The Chinese have known about Fuzi (Aconite) for a long time; as early as over 2000 years ago, Shang Han Lun (Treatise on Cold Damage) introduced Si Ni Tang (Four Reversal Decoction), which is the most famous warming interior formula, primarily used for treating heart failure, yang deficiency, cold extremities, and acute cold syndromes. It often yields remarkable results, benefiting countless patients throughout history. Therefore, many physicians have a profound understanding of Fuzi, deeming it one of the most difficult herbs to use. It should only be prescribed to patients with true cold conditions. Originally, the reason for using raw Fuzi in Si Ni Tang is that the patient, suffering from external cold entering the Shaoyin, has lost yang, with cold extremities and is in a critical state of imminent death. At this moment, using Fuzi takes advantage of its extreme heat to stimulate and invigorate the body’s yang energy to expel cold pathogens. However, some misguided individuals today encourage long-term use of Fuzi, with doses of dozens or even hundreds of grams, which is largely for “enhancing fire and nourishing qi.” Si Ni Tang replenishes yang qi, which can lead to endless harm.Historically, Fuzi has always been a warming interior medicine, not a yang-replenishing herb. Traditional Chinese medicine has long discussed that warming yang herbs stimulate the body’s inherent heat to eliminate cold and dampness. Once the cold and dampness are expelled, the body’s qi naturally returns. Fuzi, however, is transient and does not retain; its nature is fierce and explosive. Overuse can lead to excessive dispersal of yang qi, depleting true water and igniting the lower source fire, making it unsuitable for long-term use. It must be paired with herbs that have a restraining effect. Therefore, traditional Chinese medicine has specialized discussions on warming interior and dispelling cold herbs, which are warm and dry in nature and can easily deplete true fluids. Thus, those with yin deficiency and excess fire or insufficient body fluids should use caution with Fuzi. The reason Fuzi can deplete yang is due to its pungent and hot nature. Excessive pungency depletes too much, and excessive heat damages qi. If the pungent and hot properties are too strong, they will deplete and damage yang qi. Fuzi’s warming yang is its normal function, while depleting yang is its transformation. The use of Fuzi should be based on the disease’s transformation and symptoms; when the disease improves after using the herb, it is its normal function; if the disease does not improve and yang qi is depleted due to excessive pungency and heat, it is its transformation.Generally, after using Fuzi or Chuanwu, if symptoms such as profuse sweating, slowed heart rate, vomiting, diarrhea, and tremors in the hands and feet occur, they can be understood as excessive dispersal of yang qi leading to its depletion. Using Gancao (Licorice), honey, and black beans can help correct this imbalance. Improper use of Fuzi often leads to fire pathogens invading the body, causing excessive yang qi, clinically manifesting as high fever, aversion to heat, flushed face, and a rapid pulse. Fire pathogens can force fluids to leak out, causing excessive sweating, and can also directly consume fluids, leading to thirst and dry throat.How does “fire pathogen” harm and deplete yang? The commentary in Jin Gui Yao Lue (Essential Prescriptions of the Golden Cabinet) states: “Fire consumes and depletes yang, causing confusion of the spirit.” Zhang Zhongjing said: “If the physician uses fire to force and consume yang, it will lead to confusion and madness.” Generally, excessive use of warming interior herbs will inevitably lead to symptoms that conflict with heat herbs, meaning that heat herbs cannot enter the yin, and the yin-cold condition worsens. Furthermore, excessive warmth cannot enter the yin and damages qi, exacerbating the yang deficiency pathology. Warming herbs misused for heat syndromes that appear cold will assist heat, leading to excessive pathogenic heat and depleting yin. When yin is depleted, it cannot contain yang, and when yang loses yin, it transforms into depletion, which means that extreme heat generates cold, and extremes must