Hu Qiaowu: Ten Combinations of Fu Zi
Author: Hu Qiaowu
Fu Zi (Aconite) is a pungent and warm herb with a wide range of clinical applications. It is commonly used in combination with warming and tonifying herbs; when used with cold and cool herbs, it serves as a modification method. For conditions with mixed cold and heat, both warming and cooling herbs should be employed. In the “Shang Han Lun” (Treatise on Cold Damage), Fu Zi is included in 20 formulas.
According to the “Yi Xue Zheng Zhuan”, it is said that Fu Zi “can guide tonifying Qi herbs to circulate through the twelve meridians, to restore the lost Yang; guide blood tonifying herbs into the blood to nourish the insufficient true Yin; promote dispersing herbs to open the pores, to expel wind and cold from the surface; and guide warming herbs to the lower jiao to eliminate internal cold and dampness.”
Huang Gongxiu praised it as: “the primary essential medicine to tonify the true fire of the Ming Men (Gate of Life).”
Zhang Xichun stated: “Fu Zi is the main herb for assisting the Yuan Yang, its power can ascend and descend, can reach internally and disperse externally. For all kinds of cold and stagnant conditions in the organs, muscles, and meridians, ‘taking this will always be effective.'”
In modern times, Xu Xiaopu proposed that Fu Zi can “guide fire back to its source and subdue false heat.”
Although Fu Zi is a key herb for dispelling cold and tonifying, it has certain toxicity. When used appropriately, its effects are as clear as a drum, but if used inappropriately, it can lead to disaster. Therefore, ancient practitioners often combined it with other herbs.
As Zhang Jingyue said: “Fu Zi is aggressive in nature and difficult to use alone; it must be combined with large sweet herbs, such as Ren Shen (Ginseng), Shu Di (Rehmannia), and Zhi Gan Cao (Honey-fried Licorice), which can temper its harshness and enhance its strength, thus ensuring success in treatment.”
He created many famous formulas combining Fu Zi with warming and tonifying Qi and blood herbs. Based on the principles of mutual necessity and mutual assistance in herbal combinations, ancient practitioners also developed effective formulas combining Fu Zi with Gan Jiang (Dried Ginger), Rou Gui (Cinnamon), Ma Huang (Ephedra), and Xi Xin (Asarum), but reports of its combination with heavy mineral herbs or bitter cold herbs for clearing heat and activating blood are still rare.
In this article, I will summarize over 40 years of experience using Fu Zi in combination with the aforementioned herbs to treat difficult diseases into ten combinations for clinical trial.
1. Combination with Shi Gao (Gypsum) for treating wind edema, cough, asthma, and rashes that are difficult to resolve
In the “Jin Kui”, there is a record under the prescription of “Yue Bi Tang” stating “for those with aversion to wind, add one piece of Fu Zi.” This opened the way for the later use of these two herbs together.Shu Chiyuan used the two herbs together in one dose to cure a case of dysentery.Zhao Yangkui combined the two herbs to treat a case of severe diabetes, which also yielded immediate results.The “Sun Zhao’s Formula” introduced the combination of the two herbs to treat wind-heat headache.Some have used Da Qing Long Tang (Major Blue Dragon Decoction) with Fu Zi to treat epidemic meningitis.Although the properties and functions of the two herbs are quite different, I have found that regardless of whether it is a seasonal disease or a mixed disease, whenever there is a combination of deficiency and excess or a mixture of cold and heat presenting one of the following three conditions, it is appropriate to use them together:
① Lung meridian with accumulated heat, Kidney Qi deficiency and cold;
② Internal heat blazing, with exterior deficiency and spontaneous sweating;
③ Wind-heat affecting the upper, with cold water impacting below.
2. Combination with Dai Zhe Shi (Hematite) for treating metrorrhagiaFor those with a constitution of deficiency and cold or Yin diseases with heat in the blood, if using hemostatic agents yields little effect, one can try using Dai Zhe Shi with Fu Zi. Zhang Xichun stated: Dai Zhe Shi “can generate blood and also cool the blood, its quality is heavy and sinking”, bitter and slightly cold, primarily entering the lung meridian, harmonizing with the warm and moving Fu Zi, creating a balance of cold and heat, stillness and movement, thus achieving the effect of regulating Yin and Yang and consolidating the Chong and Ren meridians. Recently, there have been reports of using the two herbs together with Gan Song (Sweetflag), Li Lu (Veratrum), Ling Xiao Hua (Campsis), and Shi Chang Pu (Acorus) to treat epilepsy.
