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Editor’s Note

Aconite (Fu Zi) is well-known in Traditional Chinese Medicine (TCM) for reviving yang and rescuing from collapse. It can be processed into various forms such as salt-processed Aconite, black slices, white slices, roasted slices, and light slices. Do you know how to distinguish between them? Are you aware of how to apply Aconite in clinical practice?

We have selected articles by Dr. Zhao Liang and Dr. He Shaoqi to share their clinical experiences, which may provide some inspiration.

Discussion on the Usage and Dosage of Aconite

Author: Zhao Liang

Different Types and Processing Methods of Aconite

Aconite is a processed product of the tuberous root of the plant Aconitum, which is a perennial herb that grows in mountainous grasslands or shrublands, distributed in southern Liaoning, Henan, Shaanxi, Gansu, Shandong, and Jiangsu. It is mainly cultivated in Sichuan, harvested from late June to early August, removing the mother root, fibrous roots, and soil, commonly referred to as “mud Aconite.” The processed products are as follows.

1. Salt-Processed Aconite: Choose large, uniform mud Aconite, wash it, soak it in a solution of edible gall water overnight, then add salt and continue soaking, taking it out daily to dry in the sun, gradually extending the drying time until a large amount of crystalline salt (salt frost) appears on the surface and the texture hardens, commonly referred to as “salt-processed Aconite.”

2. Black Slices: Take mud Aconite, wash it according to size, soak it in a solution of edible gall water for several days, boil it in the soaking liquid until thoroughly cooked, remove it, rinse with water, cut it into slices about 0.5 cm thick, then soak in water, dye the slices with a coloring solution to a deep tea color, steam until an oily surface appears, then dry it until semi-dry or continue drying, commonly referred to as “black slices.”

3. White Slices: Choose uniform-sized mud Aconite, wash it, soak it in a solution of edible gall water for several days, boil it in the soaking liquid until thoroughly cooked, remove it, peel off the outer skin, cut it into slices about 0.3 cm thick, soak in water, steam until cooked, dry until semi-dry, and then dry after sulfur fumigation, commonly referred to as “white slices.”

4. Roasted Slices: Take clean river sand, place it in a roasting container, heat with a strong fire until flexible, add clean Aconite slices, stir continuously until they puff up and slightly change color, remove, sift out the sand, and cool.

5. Light Slices: Take clean salt-processed Aconite, soak it in clean water, changing the water 2-3 times daily until the salt is completely removed, then boil with licorice and black beans until thoroughly cooked, cut into thin slices, dry, and sift out the fragments. For every 100 kg of salt-processed Aconite, use 5 kg of licorice and 10 kg of black beans.

Usage of Aconite

Having understood the commonly used processed forms of Aconite in today’s medical market, let us discuss the usage and dosage of Aconite.

Generally speaking, Aconite is toxic, and the longer the cooking time, the safer it may be. However, the toxicity of Chinese herbs can sometimes also be a therapeutic effect. As stated in the “Rites of Zhou, Tian Guan”: “The physician manages the medical orders, gathering toxic herbs for medical purposes.”

In clinical practice, Aconite is not necessarily better with longer cooking times. For example, in the formula Si Ni Tang from the “Treatise on Cold Damage,” one piece of Aconite is used raw, boiled with three sheng of water to yield one sheng and two he, indicating that the cooking time for Aconite in the “Treatise on Cold Damage” is not very long.

From the boiling method, it can be seen that in Si Ni Tang, Zhang Zhongjing did not emphasize prolonged cooking. In the Gan Cao and Gan Jiang Decoction, three sheng of water is boiled to yield one sheng and five he, while Si Ni Tang uses three sheng of water to yield one sheng and two he. This comparison shows that the cooking time for Si Ni Tang is not much longer than that of Gan Cao and Gan Jiang Decoction. This indicates that with accurate differentiation and corresponding formulas, a small dose of Aconite can be used without prior decoction. Currently, hospitals mainly use black slices or light slices, which are already processed and have significantly reduced toxicity. However, if a large amount of Aconite is used, it is still recommended to decoct it first to ensure clinical safety.

Dosage of Aconite

Now let us discuss the dosage of Aconite.

I do not advocate the large-scale use of Aconite for common diseases unless in emergencies to revive yang and rescue from collapse; otherwise, one should not blindly use large doses to warm yang, such as 100g or 200g of Aconite.