reverse. If there are still colleagues who do not understand the pharmacology of Fuzi, I will give another example: ginger. Ginger is pungent, slightly warm, and enters the lung, spleen, and stomach channels, with effects of releasing the exterior, dispelling cold, and warming the middle. Fuzi is actually similar to ginger; both are warming interior herbs. Ginger consumes yang qi, but it mobilizes the body’s inherent yang qi to dispel dampness. It is the yang qi that dispels dampness, and ginger merely serves as a directional guide from the physician. Therefore, ginger should not be consumed at night, as the body needs to conserve yang qi and gather yin fluids. The saying goes, “A slice of ginger at night is better than eating arsenic.” This is because ginger itself is pungent and warm, and its effect is to assist fire. At night, the body should conserve yang qi and have abundant yin, while ginger’s pungent and warm dispersing effect consumes the body’s true fluids, ultimately shortening one’s lifespan. This is similar to how some people misuse Fuzi for enhancing yang; Fuzi itself has no nourishing effect. Its extreme pungency and heat are meant to expel yin-cold. As Wu Peiheng said, for treating yang deficiency, one should use Fuzi in cycles of three months, with each dose being taken three times, using Fuzi as an assistant herb, paired with the monarch herbs like Ren Shen (Ginseng) and Dang Gui (Angelica), in a ratio of 2:10. Once the body recovers, it should be discontinued, as long-term use is toxic. If a healthy body with sufficient yin essence uses Fuzi or Gui (Cinnamon), it can lead to excessive fire in the kidneys or seasonal fire accumulating in the organs, causing excessive fire and depletion of water, resulting in yin deficiency and dryness, ultimately shortening lifespan. The fire pathogen invades the body, causing excessive heat, profuse sweating, and generally, excessive heat can severely damage the original qi; that is, excessive pungency and heat will deplete true qi.From clinical cases, many patients who have taken a lot of Fuzi feel even colder, and the reason lies here. Fuzi does not replenish yang; rather, it is a process of stimulating yang through its pungent and dry nature. Insufficient yang qi in the body is like a fire that is not strong enough; Fuzi acts like a fan that can blow the fire stronger but depletes the patient’s internal yang, making them feel more deficient. It may seem effective temporarily, but once the medicinal effect wears off, the pathogen returns, and the original qi is severely damaged. If one continuously uses excessively pungent and hot substances, the warming interior and dispelling cold herbs are warm and dry in nature, easily depleting true fluids, which is indeed a life-threatening act.Since Zheng Shou established the Huo Shen Pai (Fire God School), many have met untimely ends due to improper use of these herbs. For instance, Zheng Zhongbin at 60, Huang Yuanyu at 53, Liu Minshu at 63, Wang Zhaoji at 60, Xu Boda at 57, Chen Mingsheng at 51, Zhu Weiju at 64, Zhao Zhixiong at 57, Sun Qi at 55, Li Yangbo at 44, Wang Zhenglong at 46, Ni Haixia at 59, and Huang Yuanyu at 53. These individuals were all masters of the Huo Shen Pai and were accustomed to using Fuzi, often testing the herbs on themselves, inadvertently damaging their true yin energy, which is truly lamentable.Using this herb requires boldness and meticulousness, strict adherence to the disease mechanism, and accurate judgment of the disease’s condition. Pulse and symptoms should be correlated; if any symptoms appear, Fuzi should be used. Any pungent substance from the four qi and five flavors can deplete qi, especially large pungent and hot substances, which will inevitably deplete original qi over time. The founder of the Fire God School, Zheng Qinan, once said that Gui and Fuzi are drying and hot, capable of warming and nourishing yang, yet they harm true yin. Therefore, they should only be used in emergencies and not abused. The correct approach is to seek yang within yin, consolidating qi and gathering it, while Fuzi’s fierce and explosive nature can easily cause yang qi to rise. It must be paired with restraining herbs to manage it.In recent years, many who do not understand