3. Combination with Shi Jue Ming (Haliotis) for treating palpitations and headachesWhen water and fire do not interact, it can often lead to palpitations and anxiety. Liver Yang with phlegm-heat can also cause headaches. The two herbs can be used together as the main treatment; the former addresses the relationship between the heart and kidneys, while the latter addresses the relationship between the upper and lower parts of the body.Shi Jue Ming can calm the rebellious Liver Yang, allowing it to descend, while Fu Zi can stimulate the Yang of the Ming Men, evaporating Kidney water, allowing it to ascend. Using both cold and heat together, water and fire can harmonize, promoting the balance of Yin and Yang.This combination is effective for treating insomnia and mental disorders caused by Kidney Yang deficiency and excessive Liver fire. Xu Xiaopu also used Fu Zi with Ci Shi (Magnetite) and Long Chi (Dragon’s Teeth) to nourish Yin and subdue Yang, which is similar to this method.
4. Combination with Da Huang (Rhubarb) for treating hemoptysis, chest pain, and diarrheaFor persistent hemoptysis due to cold congealing and obstructing the vessels; for external injuries with stabbing pain in the chest and ribs, due to Yin obstruction; and for abdominal diarrhea due to deep cold and stagnation, Da Huang can be combined with Fu Zi in different formulas to achieve warming and unblocking effects.According to treatment principles, those needing warmth should not be purged, and those needing purging should not be warmed.Fu Zi combined with Da Huang, one hot and one cold, can work together to promote their respective effects despite their opposing properties and functions. Zhang Zhongjing has the Da Huang Fu Zi Tang (Rhubarb and Aconite Decoction) and Fu Zi Xie Xin Tang (Aconite Decoction for Purging the Heart), and later practitioners have also created the Wen Pi Tang (Warming the Spleen Decoction), all of which are excellent formulas using both herbs together. Recently, there have also been reports of using these two herbs together to treat epidemic meningitis leading to acute renal failure and to treat appendicitis masses and chronic cholecystitis.
5. Combination with Huang Lian (Coptis) for treating diarrhea in the later stages of damp-heatIn the later stages of damp-heat, when the middle Yang is not functioning properly, it often leads to dampness obstructing heat, causing a lingering fever and diarrhea that is not solid.In this case, using Fu Zi with Huang Lian can yield unexpected results.Huang Lian is bitter and dries dampness, cooling and draining heat, making it an excellent remedy for dampness obstructing heat and causing fever and loose stools, with effects unmatched by other herbs.Fu Zi, being pungent and warm, can invigorate the middle Yang, expel heat outward, and also assist Huang Lian in consolidating the intestines and stopping diarrhea.Xu Xiaopu often used these two herbs together to treat patients with damp-heat injuring both Qi and Yin, with lingering heat and sweating, a white coating on the tongue, restlessness, and difficulty sleeping, as well as children with summer heat presenting with thirst, frequent urination, cold limbs, and no sweating. His self-formulated remedy for summer heat, Qing Shang Wen Xia Tang (Clear Above and Warm Below Decoction), uses these two herbs as the main ingredients.
6. Combination with Huang Qin (Scutellaria) for treating prolonged chills and feverFor individuals with a constitution of deficiency, after an external invasion, the body often cannot withstand the pathogen, leading to prolonged exterior pathogens that gradually transform into heat.Persistent fever without sweating is due to insufficient sweat production and the difficulty of the pathogen to be expelled.If pungent and warm dispersing herbs are used, it can easily injure Yin; if pungent and cool herbs are used, it may obstruct Yang.It is advisable to use Xiao Chai Hu Tang (Minor Bupleurum Decoction) for harmonizing, with a small amount of Fu Zi to stabilize the middle and expel the pathogen, which is the best approach.Although Huang Qin, which clears lung heat, is bitter and cold and not suitable for those with a white coating and cold limbs, Fu Zi can invigorate Yang Qi and assist in clearing heat and expelling pathogens.
