TCM Book Club Issue 966
One issue daily, accompanying the growth of TCM practitioners
Author/He Shaoqi
Abstract: For kidney deficiency, using Gan Jiang Ling Zhu Tang (Ginger, Poria, and Atractylodes Decoction) with Fuzi (Aconite) is more effective; for periarthritis of the shoulder, I often use Huangqi (Astragalus), Danggui (Angelica), Baizhu (Atractylodes), Yinyanghuo (Epimedium), Weilingxian (Clematis), Xiqian Cao (Herba Siegesbeckiae), Guizhi (Cinnamon Twig), Jianghuang (Turmeric), and Haitongpi (Cortex Erythrinae), but Fuzi must be used heavily, otherwise it will not be effective; for those with deficiency easily susceptible to illness, use Yupingfeng San (Jade Windscreen Powder) with Fuzi, ginger, and dates; for acute nephritis onset, with chills, no sweating, and edema, use Mahuang Fuzi Xixin Tang (Ephedra, Aconite, and Asarum Decoction); for chronic nephritis with edema, use Zhenwu Tang (True Warrior Decoction) and Shizhi Yin (Solid Spleen Decoction), both with Fuzi as the main herb; for persistent diarrhea, early morning diarrhea, and elderly incontinence, use Lizhong Tang (Regulate the Middle Decoction) combined with Sishen Tang (Four Gods Decoction) plus Rougui (Cinnamon) and Fuzi to warm and tonify the Mingmen fire; for oral ulcers that do not respond to cooling herbs, it is often due to excess yin and floating yang, can use Jiang Fuji (Ginger Aconite Preparation) to break yin and return yang, ensuring that the yin haze dissipates and the fire stabilizes; for chronic pharyngitis, use a piece of Fuzi honey-fried, cut into small pieces to dissolve in the throat; for dysmenorrhea with cold symptoms, Fuzi combined with Danggui is effective.
Fuzi is the remedy for numerous ailments
(1) People in Sichuan use Fuzi as a vegetable
When I was a child attending school, I walked over 30 miles home on weekends. During the summer, I saw an unknown “crop” by the roadside, growing very well, with leaves like mugwort, serrated, thick, dark green, and shiny. Upon inquiry, I learned it was the medicinal herb Fuzi. Later, when it was time to harvest Fuzi, economically struggling neighbors would bring bags of Fuzi home, wash, peel, and slice it to earn a little processing fee. However, they had to work quickly because fresh Fuzi spoils easily, and only soaking it in brine prevents it from rotting. During those days, all the cars in the county rushed to the salt city of Zigong to haul brine.
After becoming a doctor, I visited a Fuzi processing factory near Dazhong Temple and witnessed the entire processing of Fuzi. Jiangyou is known as the hometown of Fuzi, and there are still shops selling Fuzi on the streets, with 1 kg packages, colored like rock candy, considered top quality, used as gifts for friends and family. When I was young, I was weak and wet the bed; every winter solstice, almost every household would stew dog meat with Fuzi, and my father would take me to his friend’s house to drink dog meat Fuzi soup. In my memory, Fuzi tasted similar to potatoes, chewy after long cooking, about 4-5 slices per bowl, roughly 1 tael. Once, when I visited Mr. Jiang Chunhua in Shanghai, he asked me: “Is it true that you Sichuan people eat Fuzi as a vegetable?” I said I had eaten it, and Mr. Jiang was astonished.
(2) Sichuan doctors are adept at using Fuzi
No one uses Fuzi better than Sichuan doctors. Han Feixia from Luzhou in the Ming Dynasty said in “Yitong”: “Fuzi returns yang, its power is remarkable,” but he was not known for his adept use of Fuzi. During the Tongzhi period of the Qing Dynasty, Zheng Qinan from Qionglai established the “Fire God School” in Chengdu, and in his treatment, he always took yin and yang as the guiding principle. For yin conditions, regardless of hemoptysis, hematochezia, hematuria, insomnia, toothache, halitosis, constipation, he would use Fuzi and Ganjiang (Dried Ginger), achieving remarkable results. During the Guangxu period, there was also Luo Dingchang, who treated febrile diseases with fever and delirium, with a tongue covered in prickles, restlessness, and no pulse, using Chengqi Decoction with Fuzi. He said it was not about using Fuzi to treat diseases, but borrowing its heat to reach the Shaoyin.