medical principles believe that the more Fuzi is used, the more it proves their proficiency. At least some physicians indiscriminately prescribe Fuzi for any condition, branding themselves as “Fire God physicians,” as if using Fuzi is a hallmark of being a “Fire God.” Unbeknownst to them, this is a misinterpretation of the teachings of the “Fire God” ancestors represented by Zheng Qinan, a superficial and erroneous understanding. Zheng Qinan emphasized the dual principles of yin and yang, advocating that clinical practice should be based on the realities of yin and yang, clearly distinguishing between internal and external, and understanding yin and yang. He believed that “the path of medicine is not difficult in using herbs, but difficult in recognizing symptoms; it is not difficult in recognizing symptoms, but difficult in discerning yin and yang.” He urged scholars to seek understanding in the dualities of yin and yang. Zheng Qinan did not limit himself to the use of warming and hot herbs; his approach to herbal medicine followed the principles of yin and yang differentiation, which is clearly evident in Zheng’s book, Yi Li Zhen Chuan (True Transmission of Medical Principles). In discussing the treatment of yang deficiency, he emphasized the true yang in the kidneys, considering it the source of life, advocating for concealment as the proper approach, and not allowing it to be recklessly exposed. In discussing yang deficiency pathology, it is often the case that true yang rises and cannot be retained below. Looking at Zhang Zhongjing’s six meridian methods, it is clear that supporting yang must also subtly benefit yin, and visibly benefiting yin must also subtly support yang. Modern practitioners do not recognize the subtle transformations of yin and yang; thus, supporting yang is often done with warming herbs, while nourishing yin is done with cooling herbs, leading to numerous errors. For thousands of years, the distinction between these two schools has persisted; in fact, the essence of traditional Chinese medicine lies in the balance of yin and yang and the five elements. The efficacy of a formula or method, or the excess of a specific organ, is all pathological. Depleting the excess and replenishing the insufficient is the correct path of traditional Chinese medicine.
So, how should Fuzi be used in terms of dosage?Let’s first look at a medical case from Dr. Li:Patient Li suffered from mitral valve stenosis and underwent mitral valve separation surgery at a Western medicine hospital. Shortly after, he experienced severe heart failure. Although he was rescued, heart failure still occurred intermittently. Six months later, he was transferred to the affiliated hospital of the Shanxi Province Traditional Chinese Medicine Research Institute, where a physician prescribed 15 grams of Sheng Di (Rehmannia), 15 grams of Mai Dong (Ophiopogon), 15 grams of Tian Hua Fen (Trichosanthes), 15 grams of Wu Wei Zi (Schisandra), 15 grams of Ren Shen (Ginseng), 9 grams of Dang Gui (Angelica), and 15 grams of Fu Ling (Poria). After taking the medicine for about 20 minutes, his palpitations and shortness of breath worsened, and he experienced severe cough and abdominal distension. He urgently called for Dr. Li’s consultation;Dr. Li: “You can take Zhen Wu Tang (True Warrior Decoction) with modifications.” The prescription was: 0.3 grams of Fuzi, 0.6 grams of Bai Shao (White Peony), 0.3 grams of Fu Ling, 0.3 grams of Ren Shen, 0.3 grams of Bai Zhu, and 0.3 grams of Xing Ren (Apricot Kernel). After taking the medicine for 25 minutes, his palpitations, shortness of breath, and cough improved. An hour later, he urinated once, and his abdominal distension decreased. He was able to lie down and sleep for several hours, and by the next morning, he could turn over by himself. He continued to take the prescription, and after three days, he was able to walk over 20 steps, stating that he had not been able to walk for a year.Now, let’s look at another medical case:Patient Miao, male, 55 years old, presented with gastric distension and pain, worsening from afternoon to night. Symptoms aggravated with cold exposure or consumption of cold foods. His tongue coating was thin and white, and his pulse was wiry and tight. A