Gu Parasite Herbs From Heiner Fruehauf

Excerpted from LYME DISEASE: AN IN DEPTH INTERVIEW WITH HEINER FRUEHAUF (click for entire article)

Fruehauf: “To treat Lyme-like diseases, the Gu classics therefore outline an approach that incorporates herbs with wind-dispelling effect—a relatively novel concept, since most of us have been conditioned to use winddispelling herbs only for acute disorders and for short periods of time.

The first and most important category of traditional brain Gu treatment, therefore, does not feature botanicals considered to be directly anti-parasitic, such as Qinghao. It offers herbs that disperse wind, and at the same time limit damage to the patient’s source qi (like Mahuang, ephedra), thus making them suitable for long term use. These herbs should further be combined with “internal herbs,” such as anti-parasitic qi tonics, blood tonics, and yin tonics. This pairing will make them even safer for long-term use.

The next set of categories consists of anti-parasitic and immune-modulating herbs that are generally considered to be tonic,  particularly for the damaged blood, qi, and yin aspects of the body. I have discussed these categories at length in previous interviews and articles on the general treatment of Gu syndrome.

The blood and yin tonic categories are of particular interest in the treatment of Lyme. Note that China’s first single herb classic, Shen Nong bencao jing (Shen Nong’s Materia Medica), lists the famous blood tonic Danggui (Angelica sinensis) as an herb that treats malaria and other jungle fevers. Chuanxiong (Ligusticum wallichii) and the rarely used leaf of the same plant (Miwu), are particularly effective in alleviating headaches. Headaches are, of course, a major symptom for patients suffering from inflammation of the brain. Miwu is unfortunately not available in the West, so I began to manufacture it into a powdered extract myself, and import them under the Classical Pearls label.

There is also a category of herbs for body pain, which is another common symptom for Lyme patients. In this category, you have Xuduan (Dipsacus), which is often used as a Lyme treatment in the form of Teasel root tincture by naturopaths. I particularly like to use Wujiapi (Acanthopanax) for spirochetes. I also use Shenjincao (Lycopodium) for arthritic body pain. I use Shenjincao not only for rheumatoid arthritis, which is often a sequella of Lyme, but also preventatively to guard against the emergence of  rheumatic conditions in the future.

Another category of herbs addresses the notorious biofilm, a slimy matrix in which micro-organisms tend to embed themselves. This self-produced barrier enables the pathogens to evade attack by the immune system, and escape the noxious effect of  anti-parasitic substances. This protective film is difficult to break open, transform, or expel. The ancient Chinese approach to Brain Gu pathogens appears to have accounted for this ohenomenon, since Gu Formulas regularly contain aromatic herbs that move qi and blood and are simultaneously anti-parasitic, such as Sanleng (Sparganium), Ezhu (Zedoria), Yuzhu (Curcuma) and Zelan  (Lycopus). In addition, the earthworm Dilong (Lumbricus), represents the natural precursor to the extract Lumbrokinase, which some naturopaths and MDs now use for the specific purpose of breaking down biofilm. These herbs specifically address the problem of bio-film. The Chinese have used this approach for eons: use a worm to address another “worm” in you body, an almost homeopathic principle.

Finally, there are the herbs with a direct anti-parasitic effect, lead by Qinghao. There are lots of other anti-Gu and anti-malarial herbs in this category. Some are well known like Xuanshen (Scrofularia) and Tufuling (Smilax). Others are completely forgotten like Xuchangxing (Cynanchum) and Guijianyu (Euonymus alatus). In Chinese, the latter’s name literally means “the arrow that kills demons.” There is a long list of herbs in this category, and it is from here that most Western Lyme prescriptions are culled.

The next important category consists of herbs that stabilize the immune system to treat and prevent autoimmune complications. Spirochetes are recognized by our immune system as a particularly tricky invader; consequently, it often goes into overdrive in response to the presence of these pathogens. Among the Chinese organ networks, it is the Spleen that is most often implicated in autoimmune processes.

Some Chinese medicine texts, therefore, describe the Spleen as “the mother of all wind.” On the Chinese organ clock, for instance, the Spleen is located in the position of the 4th lunar month, which used to be called the “wind corner” of the zodiac. It is important to point out that herbs affecting the Spleen were not exclusively thought of as qi tonics such as ginseng and astragalus. Ancient texts also relate certain herbs that clear wind and blood heat to the Spleen. Three herbs that I find particularly important in this context are the classic food items Wanggua (Snake gourd), Jicai (Shepherd’s purse) and Kucai (Hare’s lettuce). These herbs are never used as ingredients in Chinese herbal formulas anymore, but I find them exceedingly useful and have begun to import them as part of the Classical Pearl powdered extract series, as well.

The last, and perhaps most important, category in this anti-Lyme material medica is composed of warming and strongly anti-parasitic herbs from the aconite family. During the last three years, when I synthesized the knowledge transmitted in the classic Gu texts into a general approach to Lyme, I concluded that the use of aconite is indispensible for most Brain Gu patients, especially in the middle and later stages of treatment. I have found different varietals of aconite to be integral elements of a long-term treatment plan for Lyme disease and other forms of nervous system inflammation, specifically Fuzi (lateral offshoots of Aconitum carmichaelii root), Chuanwu (taproot root of same plant) and Caowu (Aconitum kusnezoffii).

At the beginning of this discussion, I emphasized how important I believe it is to work WITH the life force rather than against it—recommending, in essence, a sustained support of the body’s yang qi. The brighter the body’s alarm lights are turned on—and few pathogens activate emotional and physical symptoms like Lyme spirochetes—the greater the stress and the gradual depletion of the body’s yang forces. At the beginning of therapy, Lyme patients may exhibit superficial signs of heat, such as rapid pulses, rashes, feverish sensations, and nightsweats, yet these most often mask an underlying condition of coldness and exhaustion. Once these symptoms disappear with the moderate to slightly cooling approach outlined in the design of Lightning Pearls, Thunder Pearls, Ease Pearls, and Dragon Pearls, the more the body will be comforted by the use of formulas that warm the yang and consolidate the body’s mingmen (gate of life) “battery.”

“When designing a custom Brain Gu formula, I typically use 12-15 herbs, with an average of 1-3 herbs from each of these categories. I find it important to consistently rotate at least one herb in each category every 4-6 weeks. In this way, you can stay ahead of the adaptive ability of the parasite, and avoid triggering allergic responses from your own body. This procedure can include minor changes, such as changing Guizhi to Rougui, or Fuzi to Chuanwu within a category; or medium changes, which involve changing at least one herb in each category; or major changes, which result in a change of the entire base formula.

Dosages vary: generally, I use between 12-18g of powder extracts per day (equivalent to 60-90g of decocted crude herbs per day), but in certain cases of extreme sensitivity I start with a much smaller dosage (2-6g per day), otherwise the super-sensitive types may be overwhelmed by so-called Herxheimer reactions—a common phenomenon in Lyme patients, when the spirochetes are still strong enough to react to a newly introduced treatment.”

 

Anti-lyme wind dispelling herbs:

  • Jinyinhua (Lonicera)
  • Lianqiao (Forsythia)
  • Baizhi (Angelica dahurica)
  • Zisu (Perilla)
  • Gaoben (Ligusticum sinense root)
  • Chaihu (Bupleurum)
  • Guizhi (Cinnamon twig)

 

Biofilm destroying herbs:

  • Sanleng (Scirpus)
  • Ezhu (Zedoaria)
  • Yujin (Curcuma)
  • Zelan (Lycopus)
  • Huajiao (Zanthoxylum)
  • Dilong (Lumbricus)

 

Anti-parasitic herbs:

  • Qinghao (Artemisia annua)
  • Guanzhong (Dryopteris)
  • Huzhang (Polygonum cuspidatum)
  • Guijianyu (Euonymus alatus)
  • Xuchangqing (Cynanchum)
  • Changshan (Dichroa)
  • Miwu (Ligusticum wallichii leaf)
  • Dasuan (Garlic)

 

Anti-lyme blood tonics:

  • Danggui (Angelica sinensis)
  • Chuanxiong (Ligusticum wallichii root)

 

Anti-lyme yin tonics:

  • Baihe (Lily)
  • Heshouwu (Polygonum)
  • Huangjing (Polygonatum root)
  • (Bei) Shashen (Glehnia)

 

Auto-immune:

  • Wanggua (Snake gourd)
  • Jicai (Shephard’s purse)
  • Kucai (Hare’s lettuce)
  • Huangqi (Astragalus)

 

Calming herbs (for adrenal stress, mental/emotional symptoms):

  • Danshen (Salvia)
  • Suanzaoren (Zizyphus)
  • Yejiaoteng (Polygonum stem)
  • Hehuanpi (Albizzia bark)
  • Shichangpu (Acorus)

 

Warm yang, draw life energy back into the battery:

  • Fuzi (Aconitum carmichaeli, lateral root offshoots)
  • Chuanwu (Aconitum carmichaeli, mother root)
  • Caowu (Aconitum kusnezoffi)
  • Rougui (Cinnamon bark)
  • Ganjiang (Ginger, dried)
  • Paojiang (Ginger, roasted)
  • Shengjiang (Ginger, fresh)
  • Wuzhuyu (Evodia)

 

Body pain:

  • Wujiapi (Acanthopanax)
  • Xuduan (Dipsacus)
  • Shenjincao (Lycopodium)

 

 

NOTE: In an earlier article, Fruehauf gave the following categories

Herbs that Scatter Toxins (San Du):

  • Zi Su Ye
  • Bai Zhi
  • Bo He
  • Gao Ben
  • Sheng Ma
  • Ju Hua
  • Lian Qiao

Qi and Blood Tonics with Anti-Gu Natures:

  • Dang Gui
  • Bai Shao
  • He Shou Wu
  • Huang Qi
  • Gan Cao
  • Wu Jia Pi

Herbs that Calm the Spirit (An Shen):

  • Huang Jing
  • Bai He
  • Sha Shen
  • Sheng Di
  • Xi Yang Shen
  • Fu Shen
  • Jiang Xiang
  • Xuan Shen

Herbs that Kill Worms or Parasites (Sha Chong):

  • Yu Jin
  • Ku Shen
  • She Chuang Zi
  • Shi Chang Pu
  • Jin Yin Hua
  • He Zi
  • Lei Wan
  • Qing Hao
  • Da Suan
  • Bing Lang
  • Ku Gua
  • Ding Xiang
  • Huai Hua
  • Chuan Shan Jia

Herbs that Move the Qi and Break Accumulation (Xing Qi and Po Ji):

  • Chuan Xiong
  • Chai Hu
  • E Zhu
  • San Leng
  • Chen Pi
  • Ze Lan
  • Mu Xiang
  • San Qi

 

Additional Notes

  • Fruehauf says Ren shen and Dang shen can exacerbate gu. If someone takes it and feels worse, they have advanced gu usually.
  • Releasing the ext by “fumigating” the body – done for 6-12 mos. with herbs such as Gao ben, Bo he, Zi su ye, Bai zhi
  • Favorite herb: Bai he.  No side effects, kills parasites.
  • Favorite qi tonic for all gu, specifcally when any kind of joint pain is present: Wu jia pi.
  • Most cancer and chronic disease cases and any viral/spirochete/etc are Gu.
  • Gu often implicated in complex presentations. Gu cases don’t have a clear pattern.

Luo Bu Ma – Apocynum leaf – Dogbane

Nature: sweet, bitter, cool

Enters: Liver

Actions: Calms the liver and subdues yang; clears heat and promotes urination; nourishes the heart and quiets the spirit. Lowers blood pressure.

Indications:
• Liver yang rising: dizziness, hypertension, etc.
• Drunk by older people in China as a general health tonic to prevent the problems of aging.
Flaws: Luo Bu Ma (Herba Apocyni Veneti) may be unknown to many students and younger practitioners of Chinese medicine. In part, this is because it is not found in most entry-level Chinese materia medica, nor is it found any major traditional Chinese formulas. However, I think it is a good medicinal to know about. It is included in Bensky et al.’s Chinese Herbal Medicine: Materia Medica, 3rd edition (pages 976-977). In that book, Luo Bu Ma is categorized as a wind-extinguishing medicinal (xi feng yao). According to Bensky et al., it is sweet, bitter, and cool and enters the liver. (Other Chinese sources say this medicinal is bland and astringent. Such differences of opinion are common for relatively “new” Chinese medicinals). Luo Bu Ma levels or calms the liver and subdues yang, clears heat and promotes urination, and nourishes the heart and quiets the spirit (although I’m not convinced about these last functions; more to say about that below).

Luo Bu Ma was, up until recently, a folk medicinal mostly found and drunk as a healthy beverage tea in Inner Mongolia. However, recently, this medicinal has been found to lower blood pressure, lower bad cholesterol at the same time as raising high density (good) cholesterol, reduce edema due either to kidney or heart dysfunction, enhance immunity, and promote longevity. Therefore, this herb is now often drunk both preventively and remedially by the middle-aged and elderly in China and Japan. (The first anti-aging research I can find on this medicinal published in China dates from 1990.)

Research on Luo Bu Ma has been conducted in China, Korea, Japan, and several Western countries. This research shows that this medicinal definitely lowers blood pressure (by increasing nitric oxide and thus vasodilation) and has diuretic, cardiotonic, and antioxidant activity. Other research indicates that Luo Bu Ma has antidepressant potential and can reduce anxiety (in mice, equal to benzodiazapines). Yet other research shows that this medicinal is effective for hypercholesteremia and the prevention of atherosclerosis. A water infusion of this herb has been shown to be hepatoproctective in mice. As if that weren’t enough, Luo Bu Ma can reduce the formation of advanced glycation endproducts which are largely involved in the pathogenesis of diabetic vascular complications. Chinese research suggests that the active ingredients in Luo Bu Ma mainly consist of rutin, d-catechin, and quercetin. However, Japanese research shows that Luo Bu Ma contains more than 15 kinds of phenolic constituents.

The root of this plant contains cardioglycosides and is, therefore, potentially toxic. The leaves, however, do not contain the same cardioglycosides or at least contain much fewer of them. Thus the leaves are considered safe to use even long-term. In fact, Zhang Yun-ru says that its leaves are non-toxic (Bensky, p. 977).

As for Luo Bu Ma nourishing the heart and quieting the spirit, because this medicinal is antidepressant and anxiolytic, it is tempting to make that assumption. However, not all Chinese sources on this medicinal include this function, and I believe it is a species of “over-diagnosis.” The fact that Luo Bu Ma clears heat from the liver appears to be unanimous in the Chinese language Chinese medical literature, and heat ascending (mainly from the liver) to harass the heart is one of the three main proximate causes of the heart spirit stirring frenetically. By clearing this heat, the heart spirit is automatically quieted. However, this does not mean that the medicinal should be thought of a heart-nourishing, spirit-quieting medicinal. In Chinese medicine, there are two kinds of spirit-quieting medicinals: 1) those that nourish the heart and quiet the spirit and 2) those that heavily settle and quiet the heart. Heart-nourishing spirit-quieters tend to nourish and enrich heart blood and yin, and I see nothing in any descriptions of this medicinal that suggest it nourishes yin-blood. I think all this medicinal’s empirical effects can be encompassed by the functions of clearing heat, extinguishing wind, and promoting urination.

This medicinal is included in several Chinese ready-made or so-called patent medicines for hypertension. However, you might consider adding it to other standard formulas based on pattern discrimination when the major complaint is high blood pressure and liver heat, liver yang, or liver wind are playing a part in the overall disease mechanisms. It may also be drunk as a tea (infusion) as a daily beverage in the middle-aged and elderly who, by nature, tend to suffer from a surplus in the liver.

Examine.com:

This plant has similar bioactives to Hypericum perforatum [St. John's Wort] and while drug-drug interaction tests have not yet shown adverse interactions it is highly plausible that they exist.

At this moment in time there is no optimal dose known for humans, although most of the benefits associated with this plant occur in the rat dosing range of around 25-100 mg/kg and with the water extract of the leaves (ie. the tea). This assumes an estimate human dose of:

  • 270-1,100 mg for a 150lb person
  • 360-1,400 mg for a 200lb person
  • 450-1,800 mg for a 250lb person

These doses are well within the range one would use the leaves to make tea from, suggesting that the food product is active and supplementation may not be needed.

1. Sources and Composition

1.1. Sources

Apocynum venetum (of the family Apocynaceae) is a Traditional Chinese Medicine commonly referred to as Chinese dogbane which has traditional usage for its blood pressure reducing properties secondary to diuresis.[1] Beyond the cardiovascular benefits, it has traditionally been touted to promote longevity[2] and treat both nephritis and neurasthenia[3] but more recently is associated with claims of blood pressure reduction and sedation (which opposes the stimulatory effect of green tea from camellia sinensis due to the Caffeine content).[4] At times medicinal usage of this plant is seen as interchangeable with poacynum pictum and poacynum hendersonii (of the same Apocynaceae family) due to their visual similarity;[4] they can be distinguished genetically[5] or by the hyperoside content.[6]

It should not be confused with the related plant Apocynum cannabinum (Indian Hemp) nor the related plant Apocynum androsaemifolium, both of which have traditional usage for heart health due to their Cymarin content which is therapeutic at low doses but toxic at higher doses; apocynum venetum does have a cymarin content as well (113?g/g in the leaves)[7] which is regarded as safe[4] although the higher levels in the aged stem (1,310?g/g) may not be.

The leaves are sometimes called ‘Luobuma’ (China) or ‘Rafuma’ (Japan), and Luobuma tea refers to the water extract of the leaves.[8][1] The plant itself is a small herbaceous shrub 1-2 meters tall with purplish red to pink flowers, and bears fruits in autumn 7-8 months after flowering.[4] The apocynum venetum shrub is surprisingly resistant to drought and stress (sand, winds, and salt), which may underlies its name of “Herbal for Relief of Famines” (Jiu-Huang-Ben-Cao from the Ming Dynasty).[4]

Apocynum venetum is a small shrub which bears leaves (Luobuma) that are commonly drunk as a tea in order to reduce blood pressure and are claimed to have an added relaxing effect (somewhat opposite of a similar tasting tea, green tea from camellia sinensis); the usage of Luobuma parallels that of Roselle

1.2. Composition

Luobuma (leaves unless otherwise specified) contains:

  • Apocynin A-D (very confusing as this is not the apocynin phenolic (acetovallinone) found in other plants)[9][4]
  • Cymarin at 113?g/g in the leaves, lower levels than Apocynum cannabidum[7] although there are higher levels in the stem (367?g/g) and aged stem (1,310?g/g) as well as the root (195?g/g)[7]
  • Apocyanisode I and II (Ionone glucosides)[10]
  • (+/-)Gallocatechin and (+/-)Catechin[11]
  • (-/-)Epigallocatechin and (-)-Epicatechin[11]
  • (-/-)Epicatechin-()Gallocatechin and Epigallocatechin-()Epicatechin[11]
  • Quercetin[12][13] and related structures such as hyperoside (Quercetin 3-Galactoside) and isoquercitrin (Quercetin 3-Glucoside);[3] said to be in comparable levels to that of Hypericum perforatum;[14] also contains Baimaside (Quercetin 3-O-Sophoroside),[13] Avicularoside (Quercetin-3-Arabinoside)[15] Rutin (Quercetin 3-Rutinoside),[15] and Quercitronic Acid/Querciturone (Quercetin-3-Rhamnoside)[15]
  • Kaempferol[16] and its 3-O-?-D-glucoside (Astragalin),[15][13] Trifolin (Kaempferol 3-Galactoside),[15]
  • Apigenin biflavonoids including Amentoflavone and Biapigenin[15]
  • Hyperforin and Adhyperforin;[15] once novel constituents of Hypericum perforatum
  • Procyanidin B2[11]
  • Cinchonain Ia[17]
  • Caffeic acid and 3-O-caffeoylquinic acid[18]
  • Vanillic acid[13] and Chlorogenic Acid[16]
  • Daucosterol[13] and both Lupeol and Phytol in roasted leaves[10]

The overall content of flavonoids is known to heavily rely on growing conditions.[12]

There is a total amino acid content ranging from 81.76-83.25mg/g (leaf equivalent) but a free amino acid content of 3.85-4.04mg/g, with the most abundant amino acid being glutamic acid (9.82-10.01mg/g total amino acid and 0.29-0.31mg/g free) which was said to confer the Umami taste of the tea.[19]

The leaves of this plant appear to be high in flavonoids, mostly some catechins (some novel and some in green tea) and a large amount of quercetin variants. There also seems to be a lot of parallels in these constituents and those seen in St.John’s Wort surprisingly, since the plants are not phylogenetically related

2. Molecular Targets

2.1. Ion Channels

Apocynum venetum, in cultured N2A neuroblastoma cells at a concentration of 20µg/mL, has been demonstrated to inhibit steady state sodium channels independent of nitric oxide and with an IC50 of 18.4?g/mL; it was readily reversed with washout and voltage gated sodium channels were unaffected.[20]

There was a mild inhibitory effect on voltage gated potassium channels (16.2+/-3.7% and 48.0+/-2.9% inhibition at 10 and 30?g/mL) yet none on ATP-sensitive channels.[20] These effects were lost in the presence of diazoxide, a potassium channel opener.[20]

The leaf extract of apocynum venetum appears to cause mild inhibitory effects on both potassium and sodium channels at a concentration where blood pressure reduction in noted; this is not dependent on nitric oxide formation

3. Pharmacology

3.1. Phase I Enzyme Interactions

Apocynum venetum has similar bioactives to Hypericum perforatum, raising concerns of possible drug interactions.

When fed to rats at 3.3mg/kg, Apocynum venetum leaf extract failed to alter the pharmacokinetics of nifedipine while 33mg/kg and 15mg/kg St. John’s Wort both trended to reduce plasma concentrations over the next 30 minutes.[21] Two weeks treatment of 15mg/kg managed to reduce the AUC of nifedipine while 3.3mg/kg apocynum venetum was ineffective.[21]

May not influence CYP3A activity, although the above study did not test higher (and more practical) doses over two weeks despite trends towards inhibition being present

3.2. Drug Interactions

Apocynum venetum at 3.3mg/kg over two weeks to rats has failed to alter the intestinal permeation of methylprednisone, suggesting no significant influence on the P-glycoprotein transporter.[21]

No significant influence known with P-glycoprotein transporters

4. Neurology

4.1. GABAergic Neurotransmission

The anxiolytic properties of the leaf extract (100-125mg/kg in mice) doses is fully mediated by the GABAA receptor, while lower doses (22.5-30mg/kg) are not; this is thought to be due to Kaempferol which is active at 0.02-1mg/kg oral intake.[16]

Higher doses of this herb appear to have anxiety reducing properties secondary to the kaempferol content acting on the benzodiazepine receptors

4.2. Adrenergic Neurotransmission

A water extract of the leaves for 2-8 weeks in rats noted decreases in noradrenaline at 15-60mg/kg (but not 250mg/kg) in the hypothalamus (8 weeks) and striatum (starting at 2 weeks) by 33-44% in the hypothalamus and 22-39% in the striatum; there was no time nor dose dependence noted.[3] The decline in noradrenaline and its metabolite (homovanillic acid) during depression, however, are fully preserved with 10 days supplementation of 50-100mg/kg (but not 25mg/kg) in mice.[22]

While there may be a small suppressive effect on noradrenaline concentrations at rest, the decline seen during depression is greatly attenuated; this suggests a modulatory effect

Adrenergic receptor density does not appear affected.[3]

No known interactions with adrenergic signalling beyond modifying noradrenaline levels

4.3. Dopaminergic Neurotransmission

L-Tyrosine concentrations in all brain organs does not appear affected with oral ingestion of 15-250mg/kg of the leaf extracts for 8 weeks in otherwise normal rats.[3]

A water extract of the leaves at 15mg/kg daily for eight weeks was able to slightly reduce dopamine concentrations in the hypothalamus (20%); there was no influence of higher doses (60-250mg/kg) nor lower time frames (2 weeks) and these effects were exclusive to the hypothalamus.[3] Elsewhere, 50-100mg/kg (but not 25mg/kg) in mice for 10 days preserved the decrease in dopamine concentrations seen in depression.[22]

DOPAC was slightly reduced when dopamine or noradrenaline were increased[3] but is significantly preserved in states of depression (when dopamine is also preserved.[22] Furthermore, the antidepressant effects of 50-100mg/kg of the extract over 10 days in mice appears to be blocked by both D1 receptor antagonists and D2 receptor antagonists.[22]

Similar to the effects seen with adrenergic signalling, there appears to be little to no effects on dopamine at rest or a small decline in dopamine levels are seen. In states of depression where dopamine would normally be reduced, however, there is a significant preservation of dopamine levels

4.4. Serotonergic Neurotransmission

15-250mg/kg of the leaf water extract for up to 8 weeks in rats does not influence concentrations of serotonin, L-tryptophan, or 5-HIAA.[3] In depressed mice, 25-100mg/kg of the extract has failed to preserve the reduction in serotonin seen in depression.[22]

Unlike the influence on catecholamines (dopamine and noradrenaline), the reduction in serotonin seen with depression is not prevented

The lower anxiolytic dose of the leaf extract (22.5-30mg/kg in mice) appears to be mediated by the 5-HT1A receptors, while higher (100-125mg/kg) doses are not.[16]

There may still be some serotonergic signalling when it comes to very low doses of this plant and possible reductions in anxiety, although more practical higher doses do not appear to be assocaited with serotonin signalling at all

4.5. Alertness

In a rat antidepressant test there did not appear to be any alterations in locomotion nor defecation (thus, no amphetamine like activity is thought to exist).[14] In anxiolytic tests (testing for sedation from benzodiazepine like effects) the leaf extract was not significantly different from 1.5mg/kg diazepam at the active doses (22.5-30mg/kg) in altering motor function[23] nor was the active GABAergic agent Kaempferol (0.02-0.08mg/kg).[16]

Does not appear to have any significant sedating properties (assessed by locomotor tests) nor amphetamine-like properties when tested in rodents

4.6. Neuroprotection

Mechanistically, hyperoside at 2.5-10?g/mL appears to attenuate the increase in intracellular calcium (PC12 cells) induced by corticosterone (10?M) with a protective effect comparable to 10?M fluoxetine[24] and thought to be secondary to this there was a preservation of BDNF and CREB activity (greater than fluoxetine but not normalized to control)[24] associated with a relative preservation of BDNF and MAP4 mRNA levels.[25]

In the presence of hyperoside, the neurodegenerative effects of corticosterone are attenuated and the antidepressive factors (BDNF, CREB, MAP4) are preserved somewhat

Elsewhere, in vitro with PC12 cells treated with 1-10?g/mL of the herbal extract apocynum venetum appeared to reduce lipid peroxidation to a greater extent than both Ginkgo biloba and St.John’s wort, although 100?g/mL of the extracts were comparable.[26]

In an in vitro test of oxygen and glucose deprivation (test of benefits against ischemia-reperfusion), 5-50?g/mL of apocynum venetum showed mild protective effects not exceeding 50% cell viability (control at 100% and oxygen deprivation near 30%);[27] higher concentrations (5-500mg/mL) were not significantly better.[27]

500mg/kg of the extract in rats prior to ischemia has been noted to improve the neurological score when measured 24-72 hours after ischemia (250mg/kg only active after 72 hours and 125mg/kg ineffective) and was able to half infarct size relative to control.[28] Alongside the reduced infarct size was reduced edema and brain leakage, which appeared to be associated with preservation of the blood brain barrier’s structure (and reductions of both MMP2/9 and lipid peroxidation).[28]

Shows some promise against lipid peroxidation and oxidative stressors, and while the potency against oxygen deprivation seems to be less it is relevant in rat models of ischemia where there are minor anti-stroke properties

4.7. Depression

30-125mg/kg of the leaf water extract of apocynum venetum appeared to possess antidepressant effects in the forced swim test with a potency comparable to 20mg/kg Imipramine.[14] Higher doses of the extract (250-500mg/kg) were ineffective initially but performed equally after two weeks[14] and 50-100mg/kg of the extract, but not 25mg/kg, has elsewhere been effective in the tail suspension test (more than 5mg/kg fluoxetine) while all doses were comparable to fluoxetine in a forced swim test[22] and prevented with dopamine receptor antagonists (D1 and D2).[22]

There appears to be a somewhat respectable antidepressive effect associated with catecholamine metabolism, probably secondary to preventing their decline during stress

4.8. Anxiety

In an elevated maze plus test, mice given 22.5–30mg/kg and 100–125mg/kg of the leaf extract (standardized to 3.5% hyperoside and 3.2% isoquercitrin) experience a reduction in anxiety with the lower dose being more potent (to a comparable level as 1.5mg/kg diazepam and 10mg/kg buspirone).[23][16] The lower dose hindered by 5-HT1A receptor antagonists while the higher dose was fully blocked by benzodiazepine receptor antagonists.[16]

There are anti-anxiety effects associated with the tea, but unlike the antidepressive properties (associated with catecholamines) these seem to be related to GABA and serotonin signalling; it occurs at lower doses than antidepressive effects

5. Cardiovascular Health

5.1. Cardiac Tissue

In isolated atria cells (guinea pig), apocynum venetum causes a cardiotonic effect at 1mg/mL (little to no response at 100µg/mL) yet this was not correlated with the cymarin content of the plant (cymarin being a known cardiac glycoside in this plant species) nor was it blocked by propanolol;[7] it appears that components of apocynum venetum have PDE3 inhibiting properties, with 1mg/mL of the leaf, root, and stem extracts inhibiting 84-88% of PDE3 activity.[7]

Preliminary evidence suggests a cardiotonic effect, but practical relevance is unknown (and a high concentration used in the heart, which may not apply to oral supplementation)

5.2. Blood Pressure

While the water extract of the leaves (0.1–10µg/mL) does not influence endothelial function in vitro at rest nor is it active in denuded cells, it appears to concentration dependently inhibit phenylephedrine and U46619 (Thromboxane A2 receptor agonist) in a manner fully dependent on NOS enyzmes.[1] There is no relaxing effect against endothelium precontracted with potassium, but the effect persisted after two washes of the cells.[1] The mechanisms are known to involve potassium channels[29][1] although it is not clear how, although some authors[1] have noted the atypical mechanisms are similar to both Eucommia ulmoides[30] and Eleutherococcus senticosus[31] and apocynum venetum has elsewhere been noted to have mild inhibitory effects on voltage gated but not ATP sensitive potassium channels (not mediated by nitric oxide).[20]

0.3-10?g/mL apocynum venetum appears to suppress the aortic contractions induced by ACE (Angiotension II),[32] the peptide of which its inhibition is the current blood pressure reducing therapy. This is thought to be due to inhibiting ACE induced superoxide production (ACE, via acting on the AT1 receptor, increases NADPH oxidase and O- production[33][34] which suppresses nitric oxide[35]) and induction of nitric oxide synthesis.[32] Furthermore, the reaction of superoxide and nitric oxide is known to produce peroxynitrite (ONOO-) which can negatively regulate NOS enzymes[36] and apocynum venetum directly sequesters these peroxynitrite radicals via its catechins;[37] sequestering ONOO- is known to block its suppressive effects.[36]

Apocynum venetum appears to have blood pressure reducing mechanisms that are within a feasible concentration range, and while the mechanisms are not fully elucidated they appear to be related to nitric oxide signalling, antioxidant effects, and calcium channels

In hypertensive rat models (spontaneously, renal, and salt fed) given 70mg of the water leaf extract of apocynum venetum daily (333-350mg/kg) for 40-100 days, the tea was able to reduce blood pressure in all three rat models more than control and while equally potent to 30mg/kg Captopril in one model (renal hypertensive) it underperformed in the other two.[8]

In the sodium fed rats, urine output was increased with apocynum venetum (2.1 and 2.6 fold on days 20-60) which did not occur with the roasted leaves;[8] there were no differences in the magnitude of blood pressure reduction between groups, and increased urination occurred in both groups of the renal hypertensive rats.

Blood pressure reduction has been noted with ingestion of the water extract of the leaves, and this appears to occur to a lower degree than the reference drug but up to two-fold higher doses than the antidepressant effects

5.3. Atherosclerosis

In vitro, LDL oxidation from copper is reduced by 10-100µg/mL of apocynum venetum extract with the higher dose preventing any significant differences from nonoxidized control[38] and an IC50 value of 68.1µg/mL being determined for the leaf extract (mostly due to chlorogenic acid and epigallocatechin, with IC50 values of 1.9µM and 2.3µM respectively).[17]

This potent inhibition of LDL oxidation was met with only 39% inhibition of lipid peroxidation (TBARS) and halved the increase in macrophage cholesterol accumulation when LDL and macrophages were in the same culture with copper[38] (to assess foam cell formation, involved in the pathology of atherosclerosis). Elsewhere, TBARS from LDL oxidation was reduced in a concentration dependent manner between 2.5-200µg/mL (9.8-88.3%) with most inhibitory effects coming from hyperoside, chlorogenic acid, and epigallocatechin.[17]

May reduce LDL oxidation due to its antioxidant properties, but practical relevance of this information is not known. Possible anti-atherosclerotic properties and reducing plaque formation on arties

6. Interactions with Glucose Metabolism

6.1. Glycation

When investigating the formation of advanced glycemic end products (AGEs) the water extract appeared to inhibit AGE formation with an IC50 value of 37.2+/-0.6µg/mL, which outperformed the reference drug of Aminoguanidine (59.2+/-1.5µg/mL).[11] This may be related to the known catechins, which had IC50 values between 19.8+/-0.8µg/mL (Gallocatechin) and 9.1+/-0.2µg/mL (Epigallocatechin).[11]

Possible antiglycative properties, which would reduce AGE formation and may be of use for diabetes or insulin resistance (reducing organ damage, rather than treating the state)

7. Interactions with Oxidation

7.1. Lipid Peroxidation

The aqueous leaf extract at 10mg/kg given to rats after liver damage (from CCl4) failed to significantly reduce serum MDA levels relative to control, although it trended towards such[39] and appeared to have antioxidative properties against H2O2 and iron in vitro in the range of 15-1,000µg/mL.[39]

8. Interactions with Organ Systems

8.1. Kidneys

Chronic (20-60 days) ingestion of a nonroasted water extract of apocynum venetum leaves in rats at 335-350mg/kg appears to increase urine output of rats on a high sodium diet (2.1-fold and 2.6-fold on days 20 and 60); this effect was not noted with twice roasted leave.[8] Oddly, diuresis was increased by both the roasted and unroasted leaves in rats with hypertension secondary to renal damage.[8]

Appears to be a diuretic at the doses which reduce blood pressure

9. Safety and Toxicology

9.1. General

The LD50 of apocynus venetum appears to be greater than 10g/kg in rats and preliminary genotoxic and teratogenic studies have failed to find any harm associated with the plant,[4] and later a 30 day test failed to find any abnormalities up to 30g/kg in mice[40] and in continuing the in vitro studies a lack of genotoxicity was repeated and no abnormalities in sperm cells were noted.[40]

Preliminary evidence in rodents does not suggest any toxic effects from this plant even at abnormally high oral doses

 

Dose: 3-9g

Liu Huang – Sulfur – “Sulfur Yellow”

Nature: sour, toxic, warm

Enters: Kidney, Large Intestine

Topical Actions: Kills parasites; eases itching; relieves toxicity.

Topical Indications:

• Scabies, eczema, ringworm, Yin furuncles, damp festering sores, ulcers, carbuncles, itching, acne.
• Used as powder or paste. Also available in soap form (e.g., Thylox) for acne.
Hsu: Dissolves corneous skin, can cause hair to fall out.

 
Internal Actions:  Tonifies kidney Yang (strengthens Ming Men fire); promotes bowel movement.

Internal Indications:

• Yang deficiency, internal cold: asthma, impotence, painful lower back and knees
• Cold: constipation, especially in the elderly (works by helping the Yang to pass the stool and also by irritating the wall of the gut by forming sulfides – more pronounced effect when there is an abundance of fatty substances in the gut).
Hsu: Antifungal, purgative.

Internal Dose: 1-6g (pills and powders)

Lu Feng Fang – Hornet Nest

Nature: sweet, toxic, neutral

Enters: Lung, Stomach

Topical Actions: Relieves toxicity, expels wind, alleviates pain.

Topical Indications:

• As an ointment or wash for rashes, itching, scabies, ringworm, sores, carbuncles, swollen glands.
• As a gargle: use warm for a severe toothache that feels “as if a worm is burrowing in the tooth.”

 
Internal Actions:  Expels wind, dries dampness.

Internal Indications:

• Wind-damp Bi.
• Wind rashes.
• Recent use in the treatment of a variety of tumors.
• Shortens blood coagulation time.
• Mastitis: In one study, 3g of dry-fried Lu feng fang was given with wine every 4 hours for 3 days. 23 of 26 cases were cured (in an average of 2 days) and 1 was improved. No side effects or toxic effects were noted. This form of therapy is not effective for suppurative mastitis.
• Toxic: large doses cause nephritis.

Internal Dose: 6-12g (1.5-3g directly as powder)

Ma Qian Zi – Strychnos nux-vomica seeds – Nux-vomica – “Horse Money Seeds”

Nature: bitter, cold, very toxic

Enters: Liver, Spleen

Actions:  Unblocks the channels, disperses clumps, reduces swelling, alleviates pain.

Indications:
• Internal or external for abscesses, sores, yin-type ulcers, and swelling and pain due to trauma.
• Wind-damp Bi, paresthesias, spasms.
• Recently used in the treatment of various types of tumors.
• Facial paralysis: the herb was applied locally as a paste in over 15,000 cases, with effective results in 80% of the cases.
• Contains strychnine. Overdoses in humans have been recorded with as little as 50 mg of the herb. Overdosage presents with a crawling sensation in the cervical area, difficulty in swallowing, and irritability. The progresses to convulsions of great force.
• Used externally in powders for local application, including insufflation into the throat.
RW: In small doses, the herb is a bitter tonic. This herb is the leading nervous system stimulant. Indispensable as a major nerve tonic. The drug of choice when one needs powerful and lasting stimulation of the nervous system. Often used for the elderly, and for pale children lacking an appetite (good with galanga). For nervous stomach conditions, it also reduces sensitivity to pain.
• According to Weiss, this herb is safer than stated. “Really good results are achieved only with relatively large doses: 10-20 drops of the tincture in a glass of water three times daily.”
[Other sources (PCBDP) are much more cautionary - strychnine can be fatal.]
Hsu: Promotes blood circulation and breathing; can induce muscular tetany; increases intestinal peristalsis.