Many scholars have inherited this school over the past century: Wu Peiheng went south to Kunming, and Yunnan became known for “Wu Fuzi”; he was particularly adept at using Fuzi to treat measles with reverse symptoms and became famous for a time. Zhu Weijun went east to Shanghai, and at that time, almost everyone in Shanghai knew “Zhu Fuzi”; he treated febrile diseases, even with high fever and delirium, dry lips and tongue, still used Fuzi, saying that febrile diseases do not die from fever but from heart failure. Mr. Zhang Ciguang was very impressed by this, saying he treated diseases “with a ruthless hand”.
Famous doctor Xu Xiaopu’s two sons both died from febrile diseases; his younger son was also ill with fever and nearly did not survive. Zhu used Fuzi to revive him. Today, Xu’s pediatric clinic in Shanghai still excels in using Fuzi, as taught by Mr. Zhu in the past. Zhu Weijun praised Fuzi as “the remedy for numerous ailments,” often using 3-4 taels per dose. Liu Minshu from Huayang practiced medicine in Shanghai; a high monk, Huizong, suffered from gastric cancer, with continuous vomiting of blood. Liu prevented Western doctors from giving blood transfusions, using large doses of Ganjiang and Fuzi with licorice, Zhaoxin yellow earth, Huahuashizhi, Yunnan Baiyao, and Ejiao, and after three doses, the bleeding stopped completely. Recently, esteemed doctors like Gong Zhixian from Chongqing and Dai Yunbo from Chengdu have treated wind-cold-damp bi syndrome, using over 60g of Fuzi, among which Dai’s proposed Wufumaxin Jianggui Caotang is a famous formula for treating bi syndrome. One year, a Sichuan doctor brought a computer software for bi syndrome to Beijing for free consultations, prescribing 30g of Fuzi and 30g of Chuanwu (Chuan Aconite). No one dared to take it, and many in the TCM community criticized him, and soon the clinic was deserted, returning in defeat.
(3) Fuzi warms yang, returns yang to rescue from reversal
Fuzi is very pungent and hot, circulating through the twelve meridians, its nature is strong and masculine, warming the yang of the five organs.
Heart failure is often seen in pulmonary heart disease, rheumatic heart disease, coronary heart disease, etc., generally based on heart yang deficiency, with blood stasis and water retention as the manifestations, presenting with palpitations, cold limbs, shortness of breath, fatigue, pale complexion, cyanosis, chest tightness, abdominal distension, lower limb edema, and in severe cases, even chest and abdominal water, generalized edema, and difficult urination, with a pulse that is deep and thin or intermittent, and a pale tongue with a white coating. Commonly used formulas include Shenfu Decoction, Zhenwu Decoction, Gui Zhi Fu Ling Wan, and Fangji Huangqi Tang, which yield rapid results.
I once consulted on a patient with rheumatic heart disease and congestive heart failure at a military hospital; one dose was effective, and after the second dose, he could get out of bed. Han Feixia said that ginseng returns vitality to the realm of nothingness, which is the royal way; black Fuzi returns yang, its power is remarkable, and when used for heart failure, they complement each other. For severe heart failure, Ganjiang must be used, or both Ganjiang and Shengjiang (Fresh Ginger) together; Fuzi cannot warm without ginger. Fuzi combined with Ganjiang and licorice is the same as Zhang Zhongjing’s Si Ni Tang (Frigid Extremities Decoction), used for heart failure with continuous vomiting and diarrhea, having the power to return yang and revive the dead; when yang is deficient and yin is exhausted, combine with Shengmai Yin to nourish both yin and yang. Mr. Zhang Ciguang often used the Quanzhen Yiqi Decoction from “Feng’s Golden Bag” for heart failure, which includes ginseng, Fuzi, Mai Dong (Ophiopogon), Wu Wei Zi (Schisandra), Shudi (Rehmannia), Baizhu, and Huai Niu Xi (Achyranthes).
