The compatibility of Aconite (Fu Zi) has always been a hot topic. Here, we summarize ten methods of pairing Aconite, focusing mainly on its combination with mineral-based heavy medicines and bitter, cold, blood-activating substances. The balance of cold and warmth, as well as the harmony of movement and stillness, can lead to better outcomes for complex and difficult diseases when appropriate combinations are used.
Hu Qiaowu: Ten Combinations of Aconite
↓Swipe to view the full introduction↓
Introduction:Hu Qiaowu, 1915—2002, male, from She County, Anhui, was the chief physician at the affiliated hospital of Anhui University of Traditional Chinese Medicine. In 1991, he was selected by the Ministry of Personnel, the Ministry of Health, and the State Administration of Traditional Chinese Medicine as one of the first national experts in traditional Chinese medicine to guide the inheritance of academic experience. He was a renowned old TCM doctor in Anhui Province, skilled in diagnosing and treating internal injuries and external febrile diseases. He authored several books, including “Three Character Formula of TCM Clinical Practice,” “Collection of Old TCM Experts’ Experience: Hu Qiaowu Special Edition,” and “A Spoonful of Tangerine Well: Common Seasonal Syndromes and Their Treatments,” and published over 30 academic papers in domestic TCM journals.
Aconite is a pungent and warm herb with a wide range of clinical indications. It is commonly used in combination with warming and tonifying substances; when paired with cold and cool herbs, it serves as a modification method. For syndromes of mixed cold and heat, both warming and cooling medications should be administered. In the “Shang Han Lun,” Aconite is used in 20 formulas.
According to the “Medical Canon,” it is said that Aconite “can guide tonifying Qi herbs to circulate through the twelve meridians, restoring the lost Yang; guide blood tonics into the blood to nourish the insufficient true Yin; guide dispersing herbs to open the pores, expelling 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 medicine for tonifying the true fire of the congenital Mingmen (Gate of Life).”
Zhang Xichun stated: “Aconite is the main herb for assisting the original Yang; its power can ascend and descend, reach internally and disperse externally. For all cold and stagnant conditions in the organs, joints, and meridians, ‘none fail to be effective when taking this.'”
In modern times, Xu Xiaopu proposed that Aconite can “guide fire back to its source and subdue false heat.”
Although Aconite is a crucial herb for dispelling cold and tonifying, it has certain toxicity. When used appropriately, its effects are as strong as drums, but if used improperly, it can lead to disaster. Therefore, ancient practitioners often combined it with other herbs.
As Zhang Jingyue said: “Aconite is aggressive and difficult to handle alone; it must be paired with large sweet herbs, such as Ginseng (Ren Shen), cooked Rehmannia (Shu Di), and honey-fried Licorice (Zhi Gan Cao), which can temper its harshness and enhance its strength, ensuring beneficial outcomes.”
He created many famous formulas combining Aconite with warming and tonifying Qi and blood herbs.Based on the principles of mutual necessity and mutual assistance in herbal compatibility, ancient practitioners also created effective formulas combining Aconite with dried Ginger (Gan Jiang), Cinnamon (Rou Gui), Ephedra (Ma Huang), and Asarum (Xi Xin), but reports of its combination with mineral-based heavy medicines and bitter, cold, blood-activating substances are still rare.In this article, I humbly summarize over 40 years of experience using Aconite in combination with the aforementioned herbs to treat difficult diseases into ten pairings for clinical trial.1Pairing with Gypsum to Treat Wind Water, Cough, and Difficulty in Rash Eruption
In the “Jin Kui,” there is a record under the prescription of “Yue Bi Decoction” stating “For aversion to wind, add one piece of Aconite.” This opened the way for the future use of these two herbs together.Shu Chiyuan used both herbs in the “Six Meridians Differentiation” and cured a case of stubborn dysentery with one dose; Zhao Yangkui combined the two herbs to treat a severe case of diabetes, achieving 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 Decoction with Aconite to treat epidemic meningitis.Although the properties and functions of the two herbs are quite different, I have found that whether for seasonal diseases or miscellaneous diseases, whenever there is a combination of the following three conditions, whether it is a deficiency presenting as a surplus or a mixture of cold and heat, one can confidently use this combination:
① Lung meridian with heat accumulation, Kidney Qi deficiency and cold;
② Internal heat blazing, exterior deficiency with spontaneous sweating;
③ Wind-heat affecting the upper, cold water impacting the lower.