Dose: 0.3-0.9g internally in pills and powders

Ming Fan – Bai Fan – Alum – Basic Potassium Aluminum Sulfate – also Ku Fan, the prepared form

Nature: sour, cold

Enters: Lung, Liver, Spleen, Stomach, Large Intestine.

Topical Actions: Eliminates toxicity; kills parasites; dries dampness; eases itching; stops bleeding.

Topical Indications:

• As a wash for scabies, ringworm, carbuncles, damp/damp-heat rashes – eczema.
• Bleeding: epistaxis, hemorrhoidal bleeding, bleeding gums, bleeding due to external injury.
• Swollen and painful throat or eyes.
• Ear drops for chronic otitis media.
• For external use, Ku fan (the prepared form) is preferred for sores and abscesses, oral sores, eye problems.

Topical Dose: 15-30g

 
Internal Actions:  Stops bleeding and diarrhea; clears heat and phlegm; dried dampness.

Internal Indications:

• Hematemesis, epistaxis, hemafecia, chronic diarrhea, uterine bleeding, vaginal discharge. Ulcerative colitis.
• Jaundice.
• Wind-phlegm/phlegm-heat: epilepsy, irritability, delirium, depression, mania, cough with difficult-to-expectorate sputum.
• Ming fan has a strong stimulatory effect on the body’s tissues. Overdose can cause ulceration, vomiting, diarrhea, shock.
• The cumulative effect of long term ingestion of aluminum may not be healthy (Alzheimer’s?).
• Crush before using.

Internal Dose: 0.6-3g

Peng Sha – Borax – Sodium Borate / Sodium Tetraborate Decahydrate

Nature: sweet, salty, cool.

Enters: Lung, Stomach.

Topical Actions: Dries dampness, relieves toxicity, prevents putrefaction.

Topical Indications:

• Blisters between toes caused by damp-toxicity.
• Sores, including nasal, pharyngeal, vaginal sores.
• Used internally or externally for pain and swelling in the throat, open sores in the mouth (canker sores), white draining vaginal lesions (e.g. severe candidiasis).

 
Internal Actions: Clears heat; dissolves phlegm; transforms stones, relieves toxicity, prevents putrefaction.

Internal Indications:

• Phlegm-heat obstruction with difficult-to-expectorate sputum.
• Painful urinary dysfunction with stones.
• Used internally or externally for pain and swelling in the throat, open sores in the mouth, white draining vaginal lesions (e.g. severe candidiasis).
• In the Bensky/Clavey/Stoger Materia Medica, this substance is classified as “obsolete,” which the authors claim is due to its toxicity. I have not seen Peng sha referred to as toxic in other resources on Chinese herbs. However, in the Wikipedia entry on borax, its toxicity is discussed at length. Here is an excerpt:
“Borax, sodium tetraborate decahydrate, is not acutely toxic. Its LD50 (median lethal dose) score is tested at 2.66 g/kg in rats: a significant dose of the chemical is needed to cause severe symptoms or death. The lethal dose is not necessarily the same for humans.
“Sufficient exposure to borax dust can cause respiratory and skin irritation. Ingestion may cause gastrointestinal distress including nausea, persistent vomiting, abdominal pain, and diarrhea. Effects on the vascular system and brain include headaches and lethargy, but are less frequent. ‘In severe poisonings, a beefy red skin rash affecting palms, soles, buttocks and scrotum has been described. With severe poisoning, erythematous and exfoliative rash, unconsciousness, respiratory depression, and renal failure.’
“Borax was added to the Substance of Very High Concern (SVHC) candidate list on 16 December 2010. The SVHC candidate list is part of the EU Regulations on the Registration, Evaluation, Authorisation and Restriction of Chemicals 2006 (REACH), and the addition was based on the revised classification of Borax as toxic for reproduction category 1B under the CLP Regulations. Substances and mixtures imported into the EU which contain Borax are now required to be labelled with the warnings “May damage fertility” and “May damage the unborn child”.”

Internal Dose: 1.5-3g

She Chuang Zi – Cnidium seed – “Snake’s Bed Seeds”

Nature: acrid, bitter, warm

Enters: Kidney

Topical Actions: Dries dampness; kills parasites; stops itching.

Topical Indications:

• Dampness: eczema, any itching, weeping skin lesion especially of the external genitalia region.
• Scabies.
• Ringworm.
• Use as a wash, powder, or ointment.

Topical Dose: 15-30g

 
Internal Actions: Tonifies kidney Yang; disperses wind, cold; dries dampness.

Internal Indications:

• Kidney deficiency or cold womb: impotence, male or female infertility.
• Cold and dampness: leukorrhea, trichomonal vaginitis.
• Dampness (especially wind-cold-damp): lumbar pain.
Hsu: Antifungal; antiviral; anthelmintic; sex-hormone-like action – prolongs sexual intercourse in mice and can induce copulation in castrated mice.
HF: A Sha Chong (kill worms or parasites) herb, important in Gu Zheng (Gu parasites) formulas.

Internal Dose: 3-10g

Wa Leng Zi – Ark shell – Cockle shell

Nature: salty, neutral

Enters: Lung, Stomach, Liver

Topical Actions: Regenerates tissue for ulcers.

 
Internal Actions: Resolves phlegm; promotes blood circulation and dispels blood stasis; softens and resolves masses and lumps; neutralizes stomach acid; alleviates pain.

Internal Indications:

• Stagnation of blood, Qi, and/or phlegm: fibroids, cirrhosis of the liver, immobile or mobile abdominal masses.
• Chronic pain in the pit of the stomach (such as ulcer pain) or blood stasis pain accompanied by vomiting with acid reflux.
• Ulcers: In one clinical trial, 124 patients with gastric and duodenal ulcers were treated with a powder of 5 parts Wa leng zi and 1 part Gan cao. Treatment periods ranged from 29 to 56 days. 59 cases were cured and another 48 showed significant improvement.
• The raw herb should be used for promotion of blood circulation and dissolution of phlegm, while the calcined form is preferred for the neutralization of stomach acid, acid reflux (GERD), heartburn.
• Requires precooking. The herb should be broken into pieces or ground into powder before cooking.
• Bensky and Gamble classify this herb as a blood mover. The herb is also commonly classified among herbs that resolve phlegm (a categorization Guohui Liu also agrees with).

Internal Dose: 9-15g

Xiong Huang – Realgar – Arsenic Sulfide – “Male Yellow”

Nature: acrid, bitter, warm, toxic

Enters: Heart, Liver, Stomach

Topical Actions: Eliminates toxicity; kills parasites.

Topical Indications:
• Carbuncles, snake bites, scabies, ringworm, damp rashes, abscesses, suppurative inflammation of the soft tissue, ulcerations.
• Very commonly used in soaks for any skin itching.
• As a paste for neurodermatitis/shingles.
• Because it is absorbed through the skin, the herb should not be applied to large areas.

 
Internal Actions: Kills worms; dries dampness; expels phlegm; checks malarial conditions.

Internal Indications:
• Worm parasitism in the intestines: pain – especially for roundworms, and particularly with signs of accumulation.
• Dampness/phlegm accumulation: wheezing; seizures; malarial conditions.
• Do not calcine. Calcination produces the extremely toxic As2O3.

Internal Dose: 0.15-0.6g in pills and powders

Sang Piao Xiao San

Ingredients: sang piao xiao, long gu, ren shen, fu shen, yuan zhi, shi chang pu, (zhi) gui ban, dang gui

Actions: regulate & tonify Ht & K, stabilize essence, stop leakage

Indications: K & Ht Qi xu: frequent urination, sometimes incontinence, urine the color of rice water, maybe spermatorrhea; also disorientation, forgetfulness, pale tongue, white coat, thin slow frail pulse.

See S. Dharmananda’s “Sang Piao Xiao San – Example of a Mind-Body Formula”

Xue Jie – Dragon’s Blood – Resinous secretion of Daemonorops draco or Dracaena cambodiana

Nature: sweet, salty, neutral

Enters: Heart, Liver

Topical Actions: Promotes regeneration of tissue; stops bleeding.

Topical Indications:
• Bleeding due to external trauma.
• Non-healing skin ulcers: protects the surface of the ulcer, prevents decay, and generates flesh.
Weng Weiliang, et. al.:
• Ulcer after tumor operation: Xiao Du San: xue jie, feng fang tan, bi hu, 10g each; bing pian 5g, honey of proper amount. The drugs were grounded into fine powder and applied to the ulcer which was surrounded by honey later, then the honey was applied on top of the drug powder. 33 cases of ulcer after tumor operation were treated, and scab formed after 6.5 days averagely.
• Primary liver cancer: Pu Tuo Gao made of xue jie, quan xie, wu gong, shui hong hua zi, bai jiang can, mu bie zi, da feng zi, zhe cong, bing pian was applied externally for 5~7 days. Change the dressing after 3 days’ interval, 12 times as a course of treatment. 67 cases of primary liver cancer were treated, and the pain alleviating rate was 96.7%.
• Bedsore: san qi, xue jie, hong hua, ze lan, dang gui wei, ru xiang, mo yao, zhi ma qian zi, hu po, sheng da huang, tao ren, xu duan, gu sui bu, zhe chong, zi ran tong, su mu, qin jiao, zao xiu. All drugs were soaked in wine for 3~6 months. The infusion could be used to treat bedsore and had swelling relieveing, tissue regenerating effect.

Topical Dose: 6-9g

 

Internal Actions: Promotes blood circulation, dispels blood stasis, alleviates pain.

Internal Indications:
• Blood stasis: trauma, swelling, pain, symptoms related to injury from falls, fractures, contusions, sprains, endometriosis.
• Similar to San qi, but weaker than San qi at promoting blood circulation or stopping bleeding.
• Contraindicated in patients without blood stasis.
• Bensky and Gamble classify this herb as a blood mover.
Eric Brand:
Xue Jie (Daemonoropis Resina) is a fascinating substance. Also known as Dragon’s Blood, Xue Jie has been used for hundreds of years in many different cultural contexts. Xue Jie is a tree resin that has been used as a medicine, incense, and dye since ancient times. It was recorded in Greece by Dioscorides and appeared for the first time in Chinese medicine in the Lei Gong Pao Zhi Lun (Master Lei’s Treatise on Drug Processing), written in the Northern and Southern Dynasties period (420-589 CE). It later appeared in the Tang Ben Cao (Tang Materia Medica), the first Imperial textbook on materia medica.
Xue Jie is used for a diverse range of purposes. In Chinese medicine, it is said to quicken the blood, stanch bleeding, and engender flesh. It is a major medicinal in traumatology and is also used to treat bleeding in the upper GI tract. Beyond injuries and bleeding, if we look at its applications in modern Chinese medical gynecology, we find that Xue Jie is an incredibly important medicinal in empirical formulas to treat endometriosis.
The importance of Xue Jie in endometriosis is evident when examining modern Chinese textbooks on TCM gynecology. Its claim to fame lies in expelling old blood stasis so that new blood can be engendered; in fact, its Chinese name literally means “exhausted (spent) blood.” Looking at the treatments for endometriosis relative to traditional TCM disease categories such as painful menstruation or concretions and conglomerations (zheng jia), we see that the formulas selected for the same patterns are consistent but nearly all the endometriosis formulas add in Xue Jie. Thus, clearly the experts in China know something about Xue Jie that most of us do not.
Xue Jie in the treatment of Endometriosis
Hsu: Antibacterial, hemostatic.

Internal Dose: 0.3-1.5g

Notes on This Category

• These herbs stop bleeding by any of four actions:
1. Cooling the blood
2. Astringing
3. Dispelling blood stasis
4. Warming the channels
• Herbs in this category are commonly combined with:
A. Herbs that tonify the spleen when bleeding is caused by spleen Qi deficiency.
B. Herbs that clear heat and cool the blood when blooding is caused by heat in the blood.
C. Herbs that promote blood circulation when bleeding results from blood stagnation.
D. Herbs that warm the Yang when bleeding is due to Yang deficiency cold.
• Qi should only be strongly tonified (in cases of bleeding) when heavy bleeding has led to Qi collapse.

Other Herbs to Consider for Stopping Bleeding, When Appropriate (most better when charred):
Bai ji li – Tribulus, Chi shi zhi – Clay (halloysite / kaolinite), Chun gen pi – Ailanthus, Da huang – Rhubarb, Dai zhe shi – Hematite, Dong chong xia cao – Cordyceps, E jiao – Ass hide gelatin, Gan jiang – dry Ginger, Gu sui bu – Drynaria, Guan zhong – Dryopteris (or analogs), Gui ban – Turtle shell, Hai piao xiao – Cuttlefish bone, Han lian cao/Mo han lian – Eclipta, Huang lian – Coptis, Huang qin – Scutellaria, Huang yao zi – Dioscorea bulbifera, Jiang huang – Turmeric, Jiang xiang – Dalbergia, Jing jie – Schizonepeta, Lian xin  – Lotus heart, Lu jiao jiao – Deer antler gelatin, Ma bo – Puffball mushroom, Ming fan – Alum, Mu dan pi – Moutan, Mu zei – Equisetum, Qing hao – Artemisia annua, Ren shen – Ginseng, Sang ye – Morus leaf, Shan zhu yu – Cornus berry, Shi liu pi – Pomegranate rind, Shi wei – Pyrossia, Su mu – Sappan, Wu bei zi – Sumac gall, Wu ling zhi – Flying squirrel feces, Wu mei – Mume, Xu duan – Dipsacus, Xue jie – Dragon’s blood resin, Yin chai hu – Stellaria, Zhi zi – Gardenia, Zhu ru – Bamboo.

Ai Ye – Mugwort leaf – Artemisia argyi or A. vulgaris or A. lavandulaefolia

Nature: bitter, sweet, astringent, slightly cold

Enters: Lung, Liver, Stomach

Actions: Relieves swelling; promotes tissue regeneration; stops bleeding by astringing.

Indications:
• Mainly used for bleeding from the Lungs or stomach: hemoptysis, hematemesis, epistaxis.
• Heat and toxicity: carbuncles, cracks on hands and feet; also sores, ulcers, chapped skin. Reduces the swelling of sores, helps speed resolution of ulcers. Especially useful for chronic, non-healing ulcers. For these indications, and for bleeding from traumatic injury, it is usually applied topically.
• Pulmonary tuberculosis: in 60 chronic cases which had not responded to normal therapy, 42 were clinically cured and 13 were significantly improved after taking Bai ji for three months. Also successful in bronchiectasis.
• Useful as a powder for stopping bleeding in surgery.
• Bleeding ulcers, carefully selected cases of gastric or duodenal perforation: Stopped bleeding in all 69 cases of bleeding ulcers in one study. Successful in 23 of 29 cases of perforated ulcers in another study. Contraindicated for patients who (1) do not have a definite diagnosis; (2) have recently eaten; (3) the physical exam reveals marked abdominal distention, reduced bowel sounds, or a painful rectal examination; or (4) are in unstable condition for any reason. Some clinicians feel Bai ji should not be used for perforation for the following reasons: (1) the powdered herb can increase peristalsis and therefore enlarge the perforation; (2) the above, together with an increase in nausea and vomiting, can increase leakage into the abdominal cavity; and (3) because powdered Bai ji is adhesive, it can cause a serious problem if it enters the abdominal cavity.
• Topical, as a sterile ointment: for burns.
• Added to topical formulas to reduce the incidence of skin reaction.
MLT: In powder with sesame oil for chapped, bleeding hands and feet, wind/sunburn.
• Not for Lung/stomach bleeding when there are true excess heat signs, external pathogens, or with Lung abscess.
DY: With San qi, the two herbs act to mutually reinforce one another, and together they effectively dispel stasis, stop bleeding, promote granulation and engender muscle (flesh) without producing blood stasis. For such indications as hemoptysis, hematemesis, and bleeding caused by trauma. For internal use, take 3-6g of each herb, powdered, 2-3 times per day. Most bleeding can be stopped within two days. For gastric hemorrhages, it is advised to mix this powder with cool water in order to increase its vasoconstricting mechanism within the stomach.

Dose: 3-15g

Bai Ji – Bletilla rhizome

Nature: bitter, sweet, astringent, slightly cold

Enters: Lung, Liver, Stomach

Actions: Relieves swelling; promotes tissue regeneration; stops bleeding by astringing.

• Mainly used for bleeding from the Lungs or stomach: hemoptysis, hematemesis, epistaxis.
• Heat and toxicity: carbuncles, cracks on hands and feet; also sores, ulcers, chapped skin. Reduces the swelling of sores, helps speed resolution of ulcers. Especially useful for chronic, non-healing ulcers. For these indications, and for bleeding from traumatic injury, it is usually applied topically.
• Pulmonary tuberculosis: in 60 chronic cases which had not responded to normal therapy, 42 were clinically cured and 13 were significantly improved after taking Bai ji for three months. Also successful in bronchiectasis.
• Useful as a powder for stopping bleeding in surgery.
• Bleeding ulcers, carefully selected cases of gastric or duodenal perforation: Stopped bleeding in all 69 cases of bleeding ulcers in one study. Successful in 23 of 29 cases of perforated ulcers in another study. Contraindicated for patients who (1) do not have a definite diagnosis; (2) have recently eaten; (3) the physical exam reveals marked abdominal distention, reduced bowel sounds, or a painful rectal examination; or (4) are in unstable condition for any reason. Some clinicians feel Bai ji should not be used for perforation for the following reasons: (1) the powdered herb can increase peristalsis and therefore enlarge the perforation; (2) the above, together with an increase in nausea and vomiting, can increase leakage into the abdominal cavity; and (3) because powdered Bai ji is adhesive, it can cause a serious problem if it enters the abdominal cavity.
• Topical, as a sterile ointment: for burns.
MLT: In powder with sesame oil for chapped, bleeding hands and feet, wind/sunburn.
• Not for Lung/stomach bleeding when there are true excess heat signs, external pathogens, or with Lung abscess.
DY: With San qi, the two herbs act to mutually reinforce one another, and together they effectively dispel stasis, stop bleeding, promote granulation and engender muscle (flesh) without producing blood stasis. For such indications as hemoptysis, hematemesis, and bleeding caused by trauma. For internal use, take 3-6g of each herb, powdered, 2-3 times per day. Most bleeding can be stopped within two days. For gastric hemorrhages, it is advised to mix this powder with cool water in order to increase its vasoconstricting mechanism within the stomach.

Dose: 3-15g

Bai Mao Gen – Imperata rhizome – Woolly grass – White grass

Nature: sweet, cold

Enters: Lung, Stomach, Bladder, Large Intestine

Actions: Cools the blood; stops bleeding; clears heat; promotes urination.

Indications:
• Damp-heat: painful urination, edema, jaundice, urinary difficulty.
• Heat in the blood: hemoptysis, hematuria, hemafecia, epistaxis, uterine bleeding.
• Stomach heat: nausea, thirst.
• Lung heat: wheezing.
• Acute nephritis: found to reduce edema, lower blood pressure, normalize examination of urine, shorten duration of the disease.
Li: Beneficial for prostate cancer.
Weng Weiliang, et. al.:
• Bleeding: bai mao gen could be used to treat nasal bleeding, haematemesis, hematuria and uterine bleeding. It had good effects on skin or mucous petechiae, nasal or gingival bleeding and bleeding in sputum.
• Acute glomerulonephritis, acute edema: bai mao gen 250~500g was decocted with 500~1000ml water for 10 minutes with slow fire after boiling. It had good short-term effect on acute glomerulonephritis.
• Acute or chronic infectious hepatitis: bai mao gen decoction was used to treat 200 cases of acute or chronic infectious hepatitis and had satisfactory effect. 33 cases of acute or chronic infectious hepatitis were treated with bai mao gen, xuan shen, dang gui, ren dong teng, sheng gan cao, sheng huang qi, sheng ma, tu fu ling, 25 cases were markedly effective, 6 effective, and the total effective rate was 94%.
• Upper respiratory tract infections: Qing Wen Tang No. 1 (bai mao gen, da qing ye, sang ye, lu gen, sheng shi gao, gan cao) was used to treat 40 cases of upper respiratory tract infections. It had good effects on fever, cough, nasal discharge, poor appetite, thirst, scanty and yellow urine and dry stools. 85% cases had fever allayed within 2 days.

Dose: 9-24g (to 60g when used alone)

 
Mao Hua: the flower
• Sweet, cold.
• Cools the blood, stops bleeding.
• Heat in the blood: epistaxis, hematemesis.
• Less effective than Bai mao gen for painful urinary dysfunction.

Ce Bai Ye – Biota leaf – Thuja orientalis (synonyms include Platycladus and Biota) – Leafy twig of Chinese Arborvitae – “Flat Fir Leaves”

Nature: bitter, astringent, slightly cold

Enters: Lung, Liver, Large Intestine, Heart

Actions: Eliminates phlegm; stops coughing; clears Lung heat; cools the blood; stops bleeding; promotes healing of burns.

Indications:
• Bleeding: hemoptysis, epistaxis, hematemesis, hematuria, hemafecia, uterine bleeding, bleeding gums, bloody dysentery disorders. Mainly for bleeding due to heat in the blood, but, appropriately combined, this herb can be used for cold disorders as well.
• Lung heat: cough, copious phlegm. Especially important in cases of difficult-to-expectorate sputum streaked with blood.
• Topical, as a powder or ointment: psoriasis or early stages of burns over a small to moderate surface area. For psoriasis, the herb can be applied topically and taken as a decoction. It is especially effective for acute conditions.
• Topical decoction for pain.
• Dysentery: powdered Ce bai ye effectively treated 100 of 114 cases of dysentery in one study.
• Hemorrhage due to gastric or duodenal ulcer. One study showed quicker results with Ce bai ye than standard therapy.
• Alopecia: (use tincture) generates new hair, density proportional to frequency of application.
• Use the herb raw or charred.
Dose: 6-15g

Da Ji – Japanese Thistle – Circinum – “Big Thistle”

Nature: sweet, cool

Enters: Liver, Spleen

Actions: Cools the blood; stops bleeding; reduces swelling; generates flesh at sores.

Indications:
• Heat in the blood: epistaxis, hematemesis, hematuria, hemafecia, uterine bleeding.
• Especially effective for vomiting or coughing of blood.
• Topical: for carbuncles, sores, swellings.
• Lowers blood pressure (usually 10-20 mm Hg diastolic).

Dose: 4.5-15g

Di Yu – Sanguisorba root – Burnet-bloodwort root

Nature: bitter, sour, slightly cold

Enters: Liver, Stomach, Large Intestine

Actions: Stops bleeding; cools the blood; reduces fire; eliminates toxicity; promotes healing of non-healing skin ulcers; clears heat, generates flesh, reduces oozing.

Indications:
• Heat in the blood: hemoptysis, hemafecia, hematuria, epistaxis, hematemesis, bleeding hemorrhoids, uterine bleeding, bloody dysenteric disorders.
• Topically (sometimes calcined): burns, sores, ulcers, injuries, eczema. May be powdered and mixed with sesame oil.
• Especially good for bleeding in the lower Jiao due to damp-heat.
• Broad spectrum antimicrobial.
• Reduces seepage, infection rate, mortality, and healing time of burns.
• One study showed significant benefit in eczema (using 30% roasted herb in petroleum jelly).
• Use charred to stop bleeding.
Weng Weiliang, et. al.:
• Primary thrombopenic purpura: Qing Huo Xiao Yu Tang: sheng di, shui niu jiao, bai mao gen, sheng shi gao, 30g each; di yu, dan pi, chi shao, dang gui, 12g each; xian he cao 20g; tu da huang 15g; gan cao 10g. The formula was used to treat primary thrombopenic purpura of Blood Heat type. The other type was treated with another formula. 1 dose every day, water decoction, for 1~3 months. 32 cases were treated, 14 markedly effective, 11 effective, 6 improved and 1 ineffective.
• Nephritis due to purpura: 110 cases of nephritis due to purpura were treated with yu mi xu 30g; bai mao gen, xian he cao, 20g each; zi cao 12g; parched di yu, qian cao, dan pi, 9g each; shi wei, sheng di, huang qi, 15g each; san qi powder 3g (taken with water). 1 dose every day, water decoction. After 30~60 doses, all cases were cured and no recurrence was reported.
• Hemorrhage of the upper digestive tract: Di yu was used in various formulas for the treatment of hemorrhage of the upper digestive tract, and it had good effect.
• Necrotic enteritis: Bai tou weng, bai jiang cao, 15g each; da huang 10g; huai hua 12g; zhi shi, dan shen, bai shao, hou po, 9g each; pu gong ying 25g; di yu, huang lian, huang qin, 6g each; hong hua 3g. 1 dose every day, water decoction. The formula was used to treat 23 cases of necrotic enteritis, 20 were cured and 3 ineffective.
• Dysfunctional uterine bleeding: Chao di yu, shu di, huang qi, dang shen, 30g each; chao bai zhu, dang gui, 15g each; pao jiang, e jiao (melted), 10g each; sheng ma 6g. 1 dose every day, water decoction. After 3~9 doses, all treated 32 cases were cured.
• Skin diseases: Charred di yu powder and vaseline were made into 30% ointment for external application to treat skin diseases such as eczema and ringworm of the feet, etc.. 109 cases were treated, and 47 cured, 50 markedly effective or effective.

Dose: 6-12g

Huai Hua – Huai Hua Mi – Sophora flower bud – Pagoda Tree flower bud

Nature: bitter, slightly cold

Enters: Liver, Large Intestine

Actions: Cools the blood; stops bleeding; clears liver heat.

Indications:
• Damp-heat: bleeding hemorrhoids, hemafecia, dysentery
• Heat in the blood: many forms of bleeding, especially of the lower body/large intestine; also for coughing blood, epistaxis, uterine bleeding.
• Liver heat: headache, red eyes, hypertension, dizziness.
• Topical: tongue bleeding.
• Lowers blood pressure.
• Use charred to stop bleeding.
• Contains rutin and quercetin (anti-inflammatory, reduce capillary permeability, reduce tension in bronchial and intestinal smooth muscle, relieve intestinal spasms, anti-allergic effects, improve coronary circulation by dilating coronary blood vessels, may protect against development of atherosclerosis, more).
HF: A Sha Chong (kill worms or parasites) herb, important in Gu Zheng (Gu parasites) formulas
Zhaoxue Lu: As we know, most books mention Huai Hua enters Liver, LI intestine with the function to clear heat, cool blood and stop bleeding. It is commonly used for LI wind with hemorrhoid or blood in the stool. For psoriasis, we usually think it belongs to warm febrile disease and related to skin (Lung). So we use the function of Huai Hua which can cool blood and clear heat from Li to clear the skin. There is a clinical report to use Huai Hua 3g bid after meals every day to treat psoriasis. Huai Hua was ground into power after being dry fried into yellow color.

Dose: 6-15g

 

Huai Jiao: the fruit
• Weaker effect on bleeding than the flower bud, but more effective at draining heat.
• Often used for inflamed hemorrhoids.
• Directs Qi downward (therefore contraindicated in pregnancy).

Dose: 9-15g

Lian Fang Mature – Lotus receptacle – Lotus peduncle

Nature: bitter, astringent, warm

Enters: Liver, Kidney, Spleen

Actions: Dispels blood stasis; stops bleeding; calms the fetus; dispels summer-heat and dampness.

Indications:
• Uterine bleeding, hematuria.
• Restless fetus, threatened miscarriage.
• Summer-heat with dampness: diarrhea in children.
• Recent use: for cervical cancer and pemphigus.
• Use fresh for summer-heat.
Jin: To promote blood circulation, best prepared with vinegar or wine.

Dose: 3-9g

Ou Jie – Node of Lotus Rhizome

Nature: sweet, astringent, neutral

Enters: Liver, Lung, Stomach

Actions: Stops bleeding by astringing; dispels blood stasis

Indications:
• Many forms of bleeding, especially heat in the Lungs or stomach: hemoptysis, hematemesis. Also for chronic bleeding when combined appropriately.
• Heat in the blood: prolonged menstruation.
• Can be cooked as a food
• Use raw for bleeding due to heat in the blood (the fresh herb crushed into juice is even better).
• Partially char the herb for bleeding due to cold from deficiency.
• Ping-Qi Kang includes this herb in his headache/migraine formula.
Jin: To promote blood circulation, best prepared with vinegar or wine.
Yoga: Padma, Kamala, Pushkara, more names
• The lotus is India’s most sacred plant, the symbol of spiritual unfoldment. (See also Lian zi, Lian xin, Lian fang, etc.)
• Sweet, astringent/cooling/sweet.
• P, V-; K+ (in excess)
• Nutritive tonic, rejuvenative, aphrodisiac, astringent, hemostatic, nervine.
• Diarrhea, bleeding disorders, menorrhagia, leukorrhea, impotence, spermatorrhea, venereal disease, heart weakness.
• Opens the first chakra (muladhara) – the root center: for first chakra disorders. (PLB: e.g., self-indulgence, self-centeredness, insecurity, instability, rootlessness, ungroundedness, etc.)
• Calms the mind, subdues restless thoughts and dreams.
• The lotus is sacred to Lakshmi, the goddess of prosperity, and brings spiritual and material abundance.

Dose: 9-15g

Qian Cao – Qian Cao Gen – (Red) Madder root – Rubia

Nature: bitter, cold

Enters: Liver, Heart

Actions: Promotes blood circulation, dispels blood stasis; cools the blood; stops bleeding.

Indications:
• Blood stasis: pain in the flanks, chest, joints in Bi syndrome, trauma.
• Blood stasis: amenorrhea, lochioschesis, early stages of carbuncles.
• Heat in the blood: any form of bleeding, including hematemesis, hemafecia, hematuria, hemoptysis, uterine bleeding, etc.
• Stimulant effect on uteri of post-partum women.
Yoga: Manjistha: bitter, sweet/cooling/pungent; P, K-; V+
• Alterative, hemostatic, emmenagogue, astringent, diuretic, lithotriptic, antitumor effect.
• Best blood purifier in Ayurveda. Detoxifies the blood, removes obstruction (including in the kidneys and liver).
• Amenorrhea, dysmenorrhea, menorrhagia, menopause, bleeding, kidney, bladder, or gall stones, jaundice, hepatitis, diarrhea, dysentery, trauma, cancer, heart disease, obstinate skin problems, dropsy, rickets, paralysis, herpes.
• For all inflammatory conditions.
• Helps knit broken bones.
• Topical: as a paste for skin discoloration, inflammation, burns, damaged tissue
• Major anti-Pitta herb.
Hsu: Antibacterial, antitussive.

Dose: 6-9g

San Qi – Tian Qi – Panax pseudoginseng or P. notoginseng – “Three Seven”

Nature: sweet, slightly bitter, warm

Enters: Liver, Stomach, Large Intestine

Actions: Stops bleeding; promotes blood circulation, dispels blood stasis, relieves pain, reduces swelling; commonly thought of as a tonic, similar to ren shen.

Indications:
• Bleeding: any form, internal or external, including hematemesis, epistaxis, hematuria, hemafecia, etc. A particularly important herb because it stops bleeding without causing stasis.
• Traumatic injury: the herb of choice for swelling and pain due to falls, fractures, contusions, sprains.
• Blood stasis: pain, including of the chest, abdomen, joints.
• Yin deficiency heat: bleeding (combine with Yin tonics).
• Coronary heart disease, angina pectoris: may replace nitroglycerin.
• May lower blood pressure.
• May reduce serum lipids, cholesterol.
• Effective for Crohn’s disease.
• The liver seems to play an important role in San qi’s ability to stop bleeding internally, since its effectiveness is lost if the portal vein is ligated. Also shortens thrombin time.
Li: May be beneficial in obesity for weight loss.
MLT: For internal or external hemorrhages.
• Powerfully dissolves clots, normalizes circulation.
• Increases coronary artery flow.
HF: An important herb in anti-Gu therapy to move Qi (xing Qi) and break accumulation (po ji).
Hsu: Cardiotonic: increases coronary blood flow, decreases oxygen consumption by cardiac muscle, thereby diminishing the load on the heart.
• Lessens lipid and cholesterol levels in the blood.
• Possesses an anti-tumor effect.
• Enhances the immune system.
SD: Has been successfully employed as an adjunct to radiation therapy of nasal cancer, greatly improving the success of the treatments. Improves immune system functions and promotes blood circulation.
DY: With Bai ji, the two herbs act to mutually reinforce one another, and together they effectively dispel stasis, stop bleeding, promote granulation and engender muscle (flesh) without producing blood stasis. For such indications as hemoptysis, hematemesis, and bleeding caused by trauma. For internal use, take 3-6g of each herb, powdered, 2-3 times per day. Most bleeding can be stopped within two days. For gastric hemorrhages, it is advised to mix this powder with cool water in order to increase its vasoconstricting mechanism within the stomach.
• With Dan shen to quicken the blood, dispel stasis, nourish the heart, open the network vessels, stop pain, and settle palpitations. For indications such as chest Bi or impediment, i.e. cardiac problems with pain and severe palpitations. For these indications, wine mix-fried Dan shen should be used. This combination treats heart pain no matter what the cause. This action may be reinforced by adding Shi chang pu, Xie bai, Gua lou pi, Gui zhi, and Tan xiang.
• There are two methods of preparation of San qi:
- Uncooked San qi quickens the blood, dispels stasis, and stops bleeding.
- Steamed San qi nourishes the blood, and is not effective for either quickening the blood or stopping bleeding. If San qi is cooked by adding it together with other decocting medicinals, its ability to quicken the blood and stop bleeding is lost. Therefore, for these indications, San qi is more efficient when administered [directly] in its powdered form.
• Modern research has clearly demonstrated that San qi has a definite effect on coronary heart disease, angina pectoris, and hypercholesterolemia.
Eric Brand: San Qi, also called Tian Qi, notoginseng, or pseudoginseng, is an important medicinal substance in Chinese medicine. San Qi comes from the same genus as Chinese and American ginseng, and the plants and their roots have similarities in appearance and odor. All three of these Panax species have some overlapping constituents, though they also have significant differences in their chemistry and clinical use. In contrast to the primarily supplementing American and Chinese ginsengs, San Qi is most well-known for its ability to stop bleeding and quicken the blood.
While San Qi is easy to identify visually, it is not uncommon to see mistaken substitute for San Qi on the market. The substitute, known as Chuan San Qi, is completely unrelated but it is confused with standard San Qi because of similarity in their Chinese names. I first became aware of this issue years ago when I was still in school in California. At the time, I often hung out in Chinatown-style herb shops, and I saw that many shops would refer to the normal San Qi that we learned about in school as Tian Qi, and would dispense a different herb when San Qi was specified. All textbooks clearly state that these two names are synonymous and should both refer to normal notoginseng, and it took me years to learn what that mysterious other herb was.
The true notoginseng is the hard, dense, node-heavy product that most of us are familiar with. The false notoginseng is a sliced, light, and white root product that looks similar to yu zhu (Siberian Soloman’s seal). The white, misidentified product is known as Rhizoma Tupistrae, and it is toxic. The exact species used has not yet been definitively identified, but the genus is known. This plant is a heat-clearing, toxin-resolving substance that should not be used in place of San Qi. True san qi should be very dense, grayish-yellow, brownish-yellow, or black; the true and false products are easily distinguished visually.
Once the correct species is identified, the next issue to be aware of relates to processing methods. For authentic San Qi, we see two different products on the market. In the past, all the best San Qi was exported, and the export grade was colored with coal smoke and coated with insect wax to make it shiny. This causes the roots to have a black, shiny appearance, and the prominence of this processing method for quality San Qi caused many global markets to develop a preference for the black, shiny form. Consequently, we see this black-processed form in herb shops around the world.
Unprocessed San Qi is naturally brownish-yellow, and often slightly gray in color. Depending on the soil and growing environment, it can come out more yellowish or more brownish, but it is quite distinct from the black, shiny form. Regardless of color, the roots have the same characteristic dense, stubby, and nodular shape. San Qi is graded based on size. Small roots are inexpensive, while older and larger roots fetch a premium price.
Weng Weiliang et. al.:
Bleeding due to ulcer
San Qi Bai Ji Tang (experiential formula): san qi powder, bai ji powder, sheng da huang powder, 6g each; xian he cao, duan wa leng zi, 20g each; zhi shi 9g; chen pi, fu ling, 15g each; qing ban xia 10g. 1 dose every day. Modify the formula according to accompanied symptoms. 36 cases of bleeding due to gastric or duodenal ulcer were treated, 34 were cured, 1 markedly improved and 1 improved. The average hemostasis time was 4 days.
Ulcerative colitis
San Qi Zhen Zhu San No. 1: san qi 50g; zhen zhu 50g, er cha 50g, xue jie 50g, bai ji 50g, bing pian 15g, for patients with excessive bleeding. No. 2: san qi 50g, zhen zhu 15g, xue jie 50g, er cha 50g, bai ji 50g, bing pian 15g, da bei mu 50g, for large ulcers. 5~10g powder was added with 50~100 ml physiological saline for retention enema, once daily before sleep, 15 days as a course of treatment, 2~4 courses totally. Among 36 treated cases, 28 were basically cured, 7 improved and 1 ineffective.
Enteritis
San qi was ground into very fine powder, 1~3g, tid, three days as a course of treatment, 1~2 courses totally. 26 cases (17 acute and 9 chronic) enteritis were treated, 23 cured and 3 improved.

Dose: 3-9g (1-3g direct as powder)

 

San Qi Hua: the flower
• Sweet, cool.
• Pacifies the liver; lowers blood pressure.
• Hypertension: dizziness, vertigo, tinnitus.
• Acute sore throat.

Xian He Cao – Agrimony – “Immortal Crane Herb”

Nature: bitter, astringent, neutral

Enters: Lung, Liver, Spleen

Actions: Stops bleeding and diarrhea by astringing; kills parasites.

