Chinese Medicine Book Club Issue 1932
Daily updates to accompany the growth of TCM practitioners
IIntroduction: Fuzi (Aconite) is one of the four major herbs in traditional Chinese medicine (TCM), alongside Ginseng, Gypsum, and Rhubarb. 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 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. (Editor/Yan Qifeng)
Fuzi Warms the Yang of the Five Organs: Use Wisely, Do Not Abuse
Compiled by He Shaoqi
Fuzi is one of the four major herbs in TCM (Ginseng, Gypsum, 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 effectively using Fuzi. In the “Shang Han Lun” (Treatise on Cold Damage), there are numerous formulas that include Fuzi for various syndromes. In the Taiyang chapter, there are formulas such as Guizhi Jia Fuzi Tang (Cinnamon Twig Decoction with Aconite), Guizhi Qu Shaoyao Jia Fuzi Tang (Cinnamon Twig Decoction without Peony with Aconite), Gancao 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 in the Si Ni Tang (Frigid Extremities Decoction) series, as patients with heat diseases often do not die from heat itself but from heart failure.
In the past, Mr. Zhang Cigong pointed out: “Zhongjing was the first to identify heart failure in heat diseases,” and the first choice for rescuing heat-induced heart failure is Fuzi. 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, he insisted on using Fuzi, effectively addressing the critical issue of heart failure caused by heat, saving many severely ill patients. Mr. Zhang once praised Mr. Zhu’s “ruthless and decisive” use of medicine in the preface of Chen Susheng’s “Shang Han Zhi Nan”.
Mr. Zhang also effectively used Fuzi, particularly in the later stages of heat diseases when the evil force weakens but the body is still weak, posing a risk of collapse. He recommended the use of the “Feng’s True Qi Decoction,” which combines Ren Shen (Ginseng), Fuzi, Di Huang (Rehmannia), 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 Mr. Zhu and Mr. Zhang were often overlooked until recently, when they have begun to regain recognition. The Si Ni Tang (and its modified forms) is 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 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 not save the patient. He proposed the following criteria: a pale, moist, swollen tongue, thirst without desire to drink, or only desiring hot soup; a pale complexion; sweating with cold limbs; clear urine. Even in the presence of high fever, delirium, agitation, and rapid pulse, Fuzi should still be used to invigorate the declining Yang and prevent the loss of Yang leading to 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, with 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 (Lepidium Seed), Zhi Ke (Bitter Orange), and Jie Geng (Platycodon). The head of the department 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 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 patient’s condition improved significantly, with a notable decrease in temperature to low fever, and the pulse dropped below 100 beats per minute. This child is now in middle school.
Fuzi’s effective component for strengthening 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, Fuzi injection has been administered intramuscularly or via intravenous drip, effectively enhancing the emergency application of Fuzi. Acute heat diseases and chronic congestive heart failure can also benefit from Fuzi. 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, 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 method, Fuzi is used for urgent rescue in cases of collapse, to restore lost Yang immediately, and it must be used fresh for maximum effect. However, improper use of fresh Fuzi can lead to poisoning. Currently, fresh Fuzi is often in short supply. Mr. Zhu believes that using processed Fuzi is also very effective, and it is not necessary to be overly strict about it.
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, 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 (3-5g) 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 (Frog 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 that houses 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 genitals. 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 suffering. In cases where cold and dampness coexist, and symptoms are predominantly cold, Mr. 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. For ankylosing spondylitis, large doses of Fuzi are often combined with kidney-tonifying 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 (Worm), Ba Jitian (Morinda), Di Bie Chong (Ground Beetle), 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. Mr. Zhu believes that one should not shy away from using Fuzi just because it has the word “inflammation”; Fuzi actually has good anti-inflammatory properties. Of course, the principle of differentiation and treatment remains paramount. 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 (Job’s Tears, Aconite, and Baijang Powder), which has set a precedent. Wang Ang’s “Bencao Beiyao” provides a comprehensive and insightful description of Fuzi’s functions: “Its nature is floating and not sinking, its use is swift and not restrained, it circulates through the twelve meridians, reaching everywhere. It can draw tonic Qi herbs to restore lost Yang; draw blood-tonifying herbs to nourish insufficient true Yin; promote dispersing herbs to open the pores and expel exterior wind and cold; and warm herbs to reach the lower jiao to eliminate internal 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 effects in warming Yang and invigorating the declining, often misuse Fuzi. There have been reports of a certain famous doctor whose prescriptions included Fuzi in every formula, and every patient received Fuzi; others have written that Fuzi can be added to any formula like adding MSG to enhance flavor, which betrays the spirit of 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 pointed out to us multiple times:
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 optimal processing methods. 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 pre-boiling or prolonged boiling (of course, the dosage in Japanese Kampo medicine is much smaller). Given the current situation, if a larger dose of Fuzi is used, it is advisable for the preparer to enter the medicine. It must be boiled for at least half an hour, and it is best to add 3-5 slices of fresh ginger or a spoonful of honey during boiling. The experience of doctors in Sichuan is to taste until there is no numbness in the mouth. If there is a tingling sensation, it should be boiled again. Additionally, the water used to boil Fuzi should be sufficient from the start, without adding more water midway.
In recent years, Mr. Zhu has praised the experiences of the famous Shanxi TCM practitioner Li Ke, who is adept at using Fuzi to treat critical conditions. His usual dosage is 30g, which can be increased to 50-200g depending on the condition. This is due to precise combinations and appropriate boiling methods, with prolonged boiling and divided doses, and no adverse events have been reported, 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. 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.
Recommended Reading
Li Hanqing: Six Uses and Eight Precautions for Fuzi
Fuzi and Its Ten Good “Partners”
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