The Proper Use of Fuzi to Warm the Yang of the Five Organs

Introduction: Fuzi (Aconite) is one of the four major herbs in Traditional Chinese Medicine (TCM). Throughout history, countless practitioners have studied and utilized it, especially in critical moments where it has proven to be remarkably effective. However, due to its toxic nature, many practitioners are hesitant to use it. As the title of this article suggests, “It must be used wisely and not abused.” After reading this article, you will gain a deeper understanding of this herb.

Fuzi warms the Yang of the five organs; it must be used wisely and not abused

Fuzi is one of the four major herbs in TCM (Ren Shen (Ginseng), Shi Gao (Gypsum), Da Huang (Rhubarb), Fuzi), also known as the “Four Pillars of Medicine,” highlighting its importance. The function of Fuzi lies in warming the Yang of the five organs.

Historically, Zhang Zhongjing is the foremost practitioner known for the effective use of Fuzi. In his work, “Shang Han Lun” (Treatise on Cold Damage), he mentions numerous formulas that include Fuzi, such as Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite), Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without Peony and with Aconite), Gancao Fuzi Tang (Licorice and Aconite Decoction), Guizhi Fuzi Tang (Cinnamon Twig and Aconite Decoction), Mahuang Xixin Fuzi Tang (Ephedra and Asarum Decoction with Aconite), Mahuang Fuzi Gancao Tang (Ephedra, Aconite, and Licorice Decoction), Fuzi Xiexin Tang (Aconite Heart-Draining Decoction), and Shaoyao Gancao Fuzi Tang (Peony, Licorice, and Aconite Decoction). In the Taiyin chapter, there is Lichong Tang (Pill); in the Shaoyin chapter, there are Si Ni Tang (Frigid Extremities Decoction), Si Ni Jia Ren Shen Tang (Frigid Extremities Decoction with Ginseng), Tongmai Si Ni Tang (Unblocking the Pulse Frigid Extremities Decoction), Tongmai Si Ni Jia Zhu Dan Zhi Tang (Unblocking the Pulse Frigid Extremities Decoction with Pig Gallbladder), Ganjiang Fuzi Tang (Dried Ginger and Aconite Decoction), Fuzi Tang (Aconite Decoction), Bai Tong Tang (White Unblocking Decoction), Bai Tong Jia Zhu Dan Zhi Tang (White Unblocking Decoction with Pig Gallbladder), Zhenwu Tang (True Warrior Decoction), and Fuling Si Ni Tang (Poria Frigid Extremities Decoction). There are nearly 20 formulas, which account for more than one-sixth of the 112 formulas in the entire book.

The Proper Use of Fuzi to Warm the Yang of the Five Organs

In the prescriptions using Fuzi, the most important aspect is its cardiotonic effect in formulas like Si Ni Tang, as few patients die from heat diseases caused by heat itself, but many succumb to heart failure.

Historically, Mr. Zhang Cugong pointed out: “Zhongjing was the first to discover heart failure in heat diseases,” and the first choice for rescuing heat-induced heart failure is “Aconite.” In the 1930s, Mr. Zhu Weijun gained fame in Shanghai for his adept use of Fuzi, earning the nickname “Zhu Fuzi.” Even in cases of high fever and delirium, with dry lips and a rapid pulse, he insisted on using Fuzi, effectively addressing the critical issue of heart failure caused by heat, saving many severely ill patients. Mr. Zhang once expressed his admiration for Mr. Zhu’s “ruthless and decisive” use of medicine in the preface of Chen Susheng’s book, “Shang Han Zhi Nan”.

Mr. Zhang was also skilled in using Fuzi. He applied it in the middle and later stages of heat diseases when the evil force was declining but the patient’s strength was insufficient, risking collapse. He praised the use of the formula from the “Feng’s Golden Bag” called Quanzhen Yiqi Tang, which combines Ren Shen (Ginseng), Fuzi, Di Huang (Rehmannia), Mai Dong (Ophiopogon), to invigorate the heart and rescue the Yang, nourishing Yin and boosting Qi, which was a novel approach in treating heat diseases. However, the experiences and insights of Mr. Zhu and Mr. Zhang were often dismissed by the unlearned until they began to regain prominence in the last thirty years. Si Ni Tang (and its improved formulations) has been widely used in treating infectious shock and cardiogenic shock in internal medicine, with remarkable effects in strengthening the heart, raising blood pressure, and improving microcirculation.

