Introduction:Fuzi (Aconiti Radix) is one of the four major herbs in traditional Chinese medicine (TCM). Throughout history, countless practitioners have studied and utilized it, especially in critical situations where it has proven to be remarkably effective. However, due to its toxic nature, many practitioners hesitate 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, Use Wisely, Do Not Abuse 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 proper use of Fuzi. In his “Shang Han Lun” (Treatise on Cold Damage), he mentions Fuzi in various formulas for different syndromes. In the Taiyang chapter, there are formulas such as Gui Zhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite), Gui Zhi Qu Shao Yao Jia Fuzi Tang (Cinnamon Twig Decoction without Peony with Aconite), Gan Cao Fuzi Tang (Licorice and Aconite Decoction), and many others, totaling nearly 20 formulas, which account for more than one-sixth of the entire text’s 112 formulas. Among the prescriptions using Fuzi, the most important are those for heart-strengthening, such as the Si Ni Tang (Four Reversal Decoction). It is rare for patients to die from heat diseases caused by heat itself; rather, many succumb to heart failure. Historically, Zhang Ciguang pointed out that “Zhongjing was the first to identify heart failure in heat diseases,” and the first choice for rescuing heat-induced heart failure is indeed Fuzi. In the 1930s, Zhu Weijun gained fame in Shanghai for his adept use of Fuzi, earning the nickname “Zhu Fuzi.” Even in cases of high fever, delirium, dry lips, and rapid pulse, he insisted on using Fuzi, effectively addressing the critical issue of heart failure caused by heat, saving many critically ill patients. Zhang once expressed his admiration for Zhu Weijun’s “ruthless and decisive” use of medicine in the preface of Chen Susheng’s “Shang Han Zhi Nan” (Difficulties in Treating Cold Damage). Zhang was also skilled in using Fuzi. He recognized that in the middle and late stages of heat diseases, when the evil force weakens but the body is still weak, there is a risk of collapse. He praised the use of the “Feng’s True Qi Decoction,” which combines Ren Shen (Ginseng), Fuzi, Di Huang (Rehmannia), and Mai Dong (Ophiopogon) to strengthen the heart and rescue the Yang, nourishing Yin and boosting Qi, which is a novel approach in treating heat diseases. However, the experiences and insights of Zhu and Zhang were often dismissed by less knowledgeable practitioners until they began to resurface in the last thirty years. The use of Si Ni Tang (and its modified forms) in treating infectious shock and cardiogenic shock has become widespread in internal medicine, demonstrating significant heart-strengthening and blood pressure-raising effects, as well as improving microcirculation. Master Zhu pointed out that when using Fuzi for heat diseases, one must observe subtle signs. If symptoms such as cold limbs, profuse cold sweat, weak pulse, and cold breath appear, using Fuzi at that point may be too late. He proposed the following criteria: Tongue is pale, moist, and swollen; thirst without desire to drink, or only desiring hot soup; pale complexion; sweating with cold limbs; clear urine. Even if high fever, delirium, agitation, and rapid pulse are present, Fuzi should still be used to invigorate the declining Yang and prevent the loss of Yang and collapse. Over twenty years ago, under Master 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 eight days, was lethargic, agitated, had rapid breathing, and a pulse of 150 beats per minute, with a pale complexion, sweating, 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 Ke (Bitter Orange), and Jie Geng (Platycodon). The department head questioned the prescription, saying, “Ginseng is a great tonic, and Fuzi is very warming. The child has a temperature above 39°C. According to your TCM theory, the evil heat is rampant; is this appropriate?” I replied, “If there is heart failure, would you not use heart failure medications? This is TCM’s remedy for heart failure.” As a result, after three days of treatment, the child’s condition improved significantly, with a marked decrease in temperature to low fever and a pulse rate below 100 beats per minute. That child is now in middle school. The effective component of Fuzi that strengthens the heart is aconitine. Modern research has confirmed its reliable heart-strengthening effects, improving peripheral and coronary blood circulation, increasing myocardial contractility, enhancing cardiac output, dilating peripheral blood vessels, and reducing peripheral resistance. In the past twenty years, Fuzi injection has been administered intramuscularly or via intravenous drip, effectively enhancing the emergency application of Fuzi. In acute heat diseases, Fuzi is also effective in chronic congestive heart failure. Heart failure fundamentally stems from Yang deficiency, with blood stasis and water retention as secondary issues. For heart failure presenting with 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, Master 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 remarkable results. According to Zhongjing’s methods, Fuzi is used for the urgent rescue of collapse, to restore lost Yang immediately, requiring the use of fresh Fuzi, which has a strong effect. However, improper use of fresh Fuzi can lead to poisoning. Currently, fresh Fuzi is often in short supply, and Master Zhu believes that using processed Fuzi is also very effective, suggesting that it is not necessary to be overly rigid about this. Fuzi Warms 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, low back pain, and fatigue due to deficiency (as in Jin Gui Shen Qi Wan (Kidney Qi Pill)). In formulas for urinary stones, adding Fuzi 3-5 grams enhances stone expulsion. Fuzi Warms 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 is 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 small addition of Wu Mei (Mume), Huang Lian (Coptis), achieving quick effects. Fuzi Also Warms 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, housing the fire of the body. Liver Yin and Liver Blood are the foundation, while Liver Yang and Liver Qi are the functional aspects. 