As we learn from the “Huangdi Neijing,” “A little fire generates qi, while a strong fire consumes qi,” meaning that small doses of warming yang can replenish yang qi, while large doses, although effective in the short term, will inevitably deplete the body’s yang qi over time. Once Aconite is stopped, the yang qi will be even more deficient. It is like a child’s growth; if parents do everything for them (large doses of warming yang), they will inevitably achieve nothing when they grow up. However, if they are slightly supported when they go astray (small doses of warming yang), they can become great in the future.

Moreover, every medication has its safe dosage range, with effective doses and toxic doses. Once one understands Chinese culture, it becomes clear that TCM often treats diseases by adapting to circumstances, using a little to achieve a lot. In urgent and critical conditions, one can initially use a heavy dose to revive yang, but once the yang qi is restored, do not continue with large doses of warming yang; instead, follow up with small doses of tonifying formulas to achieve the best results.

Clinical Experience with Aconite

Next, I will share my experience with the dosage and usage of Aconite in clinical practice.

1. Dosage: In my unit’s pharmacy, we use black slices, and my usual dosage is 5~20g, with a maximum of 30g for extremely rare cases of severe yang deficiency, such as some acute left heart failure patients, where I use 20~30g, which has shown excellent efficacy.

2. Cooking Time: I usually prescribe that patients boil it vigorously, then simmer for at least 1 hour, so I rarely require Aconite to be decocted first in my prescriptions.

3. Aconite Indications: Cold extremities, joint pain, undigested stools, and overall body weakness.

4. Aconite Combinations: For exterior yang deficiency, Aconite is combined with Ma Huang; for interior yang deficiency, Aconite is combined with Gan Jiang.

[Appendix] He Shaoqi: A Discussion on Aconite

Author: He Shaoqi

From Zhang Zhongjing to Myself: Experiences in the Application of Aconite

It is said that people from Sichuan like to use Aconite due to the humid climate of the basin. This does not mean that they do not understand Aconite, nor do they understand the words of Sichuan people. Zhang Zhongjing was the first person to skillfully use, advocate for, and frequently use Aconite. Zhang Zhongjing used Aconite:

• In combination with Gan Jiang and Gan Cao (Si Ni Tang) as the primary formula for reviving yang and rescuing from collapse;

• In combination with Fu Ling, Bai Zhu, Bai Shao, and Sheng Jiang (Zhen Wu Tang) to treat edema;

• In combination with Ren Shen, Bai Zhu, Fu Ling, and Bai Shao (Aconite Decoction) to warm and tonify the original yang;

• In combination with Ma Huang and Xi Xin (Ma Huang Fu Zi Xi Xin Tang) to warm the meridians and release the exterior;

• In combination with Bai Zhu, etc. (Gui Zhi Fu Zi Qu Gui Jia Bai Zhu Tang) to treat painful joints due to wind-dampness (Bai Zhu is a sacred herb for removing dampness);

• In combination with Ban Xia, Jing Mi, Da Zao, and Sheng Jiang (Aconite Jing Mi Tang) to warm the spleen and stop diarrhea;

• In combination with Da Huang and Xi Xin (Da Huang Fu Zi Tang) to warm and eliminate cold accumulation;

• In combination with Da Huang, Huang Qin, and Huang Lian (Fu Zi Xie Xin Tang) to support yang and resolve phlegm;

• In combination with Sheng Di, E Jiao, Huang Tu, Bai Zhu, Gan Cao, and Huang Qin (Huang Tu Tang) to warm the spleen and stop bleeding;

• In combination with Yi Yi Ren and Bai Jiang Cao (Yi Yi Fu Zi Bai Jiang San) to treat intestinal abscess;

• In combination with Wu Mei, Huang Lian, Huang Bai, and Chuan Jiao (Wu Mei Wan) to treat roundworm convulsions and chronic diarrhea;

• In combination with Di Huang, Shan Zhu Yu, Shan Yao, Dan Pi, Fu Ling, Ze Xie, and Gui Zhi (Shen Qi Wan) as a foundational formula for tonifying the kidneys…

It can be said that he has maximized the use of Aconite, and Zhang Zhongjing was not from Sichuan.

Since Zhang Zhongjing, the clinical application of Aconite has become even more widespread, such as:

• In “Ancient and Modern Records of Efficacy,” Aconite is combined with Ma Huang, Gui Zhi, Dan Shen, Ren Shen, Fang Feng, Xing Ren, Fang Ji, Huang Qin, Sheng Di, and Gan Cao (Xiao Xu Ming Tang) to treat unbearable wind-cold joint pain, and severe back pain that cannot be turned at night.