Mr. Zhu pointed out: In heat diseases, the use of Fuzi must be based on subtle signs. If there are cold limbs, profuse cold sweat, a weak pulse, and cold breath, using it at this stage may be too late. He proposed the following criteria: a pale, moist, plump tongue, thirst without desire to drink, or only desiring hot soup; a pale complexion; sweating with cold limbs; clear urine. Even if there are simultaneous high fever, delirium, agitation, and a rapid pulse, Fuzi should still be used to invigorate the declining Yang and prevent the loss of Yang and collapse.

Over 20 years ago, under Mr. Zhu’s guidance, I used Fuzi in many critically ill patients, especially in cases of children with toxic dysentery and measles complicated by pneumonia. Despite high fever and rapid pulse, I did not hesitate to use it, effectively saving many lives. A few years ago, I consulted on a pneumonia patient named Zhu at Beijing Anzhen Hospital, who had a persistent high fever for 8 days, was lethargic, agitated, had rapid breathing, and a pulse of 150 beats per minute, yet had a pale complexion, sweating, a pale tongue, and clear urine. I immediately prescribed Hong Ren Shen (Red Ginseng), Fu Pian (Aconite slices), Long Gu (Dragon Bone), Duan Mu Li (Calcined Oyster Shell), Bai Shao (White Peony), Zhi Gan Cao (Honey-fried Licorice), Zi Su Zi (Perilla Seed), Ting Li Zi (Descurainia Seed), Zhi Qiao (Bitter Orange), and Jie Geng (Platycodon). The head of the ward questioned the prescription, saying: Ginseng is a great tonic, and Fuzi is very warming. Given that the child’s temperature is above 39°C, according to your TCM principles, the evil heat is rampant; is this appropriate? I replied: “If there is heart failure, would you not use cardiotonic drugs? This is TCM’s cardiotonic.” As a result, after three days of treatment, the patient’s condition improved significantly, with a marked decrease in temperature to low fever, and the pulse dropped below 100 beats per minute. This child is now in middle school.

The effective component of Fuzi that strengthens the heart is aconitine, and modern research has confirmed its reliable cardiotonic effects, improving peripheral and coronary blood circulation, increasing myocardial contractility, enhancing cardiac output, dilating peripheral blood vessels, and reducing peripheral resistance.In the past 20 years, there have been intramuscular injections or intravenous infusions of Renfu injection, which have effectively enhanced the emergency use of Fuzi. In acute heat diseases, as well as in chronic conditions where congestive heart failure occurs, Fuzi has also shown efficacy. Heart failure fundamentally stems from Yang deficiency, with blood stasis and water retention as secondary issues, presenting symptoms like palpitations, spontaneous sweating, shortness of breath, fatigue, and even cold limbs, edema, reduced urination, frequent nighttime urination, pale tongue with white coating, and weak or irregular pulse. Mr. Zhu often uses Fuzi as the main herb to invigorate the Yang of the heart and kidneys, combined with Ren Shen, Fu Ling (Poria), Bai Zhu (White Atractylodes), Sheng Jiang (Fresh Ginger), Chi Shao (Red Peony), Bai Shao (White Peony), Gui Zhi (Cinnamon Twig), Ting Li Zi, Xian He Cao (Agrimony), Dan Shen (Salvia), and Yi Mu Cao (Motherwort), achieving quick results. According to Zhongjing’s methods, Fuzi is used for the urgent rescue of collapse, to restore lost Yang energy immediately, requiring the use of fresh Fuzi, which has a strong effect. However, improper use of fresh Fuzi can often lead to poisoning. Currently, fresh Fuzi is often in short supply, and Mr. Zhu believes that using processed Fuzi is also very effective, suggesting that there is no need to be overly rigid.

Fuzi warms the Kidney Yang

It is used for Kidney Yang deficiency leading to inability to transform Qi and circulate fluids, resulting in edema (as in Ren Shen Tang (Ginseng Decoction), Zhen Wu Tang (True Warrior Decoction)), and for symptoms of nocturia, fatigue, and low back pain due to deficiency (as in Jin Gui Shen Qi Wan (Kidney Qi Pill)). In formulas for urinary stones, adding Fuzi 3-5 grams can enhance stone expulsion.