physician prescribed Gui Fu Li Zhong Tang (Cinnamon and Fuzi Regulating the Middle Decoction) with modifications, with the prescription: 6 grams of Fuzi, 6 grams of Rou Gui (Cinnamon), 6 grams of Dang Shen (Codonopsis), 6 grams of Bai Zhu, 6 grams of Cang Zhu (Atractylodes), 6 grams of Gan Jiang (Dried Ginger), 6 grams of Mu Xiang (Aucklandia), 6 grams of Chen Xiang (Aquilaria), and 6 grams of Ding Xiang (Clove). After taking six doses, there was no significant effect.He then sought treatment from Mr. Pu Fuzhou.Mr. Pu said: “This is a case of spleen and kidney yang deficiency with cold dampness obstructing. The treatment should be Gui Fu Li Zhong Tang with modifications.” The prescription was: 15 grams of Huang Qi (Astragalus), 30 grams of Fuzi, 15 grams of Rou Gui, 12 grams of Dang Shen, 12 grams of Bai Zhu, 15 grams of Cang Zhu, 12 grams of Hou Po (Magnolia Bark), 10 grams of Chen Xiang, 10 grams of Mu Xiang, 15 grams of Sha Ren (Amomum), and 12 grams of Xiao Hui Xiang (Fennel). After taking one dose, his symptoms significantly reduced. Some were puzzled and asked for clarification, to which the teacher replied: “The strength of the herbs you used was insufficient; you must use a large dose to be effective.”From these two cases, one used Fuzi in a dosage as low as 0.3 grams, while the other used 30 grams. What insights can you draw from these cases?From these cases, we can derive two key phrases:“When the evil is strong and the righteous is not deficient, a large dose is appropriate; when the righteous is deficient and the evil is weak, a small dose is appropriate.”This means that the strength of the patient’s original qi must be considered. When the original qi is strong, and the cold evil is strong, a large dose can be used to expel the evil. When the original qi is weak, only a small dose can be used to gradually expel the evil, as stated in the book Jiang Fuzi Clinical Experience: “Physicians must learn to recognize the situation, follow the trend, and use the herbs accordingly. Only by adhering to the strategy based on the strength of the original qi can one achieve twice the result with half the effort.”The key point to understand is that Fuzi is extremely warming and hot, capable of expelling cold evils, but it can also disperse greatly. What does great dispersal mean? When the patient’s original qi is weak, a large dose of Fuzi will lead to what? The herb itself has no inherent medicinal properties; it is merely a directive. When the herb enters the body, it issues commands to our original qi, allowing it to transform into the medicinal properties and reach the disease site. This means that when Fuzi is used in large amounts, if the original qi is sufficient, it can be mobilized; if the original qi is insufficient, it cannot be mobilized.The application of Fuzi must adhere to the ten prohibitions and three inquiries.Ten prohibitions: 1. Do not use for flushed face; 2. Do not use for red tongue with yellow coating; 3. Do not use for delirium and agitation; 4. Do not use for scanty, red urine; 5. Do not use for a rapid and strong pulse; these five clinical manifestations indicate yang heat excess, and Fuzi must not be used. However, clinical practice must distinguish between false heat syndromes, such as a face that is red like makeup, repetitive and low speech, and a floating pulse that is large and without root; these indicate false yang rising and can use Fuzi to draw fire back to its source. 6. Do not use for patients with severe liver and kidney diseases or myocardial diseases; 7. Do not use for weak constitution or those with yin deficiency and internal heat; 8. Do not use during pregnancy; 9. Do not use for patients with atrioventricular block; 10. Do not use with Ban Xia (Pinellia), Gua Lou (Trichosanthes), Bei Mu (Fritillaria), or Bai Lian (White Lotus).Three inquiries: After the patient takes Fuzi, inquire about: 1. How is their sleep? 2. How much urine do they produce? 3. What is their activity level? In summary, if the patient sleeps well, has increased urine output, and can move freely without agitation, this is a normal response to Fuzi. Conversely, if not, it should be considered a contraindication for Fuzi.
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