.”
(Same source) This is supported by the “Gangmu” which states: “Raw use disperses, cooked use tonifies severely.”
Although the wording differs, the meaning is similar; Zhang Shanlei describes it more specifically:
“When the group of yin is active, the true yang is submerged, the earth adds to the sky, and in sudden violent cases, the limbs are cold and the skin is clear, the pulse is weak and about to disappear, or there is vomiting and diarrhea, clear and odorless, only raw Aconite can be effective; while other cold symptoms can be treated more gently with cooked Aconite.”
It is evident that ancient scholars placed great importance on the differentiation of raw and cooked Aconite.Medicines undergo changes after processing, and their properties vary; this is not unique to Aconite.
However, traditional views and modern pharmacological research results differ; for example, the “Chinese Herbal Medicine” (trial textbook, 1978) states that the effective component of Aconite for strengthening the heart is the heat-resistant non-alkaloid part, and after processing, aconitine is decomposed, reducing toxicity, but the cardiotonic effect does not diminish.
From this perspective, while raw use can indeed restore yang and rescue from reversal, cooked use should not necessarily weaken its effects; Chen Zhongquan’s statement that “misuse leads to no benefit and harm” may be a misstatement; or perhaps there is some truth in it?
2. On the issue of toxicity during use
The “Bencao Gangmu” states: “Wu Aconite is a toxic medicine; some people may feel restless after taking a small amount, while in ancient times, it was commonly used as a tonic; could it be that the climate has changed?”
It is evident that improper use of Aconite can lead to toxicity, which ancient scholars were already aware of; however, the cause of restlessness during use, as noted by Li Shizhen, seems to be attributed to “climate differences,” which is not a valid argument. If it were due to climate, then in some years, there would be no cases of toxicity, while in other years, there would be many cases of toxicity; the mention of “some people” indicates that it is not the case.
The “Dictionary of Chinese Medicinal Herbs” states: “Aconite is extremely toxic, and due to differences in species, collection time, processing, and boiling time, the toxicity can vary greatly.” In fact, Aconite is similar: “The toxicity of Aconite pieces can vary by up to eight times depending on the region.”(same book) Thus, whether or not toxicity occurs during use also depends on factors such as method, dosage, and individual constitution.
Li’s statement about “only a small amount” likely refers to powdered forms taken in pills or powders, which are indeed more toxic than decoctions; the “Dictionary of Chinese Medicinal Herbs” states: “The toxic dosage of Aconite is 0.5 to 2 liang (15 to 60 grams),” which refers to decoctions, while the dosage for pills has not been reported. Given that many people take Aconite in pill or powder form, this should also be clarified, though it remains uncertain.
3. On the issue of hot medicine and cold administration
Li Shizhen states: “For all medicines using Wu Aconite, they should be taken cold; using hot will lead to cold symptoms. The reason is that yin cold is below, and the floating yang is above; treating it with cold will only exacerbate the yin, while treating it with heat will cause it to reject and not accept. Using hot medicine cold will allow the heat to be released after swallowing, and the cold body will dissipate, and the hot nature will emerge, thus the disease will improve, which is a wonderful method of treatment.”
However, Miao Xiyong states: “Dispersing cold medicines should be taken hot.”
This is a common principle of taking medicine; in cases of true cold and false heat, treating with hot medicine cold is a variation of the method.
Although this method is currently extremely rare in clinical practice, it is necessary to state that in special circumstances, it can be used; however, it should not be stated that it is absolutely impossible. Li’s statement is reasonable, and retaining this method is necessary, but clinical reports have not yet been seen, and further practice is needed to verify it.
4. On the issue of combining with dried ginger
The “Zhengzhi Yaojue” states: “Aconite cannot be heated without dried ginger.”
It is noted that Aconite is widely used in clinical practice, and it is not necessary to combine it with dried ginger; Dai’s emphasis on dried ginger likely stems from the Four Reversal formulas used to treat symptoms of excessive yin and yang collapse.
However, recent research results indicate:
“Dried ginger, licorice, and cooked Aconite pieces boiled together can greatly reduce the toxicity of the latter.”(“Dictionary of Chinese Medicinal Herbs”)
Initially, there was no explanation for the synergistic effects of these three medicines boiled together; however, this is a report on the three medicines boiled together, and it is regrettable that further research has not been conducted to determine whether the combination with dried ginger reduces toxicity or enhances the efficacy of Aconite.
The examples mentioned above are just a few that require further research; there are certainly many more topics that need to be explored. I believe that with the continuous advancement of scientific research and the revitalization of TCM, the study of Aconite will gradually deepen, leading to new discoveries and ongoing progress.
—Copyright Statement—• Article excerpt from “Ye Xianchun on Formulas” (2003) | Editor / Ye Xianchun; co-editor Ye Mingzhu | Author / Ye Xianchun • Edited by Wang Qinyi | Recommended by Xiao Jia | Reviewed by Ju Ye | Typeset by Shisan | Proofread by Jia Guo Jia | Second proofread by Tao Heqi.• This article is copyrighted by the rights holder. It is for learning and exchange purposes only; please do not use it casually.