Professor Huang Huang’s Lecture: Fuzi (Aconite)
Fuzi (Aconite)
Fuzi is the lateral tuber of the Aconitum plant, belonging to the Ranunculaceae family. Yun Tieqiao said: “Fuzi is the most useful, yet also the most difficult to use.” The phrase “most useful” indicates that Fuzi can save lives in critical situations, being referred to as the top medicine for reviving yang and rescuing from peril; Fuzi also strengthens the body, as it is said to circulate through the twelve meridians, warming the internal organs, bones, and marrow, and externally warming the muscles and skin. Many renowned physicians are famous for their adept use of Fuzi. The famous physician Yan Guan from Zhejiang in the Ming Dynasty often used ginger juice to prepare Fuzi, earning him the nickname “Yan Fuzi.”
In modern times, the famous physician Zhu Weiju from Sichuan was also skilled in using Fuzi. In the 1930s, while practicing medicine in Shanghai, he frequently used Fuzi to treat critical illnesses, demonstrating extraordinary courage, unique combinations, and remarkable efficacy, earning praise from patients and peers, and he was known as “Zhu Fuzi.” The modern Yunnan elder TCM physician Wu Peiheng also used Fuzi very effectively, often in large doses, sometimes up to 400 grams, which astonished many, and he was called “Wu Fuzi.”
The phrase “most difficult to use” has two meanings, in my view. First, it refers to the wide range of applications of Fuzi, but the symptoms indicating the need for Fuzi are difficult to identify; often, in critical moments, the opportunity is missed, or the treatment is ineffective due to incorrect diagnosis. Second, Fuzi is toxic; if not used correctly, it can not only be ineffective but also cause toxic side effects. Therefore, it is essential to pay attention to the indications, combinations, dosage, method of administration, cooking time, and types of herbs used when applying Fuzi. Because of this, many ancient physicians were cautious in using Fuzi. As the Qing Dynasty physician Zhang Yinan said in “Bencao Chongyuan”: “Some practitioners may spend their entire lives in medicine, yet always regard Fuzi as a venomous creature, warning others that Fuzi should not be taken, as it will surely cause madness and bleeding from the nine orifices; taking it will surely cause fire, leading to the sudden onset of boils and toxins; taking it may rot the five organs internally, and if taken this year, the poison will manifest next year.” The difficulty in using Fuzi can be seen from this perspective.
Indications
Fuzi is indicated for a weak and submerged pulse, and it also treats pain.
Fuzi is an ancient rescue medicine, often used for severe vomiting, diarrhea, and excessive sweating leading to critical conditions characterized by a weak or submerged pulse, and cold extremities. Many formulas containing Fuzi in “Shanghan Lun” (Treatise on Cold Damage) record pulse patterns. From the original text of “Shanghan Lun”, Zhang Zhongjing placed great importance on the pulse patterns indicating the need for Fuzi, including weak pulse, submerged pulse, and pulse that is almost absent, as well as submerged and weak pulses. The submerged and weak pulse is the most typical.
The so-called submerged and weak pulse refers to a pulse that is extremely thin and weak, felt like a floating thread, almost imperceptible; or a submerged pulse that only becomes palpable with firm pressure down to the bone, which is the unique pulse pattern indicating the need for Fuzi. I refer to this as the “Fuzi pulse.” This pulse is often seen in patients who have experienced significant sweating, severe diarrhea, major blood loss, or extreme fatigue, cold stimulation, leading to a significantly weakened constitution, as well as in patients suffering from long-term illnesses, elderly patients, or infants. Symptoms accompanying this pulse pattern often include:
① Gray complexion without luster, lethargy, extreme fatigue, and a weak voice;
② Aversion to cold, cold extremities;
③ Loose stools or diarrhea, often with undigested material, accompanied by abdominal fullness and pain;
④ Edema, especially pitting edema in the lower limbs, and sometimes ascites.
If blood pressure is measured, it is often low, and heart and kidney functions may be impaired.
Therefore, the “submerged and weak pulse” should not merely be understood as a symptom, but rather as a state of constitution, which is what TCM refers to as “yang deficiency” or “lesser yin disease.”
The Fuzi pulse can also present in special situations; one situation is when the pulse suddenly becomes floating, large, and soft, often accompanied by profuse cold sweat or agitation, which is often a precursor to extreme weakness of constitution or the escape of yang qi.
Another situation is when the pulse is not weak but rather strong, referred to by Zhang Zhongjing as “tight and string-like pulse”; this situation is often seen in cases of severe pain.
