Fu Zi (Aconite) is one of the most widely used and important herbs in classical prescriptions. In the “Shang Han Lun” (Treatise on Cold Damage), Fu Zi not only warms the interior and dispels cold but is also crucial for warming and tonifying, saving lives in critical situations. However, due to its toxicity, its clinical application often evokes a sense of both love and fear. This article will outline key issues regarding the processing, dosage, decoction methods, and compatibility of Fu Zi for reference by practitioners.
1.Fu Zi is a powerful tool for reviving yang and dispelling cold, capable of addressing severe illnesses. The Fire God School utilizes it extensively. Zhang Zhongjing differentiated between raw and processed Fu Zi, which is entirely dependent on the physician’s preparation. Currently, the focus is on processing, with the authentic source being Zhongba Town in Jiangyou, Sichuan. In the academic field of traditional Chinese medicine, it is noted that there are many processing types; previously, there were over eight varieties, but now only three remain: salt-processed Fu Zi, black Fu Pian (slices), and white Fu Pian. Thin-layer chromatography results indicate that the alkaloid content of black Fu Pian, white Fu Pian, cooked slices, and yellow Fu Pian is about 1/8 to 1/6 that of raw Fu Zi slices (unprocessed). The alkaloid content of salt-processed Fu Zi is about 1/3 to 1/2 that of raw slices.
Two issues are worth noting: first, during the processing of black Fu Pian, some small cut pieces are referred to as “Fu Ba Pian” and sold together with black Fu Pian; second, in recent years, some individuals, driven by profit, have abandoned standards and used toxic chemical materials for improper processing. Therefore, it is essential to thoroughly investigate the source of Fu Zi products to prevent accidents. If one encounters substandard toxic Fu Zi, even the most skilled physician cannot provide a clear explanation for the resulting issues.
2.The dosage of Fu Zi: The pharmacopoeia states 3-15g. Zhang Zhongjing used 1 piece of raw Fu Zi or 1-3 pieces of processed Fu Zi. Based on 1 piece of Fu Zi weighing 20-30g, the maximum dosage can reach around 90g. However, it should only be decocted once and taken in three doses. Today, the dosage of Fu Zi in the Fire God School is astonishing, reaching 100-300g, which is not advisable for beginners without medication experience. Contemporary renowned physicians use Fu Zi in the following dosages: Yin Huihe 3-30g, Jiao Shude 3-12g, Zhu Liangchun 3-30g. Huang Huang advocates that in emergencies requiring revival of yang, the dosage of ginger and Fu Zi should be between 20-100g to be effective.
3.The issue of pre-decocting Fu Zi: In the “Shang Han Lun”, Fu Zi, whether raw or processed, is not pre-decocted. However, each formula is only decocted once and taken in 2-3 doses. The Gui Zhi Jia Fu Zi Tang (Cinnamon Twig Decoction with Aconite) states: “Originally it was Gui Zhi Tang, now with the addition of Fu Zi, it should be prepared as before.” This means to observe the condition according to Gui Zhi Tang and take the medicine in divided doses. Textbooks indicate pre-decocting for 30-60 minutes. The vast majority of physicians advocate pre-decocting, preferably with boiling water. I suggest that for a dosage of 3-6g of Fu Zi, pre-decocting is unnecessary. For a dosage of 10-15g, pre-decoct for 20 minutes, and for every additional 10g, increase the pre-decocting time by 10 minutes. According to research in “One Hundred Classical Formulas”, pre-decocting Fu Zi for over 1 hour significantly diminishes its efficacy.