Fuzi warms kidney yang; Li Shizhen said Fuzi is “the medicine to tonify the yang of the lower jiao and the Mingmen deficiency”; “Bencao Zhengyi” states Fuzi “reaches the lower source and warms the cold”. For kidney yang deficiency, symptoms include cold limbs, frequent urination, thirst, poor appetite, diarrhea, cold abdominal pain, low back pain, impotence, and dysmenorrhea, all of which can use Fuzi. When the Mingmen fire is weak, and the fire does not warm the earth, Ruan Gui Wan (Right Return Pill) is often used; for both spleen and kidney deficiency, Fuzi can be combined with fried yam, ginseng, and Baizhu; for cold dysmenorrhea, Xiao Wenjing Tang (Minor Warming the Meridians Decoction) is often used (Fuzi, Danggui); for late-stage diabetes with yin damage and yang deficiency, when extreme thirst and cooling do not produce fluids, Fuzi and Rougui can be used. In the Tang Dynasty, Wang Tao’s “Secret Essentials of the Outer Chamber” used the dry cover of a pot as a metaphor: “For example, if there is water in the pot, warming it with fire, if the lid is covered with a board, the warm air rises, so the board can moisten; if there is no fire, the water vapor does not rise, and this board cannot moisten.” As for kidney yang deficiency, which cannot transform qi and circulate water, Zhenwu Tang is essential for efficacy.
“Zhenzhu Nang” states Fuzi “warms the spleen and stomach”; when spleen yang is injured and diarrhea does not stop, with cold abdominal pain, and cold hands and feet, with a deep and slow pulse, use Lizhong Tang with Fuzi, which is Fuzi Lizhong Tang. I often encountered children who came for help due to severe vomiting and diarrhea leading to yang collapse; I urgently used large doses of Fuzi with ginseng, Ganjiang, licorice, dragon bone, and oyster to return yang and stabilize the collapse, often able to save them. There was an elderly man with the surname Zuo, who had cold evil directly attacking the three yin, with continuous vomiting and diarrhea, confusion, and restlessness, waving his hands and feet, and some suspected it was a yang condition and suggested using clearing methods. I prevented this, as the six pulses were extremely deep and weak; I used prepared Fuzi 24g, red ginseng 10g, Ganjiang 15g, honey-fried licorice 6g, Baizhu 10g, dragon bone, and oyster each 30g, and one dose stopped the diarrhea completely, allowing him to sleep soundly. The next day, I adjusted the formula for stability. “Shanghan Yun Yao” states Fuzi has “the power to open yin and return yang, the ability to revive the dead,” and I believe this.
Fuzi also warms lung yang and liver yang. Lung yang deficiency leads to cough, wheezing, and expectoration of clear, thin phlegm, with a cold back and cold body; liver yang deficiency leads to fatigue, headache, and pain in the sides and lower abdomen with coldness. The former can use Fuzi combined with Ganjiang and fried licorice, while the latter can use Fuzi combined with Rougui and Huangqi (Astragalus).