Indications:
• Treats many forms of bleeding: hemoptysis, hematemesis, hemafecia, hematuria, epistaxis, uterine bleeding, bleeding gums. When combined appropriately, this herb can be used for heat or cold, in excess or deficient patterns.
• Chronic diarrhea or dysentery due to deficiency. Can be used as a suppository for diarrhea.
• Tapeworms.
• Trauma: Xian he cao powder is commonly used in surgery as a hemostatic: hemorrhage or seepage usually stops within 1-2 minutes.
• Topical: use the decoction as a wash for trichomonas vaginitis
• Occasionally used to “astringe” Qi – for fatigue due to overexertion.
MLT: The calcined ashes of Xian he cao are most effective to stop bleeding.
• For vaginitis due to trichomonas vaginalis, soak a cotton ball in a strong decoction, and insert overnight. Next morning, douche with a decoction of agrimony and yellow dock.
• Can be used to relieve pain and coalesce and strengthen the good cells of the body to resist all kinds of pathogenic influences.
• Recent: valuable for cancer (as in the formula Ping Xiao Dan).
MW: For liver Qi stagnation: irritability, suppressed emotions (similar to bupleurum).
• Nearly the same as Cinquefoil: Cinquefoil has characteristic leaves made up of five leaflets, like a hand. It (and agrimony) has a magic function to ease problems associated with labor (work with the hands, one’s calling, spiritual work) and the work environment (coworkers, boss, or other facets of the situation). Taking it or keeping some around changes a person’s environment (e.g. for an oppressive or dysfunctional work environment).
• The characteristic mental state of the agrimony patient: tension, frustration, anger, inner torment, feels “caught in a bind,” unable to do the right thing, they constrict their breathing from tension, may hold exhalation back, try to hold back pain and not complain – tension and pain hidden behind a facade – act stoic or jovial.
• Female problems: dysuria, dysmenorrhea.
• The “bad hair day” remedy: tension manifests in the hair – poor growth, frazzled, breaks, patchy, nails break also.
• Intermittent fever, chills, influenza, Shaoyang symptoms.
• Sharp, shooting pain in the kidney region.
• Helps passage of gallstones and kidney stones.
• Also for ulcers on the lower body; skin eruptions; alopecia; toxemia; hypertension; colitis, enteritis.
• Tension related to bed wetting.
• This is wolf medicine.
• Matt Wood usually gives agrimony in low-potency homeopathic doses (12x-30x) or 3 drops of the tincture daily.
K&R: Hypoglycemiant, astringent, diuretic, anti-inflammatory, cytophylactic.
• Earth yang, metal yang.
• For diabetes; asthma; jaundice.
Earth: obesity, intestinal mycosis, gout, headache, cataracts, tonsilitis, stomatitis, pharyngitis, aphthous ulcer, infected wounds, contusions, neuritis, cholecystitis with hyperacidity.
Metal: acute bronchopneumopathy with lots of sputum, hemoptysis, headache, tonsilitis, dysentery, hoarseness, EPI with fever, diarrhea, atonic bowel.
Hsu: Hypotensive, anti-inflammatory, antibacterial, inhibits proliferation of some types of cancer cells, regulates heart rate.
IBIS: Qualities: bitter, cool, dry
Affinities: liver
Actions: mild astringent, tonic, diuretic, vulnerary
Dosage: tincture: 2 – 4 mL
There is no remedy which is better suited to the treatment of tension, especially that tension to which traditional Chinese medicine refers as Constricted Liver Qi. The patient feels extreme mental tension, torment, as if caught in a bind (see Dr. Bach’s use of Agrimony). There is corresponding physical tension, as if the part were caught in a bind; constricted respiration, harassing cough; sharp pains in the kidneys (Scudder), kidney-stones, bladder and menstrual problems (Ellingwood). This is a traditional remedy for gall-stone passage. The tongue is clear, but sometimes there are longitudinal, oval ulcers. During passage of a gall- or kidney-stone, the tongue is usually dark blue or purple, due to the congestion of blood. The wiry pulse is the great indicator, in combination with the tormented mental state (Wood).
AHPA Botanical Safety Rating: 1
Toxicity: 0
Weng Weiliang et. al.:
Primary thrombocytopenia purpura
Xian he cao, sheng di, 30~60g; hua sheng yi, xue yu tan, fu ling, bai zhu, e jiao, qian cao, dan pi, jiao san xian, mai ya, gu ya, 16g each; gou qi, he shou wu, bai mao gen, ou jie, 15g each; dan shen, zhi gan cao, 9g each. Modify the formula according to accompanied symptoms, 1 dose daily, 3 months as a course of treatment. 30 cases of primary thrombocytopenia purpura were treated, and 16 markedly effective, 8 effective, 3 improved and 3 ineffective.
Purpura nephritis
Yu mi xu 30g; xian he cao, bai mao gen, 20g each; zi cao 12g; qian cao, dan pi, di yu tan, 9g each; shi wei, sheng di, haung qi, 15g each; san qi fen 3g. Modify the formula according to TCM patterns. 1 dose daily. After 30~60 doses, all treated 120 cases were cured.
Hemorrhage of the upper digestive tract
Supplemented Xie Xin Tang (huang lian 6g; huang qin 10g; da huang 8g; xian he cao, bai ji, wu zei gu, 15g each; sheng di yu 30g; ce bai tan 30g; qian cao gen 12g), 1 dose daily. 24 cases of hemorrhage of the upper digestive tract were treated and all were cured.
Colitis
Xian he cao 30g, wu mei 10g, jie geng 9g, zhi sheng ma 6g, bai shao 10g, he zi rou 12g, di jin cao 24g, zhi huang qi 15g, dang shen 12g, sheng bai zhu 12g, gan cao 10g. 1 dose daily, water decoction, 14 days as a course of treatment. Modify the formula according to TCM pattern. 84 cases of chronic colitis were treated, and 69 were cured, 8 improved, 2 ineffective.
Dysfunctional uterine bleeding
Huang qi 15~30g; shu di 10~20G; e jiao 10~15g; xian he cao, di yu, bai shao, shan yao, xu duan, sang ji sheng, tu si zi, 15g each; shan yu rou 10g. Modify the formula according to TCM patterns. 1 dose daily, 6 days as a course of treatment. 56 cases of menopausal dysfunctional uterine bleeding were treated, 38 were cured, 14 effective and 4 ineffective.
Pain due to cancer
Decoction of xia he cao 50~80g was mixed with decoction of gan cao, bing lang, zhi ban xia, bai mao teng and long kui, 1 dose daily for 30 days. After 30 days, 1 dose every other day. 155 cases of pan due to cancer were treated, and 88 cases were relieved.

Dose: 9-15g

Xiao Ji – Small Thistle – Cephalanoplos

Nature: sweet, cool

Enters: Heart, Liver, Spleen

Actions: Cools the blood; stops bleeding; eliminates toxicity; slightly promotes urination.

Indications:
• Heat and toxicity: boils, carbuncles.
• Heat in the blood: epistaxis, hematemesis, hemoptysis, uterine bleeding, and especially hematuria.
• Not as strong as Da ji.
Hsu: Hypotensive, antibacterial.

Dose: 4.5-15g

Xue Yu Tan – Charred Human Hair – “Charred Excess of the Blood”

Nature: bitter, astringent, neutral

Enters: Liver, Stomach, Heart, Kidney

Actions: Stops bleeding; promotes blood circulation; promotes urination; mildly nourishes Yin.

Indications:
• Many forms of bleeding, including hemoptysis, hematuria, hemafecia, and especially uterine bleeding and epistaxis.
• Dysuria, hematuria.
• Usually taken as powder.
• For epistaxis, a small amount of the powder may be blown into the nasal cavity.
• Topical: trauma, pain, bleeding.
• Most Westerners are averse to the smell and idea of this medicine.

Dose: 1.5-9g

Notes on This Category

• These herbs are used to control sweating, diarrhea, coughing, bleeding, leukorrhea, and urination; and to retain Qi, blood, body fluids, Yin, Yang, and Jing.
• These herbs treat only the branch of diseases. The root – usually deficiency of Qi, blood, Yin, or Yang – should be treated concurrently. Most of the herbs in this category are contraindicated in cases of leakage due to excess – e.g., heat, accumulation of dampness, exterior syndromes.

Chi Shi Zhi – Red Kaolin/Kaolinite Clay – Halloysite Clay – “Crimson Stone Resin”

Nature: sweet, sour, astringent, warm

Enters: Large Intestine, Stomach, Spleen

Actions: Astringes the large intestine; stops diarrhea; stops bleeding; promotes wound healing.

Indications:
• Yang deficiency cold: chronic diarrhea, dysentery, especially with blood and mucus (not for damp-heat) or chronic uterine bleeding, excessive menstruation, leukorrhea, bleeding prolapsed rectum.
• Topical: for bleeding from trauma, chronic non-healing sores, weeping damp sores.
• Usually calcined before use.
• Kaolin/kaolinite, one form of clay used as this herb is where the “Kao” in the popular diarrhea remedy Kaopectate came from (the “pect” part came from pectin). Kaopectate is now bismuth subsalicylate.
• The two main forms of clay used as this medicine, kaolinite and halloysite both have the same basic chemical structure: Al2Si2O5(OH)4. As 1:1 “alumino-silicate clay minerals,” they are rich sources of aluminum, which makes Chi shi zhi probably not safe for long term consumption, due to the potential neurotoxic role of aluminum. It may even be worth retiring from the contemporary Chinese medicinal pharmacopaeia.
Hsu: Anti-diarrheal, absorbs abnormally fermented food in the intestines and protects intestinal mucosa; hemostatic.
SD: May help antidote mercury poisoning.

Dose: 9-30g

Chun Gen Pi – Chun Pi – Ailanthus bark or root bark

Nature: bitter, astringent, cold

Enters: Stomach, Large Intestine

Actions: Clears heat; dries dampness; stops leukorrhea; astringes the intestines; stops bleeding; kills parasites.

Indications:
• Chronic diarrhea or dysenteric disorders (research shows very effective for acute bacillary dysentery), especially those due to damp-heat. Particularly useful when there is blood in the stool.
• Damp-heat: chronic vaginal discharge.
• Menorrhagia or uterine bleeding.
• Roundworms.
• Topical: for itchy, tinea-like rashes.

Dose: 3-15g

Fu Pen Zi – Unripe Raspberry – Rubus fruit – “Overturned Basin”

Nature: sour, sweet, slightly warm

Enters: Liver, Kidney

Actions: Tonifies and stabilizes the kidneys, controls Jing and urine; assists Yang, improves vision.

Indications:
• Kidney Yang deficiency: seminal emission, frequent urination, urinary incontinence, enuresis.
• Kidney and liver deficiency: blurry vision, impotence, soreness of the lower back.
• Estrogen-like effects: may be useful in hormonal imbalance (e.g. acne) – as in Hong Jin’s acne formula.
• Astringes without trapping pathological factors.
• The name “overturned basin” may refer to this herb’s efficacy at treating urinary incontinence. After this herb cures the incontinence, the basin (bedpan or toilet) can be turned over because it is empty or is no longer needed.
Weng Weiliang et. al.: Male infertility – Carrot 500g (boiled as diet, and the left water was used to decoct the drugs); tu si zi 60g; nu zhen zi, gou qi, fu pen zi, wu wei zi, bu gu zhi, jiu cai zi, che qian zi, shan zhu yu, 15g each; sang shen, 30g, zhi gan cao 5g. Modify the formula according to accompanied symptoms. 1 dose every day, 30 days as a course of treatment, 20 days~5 months totally.489 cases were treated, and 331 were cured.

Dose: 4.5-9g

Fu Xiao Mai – Floating Wheat (light grains) – “Floating Little Wheat”

Nature: sweet, cool

Enters: Heart

Actions: Tonifies Qi; clears heat; nourishes the heart, calms the Shen; stops sweating.

Indications:
• Yin, Yang, or Qi deficiency: night sweats or spontaneous sweating.
• Yin deficiency: tidal fever.
• Palpitations, insomnia, irritability, emotional instability, disorientation associated with restless organ disorder.
• Enuresis in children.
• Can be used raw or dry-fried until aromatic.
• Very safe herb.
Fu xiao mai may antagonize a wheat/gluten sensitivity – keep this in mind with sensitive patients.
DY: With Huang qi to supplement Qi, nourish the heart, clear heat, secure the exterior, and stop perspiration. For indications such as spontaneous sweating due to exterior deficiency. (Mu Li San) Use stir-fried Fu xiao mai.
• With Ma huang gen to supplement the Qi, nourish the heart, secure the exterior, clear heat, and stop perspiration. The combination is found in Mu Li San for indications such as:
- 1. Spontaneous or profuse perspiration due to Qi deficiency.
- 2. Night sweats due to Yin deficiency.
• These are under-developed grains of ripe wheat which float when the wheat is washed.
• Xiao mai (Huai xiao mai) is the heavy, full grains which sink when washed. Xiao mai is better than Fu xiao mai for nourishing the heart and quieting the Shen for visceral agitation, vexation, sadness.
Fu xiao mai is the blighted grains which, when dried, float on the surface of the water when washed. Fu xiao mai is superior to Xiao mai for stopping perspiration by astringing, eliminating heat (deficiency), and treating spontaneous perspiration, night sweats, or the feeling of heat in the bones.
• Stir-fried Fu xiao mai is more powerful than uncooked Fu xiao mai at stopping sweating.
• Wheat from southern China is reputed to be warm, while that from the north is believed to be cool.
Chen xiao mai is wheat which has been stored and aged. This is preferred by some practitioners, since the more recent wheat, freshly harvested, is too warm in nature. This warmth is lost when aged.
Bai mian is wheat flour. When stir-fried (Chao mian) it supplements the spleen and stops diarrhea.

Dose: 9-15g (DY: to 30g)

Hai Piao Xiao – Cuttlefish bone

Nature: salty, astringent, slightly warm

Enters: Liver, Kidney, Stomach

Actions: Stops bleeding and leukorrhea; controls Jing; neutralizes acid, relieves pain; promotes tissue regeneration; resolves dampness; stops diarrhea.

Indications:
• Bleeding: uterine bleeding, hematemesis, hemoptysis, bleeding from trauma; especially useful for bleeding from deficiency patterns.
• Kidney deficiency: nocturnal emission, leukorrhea, spermatorrhea.
• Acid reflux, epigastric pain, peptic ulcer, foul burps (take uncooked powder).
• Deficiency: chronic diarrhea or dysentery with pain around the navel.
• With rice wine for malaria.
• Topical: chronic, non-healing skin ulcers, damp rashes of long duration, eczema.
• Topical: for bleeding (may be mixed with starch). In tooth extraction, epistaxis, and surgery – is a more effective hemostatic than either plain sponges or gelatin sponges.
Dose: 4.5-12g

He Zi – Chebulic Myrobalan fruit – Terminalia Chebula – Haritaki

Nature: bitter, sour, astringent, neutral

Enters: Lung, Large Intestine, Stomach

Actions: Astringes the Lungs and large intestine; descends Lung and large intestine Qi; eases the throat; stops coughing.

Indications:
• Chronic diarrhea or chronic dysentery due to deficiency (can be used for both hot and cold patterns when combined appropriately).
• Lung deficiency: chronic cough, asthma, wheezing, hoarse voice or loss of voice (can be used for cough due to phlegm-fire obstructing the Lungs, when appropriately combined).
Yoga: Haritaki: means it carries away all diseases and is sacred to Shiva (also called Abhaya: promotes fearlessness).
• All tastes but salty; mainly astringent/heating/sweet; VPK=
• Rejuvenative, tonic, astringent, laxative, nervine, expectorant, anthelmintic.
• For cough, asthma, hoarse voice, hiccups, vomiting, hemorrhoids, diarrhea, malabsorption, abdominal distention, parasites, tumors, jaundice, spleen disease, heart disease, skin disease, itching, edema, nervous disorders.
• Caution with severe exhaustion, emaciation, or dehydration.
• One of most important Ayurvedic herbs.
• Rejuvenates Vata, regulates Kapha, only aggravates Pitta in excess.
• Feeds the brain and nerves, imparts the energy of Shiva (pure awareness).
• Heals ulcerated membranes.
• Regulates the colon: based on dosage, corrects either diarrhea or constipation; improves digestion and absorption.
• Promotes voice and vision.
• Aids longevity, increases wisdom and intelligence.
• Raises prolapsed organs, checks excess discharges: including spermatorrhea, menorrhagia, sweating, leukorrhea, etc.
• Reduces accumulated and congested Vata.
Triphala, 3 fruit formula: laxative and balancing bowel tonic: haritaki (rejuvenates Vata), amalaki (rejuvenates Pitta) and bibhitaki (rejuvenates Kapha).
HF: A Sha Chong (kill worms or parasites) herb, important in Gu Zheng (Gu parasites) formulas.
Hsu: Antibacterial, antiviral, antispasmodic, protects ulcerations of mucosa caused by enteritis or dysentery bacteria.

Dose: 3-9g

Jin Ying Zi – Rosehip – “Golden Cherry Fruit”

Nature: sour, astringent, neutral

Enters: Kidney, Bladder, Large Intestine

Actions: Stabilizes the kidneys, controls Jing and urine; astringes the large intestine, stops diarrhea.

Indications:
• Kidney deficiency: spermatorrhea, frequent urination, urinary incontinence, copious leukorrhea.
• Kidney and spleen deficiency: chronic diarrhea or dysentery, prolapsed rectum or uterus, excessive uterine bleeding.
• May lower cholesterol, may reduce atherosclerosis.
• Rich in vitamin C.
MLT: Acute postpartum uterine hemorrhage (take some of the stem and leaf along with the fruit).
BII: Beneficial for kidney stones.
Hsu: Antibacterial, antiviral, (extract) quite effective for treating uterine prolapse.
DY: Stops abnormal vaginal discharge.
• With Qian shi to effectively supplement the kidneys, secure the essence, reduce urination, fortify the spleen, and stop diarrhea and abnormal vaginal discharge. This combination, Shui Lu Er Xian Dan, is used for indications such as:
- 1. Chronic diarrhea due to spleen-kidney deficiency. (Use bran stir-fried Qian shi.)
- 2. Urinary incontinence, enuresis, frequent micturition, and nocturia due to kidney Qi deficiency.
- 3. Chronic white vaginal discharge due to spleen-kidney deficiency.
- 4. Seminal emission and premature ejaculation due to kidney Qi not securing.

Dose: 4.5-9g

Lian Zi – Lotus seed

Nature: sweet, astringent, neutral

Enters: Spleen, Kidney, Heart

Actions: Tonifies spleen Qi; stops diarrhea; tonifies kidney Qi, controls Jing; nourishes the heart, calms the Shen.

Indications:
• Spleen Qi deficiency: chronic diarrhea, poor appetite (caution when Qi deficiency has led to Qi stagnation).
• Kidney Qi deficiency: spermatorrhea, premature ejaculation, excessive uterine bleeding, vaginal discharge.
• Heart deficiency: restlessness, insomnia, palpitations, irritability.
• Especially useful for lack of communication between the heart and kidneys.
• Common dietary therapy (use up to 60g).
Lian zi should have its heart (Lian xin) removed.
• All parts of the lotus plant are medicinal. The lotus is the source of at least eight distinct herbs.
Yoga: (see also Ou jie, Lian xin, Lian fang) Padma, Kamala, Pushkara, more names (this is India’s most sacred plant, the symbol of spiritual unfoldment).
• Sweet, astringent/cooling/sweet
• P, V-; K+ (in excess).
• Nutritive tonic, rejuvenative, aphrodisiac, astringent, hemostatic, nervine, cardiac and seminal tonic.
• Calms the mind, subdues restless thoughts and dreams.
• Helps open the heart [fourth] chakra: for heart chakra disorders [PLB: e.g., afraid to love, to feel with the heart, to connect with others, to listen to the heart, difficulty being compassionate, emotionally closed, no sense of boundaries around intimacy, impropriety, especially around intimacy "“ see also five element interpretations of fire imbalance].
• Good for devotion and aspiration, improves speech, helps stop stuttering and improves concentration.
• Diarrhea, bleeding disorders, menorrhagia, leukorrhea, impotence, spermatorrhea, venereal disease, heart weakness.
• As a food, 5g can be taken three times daily, with basmati rice or other tonics such as Shatavari and Ashwagandha, suitably spiced and sweetened.
• The lotus is sacred to Lakshmi, the goddess of prosperity, and brings spiritual and material abundance.
Hsu: Relaxes smooth muscle; dilates coronary artery.

Dose: 6-15g

Ma Huang Gen – Ephedra root – “Hemp Yellow Root”

Nature: sweet, neutral

Enters: Lung

Actions: Stops sweating.

Indications:
• Yin, Yang, or Qi deficiency: night sweats, spontaneous sweating, post-partum sweating.
• Similar to Fu xiao mai but stronger (they are often combined).
Ma huang gen closes the pores.
• It can be used topically.
Hsu: Hypotensive, dilates peripheral blood vessels.

Dose: 3-10g

Qian Shi – Euryale seed – Foxnut

Nature: sweet, astringent, neutral

Enters: Spleen, Kidney

Actions: Tonifies spleen Qi, eliminates dampness; tonifies kidney Qi, controls Jing.

Indications:
• Spleen Qi deficiency (and dampness): chronic diarrhea (especially good for children and often cooked in soup).
• Kidney deficiency: nocturnal emission, premature ejaculation, leukorrhea, spermatorrhea, urinary frequency or incontinence.
• Deficiency or damp-heat: vaginal discharge.
• Stronger than Lian zi to tonify kidney Qi and control Jing.
• One of the strengths of this herb is that it has almost no taste.
DY: Stops diarrhea and abnormal vaginal discharge, reduces urination.
• With Jin ying zi to effectively supplement the kidneys, secure the essence, reduce urination, fortify the spleen, and stop diarrhea and abnormal vaginal discharge. For specific indications of this combination, see Jin ying zi in this category.
Weng Weiliang et. al.:
• Prolonged diarrhea due to Spleen deficiency: Qian shi was often used in compound formula in combination with dang shen, bai zhu and shan yao, etc. to treat syndromes due to Spleen deficiency. The following formula was effective on syndromes differentiated as Spleen deficiency, especially those senile patients: dang shen, 15g; fu ling, bai zhu, lian rou, qian shi, chao bian dou, yi yi ren, 12g each; shan yao 15g; sha ren, 6g; chi shao 10g; zhi gan cao 6g, three doses every week.
• Spermatorrhea, premature ejaculation, incontinence of urine or frequent urination due to Kidney deficiency: Jin Suo Gu Jin Wan which containing Qian Shi had good therapeutic effect on spermatorrhea and frequent urination. Supplemented Shui Lu Er Xian Dan (qian shi, jin ying zi, nu zhen zi, 15g each; wu wei zi, shan yu rou, 10g each; tu si zi 12g; lian xu 10g; dang gui 10g; bai shao 10g; zhi gan cao 6g) was effective in treating spermatorrhea, impotence, premature ejaculation, irregular menstruation and leukerrhea, etc..
• Proteinuria due to chronic nephritis: Qian shi, shan yao, 30g each; jin ying zi, huang qi, bai he, huang jing, wu mei tan, 15g; bai zhu, fu ling, 12g; shan zha rou, pi pa rou, 10g each; shui zhi powder 3g (taken with water), tu si zi 20g. The formula was modified according to accompanied symptoms to treat 37 cases of proteinuria due to chronic nephritis, and 31 cases were completely relieved, 1 basically relieved and 5 ineffective.

Dose: 9-15g (to 30g in severe cases)

Rou Dou Kou – Nutmeg – Myristica seed – “Fleshy Cardamom”

Nature: acrid, warm

Enters: Spleen, Stomach, Large Intestine

Actions: Warms the middle Jiao; promotes Qi circulation; alleviates pain; astringes the large intestine, stops diarrhea.

Indications:
• Spleen and stomach or spleen and kidney Yang deficiency cold: chronic diarrhea, daybreak diarrhea (not for damp-heat patterns).
• Yang deficiency cold with Qi stagnation: distention and pain of the epigastrium and abdomen, poor appetite, vomiting.
• Preparation: smash on paper and allow the paper to soak up the oil (otherwise will exacerbate diarrhea); very small doses of the oil (0.03-0.2 mL) directly stimulate the gastrointestinal tract.
• Roast to increase its ability to warm the middle Jiao and stop diarrhea.
• One constituent, myristicin, is an MAO inhibitor and a hallucinogen in large doses.
Yoga: Jatiphala: V, K-; P+
• Pungent/heating/pungent.
• Astringent, carminative, sedative, nervine, aphrodisiac, stimulant.
• For poor absorption, abdominal pain and distention, diarrhea, dysentery, intestinal gas, insomnia, nervous disorders, impotence.
• Increases absorption in the small intestine.
• Reduces high Vata in the colon and nervous system.
• Calms the mind (500 mg in warm milk before sleep).
Tamasic: in excess it can dull the mind.
DY: Scatters cold; disperses distention.
• With Bu gu zhi to supplement spleen and kidney Yang, secure the intestines, and stop daybreak or “cock-crow” diarrhea. For indications such as:
- 1. Chronic diarrhea due to spleen-kidney Yang deficiency. (Si Shen Wan) Use salt mix-fried Bu gu zhi and roasted Rou dou kou.
- 2. Daybreak diarrhea with abdominal pain and rumbling noises due to spleen-kidney Yang deficiency. (Er Shen Wan)
PCBDP: Spasmolytic, anti-emetic, orexigenic, topical anti-inflammatory.
• Decreases prostaglandin levels in the colon, PGE2 inhibitor – has been used successfully in Crohn’s disease.
Dose: 1.5-9g

Sang Piao Xiao – Praying Mantis Egg Case

Nature: sweet, salty, neutral

Enters: Liver, Kidney

Actions: Mildly tonifies kidney Yang; controls Jing and urine.

Indications:
• Kidney Yang deficiency (leading to failure of the kidneys to control the orifices): enuresis, spermatorrhea, frequent urination, urinary incontinence, copious leukorrhea (not for damp-heat), nocturnal emissions (especially when not accompanied by dreams).
• This is the herb of choice for bed wetting in children.
Hsu: Suppresses urination and sweating.
Weng Weiliang, et. al.:
• Children’s enuresis: Sang piao xiao, duan mu li, 12g each; jiu cai zi 6g; ku fan 3g were decocted to 50ml juice. Take the juice before sleep. 50 cases of children’s enuresis were treated, 45 were cured and 5 ineffective.
• Spermatorrhea: Sang piao xiao 10g; tu si zi, gou qi, bu gu zhi, 12g each; sheng long gu, sheng mu li, 25g each; with impotence, add dang gui, bai shao and zhi gan cao, 12g each; wu gong, 2 pieces.
• Shingles: Sang piao xiao was baked with a slow fire to charred ones, and grounded into fine powder, which was mixed with sesame oil into paste and applied to affected areas of shingles, 3~5 days every day. 30 cases were treated and all were cured.
Subhuti Dharmananda: “Sang Piao Xiao San – Example of a Mind-Body Formula”

Dose: 3-9g

Shan Zhu Yu – Shan Yu Rou – Cornus fruit – Asiatic Cornelian Cherry – Chinese Dogwood fruit

Nature: sour, slightly warm

Enters: Liver, Heart, Kidney

Actions: Tonifies kidney and liver Yin; astringes the lower Jiao; astringes sweat; slightly tonifies kidney Yang; stabilizes the kidneys, controls Jing; stops excessive sweating, supports what has collapsed; stabilizes the menses; stops bleeding (weak); may mildly nourish Jing.

Indications:
• Kidney and liver deficiency: dizziness, vertigo, weakness of the lumbar region and knees, impotence.
• Yang collapse or Qi collapse: shock, excessive sweating.
• Kidney Qi deficiency: seminal emission, urinary incontinence, profuse sweating.
• Deficiency: excessive uterine bleeding, prolonged menstruation.
• Difficult to digest.
Li calls Shan zhu yu the “Ginseng for the Kidneys,” and claims this herb is more of a tonic than an astringent.
PFGC: For alternating hot and cold (not Shaoyang) due to internal injury to the Jueyin liver system – e.g. extreme liver deficiency causing sudden sensation of heat and cold, and dangerous loss of sweat.
Hsu: Diuretic, antibacterial, antihistamine actions.
Weng Weiliang, et. al.: This herb is indicated in the treatment of diabetes, lumbago, impotence, enuresis, infertility, vertigo, spermatorrhea, functional uterine bleeding.
Chronic pharyngitis:
Yang Yin Jiang Huo Tang (experiential formula): shu di 30g; shan zhu yu, wu wei zi, dan pi, bai jiang can, chuan niu xi, 10g each. Modify the formula according to TCM differentiation, 1 dose every day. Other treating methods were also applied. 15 days as a course of treatment, 32 patients were treated, and 31 were effective.
Diabetes:
shan yu rou, wu wei zi, dan shen, 30g each; huang qi, 40g. Modify the formula according to TCM differentiation, 1 dose every day, 1 month as a course of treatment. 300 cases were treated, and the effective rate was 85%.
Albuminuria due to nephropathy:
Yi Shen Li Shui Huo Xue Fang: shan yu rou, ze xie, dan pi, sang bai pi, 10g each; shan yao, sheng di, huai niu xi, chi shao, 15g each; che qian zi 10g; dan shen 30g; da huang 3~6g. Modify the formula according to TCM differentiation. 1 dose every day. 153 cases were treated, after 6~30 doses, 148 cases’ albuminuria turned negative.
Leucopenia:
Zi Yin Bu Shen Tang (experiential formula): shan yu rou 30g, shan yao, gou qi, huai niu xi, shu di, 15g each; gui ban, e jiao, 6g each; tu si zi 20g, bai zhu, sha ren and chen pi etc. were also added. 1 dose every day, water decoction. After 2~7 days’ treatment, 25 were effective, 1 ineffective. This formula was fit for leucopenia caused by chemotherapy or radiotherapy in the treatment of tumor.
Prostatic hyperplasia:
Tong Qian Tang (experiential formula): shu di, shan zhu yu, 12g each; rou gui, bai zhu, chuan shan jia, dang gui, niu xi, hai zao, kun bu, wang bu liu xing, 10g each; fu ling 20g; ze xie 15g. Modify the formula according to TCM differentiation. 1 dose every day, water decoction. After 30~60 days’ treatment, 48 out of 52 cases were effective.
Stroke in the convalescent stage:
sheng di, nu zhen zi, shan zhu yu, niu xi, chuan xiong, hong hua, dang gui, di long, 10g each; shan zha, 15g; sang ji sheng, ji xue teng, 20g each. Modify the formula according to TCM differentiation. 161 cases were treated, except for 8 ineffective cases, certain effects were obtained.

Dose: 3-12g (30-200g in shock)

Shi Liu Pi – Pomegranate rind

Nature: sour, astringent, warm, slightly toxic

Enters: Stomach, Large Intestine, Kidney

Actions: Astringes the large intestine, stops diarrhea; kills parasites; stabilizes the kidneys, controls Jing.

Indications:
• Chronic diarrhea or chronic dysentery (not for acute), rectal prolapse.
• Abdominal pain due to rouundworms (only when worms give rise to chronic diarrhea) – not strong as Shi jun zi.
• Roundworms, tapeworms, topical for ringworm.
• Kidney instability: spermatorrhea, premature ejaculation, excessive uterine bleeding, vaginal discharge.
• Amebic dysentery.
• Not for early stages of diarrhea.
• Should not be taken with oils or fats, in order to prevent absorption of toxin into the system.
• Use charred to stop bleeding.

Dose: 3-9g

 
Shi Liu Gen Pi: the root bark
• Much stronger at killing parasites, especially tapeworms and roundworms, than Shi liu pi.
JC: (various parts, especially the root bark) Anthelmintic (taeniafuge, vermifuge), astringent, refrigerant, antibilious, anticancerous.
• Use the rind for sore throat.
Yoga: Dadima: (rind, root bark, fruit)
• Sweet variety: VPK=
• The sour variety may aggravate Pitta. The sweet variety may increase Ama.
• The rind is anti-inflammatory to the mucus membranes.
• Use as a douche for leukorrhea.
• Topical (paste) for sores, ulcers, hemorrhoids.
• All parts are stomachic, anthelmintic, especially the root bark.
Hsu: Antibacterial, antiviral, antifungal.

Dose: 1.5-9g

Wu Bei Zi – Gall of Chinese Sumac (caused by the insect Melaphis)

Nature: sour, salty, cold

Enters: Kidney, Lung, Large Intestine

Actions: Astringes Lung Qi; stops coughing; astringes the large intestine, stops diarrhea; controls leakage of fluids; absorbs moisture; reduces swelling; relives fire toxicity.

Indications:
• Lung deficiency: chronic cough.
• Chronic diarrhea, dysenteric disorders, chronic blood in the stool, rectal prolapse.
• Leakage: nocturnal emission, spermatorrhea, excessive sweating, bleeding.
• Topical: as a powder or wash for sores, ringworm, toxic swellings, damp and ulcerated skin.
• Topical: for scar tissue.
• Topical: apply as a paste to the navel for night sweats (from tuberculosis in one study) or asthma.
• Antibiotic against a wide range of bacteria and some viruses.
Hsu: Hemostatic, antibacterial, antiviral, antifungal, stimulates the CNS, regulates the cardiovascular system – improves blood circulation, hypotensive.
JTCM: It was recorded in Ben Cao Gan Mu that Wu bei zi can astringe the Lungs, drain fire, transform phlegm, dissipate red swellings, eliminate toxicity, astringe non-healing ulcers, and lift prolapse of the anus, uterus and intestines. Modern scientific research shows that Wu bei zi contains tannic acid which has can coagulate proteins and blood locally, promoting the healing of ulcers.
• Mouth Ulcers:
Recurrent mouth ulcers are difficult to treat. Dry Wu bei zi powder often produces results within a week. Apply the powder 5 to 6 times a day. Usually the pain will be reduced and ulcers will heal in 7 days.
• Hemorrhoids and Prolapse of the Anus or Uterus:
Wu bei zi can astringe kidney Qi. The kidney opens to the external genital area. So, Wu bei zi can be used for kidney deficiency causing prolapse in the genital area.
For hemorrhoids, after the patient moves their bowels, clean the anus with warm water. Put 5g Wu bei zi powder on gauze and gently apply to the anus. Usually hemorrhoids will heal within a week.
For uterine prolapse mix Wu bei zi powder with sesame oil to make a paste. Apply the paste to gauze, insert into the vagina at night before bed, and remove it in the morning. Recovery will usually occur within 2 weeks.
For anal prolapse, break 60g Wu bei zi into small pieces. Cover with water, bring to a boil, and cook for 30 minutes. While the decoction is still steaming, let the steam bathe the anus. Then wash the anus with the decoction, or sit in a basin of the fluid for 30 minutes. The prolapse will usually be reduced after three washes, with total recovery in a week.
• Spontaneous Sweats and Night Sweats:
It was recorded in Ben Cao Bei Yao that Wu bei zi has a strong function to astringe the Lung. With its cool nature it can clear heat, transform phlegm and stop coughing, and it can also stop bleeding and sweating. Sweating is related to the Lungs. The umbilicus is the key point on the Ren Mai, and the Ren Mai can adjust all the Yin meridians in the body. When Wu bei zi enters this point, it can help the Ren Mai adjust all the Yin meridians in order to astringe sweating.
Traditional Chinese medical theory states that spontaneous sweats are a symptom of Yang deficiency and that night sweats indicate Yin deficiency, but in the clinic this is not always true – we still need to differentiate. However, either type can be treated with topical herbs. The combination known as Long Bei San is comprised of equal parts Wu bei zi powder and calcined Long gu. Mix Long Bei San with a small amount of water, apply to the umbilicus, and cover with an adhesive bandage. Change the application every other day. Usually it takes 2 to 6 applications to arrest the sweating.
• Eneursis and Seminal Emission:
Wu bei zi secures the essence of the kidney and the Qi of the bladder. Accordingly, it is a good herb for the treatment of enuresis and seminal emission caused by kidney deficiency.
For children’s bed wetting, the use of Long Bei San provides good results. For patients with seminal emission, combining Long Bei San on the umbilicus while simultaneously administering an internal formula yields better results.
Modern research shows that Wu bei zi contains tannic acid which can coagulate protein and form a thin membrane to strengthen the filtration capacity of the nephron tubule and increase resorption from the nephron. As a result, it can prevent proteinuria.
• Chronic Diarrhea and Dysentery:
Wu bei zi powder and white pepper powder can be mixed with a few drops of white wine, applied to the umbilicus, and covered with an adhesive bandage. A hot water bottle can be used to warm the abdomen simultaneously. The powder should be changed every other day.
• Toothache:
Zhao Pin Su liked to use Wu bei zi as a topical herb to treat all kinds of toothaches including those caused by wind-heat, stomach fire, tooth decay, etc. Dosage ranged from 10 to 30g. He said Wu bei zi was the best herb for the treatment of toothache, especially when caused by tooth decay. Wu bei zi powder can be applied to the painful spot or it can be decocted and gargled with. Sometimes the toothache stops immediately. Afterwards, the decayed area can be filled with Ru xiang to prevent inflammation.
• Chronic Cough due to Lung and Kidney Qi Deficiency Caused by Excessive Dispersion of the Lung:
(Because Wu bei zi has very strong astringent action, it is not indicated for acute cough caused by an EPI.) Prepare a formula of 100g each of Wu bei zi, Hu tao rou, Mai men dong, and Wu wei zi, grind to a powder, and give 6g twice a day, morning and night. Two to eight weeks of treatment with the above combination produces good results in every case.

Dose: 4.5-9g

Wu Mei – Mume fruit – Black Plum – “Dark Plum”

Nature: sour, neutral

Enters: Liver, Spleen, Lung, Large Intestine

Actions: Astringes Lung Qi; astringes the large intestine; stops coughing and diarrhea; generates body fluids, eases thirst; calms roundworms; stops bleeding.