• In “Qian Jin Fang,” Aconite is combined with Xi Xin, Fang Feng, Gan Jiang, Shan Zhu Yu, and Fu Ling (San Wu San) to treat severe cold in the wind palace, with urgent headaches and tight neck muscles.

• In “Jin Xiu Fang,” Aconite is combined with Bai Zhu, Gan Cao, Da Zao, and Sheng Jiang (Zhu Fu Tang) to treat dizziness due to wind deficiency.

• In “Zhou Hou Fang,” Aconite is combined with Tian Xiong and Chuan Wu (San Jian Tang) to treat original yang deficiency with cold evil entering, resulting in a submerged pulse.

• In “Tai Ping Sheng Hui Fang,” Aconite is combined with Du Huo, Niu Xi, Gui Xin, Chuan Xiong, Chi Shao, Dang Gui, and Tao Ren (Du Huo San) to treat cold stagnation and wind qi attacking, causing limb pain.

• In “San Yin Fang,” Aconite is combined with Gan Jiang, Gan Cao, Ren Shen, Shao Yao, Fu Ling, Gui Xin, and Bai Zhu (Aconite Eight Herbs Decoction) to treat joint pain in the limbs, as if being hammered and cannot be tolerated.

• In “Ju Fang,” Aconite is combined with Cao Wu, Quan Xie, Tian Ma, Cang Zhu, and Walnut Meat (Shan Shen San) to treat kidney qi deficiency, causing pain in the waist and joints, and inability to bend the knees;

• In combination with Lu Rong, Rou Cong Rong, Ren Shen, Shu Di, Rou Gui, Shi Hu, Wu Wei Zi, Huang Qi, Fu Ling, Bai Shao, Bai Zhu, Ban Xia, and Gan Cao (Lu Rong Da Bu Tang) to treat various deficiencies in pregnant women;

• In combination with Ren Shen, Gan Jiang, Gan Cao, Rou Gui, Wu Zhu Yu, Mai Ya, Shen Qu, Zhi Shi, Jie Geng, and Xi Xin (Da Wen Pi Wan) to treat spleen and stomach deficiency cold, causing food not to digest, and insufficient appetite.

• In “Chi Shui Xuan Zhu,” Aconite is combined with raw Aconite, raw Ban Xia, and raw Sheng Jiang (San Sheng Yin) to treat phlegm dizziness.

• In “Zhang’s Medical Communication,” Aconite is combined with Bai Guo, Ju Hong, Sheng Jiang, and Gan Cao (Leng Xiang Yin Zi) to treat abdominal pain and vomiting in the summer months.

• In “Medical Insights,” Aconite is combined with Gan Jiang, Bai Zhu, Gan Cao, and Yin Chen (Yin Chen Zhu Fu Tang) to treat jaundice.

The above famous formulas are just a few examples, and there are countless more. From the Tang and Song dynasties to the Ming and Qing dynasties, from official texts to personal writings, it is evident that the use of Aconite is extensive! Recently, the esteemed Zhu Wei Ju has also used Aconite combined with Zao Ren to treat tachycardia and premature contractions; combined with Zhi Mu to treat febrile diseases with thirst; and combined with magnetite to treat insomnia due to neurasthenia. Mr. Jiang Chunhua believes that many chronic difficult diseases, especially many chronic inflammations, do not respond to conventional methods of clearing heat and detoxifying, because the body is weak from prolonged illness, and damp-heat fire toxins are unresolved. He has been inspired by Zhang Zhongjing’s Wu Mei Wan and Yi Yi Fu Zi Bai Jiang San, breaking conventions, using warming and clearing together, and tonifying and purging simultaneously, treating the body and disease together. For example, he treated Behçet’s disease by combining Aconite with Dang Shen, Huang Qi, Gan Cao, Yin Yang Huo, Huang Lian, Huang Qin, Dan Pi, Pu Gong Ying, and Ban Zhi Lian, achieving effective results.