(4) Fuzi opens blockages and can treat bi syndrome
Fuzi is used in many ancient formulas for bi syndrome; Zhang Zhongjing’s Guizhi Fuzi Tang treats wind-dampness with pain all over the body, unable to turn or lie down; Guizhi Shaoyao Zhi Mu Tang treats painful joints with swollen feet. “Tangye Bencao” states “Fuzi reaches everywhere, its taste is pungent and hot, being the yang among yang, thus it moves and does not stop.” The pathogenesis of bi syndrome is “closure”; Fuzi moves and does not stay, warming the meridians, dispersing cold, and removing dampness, making it an indispensable medicine for bi syndrome. For severe pain, Fuzi combined with Chuanwu, Caowu, and Xixin can enhance the effect of dispersing cold and relieving pain; Fuzi combined with Guizhi enhances the warming and opening of the meridians. Not only can Fuzi be used for wind-cold-damp bi syndrome, but even for wind-heat-damp bi syndrome with a red tongue and rapid pulse, it can be used in small doses of Fuzi to open blockages and resolve knots based on the principles of dispelling wind, clearing heat, and drying dampness. I treat rheumatoid arthritis, rheumatic arthritis, periarthritis of the shoulder, sciatica, lumbar disc herniation, ankylosing spondylitis, etc., always using large doses of Fuzi and Chuanwu together. The “Qianjin Fang” Du Huo Ji Sheng Tang is also a famous formula for treating bi syndrome, used for shoulder, waist, knee, and leg pain due to prolonged wind-cold-damp retention. Chen Wuzhe’s “San Yin Fang” states: if Fuzi is added, the efficacy is better.
(5) From Zhang Zhongjing to my experience with Fuzi
Some say: Sichuan people like to use Fuzi because the basin is rainy and humid, due to the terrain. This does not understand Fuzi, nor does it understand the Sichuan people’s words; Zhang Zhongjing is the first person to use, advocate, and frequently use Fuzi. Zhang Zhongjing used Fuzi with Ganjiang and licorice (Si Ni Tang) as the first formula for returning yang and rescuing from reversal; with Fuling, Baizhu, Bai Shao, and Shengjiang (Fresh Ginger) (Zhenwu Tang) to treat edema; with Ren Shen, Baizhu, Fuling, and Bai Shao (Fuzi Tang) to warm and tonify the yuan yang; with Mahuang and Xixin (Mahuang Fuzi Xixin Tang) to warm the meridians and release the exterior; with Baizhu, etc. (Guizhi Fuzi Qu Gui Jia Baizhu Tang) to treat wind-damp joint pain (Baizhu and Fuzi are used as the holy medicine for removing dampness); with Banxia, Jingmi, Dazao, and Shengjiang (Fuzi Jingmi Tang) to warm the spleen and stop diarrhea; with Dahuang and Xixin (Dahuang Fuzi Tang) to warm and eliminate cold accumulation; with Dahuang, Huangqin, and Huanglian (Fuzi Xie Xin Tang) to support yang and eliminate fullness; with Shengdi, Ejiao, Huangtu, Baizhu, and licorice (Huangtu Tang) to warm the spleen and stop bleeding; with Yiyiren and Baijian Cao (Yiyiren Fuzi Baijian San) to treat intestinal abscess; with Wumei, Huanglian, Huangbai, and Chuanjiao (Wumei Wan) to treat roundworm and chronic diarrhea; with Dihuang, Shanzhuyu, Shanyao, Danpi, Fuling, Zexie, and Guizhi (Shenqi Wan) to tonify the kidneys… It can be said that he has maximized the use of Fuzi, and Zhang Zhongjing is not a Sichuan person.