7. Combination with Shan Zhi Zi (Gardenia) for treating abdominal painChest and abdominal pain often present with mixed cold and heat symptoms.For example, a thin and rapid pulse with a pale white tongue, bitter mouth, and clear urination, with paroxysmal pain that is relieved by pressure, and internal heat with cold limbs, etc.Ancient practitioners often used oppositely flavored herbs together, and the combination of the warm and dispersing Fu Zi with the bitter and cold Jiao Zhi Zi is particularly suitable for these symptoms.Its efficacy can disperse stagnation and relieve pain, similar to the combination of Gan Jiang (Dried Ginger) with Jiao Zhi Zi for treating stomach pain.
8. Combination with Pao Jia (Pangolin Scales) for treating bone pain, masses, and lumpsThe use of Pao Jia in medicine was first seen in Tao Hongjing’s “Ming Yi Bie Lu”.Since the Song and Yuan dynasties, it has been used for external symptoms such as sores and for promoting lactation and regulating menstruation.Li Shizhen used it in the “Fa Sheng Tang Experience Formula” to treat rheumatic cold obstruction, with severe stiffness and inability to bend, and intolerable pain.It emphasizes its ability to promote circulation and unblock meridians, but many practitioners fear its harshness and rarely use it. However, modern practitioners such as Long Zhi Zhang, Zhang Xichun, and Zhang Ci Gong have effectively used this herb.Long praised it as a gentle general, stating that its efficacy is unmatched by Da Huang (Rhubarb) or Ba Dou (Croton), as the latter only breaks up solid accumulations, while Pao Jia can also penetrate and resolve hidden accumulations.
Zhang stated: “The ability of Pao Jia to penetrate is thorough, thus it can promote the circulation of the organs, pass through the meridians, and reach the joints. Any blood stasis or accumulation can be opened. It can also treat masses, paralysis, urinary obstruction, and abdominal pain.”
Mr. Zhu Liangchun, following the teachings of his master Zhang Ci Gong, also effectively used it to treat various difficult diseases.In my experience, whenever encountering pain in the bones due to the intersection of cold and heat, stagnation of Qi and blood, as well as joint swelling and pain, and masses formed by cold congealing and blood stasis in both men and women, I often use Pao Jia combined with Fu Zi, taking advantage of one being cold and the other being hot, one dispersing and one penetrating, directly reaching the Yin to warm and unblock the visible diseases.
9. Combination with Xi Xian Cao (Siegesbeckia) for treating rheumatic pain
According to the “Gang Mu”, “Xi Xian Cao is effective for liver and kidney wind Qi, numbness in the limbs, bone pain, and weakness in the knees, as well as rheumatic sores.”
This commonly used herb for dispelling wind and dampness is mostly pungent and warm, while this herb is unique in that it has a bitter quality that can dry dampness, coldness that can eliminate heat, and pungency that can disperse wind.For those with chronic rheumatism, Kidney Yang deficiency, and the pathogen entering the meridians and transforming into heat, presenting with widespread joint pain, muscle soreness, and a red tongue with a slightly rapid pulse, if using pungent and warm herbs to dispel wind and dry dampness yields little effect, one can often use Fu Zi with Xi Xian Cao, treating both the root and the branch, solidifying the body and dispelling the pathogen.However, Xi Xian Cao must be prepared with wine and honey, steamed and dried nine times to eliminate its turbid and Yin qualities for best results.