2Pairing with Daizhe Stone to Treat Uterine BleedingFor those with a history of cold deficiency or Yin diseases and Yang, and uterine bleeding with heat in the blood, if using hemostatic agents shows little effect, one can try using Daizhe Stone with Aconite. Zhang Xichun stated:Daizhe Stone “can generate blood and cool the blood, its quality is heavy and sinking,”being bitter and slightly cold, it primarily enters the Lung meridian. When paired with the warm and moving Aconite, it creates a balance of cold and heat, stillness and movement, thus harmonizing Yin and Yang and solidifying the Chong and Ren meridians. In modern times, there are reports of using these two herbs together with Gan Song, Li Lu, and Ling Xiao Hua to treat epilepsy.3Pairing with Shi Jue Ming to Treat Palpitations and HeadachesWhen water and fire do not interact, it can often lead to palpitations and anxiety. Liver Yang combined 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.Shi Jue Ming can calm the rebellious Liver Yang, allowing it to descend, while Aconite can invigorate the Yang of the Mingmen, evaporating Kidney water, allowing it to ascend. The combination of cold and heat, and the interaction of water and fire, can promote the balance of Yin and Yang.This combination is effective for treating insomnia, mania, and other mental disorders caused by Kidney Yang deficiency and excessive Liver fire.Xu Xiaopu used Aconite with Magnetite and Dragon Teeth to nourish Yin and subdue Yang, which is similar to this method.4Pairing with Rhubarb to Treat Hemoptysis, Chest Pain, and DiarrheaFor persistent hemoptysis due to cold obstructing the vessels; for external injuries causing stabbing pain in the chest and ribs, due to Yin obstruction; and for abdominal diarrhea due to deep cold, Rhubarb can be paired with Aconite in different formulas to achieve warming and unblocking effects.According to common treatment principles, warming agents should not be used for purging, and purging agents should not be used for warming.When Aconite is paired with Rhubarb, one is hot and the other cold, working together to promote efficacy despite their opposing properties. Zhang Zhongjing has formulas like Rhubarb and Aconite Decoction and Aconite Xie Xin Decoction, and later practitioners have also created formulas like Warming the Spleen Decoction, all of which are excellent combinations of the two herbs. Recent practitioners have also reported using these two herbs together to treat acute kidney failure caused by epidemic meningitis and to treat appendicitis masses and chronic cholecystitis.5Pairing with Huang Lian to Treat Loose Stools in the Later Stage of Damp-HeatIn the later stage of damp-heat, the middle Yang is often not expressed, leading to dampness obstructing heat, resulting in symptoms of lingering heat and loose stools.Due to heat being trapped in dampness, fever often persists; dampness obstructs the middle jiao, causing disharmony in the bowels and leading to loose stools.These two conditions can be quite challenging for physicians.At this time, using Aconite with Huang Lian in the formula can yield unexpected effects.Huang Lian is bitter and dries dampness, cooling and draining heat, making it an excellent remedy for dampness obstructing heat, leading to body heat not rising and loose stools, with effects unmatched by other herbs.Aconite, being pungent and warm, can invigorate the middle Yang, expel heat outward, and also assist Huang Lian in solidifying 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 evil causing symptoms of heat, sweating, a white coating, irritability, and difficulty sleeping, as well as children with summer heat presenting with thirst, frequent urination, cold limbs, and no sweating. His self-created formula for treating summer heat, Qing Shang Wen Xia Decoction, uses these two herbs as the main ingredients.6Pairing with Huang Qin to Treat Prolonged Chills and FeverFor individuals with a generally weak constitution, after external invasion, the righteous Qi often cannot withstand the evil, leading to prolonged exterior evil.When body heat does not subside, it is due to insufficient sweating and the evil cannot be expelled.If one uses pungent and warming dispersing agents, it can easily injure Yin; if one uses pungent and cooling agents, it may hinder Yang.Therefore, it is advisable to use Xiao Chai Hu Decoction for harmonizing, with a small amount of Aconite to stabilize the middle and expel the evil, which is the best approach.Although Huang Qin, which clears and drains Lung heat, is bitter and cold and not suitable for those with a white coating and cold limbs, Aconite can invigorate Yang Qi and assist in clearing and draining while also promoting the expulsion of evil.7Pairing with Mountain Gardenia to Treat Abdominal PainChest and abdominal pain often presents 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, internal heat with cold limbs, etc.Ancient practitioners often used oppositely flavored herbs together, and the combination of the warm and dispersing Aconite with the bitter and cold resolving heat Gardenia is particularly effective for these symptoms.Their combined effects can relieve pain and resolve stagnation, similar to the combination of dried Ginger with Gardenia for treating stomach pain.8Pairing with Pangolin Scales to Treat Bone Pain, Tumors, and CystsThe use of Pangolin Scales in medicine was first noted in Tao Hongjing’s “Record of Famous Physicians.”Since the Song and Yuan dynasties, it has been used for external symptoms such as sores and for promoting menstruation.Li Shizhen used it in the “Fashengtang Experience Formula” to treat rheumatic cold obstruction, where the whole body is stiff and cannot bend, with unbearable pain.He emphasized its ability to penetrate and unblock meridians, but many practitioners fear its harshness and rarely use it. However, modern practitioners like Long Zhizhang, Zhang Xichun, and Zhang Cigu have effectively utilized this herb.Long praised it as a peaceful general, stating that its efficacy surpasses that of Rhubarb and Croton, as Rhubarb and Croton only break down solid accumulations, while Pangolin Scales can also penetrate and resolve hidden accumulations.