4.The issue of Fu Zi and Ban Xia (Pinellia): Zhang Zhongjing did not mention this, but there is evidence in the “Jin Gui Yao Lue” (Essential Prescriptions of the Golden Cabinet) regarding Fu Zi and rice soup. Before retirement, I treated a case: a 45-year-old Uyghur male blacksmith suffering from intestinal tuberculosis for many years, experiencing intermittent symptoms despite treatment with anti-tuberculosis drugs. Due to significant abdominal pain, frequent borborygmi, and loose stools, he visited the clinic 2-3 times a day. Abdominal palpation revealed a doughy texture, with significant pain in the right lower abdomen but no tenderness, good appetite, a wiry and thin pulse, and a white greasy tongue coating. Following the teachings of Teacher Hu Xishu, I prescribed Fu Zi and rice soup with the original formula plus Zhi Qiao (bitter orange), using 15g of Fu Zi (pre-decocted for 20 minutes), 10g of Qing Ban Xia, 6g of Zhi Gan Cao (licorice), 15g of Zhi Qiao, 5 dates, and 1 tablespoon of rice, for 5 doses. After taking the medicine, the abdominal pain significantly decreased without adverse reactions. Subsequently, he intermittently took the medicine for 3 months, with each course consisting of 5 doses, totaling over 30 doses, and the condition was resolved, with the abdominal distension disappearing. The patient even gifted me an axe as a token of gratitude.
The State Administration for Market Regulation of the People’s Republic of China pointed out in the “National Standards for the Processing of Traditional Chinese Medicine” (1988 edition) that Fu Zi should not be used with Ban Xia, Gua Lou (Trichosanthes), Bai Ji (Bletilla), or Bai Lian (Smithsonia). This is enforced in hospitals’ traditional Chinese medicine pharmacies nationwide. The “Cihai” (Dictionary of Chinese Terms) contains eighteen counter-indications, but lacks authoritative sources.
5.The issue of Fu Zi poisoning: Pharmacological studies indicate that raw Fu Zi contains aconitine, mesaconitine, and other alkaloids. Toxicological studies show that the toxicity of Fu Zi primarily affects the heart. Its toxicity is greatly reduced after hydrolysis.
Symptoms of poisoning: Mild cases may experience tongue numbness, lip numbness, excessive salivation, slurred speech, palpitations, rapid pulse, coarse breathing, and clear consciousness 10-20 minutes after ingestion; severe cases may experience worsening numbness of lips, tongue, and limbs, nausea, vomiting, dizziness, difficulty breathing, arrhythmia, hypotension, or shock. For out-of-hospital rescue from Fu Zi poisoning, honey (200-300g) dissolved in water is simple and effective. Alternatively, raw licorice (100-200g) can be decocted in water, or mung bean soup can be taken frequently.
I have encountered two cases of Fu Zi poisoning: the first was in 1963 when teachers Wang Ziyu, Yang Jiasan, and Wei Woqian took our class to complete mid-term internships in Yongning Commune, Yanqing County. One night, an emergency patient came in who had taken traditional Chinese medicine about half an hour earlier and experienced nausea, vomiting, tongue numbness, excessive salivation, dizziness, and palpitations, but remained conscious. After symptomatic treatment, the symptoms gradually improved, and she was kept for observation at the health center. The teachers were surprised and checked the prescription, finding 30g of Fu Zi, which seemed impossible to cause such a strong reaction. They immediately checked the decoction pot and found that the amount of Fu Zi was excessive, having been left on the stove overnight to dry, weighing nearly 90g. It was later confirmed that the pharmacy had mistakenly interpreted 30g as 300g, causing quite a scare. The second case was in 1972 when a team from the Autonomous Region’s Traditional Chinese Medicine Survey Group came to Manas County for field investigations. In Qingshuihe Town, a local Kazakh elder pointed to a certain herb and said that it was inedible for cattle and horses, and a small root could poison a horse. A skeptical ethnic leader present licked the freshly dug root with his tongue and quickly felt numbness, prompting professional personnel to rush him back to the county hospital, where he was given 500mL of 5% glucose, and everything returned to normal without incident.
6.Zhang Zhongjing used Aconite with a large amount of honey to reduce its toxicity. When using Fu Zi, it is often combined with Gan Jiang (dried ginger), Gan Cao (licorice), or Zhi Gan Cao (honey-fried licorice). Modern research indicates that Zhang Zhongjing’s method of decocting Fu Zi with ginger and licorice not only effectively reduces the toxicity of Fu Zi but also enhances its efficacy. Zhou Fengwu in “Ancient and Modern Medicinal Formulas” states: “Cooked Fu Pian with dried ginger and licorice, the alkaloids undergo chemical changes, greatly reducing toxicity.” Therefore, it is recommended to use Fu Zi in conjunction with dried ginger or fresh ginger, and licorice or honey-fried licorice.
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