After Zhang Zhongjing, the clinical application of Fuzi has become even more extensive. For example, “Gujin Luyian” uses Fuzi with Mahuang, Guizhi, Danshen, Ren Shen, Fangfeng, Xingren, Fuling, Huangqin, Shengdi, and licorice (Xiaoxu Ming Tang) to treat unbearable wind-cold joint pain, and back pain that cannot turn or lie down, quiet during the day and severe at night. “Qianjin Fang” uses Fuzi with Xixin, Fangfeng, Ganjiang, Shanzhuyu, and Fuling (Sanwu San) to treat severe cold in the wind palace, with urgent headache and tight neck muscles. “Jinxiaofang” uses Fuzi with Baizhu, licorice, Dazao, and Shengjiang (Zhu Fuzi Tang) to treat wind deficiency with heavy dizziness. “Zhouhou Fang” uses Fuzi with Tianxiong and Chuanwu (San Jian Tang) to treat original yang deficiency, with cold evil entering from the outside, leading to a deep pulse. “Taiping Shenghui Fang” uses Fuzi with Duhuo, Niuxi, Guixin, Chuanxiong, Chisha, Danggui, and Taoren (Duhuo San) to treat cold stagnation and wind attacking, causing limb pain. “San Yin Fang” uses Fuzi with Ganjiang, licorice, Ren Shen, Shaoyao, Fuling, Guixin, and Baizhu (Fuzi Bawu Tang) to treat painful joints in the four limbs, as if being hammered and cannot be tolerated. “Jufang” uses Fuzi with Caowu, Quanxie, Tianma, Cangzhu, and Walnut meat (Shan Shen San) to treat kidney qi deficiency, with pain in the waist and joints, and inability to bend the knees; combined with Lu Rong, Rou Congrong, Ren Shen, Shudi, Rougui, Shihu, Wuweizi, Huangqi, Fuling, Bai Shao, Baizhu, Banxia, and licorice (Lu Rong Da Bu Tang) to treat various deficiencies in pregnant women; combined with Ren Shen, Ganjiang, licorice, Rougui, Wuzhuyu, Maiya, Shenchu, Zhi Shi, Jiegeng, and Xixin (Da Wenpi Wan) to treat spleen and stomach deficiency and cold, with undigested food and excessive damage. “Chishui Xuanzhu” uses raw Fuzi, raw Banxia, and raw ginger (San Sheng Yin) to treat phlegm dizziness. “Zhang’s Medical Communication” uses Fuzi with Ginkgo, Juhong, Shengjiang, and licorice (Lengxiang Yinzi) to treat abdominal pain and vomiting in the summer. “Yixue Xinwu” uses Fuzi with Ganjiang, Baizhu, licorice, and Yincheng (Yincheng Zhu Fuzi Tang) to treat yin jaundice. The above famous formulas are just a few examples, and there are countless more from the Tang and Song Dynasties to the Ming and Qing Dynasties, from official texts to personal writings, all showing the extensive use of Fuzi! Recently, Zhu Weijun has also used Fuzi with Zao Ren to treat tachycardia and premature contractions (early beats); combined with Zhimu to treat febrile diseases with thirst and desire to drink but weak heart yang; combined with magnetic stone to treat insomnia due to neurasthenia. Mr. Jiang Chunhua believes that many chronic difficult diseases, especially many chronic inflammations, do not respond to conventional methods of clearing heat and detoxifying, because the reason lies in the long-term illness leading to body deficiency and damp-heat fire toxins not resolving. He was inspired by Zhang Zhongjing’s Wumei Wan and Yiyiren Fuzi Baijian San, breaking conventions, using warming and clearing together, tonifying and purging simultaneously, treating the body and disease together, such as treating Behçet’s disease with Fuzi combined with Dangshen, Huangqi, licorice, Yinyanghuo, Huanglian, Huangqin, Danpi, Dandelion, and Ban Zhilan, achieving efficacy.
I also have some experience using Fuzi. In addition to what has been mentioned, for kidney deficiency, using Gan Jiang Ling Zhu Tang with Fuzi is more effective; for periarthritis of the shoulder, I often use Huangqi, Danggui, Baizhu, Yinyanghuo, Weilingxian, Xiqian Cao, Guizhi, Jianghuang, and Haitongpi, but Fuzi must be heavily used, otherwise it will not be effective; for those with deficiency easily susceptible to illness, use Yupingfeng San with Fuzi, ginger, and dates; for acute nephritis onset, with chills, no sweating, and edema, use Mahuang Fuzi Xixin Tang; for chronic nephritis with edema, use Zhenwu Tang and Shizhi Yin, both with Fuzi as the main herb; for persistent diarrhea, early morning diarrhea, and elderly incontinence, use Lizhong Tang combined with Sishen Tang plus Rougui and Fuzi to warm and tonify the Mingmen fire; for oral ulcers that do not respond to cooling herbs, it is often due to excess yin and floating yang, can use Jiang Fuji to break yin and return yang, ensuring that the yin haze dissipates and the fire stabilizes; for chronic pharyngitis, use a piece of Fuzi honey-fried, cut into small pieces to dissolve in the throat; for dysmenorrhea with cold symptoms, Fuzi combined with Danggui is effective.