Zhang stated: “The penetrating nature of Pangolin Scales is thorough, thus it can open the organs, pass through the meridians, and reach the joints. Any blood coagulation and accumulation can be resolved. It can also treat tumors, paralysis, urinary obstruction, and abdominal pain.”
Mr. Zhu Liangchun, following the teachings of his mentor Zhang Cigu, also skillfully uses it to treat various difficult conditions.In my experience, whenever encountering pain in the bones and joints due to the combination of cold and heat, stagnation of Qi and blood, as well as pain and swelling in the joints, and tumors or lumps formed after cold coagulation in women and men, I often use Pangolin Scales with Aconite, taking advantage of their contrasting properties to warm and disperse the visible diseases.9Pairing with Xie Qian Cao to Treat Wind-Damp Bi Pain
According to the “Compendium of Materia Medica”: “Xie Qian Cao is effective for liver and kidney wind Qi, numbness in the limbs, bone pain, and wind-damp sores.”
This commonly used wind-damp dispelling herb is mostly pungent and warm, while this herb is unique in that it has bitter properties to dry dampness, cold properties to eliminate heat, and pungent properties to disperse wind.For those with chronic wind-damp conditions, Kidney Yang deficiency, and evil entering the meridians causing heat, symptoms may include widespread joint pain, muscle soreness, and a red tongue with a slightly rapid pulse. When using pungent and warm wind-dispelling and damp-drying agents shows little effect, one can often use Aconite with Xie Qian Cao, treating both the root and the branch, solidifying the proper and dispelling the evil.However, Xie Qian Cao must be prepared with wine and honey, steamed and dried nine times to eliminate its turbid and Yin qualities for best results.10Pairing with Dan Shen to Treat Chest Obstruction, Palpitations, and Irregular PulseAncient practitioners stated: “The chest is the position of Yang, a clear and open place, difficult to bear even a trace of shadow. If obstructed, Yang Qi cannot circulate, leading to pain.”This clearly indicates that the pathogenesis of chest obstruction and pain is related to the failure of chest Yang to thrive, with phlegm turbidity obstructing and leading to blood stasis in the heart vessels.Thus, palpitations and irregular pulse also occur due to chest pain causing Qi and blood stagnation.Therefore, for patients with yellowish complexion, cold extremities, blue-green eyes, pale and swollen tongue with purple spots, or white greasy or light yellow coating, and a pulse that is deep, thin, wiry, or intermittent, along with symptoms of chest tightness and pain, Aconite can be paired with Dan Shen as the main agent.Huang Gongxiu stated: “Dan Shen is bitter and red, neutral and descending, capable of entering the heart and breaking blood stasis.”Since Aconite is also a key herb for strengthening the heart, the combination of these two herbs can directly address the pathogenic factors in the heart and pericardium.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 uses Dan Shen with Aconite to treat joint pain due to cold stagnation and dampness, also benefiting from the warming and blood-moving properties of both herbs.(Hu Guojun, Hu Guotang, Hu Guozhen, Hu Guoying, Ma Jisong compiled)•This article is excerpted from “Liaoning Journal of Traditional Chinese Medicine” (1982)丨Author/Hu Qiaowu