Indications:
• Lung Qi deficiency: chronic cough.
• Chronic diarrhea, chronic dysentery, blood in the stool.
• Yin deficiency (or Qi deficiency) heat: thirst, wasting and thirsting disorder.
• Roundworms (also for hookworms): epigastric and abdominal pain, vomiting (must purge the patient after calming the worms with Wu mei).
• Occasionally used for abdominal pain and vomiting without parasites.
• Bleeding: uterine, fecal (especially when there are accompanying symptoms of blood deficiency including dryness, thirst, parched mouth).
• Topical (as a paste made by powdering and mixing with vinegar, or in plaster form): protruding lumps on the skin – warts, corns, etc.
• Bensky/Gamble: soften the growth in hot water, remove it, then apply the herb, cover with gauze, and change every 24 hours.
• Bacillary dysentery.
• Stimulates production of bile and contraction of bile duct.
• Partially char when using to stop bleeding.
Wei Li gives in large dose for recalcitrant skin disease, such as eczema (20-100g).
Hsu: Pronounced antibacterial effect, antifungal, anti-allergic effect.
BF: Mume is a plum picked green in the fifth month. It is then preserved by drying over a slow-baking fire for several days. In Japan, umeboshi is made from this same plum which is pickled with salt and Perilla leaves (called chiso in Japanese). According to Michio Kushi, a leading proponent of Japanese macrobiotics, umeboshi plums “neutralize an acidic condition and relive intestinal problems, including those caused by microorganisms.” Another Macrobiotic teacher, Naburo Muramoto, says: “As medicine the umeboshi plum works miracles. Stomach aches, stomach cramps, migraines, certain types of headaches, and acidity are some of the minor pains these plums can relieve. They also counteract fatigue and act as a preventive against dysentery.”
Wu Mei Wan with additions and subtractions can be used for women with severe dysmenorrhea in turn due to endometriosis with a pattern of damp heat stasis and stagnation, spleen qi deficiency, and even a bit of yang deficiency.
In modern Chinese medicine, Mume has three main uses. First, it astringes the intestines and stops diarrhea. Secondly, it expels worms or parasites. And third, it engenders fluids. However, the Shen Nong Ben Cao says that Mume “precipitates or descends the qi, eliminates heat and vexatious fullness, quiets the heart, relieves pain in the limbs, treats hemilateral withering, insensitivity, and dead muscles, and removes green-blue and black moles and malign diseases.” Likewise, the Ri Hua Zi Ben Cao says Mume “eliminates taxation [read: deficiency]…and treats one-sided withering of the skin with numbness and impediment.” Pain in the limbs, one-sided withering, insensitivity, and dead muscles might certainly be describing an autoimmune condition like MS or amyotrophic lateral sclerosis (ALS). And the Ben Cao Tu Jing says Mume “rules … vacuity taxation emaciation and skinniness” which might also describe certain autoimmune and immune deficiency diseases. Vexatious fullness suggests liver depression qi stagnation, the necessity of precipitating the qi suggests upward counterflow, eliminating heat suggests depressive heat, and quieting the heart, when read together with the other symptoms, suggests yin fire disturbing the heart spirit. Li Dong-yuan did sometimes use Mume in his yin fire formulas. Green-blue and black moles suggest blood stasis, while malign diseases means both injurious diseases and also suggests blood stasis, since static blood is also called malign blood.
Heiner Fruehauf says that a number of medicinals are specifically quieting to the spirit in gu zheng cases. He then goes on to list a number of yin-enriching, fluid-engendering medicinals, such as Radix Glehniae Littoralis (Bei Sha Shen), Bulbus Lilii (Bai He), and Rhizoma Polygonati (Huang Jing). Fructus Pruni Mume likewise engenders fluids. It is also the best known of the commonly used Chinese medicinals for treating worms or parasites. Although Fruehauf does not mention Mume being described in the Chinese gu zheng literature as a typical anti-gu medicinal. I believe it should be. In addition, I think the combination of Mume and Perilla is a very effective one in clinical practice. One can add Mume to anti-gu formulas containing Perilla and/or eat Japanese umeboshi plums as a condiment in their diet. (Perilla, by the way, can also be grown as a self-reseeding garden herb and eaten as a salad green.)
See also BF’s commentary on Zi su ye, where he discusses the use of Mume in combination with dispersing herbs to prevent depletion.

Dose: 3-9g

Wu Wei Zi – Schizandra fruit – “Five Flavor Seed”

Nature: sour, warm

Enters: Lung, Kidney, Heart

Actions: Strongly astringes Lung Qi, stops coughing; mildly nourishes kidney Yin; generates body fluids; stops sweating; controls Jing; stops diarrhea; quiets the Shen and calms the heart.

Indications:
• Lung deficiency or Lung/kidney deficiency: asthma and cough, especially chronic (inhibits leakage of Lung Qi above, nourishes kidney Yin below).
• Yin deficiency: night sweats.
• Yang deficiency: spontaneous sweating.
• Body fluid injury: thirst.
• Kidney deficiency: seminal emission, including nocturnal, vaginal discharge, frequent urination.
• Kidney and spleen deficiency: chronic/daybreak diarrhea, seminal emission.
• Kidney and heart Yin deficiency with blood deficiency: insomnia, dream-disturbed sleep, palpitations, irritability.
• Skin disorders.
• May improve liver function in hepatitis: reduces liver enzyme levels (particularly SGPT).
• Stimulatory effects: improves reflexes, stimulates respiration through a direct effect on the CNS: helps resistance of respiratory depression from morphine.
• Can induce/promote labor.
• Increases visual acuity and visual field.
• Raises acuity of tactile discrimination.
• Adaptogenic.
• Beneficial in neurasthenia.
• Soak in 80-proof alcohol as a medicinal wine for itchiness and irritation of the skin associated with a wind rash.
• Crush before using.
• Use dry for deficiency heat.
• Use wine-prepared for tonification.
MLT: Inhibits loss of physical and mental energy. Its spirit calming effects lie in its ability to heal and prevent loss of psycho-physiological energy.
• Useful for those who tend to feel agitated or scattered.
• Can be taken in wine to calm the heart/Shen.
Hsu: Excites the CNS, increases brain efficiency, regulates the cardiovascular system to improve circulation, antitussive, expectorant, stimulates uterine smooth muscle, strongly antibacterial, cardiotonic, analgesic, cholagogue.
JTCM:
• Insomnia and Memory Loss:
Wu wei zi can nourish Yin and harmonize Yang, astringe Yang into the Yin, balance the zang-fu organs, calm the shen and strengthen the will. Li Pei Shen has an extensively used formula called Wu Wei An Mian Tang, containing Wu wei zi, Fu shen, He huan hua, and Fa ban xia. It is very effective at treating stubborn insomnia.
Typical daily doses: Wu wei zi 50g, Fu shen 50g, He huan hua 15g, Fa ban xia 15g
• Chronic Fatigue and Menopausal Symptoms:
Liu Zhen Ji often used a large dose of Wu wei zi to treat chronic fatigue with difficult recovery after extreme physical labor, and menopausal symptoms.
Typical dose for menopausal symptoms or extreme physical exhaustion: 100g/day.
It is recorded in Yong Yao Fa Xiang that Wu wei zi has the function to tonify the source Qi and astringe dispersed Qi. Modern pharmacological research shows that Wu wei zi can improve human intelligence and efficiency. At concentrations of 5 to 10 mg in the bloodstream, Wu wei zi can improve the attention and balance movement by affecting muscle chemistry. (It also works through enhancement of the cortex.) Wu wei zi can stimulate the smooth muscle of the uterus, so it is not recommended for pregnant women.
• Prevention of Asthmatic Bronchitis:
blockage and rebellion of Qi in the bronchi: recurrent bronchial spasm, shortness of breath, coughing, expectoration of mucus and wheezing
Li Zhen Lin used a method which had been passed on in his family for the treatment of night sweats – application of Wu wei zi to the navel – for a patient who also had asthmatic bronchitis. When the night sweats were gone he found that the asthmatic bronchitis was cured as well. (Overall efficacy rate is about 85%.)
Method of application: grind raw Wu wei zi to a powder and add 70% ethanol. Mix to form a paste and save in a bottle. Take an egg-sized amount of paste, put on the umbilicus, cover with plastic wrap and use tape to fix it in place. It is usually applied before bed and removed the following morning. Re-evaluate the patient after 3 20-day courses.
Pharmacological research shows that Wu wei zi can enhance the body’s defenses against irritants and improve function of the adrenal cortex and the immune system. Shen Que [CV-8] has a biao-ne relationship with the Du Mai, connects with the twelve meridians, five zang and six fu organs, and joins the upper and lower body. Medical research shows the umbilicus is the last place to close during the development of the embryo. Beneath it, there is no adipose tissue, but a number of large blood and lymph vessels and nerves. From an anatomical perspective, the umbilicus is thus an excellent passage for absorption of topical herbs. The properties of Wu wei zi penetrate this passage to act on the human body.
• Treatment of Viral Hepatitis:
Research has shown that Wu wei zi can decrease glutamine- alanine transaminase, the enzyme which converts glutamic acid to alanine – necessary for propagation of the hepatitis virus. The key components in Wu wei zi that can decrease glutamine-alanine transaminase are in the seed of the Wu wei zi fruit. So the correct way to prepare Wu wei zi is to bake it and then grind it into a powder. Take the powder, 3g at a time, three times a day. It also can be made into pills with honey. If cooked in a decoction, it must be ground first.
When using Wu wei zi to lower glutamine-alanine transaminase, we need to be cautious. After glutamine-alanine transaminase is back to normal, we should decrease the dosage of the Wu wei zi. If we use only Wu wei zi to lower the glutamine-alanine transaminase level, it is easy for the patient to relapse. When jaundice appears we should move the blood and dispel blood stasis. It is better to disperse the pathogen than to astringe it. Sometimes only using Wu wei zi can trap the pathogen inside and the disease will progress to severe jaundice or cirrhosis of the liver. Therefore, the best way to treat hepatitis is to combine Wu wei zi with some herbs to move Qi and blood and dispel blood stasis.
• Diabetes:
Wu wei zi is very effective at treating Type II diabetes mellitus (non-insulin dependent). The source of the disease is related to deficiency of the prenatal yuan Qi and postnatal imbalance, causing kidney deficiency and leakage of the Jing, blood, and body fluids. Wu wei zi’s sweet taste can strengthen the spleen, and the sour can astringe. In this case, astringing means storage. The kidney is in charge of the storage of Jing, so Wu wei zi is a key herb to tonify the kidney and treat diabetes. Use a large dosage of Wu wei zi and make it into pills. If the patient has hypertension, add Yi mu cao, and Huai niu xi. If the patient has high cholesterol and atherosclerosis, add Jue ming zi, He shou wu, Dan shen, and Shan zha. If the patient has coronary artery disease, add San qi, Jiang xiang, and Tian hua fen.
The Lung is the upper water passage and the kidney is the lower water passage. Insufficiency of the upper water passage and leakage from the lower water passage are the key causes of polydipsia and glucosuria in diabetes. Wu wei zi enters the Lung and kidney, and it can astringe the Lung and tonify the kidney – this is how it can ease thirst and prevent the leakage of Jing.
• Itchiness and Dryness of the Throat:
When treating dryness and itchiness of the throat, the first herb to consider is Wu wei zi. Wu wei zi nourishes body fluids, eases dryness, and also works for itchiness caused by allergies. When Wu wei zi is added to Shao Yao Gan Cao Tang, Zhen Yue Tang, and Yang Ying Qin Fei Tang, the sour flavor combined with the sweet can produce Yin and body fluids, ease dryness and benefit the throat. This method is widely used in chronic pharyngitis caused by Lung and kidney Yin xu or dryness and itchiness of the throat after chemotherapy. It follows the idea that sour and sweet can produce Yin, as recorded in the Nei Jing.
When Wu wei zi is added to formulas such as Yu Ping Feng San, Jin Fang Bai Du San, Qing Fei San, etc., the sour flavor of Wu wei zi can balance the acrid herbs such as Fang feng, Jing jie, Bo he, etc. In this way, we can disperse pathogenic factors and at the same time astringe the Qi and body fluids to stop the itchiness of the throat. Clinically we use these combinations to treat cough with itchiness and dryness of the throat due to allergic pharyngitis.
Wu Wei Zi Can Constrict the Pupils and Stop Tearing:
It was written in Yong Yao Fa Xiang that Wu wei zi can astringe dispersed Qi and constrict enlarged pupils. It was explained in Yi Xue Zhong Zhong Chan Xi Lu that the sour flavor of Wu wei zi can enter the liver, and the liver opens to the eyes, so Wu wei zi can “astringe” dilated pupils. Because tears are the fluid of the liver, and Wu wei zi enters the liver, it can astringe tears also. However, it cannot treat all forms of pupil dilation and tearing. Due to its warm nature and sour taste, it can treat symptoms caused by liver and kidney deficiency or liver Qi consumption. It was recorded in Yan Ke Liu Jin Fa Yao that Wu wei zi is good for treatment of eye problems caused by liver Qi stagnation, excess heat in the Lung, or spleen Qi xu with dampness.
Three additional guidelines to consider when using:
1. Large doses, from 10 to 20g, can be used with no side effects from long-term use.
2. It can be combined with a small dose of Gan cao, so as to blend sweet and sour and produce Yin. This combination will strengthen Wu wei zi’s nourishing function, and it can be taken for a long time.
3. When cooking Wu wei zi in a decoction we must grind it into a powder first, just as Zhang Xi Chun said. Wu wei zi’s skin is sour and its seed is acrid. So as a whole (when ground to release the contents of the entire fruit and seed) its astringing and dispersing functions are balanced.
• Topical Use for (Non-Healing) Ulcers:
After cleaning the surface of the ulcer, apply a small amount of Wu wei zi powder and cover with sterile gauze. Change the gauze every other day.
When applied in the clinic, we need to wait until all the toxins and unhealthy tissue on the surface are gone. Be cautious not to apply too much powder, because too much will form a scab and cover the surface, which prolongs healing time. Apply a thin enough layer of Wu wei zi powder so that the tissue beneath is still visible.
DY: With Gan jiang to effectively warm the Lungs, transform phlegm, stop cough, and calm asthma. For indications such as cough and/or asthma with profuse, clear, and white phlegm due to cold in the Lungs, Lung Yang deficiency, or phlegm-cold. For these indications, the combination is used in Xiao Qing Long Tang accompanied by Xi xin. For more details on the mechanisms of the combination of Wu wei zi and Gan jiang, see Gan jiang.
Examine.com: • Bioavailability of Schisandrin lignans is poor in water, and can be enhanced in the presence of fatty acids or a good solvent. Although most lignans appear to be absorbed, some have a relatively greater absorption than each other and they can increase each other’s absorption.
• In general, ethanolic extracts of the fruit are preferred due to higher extraction of lignans. The ethanolic extract per se is sometimes dubbed Wurenchun in traditional chinese medicine.
• Despite all lignans being bioactive and of concern, Schisandrin and y-Schisandrin tend to be seen as the ‘main’ lignans; the comprise 0.5% and 0.3% of the Schisandra fruit by weight, respectively and on average.[3] The lignans tend to be named related to either the plant (lignans that sound like Shisandra) the Japanese tea Gomishi made from Schisandra berries (Gomisin lignans) or the Chinese name for the ethanolic extract of Schisandra, Wuweizi (some of the nortriterpenoids).
• The lignans are also found in the shoot and leaves, just in a higher concentration in the fruits.[13][15] Some of them possess an anti-oxidant capacity.[16] It has been estimated that maximum value of total lignans reaches 6-11% at flowering in the stem and bark of Schisandra Chinensis, in which 3-8% was either Schisandrin, Schisandrol, or Gomisin A.
• Has potential to interact with a large range of pharmaceuticals, and should be used with caution in drug-drug combinations
• Schisandra interacts with Warfarin by increasing clearance rate; consult a doctor prior to using Schisandra fruit extracts if using Warfarin.
• The entire fruit of Schisandra has been shown to activate the PXR receptor in rats, and increased Warfarin clearance rate.[1] It (in reference to Schisandrol B in particular, but also the entire class of lignans in Schisandra[24]) also acts as a P-glycoprotein inhibitor and can increase circulating Paclitaxel concentrations in rats[25] and 300mg fruit extract has been shown to increase the Cmax of talinolol by 51% and the 24-hour AUC by 47%, approximately double the potency of 120mg Ginkgo Biloba.
• Schisandria Chinensis fruit extract is able to inhibit the CYP3A4 enzyme[27] which metabolizes over 50% of pharmaceuticals; this inhibition may be due to the Lignan components, specifically Schisandrin A and B[28] and more potently with Gomisin A.[29] Despite a roughly equipotent inhibition of CYP3A4, the combination Kampo therapy including the fruit extract (Shoseiryuto) did not actually alter subsequent pharmacokinetics of nifedipine, a tracer drug.
• Schisandra lignans as hormetic anti-oxidants underlies most of the therapeutic, preventative, and (theoretically, not yet demonstrated) life enhancing properties of Schisandra Chinensis in most organ systems Schisandra has been demonstrated to reach (brain, liver, lungs, kidneys, spleen, and heart).
• Circulation has been shown to be improved by approximately 9% after consumption of Schisandra at 130mg daily in persons who, although otherwise healthy, had slightly impaired blood flow.
• The direct mechanism may be (in part) due to weak agonism of Estrogen receptors,[41] which increases activity of the NO-cGMP pathway and induces endothelial relaxation. Increase Nitric Oxide circulating after ingestion of about 360mg Schisandra Chinensis extract has been noted in human athletes of both novice and elite caliber.
• In part, subjective improvements in cognition can be attributed to placebo or reductions in stress. Currently, the only human study on cognition related to Schisandra has been conducted under conditions of stress.[45] Schisandra seems to possess adaptogenic properties, reducing the biochemical markers of perceived stress; this effect has been recorded as reductions in corticosterones, and reductions in stress-induced liver damage.
Another possible mechanisms of improved cognition is pertaining to acetylcholine, whereas consumption of Schisandra Chinensis fruits is associated with inhibiting Acetylcholinesterase (thereby increasing levels of acetylcholine) and simultaneously possessing the capacity to enhance Cholinergic signalling in the presence of a ligand.
• Schisandrin B appears to be an active lignan in protecting the heart tissue from myocardial infarction damage via glutathione (primarily in the cardiac mitochondria[51]), but only when preloaded suggesting a preventative effect rather than rehabilitative.
• There is biological basis for claims of Schisandra Chinensis fruit extract (some of the lignans) to benefit the heart organ itself, and it appears to induce these benefits by a hormetic (induce a bit of harm, reap a greater amount of benefit) mechanism.
• Schisandra Chinensis extract appears to be able to increase blood flow and nitric oxide bioavailability, which can compliment the previously mentioned cardio-protective effects.
• In general, research from Russia past suggests Schisandra Fruit extract is able to exert an adaptogenic effect and reduce stress from abnormal temperatures.
• A study in rats suggest that one of the lignans from Schisandra, Deoxyschizandrin, was able to increase memory and cognition in mice with excessive beta-amyloid pigmentation; this was hypothesized to be secondary to its anti-oxidative abilities, and suggests Schisandra may help Alzheimer’s Disease symptoms.[74] Schisandrin B also exerts a general protective effect on scopolamine-induced memory impairment.[75] In this latter study, a preservation of glutathione levels was seen in rats subject to Schisandra.
• Schisandrin was also implicated in enhancing M1 receptor (cholinergic) neurotransmission as assessed by oxotermorine-induced tremors, able to enhance the tremoring effects of the drug while not confering any tremors on its own at this dose; oral doses of 1 and 10mg/kg bodyweight water extract were insignificantly different. [46] Injections of 175mg/kg Schisandrin do induce convulsions, however.
• In accordance with traditional usage of Schisandra as a hypnotic and sedative (and to treat insomnia, historically[77]), a study in mice found that oral administration of 100-200mg/kg bodyweight Schisandra extract was able to attenuate rises in catecholamines and cortisol associated with restraint stress and increase the amount of anxiolytic behaviours of mice (relative to control).[77] Schisandra was more effective than Diazepam at normalizing adrenaline and serotonin changes in stress, but not dopamine.[77] This reduction in activation of the HPA (Hypothalamus-Pituitary-Adrenal) axis seems to extend to exerise, where there is also noted attentuations in cortisol.[69] In rats subject to the same restraint mentioned previously (a research model for Anxiety and Stress Relief), it was found that stress was able to increase tumor growth in rats already harboring tumors; 100-200mg/kg oral Schisandra fruit was able to normalize the immune system biomarkers and oxidation in test rats and reduced the amount of hepatic metastatic nodules.[78] This anti-stress effect has been somewhat replicated in a human study using Schisandra which noted that cognition, accuracy and attention was increased during periods of study by stressed persons using the supplement relative to placebo, but this study was confounded by Siberian Ginseng and Rhodiola Rosea which also share an adaptogenic property.
Without a prior stress, administration of Schisandra at 25-100mg/kg demonstrated an anxiolytic effect and promoted sedation and sleepfulness in rats.
• A study delineating how Schisandra affects the liver practically found that both the anti-oxidative protection (mediated via glutathione induction) and anxiolytic effects of reducing corticosterone were crucial (as psychological stress may adversely affect liver function[89]).[85] Furthermore, Schisandra offers a protective effect on hepatic (liver) tumor cells that are responsive to stress.[78] On the anti-oxidant side of things, induction of glutathione (S-transferase and reductase) and buffering anti-oxidant status prior to chemical insult has been demonstrated to protect against aflatoxin,[90] cadmium,[90] Hepatitis C,[91] and carbon tetrachloride.[92] It is said to confer a protective effect that is not specific for a toxin, but instead general.
• In regards to liver enzymes; Schisandra lignans can reduce a stress-induced increase of ALT from 96.7±6.3IU/L to 29.70-34.76IU/L, with 100mg/kg being more effective than 200mg/kg; the control group in this study had ALT levels at 17.5 ± 4.7IU/L.[85] These benefits have been noted in humans with 260mg Schisandra extract plus 10mg Sesamin daily, and alongside the reductions in liver enzymes (ALT, AST) the increase in anti-oxidant enzymes (glutathione, reductase) as well as a reduction in fatty liver and inflammatory markers was seen; no significant influences were noted on bilirubin.[93] A study on blood flow in humans using half the dose of the previous study found increased blood circulation with no influence on liver enzymes; these humans were healthy, so either the dose or prior disease state may account for the discrepancy.[40]
• It has been demonstrated that Sheng Mai San results in better bioavailability of Schisandrin (a lignan used as biomarker) than does a basic aqueous extract of Schisandra fruit delivering the same about of Schisandrin.[101] Whereas isolated Shisandrin at 5mg/kg delivered an AUC of 31766.4+/-7551.1ug/mL, the AUC from Schisandra was 70209.1+/-29155.0ug/mL and from the Sheng-Mai-San concoction 116697.4+/-35816.4ug/mL.[101] This is a 121% enhancement of average AUC using the whole plant, and a 267% enhancement of average AUC using the three herbs.

Dose: 1.5-9 (6-9g as tonic, 1.5-3g for chronic cough)

Notes on This Category

• These herbs are used to nourish Yin, produce body fluids, and moisten dryness.
• They are often combined with herbs that clear deficiency heat.
• Since many of these herbs are moist and cool, caution should be taken in cases of spleen Qi deficiency or accumulation of dampness in the middle Jiao.
Wei Li: Yin tonics are an important component in herbal formulas for lowering diastolic blood pressure and controlling hyperthyroidism.

Bai He – Lily bulb – “Hundred Meetings”

Nature: sweet, slightly cold

Enters: Lung, Heart

Actions: Moistens the Lungs, generates body fluids, stops coughing; clears heat from the Lungs and heart; calms the Shen.

Indications:
• Lung heat and/or dryness: cough, including with bleeding, sore throat.
• Heart heat with Shen disturbance: palpitations, insomnia with lots of dreams, restlessness, irritability, intractable low-grade fever.
• Can be used alone for insomnia due to Lung Yin deficiency.
• Not as strong as Mai men dong at nourishing Lung Yin.
DY: Nourishes heart Yin.
• Sweet and cold, but moistens without being slimy.
• With Zhi mu to moisten the Lungs and clear heat, nourish the heart and quiet the spirit. For such indications as:
- 1. Vexation and agitation, insomnia, vertigo, thirst related to a warm disease which has damaged Yin or due to Yin deficiency with deficiency heat.
- 2. Dry cough, vexation and agitation after a warm disease.
- 3. Lily disease.
Bai He Syndrome – “Lily disease,” named for the major herb that treats it, is a form of mental depression with depressed emotions, anxiety, taciturnity, a desire to sleep without being able to, a desire to walk without being able to, and a subjective feeling of cold or hot. It follows either a warm disease, in which case it is of sudden and recent onset, or emotional problems which have damaged heart Yin, in which case it is enduring and progressive in nature.
Bai he is also effective for numerous psychological and cardiac imbalances related to heart Yin deficiency: palpitations, deep cardiac pain with a feeling of emptiness in the cardiac region, insomnia, profuse dreams, vexation, agitation, neurasthenia.
• When dry cough is predominant, honey mix-fried Bai he should be used.
• If vexation and agitation or insomnia is predominant, uncooked Bai he should be prescribed.
HF: An An Shen (spirit calming) herb, important in Gu Zheng (Gu parasite) formulas (because of emotional disturbance common in patients with Gu).
JCM: [BAI HE SYNDROME by Professor Gu Yue Hua, Transcribed by Arne Kausland. Number 40, Sep 1992] The name ‘Bai He’ has two meanings: i. ‘Bai’ means ‘hundred’ and ‘He’ means meeting/communicating’. There is a saying “All the hundred branches (i.e. the channels and collaterals) originate in the Heart and meet in the Lung”. Thus the syndrome mainly relates to the Lung; ii. Bai He is the name of the herb (Bulbus Lilii) in the Chinese pharmacopoeia which nourishes Lung-Yin and Heart-Yin and pacifies Heart-Fire, and is used to treat this syndrome.
The main symptoms of Bai He syndrome are absentmindedness (being in a ‘trance’), abnormal appetite and behaviour, a bitter taste in the mouth, and a slightly rapid pulse. The main zang involved are the Lung and Heart and sometimes also the Spleen. It is generally caused by injury due to excess of the seven emotions, and often begins with depression which damages the Heart and Lung Yin. Sometimes Bai He syndrome develops after a febrile disease that damages the Yin of the Heart and Lung leading to emotional problems.
The Heart stores the Shen; when the Heart is injured, the Shen is disturbed. The ‘intellectual function’ of the Lung is to store the Po. When the Po is disturbed, the patient is usually absent-minded and, because the Po belongs to the Lungs, easily suffers from sadness and grief; when the Po is uneasy the patient suffers from hallucinations. The general treatment principle for Bai He syndrome is to treat the Heart and Lung, concentrating on whichever of these two zang most predominates.
The main patterns of Bai He syndrome are:
1. Yin-Xu of Heart and Lung:
Herbal prescription: Bai He Di Huang Tang plus Gan Mai
Da Zao Tang
Bai He (Bulbus Lilii) 30g
Zhi Mu (Radix Anemarrhenae Asphodeloidis) 10g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 30g
He Huan Hua (Flos Albizziae Julibrissin) 10g
Ye Jiao Teng (Caulis Polygoni Multiflori) 12g
Mu Xiang (Radix Saussureae seu Vladimirae) 9g
Da Zao (Fructus Zizyphi Jujubae) 30g (8-10 dates)
2. Internal Disturbance of Phlegm-Heat
Herbal Prescription: Bai He Huan Tan Tang
Bai He (Bulbus Lilii) 30g
Zhi Mu (Radix Anemarrhenae Asphodeloidis) 10g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 30g
Gua Lou (Fructus Trichosanthis) 10g
Xing Ren (Semen Pruni Armeniacae) 9g
Zhi Shi (Fructus Citri seu Ponciri Immaturus) 10g
Chen Pi (Pericarpium Citri Reticulatae) 6g
Ban Xia (Rhizoma Pinelliae Ternatae) 9g
Fu Ling (Sclerotium Poriae Cocos) 12g
Dan Nan Xing (Pulvis Arisaemae cum Felle Bovis) 10g
Huang Qin (Radix Scutellariae Baicalensis) 10g
Gan Cao (Radix Glycyrrhizae Uralensis) 6g
3. Heart-Yin Xu
Herbal prescription:
Bai He (Bulbus Lilii) 30g
Zhi Mu (Radix Anemarrhenae Asphodeloidis) 10g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 12g
Cao Zao Ren (Semen Ziziphi Spinosae Praeparatae) 20g
Bai Zi Ren (Semen Biotae Orientalis) 20g
Zhu Sha (Cinnabaris) 2g [Could probably substitute Hu po or Long chi -PB]
4. Stagnation of Liver-Qi and Yin-Xu
Herbal prescription:
Bai He (Bulbus Lilii) 30g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 12g
Zhi Mu (Radix Anemarrhenae Asphodeloidis) 10g
Qing Pi (Pericarpium Citri Reticulatae Viride) 6g
Chen Pi (Pericarpium Citri Reticulatae) 6g
Zhi Shi (Fructus Citri seu Ponciri Immaturus) 12g
Wa Leng Zi (Concha Arcae) 15g
Mu Xiang Mian (Powdered Radix Saussureae seu Vladimirae) 6g
Fo Shou (Fructus Citri Sarcodactylis) 6g
• In case of Stomach heat add Huang Lian (Rhizoma Coptidis) 7g and Wu Zhu Yu (Fructus Evodiae
Rutaecarpae) 3g.
• When the condition improves, give Xiao Yao Wan to soothe the Liver and regulate the patient’s mental state.
5. Stagnation of Spleen-Qi and Injury to the Lung
Herbal prescription:
Bai He (Bulbus Lilii) 30g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g
Zhi Mu (Radix Anemarrhenae Asphodeloidis) 12g
Gui Zhi (Ramulus Cinnamomi Cassiae) 6g
Cang Zhu (Rhizoma Atractylodis) 15g
Sha Ren (Fructus seu Semen Amomi) 9g
Dai Zhe Shi (Haematitum) 15g
Yu Jin (Tuber Curcumae) 9g
Chuan Jiao (Fructus Zanthoxyli Bungeani) 7g
6. Lung and Kidney Yin-Xu
Herbal prescription:
Bai He (Bulbus Lilii) 30g
Zhi Mu (Radix Anemarrhenae Asphodeloidis) 12g
Sheng Di Huang (Radix Rehmanniae Glutinosae) 15g
Di Gu Pi (Cortex Lycii Chinensis Radicis) 15g
He Shou Wu (Radix Polygoni Multiflori) 18g
Bie Jia (Carapax Amydae Sinensis) 10g
7. Disharmony between Heart and Kidney
[no formula given]
The value of understanding the syndrome of Bai He lies in its practical relevance in the analysis and treatment of patients suffering from depression, uneasiness, absentmindedness, lack of concentration, sadness, grief etc. Since the clinical manifestations of patients with emotional disorders do not avail themselves of clear-cut categorisation (whether in Western medicine or TCM), the broader the understanding of the possibilities the better the weaving of a treatment prescription.

Dose: 9-30g

Bai Mu Er – Wood Ear mushroom – Tremella – “White Wood Ear”

Nature: sweet, bland, neutral

Enters: Lung, Stomach

Actions: Nourishes stomach Yin; moistens the Lungs; generates body fluids; nourishes Lung Yin.

Indications:
• Yin deficiency with Yang rising, especially with emaciation, heat in the five centers (five hearts hot).
• Lung consumption, lung cancer.
• Lung heat: dry, nonproductive cough or blood-streaked sputum.
Li: Useful for chronic hepatitis with Yin deficiency; boosts the immune system.

Dose: 3-9g

Bie Jia – Turtle Shell (Salt-water, Soft-shelled, Dorsal Aspect)

Nature: salty, cold

Enters: Liver, Spleen

Actions: Subdues liver Yang; nourishes liver Yin; softens and resolves masses; promotes blood circulation; promotes menstruation.

Indications:
• Liver Yin deficiency leading to liver wind stirring: trembling, convulsions.
• Yin deficiency: low grade fever or fever in leukemia after chemotherapy, steaming bone disorder, night sweats, consumption.
• Masses or lumps in chronic malaria.
• Chest and flank accumulations causing pain and amenorrhea.
• Heat in the blood: excessive menstruation.
• Cirrhosis: Bie jia softens hardness (of the liver).
• Not as strong a tonic as Gui ban, and unlike Gui ban, Bei jia does not tonify the kidneys. However, Bie jia is more effective at treating palpable abdominal masses, and is less apt (than Gui ban is) to cause stagnation.
• Cook 30 minutes longer than other herbs.
• Liu: stronger than Gui ban at subduing rising liver Yang (but see below)
DY: Clears heat from the Yin division; dispels stasis and scatters nodulation.
• Better than Gui Ban at clearing deficiency heat, but inferior at subduing Yang.
With Gui ban to make Yin and Yang interact, to enrich Yin, clear deficiency heat, subdue Yang, extinguish wind, and stop tremors. For such indications as:
- 1. Tidal fever, steaming bones, and night sweats due to Yin deficiency heat. (Use vinegar dip-calcined Gui ban.)
- 2. Weakness of the limbs, involuntary trembling of the hands and feet, and a red tongue with little or no fur due to a warm disease which has damaged the fluids and which causes internal wind of the deficiency type.
- 3. Headaches, vertigo, head distention and tinnitus due to ascendant hyperactivity of liver Yang.
- 4. Hypertension due to Yin deficiency which causes Yang to rise.
- 5. Abdominal conglomeration, such as hepatomegaly and splenomegaly. (Use vinegar dip-calcined Bie jia.)
Bie jia is incompatible with peach and amaranth.

Dose: 9-30g

 
Bie Jia Jiao: Bie jia gelatin
• Compared to Bie jia, this is richer, more cloying, a strong Yin and blood tonic.
• Commonly used for consumption from deficiency, or exhausted Yin and blood with tidal fever and internal movement of liver wind.
• Dissolve in hot water or a strained decoction.

Dose: 3-9g

Gou Qi Zi – Lycium fruit – Wolfberry – “Goji Berry” (ugh…)

Nature: sweet, neutral

Enters: Liver, Kidney, Lung

Actions: Nourishes kidney and liver Yin; brightens the eyes; mildly moistens the Lungs, nourishes Lung Yin; mildly supports Jing; mildly tonifies Yang.