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 twenty diseases. Master 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 severe pain and persistent symptoms, he often combines decoctions to quickly control the condition and alleviate suffering. In cases where wind, cold, and dampness coexist, and symptoms are predominantly cold, Master Zhu often uses 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, with a course of 15 doses often yielding results. In cases of ankylosing spondylitis, large doses of Fuzi are often combined with kidney-invigorating and blood-activating herbs, such as Lu Jiao (Deer Antler), Yin Yang Huo (Epimedium), Shu Di Huang (Rehmannia), Bu Guo Zhi (Psoralea), Lu Feng Fang (Bee Nest), Qi She (Agkistrodon), Ba Jiao Tian (Morinda), Chi Shao, and Hong Hua (Safflower), 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, Fuzi is Also Used for Many Chronic Inflammations Such as chronic appendicitis, chronic nephritis, chronic pelvic inflammatory disease, and chronic bronchitis. Master Zhu believes that one should not avoid using Fuzi just because it has the word “inflammation”; Fuzi actually has good anti-inflammatory properties. Of course, the overall approach should still be based on syndrome differentiation and treatment. Additionally, Fuzi can 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 (Job’s Tears, Aconite, and Baijang Powder), which has set a precedent. Wang Ang’s “Bencao Beiyao” (Essential Herbal Medicine) comprehensively and incisively describes the functions of Fuzi: “Its nature is floating and not sinking; its use is swift and not restrained, passing 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 and cold; and draw warming herbs to reach the lower jiao to expel interior cold and dampness.” 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 warming and invigorating effects, often misuse Fuzi. There have been reports of a certain famous doctor whose prescriptions included Fuzi in every formula, and no patient was treated without it; others have written that Fuzi can be added to any formula 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 usage of Fuzi, Master Zhu has repeatedly pointed out to us: First, different individuals have different tolerances to Fuzi. Some can use 30-60 grams without issue, while others may experience toxic reactions with just a few grams. Therefore, except in emergencies, caution should be exercised. It is advisable to start with a small dose (3-6 grams); if there are no reactions, the dosage can be gradually increased, generally up to 30 grams. Once effective, there is no need to continue with large doses; a gradual reduction can also be adopted. Second, the processing of Fuzi involves soaking it in brine and then steaming it, 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 optimal processing methods for manufacturers. The Japanese processing method involves high temperature and pressure to destroy its aconitine, making it much safer for use in decoctions without the need for prolonged boiling (of course, the dosage of Fuzi in Japanese herbal medicine 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 is also essential to boil it for half an hour, preferably adding three to five slices of fresh ginger or a spoonful of honey during the boiling process. The experience of doctors in Sichuan is to taste it until it is not numbing. 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, Master Zhu has praised the experience of the famous Shanxi TCM practitioner Li Ke, who is adept at using Fuzi to treat critical conditions. His usual dosage is 30 grams, which can be increased to 50-200 grams or more 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 include 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 60 grams of licorice. 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.
Previous Recommendations
White Atractylodes for Stomach Diseases, with Many Functions!Effective Folk Recipe for Treating Spring Eye Itching (from an Ophthalmology Expert)Family Secret Recipe for Treating Difficult External Ulcers— THE END —
▶ Copyright Statement:
1. Source: This article is excerpted from “Zhu Liangchun’s Experience in Medication,” published by Hunan Science and Technology Press, compiled by He Shaoqi, Zhu Buxian, Zhu Jianhua, Zhu Shenghua, Zhu Wanhua, etc., organized by He Shaoqi. Edited by the senior disciple.2. This platform aims to disseminate knowledge of TCM culture, and the copyright belongs to the relevant rights holders. We respect knowledge and labor; please retain copyright information when reprinting. If there are any improper uses, please feel free to contact us for negotiation.Contact (WeChat):gyzdxueshu3. We welcome submissions; submission email: [email protected]
You take every like I receive seriously as a sign of appreciation.