10. Combination with Dan Shen (Salvia) for treating chest obstruction, palpitations, and irregular pulseAncient practitioners stated: “The chest is the Yang position, a place of clarity and openness, difficult to bear even a trace of shadow. If obstructed, Yang Qi cannot distribute, leading to stagnation and pain.”This clearly points out that the pathogenesis of chest obstruction and pain is related to the failure of chest Yang to thrive, with phlegm and turbidity rising, leading to stasis in the heart vessels.Thus, palpitations and irregular pulse also appear due to the obstruction of Qi and blood in the chest.Therefore, patients presenting with a pale complexion, cold extremities, blue-green eyes, a pale and swollen tongue with purple spots, or a white greasy or light yellow coating, with a deep, thin, wiry, or intermittent pulse, along with chest tightness and pain, can use Fu Zi combined with Dan Shen as the main treatment.Huang Gongxiu stated: “Dan Shen is bitter and red, neutral and descending, can enter the heart and break stasis.”Fu Zi is also a key herb for strengthening the heart, thus the combination of these two herbs can directly address the pathogenic stasis in the heart vessels.Among all blood-activating and stasis-resolving herbs, Dan Shen is particularly adept at treating heart diseases, and there are many reports of using Dan Shen with other herbs to treat coronary heart disease or acute myocardial infarction, which beginners should pay attention to. Ding Ganren often used Dan Shen with Fu Zi to treat joint pain due to cold stagnation and dampness, also taking advantage of the warming and blood-activating effects of both herbs.
(Compiled by Hu Guojun, Hu Guotang, Hu Guozhen, Hu Guoying, Ma Jisong)
This article is excerpted from the “Liaoning Journal of Traditional Chinese Medicine” (1982) | Author: Hu Qiaowu
Compiled by: Fu Wenlu
1. Fu Zi with Ci Shi (Magnetite)Fu Zi combined with Ci Shi and other heavy herbs that descend, warms Yang and also subdues, thus it is called the warming and descending method.Zhu Weiju primarily applies it to treat insomnia.He believes: “For those with deficiency, excessive agitation is due to internal Qi weakness and external Yang floating, leading to excitement, which is a type of false excitement. Sweet and cool herbs can provide slight calmness, but if taken frequently, the Qi becomes weaker and the Yang floats more. This is not due to excessive Yang, but rather Yang deficiency that cannot self-seal.”Generally, those with nervous exhaustion are prone to fatigue and excitement. The method of nourishing Yin and clearing fire, although it has a calming effect, its soft and Yin-nourishing nature can harm the original Yang, which is not the best approach.The “Nei Jing” states: ‘The key to Yin and Yang is that Yang must be sealed to be firm.’Qi deficiency and Yang floating is caused by Yang deficiency that cannot self-seal.Therefore, Zhu Weiju believes that the deficient should be warmed and tonified, which is the common method.For those with Qi deficiency and excessive excitement, it is advisable to use warming and descending herbs to strengthen their weakness, calm their agitation, guide fire back to its source, and lead the dragon into the sea, which are all ancient good methods. One should not recklessly use cooling and nourishing herbs just because of external excitement.2. Fu Zi with Shi Gao (Gypsum)(“Critical Illnesses and Difficult Diseases Relying on Fu Zi”)Fu Zi combined with Shi Gao, one supports Yang, the other restrains fire.The warmth of Fu Zi can reduce the coolness of Shi Gao, but cannot eliminate its ability to stop secretion. For those with a weak body and excessive inflammation, using more Fu Zi and less Shi Gao still serves as a warming and strengthening agent. In Yangming cold damage, excessive resistance throughout the body leads to insufficient heart strength.In the “Qian Jin”, the “Yue Bi Tang” uses Shi Gao and Fu Zi together, one to restrain excess, the other to strengthen the heart. The coldness of Shi Gao is sufficient to counteract the warmth of Fu Zi, yet Fu Zi reduces its heat without diminishing its heart-strengthening effects. When Qi is strong and the heart is strong, using more cold than heat is also a valid cooling method. Generally, the properties of herbs can change due to their mutual compatibility, yet the essence of each herb can still exert its unique effects, which is the beauty of this compound.3. Fu