Indications:
• Kidney and liver Yin or blood deficiency: dizziness, vertigo, poor vision, weakness in the lumbar region and knees, sore back and legs, seminal emission, low-grade abdominal pain, wasting and thirsting disorder, consumption.
• Kidney and liver deficiency where Jing and blood fail to nourish the eyes: blurred vision, poor visual acuity, dizziness.
• Lung Yin deficiency: cough (including consumptive patterns).
• Beneficial in male sterility.
• May protect liver cells and hasten recovery from damage by chemicals.
• Contains extremely potent anti-oxidant pigments.
• Bensky/Gamble classifies this herb as a blood tonic.
Li: Important herb for sedating liver Yang.
Hsu: May help promote regeneration of liver cells and inhibit precipitation of fat in liver cells.
• Hypoglycemiant; hypotensive.
DY: With Ju hua to effectively nourish and supplement the liver and kidneys, clear heat, calm the liver, and brighten the eyes. For indications such as blurred vision, diminished visual acuity, “moving black spots in front of the eyes,” fire sparks in the eyes, photophobia, dry eyes with distention and headache, and pain in the lower back and knees due to liver-kidney deficiency. For these indications, the combination is present in Qi Ju Di Huang Wan. Bai ju hua should be used. Ju hua carries the action of Gou qi zi toward the eyes.
• In cases of loose stools or diarrhea due to Qi deficiency or spleen Yang deficiency, it is worthwhile to prescribe stir-fried Gou qi zi in order to lessen its slightly cold and moistening nature, which tends to damage the spleen. However, when prepared this way, the herb tends to be weaker at nourishing the liver and kidneys, blood and Jing.
SD: Lycium fruit is the red berry obtained from two closely related plants, Lycium chinense and Lycium barbarum, naturally occurring in Asia, primarily in northwest China (mainly in Qinghai, Gansu, Ningxia, and Inner Mongolia, but east as far as Hebei and west to Tibet and Xinjiang). The fruits from these species are considered interchangeable, though larger fruits are preferred and are more often found on plants of L. barbarum. Lycium is in the Solanaceae family that yields numerous foods, including some that are yellow to red fruits, such as peppers, tomatoes, and the cape gooseberry (a Peruvian species of Physalis).
The Chinese name for the lycium plant is gouqi and for the fruits is gouqizi (zi is used to describe small fruits); the common name “wolfberry” comes about because the character gou is related to the one that means dog or wolf. The spiny shrub has also been called matrimony vine, for reasons long lost. Carl Linnaeus provided the genus name Lycium in 1753. He is responsible for the species name barbarum, while botanist Philip Miller described Lycium chinense just 15 years later. Lycium is extensively cultivated, especially in Ningxia Province, a small autonomous region formerly part of Gansu, with several production projects initiated since 1987. China now produces over 5 million kilograms of dried lycium fruit each year, most of it for domestic use. The fruits are dried with or without sulfur to yield the market herb, or the fresh fruits may be squeezed for their juice that is then concentrated to preserve it for future use in making various beverages.
TRADITIONAL AND MODERN USES
Although lycium fruit was described in the Shennong Bencao Jing (ca 100 A.D.), its use in traditional formulas was rather limited until the end of the Ming Dynasty period (1368–1644). At that time, it was frequently combined with tonic herbs such as rehmannia, cornus, cuscuta, and deer antler to nourish the “kidney” (as described in Chinese medicine) for the treatment of a variety of deficiency syndromes. This therapeutic approach, using gently warming and “thick” tonifying herbs for nurturing the internal organs, was especially promoted by Zhang Jingyue, whose work is described in the book Jingyue Quanshu(ca 1640). Lycium fruit is depicted by Chinese doctors as having the properties of nourishing the blood, enriching the yin, tonifying the kidney and liver, and moistening the lungs, but its action of nourishing the yin of the kidney, and thereby enriching the yin of the liver, is the dominant presentation. It is applied in the treatment of such conditions as consumptive disease accompanied by thirst (includes early-onset diabetes and tuberculosis), dizziness, diminished visual acuity, and chronic cough. As a folk remedy, lycium fruit is best known as an aid to vision, a longevity aid, and a remedy for diabetes. With the intensive research work done in recent years, reliance on descriptions of centuries-old use of the herb is less important than for many other Chinese herbs, since much is now known about the chemical constituents and their potential health benefits.
Constituents and Actions
The color components of lycium fruit are a group of carotenoids, which make up only 0.03–0.5% of the dried fruit (1). The predominant carotenoid is zeaxanthin (see structure below), which is present mainly as zeaxanthin dipalmitate (also called physalien or physalin), comprising about one-third to one-half of the total carotenoids. Lycium fruit is considered one of the best food sources of zeaxanthin.
Zeaxanthin is a yellow pigment (an isomer of lutein and a derivative of ?-carotene) produced in plants. It contributes to the color of corn, oranges, mangoes, and egg yolks (from dietary carotenoids), and it is also the main pigment of another medicinal fruit recently popularized in China: sea buckthorn (hippophae). When ingested, zeaxanthin accumulates in fatty tissues, but especially in the macula, a region of the retina. It is believed that by having a good supply of this compound, the macula is protected from degeneration, which can be induced by excessive sun exposure (UV light) and by other “oxidative” processes (2–4). Lutein, another yellow carotenoid that accumulates in the macula and provides similar protection, is an ingredient of yellow chrysanthemum flowers (juhua) that are often combined with lycium fruits in traditional Chinese herb formulas to benefit the eyes, including deteriorating vision that occurs with aging and may, in some cases, correspond to macular degeneration. The effective daily dose of these two carotenoids, from food and supplements, has been estimated to be about 10 mg.
Another plant in the Solanaceae family used in Chinese medicine (though rarely), is Physalis alkekengi, the Chinese lantern plant, which contains zeaxanthin dipalmitate as a major active component. In addition, the plant contains some steroidal compounds that have been named physalins, producing some confusion about the use of this term because of its former application to the carotenoid. Physalis is used as a treatment for viral hepatitis, and this effect may be attributed in part to zeaxanthin and also to the steroidal compounds. Physalis is used for treating a variety of inflammatory disorders, perhaps aiding treatment of infections; extracts of physalis have been shown to increase natural killer cell activity when administered to mice.
The red carotenoids of lycium have not been fully analyzed. It is believed that part is due to lycopene, the major red pigment in tomatoes and capsicum fruits. The red portion of lycium has been designated as renieratene; the red color overwhelms the yellow of zeaxanthin and the small amount of ?-carotene, though the fruits often display an orange tinge due to the yellow components.
Benefits of carotenoid intake are thought to mainly arise from prolonged use. Therefore, lycium fruit, as a source of zeaxanthin and other carotenoids, would be consumed regularly to complement dietary sources, boosting the amount of these components available from fruits and vegetables and egg yolks.
Another component of lycium is polysaccharides, chains of sugar molecules with high molecular weight (several hundred sugar molecules per chain). It is estimated that 5-8% of the dried fruits are these polysaccharides (5), though measures of the active polysaccharides are difficult to undertake, since differentiating functional long chains versus non-functional short chains is challenging; this figure for polysaccharide content is likely on the high side. Studies of the polysaccharides have indicated that there are four groups of them, each group having slightly different structures and molecular weights (6). Although referred to as polysaccharides, the functional immune-regulating substance is actually a polysaccharide-peptide mixture; the amino acid chains maintain a critical structure for the polysaccharide.
Clinical effects of polysaccharides are also somewhat difficult to determine because absorption after oral administration of polysaccharides is limited and may be quite variable; it is estimated that less than 10% of the high molecular weight plant polysaccharides are absorbed, possibly as little as 1%. So, most studies of these polysaccharides are done with isolated cells or with injections of the purified component to laboratory animals, yielding results that may or may not occur when these substances are consumed orally. In one clinical evaluation, cancer patients were treated with a combination of IL-2 and activated lymphokine killer cells plus lycium fruit polysaccharides (which are reported to promote the body’s production of these therapeutic substances), in which patients were given an oral dose of 1.7 mg/kg of the polysaccharides (so, about 100 mg for a 60 kg person), with the reported result that the response rate was higher than without the polysaccharides (7). This dose of polysaccharides is quite low compared to usual clinical practice, and further evaluation is needed.
These lycium fruit polysaccharides, like those obtained from medicinal mushrooms and from several herbs (the best known as a source is astragalus), have several possible benefits, including promoting immune system functions, reducing gastric irritation, and protecting against neurological damage. The latter application has been the subject of several recent studies at the University of Hong Kong, where lycium polysaccharides are proposed, on the basis of laboratory studies with isolated neurons, to be of benefit to those with Alzheimer’s disease, though clinical trials have not yet been carried out (8, 9).
The immunological impacts of polysaccharides have been the primary focus of study (10). One of the primary mechanisms of action for these large molecules may be that they appear to the immune system as though they were cell surface components of microorganisms, promoting activation of a response cascade involving interleukins (such as IL-2) that impact immune cells (such as T-cells). Since the plant polysaccharides are not the same as the structures on particular pathogens, but have a more poorly defined quality, the response is non-specific. It is possible that repeated exposure to large amounts of polysaccharides might result in a lessened response, so that this method of therapy is probably best suited to relatively short duration (e.g., a few weeks). Low dosage exposure may result in no immunological responses, since these polysaccharides are present in several foods in small amounts, and the immune system would be protected from reacting to ordinary exposure levels.
A review of research on lycium fruit appearing in Recent Advances in Chinese Herbal Drugs (11), indicates that polysaccharides from lycium fruit enhance both cell-mediated and humoral immune responses. It was reported, for example, that in laboratory animals, a dose of 5–10 mg/kg lycium fruit polysaccharides daily for one week could increase activity of T-cells, cytotoxic T-cells, and natural killer cells; other studies showed that part of the mechanism of action was via IL-2 stimulation. The end response to polysaccharide administration did not appear to be solely a stimulation of immune activity, however. In a laboratory study of lycium on IgE responses, it was noted that lycium fruit reduced antibodies associated with allergy-type reactions, which was presumed to be accomplished through the mechanisms of promoting CD8 T-cells and regulating cytokines; licorice root had a similar effect (12).
Extraction and isolation of polysaccharides in low concentration is simple, as they are soluble in hot water that is used as an extracting agent. Getting a high concentration of polysaccharides is a more significant task. The easiest method is to first produce a hot water extract of the herb (using more than one extraction to get most of the polysaccharides into solution), and then force the polysaccharides out of solution by adding alcohol, in which they are not soluble; then, the liquid is separated off and the residue is dried to produce the finished polysaccharide product. This method will also condense other large molecules. Although small amounts of highly purified polysaccharides can be produced for laboratory and clinical studies, at this time, commercial extracts containing 40% polysaccharides represent the highest concentration available, while 10–15% polysaccharide content from simple hot water extraction is more common.
A third constituent of interest is the amino-acid like substance betaine, which is related to the nutrient choline (betaine is an oxidized form of choline and is converted back to choline by the liver when it is ingested). When added to chicken feed, betaine enhances growth of the animals and increases egg production; it is currently used in poultry farming because of these effects. In recent years, betaine has been included in some Western nutritional supplement products, especially those used for improving muscle mass, using several hundred milligrams for a daily dose. Betaine was shown to protect the livers of laboratory animals from the impact of toxic chemicals; other pharmacologic studies have shown that it is an anticonvulsant, sedative, and vasodilator. It has been suggested that betaine could aid the treatment of various chronic liver diseases, such as non-alcoholic fatty liver disease. Betaine is found also in capsicum, silybum (the source of the liver-protective flavonoid silymarin), and beets (Beta vulgaris, from which betaine gets its name). The amount of betaine in lycium fruit, is about 1% (10), so to get a significant amount, a large dose of lycium fruit would need to be consumed (e.g., 20–30 grams).
The mild fragrance of the fruits is attributed to a small amount of volatile oils, mainly two sesquiterpenes: cyperone and solavetivone (13). The amount present does not have significant pharmacological functions when lycium is consumed in ordinary amounts. The fruit also contains about 0.15% flavonoids, including rutin and chlorogenic acid (14).
Typical Dosing of Lycium Fruit
Lycium fruit is most often incorporated into complex herb formulas, in which its dose is in the range of 6–18 grams. Since other herbs in the formula could contribute significant amounts of compounds such as carotenoids and polysaccharides, this dose may be insufficient if lycium is used as a single herb remedy instead. There have been a few reports of using lycium fruit as a single herb or as a major component in a small recipe. For example, in the treatment of atrophic gastritis, one of the recommended therapies is to consume lycium fruits, 10 grams each time, twice daily (15). In folk medicine, for diabetes it is recommended to consume 10 grams each time, two or three times daily (16). As a food therapy for strengthening the elderly or debilitated, it is cooked with lean pork, bamboo shoots, and typical Chinese flavorings, and the daily dose would be 15–30 grams (17). As a dietary supplement for eye health (2), a dose of 15 grams per day was deemed beneficial in supplying adequate zeaxanthin (estimated at 3 mg/day). A simple tea for decreased visual perception is made from 20 grams lycium fruit as a daily dose (18). Thus, the dose in complex formulas of 6–18 grams shifts to a dose of 15–30 grams when it is the main herb, or about a 2.5-fold increase in the dose.
A tableted formula for benefiting vision, made from extracts of lycium fruit, cuscuta seed (tusizi), bilberry fruit (a type of blueberry), and marigold flowers (source of lutein), is produced by ITM and called Lycuvin (19). Two tablets of the formula (a typical daily dose) provides lycium extractives from 10 grams of the fruit (with about 3 mg of zeaxanthin); cuscuta extractives from 6 grams of the seeds (a good source of the flavonoid quercetin, and with a polysaccharide content similar to that of lycium fruit); 75 mg of anthocyanins (another visual pigment) from bilberry, and 8 mg of lutein. These quantities are all consistent with high supplementation levels suggested in the literature for eye health, particularly of benefit to the macula.
Like other commonly eaten fruits, lycium is non-toxic. Toxicity studies showed that injection of 2.4 grams/kg of lycium fruit extract did not cause adverse reactions; the LD50 by injection was determined to be about 8.3 grams/kg, a large amount (10). There was one recent report of possible hepatic reaction to consumption of a lycium fruit beverage product (20). A possible case of interaction of lycium fruit with Warfarin (coumadin) was reported (21); however, given the high frequency of use of lycium fruit and of Warfarin, the lack of more reports of interaction suggests that the incidence may be very low.
Himalayan Goji Juice
In the U.S., lycium fruit is already better known as an ingredient of the juice product called Himalayan Goji Juice (goji is another transliteration of gouqi), than as an ingredient in traditional Chinese medicine prescriptions or food therapy. The product was developed by Earl Mindell, who is best known for his book “Vitamin Bible” (which now has a 25th Anniversary revised edition). He learned of lycium fruit from a Chinese herbal specialist in 1995, and introduced a juice product in 2003, which is made from the reconstituted extracts of four fruits: lycium, grape, apple, and pear (with pear puree added). It is provided in bottles of 33 fluid ounces (1 liter), with recommended use of 2–4 ounces per day, so one bottle is about an 8–16 day supply. Very quickly, a number of other companies have imitated this popular product, and some have gone on to make other formulations featuring lycium fruit as a primary or secondary ingredient.
Comparing this juice to the lycium fruit described in traditional Chinese medicine is somewhat difficult. The manufacturer indicates: “One liter of Himalayan Goji Juice contains the polysaccharides equivalent of 2.2 pounds [1 kg] of fresh goji berries.” Typically, a dried berry is about one-sixth the weight of a fresh berry (that is, the moisture content of the fresh fruit is about 83%), so a dose of 2–4 ounces of the juice would correspond to 10–20 grams of the dried fruit, which is in the correct dosage range in accordance with traditional recommendations, though higher doses have been used in some applications. Dried lycium fruit can be eaten whole (sold most in one pound bags, about 23–46 doses of 10–20 grams), and can be obtained at a lower cost because it is in crude form. The makers of this juice, and other similar products, proclaim unique benefits to the juice, mainly because of specific selection of berries, compared to the dried lycium fruits readily available from Chinese herb and grocery stores. The juice is a convenient form of administration and also provides other juices (that yield a more acceptable flavor), so the extra expense may be considered worthwhile, while there is little evidence that would support a contention of differing therapeutic effect if similar amounts of the lycium fruit are obtained from drinking the juice or from eating the dried fruits or taking supplements made from lycium extracts.
An ITM Health Protocol with Lycium Fruit
While ITM has advocated consuming dried lycium fruits, in much the way one would eat raisins or other small dried fruits, as a means of getting an adequate quantity of the fruit, it is recognized that many people prefer other methods of consuming herbs, such as tablets. The following protocol, relying on tableted herbs, provides a good dose of lycium fruit along with other herbs that also have the reputation of nourishing the yin, supplementing the kidney and liver (as described in Chinese medicine terms), benefiting the eyes, enhancing immune functions, and protecting against adverse impact of oxidation:
Tremella 14 (Seven Forests): 5 tablets each time, twice daily
Lycuvin (White Tiger): 1 tablet each time, twice daily
China Rare Fruits Blend (Jintu): 2 tablets each time, twice daily
Tremella 14 is a yin-nourishing combination of crude herbs; about one third of the formula is made of equal parts lycium fruit, tremella (a tree mushroom, yiner), and astragalus (huangqi); these three herbs are excellent sources of active polysaccharides. Lycuvin was described above, and is a source of visual pigments, especially zeaxanthin and lutein, as well as polysaccharides from lycium and cuscuta. China Rare Fruits Blend is a combination of medicinal fruits including lycium and hippophae (shaji) as sources of zeaxanthin; the formula is considered especially useful for nourishing skin, hair, and nails. This protocol of three products provides extract and powder from 15 grams of lycium fruit in a daily suggested dose. The cost of such a protocol is similar to that for consuming the juice products. Although many potential benefits are described for lycium fruit, the goji juice, and these tablets, only the claim of providing useful amounts of carotenoids and other pigments for nourishing the retina (especially the macula) can be adequately verified at this time.

Dose: 6-18g

Gui Ban – Turtle Shell – Testudinis (Freshwater / Land, Hard Shelled, Mainly Ventral Aspect)

Nature: sweet, salty, cold

Enters: Liver, Kidney, Heart

Actions: Nourishes liver and kidney Yin; subdues liver Yang rising; tonifies the kidneys to strengthen the bones; mildly nourishes heart blood; cools the blood, stops uterine bleeding; softens hardness; expels stasis; aids in difficult births.

Indications:
• Stirring of wind due to liver Yang rising as a result of Yin deficiency: facial spasms, hand and foot tremors.
• Yin deficiency heat: fever.
• Kidney deficiency: weakness of the lumbar region and feet, retardation in children, poor skeletal development, failure of fontanel to close.
• Heart blood deficiency: palpitations, insomnia, anxiety, poor memory.
• Heat in the blood: uterine bleeding or excessive menstruation.
• Non-healing sores and ulcers.
• Hypertension due to Yin deficiency.
• First choice for Wei syndrome due to kidney and liver Yin deficiency
• Some ancient sources say Gui ban is contraindicated in pregnancy since it softens hardness, expels stasis, and aids in difficult births – but can be used appropriately when baby is due.
• Doctrine of signatures: the turtle is so Yin it hardly moves; regarding its ability to aid in childbirth, it helps coax the turtle (baby) out of its shell (mother).
• Crush before use.
• Frying in vinegar focuses its effects on the liver and makes it easier to crush.
• Cook 30 minutes longer than other herbs.
DY: Makes the heart and kidneys and the Ren Mai and Du Mai communicate.
• Better than Bie Jia at subduing Yang, but less effective at clearing deficiency heat.
• With Bie jia: See Bie jia in this category for properties and indications of the combination.
Hsu: Antipyretic, analgesic.
SD: BACKGROUND
The tortoise (gui) is one of the four spiritually-endowed creatures described in the Book of Rites of the Confucian Classics, where it serves as an emblem of strength, longevity, and endurance, and symbolizes the Universe (1). Each of these creatures is associated with a direction and element, the tortoise, usually depicted in conjunction with a snake, represents the north, and is thereby associated with the water, darkness (the color black), and the earth (28), the element which was later put into the five element system in the center.
The tortoise shell was long used in divination, by observing the patterns of cracks that developed when a hot instrument was touched to one of its many “divination points,” and then interpreting the implication of the pattern. The prognostications and insights learned from the cracks were often written right onto the shells, and it is from buried fragments of tortoise shells (along with some mammal bones that were used similarly) that we know the most ancient forms of Chinese writing. The Chinese character bu, which means to divine by looking at the cracks in the tortoise shell as the heat develops them, is represented by two lines depicting cracks. This character became incorporated into numerous others as a radical. Thus, the tortoise and its shell have been an important part of Chinese culture.
Further, the tortoise has been used as both food and medicine since ancient times, and is recorded as being used for these purposes since the Han Dynasty, 2000 years ago. Regarding their inclusion in the Chinese diet, E. N. Anderson comments that “Animals that are very tenacious of life, or very unusual-looking and -acting, are regarded as having special power; they are supplementing (bu). Notable supplementing foods are pangolins, raccoon dogs, soft-shelled turtles, tortoises, snakehead fish, birds of prey….(3)” Although the tortoise is not a major food in China today (turtles have long been preferred over tortoises for food), it remains one of the foods included in some diets. Anderson also points out that “During Han, and throughout Chinese history, the boundary between medicine and food was so vague as to be non-existent in practice. Many things were purely medicines, but medicines often became foods if people learned to like them; many foods became merely medicines when people stopped relishing them….”
ANIMAL MEDICINES AND THEIR CONSTITUENTS
Tortoise shells were described as medicines in the Shennong Bencao Jing (4), listed there as guijia (tortoise scale). They have become one of the standard items of the Materia Medica, with consistent use since the earliest recorded medical books. In fact, shells, along with similar animal materials, such as scales, antlers, and skins, are the most commonly used animal substances in the Chinese Materia Medica. Among these, oyster shell is probably the most widely used, followed by deer antler, tortoise shell, and pangolin scale, with lesser amounts of donkey skin gelatin and turtle shell being utilized, though still important to Chinese practice. These materials are rich in collagen and calcium compounds; collagens are the proteins that help determine the overall physical structure and the calcium compounds contribute to rigidity. Pangolin scale, as well as other animal materials such as cicada slough, snake slough, and horns (rhino, antelope, buffalo), are comprised mainly of another protein, keratin, which is similar to collagen; turtle and tortoise shells, as well as deer antlers contain some keratin (the hairs of antler velvet are mainly keratin).
Oyster shell, which is extremely hard, is mainly comprised of calcium carbonates and calcium phosphates with relatively little protein, while donkey hide is mainly comprised of collagen with a little calcium; the other materials mentioned above have intermediate content. As an example, deer antler in velvet (which is the most studied item) contains about 50% protein, with about half of it in the form of collagen that can be converted to gelatin. It also contains calcium carbonate, calcium phosphate, and calcium chloride, making up about 50% of the antler, and the amount of those components increases as the antler ages and becomes ossified (hardened), with a decline in the amount of collagen and other proteins. Tortoise shell and deer antler also contain chondroitin sulfate, a protein-polysaccharide complex that has recently been utilized to treat joint degeneration (it is a building block of the cartilage, comprised mainly of glucosamine). Small amounts of cholesterol and other animal substances are also present in the shells, scales, and skins. An alcohol extract of deer antler (alcohol doesn’t solubilize collagen or calcium), called pantocrine, is reported to have hemopoietic and androgenic activity; its ingredients have not been reported. Presumably, tortoise shell also contains some substances that contribute similar kinds of activity. A 70% alcohol extraction medium solubilizes 2–3% of the substances in tortoise and turtle shells (31). Traditionally, antler is said to tonify and open the governing vessel (dumai) while tortoise shell tonifies and opens the conception vessel (renmai), the two vessels that run along the midline of the body, back (yang) and front (yin), respectively. Perhaps there are slightly differing constituents that can be found to explain the differing attributes. The Chinese interpretation may have originated with the observation of the natural materials more than from observation of physiological responses: the antler arises from the back and top of the deer’s head (yang) and the plastron protects the tortoise’s underbelly (yin).
Tortoise shell, as a medicinal agent, is most often utilized in rehmannia-based formulas that nourish the yin and blood and settle the yang (5). Relatively little is known of the pharmacology of the individual herbs of these formulas, though the overall effects include changes in hormones and hormone receptors. It is possible that tortoise shell provides a nutritional component to some formulas, with calcium and protein, though the flesh of the tortoise would be a better source of protein. Until recently, oyster shell calcium was the main source for calcium in Western nutritional supplements (now, more absorbable forms are often used instead); these supplements are reputed to have several medicinal applications, especially for calcium-deficient individuals.
The use of animal substances, such as tortoise shell, in the modern practice of natural healing is somewhat unusual for Westerners, many of whom view herbalism as a practice involving only plant materials (whereas Chinese “herbs” include minerals and animals). Indeed, for many Westerners, the use of herbs as a standard part of health care is often allied with practices, such as vegetarian diet, that differ from standard Chinese approaches and that would eliminate from consideration the ingestion of animal-derived medicinals. The use of tortoise shell is of particular concern to Westerners because some tortoises have been placed on the endangered species list, and are thereby prohibited from collection and trade. The tortoise shells used in Chinese medicine are obtained from aquatic but land-based tortoises, which are not included on the endangered species list, unlike sea tortoises or some desert species. However, due to the modernization of China (including plans to install a major dam across the Yangzi River), along with its large and still growing population, even these land tortoises may become endangered in the future. Increasing efforts are being made in China (and elsewhere) to raise the tortoises.
SPECIES AND SOURCE
According to the 1995 Chinese Pharmacopoeia (6), tortoise shell (guiban) is obtained from Chinemys reevesii; this is the same species that has been specified in earlier editions of the Pharmacopoeia of the PRC (7) and other sources (5, 8, 9, 10, 11). This is a land tortoise (Figure 5), found in rivers, lakes, and marshes, which is known in the West as the Reeve’s tortoise. It is particularly prevalent in the Yangzi (Yangtze) River region, with most of the commercial supply harvested in Hubei, Hunan, Jiangsu, and Zhejiang Provinces, though also obtained from Guangdong, Sichuan, Guizhou, Fujian, Shaanxi, and Henan Provinces (6, 12, 13). Two substitute species obtained 3 from Anhui Province, Cuora amboinensis and Cuora flavomarginata, have been raised and sold on the market, but are not officially-recognized substitutes (14, 16). The latter species is thought to be the one denoted as shuigui in Li Shizhen’s Ben Cao Gang Mu (15). Other substitutes include Mauremys mutica and Testudo elongata (11). Another tortoise, Eretmochelys imbricata, is used as a separately listed item in the Chinese Materia Medica, known as daimao (Figure 6).
Although the Reeve’s tortoises and some of the substitute species are raised in China for their shells (17), there is still a huge natural supply and the majority of the shells are obtained from the wild resources. They can be collected all year round, but are usually obtained in autumn and winter. Tortoise collection, like that of fish in the same region, is mainly accomplished by use of nets. PROCESSING
The bottom part of the Reeve’s tortoise shell, known as the plastron, is the desired item; by contrast, for daimao and for the turtle (biejia), the top part of the shell, called the carapace, is used. It is not clear why the plastron was chosen, other than the historic value of the plastron in divination. Recent analysis shows that the tortoise carapace has twice the amount of extractable gelatin as the plastron (22), with no difference in composition; similarly, the carapace of the turtle has about twice the water-soluble protein, mainly gelatin, as the tortoise plastron. In a report on conserving drug resources (41), it was noted that the shell (carapace) of the Reeve’s tortoise could be used along with the plastron, as they have similar activities.
The plastron is separated from the flesh and skin of the animal after the whole carcass has been boiled, steamed, or scalded in hot sand. In earlier times, the plastron was separated after letting the animal partially decay in cool water (18); the method of heating before drying is more sanitary and quicker. If 20% lime water is used in place of clear water, the process of cleaning the plastron is even faster (19). Modern efforts at obtaining the medicinal plastron are aimed at improving the speed of the process and alleviating some of the difficulties (e.g., exposure to smoke and flue dust during the cooking, bad smell of the processed material due to decay), while maintaining or improving the content and extractability of the active components (20). A typical water processing method used in modern times involves steeping the shells in clear water for two days, steaming on a strong fire for about an hour, putting them into warm water, then scraping off the non-medicinal parts, and drying the plastron. A comparison of the chemical composition of tortoise shells processed by old and new methods was undertaken and no significant differences were noted (21). However, the details of processing are important: in a study of processed tortoise shell and turtle shell (29), it was shown that proper processing procedures could yield up to twice as much water-soluble substances.
Vinegar processing is the main additional method used by the Chinese. The plastrons isolated by the boiling method are first rapidly heated in a hot pot and then immediately dipped into vinegar; this process can be repeated. According to the report in Pao Zhi (30), the raw tortoise shell is mainly used for treating vertigo, tinnitus, deafness, headache, and convulsion due to wind agitation of liver yin deficiency (i.e., it settles yang, much like oyster and haliotis shells), whereas the vinegar-treated tortoise shell is appropriate for treating nightsweating, weakness of back and legs, insomnia, heart palpitations, and other disorders due to deficiency of liver and kidney (i.e., it nourishes yin and blood, much like rehmannia, ho-shou-wu, and lycium).
Tortoise shell gelatin is obtained by boiling the plastrons; the collagen is converted to gelatin during this process and is then formed into small hard blocks. The gelatin is especially used for treating impotence, low back pain, and uterine bleeding due to kidney essence deficiency. Turtle shell gelatin (biejia jiao) is made as a medicinal product and is also used to treat uterine bleeding; it is also used for hemoptysis associated with tuberculosis, but is not indicated for the kidney deficiency symptoms of back pain and impotence. According to the report in Dui Yao (38), 4 when the turtle and tortoise are combined, they “make yin and yang interact; in addition, together, they enrich yin and clear deficiency heat, subdue yang, extinguish wind, and stop tremors.”
MEDICINAL PREPARATIONS AND DOSAGE
In traditional Chinese formulas, tortoise shell is most often included in pills, with about 2 grams of shell per daily dose (similar to the amount of deer antler or oyster shell prescribed in pill form). Tortoise shell is also used in decoctions, in which case it is to be boiled for some time before adding other materials, since its gelatin and calcium are very slowly extracted. The dose of plastron to be used in decoction is generally 9–24 grams for a one day dose, though in several reference texts up to 30 grams is recommended. Tortoise shell gelatin may be powdered for making pills or may be added to the hot strained decoction after the other herbs have been thoroughly boiled; that is, the gelatin is not cooked further, but simply dissolved into the hot liquid.
The difference between dosage of tortoise shell used in decoctions versus pills is large, about 10:1, but this difference is relatively easily explained. Whereas the shell is very poorly soluble in hot water, yielding only a small fraction of the active constituents to the decoction, the shell is dissolved readily by stomach acid and is well extracted in the digestive system.
CHEMICAL CONSTITUENTS
Calcium compounds make up about half of the tortoise plastron and turtle carapace (31). The calcium content of the plastron, when used in the dosages recommended by the Chinese texts, contributes a significant amount—several hundred milligrams—compared to the currently recommended nutrition levels of about 1 gram. The typical Chinese diet is often low in calcium. Therefore, a course of therapy using tortoise shell in the amount of several grams per day may treat those conditions which are responsive to calcium supplementation. In the West, calcium citrate, calcium carbonate, bone meal (calcium hydroxyapatite), and other preparations are available in tablet, capsule, and liquid forms that can easily provide amounts similar to the Chinese herb preparations with tortoise shells. Also, the Western diet includes milk products that provide considerable amounts of absorbable calcium; by contrast, the Oriental diet is essentially free of milk products, and vegetable-source calcium is of variable availability (e.g., oxalates in the vegetables render much of the calcium unabsorbable).
The bone disease rickets, which is due to impaired deposition of bone calcium in children, has been treated in China with shell formulas. For example, in a study (36) involving several hundred cases, Longmu Zhanggu Tang was administered. It is comprised of tortoise shell, oyster shell, astragalus, atractylodes, codonopsis, hoelen, dioscorea, schizandra, jujube, licorice, and gallus. The tea was made with 15 grams of the materials, and administered three times daily (thus, 45 gram daily dosage). Among 278 cases treated, it was reported that serum calcium and phosphorus levels increased, and bone mass (as detected by x-ray analysis) improved; nearly all symptoms were alleviated. A control group of 200 cases received cod liver oil (source of vitamin D), calcium, and calciferol. The effects were the same, except that the herb infusion, which included several spleen tonic herbs, was better in improving appetite. These results suggest that the calcium provided by the shells, like that provided to the control group as a supplement, was a key component of treatment.
Collagen, a fibrous protein that is converted to gelatin by boiling in water, makes up about 7% of the tortoise plastron. Collagen is the most abundant protein in higher animals, making up one-third or more of the total body protein of vertebrates, with most of it present in specific body structures (e.g., skin, bones, nails, hooves). The collagen forms a network of tough but pliable fibers (Figure 7) that are partially or completely solidified by calcium carbonates and phosphates. The plastron is formed basically in the same way that bones and horns are made, and is sometimes described as an exoskeleton.
It is unclear whether there is anything unique about tortoise collagen and gelatin compared to that obtained from other sources, such as deer antler or donkey skin. In fact, relatively little is known about the medicinal value of these proteins. Recently, interest has developed in the ability of ingested collagen to inhibit arthritis (perhaps by deflecting immune attacks against the joints to the ingested collagen) and for its ability to inhibit angiogenesis (blood vessel formation) as a means of inhibiting tumor growth. In the West, collagen from chicken bones has been tested for arthritis treatment, while collagen from sharks and cattle has been tested for cancer treatment. There may be some correlation with traditional uses of these substances in China. Bones, such as tiger, dog, and pig bones, have been used for arthritis treatment in traditional Chinese medicine. Deer bone gelatin was given orally at 10 grams twice daily in a trial for arthritis treatment (43); of 124 cases treated, more than half had marked improvement or complete resolution of symptoms with 10–20 days typical treatment time. Wang Weilan, a specialist in arthritis treatments (39) frequently recommended gelatins for treatment of deficiency-type arthritis. For example, in cases of soreness and pain of the back and spine, enlargement of the joints, sore legs, painful heals, inability to raise the upper limbs, difficulty lifting the legs, and in persons with obvious weakness, he prescribes a complex formula that includes tortoise shell, turtle shell, donkey skin gelatin, and deer antler gelatin. During the phase of remission, when there is absence of redness and swelling, but there is severe limitation of movement and rigid deformation, he recommends a complex prescription that includes tortoise shell gelatin and deer antler gelatin. He stated that “Deer antler gelatin and tortoise plastron gelatin warm and strengthen the conception and governing meridians. Since they are derived from an animal source, they are very compassionate to human beings; thus, they can invigorate the bone and replete the marrow. They are essential in the treatment of the late stage rheumatoid arthritis (deformity of joints, osteoporosis, defective cartilage of the joint surfaces, etc.). Their use is in accordance with the old saying: use the bone to tonify the bone— the seeking of the similar qi.”
It is possible that gelatin polypeptides (fragments after partial digestion) contribute to inhibition of bleeding, perhaps by a mechanism similar to that of carbonized materials (which the Chinese frequently employ to stop bleeding). In a study of treatment of vaginal bleeding in women above age 40 (37), those diagnosed with weakness of the chong and ren meridians (conception and penetrating vessels), were administered tortoise shell, deer antler gelatin, donkey skin gelatin, rehmannia, dioscorea, cornus, lycium, cuscuta, rubia, and schizandra. Most of the women so treated were cured of bleeding or had reduced bleeding. Other formulas were used to treat bleeding associated with uterine fibroids (turtle shell, which is reputed to resolve masses, was included).
Westerners tend to get little gelatin in the diet, some coming from soups made from animals (when bones, tendons, and/or skin are included in the cooking) and a very slight amount coming from gelatin-based desserts. It has been proposed that gelatins may provide a nutritional benefit for the collagen portions of the body (e.g., gelatin to improve the nails), and one of the accompanying compounds, chondroiton, has been shown to nourish the joints.
There are also small amounts of fats, magnesium, trace minerals, such as zinc, and vitamins, including Vitamin D, in the tortoise shells. As with other natural calcium sources, there are small amounts of lead, but not enough to be of concern.
It is still difficult to explain some of the traditional indications for tortoise shell (see below) based on the limited knowledge of its constituents and their effects. Persons who have habitual low levels of calcium in the diet may experience health improvements when tortoise shell is used in adequate doses due to the calcium and protein it contains (gelatin may enhance calcium absorption); the protein contribution of tortoise shell is only significant when the plastron is used in decoction at high dosage. There may be substances in the shell that stimulate the body to produce hormones or generate another response that would explain the traditional indications, but these substances have not been identified. In one frequently cited study (23), it was shown that both rehmannia and tortoise shell could affect beta-adrenoreceptors in rats with induced hyperthyroidism, thus alleviating some of the symptoms of the thyroid disorder. A shell-based formula has been clinically tested for treating Grave’s disease, a hyperthyroid condition (34): twenty-five patients were treated with a decoction that included turtle, tortoise, and oyster shells, plus astragalus, codonopsis, polygonatum, scrophularia, brassica, arisaema, and prunella. This formula tonifies qi and nourishes yin, 6 while the latter four herbs are used for treating a swelling in the throat that is due to qi stagnation and phlegm accumulation (see Treatment of thyroid diseases with Chinese herbs). According to the report, after administering the decoction three times daily before meals for three weeks, along with the Western drug methimazole and, if needed, propranolol, 14 of the patients showed complete remission of symptoms, and 10 others had partial but clinically significant remission.
COMPARING TRADITIONAL AND MODERN INDICATIONS FOR USE OF TORTOISE SHELL
According to the Shennong Bencao Jing, tortoise is salty and balanced. It mainly treats “red and white leaking” (this is a usual description for uterine discharge, meaning uterine bleeding and leukorrhea, respectively), “breaks concretions and conglomerations” (this is the usual description for masses, especially those that occur in the abdomen), and cures “malaria, the five hemorrhoids, genital erosion, damp impediment, heaviness and weakness in the limbs, and non-closure of the fontanel in children.” The original uses of tortoise shell differ from many of the modern applications, which emphasize nourishing yin and blood and calming agitated yang. Today, turtle shell is preferred over tortoise shell for resolving masses, and oyster shell is more frequently used than tortoise shell for “white leaking.” Heaviness and weakness of the limbs is the main indication from ancient times that is still deemed important today.
As an example of the elaboration of uses in modern practice, the English-Chinese Rare Chinese Materia Medica (11) states the following actions and indications:
1. Nourishing yin and suppressing hyperactive yang. It is efficacious in the treatment of dizziness due to hyperactivity of yang caused by deficiency of yin, or, of stirring-up of endopathic wind of deficiency type resulting from impairment of yin in the course of febrile disease.
2. Reducing fever of deficiency type. It is efficacious in the treatment of hectic fever, consumptive fever, and night sweat, all due to deficiency of yin.
3. Tonifying the kidney and strengthening the bones. It is efficacious in the treatment of flaccidity and weakness of loins and feet, chondropathy (cartilage disorder), and infantile metopism (non-closure of fontanel).
4. Nourishing the blood and tonifying the heart. It is efficacious in the treatment of palpitations, insomnia, and amnesia due to deficiency of the heart.
Another elaboration that provides good insight is from the Advanced Textbook on Traditional Chinese Medicine and Pharmacology (5):
1. To replenish yin and pacify yang. Indications: Kidney yin insufficiency leading to hyperactive yang in deficiency conditions marked by hectic fever and night sweating, for which it is often prescribed along with cooked rehmannia, anemarrhena, and phellodendron, as in Da Buyin Wan. Late stages of febrile diseases with consumption of yin fluid and hyperactivity of deficiency wind marked by dizziness and convulsion. For such cases, it is often combined with oyster shell, turtle shell, and raw rehmannia.
2. To nourish the kidney and strengthen the bones. Indicated for insufficiency of the liver and kidney marked by weakness of the lower back and limbs, weakness of the muscles and bones, and retarded and incomplete closure of the fontanel in infants, for which it is often combined with cooked rehmannia, achyranthes, and cynamorium.
3. To strengthen the meridians and check bleeding. Indicated for yin deficiency and blood heat in women marked by menorrhagia or metrorrhagia, for which it is often prescribed along with ailanthus, peony, and scute.
The treatment of flaccidity and weakness of loins and feet (alternatively described as weakness of the lower back and limbs) corresponds to treatment of heaviness and weakness in the limbs from the Shennong Bencao Jing; the treatment of uterine bleeding, corresponds to red leakage; and there is common mention of closure of the fontanel, connecting the ancient and modern uses. It is possible that the treatment of fever of deficiency type and treatment of malaria make reference to a common concern, since malarial fevers may have this appearance. However, most references to malarial fevers, both ancient and modern, do not indicate a yin-deficiency type syndrome.
TRADITIONAL PRESCRIPTIONS RELYING ON TORTOISE SHELL
Whatever the indications for the tortoise plastron in modern Materia Medicas, its history of use is perhaps best observed via the well-known formulas that rely on it as a major ingredient. The traditional prescriptions that utilize tortoise shell as a key ingredient may be classified into three groupings:
1. Formulas for yin deficiency accompanied by deficiency fire. These formulas include Da Buyin Wan and its derivatives. Da Buyin Wan (Major Replenish Yin Pills) has four ingredients: tortoise shell, cooked rehmannia, anemarrhena, and phellodendron. The herbs are powdered, combined with honey, and made into large boluses of 9 grams each. Dosage is one pill each time, two or three times per day. Each pill contains about 6 grams of herbs and 3 grams of honey, with just over 2 grams of tortoise shell per pill. This formula is used for replenishing the yin and calming upflaring of kidney fire (deficiency fire). Typical indications include fever and night sweating, restlessness, red tongue, thin tongue coating, and rapid pulse. Tortoise shell also addresses weakness, heaviness, and pain in the legs. One of the best-known derivatives of this formula is Huqian Wan (Pill of Hidden Tiger; referring to stealthy walking of the tiger). This is made by combining the four ingredients of Da Buyin Wan with cynamorium, tiger bone, peony, ginger, and citrus (produced as honey boluses in the same manner). Today, tiger bone is not used, but may be substituted by other bones that are readily available (e.g., pig bones). Like tortoise shells, bones are mainly comprised of collagen and calcium compounds (with emphasis on calcium phosphate). The incorporation of cynamorium and tiger bone (or its substitutes) is intended to focus the action of the formula on flaccidity of muscles and bones, weakness of the lower back and legs, and difficulty walking. As a result, this formula, and modifications made by adding even more tonic ingredients, such as Jianbu Huqian Wan (sometimes called Pill of Flying Feet; literally, Healthy Steps Stealthy Tiger Pills), have been applied in recent times for disorders that cause leg paralysis (such as multiple sclerosis and ALS). Another formula that is based on Da Buyin Wan is Heche Dazao Wan (Placenta Great Nourishing Pills), which replaces anemarrhena with ophiopogon and asparagus, and includes the tonic group ginseng, eucommia, placenta, and achyranthes to tonify qi and yang and nourish blood.
2. Yin deficiency without deficiency fire, accompanied by a slight deficiency of yang. Tortoise shell is combined with deer antler for this purpose, as occurs in Gui Lu Erxian Jiao (Tortoise-Antler Two Immortals Glue). In this case, the two gelatin-containing ingredients are combined with ginseng and lycium in the form of a powder; this is taken in doses of 3 grams each time with some boiled water. The formula nourishes yin (tortoise and lycium) and invigorates yang (ginseng and deer antler), and is used to treat weakness of the back and legs. Another example is Zuogui Wan (Left Returning Pill; that is, pill for restoring the yin to the left kidney). In this formula, the gelatin of tortoise shell and of deer antler is added to a modification of Rehmannia Six Formula (Liuwei Dihuang Wan) containing rehmannia, dioscorea, cornus, lycium, achyranthes (or cyathula, chuanniuxi), and cuscuta.
3. Yin and blood deficiency with stirring of internal wind. Tortoise shell is combined with peony and other liver nourishing agents and with oyster shell (alone or with other wind suppressing agents) for this purpose. Examples are Zhengan Xifeng Tang (Decoction to Rectify the Liver Function and Reduce Wind), which contains the yin and blood nourishing agents tortoise shell, peony, achyranthes, scrophularia, and asparagus to prevent development of wind due to liver deficiency, and the heavy sedating agents hematite, dragon bone, and oyster shell to suppress the rising wind. In addition, the formula contains malt, melia, and capillaris to regulate liver qi in order to avoid having the liver overly suppressed by the combination of rich tonics and heavy sedatives. Another such formula is Da Dingfeng Zhu (Big Pearl to Calm Wind), which combines the yin and blood nourishing agents tortoise shell, egg yolk, gelatin, peony, raw rehmannia, and ophiopogon with oyster shell to suppress wind. A third example is Sanjia Fumai Tang (Decoction of Three Shells to Recover the Pulse) which nourishes yin and blood using tortoise and turtle shells, gelatin, ophiopogon, peony, and raw rehmannia, with oyster shell to suppress wind. These formulas all have a cooling quality to help calm the agitation of the liver. For heart agitation associated with yin deficiency, tortoise shell is combined with dragon bone, as in Zhenzhong Dan, which is comprised of these two ingredients along with acorus and polygala to open the heart orifices. This will treat insomnia and irritability; similar formulations have been applied in modern times to treat attention deficit disorder with hyperactivity.
It will be noted here that nourishing yin and blood are the primary functions of these formulas, and that some of the other indications, such as treatment of bleeding and closure of fontanel, are not mentioned directly, as they are secondary applications.
Acknowledgment: Dr. Fu Kezhi, at the Harbin office of ITM, conducted a literature search and provided valuable background information for this article.