Fuzi also treats pain syndromes.
The pain syndromes treated by Fuzi are often severe, and may present in the following ways:
① Generalized pain without a fixed location, with the patient appearing pale and weak, or experiencing aversion to cold, spontaneous sweating, or agitation;
② Joint pain and stiffness;
③ Severe pain in the hypochondrium and abdomen without rigidity or resistance to pressure;
④ Chest pain radiating to the back, with cold extremities beyond the elbows and knees.
Formulas
1. Diseases characterized by a submerged and weak pulse and cold extremities
A submerged and weak pulse with cold extremities is often seen in heart failure, various types of shock, etc. Fuzi is often combined with dried ginger and licorice, as in the formula Si Ni Tang. Si Ni Tang is a traditional cardiotonic and pressor agent. Renowned later physicians who excelled in using Si Ni Tang are known as the “Fire God School” of southwestern physicians, such as Wu Peiheng and Fan Zhonglin. Si Ni Tang is suitable for conditions of deficiency and cold, which often arise from extreme fatigue, cold stimulation, prolonged high fever, severe diarrhea, vomiting, or major blood loss, with patients presenting with a dull complexion, apathetic demeanor, low blood pressure, cold extremities, or cold sweat, and a weak and thin pulse.
Si Ni Tang is often modified in clinical practice. Common modifications include:
—— Adding ginseng, known as Si Ni Jia Ren Shen Tang, suitable for those with profuse cold sweat or major blood loss.
—— Adding cinnamon, gui zhi, dragon bone, oyster shell, etc., suitable for palpitations, cold sweat, and a large empty pulse.
—— Adding ginseng, mai dong, and wu wei zi, suitable for those with shortness of breath, profuse sweating, and a red, tender tongue.
—— Adding ginseng and Bai Zhu (White Atractylodes), known as Fuzi Lizhong Tang, suitable for deficiency and cold diarrhea.
—— Adding huang lian, used for dysentery and enteritis with mixed cold and heat.
—— Adding yin chen, used for jaundice.
2. Diseases with severe pain
Fuzi has a significant analgesic effect, and different combinations treat different types of pain.
1. Combined with Xi Xin (Asarum) and Ma Huang (Ephedra), as in the formula Ma Huang Fuzi Xi Xin Tang, suitable for acute lumbar sprains and lumbar disc herniation causing low back pain. 2. Combined with Shao Yao (Peony), as in Shao Yao Gan Cao Fuzi Tang and Zhen Wu Tang, suitable for sciatica, lumbar disc herniation, and vascular inflammation causing low back and leg pain.
3. Combined with Gui Zhi (Cinnamon Twig), as in Gui Zhi Jia Fuzi Tang, suitable for joint pain.
4. Combined with Xi Xin and Da Huang (Rhubarb), as in Da Huang Fuzi Tang, suitable for tumor pain, biliary colic, and renal colic.
5. Combined with Da Huang, Gan Jiang (Dried Ginger), Rou Gui (Cinnamon), and Ren Shen, as in Wen Pi Tang, suitable for abdominal pain caused by incomplete intestinal obstruction.
3. Diseases with generalized edema
1. Combined with Bai Zhu, Fu Ling (Poria), Shao Yao, etc., as in Zhen Wu Tang. Its original indications include “palpitations below the heart, dizziness, body tremors, and a feeling of impending collapse” (82) and “abdominal pain, difficulty urinating, heavy and painful limbs, and diarrhea” (316). In later practice, it is often used for edema accompanied by palpitations, dizziness, abdominal pain, etc., known as yang deficiency with water flooding. Currently, it is frequently reported in clinical cases of congestive heart failure, chronic glomerulonephritis, nephrotic syndrome, chronic renal failure, hypoproteinemia, side effects of adrenal cortex hormones, and hypothyroidism.
2. Combined with Niu Xi (Achyranthes), Che Qian Zi (Plantago), Rou Gui, Di Huang (Rehmannia), Fu Ling, and Ze Xie (Alisma), as in Ji Sheng Shen Qi Wan. This formula is suitable for renal edema, ascites, etc.
4. Deficiency asthma
Bronchial asthma, chronic bronchitis, and pulmonary heart disease often present with a dark complexion, aversion to cold, and cough with wheezing, or in those who have been taking corticosteroids for years, often belong to deficiency asthma.