In summary, based on ancient and modern experiences with Fuzi and my own rudimentary understanding, Fuzi can be used for both ascending and descending, can attack and tonify, can be cold or hot, can move or stop, can be internal or external, and varies infinitely with its combinations. When used appropriately, its therapeutic effects are remarkable, and it holds an irreplaceable role among herbs, so saying it is “the king of all medicines” is not an exaggeration.
(6) Dosage, preparation methods, and the issue of Banxia
The dosage of Fuzi has always been a topic of great debate. Zhang Zhongjing’s formula uses one piece of Fuzi, processed, broken into eight pieces, thus each dose is about 60g. The quality of Fuzi, one large piece is 6-8g, referred to as “processed”, which is raw Fuzi, and its potency is greater. Therefore, when using Fuzi, there is no need to be overly cautious; initially use 10-15g, and if there are no issues, it can be increased to over 30g.
For treating bi syndrome, with yang deficiency and cold sensitivity, the dosage is generally over 30g. I have often faced refusals from pharmacies to dispense it, and I have to sign carefully, but there are times when they still refuse even after signing. I once treated a patient named Zhang with rheumatoid arthritis, using 30g of Fuzi per dose; the pharmacy refused to dispense it, and the doctor was also reluctant to write the prescription. Fortunately, he had a relative in Haidian Pharmacy, which allowed him to obtain it, and after taking over a hundred doses, he recovered, using over ten kilograms of Fuzi in total. I also treated a patient named Sun with cold-damp bi syndrome, using 30g of Fuzi, which did not respond, and increased it to 60g. To save time, he cooked two doses together, resulting in an actual dosage of 120g. I am not saying that larger doses are always better, but for severe conditions, using only a few grams is like scratching the surface and cannot solve the problem.
Fuzi must be decocted first; for small doses (around 9g), decoct for half an hour; for medium doses (around 15g), decoct for 1 hour; for large doses (over 30g), decoct for 2 hours. The first decoction is done this way, and the second decoction can be simmered for 40 minutes. When decocting Fuzi, adding a piece of ginger (about 30g, smashed) and 1 tael of honey is better, as it can reduce the toxicity of Fuzi.
Using Fuzi will not lead to accumulation or poisoning. There is a patient with ankylosing spondylitis in Shenyang who has taken over 400 doses, each with a heavy use of Fuzi up to 30g, totaling dozens of kilograms of Fuzi, and since the first diagnosis, he has continued to work and has basically recovered.
In ancient times, there were sayings about Wu Tou (Aconite) being incompatible with Banxia, Gua Lou, Bei Mu, Bai Ji, and Bai Lian, which are a group of “eighteen incompatibilities”, but there is no mention of Banxia or Gua Lou being incompatible with Fuzi. Chuanwu is the mother of Fuzi, but these are two different herbs; if one says Banxia and Gua Lou are incompatible with Fuzi, it would be a “guilt by association”. Moreover, the combination of Wu Tou and Banxia has already been pioneered by the medical sage Zhang Zhongjing.
There are many opportunities for using Banxia and Fuzi together. If you ask me to prove it, I can cite over 100 medical cases and prescriptions from ancient and modern times as evidence. Once, I prescribed a formula with both Banxia and Fuzi, and a pharmacy worker looked at the prescription and scoffed, saying, “Which quack doctor wrote this?” They didn’t even understand basic knowledge. I was not angry, just smiled bitterly. Contemporary famous doctors like Jiang Chunhua, Zhu Liangchun, and Yan Dexin have all seriously written articles refuting the idea that Banxia is incompatible with Fuzi; readers interested can look for them.
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