Dose: 9-30g

 
Gui Ban Jiao: Gui ban gelatin
• Same functions as Gui ban, but is richer, more cloying, stronger to nourish Yin, and stops bleeding.
• Beneficial for uterine bleeding due to kidney Qi deficiency.
• Dissolve in wine or a strained decoction.

Dose: 3-9g

Han Lian Cao – Mo Han Lian – Eclipta

Nature: sweet, sour, cold

Enters: Liver, Kidney

Actions: Cools the blood; stops bleeding; mildly nourishes kidney and liver Yin; sharpens the senses.

Indications:
• Kidney and liver Yin deficiency: dizziness, early greying of the hair, blurry vision, vertigo.
• Yin deficiency heat: hematemesis, hemafecia, epistaxis, uterine bleeding, coughing up blood, and especially hematuria.
• Beneficial for diphtheria.
• Topical: for hemorrhage.
• Similar in actions to Sheng di, but not greasy – a better choice when the patient has a digestive disorder.
Han lian cao’s function to nourish Yin is quite limited.
Hsu: Antibacterial, hemostatic, blood cooling, possibly anti-inflammatory.
DY: Nourishes the lower and upper parts; enriches Yin and blackens the hair.
• With Nu zhen zi to effectively supplement the liver and kidneys, cool the blood and stop bleeding, and blacken the hair. For the following indications, this combination, Er Zhi Wan, should be prepared with wine-steamed Nu zhen zi.
- 1. Liver-kidney deficiency heat.
- 2. Vertigo, dizziness, insomnia, and loss of memory due to liver-kidney deficiency with Yin and blood not nourishing the upper part of the body.
- 3. Premature greying of the hair and beard due to kidney essence deficiency.
- 4. Nosebleed, bleeding gums, hemoptysis, hematemesis, hematuria, and metrorrhagia due to Yin deficiency heat which forces the blood out of the vessels. Han lian cao’s action of cooling the blood and stopping bleeding is not very strong. The combination can be strengthened for these purposes by adding Sheng di, Mu dan pi, Ce bai ye, and Qian cao gen.

Dose: 9-15g (to 30g when fresh)

Hei Zhi Ma – Black Sesame seed

Nature: sweet, neutral

Enters: Liver, Kidney

Actions: Nourishes blood; supports Jing; moistens the large intestine, promotes bowel movement; extinguishes wind (due to blood deficiency).

Indications:
• Blood deficiency, body fluid deficiency, or Yin deficiency: constipation (good for the elderly).
• Blood and Jing deficiency: early greying of the hair, dizziness.
• Internal wind due to blood deficiency: headache, dizziness, numbness.
• This herb is only a weak tonic, but it has no side effects.
• Very rich in calcium.
• Sesame oil: excellent for massage, non-comedogenic, bacteriostatic.
Yoga: Tila: V-; P, K, or Ama + (in excess)
• Rejuvenative tonic for Vata.
Sattvic.
Hsu: Purgative, lowers blood sugar.

Dose: 9-30g

Huang Jing – Polygonatum sibiricum rhizome – Siberian Solomon’s Seal – “Yellow Essence”

Nature: sweet, neutral

Enters: Lung, Spleen, Kidney

Actions: Nourishes Lung Yin; tonifies spleen Qi, nourishes spleen Yin; mildly nourishes kidney Yin and Jing.

Indications:
• Lung Yin (and Qi) deficiency: dry cough.
• Kidney Jing deficiency: weakness and soreness in the lumbar region and knees, dizziness, weakness in the lower extremities, lightheadedness.
• Spleen and stomach Qi deficiency: poor appetite, fatigue, weak pulse, lassitude.
• Spleen and stomach Yin deficiency: dry mouth, poor appetite, loss of taste, dry stool, dry, red tongue.
• Lung, stomach, and kidney Yin deficiency: diabetes/wasting and thirsting disorder.
• Very safe, will not trap an EPI in the body, not greasy. Liu: “Typical Taoist herb.”
• Can be taken long-term.
• May lower blood pressure.
• Beneficial in tuberculosis.
• The raw form (less used) is more of a Yin tonic than a Qi tonic.
• The prepared form (common), which is wine-steamed, is more of a Qi tonic than a Yin tonic.
• Bensky/Gamble classify this herb as a Qi tonic.
• Michael Tierra compares this herb, rather than Yu zhu, to American Solomon’s Seal (an error?), and considers American Polygonatum to be as good or better than the Chinese variety.
Li: Good non-warming immune tonic.
Hsu: Antifungal, antibacterial, hypotensive, hypoglycemiant.
HF: An An Shen (spirit calming) herb, important in Gu Zheng (Gu parasite) formulas (because of emotional disturbance common in patients with Gu).

Dose: 6-18g

Luo Han Guo – Momordica fruit – “Arhat Fruit”

Nature: sweet, neutral

Enters: Lung, Spleen

Actions: Moistens and cool the Lungs; dissipate nodules.

Indications:
• Hot coughs, especially in cases of Lung Yin deficiency.
• Phlegm nodules in the neck, such as scrofula.
• Recently used as the source of a low-calorie sweetener.
Hsu: Diuretic, vasodilator – coronary and renal; strengthens capillaries, anti-inflammatory.

Dose: 9-15g (½ to 2 pieces of fruit)

 
Luo Han Ye: Momordica leaf
• Similar to the fruit.
• Chronic throat problems, chronic bronchitis.

Mai Men Dong – Mai Dong – Ophiopogon tuber – “Lush Winter Wheat”

Nature: sweet, slightly bitter, slightly cold

Enters: Lung, Heart, Stomach

Actions: Nourishes Yin; moistens the Lungs, stops coughing; generates Yin and body fluids for the stomach; clears heat from the heart to ease restlessness; moistens the intestines.

Indications:
• Lung heat and Yin deficiency: dry cough, thick, difficult to expectorate sputum, coughing up blood.
• Stomach Yin deficiency: dry mouth, thirst.
• Heart heat and Yin deficiency or ying-level febrile disease: restlessness, insomnia, irritability, worse at night.
• Yin deficiency or aftermath of a febrile disease: constipation, dry mouth, irritability.
• Can reach the upper and middle Jiaos.
• May lower blood sugar.
• For Lung heat and dryness, compared to Tian hua fen and Tian men dong, Mai men dong is best when the origin is heart fire (Tian hua fen is best when the origin is stomach heat and Tian men dong is best when the origin is kidney Yin deficiency)
• Frying the herb in wine reduces its cold properties, which is indicated when the herb is used in tonic formulas.
DY: Compared to Tian men dong, Mai men dong is better for Lung/stomach Yin deficiency, and better for nourishing the heart and quieting the spirit.
Hsu: Antipyretic, antitussive, expectorant, cardiotonic, diuretic, hypoglycemiant, antibacterial, may have anti-inflammatory properties.

Dose: 6-15g

Nu Zhen Zi – Ligustrum seed – Privet fruit – “Female Chastity Seed”

Nature: sweet, bitter, cool

Enters: Liver, Kidney

Actions: Nourishes kidney and liver Yin; clears liver heat; improves vision; clears Yin deficiency heat.

Indications:
• Kidney and liver Yin deficiency: dizziness, weak lumbar region and knees, premature aging, early greying of the hair, diminished visual acuity, blurry vision, tinnitus.
• Yin deficiency heat: fever.
• As a tonifying seed, this herb is sometimes thought of as promoting fertility.
• No greasy side effects – good for Yin deficient patients with poor digestion.
• This herb is not a powerful Yin tonic.
• Doctrine of signatures: black and shaped like a kidney – nourishes the kidneys.
JTCM: Lowers serum cholesterol; improves blood supply to the heart.
• Acne: may help by regulating endocrine function.
• Lowers blood sugar.
• Treats cirrhosis of the liver.
• Hyperthyroidism.
• Brown spots on the skin.
MLT: Immune tonic to counter effects of radiation and chemotherapy.
Hsu: Cardiotonic, purgative, nutritive, may inhibit tumor growth.
DY: With Han lian cao to effectively supplement the liver and kidneys, cool the blood and stop bleeding, and blacken the hair. See Han lian cao in this category for specific indications and notes on this combination.

Dose: 4.5-15g

Sang Ji Sheng – Mistletoe (parasitizing Morus) – Viscum/Taxillus or Loranthus – “Mulberry Parasite”

Nature: bitter, neutral

Enters: Liver, Kidney

Actions: Tonifies the liver and kidneys; strengthens the tendons and bones; expels wind and dampness; nourishes blood; calms the fetus/womb; benefits the skin.

Indications:
• Liver and kidney Yin deficiency (with or without wind-damp): soreness and pain in the lower back and knees, joint problems, numbness, weakness and atrophy of the sinews and bones.
• Wind-dampness: Bi syndrome with some lumbar region and knees.
• Restless fetus, uterine bleeding, threatened miscarriage in pregnancy.
• Blood deficiency: dry, scaly skin.
• Hypertension.
• Diuretic component.
• Wine-fry the herb to strengthen its ability to expel wind-dampness.
Li: Drunk alone as tea by elderly in China, “Tonifies everything.”
MLT: Versatile for back and joint pains, stiffness from various causes, especially for those who develop gradual stiffness and aching pain of the lower back with difficulty bending at waist.
Hsu: Lowers serum cholesterol, diuretic, antibacterial, pronounced antiviral.
RW: (host not specified)
• Hypertension: parasympathetic stimulant, vasodilator.
Definite benefit in hypertension, however, “oral use cannot provide effective treatment for arterial hypertension, nor can too much be expected as regards reduction in blood pressure, and certainly no lasting effect… yet practitioners and patients repeatedly find it has excellent subjective effects on headaches, dizziness, loss of energy, irritability and other symptoms connected with hypertension…” No unpleasant side effects, non-toxic in usual dosage, gentle, good for extended treatment of slightly or moderately raised blood pressure, which will go down in the course of treatment. Ideal treatment for blood pressure of about 160/100. Best prepared as a cold water extract: pour 1/4 liter cold water over 2-4 teaspoons chopped herb, let stand overnight and drink in morning. prepare another cup to be drunk at night.
Patients are very fond of this three herb blend: equal parts mistletoe, (Western) hawthorn flowers and leaves (to improve coronary circulation), melissa (lemon balm) leaves (as a cardiac sedative). Take 1 cup morning and night, prepared by infusing 2 teaspoons of the mixture for 5-10 minutes, taken in sips while still warm. May be sweetened with honey.
• Cancer: extensive literature available on commercial extracts (e.g. Iscador). Unlike cytostatic drugs, mistletoe extracts are non-toxic, well tolerated. Reported to reduce tumor size and improve patients’ general condition. Used mainly after surgery and radiation.
• Arthritis: mistletoe preparations (e.g. Plenosol) are injected into the joint.
PCBDP: Cardiac tonic; antineoplastic (binds to DNA, inhibits protein synthesis).
For various cancers (including lung, ovary).
JC: Nervine, antispasmodic, tonic, slight narcotic, diuretic, emmenagogue, emetic.
• Used in all problems caused by weakness of or a disordered state of the nervous system. Quiets, soothes, and tones the nerves, lessens cerebral excitement, helps febrile conditions.
• Useful in weakness of female generative organs, incites uterine contractions.
• Gives tone in cardiac affections. possesses non-injurious properties.
• For hysteria, epilepsy, uterine hemorrhages, amenorrhea, dysmenorrhea, heart troubles (especially in typhoid fever), hypertension, convulsions, delirium, nervous debility, fits, nervousness, chorea (St. Vitus’ Dance), cardiac edema, cholera.

Dose: 9-60g

Sang Shen – Morus fruit – Mulberry

Nature: sweet, cold

Enters: Heart, Liver, Kidney

Actions: Nourishes blood and Yin; generates body fluids; moistens the large intestine.

Indications:
• Heart, liver, and kidney Yin/blood deficiency: dizziness, diminished vision, tinnitus, insomnia, premature greying of hair.
• Injury of body fluids: thirst.
• Yin and blood deficiency: constipation with dry stool (good for the elderly).
• Yin deficiency: wasting and thirsting disorder.
• Use prepared form for blood deficiency.
• Bensky/Gamble categorize this herb as a blood tonic.

Dose: 6-15g

Sha Shen – Bei Sha Shen – Glehnia root – “Sand Root”

Nature: sweet, bland, slightly cold

Enters: Lung, Stomach

Actions: Clears heat; nourishes Lung Yin; produces body fluids for the stomach; moistens the Lung and stops coughing; moistens the exterior.

Indications:
• Lung heat with Yin deficiency: dry, nonproductive or bloody cough, hoarseness.
• Stomach body fluid injury due to heat in febrile disease: poor appetite, dry mouth and throat, thirst, accompanying constipation.
• Dry itchy skin, especially when worse with cold, dry weather.
• A key herb for Lung and stomach Yin deficiency.
Sha shen usually implies Bei sha shen.
Li: Good for depression. Nourishes spleen Yin so it can fight off attack by the liver.
Hsu: Antipyretic, analgesic (ethanol extract), slight expectorant.
MLT: Nearly the same as Xi yang shen, but cheaper.
HF: An An Shen (spirit calming) herb, important in Gu Zheng (Gu parasite) formulas (because of emotional disturbance common in patients with Gu).

Dose: 9-15g

 
Nan sha shen – Adenophora: This herb is also called Sha shen, although it is somewhat less common. It is weaker at nourishing Yin and Qi than Bei Shan Shen is, and unlike Bei Sha Shen, it does not generate fluids, but it is better than Bei sha shen at stopping coughs.

Shi Hu – Dendrobium – “Bushel of Stone” (also the substitute, Ephemerantha)

Nature: sweet, slightly cold

Enters: Stomach, Kidney

Actions: Generates body fluids for the stomach; nourishes stomach Yin, mildly nourishes kidney Yin; clears heat; brightens the vision; strengthens the lower back.

Indications:
• Stomach Yin deficiency or injury of stomach body fluids by heat: dry mouth, thirst, stomach ache, dry heaves, shiny tongue, intractable fever, wasting and thirsting disorder.
• Kidney Yin deficiency: prolonged low grade fever (do not count on Shi hu alone in cases of kidney Yin deficiency).
• Can trap an EPI in the body and prolong the sickness. If there is a chance of EPI, Mai men dong or Yu zhu is a better choice.
• Premier herb for stomach Yin deficiency: stronger than Mai men dong at nourishing stomach Yin.
• The true herb is effective at lowering blood pressure, even in small doses.
• The true herb is quite difficult to obtain in the U.S., and is very expensive, though it is also very popular with some practitioners.
Hsu: Stimulates smooth muscle contraction of the small intestine, increases its tonicity, promotes peristalsis and gastric secretion.
• Slightly antipyretic and analgesic.
Eric Brand: Shi Hu is a yin-supplementing medicinal that is sold in many different grades and qualities. True Shi Hu refers to dendrobium orchid, but in actuality most of what is used as Shi Hu on the market is a tolerated substitute rather than true dendrobium. The substitute pictured above is an authentic medicinal, but it is considered a less expensive and less effective form of Shi Hu. True Shi Hu and its substitute (which is properly called “You Gua Shi Hu,” derived from Ephemerantha fimbriata (Bl.) P.E. Hunt et Summ) are both in the orchid family, but they are from plants in different genera that have significantly different appearances. Generally speaking, the two should be differentiated in trade and in clinical use.
The true Shi Hu seen on the market is almost always cultivated. Wild Shi Hu is endangered and is protected under CITES law, so trade is only permitted if a certificate of cultivation is provided. It is common to see products on the Chinese wholesale market or the Chinatown market that are sold as “wild” Shi Hu, but these products are nearly always cultivated and are not truly wild. Generally true Shi Hu is sold in thin, long (or cut) pieces or rolled bundles. The rolls can be large or small, and different subtypes of the medicinal have stems of varying thickness. High quality Shi Hu can be quite expensive.
To test the quality of true Shi Hu, chew it. As you chew, pay attention to the flavor and texture. The more fibrous it is, the more average the quality is. The more sticky and soft it is, the better it is. The good stuff is sticky and slightly sweet when chewed, but it needs to be chewed slowly and held in the mouth to get the full effect. True Shi Hu and You Gua Shi Hu can be differentiated from each other at a glance, but the different grades of true Shi Hu require the test of chewing to fully assess their quality.
Shi Hu is very popular in Japan, Taiwan, and Hong Kong. The Chinese medicine culture in Southern China (Canton, Hong Kong, etc) tends to favor cooling, yin-supplementing agents like Shi Hu, so the South is the place to see a lot of it. The area around Hangzhou is also a major production region for Shi Hu, so it is popular there as well. Shi Hu is often grown in greenhouses and can be grown hydroponically. The best quality tends to go to the Japan, Taiwan, and Hong Kong markets, and premium quality Shi Hu is grossly overpriced in the U.S. As a general rule, don’t believe vendors that try to tell you that the product is wild, because the wild product is truly rare and insanely expensive.
Good quality Shi Hu is a beautiful thing, and I feel that Shi Hu is underappreciated in the Western TCM world. As I mentioned before in my blog about Chuan Bei Mu, any herb that gets the attention and respect of an entire cultural region is worth looking into. Shi Hu has an incredibly developed niche in East Asian culture and it is a special medicinal that deserves more attention.

Dose: 6-15g

Tian Men Dong – Asparagus tuber – “Lush Winter Aerial Plant”

Nature: sweet, bitter, very cold

Enters: Lung, Kidney

Actions: Clears heat and reduces fire from the Lungs; nourishes Lung and kidney Yin; moistens dryness.

Indications:
• Lung heat or fire and Yin deficiency: dry cough with small amount of sticky sputum or cough with bleeding.
• Injury of Yin by heat: dry mouth and thirst.
• Lung and kidney Yin deficiency: wasting and thirsting disorder, consumption, low-grade afternoon fever.
• Large intestine dryness: constipation.
• Reaches the upper and lower Jiaos.
• Often used with Mai men dong to treat both the mother and son.
• Has a viscous, cloying nature – can easily produce stagnation.
• Antibiotic effects.
• May help leukemia.
• Said to engender love and compassion.
• For Lung heat and dryness, compared to Tian hua fen and Mai men dong, Tian men dong is superior when the origin is kidney Yin deficiency (Tian hua fen is best when the origin in stomach heat and Mai men dong is best when the origin is heart fire)
DY: Compared to Mai men dong, Tian men dong is better for Lung/kidney Yin deficiency, and better for clearing and moistening.
Yoga: Shatavari: “who possesses 100 husbands” – named such because it is so tonic and rejuvenative to the female reproductive organs.
• P, V-; K and ama+ (in excess); Sattvic.
• Sexual debility, especially of the female organs, infertility, impotence, menopause, diarrhea, dysentery, stomach ulcers, hyperacidity, dehydration, lung abscess, hematemesis, cough, convalescence, cancer, herpes, leukorrhea, chronic fevers.
• A rasayan for Pitta, for the female reproductive system, and for the blood.
• Demulcent for dry and inflamed membranes.
• Topical: emollient for stiff joints, neck, muscle spasm.
• Contains many female hormones.
PCBMP: Diuretic, laxative, cardiac tonic and sedative.
• Also for neuritis and rheumatism.
Hsu: Antibacterial, antitussive, diuretic, laxative.

Dose: 6-15g

Xi Yang Shen – American Ginseng – Panax quinquefolium – “Western Seas Root”

Nature: bitter, sweet, cold

Enters: Heart, Lung, Kidney

Actions: Nourishes Yin; tonifies Qi; clears heat/fire; generates body fluids.

Indications:
• Lung Yin deficiency fire: difficulty breathing, cough with sputum and blood, loss of voice, wheezing.
• Injury of Lung and stomach Yin and Qi: fatigue, thirst.
• Yin deficiency: dry mouth and tongue, chronic unabating fever.
• Aftermath of febrile disease: weakness, irritability, thirst.
• Good for tuberculosis.
• Good for patients with heat and Qi/yin deficiency.
• Much weaker than Ren shen at nourishing Qi.
• Not to be combined with Li lu.
• Do not cook this herb in an iron pot. Often cooked separately from other herbs in a double boiler.
HF: An An Shen (spirit calming) herb, important in Gu Zheng (Gu parasite) formulas (because of emotional disturbance common in patients with Gu).

Dose: 2.4-9g

Notes on This Category

• These herbs are generally contraindicated in cases of hyperactive Yin deficiency fire. Most are contraindicated when an excess, exterior, or heat condition exists. Compared to the category of herbs that warm the interior, Yang tonics are mostly sweet, many slightly nourish Yin, and most are slower acting than the interior-warming herbs to activate Yang. Herbs that warm the interior may be used for excess cold, can restore collapsed Yang, are mostly hot and acrid, and mainly activate but do not so much tonify Yang.
• Yang tonics are often combined with a small amount Yin nourishing herbs to give the Yang some substance to “cook” or “cling to.” (The formula Jin Gui Shen Qi Wan is a good example of this principle, though it utilizes Interior Warming herbs [Fu Zi, Rou Gui] instead of Yang tonics.)

Ba Ji Tian – Morinda root

Nature: acrid, sweet, slightly warm

Enters: Kidney, Liver

Actions: Tonifies kidney Yang (without blocking Qi); eliminates wind-damp (including in the bones); strengthens sinews and bones.

Indications:
• Kidney Yang deficiency: impotence, frequent urination, infertility (male or female), irregular menses, premature ejaculation, urinary incontinence, cold and pain in the lower abdomen, weak and sore lower back, muscular atrophy.
• Kidney Yang deficiency plus attack of wind-damp: weakness or pain in the lumbar region, knees, backs of the legs; bony Bi.
• Best used for cases of Yang deficiency with cold-damp.
Hsu: Antibacterial, hypotensive, has effects resembling those of cortical hormones.
Weng Weiliang, et. al.:
Aspermia:
Xing Yang Sheng Jing Dan (experiential formula): ba ji tian, ying yang huo, tu si zi, gou qi, yu biao jiao, testicles of goat, male silkworm moth, placenta, rou cong rong, jiu cai zi were made into pills, 10g, bid, three months as a course of treatment. 25 cases were treated, 20 were effective.
Impotence:
Xing Yang Chong Ji (experiential formula): chai gou shen, yin yang huo, ba ji tian, shan yu rou, chai hu, dang gui, bai shao, lu jiao jiao and gou qi were made into granules, 12g per bag, 1 bag, tid. 50 patients were treated and 43 were effective.

Dose: 6-15g

Bu Gu Zhi – Psoralea fruit – “Tonify Bone Resin”

Nature: acrid, bitter, very warm

Enters: Kidney, Spleen

Actions: Tonifies kidney Yang; controls Jing and urine; tonifies and warms spleen Yang, stops diarrhea; helps the kidneys grasp the Lung Qi.

Indications:
• Kidney Yang deficiency: impotence, cold and pain in the lumbar region and knees, weak lower back and extremities, premature ejaculation; frequent urination, urinary incontinence, enuresis, nocturnal emissions without dreams.
• Spleen Yang deficiency (usually with kidney Yang deficiency): severe, chronic diarrhea, borborygmus, abdominal pain.
• Kidneys fail to grasp the Lung Qi: wheezing.
• This herb can be hard on the stomach, but is still sometimes used cautiously for cold deficiency of the stomach.
• Topical: alopecia, psoriasis, vitiligo (especially in combination with UV light), fungus. Caution with sun/UV exposure with this herb on the skin – increases risk of sunburn.
• May dilate coronary vessels.
• With Chi shi zhi, it can stop menorrhagia.
Bu gu zhi’s kidney-tonifying properties are more pronounced than its spleen-warming qualities. The opposite is the case with Yi zhi ren.
• Topical vitiligo formula: in a base of coconut oil, extract on low heat: Bu gu zhi, barberry root bark (Western herb), and nigella (black cumin) seed (or just add cold pressed nigella seed oil to this formula).
• Crush before using.
Jin: Modern research shows hormonal (estrogen-like) effects.
• Uses in acne formula.
DY: Strengthens true Yang; warms the cinnabar field.
• With Hu tao ren to supplement metal and water, to effectively constrain the Lung Qi and promote the intake of Qi by the kidneys, stop cough, and calm asthma. For the following indications, salt-processed Bu gu zhi should be used:
- 1. Cough, dyspnea, and asthma due to kidney Yang deficiency.
- 2. Lumbago, impotence, seminal emission, constipation, frequent and abundant urination, and enuresis due to kidney Qi deficiency.
• With Rou dou kou to supplement spleen and kidney Yang, secure the intestines, and stop daybreak or “cock-crow” diarrhea. For indications such as:
- 1. Chronic diarrhea due to spleen-kidney Yang deficiency. (Si Shen Wan) Use salt mix-fried Bu gu zhi and roasted Rou dou kou.
- 2. Daybreak diarrhea with abdominal pain and rumbling noises due to spleen-kidney Yang deficiency. (Er Shen Wan)
Bu gu zhi is incompatible with pork blood.
Hsu: Dilates coronary arteries, stimulates the heart, increases rate and function.
• Antibacterial (tuberculosis).
• External use promotes production of melanin – used to treat calluses and warts.
• May have anti-cancer effects – inhibits artificially-induced tumors.
• Therapeutic action against Tinea versicolor and psoriasis.

Dose: 3-9g

Dong Chong Xia Cao – Cordyceps mushroom (and, traditionally, the carcass of the caterpillar it parasitized) – “Winter Bug Summer Herb”

Nature: sweet, warm

Enters: Kidney, Lung

Actions: Tonifies Lung Yin and kidney Yang; stops bleeding; resolves phlegm.

Indications:
• Kidney Yang deficiency: impotence, seminal emission, weak and sore lumbar region, knees, and lower extremities.
• Lung Yin deficiency: asthma and cough with bleeding, chronic bronchitis, pulmonary tuberculosis, consumptive cough with blood-streaked sputum.
• Because it tonifies both Yin and Yang and is a very safe substance, it can be taken over a long period of time.
• Often cooked with duck (or other meats) for a stronger tonic effect.
• Doctrine of signatures: for impotence – this mushroom (after invading the insect’s body with its mycelia) bursts forth from the caterpillar’s head.
• Different species of cordyceps fungi parasitize hundreds of different insects and also decaying wood. Dong chong xia cao is specifically the species that grows on the caterpillar or pupa Hepialus varians. The whole caterpillar-mushroom combination is very expensive. High quality, more affordable lab-grown fungus is now widely used.
Hsu: Bronchodilator, sedative, antibacterial, antifungal.
Eric Brand on wild vs cultivated cordyceps.
Weng Weiliang, et. al.:
Cardiovascular diseases:
• Shao Geng et al. carried out clinical research on the effects of treating hyperlipemia with cultured Cordyceps (Jin Shui Bao, a product made from cultured Cordyceps) with double-blind comparison method. 273 cases were equally divided into treated group and control group approximately. After 1~2 months’ treatment, in the treated group, the average of serum total cholesterol was lowered by 17.5% compared with that before the treatment (the control group lowered by 1.2%); triglyceride was lowered by 9.9% (the control group 6.7%); high-density lipoprotein cholesterol (HDL-C) was increased by 27.2% (the control group increased by 10.4%). Compared with the control group, the differences were statistically significant. Accordingly, it’s believed that this drug had reliable cholesterol-reducing as well as HDL-C increasing function.
• Arrhythmia was treated with Ning Xing Bao (a product made from Cordyceps) by Li Peizhang et al. and with Xing Gan Bao (a product made from different fermented Cordyceps) by affiliated hospital of Guangzhou medical college. 200 cases were reported by the former author, the total effective ate was 74.5%; while 188 cases were reported by the latter author, the total effective rate was 74.4%~79.6%.
• You Jingen used P.sinensis to treat 33 cases of coronary heart disease. The markedly effective rate of angina pectoris was 52.4%; and the effective rate of EKG was 42.4. Accordingly, it’s believed that the effect of P.sinensis came up to that of persantine.
Respiratory diseases:
• Six hospitals were organized by Jiangxi TCM factory to make the research on the effects of treating chronic bronchitis with Jin Shui Bao (a product made from Cordyceps). Results: after one month’s administration, among the 117 cases that took Jin Shui Bao, 58 cases were markedly effective (the markedly effective rate was 49.6%), 39 improved (33.3%), the total effective rate was 82.9%; among the 77 cases that took Mu Jing Oil, the markedly effective rate was 9%, and the total effective rate was 40.2%.
• Fu Fang Chong Cao (Cordyceps) Ge Jie (gecko) San was used to prevent asthma attack in 68 patients. There’re 42 males and 26 females, 35 of them had courses of diseases between 1~5 years, the other 33 cases were over 5 years. The ingredients: ge jie, one pair; Cordyceps, 5g; zi he che, huang qin, hou po, bai jie zi, 15g each; chen dan xing, 10g, huang qi, 30g. The drugs were ground into powder. For patients without symptoms, the dosage was 0.5~1g, tid; for those with symptoms of mild cough or asthma, the dosage was 1.5g tid. The patients took the treatment from later October to early April of next year, for two years. Results: within the two years, 36 cases didn’t have asthma attacks, and were markedly effective; the other cases were effective.
Sexual disorders:
• Yang Wenzhi et al. carried out clinical research on treating low sexual function with Jin Shui Bao (a product made from Cordyceps). They compared the effects of Jin Shui Bao, natural Cordyceps and placebo with method of single-blind comparison and sequential administration. Methods: dosage 1g every time, three times daily, 20 days as a course; take the medicine according to the order of Jin Sui Bao, placebo and natural Cordyceps. Results: 16 cases totally, 9 were markedly effective when given Jin Shui Bao (56.2%), only 1 markedly effective when given placebo, and 4 markedly effective when given natural Cordyceps (25%).
• Deng Xiaoan analysized 272 cases of low sexual function (11 were female), 152 cases were treated with Jin Shui Bao (a product made from Cordyceps). After 40 days’ administration, the effective rate was 66.1%. Among 23 cases treated with natural Cordyceps, the effective rate was 31.6%. In the 97 cases of control group, the effective rate was 23.7%.
Renal diseases:
• Chen Yiping et al. reported the effects of treating 30 cases of chronic renal failure with Jin Shui Bao (a product made from Cordyceps). After one month’s treatment, the patients’ renal function was improved significantly, which was manifested as obviously decreased creatinine and urea nitrogen in the blood compared with those before treatment, increased creatinine clearance and hemoglobin. Natural Cordyceps and other cultured Cordyceps preparation (Zhi Ling Capsule) had certain effects too. Shen Lingmei treated 18 cases of chronic nephritis with cultured Cordyceps, it was observed that the renal function was improved and urine protein decreased obviously.
Hepatic diseases:
• According the report of Zheng Furong, in Shanghai and some other areas, cultured Cordyceps preparation Xing Gan Bao was used to treat 256 cases of chronic viral hepatitis, the effective rate was over 80%, most patients symptoms, signs and liver function were improved to various degree, and the changes of serum albumin and sGPT were the most obvious. Zhou Liangmei used cultured Cordyceps to treat 33 cases of chronic hepatitis B, among the 32 cases with abnormal TTT, after 3 months’ administration, 10 cases returned to normal, 13 cases were improved significantly. Liu Cheng et al. used cultured Cordyceps to treat 22 cases of posthepatitic cirrhosis, after 3 months’ treatment, albumin increased; among 17 patients suffering from abdominal distension, 12 cases’ ascites disappeared, and 5 cases’ ascites decreased.
• Ma Xiong, et al did some research on Cordyceps polysaccharides (CP) in order to evaluate its therapeutic effects in chronic hepatitis C. Twenty-one patients with chronic hepatitis C were treated with CP (15ml, t.i.d, taken orally) for 3 months. Peripheral blood CD3, CD4, CD8, NK activity and serum HA etc. were tested before and after the treatment. The results showed that the serum levels of ALT and r-GT were lowered after the treatment (P<0.05). HA, PIIIP were lower (P Tumors:
• Cheng Jianhua reported the effects of treating 20 cases of lung cancer in late period with Jin Shui Bao (a product made from Cordyceps) as an auxiliary therapy. There’s also a control group with WBC-elevating drugs as the auxiliary therapy. Results: 95% of the cases in the Jin Shui Bao group completed the radiotherapy or chemotherapy, 85% of the cases had a normal blood picture, both were significantly higher than those of the control group (which were 64% and 59% respectively). Yan Rujie et al. treated 50 cases of lung cancer in late period (4 cases were complicated with radiotherapy or chemotherapy). Results: after 2~4 months’ treatment, most of patients’ subjective symptoms were obviously improved, focus of infection of 23 cases (46%) decreased by more than 25%. Zhang Jinchuan treated 30 cases of 30 cases of malignant tumors with the auxiliary therapy consisting of Zhi Ling Capsule, results: symptoms of 93% of the cases were improved, and the WBC was elevated obviously.
• Jinshuibao Capsule (JSBC), produced by Jiangxi Jinshuibao pharmaceutical Company Limited, possesses the similar active principles and pharmacological activity with those of Cordyceps sinensis. The effect of JSBC on the immunological function of 36 patients with advanced cancer showed that it could restore cellular immunological function, improve quality of life, but had no significant effect on humoral immunological function. The results suggested that JSBC could be used as adjuvant drug in advanced cancer.
• Others:
• Chen Daoming et al. reported that 30 cases of primary thrombocytopenic purpura were treated with cultured Cordyceps, after three months, patients’ subjective symptoms and bleeding condition were improved significantly, the total effective rate was 90%. Chai Weimin et al. reported that Xin Gan Bao (a product made from Cordyceps) was used to treat 20 cases of schistosomiasis of ascites type in late period, after 3 months, all symptoms were improved: abdomen circumference and the spleen decreased, the diameters of the portal vein and the splenic vein decreased too. Besides, Liu Weisheng et al. used Xin Gan Bao (a product made from Cordyceps) to treat patients with decreased hemoglobin, decreased platelet or aplastic anemia, Zhang Jinmei et al. used Cordyceps to treat allergic rhinitis and tinnitus, and better effects were obtained in these treatment.
Examine.com: In vitro, Cordycepin appears to induce apoptosis and reduce proliferation of breast cancer cells (MCF-7 and MDA-MB-231) with an approximate IC50 of 100uM.[31] Despite influencing both cell lines, the mechanisms appeared to differ.
In estrogen non-responsive cells (MDA-MB-231), Cordycepin appears to induce DNA fragmentation in a time and concentration dependent manner resulting in apoptosis. This appeared to be related to a release of cytochrome c from the mitochondria to the cytoplasm associated with caspase activation and PARP cleavage.[31] An aqueous extract of Coryceps per se shares these apoptotic effects associated with mitochondrial membrane depolarization, and aside from acting via Akt inhibition it is augmented with inhibition of PI3K/Akt in vitro.[32] Only one other study has noted anti-proliferative effects on this cell line, but was highly confounded with other Bioactive Mushrooms.[33]
In MCF-7 cells, the death of cells appeared to be autophagic.[31] Cordycepin failed to induce DNA fragmentation but 200uM clearly induced autophagic vacuoles and associated with conversion of LC3-I to LC3-II, commonly thought to be a biomarker for autophagy.[34] The exact mechanism was not elucidated but was independent of the estrogen receptors.[31] Beyond apoptotic, the ethanolic acetate fraction of Cordyceps (Mycelium) in general appears to have anti-proliferative effects on MCF-7 cells with an IC50 value of 44.7ug/mL (Petroleum 87.37+/-1.61ug/mL, ethanolic 79.57+/-2.68ug/mL, water ineffective).[10]
Another component, Cordymin (peptide) also appears to inhibit MCF-7 breast cancer proliferation in concentrations up to 5mg/mL but not surpassing 50% inhibition;[13] biological significance of this is unknown due to the large molecular weight (10,906Da) and being a long polypeptide possible not absorbed in vivo. Another peptide (12kDa) was able to induce cytotoxicity in MCF-7 cells and reduce their viability to 33.41+/-3.81% of control at 15uM with an IC50 of 9.3µM in vitro.[14]
Finally, in the highly invasive 4T1 cell line an injected water soluble extract of Cordyceps (10-50mg/kg) significantly inhibited metastasis as measured in the lung (when the tumors were injected into the breast of rodents) without significantly affecting tumor size whatsoever.[35] This study hypothesized that the immunostimulatory properties of Cordyceps on macrophages attenuated the rate of which 4T1 cells progressed from G0 /G1 to GM phase, which was demonstrated in vitro.[35]
Conclusion: A variety of compounds that could benefit breast cancer by reducing proliferation of cells or induce cancer cell death, but none of these mechanisms are currently established in living models or compared against active control drugs (to assess potency)

Dose: 4.5-12g

 

Jin Chan Hua: Cordyceps sobolifera – Cordyceps growing on Cicada.
• Tonifies Lungs, improves vision.
• Kamto Lee: Specific guiding herb for lung cancer.