I also have some insights on Aconite. In addition to what has been mentioned:

• For kidney issues, I use Gan Jiang Ling Zhu Tang with Aconite, which is more effective;

• For shoulder periarthritis, I often use Huang Qi, Dang Gui, Bai Zhu, Yin Yang Huo, Wei Ling Xian, Xi Xian Cao, Gui Zhi, Jiang Huang, and Hai Tong Pi, but I must use Aconite heavily; otherwise, it will not be effective;

• For those with weak constitutions, I use Yu Ping Feng San with Aconite, ginger, and dates;

• For acute nephritis onset, with chills, no sweating, and edema, I use Ma Huang Fu Zi Xi Xin Tang;

• For chronic nephritis edema, I use Zhen Wu Tang and Shi Pi Yin, both with Aconite as the main herb;

• For persistent diarrhea, early morning diarrhea, and elderly incontinence, I use Li Zhong He Si Shen, adding Rou Gui and Aconite to warm and tonify the life fire;

• For oral ulcers that do not respond to cooling herbs, it is often due to excess yin and floating yang, and I can use Jiang Aconite to break yin and revive yang, ensuring that the yin haze dissipates and the fire settles in its place;

• For chronic pharyngitis, I use one piece of Aconite honey-fried, cut into small pieces to swallow;

• For dysmenorrhea with cold symptoms, I use Aconite combined with Dang Gui.

In summary, based on ancient and modern experiences with Aconite, it is a versatile herb that can be used for various purposes, whether to attack or tonify, to warm or cool, to promote or stop, and for internal or external use. Its effects are remarkable when used appropriately, and it holds an irreplaceable role among herbs, making it not an exaggeration to call it the “leader of all herbs.”

The Issue of Aconite Dosage, Cooking Method, and Compatibility with Ban Xia

The dosage of Aconite has always been a topic of great debate. In Zhang Zhongjing’s formula, one piece of Aconite is used, processed into eight pieces, which amounts to about 60g. A large piece of Aconite weighs about 6-8g, and when it is “processed,” it refers to raw Aconite, which is more potent. Therefore, when using Aconite, there is no need to be overly cautious; initially using 10-15g is fine, and if there are no issues, it can be increased to 30g or more.

For treating bi syndrome with yang deficiency and cold intolerance, I generally use over 30g, and I have often faced refusals from pharmacies to dispense it, requiring me to sign a waiver. However, there have been instances where they still refused even after signing. I once treated a patient with rheumatoid arthritis, using 30g of Aconite per dose, and the pharmacy refused to dispense it. The patient had a relative in the Haidian pharmacy, which allowed them to obtain it, and after taking over a hundred doses, they recovered, having used several tens of kilograms of Aconite in total. I also treated another patient with cold-damp bi syndrome, using 30g of Aconite, which was ineffective, so I increased it to 60g. They preferred to cook both doses together, resulting in an actual use of 120g. I am not saying that larger doses are always better, but for severe and critical conditions, using only a few grams is akin to scratching the surface and will not resolve the issue.

Aconite must be decocted first. For small doses (around 9g), decoct for half an hour; for medium doses (around 15g), decoct for 1 hour; for large doses (over 30g), decoct for 2 hours. After the first decoction, simmer on low heat for 40 minutes. When decocting Aconite, adding a piece of ginger (about 30g, smashed) and 1 tael of honey is better, as it can reduce the toxicity of Aconite.

Using Aconite will not lead to accumulation of toxicity. There is a patient with ankylosing spondylitis in Shenyang who has taken over 400 doses, each with a heavy use of Aconite up to 30g, totaling several tens of kilograms of Aconite. Since the initial diagnosis, they have continued to work and have basically recovered.

In ancient texts, it is said that Aconite is incompatible with Ban Xia, Gua Lou, Bei Mu, Bai Ji, and Bai Lian, which are part of the “Eighteen Incompatibilities.” However, it does not state that Ban Xia and Gua Lou are incompatible with Aconite. Chuan Wu is the mother plant of Aconite, but these are two different herbs. If it is said that Aconite is also incompatible with Ban Xia and Gua Lou, it would be a “guilt by association.” Moreover, the combination of Aconite and Ban Xia has already been pioneered by the medical sage Zhang Zhongjing.

There are many opportunities for the combination of Ban Xia and Aconite. If you want me to prove it, I can cite over 100 medical cases and prescriptions from ancient and modern times as evidence. Once, in a prescription where I used both Ban Xia and Aconite, a pharmacy worker looked at the prescription and was greatly disdainful, asking which quack doctor wrote it, claiming it showed a lack of common knowledge. I was not angry but could only smile bitterly. Renowned contemporary doctors such as Jiang Chunhua, Zhu Liangchun, and Yan Dexin have all seriously written articles refuting the claim that Ban Xia is incompatible with Aconite. Interested readers may wish to look them up.

Friendly Reminder: The various prescriptions and formulas mentioned in this article are for reference and learning purposes for professional TCM practitioners only and should not be used as prescriptions. Please do not blindly try medications, as this platform does not bear any responsibility for any consequences arising from this.

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