1. Combined with Rou Gui and Di Huang, as in Shen Qi Wan (Fuzi, Rou Gui, Shu Di Huang, Shan Yao, Shan Yao, Fu Ling, Ze Xie, Dan Pi), “Jin Kui Yao Lue” states: “For shortness of breath with slight fluid retention, one should urinate it out. Ling Gui Zhu Gan Tang and Shen Qi Wan are both indicated” (12). It is also used for “deficiency labor with low back pain, tightness in the lower abdomen, and difficulty urinating” (6). For patients with bronchial asthma and chronic bronchitis who present with weak constitution, palpitations, and a large empty pulse, regular use of Shen Qi Wan can improve constitution and prevent recurrence.
2. Combined with Xiao Qing Long Tang. For asthma with aversion to cold, no sweating, a submerged and weak pulse, and a dull, moist tongue with white slippery coating, Fuzi combined with Xiao Qing Long Tang is effective. The modern physician Zhu Weiju has such an empirical formula (compiled by Shi Qi, “Collection of Formulas from Famous Physicians Throughout History”, page 297, Xuelin Publishing House, 1994).
3. Combined with Gui Zhi Jia Long Gu Mu Li Tang and Zhi Gan Cao Tang. In my experience, for those with chronic asthma and a weak physique, palpitations, and a large empty pulse, Gui Zhi Jia Long Gu Mu Li Tang and Zhi Gan Cao Tang with added Fuzi can have a hormone-replacing effect.
References
1. When using Fuzi in emergencies, the diagnosis must be accurate, and the action must be swift.
2. When using Fuzi for chronic diseases, it is necessary to identify the constitution. Fuzi is more suitable for those with a yin-cold constitution. The so-called yin-cold constitution is characterized by a dull, pale, or dark yellow complexion, soft muscles, weak upon palpation, dry skin, morning facial edema, dull or puffy eyes, a spiritless appearance, a tired expression, dark and dry lips, a pale and swollen tongue with dark color, often with tooth marks, and a white (or black) moist or slippery coating. They often have an aversion to cold and prefer warmth, with cold extremities, especially the lower body being notably cold, easy fatigue, a preference for rest, aversion to movement, loose stools that are often unformed, clear and prolonged urination, no thirst or little thirst, or a preference for warm drinks.
3. Large doses for pain relief, small doses for warming yang. Zhang Zhongjing used Fuzi in two dosage ranges. Large doses (3-5 pieces) are often used for treating joint pain or severe abdominal pain; small doses (1-2 pieces) are often used for treating submerged pulse and cold extremities. Therefore, large doses are used for pain relief, while small doses are used for warming yang.
4. The preparation method for Fuzi. ① Pre-cooking method: Fuzi is pre-cooked to reduce toxicity. ② Boiling method: Some propose a new method of boiling Fuzi, which involves grinding Fuzi into a coarse powder, boiling in water for 10 minutes until there is no numbness. When boiling Fuzi, enough water must be added at once, and no cold water should be added midway, as per the experience of the old TCM physician Zhu Liangchun. ③ Combined cooking method: Fuzi cooked with dried ginger and licorice can enhance efficacy and reduce toxicity. Tao Hongjing in “Bencao Jing Jizhu” stated: “Common formulas using Fuzi must combine with licorice, ginseng, and ginger to counteract its toxicity.”
5. The principle of gradually increasing the dosage of small amounts.
6. Management of Fuzi poisoning: In ancient times, sweet licorice, huang lian, rou gui, mung bean, and black bean soup were used to detoxify. In modern times, atropine, procaine, and 1%-2% tannic acid are injected, and emetics, activated charcoal, and supportive measures such as warming and oxygenation are given as needed. Drinking strong tea also has a detoxifying effect, aiming to precipitate alkaloids.
Three Reflections:
Be aware! Those with these three characteristics lack the ability to love others and often harm others.
Fifty classic sayings from Daoist texts, transcending worldly realms.
A good life comes from taking things slowly.
Liang Dong: We expend 90% of our energy on useless matters.
We often think we have plenty of time, forgetting that life is unpredictable (well said).
Those who seem to do things effortlessly are simply putting in a little more effort than you every day.
Old Shi on TCM and Men’s Health:
Six medicinal formulas to tonify the kidneys and strengthen yang for treating impotence.
For impotence, use the tonifying essence formula.
Gecko: Warming the kidneys and benefiting qi for treating kidney deficiency impotence (includes kidney tonifying and yang strengthening formula).
Be cautious with tonifying medicines for treating premature ejaculation and impotence.
Zhang Yulong’s self-formulated prescription for treating glomerulonephritis.