Du Zhong – Eucommia bark

Nature: sweet, warm

Enters: Liver, Kidney

Actions: Tonifies the kidneys and liver, strengthens tendons and bones; holds and calms the fetus; promotes smooth circulation of Qi and blood.

Indications:
• Kidney and liver deficiency: weak, sore lumbar region and knees, Wei syndrome, fatigue, frequent urination.
• Kidney and liver deficiency: threatened or habitual miscarriage, restless fetus; cold deficient kidney patterns with bleeding during pregnancy.
• Liver/kidney Yang deficiency cold: impotence, frequent urination.
• Lowers blood pressure: for hypertension, dizziness, lightheadedness from liver Yang rising.
• Compared to Xu duan, Du zhong is more effective when the problem is due primarily to deficiency, while Xu duan is used more to treat lower back pain with significant aspects of both wind-damp and kidney deficiency.
• Fry in salt water to increase kidney-tonification properties.
Hsu: Hypotensive – the fried herb is more potent, and the decoction is better than the tincture.
• Analgesic.
• Can decrease absorption of cholesterol.
DY: Secures the Chong Mai.
• The major herb to treat lumbar pain. Can be used for all types – excess or deficiency, hot or cold – when combined appropriately with other herbs.
• With Xu duan for mutual reinforcement, to supplement the liver and kidneys, strengthen the sinews and bones, stop metrorraghia during pregnancy, and quiet the fetus. For indication such as:
- 1. Aches and pains, stiffness, lumbar pain, and weakness of the lower limbs due to kidney-liver deficiency. (Du Zhong Wan) Salt mix-fry both herbs.
- 2. Knee and lumbar pain due to wind-dampness.
- 3. Metrorrhagia during pregnancy and threatened miscarriage accompanied by lumbar pains due to kidney deficiency. (Salt mix-fry both herbs.)
- 4. Traumatic lumbar pain. (Qian Jin Bao Yun Dan) Use salt mix-fried Du zhong and wine mix-fried Xu duan.
Du zhong is more powerful than Xu duan at supplementing the liver and kidneys, strengthening the sinews, bones, and lumbar area. But Xu duan promotes circulation within the vessels, dispels blood stasis, and knits together fractured bones and torn ligaments.

Dose: 6-15g

E Guan Shi – Tubular Stalactite tip – “Goose Neck Stone”

Nature: sweet, warm

Enters: Lung

Actions: Strengthens Yang; transforms phlegm; descends Qi; benefits Qi; promotes lactation.

Indications:
• Yang deficiency with phlegm: cough and wheezing, emphysema.
• Insufficient lactation.
• Doctrine of signatures: its ability to direct Qi downward is indicated by its consistent downward growth.
• Crush or powder before use.
• Excessive or prolonged use can stagnate stomach Qi.
• Bensky/Gamble: In most cases this herb is fossilized Balanophylla species (coral).
• Contraindicated in cases of wheezing with blood.
• Cook 30 minutes longer than other herbs.

Dose: 9-30g

Ge Jie – Gecko

Nature: salty, neutral

Enters: Kidney, Lung

Actions: Tonifies Lung Qi and kidney Yang; nourishes Jing and blood.

Indications:
• Lung Qi deficiency: cough.
• Kidney Yang deficiency (fails to grasp the Lung Qi): asthma.
• Also for a combination of the two above syndromes, and consumptive cough, blood streaked sputum.
• Kidney Yang deficiency: impotence, daybreak diarrhea, frequent urination.
• Often made into a tonic wine – commonly using one male and one female gecko.
• The tail is considered the most effective part.
• The head and feet are usually not used in decoctions.
Joe Coletto: May counteract the destructive effect of steroids on the adrenals.
Dose: 3-7g directly as powder or 9-15g in decoction

Gou Ji – Cibotium rhizome – “Dog Spine”

Nature: bitter, sweet, warm

Enters: Kidney, Liver

Actions: Tonifies the liver and kidneys; strengthens the lumbar region and knees, sinews and bones; eliminates wind-damp; stabilizes the kidneys.

Indications:
• Liver and kidney deficiency: stiffness, soreness, weakness of the knees, feet, lower back, spine, and lower extremities.
• Wind-cold-damp obstruction: pain, soreness, numbness; also swelling of the legs.
• Kidney deficiency: urinary incontinence, vaginal discharge.
• Similar to Du zhong, but milder to tonify the kidneys and liver.
• Compared to Ba ji tian, this herb is drier.

Dose: 4.5-15g

Gu Sui Bu – Drynaria rhizome – “Mender of Shattered Bones”

Nature: bitter, warm

Enters: Kidney, Liver

Actions: Promotes bone and sinew regeneration; promotes blood circulation; tonifies the kidneys; stop bleeding; stimulates hair growth.

Indications:
• Kidney deficiency: lumbar pain, weak feet, lumbar region, knees, tinnitus, poor hearing, toothache, bleeding gums, chronic diarrhea.
• Traumatic injury: falls, fractures, contusions, sprains. Especially good for ligamentous injuries and simple fractures (use internally and externally). Also used to help regain strength during the convalescent phase following injuries.
• Topical (tincture): for hair loss/alopecia, corns, warts (soak 100g herb in 1 L white rice wine for at least a week).
• Stronger than Xu duan at promoting blood circulation, but weaker at tonifying the liver and kidneys.
• Treats adverse effects of streptomycin in patients with a sensitivity to it: headache, dizziness, numbness of the tongue, tinnitus, hearing loss.

Dose: 6-18g

Hu Lu Ba – Fenugreek seed – Trigonella

Nature: bitter, warm

Enters: Kidney, Liver

Actions: Warms the kidneys; disperses damp and cold, alleviates pain; increases lactation.

Indications:
• Kidney Yang deficiency with cold accumulation or stagnation Qi: abdominal or flank distention and pain or hernial disorders.
• Cold-damp leg qi: soreness, numbness, weakness, edema.
• Prevents and treats mountain sickness (in studies, was effective in about 1/3 of the subjects).
• May be useful in some forms of insomnia.
• Lowers blood sugar.
K&R: Hypoglycemiant, adrenal cortex stimulant, digestive tonic, lymphatic detergent, improves digestive absorption, eliminates intestinal mucus.
• Earth deficiency, metal deficiency.
Earth: digestive aid, hypoglycemiant, good for emaciation.
Metal: neuromuscular stimulant, good for emaciation (including diabetic), malnutrition, anemia, frigidity, impotence.
Water: impotence, frigidity, lumbar pain, dysmenorrhea.
• Opera singers used for centuries to clear excess phlegm from the throat.
• Claimed equal to quinine in preventing fever.
• Topical: for cellulitis.
• Chronic prostatitis, impotence.
BII: May lower blood lipids (LDL, VLDL and trigylcerides): atherosclerosis.
• Diabetes: may improve glucose tolerance.
Yoga: Methi: bitter, pungent, sweet/heating/pungent; V, K-; P+
• Stimulant, tonic, expectorant, rejuvenative, aphrodisiac, diuretic.
• Hypo-function of the liver, seminal debility, dysentery, dyspepsia, chronic cough, allergies, bronchitis, flu, convalescence, dropsy, toothache, neurasthenia, sciatica, arthritis.
• Take gruel to improve lactation milk flow and hair growth.
• Use paste for boils, ulcers, non-healing sores.
• Caution in pregnancy.
PCBDP: Trigonelline significantly inhibits liver carcinoma in mice, is used in China for cervical cancer.

Dose: 3-9g

Hu Tao Ren – Hu Tao Rou – Walnut (nut) – “Barbarian Peach Pit”

Nature: sweet, warm

Enters: Kidney, Large Intestine, Lung

Actions: Tonifies kidney Qi, strengthens the back and knees; warms the Lungs, tonifies Lung Qi; helps the kidneys grasp the Lung Qi; moistens the large intestine, unblocks the bowels.

Indications:
• Kidney Yang deficiency: weak, cold, painful lumbar region, feet, knees, frequent urination.
• Lung cold and Qi deficiency: cough, asthma.
• Lung and kidney deficiency: wheezing.
• Large intestine dryness: constipation, especially in the elderly or that from injured fluids following a febrile disease.
• Also used to dissolve/expel urinary stones.
• Use as a paste for contact, seborrheic, and atopic dermatitis.
• Its function to tonify Yang is very mild.
• The skin of the nutmeat is astringent. Eat this in order to help the kidneys grasp the Lung Qi. To promote bowel movement, remove this skin.
Jin: Eat in pregnancy for constipation. Also helps the baby’s brain develop.
DY: Invigorates Yang; calms or levels asthma; warms and supplements the life gate.
• With Bu gu zhi to supplement metal and water, to effectively constrain the Lung Qi and promote the intake of Qi by the kidneys, stop cough, and calm asthma. For the following indications, salt-processed Bu gu zhi should be used:
- 1. Cough, dyspnea, and asthma due to kidney Yang deficiency.
- 2. Lumbago, impotence, seminal emission, constipation, frequent and abundant urination, and enuresis due to kidney Qi deficiency.

Dose: 9-30g (eaten)

Jiu Zi – Jiu Cai Zi – Allium seed – Chinese Leek seed

Nature: acrid, sweet, warm

Enters: Kidney, Liver

Actions: Tonifies kidney Yang; controls Jing; warms the stomach, stops vomiting.

Indications:
• Kidney Yang deficiency: impotence, weakness, cold and pain in lumbar and knee, urinary incontinence.
• Kidney Qi deficiency: seminal emission, frequent urination, copious leukorrhea.
• Stomach cold: vomiting.
• Must crush before use.

Dose: 3-9g (decoctions, pills, and powders)

Lu Rong – Velvet Deer Antler

Nature: sweet, salty, slightly warm

Enters: Kidney, Liver

Actions: Tonifies kidney Yang; slightly nourishes kidney Yin; nourishes Jing and blood, supports the brain; strengthens tendons and bones; tonifies the Du Mai (governing vessel); regulates the Chong Mai (penetrating vessel) and Ren Mai (conception vessel), and stabilizes the Dai Mai (girdle vessel).

Indications:
• Kidney Yang deficiency: intolerance to cold, cold extremities, impotence, seminal emission, infertility, frequent, clear urination, dizziness, sore and weak lumbar region and knees, fatigue, lightheadedness, tinnitus.
• Jing and blood deficiency: mental and physical retardation or deformity, weak tendons and bones, failure to thrive, learning disabilities, insufficient growth, Down’s syndrome, rickets – especially in children.
• Kidney Yang deficiency with cold in the Chong, Ren, and Dai Mai: copious leukorrhea, uterine bleeding, infertility with a cold womb.
• Qi and blood deficiency: chronic ulcerations or Yin-type boils (those that are concave, ooze a clear fluid, and do not heal).
• Diuretic.
• Doctrine of signatures: the antler is an extension of the deer’s Du Mai.
• It is important to start with a low dose and slowly increase it. If too much is taken at the beginning, the Yang can rise, leading to internal wind with dizziness and red eyes, or it can injure the Yin, leading to deficiency fire and even hemorrhage. In my experience, the most common side effect is an “edgy” feeling – irritable, or slightly physically overwhelmed, similar to having too much caffeine.
• Antler products are generally too valuable to cook. Take as powder or in wine.
• All antler products are contraindicated in cases of Yin deficiency heat.
• Contains pantocrinum: can regulate arrhythmias, improve poor circulation, increase work capacity, improve sleep and appetite, decrease rate of muscle fatigue.
MW: Lyme disease is caused by the same spirochete which lives on deer and stimulates their antlers to grow.
Hsu: Raises RBC count and hemoglobin, promotes growth and development, cardiotonic, increases uterine tonicity.
Weng Weiliang, et al: This TCM herb is indicated in the treatment of backache, impotence, emission, enuresis, sterility, aplastic anemia, senile osteoporosis, senile diarrhea, Raynaud’s disease, senile intractable cough and asthma, thromboangitis obliterans, lobular hyperplasia of mammary glands, etc.
• Lobular hyperplasia of mammary glands: Lu Jia San (experiential formula): lu jiao pian, chuan shan jia, 60g each; wang bu liu xing, sang leng, e zhu, 100g each; all the drugs were ground into fine powder. 9g, tid. 40 cases of lobular hyperplasia of mammary glands were treated with this method, after three months, 36 were effective.
• Hypothyroidism: Shen Lu tablet (experiential formula): lu jiao pian 4.5g, yin yang huo 30g, dang shen 12g, suo yang 12g, gou qi 9g. Each tablet contained 6g crude drugs, 5 tablets every time, three times daily, 3 months as a course of treatment. All the treated 32 cases were effective.
• Senile intractable cough and asthma: ma huang, 20g; bei xi xin, 10g, bai jie zi, gan di long, 15g each; lu jiao pian, wu wei zi, kuan dong hua, gan jiang, 10g each; dang shen, 24g, yin yang huo, 12g; shu di, 30g; rou gui, 5g. Modify the formula according to TCM differentiation, water decoction. 50 cases were treated and 48 were effective.
• Female low sexual function: Yi Shen Zhu Yang Tang (experimental formula): lu jiao shuang, 30g; shu di, shan yao, shan yu rou, gou qi, nu zhen zi, tu si zi, she chuang zi, yin yang huo, 15g; huang jing, gui ban jiao, 12g each; rou gui, 8g. With qi stagnation, add he huan pi 12g, xiang fu and chai hu 8g each; with Blood stasis, add dang gui, chuan xiong, and yi mu cao, 10g each. 1 dose every day, water decoction, 1 month as a course of treatment. 35 cases were treated, 33 were effective.
SD: Deer antler is a common ingredient in Chinese tonic preparations. It may be surprising, especially to the practitioner of Chinese medicine, to learn that New Zealand is the world’s largest producer of deer antler, followed closely by Australia and Canada (both increasing rapidly), and that Korea is probably the world’s largest user of antlers, with an apparently insatiable appetite for antlers of all species. China is also a major producer and consumer of deer antler products and appears to have the longest history of medicinal use of deer antler as well as production via deer farming.
The story of deer antler can be traced back to the first Chinese Materia Medica, Shennong Bencao Jing (ca. 100 A.D.), where it is described briefly (1). There is also reference to earlier use of deer antler in an archeological find (a set of silk scrolls named Wushier Bingfang, from a tomb dated 168 B.C.). However, use of antler appears to have been infrequent until the animals were raised on “deer farms” starting in the mid-16th Century in China (Ming Dynasty period). This is a time when several other cultivation and animal husbandry projects were established in support of medicine. Soon after, Wu Kun included a formula in his book Yi Fang Kao (Study of Prescriptions, 1584) that has inspired much work with the combination of deer antler and tortoise shell, two bone-like materials rich in gelatins. His formula is Gui Lu Erxian Jiao (gui = tortoise, lu = deer, erxian = two immortals; jiao = gelatin). The formula is made as a firm gelatin, using the following recipe (proportioned to the amount being made):
Deer antler (lujiao) 5,000 g
Tortoise plastron (guiban) 2,000 g
Lycium fruit (goujizi) 1,500 g
Ginseng (renshen) 500 g
This formula is said to replenish yin and essence, tonify qi, and strengthen yang. It is used for deficiency of kidney yin and yang, deficiency of blood and essence in the penetrating and conception vessels, with symptoms of weakness of the lower back and legs, impotence, blurred vision, etc. (2). The penetrating vessel, (chongmai), one of the extra meridians, is referred to as the “sea of blood.” The conception vessel (renmai), while sometimes associated with reproduction, is related to generation more broadly, including generation of blood. Tortoise shell and deer antler are said to nourish the marrow.
More importantly for the future of Chinese herb prescribing with deer antler, Zhang Jingyue described two important tonic formulas in pill form (presented in the book Jingyue Quanshu, 1624), one to emphasize tonification of kidney yang (said to nourish the right kidney), called Yougui Wan, and one to emphasize nourishing kidney yin (said to nourish the left kidney), called Zuogui Wan. Though prepared originally as pills (= wan), they were later commonly used as decoctions for replenishing the kidney (you = right; zuo = left; gui = replenish).
Both formulas contain deer antler gelatin derived from boiling the antler (described further below). Chinese doctors regard the whole antler as primarily a revitalizing yang tonic with some yin nourishing qualities, while the gelatin is considered to be a milder yang tonic, with greater emphasis on nourishing yin, in a manner similar to tortoise shell (which lacks yang tonic properties). Both of Zhang Jingyue’s formulas nourish the kidney yin and essence, and both nourish yang, but Yougui Wan also warms the kidney and invigorates yang. To further emphasize yang tonification, deer antler may be used in place of the gelatin in Yougui Wan.
Because of the rather late introduction of antler in standard traditional Chinese medicine formulations, this ingredient rarely appears in Japanese preparations. The last major influence on Kampo from China was Gong Tingxian (1522-1619) with his book Wanbing Huichun (1587). He did not emphasize kidney tonification strategies. As a result, the Kampo literature doesn’t reveal antler-based formulas.
During the Qing Dynasty (1644-1910), the use of ginseng and deer antler became quite popular as a method of therapy, sometimes referred to as warm tonification. The Qing Dynasty medical commentator Xu Dachun (1693-1773) complained about over-reliance on these remedies (3):
Those physicians who prefer to be fashionable use only rapidly supplementing acrid and hot substances, namely ginseng, aconite, dry ginger, red atractylodes, deer antler, and cooked rehmannia. And no matter whether a patient was harmed by cold, heat, or dampness, these physicians go back and forth between these few herbs to compose their prescriptions. Often enough, these herbs are contraindicated in the case of the illness to be treated, and every trial is bound to kill someone. Still, there is not the slightest self-reproach.
Well, this has its origin in the physicians of today who prefer to make lofty speeches to deceive the people. Also, people are pleased if one uses warm and supplementing herbs, and this applies, in particular, to the rich and noble. Those physicians who do not follow these preferences of their patients will not be able to continue their profession for long! Hence, people strive to achieve the best effects, but they cause only unending calamity.
The acrid herbs were dry ginger, aconite, and red atractylodes (which was used at that time as we now use white atractylodes), and all the herbs mentioned were warming, some of them considered hot (though today, all are classified as warm except dry ginger and raw aconite, but not processed aconite). These invigorating tonics were expected to cause people to feel an immediate response to the therapy-a stimulation of their basic energy-compared to the usual tonification approach which might require weeks of regular use of the herbs and a nearly imperceptible daily improvement. Some of these herbs, like ginseng and deer antler, were rare and costly, so the rich sought them out, figuring that they had unique access to important remedies. It is much the same today: many people seek quick fixes and may be drawn to the unusual costly herbs if they can afford them.
Xu argued that reliance on a few popular and quick acting agents tends to be contrary to the most widely accepted methodology, which is to perform differential diagnosis and then prescribe according to need, regardless of the ordinary nature of some herbs or their lack of contemporary popularity. Hence, these warm tonifying agents might be contraindicated in cases of heat syndrome, damp-heat, blood heat, stomach fire, phlegm-heat in the lungs, and yin deficiency leading to excess yang. There was much concern during his time about killing patients with wrong prescriptions. Working in the absence of modern medicine, the remedies were used for people with fatal diseases who would die if not cured, and who might be worsened by some of the therapies (for example, raw aconite could be quite toxic if not cooked properly in making a tea). These specific concerns aside, all of the herbs mentioned were recognized as valuable, so long as they were given according to need.
The use of deer antler continued through the Qing Dynasty at a modest level until the 20th century, when it became the subject of modern research methods. Both the Russians (who had been farming deer antler since the 1840s) and the Chinese started subjecting deer antler to analysis by scientific methods, though those methods were relatively crude. About the same time, patent medicine factories sprung up in China and helped fill the growing demand for tonics made with rare ingredients such as deer antler and ginseng. Chinese patent medicine factories now use more than 1,000 kg of deer antler each year. This increased interest and distribution, in turn, led to rapid build-up in the number and size of deer farms.
SPECIES OF DEER
Initially, antler was collected from several species of wild deer (animals of the Cervidae family). There are 45 species of deer in the world, divided into 17 genera; not all of them have antlers. Two species of deer have been the common source of domestic deer antler for Chinese medicine: Cervus nippon, the sika deer, and Cervus elaphus, the red deer.
The sika deer is an East Asian species, ranging from Vietnam to Taiwan in the south and from China to Korea and Japan in the north; there are about 13 different subspecies of this deer. The sika deer mainly lives in open woodlands and is typically a chestnut red to yellowish brown with white spots on the sides and a dark stripe extending from neck to tail. Sika deer have been introduced to New Zealand for deer farming to produce antlers, and have also been introduced into Europe.
The red deer originally ranged from Europe to Asia, and it has been introduced into New Zealand, Australia, Chile, and Argentina for the purpose of deer farming to produce antler. It has a glossy reddish brown color in summer (but in winter turns drab grey-brown). Red deer prefer open, grassy glades in the forest, but frequently use woody cover.
DEER FARMING
Deer farming has become a huge enterprise outside the Orient. The animal meat is used as food, and the antlers are usually exported to the Orient, though there is a new industry in making antler-based health products for domestic consumption in Canada and other countries. The table on the next page indicates the extent of deer farming (adapted from ref. 4).
In Korea, the biggest consumer nation for deer antler, data from the end of 1992 indicated that 143,000 deer were held in pens (about 20 deer each), producing about 100 tons of fresh antler, which yields about 30 tons of dried product (6). That same year, about three times as much was imported, mainly from New Zealand, Russia, and China. China later became an antler importer rather than exporter, except for finished medicinal preparations and small supplies sent to oversea Chinese pharmacies.
The primary material collected at the deer farms is called velvet. The term originally arose from the fine hairs on the antler, but is now used specifically to indicate the antler’s stage of growth: before it calcifies (ossifies). In nature, antlers will fall off after they have ossified; thus, collecting fallen antler doesn’t provide the desired “velvet.” The older material is still valued: it is boiled to yield deer antler gelatin (described below) and used for certain applications, such as dispersing swellings.
Deer velvet is removed while the deer is under local anesthetic (which is a new practice in China and is a mandated practice in other countries that developed deer antler farming more recently). The antlers then grow back. Alternatively, if the deer is killed for use as food, the antlers are removed afterward. The cut antlers are bathed in boiling water and air dried, and then further dried in the shade or by low temperature baking. The fine hairs may be removed before additional processing. A typical dried antler from the sika deer weighs about 150 grams.
ANTLER PREPARATIONS
Traditionally, deer antler is sliced very thinly or ground to powder. It is not commonly boiled in decoctions with herbs because the gelatins easily stick to the herb dregs or cooking pot, and so the loss of valuable material is considered too great. Therefore, the herb powder is usually taken separately.
To make gelatin, ossified antlers (which are less expensive than velvet) are boiled for several hours to release the gelatin (protein components) from the hard matrix. Then, the antler gelatin can be added to an herbal decoction after all the boiling is done and the dregs have been strained. Or, it too can be ground to powder, and consumed directly. After removing the gelatin from the antler, the residual hard antler material is dried and ground up to make lujiaoshuang (degelatinized deer antler), which is mostly used for topical applications (treating boils, eczema, and skin ulcers, serving as an astringent and aid to faster healing). It is also considered of some limited value as a kidney yang tonic if taken at high enough dosage.
Antler pills are a common patent medicine product; the antler is not used alone, but in various formulations. These include liquids in glass vials (ginseng-deer antler, similar to the ginseng-royal jelly product; there is a combination with ginseng, antler, and royal jelly); pills used as sexual tonics (antler combined with epimedium, cynomorium, ginseng, and lycium fruit); and general tonics (complex formulas with herbs for tonifying qi and yang, and nourishing yin and blood).
The thin slices are made by removing the outer, hairy portion of the antler, soaking the antler in hot alcohol to soften it, and then carefully slicing it to produce round wafers. The slices are best suited for soaking in wine to make a “tincture” of antler, sometimes referred to as pantocrin (or pantocrine), based on the Russian designation for the alcohol extract. Very thin slices (virtually clear) can be eaten directly.
ANTLER CONSTITUENTS
Antler is a simple extension of bone, so it has a calcium-phosphate matrix of hydroxyapatite, Ca10(PO4)6(OH)2, integrated with smaller amounts of calcium carbonate (CaCO3); its composition is similar to that of human bones. Thus, one of the therapeutic roles of taking deer antler is as a source of calcium to help prevent or treat osteoporosis, which is consistent with the traditional bone strengthening action of deer antler. An analysis of the ossified antler showed that 73% is hydroxyapatite and related mineral compounds, while 27% is organic materials (7). If consumed as a powder (rather than a decoction), a person taking 3 grams of deer antler (see dosage section, below) will get about 800 mg of calcium. Hydroxyapatite is considered one of the most efficiently absorbed forms of calcium available. In velvet, the hydroxyapatite is about 50% (8), so the calcium in 3 grams is about 600 mg.
Deer antler also has a substantial amount of gelatinous components, ones that have become widely publicized in recent years, though from other source materials: glucosamine sulfate, chondroitin sulfate (which is a polymer of glucosamine), and collagen. These compounds have been shown to benefit the joints in cases of osteoarthritis by providing substrate materials useful for regenerating the body’s connective tissues (collagens) found in joints and sinews. In addition, they may have some anti-inflammatory action, useful for arthritis and tendonitis. These actions of the gelatin portion support the traditional concept that antler benefits joints and ligaments. In a 3-gram dose of ossified deer antler powder, one will obtain about 750 mg of these substances, which is low compared to therapeutic amounts taken as supplements for osteoarthritis (about 1,500 mg/day); 3 grams of velvet antler will provide the desired 1,500 mg. If deer antler gelatin is consumed, there is an even higher proportion of these ingredients, though some of the components may be transformed during the prolonged boiling into less active forms, so the dosage of gelatin to use is higher than for antler velvet.
Recently, the traditional use of antler to nourish the bone marrow and blood has been validated by studies in which the active components responsible were identified: monoacetyldiglycerides (9, 10). These are small molecules that stimulate the marrow stem cells that produce blood cells (see illustration, next page; 11). Inhibition of hematopoiesis (blood cell production) occurs with several cancer drugs and with radiation therapy; some disease processes, such as myelodysplastic syndrome (MDS), involve progressive decline in stem cell activity with undetermined causes. If further research confirms the therapeutic importance of the monoacetyldiglycerides, they can be synthesized in large quantity. In the meantime, deer antler is the main therapeutic source for them (the amount present in antler has not been quantified).
Deer antler also has essential fatty acids, making up about 2.5% of the velvet antler (not enough to be clinically active) and insulin-dependent growth factor (for which it is not known whether there is any clinical effect). Other organic compounds have been detected, but in miniscule amounts.
DOSAGE
The velvet antler in powdered form is typically used in dosages of 1-3 grams/day. Less than 3 grams may be a low dosage for promoting bone marrow function; the dosage levels traditionally indicated may reflect the rarity and expense of the antler (which is now partly alleviated by the increase in deer farming, but velvet is still relatively costly). The 3-gram dosage is probably essential for hematopoietic effect and for benefiting joints and tendons. Antler gelatin, because it is obtained from older antler material, is relatively inexpensive, is milder, and is used in larger quantities, 6-9 grams. Degelatinized antler is consumed in dosages of 6-9 grams, or more.
TRADITIONAL MEDICINE COMMENTARIES
The book Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude (12) provides these insights:
Lurong (velvet deer antler): Warm in nature and sweet and salty in flavor, lurong supplements kidney yang, strengthens sinew and bone, boosts sinew and marrow, and nourishes the blood. It is used for patterns of vacuity detriment, such a kidney deficiency and cold limbs, soreness of the limbs, dizzy head and blurred vision, seminal emission, and impotence.
Lujiao (ossified deer antler): Salty in flavor and warm in nature, lujiao supplements kidney yang and boosts essence and blood. It is similar in action to, and can substitute for, lurong, but it is less effective.
Lujiaojiao (deer antler gelatin): Sweet in flavor and warm in nature, lujiaojiao warms and supplements the kidney, supplements yang within yin, frees the blood of the thoroughfare vessel (chongmai), engenders essence and blood, and stanches flooding (excessive uterine bleeding)….It is mostly used for flooding and spotting, vaginal discharge, deficiency bleeding, and yin type flat-abscess (lumps that are not red, swollen, hot, or painful).
Comparisons: Lurong is commonly used as a drastic liver-kidney supplementing medicinal. It has greater supplementing power than lujiao. Lujiao, by contrast, has a moderate liver-kidney supplementing effect, but it quickens the blood, dissipates stasis, and disperses swelling and toxin with greater strength than lurong…. Used processed or as a glue (lujiaojiao), it tends to warm and supplement the liver and kidney, enrich and nourish essence-blood. Lujiaojiao is similar in action to lurong, but being slower to supplement, it must be taken over a long period of time to be effective. Lujiaoshuang, which is the dregs left after making lujiaojiao, is less warming and supplementing than either lujiao or lujiaojiao. Lujiaoshuang is used for spleen-stomach deficiency cold, low food intake, and sloppy stool, and it is also used as a substitute for lujiao and lujiaojiao, in which case the dosage must be increased.
The problem of “flooding” and spotting was described by Liu Yiren in his book Heart Transmission of Medicine (ca. 1850; 13):
The disease of flooding and leaking is due to detriment of the chong (penetrating) and ren (conception) vessels. The chongmai is the sea of blood of the twelve channels, and the renmai is the original qi of engenderment and nourishment. If these two vessels suffer detriment, the blood will consequently move frenetically. At its onset, this disease is categorized as repletion heat, requiring clearing heat. Later on, it is characterized as deficiency heat, requiring nourishing the blood and clearing heat. If it endures for many days, it is categorized as deficiency cold, requiring warming the channels and supplementing the blood.
Although antler wasn’t commonly used during Liu Yiren’s time, it would today be a primary choice for treating the deficiency cold syndrome that he described. Since bleeding is part of the syndrome, antler gelatin would be utilized, probably with tortoise shell.
The Advanced Textbook of Traditional Chinese Medicine and Pharmacology (14) notes the main uses for deer antler (lurong):
a) Chronic diseases marked by general lassitude and spiritlessness, lumbago, and cold limbs, polyuria with clear urine, impotence, spermatorrhea, and leukorrhagia with clear discharge, for which it is often used with cooked rehmannia, eucommia, and cistanche.
b) Infantile maldevelopment marked by weakness of the muscles and bones, incomplete closure of the fontanel, and retarded speech and movement, for which it is often combined with cooked rehmannia and cornus [it is sometimes added to Rehmannia Six Formula, which has these ingredients, and which was designed for promoting healthy growth of children who displayed slow development].
c) Chronic diseases with blood deficiency and liver and kidney deficiency, for which it is often used with ginseng, astragalus, cooked rehmannia, and tang-kuei.
d) Deficiency of the extra meridians (e.g., chongmai) with incessant uterine bleeding, for which it is often prescribed with gelatin, sepia bone, tang-kuei, and tortoise shell.
The effects of lujiao, lujiaojiao, and lujiaoshuang derived from the antlers are basically the same: warming and nourishing kidney yang. But, lujiao also activates blood circulation and relieves swelling, lujiaojiao is more effective for nourishing blood and checking bleeding, and lujiaoshuang possesses an astringent effect [e.g., for incontinence of urine, uterine bleeding, and leukorrhea].

Dose: 1-3g (take directly, divided into two or three doses over the course of the day)

Lu Jiao – 2-3 Year Old Deer Antler

Nature: salty, warm

Enters: Liver, Kidney

• Weaker than Lu rong to tonify, but also promotes blood circulation, reduces swelling.
• Good for kidney Yang deficiency with blood stagnation.
• Non-healing fractures.
• Toxic sores and swellings.
• Breast abscesses.
• Pain from blood stasis and deep pain in the lower back.

Dose: 5-10g

Lu Jiao Jiao – Gelatin Made from Mature Deer Antler (Lu Jiao)

Nature: sweet, salty, slightly warm

Enters: Kidney, Liver

Actions: Tonifies liver blood and kidney Jing; stops bleeding.

Indications:
• Kidney Yang deficiency: intolerance to cold, cold extremities, impotence, seminal emission, infertility, frequent urination, dizziness, weak lumbar region and knees, fatigue.
• Kidney Yang deficiency cold: hematemesis, epistaxis, hematuria, uterine bleeding.
• Non-healing Yin-type carbuncles.
• Do not cook – melt into a warm decoction or yellow wine.
• Can be combined with Chen pi to counteract its greasiness.
Li: Strong blood tonic, great for chemotherapy patients.

Dose: 6-12g

Rou Cong Rong – Cistanche stem – Broomrape

Nature: sweet, salty, warm

Enters: Kidney, Large Intestine

Actions: Tonifies kidney Yang; moistens the large intestine, promotes bowel movement; warms the womb.

Indications:
• Kidney Yang deficiency: impotence, infertility, weakness and cold pains in the lumbar region and knees, urinary incontinence, posturinary dripping, spermatorrhea.
• Large intestine dryness: constipation .
• Deficiency cold womb: infertility, excessive uterine bleeding, vaginal discharge.
• Stronger than Ba ji tian to tonify Jing and blood and to moisten the large intestine.
• Sticky, but not greasy – a large dose will not hurt the spleen.
• Tonifies the Yang yet is not drying; its effects are moderate.
• Treated with salt for frequent urination or spermatorrhea.
• Increases secretion of saliva.
• Currently in protected status. Becoming increasingly difficult to find in U.S.
Jin: Tonifies both the kidneys and spleen. Not drying like some other Yang tonics.
Hsu: Laxative, hypotensive.

Dose: 9-21g

Sha Yuan Ji Li – Sha Yuan Zi – Sha Ji Li – Astragalus seed

Nature: sweet, warm

Enters: Liver, Kidney

Actions: Tonifies kidney Yang; controls Jing; nourishes liver Yin to improve vision.

• Kidney Yang deficiency: lumbar pain, impotence, seminal emission, frequent urination, urinary incontinence, copious leukorrhea, premature ejaculation.
• Liver Yin (and kidney) deficiency: poor or blurry vision.
• Compared to Tu si zi, Sha yuan ji li focuses more on improving the vision, whereas Tu si zi focuses more on tonification.
Hsu: Antidiuretic, stimulates uterine contraction.
DY: Astringing (secures the essence); harmoniously supplements Yin and Yang.
• With Bai ji li to regulate upbearing and downbearing and the liver and kidneys. Together, they course the liver and rectify Qi, resolve depression and calm the liver. They harmoniously supplement the liver and kidneys – they enrich the kidneys and secure the essence, nourish the liver and brighten the eyes. For such indications as:
- 1. Vertigo, unclear vision due to liver and kidney deficiency. (Use salt mix-fried Bai ji li.)
- 2. Lumbar pain, seminal emission, premature ejaculation, frequent urination due to kidney deficiency. (Use salt mix-fried or stir-fried Sha yuan zi.)
- 3. Abnormal vaginal discharge due to kidney deficiency.

Dose: 6-15g

Suo Yang – Cynomorium stem – “Lock Yang”

Nature: sweet, warm

Enters: Liver, Kidney, Large Intestine

Actions: Tonifies kidney Yang; moistens the large intestine, promotes bowel movement; nourishes blood and Jing; strengthens the sinews.