Fuzi also warms the Spleen Yang

For Spleen Yang deficiency leading to poor transformation of food and fluids, resulting in chronic diarrhea or acute diarrhea damaging Spleen Yang, Fuzi can be combined with Pao Jiang (Processed Ginger), Jiao Bai Zhu (Fried White Atractylodes), Fu Ling, Zhi Gan Cao, Ren Shen, and Fu Long Gan (Processed Dragon Liver), with a slight addition of Wu Mei (Mume), Huang Lian (Coptis), achieving quick effects.

Fuzi also warms the Lung Yang and Liver Yang

In TCM terminology, we do not typically refer to Lung Yang deficiency or Liver Yang deficiency; in reality, Lung Qi deficiency with cold symptoms indicates Lung Yang deficiency (such as cough, wheezing, clear phlegm, cold back, and cold body); the Liver is a solid organ that houses the fire of the heart, with Liver Yin and Liver Blood as the foundation, and Liver Yang and Liver Qi as the function. Even when there is a deficiency of Liver Yin and Liver Blood, there can be times when Liver Yang and Liver Qi are insufficient. Symptoms include fatigue, lack of joy, cold pain at the vertex, and dull pain in the hypochondrium and lower abdomen, with a cold sensation in the genital area. The pulse is wiry and weak. For Lung Yang deficiency, Fuzi can be combined with Gan Jiang (Dried Ginger) and Zhi Gan Cao; for Liver Yang deficiency, Fuzi can be combined with Gui Zhi and Huang Qi (Astragalus).

Fuzi is also a key herb for Bi syndrome

Bi syndrome encompasses a wide range of conditions, including rheumatoid arthritis, sciatica, ankylosing spondylitis, and periarthritis of the shoulder, among over 20 diseases. Mr. Zhu has dedicated decades to researching Bi syndrome, and his Yi Shen Juan Bi Wan (Kidney Invigorating Bi Expelling Pill) is renowned both domestically and internationally. For patients with stubborn conditions and severe pain, he often combines decoctions to quickly control the condition and alleviate the patient’s suffering. Among the various types of Bi syndrome, those with a cold component are often treated with Fuzi as the main herb, combined with Gui Zhi, Chi Shao, Bai Zhu, Gan Cao, Zhi Chuan Wu (Processed Aconite), Xi Xin (Asarum), Chuan Shan Long (Dichroa), and Sheng Jiang. For wind-damp-heat Bi syndrome, Fuzi is also used, often combined with Cang Bai Zhu (Pale Atractylodes), Huang Bai (Phellodendron), Can Sha (Silkworm), Ren Dong Teng (Lonicera), Bi Xie (Dichroa), Yi Yi Ren (Coix), and Lao Guo Cao (Old Stork Grass).

In this context, the use of Fuzi is justified, as there is an existing damp evil, which is Yin evil; when dampness is excessive, Yang is weak. Additionally, due to the accumulation of damp-heat, Yang energy is obstructed, hence the use of Fuzi, which is very pungent and warming to promote Yang. Although Fuzi is used, the combinations and dosages differ; for cold-damp Bi syndrome, larger doses (15-30g) are required, while for other conditions, smaller doses (3-6g) suffice. Periarthritis of the shoulder often requires Fuzi, as patients frequently report cold sensations in the shoulder, fear of wind, and a preference for warmth; if they cannot cover their shoulder while sleeping, the pain worsens. Mr. Zhu’s experience is to use Fuzi as the main herb, combined with Gui Zhi, Lou Feng Fang (Bee Nest), Qiang Huo (Notopterygium), Fang Feng (Siler), Jiang Huang (Turmeric), Hai Tong Pi (Erythrina), Chi Shao, Dang Gui (Angelica), Yin Yang Huo (Epimedium), Xi Xin, and Wei Ling Xian (Clematis), with 15 doses as one treatment course, often achieving effective results. Ankylosing spondylitis often requires large doses of Fuzi combined with kidney-tonifying and blood-activating herbs, such as Lu Jiao (Deer Antler), Yin Yang Huo, Shu Di Huang (Rehmannia), Bu Guo Zhi (Psoralea), Lou Feng Fang, Qi She (Agkistrodon), Ba Jiao Tian (Morinda), Di Bie Chong (Eupolyphaga), Chi Shao, and Hong Hua (Carthamus), along with Yi Shen Juan Bi Wan. This condition is quite stubborn and requires persistent medication; results are not seen in a short period.