Zi with Suan Zao Ren (Sour Jujube Seed)(“Zhejiang Journal of Traditional Chinese Medicine”)Zhu Weiju states: “The efficacy of these two herbs surpasses that of Western digitalis. The strength of digitalis is well-regarded in Western medicine, but its effects are not long-lasting, and it can have side effects for some patients. However, the heart-strengthening effects of Fu Zi and Suan Zao Ren do not have these drawbacks.”For patients with heart failure due to cold damage and miscellaneous diseases, this combination is often heavily used in prescriptions.Thus, Fu Zi combined with Suan Zao Ren has a strong heart-strengthening effect.4. Fu Zi with Shu Di Huang (Rehmannia)For diseases with both Yin and Yang deficiency, Zhu Weiju uses these two herbs, along with Ba Jitian (Morinda) and Yin Yang Huo (Epimedium), which are quite effective. For external Yin conditions, these two herbs can also be used.Zhu Weiju states: “Yin abscesses are due to the body’s righteous Qi being unable to resist external bacteria. The treatment must enhance the body’s strength to shift from Yin to Yang, which is the proper approach. The ancient method of using a divine lamp is a great external treatment, but modern surgeons have abandoned it, which is a pity!” Therefore, when treating Yin abscesses, Zhu Weiju often uses Yang He Tang (Yang-Warming Decoction) as the main formula, adding Fu Zi.5. Fu Zi with Ling Yang Jiao (Antelope Horn)Fu Zi and Ling Yang Jiao, one cold and one hot, are found in the ancient formula Zi Shou Jie Yu Tang, but are rarely used in later generations. However, Zhu Weiju often uses them. He once said: “Ling Yang Jiao treats the brain, while Fu Zi strengthens the heart, making it most suitable for those with brain symptoms and a weak body.”6. Fu Zi with Zhi Mu (Anemarrhena)Zhu Weiju states: “Warming and nourishing can also be used together; the combination of Fu Zi and Zhi Mu enhances the effect, and there are many precedents.”Bian Que once said that for those with Qi deficiency and insufficient body fluids, adding Zhi Mu to warming and drying agents like Fu Zi and Gui Zhi (Cinnamon) can avoid the drawbacks of excessive warmth and dryness while providing the function of generating fluids.For patients with insufficient body fluids due to cold damage, this combination indeed has this effect.Zhang Zhongjing treated rheumatism with Qi deficiency and weakness using Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon, Peony, and Anemarrhena Decoction).Those with weakness are those with insufficient body fluids, and the warming and drying properties of Fu Zi and Gui Zhi can dispel cold and dampness, while Zhi Mu and Shao Yao nourish Yin to clear heat and generate fluids. Zhu Weiju often uses this formula with significant results.7. Fu Zi with Da Huang (Rhubarb)The warmth of Fu Zi combined with the purging action of Da Huang is very effective for treating amoebic dysentery, which is a unique experience of Zhu Weiju. He once stated: “Although Da Huang Decoction is most effective for amoebic dysentery, it must be used in conjunction with Fu Zi and cooked Da Huang for the effect to be significant.”8. Fu Zi with Chai Hu (Bupleurum)This method is most frequently used by Zhu Weiju. For alternating chills and fever and malaria, he combines it with Xiao Chai Hu Tang (Minor Bupleurum Decoction) and Chai Hu Gui Zhi Tang (Bupleurum and Cinnamon Decoction); for liver enlargement and fullness in the hypochondrium, he combines it with Chai Hu, Dang Gui (Angelica), and Shao Yao (Peony), and for severe cases, he adds San Leng (Sparganium) and E Zhu (Curcuma), which can gradually reduce liver swelling; he also combines it with Chai Hu and Kong Yan Dan (Controlling Saliva Pill) to treat pleurisy with remarkable effects, which is Zhu Weiju’s unique secret.9. Fu Zi with Gua Lou (Trichosanthes) and Xie Bai (Garlic Chives)Zhu Weiju states: “The ‘Jin Kui Yao Lue’ mentions that Gua Lou and Xie Bai wine decoction is very effective for chest obstruction, and modern so-called rheumatic heart disease is quite similar to this.” He also believes that if combined with Fu Zi and other Yang-replenishing herbs, the effect will be even more pronounced.10. Fu Zi with Quan Xie (Scorpion) and Jiang Can (Silkworm)Zhu Weiju often uses this method to treat convulsions, with significant clinical efficacy.This article is excerpted from the “Fire God School’s Primary Yang-Replenishing Herb: Fu Zi” (2010) | Compiled by: Fu Wenlu