Not only for Bi syndrome, but many chronic inflammations also frequently use Fuzi

Such as chronic appendicitis, chronic nephritis, chronic pelvic inflammatory disease, chronic bronchitis, etc. Mr. Zhu believes that one should not shy away from using Fuzi just because it has the word “inflammation” in it; Fuzi actually has good anti-inflammatory properties. However, the overall approach should still be based on syndrome differentiation and treatment. At the same time, Fuzi can also be combined with herbs that clear heat and detoxify, as seen in Zhongjing’s treatment of intestinal abscess with Yi Yi Fuzi Bai Jiang San (Coix, Aconite, and Baijang Powder), which has set a precedent. Wang Ang’s “Bencao Beiyao” provides a comprehensive and insightful overview of Fuzi’s functions: “Its nature is floating and not sinking; its use is swift and not restrained, circulating through the twelve meridians, reaching everywhere. It can draw Qi tonics to restore lost Yang; draw blood tonics to nourish insufficient true Yin; promote dispersing herbs to open the pores and expel exterior wind-cold; and draw warming herbs to reach the lower jiao to eliminate internal cold-damp.” This can be referenced.

In summary, Fuzi has a wide range of clinical applications, and when used appropriately, its effects are remarkable. However, it should not be abused. Some doctors, due to its rapid effects in warming Yang and reviving the declining, often misuse Fuzi. There have been reports of a certain famous doctor whose prescriptions during a period included Fuzi in every formula, and no patient was without Fuzi; others have written that Fuzi can be added to any formula, just like adding MSG to enhance flavor, which betrays the spirit of syndrome differentiation and treatment, and is inappropriate. All medicines have their pros and cons, and they must be used judiciously.

Regarding the dosage and method of Fuzi, Mr. Zhu has repeatedly pointed out to us:

First, different individuals have different tolerances to Fuzi.

Some can use 30-60g without issue, while others may experience toxic reactions with just a few grams. Therefore, except in emergencies, it should be used cautiously, starting with a small dose (3-6g); if there are no reactions, the dosage can be gradually increased, generally up to 30g. Once effective, there is no need to continue with large doses; a gradual reduction can also be applied.

Second, the processing of Fuzi

Involves soaking in brine and then steaming, which destroys its toxic components while preserving its effective ingredients. However, the steaming process is still empirical, and it is recommended that research institutions conduct tests to provide the best processing methods for manufacturers. The Japanese processing method involves high temperature and pressure to destroy its aconitine, making it much safer for decoction, and there is no need for pre-boiling or prolonged boiling (of course, the dosage of Fuzi in Japanese Kampo is very small). Given the current situation, if a larger dose of Fuzi is used, it is advisable for the preparer to enter the medicine. It should also be boiled for half an hour, preferably with 3-5 slices of fresh ginger added, or a spoonful of honey for better results. The experience of doctors in Sichuan is to taste until there is no numbness in the mouth. If there is a tingling sensation in the mouth and tongue, it should be boiled again. Additionally, the water used to boil Fuzi should be sufficient at once and not added midway.

In recent years, Mr. Zhu has interacted with the famous TCM practitioner Li Ke from Shanxi, praising his adept use of Fuzi in treating critical conditions. His usual dosage is generally 30g, which can be increased to 50-200g depending on the condition; this is due to precise combinations and appropriate decoction methods, with prolonged boiling and divided doses, and there have been no reports of adverse events, which is worth learning from.

The first symptoms of Fuzi poisoning are dizziness, palpitations, numbness of the mouth, tongue, lips, and limbs, and slurred speech. At this point, one can take a large bowl of rice washing water, which can alleviate the symptoms of poisoning, followed by decocting 60g of licorice for consumption. In severe cases, in addition to the above symptoms, there may be nausea, vomiting, cold and wet skin, chest tightness, slow and weak heart rate, low blood pressure, premature contractions, arrhythmias, decreased body temperature, or sudden convulsions, and immediate hospitalization for emergency treatment is necessary.

This article is sourced from: “Zhu Liangchun’s Experience in Medication”, Hunan Science and Technology Press

The Proper Use of Fuzi to Warm the Yang of the Five Organs

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