Indications:
• Kidney Yang and Jing deficiency: infertility, impotence, spermatorrhea, weakness of the lumbar region and knees, weakness of the tendons and bones, frequent urination.
• Large intestine dryness (Qi and blood deficiency): constipation.
• Jing and blood deficiency: weakness of the sinews, motor impairment, paralysis, muscular atrophy.
• Doctrine of signatures: for impotence – see morphology of the stem.
• Stronger than Rou cong rong at tonifying kidney Yang, but weaker at moistening the large intestine and promoting bowel movement.
SD: Cynomorium is known in Chinese as suoyang, which is based on the herb’s medicinal effects, “locking the yang.” It is obtained mainly from the East Asian species, Cynomorium songaricum, though the similar C. coccineum is sometimes utilized as a substitute (and is used in other countries, from Europe to Central Asia, where it is the native species). The plant harvested for Chinese medicine grows at high altitude, mainly in Inner Mongolia, Qinghai, Gansu, and Tibet. It is used to tonify the yang (treat impotence and backache), strengthen the tendons, and nourish the blood to alleviate the blood-deficiency type of constipation (typically occurring with old age).
The value of cynomorium was depicted similarly in many cultures. In 16th century Europe, it was known as the Maltese mushroom, though it is not a true fungus. The plant was so highly regarded that the Knights of Malta often sent samples of it to European monarchs as presents. To protect the so-called Fungus Rock, where cynomorium was abundant, the grandmaster posted guards around the area and ordered the sides of the outcropping to be rendered smooth to eliminate any footholds and prevent access from the sea. The rock, rising to a sheer height of 60 meters (200 feet) from the rough sea, became virtually inaccessible. As an explanation of its uses by the doctrine of signatures, since the plant appears reddish-brown, and becomes darker upon drying, herbalists thought it would be useful to treat ailments of the blood. On top of that, the phallic shape indicated the plant could also be used to treat sexual problems. The dried spikes were used by the Crusader Knights after their battles to recover strength. In Saudi Arabia, the plant is called tarthuth, and is recognized to have the same properties mentioned above, as well as many others, including treatment of digestive disorders and ulcers (see Appendix for story).
Cynomorium is parasitic on the roots of salt-tolerant plants, mainly species of Atriplex, the “saltbushes” (for C. coccineum) and on Nitraria sibirica (for C. songaricum). The plant has no chlorophyll; the fleshy red stems or spikes have tiny scarlet flowers. Its active constituents have not been fully analyzed, but cynomorium is known to contain anthocyanic glycosides, triterpene saponins, and lignans. Pharmacology experiments are in the early stage, with attempts to demonstrate a hormonal effect that would explain its use in impotence (its current main application in commercial products), as well as findings that the herb extracts inhibits HIV, lower blood pressure, and improve blood flow in laboratory experiments.
Cynomorium, which has a pleasant, sweet taste when raw, has long been known as a “famine food,” that is, something not frequently eaten, but nourishing enough to help people survive when the standard foods are insufficient. In fact, a city in China is named for cynomorium because of this benefit. The city is near Anxi (in today’s Gansu Province), which lies at the center of the ancient Silk Road, and was long considered as the key to the West. During the Tang Dynasty, Anxi was established as a military base to gain control over Middle Asia. About 40 miles away was an old Han Dynasty town called Kugucheng, also of strategic military importance. Numerous walls and gates were set up to form a line of defense. During the Tang dynasty, the famous general Xue Rengui and his army were besieged in the Anxi area while on the way to conquer the West. The soldiers had used up all their supplies and they had no hope of assistance. Yet, they were able to survive by eating suoyang, and after that the city was renamed as Suoyang.
Cynomorium didn’t enter into the Materia Medica until Zhu Danxi of the Yuan Dynasty period mentioned it in his Bencao Yanyi Buyi (Supplement and Expansion of Materia Medica, 1347). The Yuan Dynasty, which was the time of Mongolian rule, introduced several plants from the Mongolian area, including this one. Zhu Danxi also offered a formula with cynomorium that became quite famous, Huqian Wan (Hidden Tiger Pills), used for impotence and/or for weakness and atrophy of the legs. The formula is named for the tiger in crouched position, ready to spring. In order to attain that position (which is also replicated in Gong Fu with the “crouching tiger” technique), one must have great strength in the tendons, ligaments, and muscles of the legs. This strengthening is sometimes referred to as “hardening” of yin (substance of the body); but that doesn’t necessarily indicate lack of flexibility. The weak leg disorders were first described in the Neijing Suwen (ca. 100 A.D.), in the chapter on wei syndrome, which is translated as atrophy or wilting syndrome. There were five types of atrophy listed, associated with each of the five organs. The disorder was thought to derive from heat or damp-heat damaging the yin.
Huqian Wan is comprised of anemarrhena, phellodendron, cooked rehmannia, tortoise shell, tiger’s bone (no longer used), peony, citrus, and dry ginger; sometimes cistanche (another parasitic desert plant) is added. The formula was recently described by Kong Lingqi (Resolutely Upholding the Concept of Hardening the Kidneys Method, by Kong Lingqi, Sichuan Chinese Medicine, 1998 (6): 8-9, translated by Bob Flaws, and edited here):
The Suwen chapter titled Treatise on Wilting says, ‘The ancestral sinews rule the binding of the bones and the disinhibition of the joints.’ If damp heat invades and assails the muscles and flesh and sinews and bones, the qi and blood will not move. The sinews will become slack and not pulled together and, hence, will be useless. If severe, the liver and kidneys will become debilitated and consumed and the ancestral sinews will cease their duty. Master Ye Tianshi, in his Guide to Clinical Conditions & Case Histories chapter titled Vacuity Taxation highly praised Zhu Danxi’s Huqian Wan for their effect of subduing yang and hardening yin. These pills use phellodendron and anemarrhena’s bitterness to harden yin. This causes the source to be cleared and flow to be cleaned. Atractylodes (cangzhu) and coix (yiyiren) dispel dampness. Cistanche (roucongrong), cynomorium (suoyang), achyranthes (niuxi), and tiger bone (hugu) strengthen the sinews and bones. Peony (baishao) and chaenomeles (mugua) emolliate the sinews and relax tension. Cooked rehmannia (shudi) and tortoise shell (guiban) enrich yin and boost the marrow. Thus damp heat is discharged and transformed, yin essence is subdued and astringed, the ancestral sinews are hardened and strengthened, and the feet are able to walk.
Because of these uses, the formula has been suggested by Chinese clinicians as a possible therapy for paralytic disorders, such as multiple sclerosis and ALS.

Dose: 4.5-15g

Tu Si Zi – Cuscuta seed – Chinese Dodder

Nature: sweet, acrid, neutral

Enters: Liver, Kidney

Actions: Tonifies kidney Yang; mildly nourishes kidney Yin; controls Jing and urine; improves vision; tonifies spleen Qi to stop diarrhea; calms the fetus.

Indications:
• Kidney Yang deficiency: impotence, frequent urination, tinnitus, copious leukorrhea, weak and sore lumbar region and knees, nocturnal emission without dreams.
• Liver and kidney Yin deficiency: blurry vision, seeing spots, dizziness, tinnitus.
• Habitual or threatened miscarriage.
• Spleen Qi deficiency (with concurrent kidney deficiency): diarrhea or loose stools, poor appetite.
• Do not count on this herb for tonification of spleen Qi – use it when there is also kidney Yang/Qi deficiency.
• Compared to Sha yuan ji li, Tu si zi focuses more on tonification, whereas Sha yuan ji li focuses more on improving the vision.
• Because this herb is a parasite of some agricultural crops, it must usually be sterilized before entry into the United States.
MLT: A tonic specific for low sperm count and inactivity of sperm.
Hsu: Cardiotonic, hypotensive, stimulates the uterus, decreases the size of the spleen, inhibits intestinal activity.

Dose: 9-15g

Xian Mao – Curculigo rhizome – Golden eye-grass – “Immortal Grass”

Nature: acrid, slightly toxic, hot

Enters: Liver, Kidney

Actions: Tonifies kidney Yang – can reach and tonify the Ming Men; eliminates cold and damp.

Indications:
• Kidney Yang deficiency: impotence, nocturnal emission, urinary incontinence, cold in the chest and abdomen, infertility from cold Jing or cold womb.
• Cold-damp Bi: cold and pain in the lumbar region, knees, abdomen, a sense of weakness in the bones and sinews.
• Especially useful for cold abdominal or lower back pain.
• Often taken soaked in wine by itself.
• Compared to Ba ji tian and Yin yang huo, Xian mao is stronger and harsher. It should not be taken long term.
• Toxic reactions, such as swelling of the tongue, can occur. This can be alleviated with a decoction of Da huang, Huang lian, and Huang qin.
MLT: For menopausal symptoms from deficiency of both Yin and Yang.
• Use as an alternative to Fu zi and Rou gui when they would be too heating and stimulating.

Dose: 3-10g (10g for impotence)

Xu Duan – Dipsacus – Teasel root – “Restore What is Broken”

Nature: bitter, sweet, acrid, slightly warm

Enters: Liver, Kidney

Actions: Promotes tendon and bone regeneration, generates flesh; tonifies the liver and kidneys; promotes blood circulation, alleviates pain; stops uterine bleeding; calms the fetus.

Indications:
• Liver and kidney deficiency: weak lumbar region, knees and legs, stiff joints, seminal emission, uterine bleeding, threatened miscarriage with bleeding, restless fetus.
• Topical or internal: for trauma, sores, pain, swelling, Bi syndrome (especially of the lumbar region and limbs).
• Given its ability to control excessive menstrual bleeding, its Yang nature, and its ability to support a fetus, Kou believe this herb has a progesterone-supporting effect and in high doses (30-60g), he says it effectively treats estrogen dominance.
• Tonifies without causing stagnation.
• Much milder than Du zhong at tonifying the liver and kidneys.
• Compared to Du zhong, Xu duan is used more to treat lower back pain with significant aspects of both wind-damp and kidney deficiency, while Du zhong is more effective when the problem is due primarily to deficiency.
• Fry in vinegar to enhance its ability to promote blood circulation and alleviate pain.
• Roasting with salt facilitates its entry into the kidney channel.
• Dry-fry or char for excessive uterine bleeding.
• Powder for topical application.
Hsu: Induces eruption of pus, stops bleeding, promotes tissue regeneration, analgesic effect on patients with carbuncle dermatosis.
DY: Stops metrorrhagia during pregnancy.
• With Du zhong for mutual reinforcement, to supplement the liver and kidneys, strengthen the sinews and bones, stop metrorrhagia during pregnancy, and quiet the fetus. For specific indications and notes, See Du zhong in this category.
MW: For torn, stretched or wrenched joints, especially in large people who throw joints out with force. Chronic muscle inflammation, limitation of movement, great pain. Widespread arthritis, stiffness, incapacitation.
• Nerve irritation, sciatica.
• Intermittent fever.
• Regarding its literal translation, “restore what is broken,” it can be used for anything “broken” in one’s life, so that a part of one’s path cannot become manifest. “For people who had a use but lost it.” Helplessness, loss of purpose.
• Powerful remedy for Lyme disease (“deer syphilis”) and Lyme-like diseases. Deer appreciate this plant for relieving a disease they carry the vector for.
• MW dosing: 1-3 drops tincture 1-3 times daily. If this produces an aggravation, the dose may be lessened. Caution: may cause a healing crisis first (perhaps syphilis-like, genital rash, etc.).
• Doctrine of signatures: The thorny stalks are a signature for tension and nerve irritation. The tall, hard stalks which remain strong through the winter seem to indicate an affinity for the bones. At intervals along the stem the opposite leaves merge to form a cup which holds water after a rain – a remedy for joints and the kidney essence.

Dose: 6-30g

Yang Qi Shi – Actinolite – “Stone for Raising the Yang”

Nature: salty, slightly warm

Enters: Kidney

Actions: Tonifies kidney Yang; warms the womb.

Indications:
• Kidney Yang deficiency: impotence, infertility, spermatorrhea, premature ejaculation, cold, soreness, weakness and pain in the lumbar region and knees.
• Cold womb: infertility, uterine bleeding.
• Increases female libido.
• Not for long term use.
• Contains oxides of iron, calcium, and magnesium, plus about 50% silica.
• Usually calcined.

Dose: 3-9g

Yi Zhi Ren – Black Cardamom – Alpinia oxyphylla – Bitter-seeded Cardamom – “Benefit Intelligence Nut”

Nature: acrid, warm

Enters: Spleen, Kidney

Actions: Warms the spleen, stops diarrhea, promotes food intake for the stomach; controls saliva (spleen and kidney Qi); warms the kidneys to control urine and Jing.

Indications:
• Spleen and kidney cold and Yang deficiency: vomiting, diarrhea, abdominal pain.
• Middle Jiao Qi deficiency: poor appetite, copious saliva (not for excess salivation due to heat forcing out fluid).
• Kidney Yang deficiency: seminal emission, frequent and copious urination, urinary incontinence, dribbling.
• Cold entering the spleen and kidneys: abdominal pain, vomiting, diarrhea.
• Excessive saliva and thick, unpleasant taste in the mouth: Yi zhi ren is better for cold conditions while Pei lan is better for hot conditions.
Yi zhi ren’s spleen-warming properties are more pronounced than its kidney-tonifying qualities. The opposite is the case with Bu gu zhi.
• Crush before use.
Hsu: Stomachic, antidiuretic, inhibits salivation.
DY: With Fu ling to fortify the spleen, secure the kidneys, reduce urination, and stop diarrhea. For indications such as:
- 1. Strangury with chyluria, milky, turbid urine, and dysuria due to deficiency cold in the kidneys or kidney Qi not securing with imbalance in the function of transformation of the bladder. (Use salt mix-fried Yi zhi ren)
- 2. Diarrhea due to deficiency cold of the spleen and kidneys. Particularly watery diarrhea. Use Yi zhi ren which has been stir-fried until scorched.

Dose: 3-9g

Yin Yang Huo – Xian Ling Pi – Epimedium – “Horny Goat Weed”

Nature: acrid, sweet, warm

Enters: Liver, Kidney, (Hong Jin: Spleen)

Actions: Tonifies kidney Yang; eliminates wind-damp; tonifies Yin and Yang to harness rising liver Yang.

Indications:
• Kidney Yang deficiency: impotence, seminal emission, frequent urination, forgetfulness, withdrawal, weak, painful, cold lumbar region and knees.
• Wind-cold-damp: pain or numbness in the limbs, spasms or cramps in the hands and feet, joint pain.
• Liver/kidney deficiency with subsequent liver Yang rising: low back pain, dizziness, menstrual irregularity.
• Sexual effects: increases sexual activity, sperm production, desire; androgen-like effects on testes, prostate and levator ani.
• May possess expectorant and antitussive qualities.
• Watch out for arisal of heat symptoms from use of this herb – contraindicated with Yin deficiency heat. Very drying.
• Particularly useful for Bi syndrome in patients with waning Ming Men fire.
• Often steeped in wine for kidney Yang deficiency or painful obstruction.
Jin: Also warms spleen Yang.
Hsu: Aphrodisiac (stimulates secretion of semen, indirectly promoting sexual desire).
• Hypotensive – dilates peripheral blood vessels, inhibits vasomotor center in the brain.
• Antitussive, expectorant, anti-asthmatic effects.
• Small doses are diuretic, large doses are antidiuretic.

Dose: 6-15g

Notes on This Category

These herbs are commonly combined with:
A. Blood tonics, because blood is the mother of Qi.
B. Herbs that promote Qi circulation – for when there is stagnation (which may be due to Qi deficiency) and also to prevent stagnation as a result of ingestion of these rich herbs.

Bai Zhu – White Atractylodes rhizome

Nature: bitter, sweet, warm

Enters: Spleen, Stomach

Actions: Tonifies spleen Qi; dries dampness; promotes urination; stabilizes the exterior, stops sweating; calms the fetus; resolves water retention and phlegm.

Indications:
• Spleen (or stomach) Qi deficiency with dampness: diarrhea, fatigue, distention in the epigastric region and abdomen, poor appetite, vomiting, constipation.
• Failure of the spleen to transform and transport food: retention of water and dampness: edema, cough, difficult breathing, nausea, vomiting, dizziness, reduced urination.
• Auxiliary herb for damp Bi syndrome.
• Spleen Qi deficiency leading to failure of the Wei Qi to control the pores: spontaneous sweating.
• Spleen Qi deficiency: threat of miscarriage.
• For constipation due to spleen Q deficiency and dampness, use 30g Bai zhu alone.
• Elevates prothrombin time.
• Use raw to dry dampness and promote urination.
• Dry-fry to strengthen the spleen and tonify Qi.
• Scorch to strengthen the spleen and stop diarrhea.
Li: Very warm and dry.
PFGC: Increases the appetite, enhances processing of ingested food.
• Best herb for tonifying spleen Qi (Yang).
• Controls excessive sweating due to spleen dampness.
• Can stimulate sweating because a strong spleen will facilitate sweating if there is a need for it.
• All disorders involving water accumulation and dampness will resolve when the spleen is built up.
Bai zhu should not be used in excessive cold-damp when water pathogens drown the entire central region of the body (must tonify kidney Yang).
• Unprocessed, it can disperse blood between the lumbar region and umbilicus that runs disorderly in the vessels and causes Qi counterflow and internal distress.
• Treats weakness or pain in the extremities caused by a dilapidated spleen.
• With rising and dispersing herbs, it can regulate the liver.
• With sedating herbs, it can nourish the heart.
• With cooling, moistening herbs, it can tonify the Lungs.
• With herbs that moisten Yin, it can tonify the kidney system.
DY: Disperses swelling.
Bai zhu is incompatible with black carp, peaches, plums, coriander, and Chinese cabbage.
• To fortify the spleen and supplement the Qi, bran stir-fried Bai zhu is prescribed. To dry dampness and disinhibit urination, unccoked Bai zhu is used.
• With Fu ling, the two herbs reinforce each other to effectively supplement the spleen and dry dampness, percolate dampness, and disinhibit urination. For such indications as:
- 1. Edema due to accumulation of dampness, due in turn to spleen deficiency. (Bai Zhu San)
- 2. Fatigue, weakness in the limbs, lack of appetite, loose stools or diarrhea caused by spleen deficiency with accumulation of dampness. (Shen Ling Bai Zhu San)
- 3. Vertigo, blurred vision, and/or heart palpitations due to phlegm-dampness. (Ling Gui Zhu Gan Tang)
- 4. Chronic cough due to phlegm-dampness and spleen deficiency. (Liu Jun Zi Tang)
• With Huang qin to clear heat stirring the fetus, dry dampness, and fortify the spleen to contain the blood and the fetus. For uterine bleeding during pregnancy, threatened miscarriage, nausea and vomiting during pregnancy caused by heat or damp-heat associated with spleen deficiency which is incapable of containing the blood within the vessels. For these indications, the Bai zhu should be bran stir-fried, and the Huang qin should be stir-fried until scorched.
• With Zhi shi to supplement without producing stagnation and drain without damaging the correct Qi, to fortify the spleen, disperse food stagnation, and effectively eliminate accumulations and distention. For the following indications, except as otherwise indicated, the two herbs should be stir-fried:
- 1. Accumulation of food, distention and fullness of the abdomen and epigastrium, and difficult bowel movements due to spleen Qi deficiency and Qi stagnation. (Zhi Zhu Wan) When the patient’s main complaint is abdominal and epigastric distention due to Qi deficiency and spleen deficiency with or without dampness, the dosage for Bai zhu should be very high – as much as 100g per day. In this case Bai zhu is generally used alone.
- 2. Splenomegaly and hepatomegaly due to Qi deficiency and stagnation.
- 3. Ptosis of the organs (stomach, uterus, and anus) due to central Qi deficiency. For these indications, honey mix-fried Huang qi, stir-fried Chai hu, and honey mix-fried Sheng ma should be added.
Dong bai zhu is Bai zhu harvested in the winter. Instead of having a drying nature, it has a moistening one. It fortifies spleen Yang and nourishes spleen Yin, moistens the intestines, and treats constipation.
Hsu: Pronounced and long-lasting diuretic effect; sedative; lowers blood sugar; stomachic.

Dose: 4.5-9g

Bian Dou – Bai Bian Dou – Dolichos – Hyacinth bean – Lablab album – “Flat Bean”

Nature: sweet, slightly warm

Enters: Spleen, Stomach

Actions: Resolves dampness; clears summer-heat; mildly tonifies spleen Qi.

Indications:
• Spleen Qi deficiency: loose stool or diarrhea, poor appetite, fatigue, copious leukorrhea, loud stomach growling.
• Summer-heat: especially with vomiting, diarrhea.
• Can tonify spleen Qi without blocking the Qi.
• Can resolve damp without damaging Yin.
• Use dry-fried to strengthen the spleen, untreated to clear summer-heat.
• Some say this herb can nourish spleen Yin.
• Bensky/Gamble: clear summer-heat category.
MLT: Must be cooked – uncooked, it can inhibit the enzymes trypsin and amylase (this effect is significantly but not completely resolved by cooking).
• Eat 50g boiled each day for gastroenteritis.

Dose: 9-21g

Ci Wu Jia – Eleutherococcus senticosus root – “Siberian Ginseng”

Nature: sweet, slightly bitter, warm

Enters: Spleen, Lung, Heart, Kidney

Actions: Tonifies Spleen, Lung, and Kidney Qi; quiets the Shen.

Indications:

• Qi deficiency: fatigue
• Generally indicated for any pain.
• Our understanding of this herb (as discriminated from Wu jia pi) is fairly modern, and largely informed by the Russian research into and use of the herb.
Eric Brand: from this Blue Poppy blog, citing his own Concise Chinese Materia Medica (with Nigel Wiseman)
Boosts qì and fortifies the spleen: Lung and spleen qì vacuity.
Cì w? ji? treats simple patterns of spleen qì vacuity or lung qì vacuity. It not only supplements spleen qì and boosts lung qì, but also dispels phlegm and calms panting.
Dual vacuity of the lung and spleen, manifesting in fatigue and lack of strength, poor appetite, and enduring cough or vacuity panting: Use alone or in combination with medicinals such as w? wèi z? (Schisandrae Fructus), tài z? sh?n (Pseudostellariae Radix), and bái gu? (Ginkgo Semen).
Supplements the kidney: Aching lumbus and knees in kidney vacuity. Cì w? ji? warms and assists yáng qì while strengthening sinew and bone.
Aching lumbus and knees due to insufficiency of kidney yáng depriving the sinews and bones of nourishment: Use alone or in conjunction with medicinals such as dù zhòng (Eucommiae Cortex) and s?ng jì sh?ng (Taxilli Herba).
Cì w? ji? is also used to treat impotence, slowness to walk in children, and wind-damp impediment (bì) patterns with concurrent liver-kidney vacuity.
Quiets the spirit: Heart and spleen insufficiency, manifesting in insomnia or forgetfulness.
Cì w? ji? supplements heart and spleen qì while quieting the spirit and sharpening the wits (improving mental faculties). It boosts qì to engender blood, and is indicated for insomnia or forgetfulness due to dual vacuity of the heart and spleen depriving the heart spirit of nourishment. For this purpose, combine it with medicinals such as hé sh?u w? (Polygoni Multiflori Radix), su?n z?o rén (Ziziphi Spinosi Semen), shí ch?ng pú (Acori Tatarinowii Rhizoma), and yu?n zhì (Polygalae Radix).
BII: Adaptogen: increases humans’ ability to withstand adverse physical conditions, increases mental alertness and work output, increases quality of work under stressful conditions, and improves athletic performance. Also has adaptogenic activity in disease states.
• Virtually nontoxic.
• Useful mainly in fatigue, depression, immunodepression.
PPP: Assists the body to counteract and adapt to stress of many origins; restores and strengthens the body’s immune response; increases vitality.
• Improves mental and physical performance.
• Used to minimize the effects of stress in those subject to chronic illness or to environmental or occupational stress: spares the adrenal glands, promotes self-repair mechanism to enhance resistance to radiation and chemical carcinogens. Compared to Ren shen, Ren shen confers a direct resistance to cells by altering cell physiology whereas the improved survival from eleutherococcus is via an indirect action on the whole organism.
• Used to improve performance and minimize the effects of stress in athletes. In studies, improved speed of runners, maximal work capacity of athletes, and enhanced muscle strength.
• Enhances immune function, especially natural killer cells and T-helper cells. Stimulates immunity against bacteria and viruses.
• May heighten protective activity of the anticoagulant system, improve repair of heart muscle. May provide greater oxygen metabolism and increase conversion of fat into glycogen for energy. May counter the effects of cerebral ischemia. Atherosclerotic patients and those with rheumatic heart lesions show an improvement in cardiovascular function and general well-being when taking eleutherococcus.
• Patients with chronic bronchitis, pneumoconiosis, and pneumonia show improved well-being and Lung capacity when taking eleutherococcus.
• Eleutherococcus lowers blood pressure in hypertension and raises low blood pressure (e.g. in hypotensive children).
• Cancer: Eleutherococcus enhances non-specific immunity and minimizes side effects from radiation, chemotherapy, and surgery, improves healing and well-being.
• Eleutherococcus has been found to inhibit spontaneous malignant tumors and tumors induced by a number of carcinogens. It also led to decreased transplantability of tumors in mice and inhibition of metastases in some cases. Components of eleutherococcus exert an antiproliferative action upon some cancer cells. Eleutherococcus potentiates the effect of some cytotoxic drugs, thereby reducing the amount of drug needed. Eleutherococcus lowered the occurrence of chromosomal mutations and increased the survival rate of plants exposed to mutagens.
• Convalescence after antibiotic therapy: Eleutherococcus has demonstrated a beneficial effect on antibiotic-induced diarrhea during convalescence.
• Adjuvant treatment in dysentery.
• Compared to Panax [true Ginseng]: Unlike ginseng, eleutherococcus rarely causes excitation or a stress-like syndrome in patients. Eleutherococcus has a more general effect on immunity than ginseng. Eleutherococcus causes a more profound increase in stamina than ginseng.
• Caution: sometimes species of Periploca – an inferior and toxic herb – are substituted for eleutherococcus.
• Recommended regime for healthy people is a course of 6 weeks followed by a 2 week break. For treatment of specific illnesses, continuous use is preferable.

 

Dose: 6-30g

Da Zao – Hong Zao – Jujube – Red Chinese Date – “Big Date”

Nature: sweet, warm

Enters: Spleen, Stomach

Actions: Tonifies spleen Qi; nourishes blood; calms the Shen; reduces herbs’ side effects (mild action), moderates and harmonizes the harsh properties of other herbs.

Indications:
• Spleen/stomach Qi deficiency: poor appetite, loose stool, fatigue, shortness of breath (good for children).
• Blood deficiency: mental depression.
• Restless organ disorder: wan appearance, irritability, severe emotional lability.
• Good for eruptions, hives, bleeding.
• Stronger than Gan cao to tonify Qi.
• Closely related to Suan zao ren.
• Seems to normalize the liver (enzymes, recovery from toxicity).
Hsu: Anti-ulcer activity.
DY: Harmonizes and protects the stomach.
• With Sheng jiang to move the defensive Qi, nourish the constructive Qi, harmonize the constructive and defensive, fortify the spleen, and harmonize the middle burner. For indications such as:
- 1. Perspiration, fear of wind, and fever due to disharmony between the constructive and defensive Qi. (Gui Zhi Tang)
- 2. Fatigue, lack of strength, abdominal pain, and lack of appetite due to disharmony between the constructive and defensive Qi. (Xiao Jian Zhong Tang)
- This pair helps insure the proper assimilation of the active principles of other medicinal substances. These are the two main harmonizing herbs in Chinese medicine.
• With Ting li zi to powerfully drain the Lungs, disinhibit urination, and drastically evacuate phlegm without damaging Yin or the stomach. Together, they downbear Qi and calm asthma. For indications such as asthma, cough with stertor, wheezing, a swollen face, and oliguria due to accumulation of phlegm in the Lungs. (Ting Li Da Zao Xie Fei Tang)
Da zao can be used as a harmonizing medicinal with herbs that are incompatible with Gan cao, such as Gan sui, Yuan hua, Da ji, and Hai zao, or in case of edema, anuria, or hypertension.
PCBDP: Emollient, sedative, antitussive, anti-allergic (increases cyclic AMP and GMP in leukocytes), nutritive; may inhibit anaphylaxis; in vitro anti-tumor activity.

Dose: 3-30g (3-12 dates)

Dang Shen – Codonopsis root – “Group Root”

Nature: sweet, neutral

Enters: Spleen, Lung

Actions: Tonifies Lung Qi; tonifies spleen/middle Jiao Qi; mildly nourishes body fluids; mildly nourishes blood.

Indications:
• Spleen Qi deficiency: fatigue, poor appetite, loose stool, lassitude, diarrhea, vomiting, weak limbs, chronic illness, prolapse of stomach, uterus, or rectum.
• Lung Qi deficiency: chronic, weak cough, shortness of breath, weak voice (also with copious sputum due to spleen Qi deficiency).
• Injury of body fluids and Qi in febrile disease: shortness of breath, thirst, wasting and thirsting disorder.
• Blood deficiency: dizziness, sallow face, palpitations.
• Pathogenic influences with significant concurrent Qi deficiency: combine Dang shen with herbs to release the exterior, drain damp, etc.
• Raises RBC count and hemoglobin.
Dang shen is similar to Ren shen, but not as strong. In most cases of Qi deficiency, it can be effectively substituted for Ren shen. In cases of deficiency of both spleen and Lung Qi, it is even preferred. However, Ren shen is imperative for collapsed Qi or devastated Yang. When replacing Ren shen with Dang shen, use about 3 times as much Dang shen as you would use of Ren shen.
• Compared to Yi tang, Dang shen is indicated for deficiency-induced cough with profuse sputum, while Yi tang is more for a non-productive deficiency-induced cough.
• Heiner Fruehauf believes this herb is what was historically used as Ren shen (not ginseng).
• Heiner Fruehauf believes this herb has some potential to exacerbate Gu parasite infections. If the Gu symptoms worsen after administering Dang shen, consider it as a possible cause.
Hsu: Hypotensive; dilates peripheral blood vessels; inhibits adrenal cortex activity.
SD: May help antidote lead poisoning. Has also been widely used for its immune enhancing effects. It is reported to have the same basic action as ginseng, and it is especially good for building up the red blood cells.
DY: Tends to supplement the middle burner and Yin.
• With Huang qi to powerfully supplement the Qi, to effectively supplement the Qi of the middle burner and the exterior defensive. For indications such as:
- 1. Chronic illness leading to Qi vacuity.
- 2. Rectal and uterine prolapse and gastric ptosis due to central Qi fall. (Bu Zhong Yi Qi Tang)
- 3. Lack of appetite, loose stools, fatigue, lack of strength, and spontaneous perspiration due to Qi deficiency.
- 4. Low-grade fever due to Qi vacuity. (Bu Zhong Yi Qi Tang)
- To supplement the middle burner, these two herbs should be honey mix-fried. In case of loose stools or diarrhea, one should prescribe rice stir-fried Dang shen. In case of spontaneous sweats, one should prescribe unprepared Huang qi.
Dang shen does not directly nourish the blood and fluids. It supplements the spleen which is the latter heaven or postnatal root, the origin of Qi, blood, fluids and humors, and acquired essence.

Dose: 9-30g

Feng Mi – Honey (light) – Mel

Nature: sweet, neutral

Enters: Spleen, Lung, Large Intestine

Actions: Tonifies spleen Qi; relaxes muscles to relieve pain; moistens the Lungs, stops coughing; moistens the large intestine, promotes bowel movement.

Indications:
• Spleen Qi deficiency: fatigue, poor appetite, abdominal and epigastric pain.
• Lung Yin deficiency: dry cough, dry throat.
• Large intestine dryness: constipation, especially in the elderly (take 30-60g in warm water or with cucumber).
Li: Honey has a quite cool nature.
• Other sugars: red is quite warm, brown is warm, white is slightly warm or neutral, rock is slightly cool.

Dose: 15-30g

Gan Cao – Licorice root – “Sweet Herb”

Nature: sweet, neutral

Enters: ALL – especially Heart, Lung, Stomach, Spleen

Actions: Tonifies spleen Qi; moistens the Lungs to stop coughing, eases difficult breathing; relaxes the muscles, eases spasms to relieve pain; clears heat; eliminates toxicity; conducts herbs into the twelve channels; coordinates herbs: reduces side effects of some herbs, antidotes some poisons, harmonizes cold and warm herbs, protects the spleen from cold herbs, mitigates the purging function of purgatives and lightens other violent qualities of herbs.

Indications:
• Spleen Qi deficiency: poor appetite, loose stool, fatigue, shortness of breath.
• Spasm and pain in the epigastrium, abdomen, limbs (including when due to malnutrition or cold).
• Fire-toxicity: carbuncles, poisoning from food or herbs, sores, sore throat.
• Used internally and externally to antidote poisons.
• Heat or cold in the Lungs: coughing and wheezing.
• Increases duration and strength of effects of cortisol: useful for low adrenal function.
• Anti-inflammatory effects (glycyrrhetinic acid [weaker than cortisol]).
• Useful for chronic asthma. Used with Ku shen and Ling zhi in the simplified ASHMI formula for asthma.
• Relieves and prevents ulcers (DGL can be used if there is concern of sodium retention and the resulting hypertensive effect).
• May possess anti-neoplastic effects.
• Can cause water retention: aldosterone-like effects, decreased urination, decreased sodium excretion – long-term use may cause hypertension and/or edema.
Zhi gan cao: honey fried – more tonic, better than the raw herb for moderating spasms. This form is used in most cases, except when clearing heat and toxicity (for which the raw herb is preferred).
• Raw Gan cao is more detoxifying and heat clearing than the prepared form.
Gan cao shao: tips of the root – can disinhibit urination and free strangury.
HF: A supplement with an anti-Gu nature, possessing acrid, toxin-resolving qualities, useful in Gu Zheng (Gu parasites) formulas.
SD: May help antidote lead poisoning.
DY: With Bai shao to engender Yin (sour + sweet), calm the liver, fortify the spleen, supplement Qi and blood, harmonize the liver and spleen, soothe the sinews, and stop pain. For indications such as:
- 1. Weakness in the lower limbs and spasms and pain in the limbs due to disharmony between the Qi and the blood which causes inadequate nourishment of the sinews and vessels.
- 2. Abdominal pain due to liver-spleen disharmony. If either disorder is accompanied by cold signs, use wine mix-fried Bai shao and mix-fried Gan cao. If the disorder is accompanied by heat signs, use raw Bai shao (or Chi shao) and raw Gan cao.
- 3. Headaches due to blood deficiency. (Add He shou wu, Bai ji li, and Jiang can.)
• The combination of Bai shao and Gan cao is very effective for numerous problems accompanied by spasms and pain, such as gastritis or colitis, spasm of the gastrocnemius muscle in the leg, contraction of the limbs, tendinitis, lateral costal pain, and hiccups or stubborn vomiting caused by spasm of the diaphragm.
Gan cao can moderate the cold nature of Hua shi and protect the middle jiao, while Hua shi can prevent stasis due to the sweet flavor of Gan cao. As a pair, they clear heat, eliminate summer-heat, disinhibit urination without damaging the middle burner, and free strangury. For such indications as:
- 1. Fever, vexation, agitation, thirst, vomiting, diarrhea, and dysuria due to attack of summer-heat with internal and external heat. (Liu Yi San)
- 2. Turbid strangury.
- 3. Stone and/or sand strangury.
- For these indications, Gan cao shao is superior to regular Gan cao.
• With Jie geng to clear heat, transform phlegm, disinhibit the throat and stop pain, evacuate pus, and resolve toxins.
- 1. Pulmonary abscess with cough, expectoration of profuse, purulent phlegm, and chest oppression and pain due to heat stasis in the chest. (Jie Geng Tang)
- 2. Pain, redness, and swelling of the throat due to heat (deficient or excess, external or internal).
- 3. Loss of voice and/or hoarse or husky voice.
- For indications 2 and 3, the combination can be reinforced by adding He zi, as in He Zi Tang. For these indications, in cases of Lung dryness, honey mix-fried Jie geng should be used.
Gan cao is incompatible with pork, seaweed (particularly Hai zao), and Chinese cabbage.
• In cases of edema, oliguria, anuria, or hypertension, the dosage of Gan cao must be moderate (3-6g) and its administration should be of short duration. In other cases, for prolonged administration, a dosage of 10g per day should not be exceeded.
• Note: Sionneau lists the usual dosage of Gan cao at 6-10g.
K&R: Anti-inflammatory, anti-allergic, immune strengthener, estrogenic, luteotropic, antispasmodic, antiulcerative, vagolytic, febrifuge, antitussive, aldosterone stimulant, MAOI, stimulates the adrenal cortex.
• Improves fat digestion, reverses degeneration of liver cells by improving detoxification – for fatty liver, chronic hepatitis, to lower cholesterol.
• Increases interferon production.
• Eye drops: for conjunctivitis, blepharitis.
• Chronic gum infections.
• Prolonged use is suitable only for the water yin type (since it can lead to K+ loss and edema).
• Earth, water, and metal yin.
Earth: GI ulcer and spasm, glossitis, stomatitis, herpes simplex infection, tooth plaque.
Water: low immune function, depression, chronic infection, gonadal insufficiency, trichomonas infection.
Metal: recurring, chronic respiratory tract infection, cough.
BII: Heals peptic ulcers (DGL preferred), estrogenic activity, aldosterone-like action (can cause sodium retention and hypertension – a high potassium, low sodium diet may prevent this), anti-inflammatory (cortisol-like action), anti-allergic, antihepatotoxic, antineoplastic, expectorant, antitussive, antiviral.
• Possible use in: HIV (seems to halt progress of the disease, may prevent decline of CD4s and CD8s), aphthous stomatitis (mouthwash), eczema, heartburn, hepatitis, inflammation, menopausal symptoms, periodontal disease.
JC: Aperient, demulcent, emollient, pectoral, slight stimulant, sialogogue, expectorant.
• Laxative or mildly purgative (by dose) to the entire intestinal tract: a moderate dose makes liquid stools within 3-12 hours (3-6 on an empty stomach).
• Useful for hemorrhoids.
• Healing to the glandular system.
• Heals mucous membranes.
Yoga: Yashti Madhu (honey stick): V, P-; K+(if used long term)
• Demulcent, expectorant, tonic, rejuvenative, laxative, sedative, nourishes the brain, increases cerebrospinal fluid.
Sattvic – calms the mind, nurtures the spirit.
• A large dose is a good emetic for cleansing the Lungs and stomach of Kapha.
Hsu: Detoxifies bacterial toxins, poisonous foods and drugs, toxins of metabolic products.
• Antispasmodic, inhibits gastric secretions caused by histamine, anti-inflammatory, antitussive, antiallergic, antiulcerative, expectorant, adrenocortical hormone-like effects.
HF: (The words of Zhang Xichun:) If processed, the tonic properties of licorice become enhanced, while if left unprocessed, it not only tonifies the center, but also disinhibits. It is therefore appropriate for the treatment of cholera. The theory that raw licorice has a disinhibiting effect can easily be proven in clinical practice. I once treated the child of a Mr. Wang from Kaiyuan. Endowed with a weak spleen and stomach, the boy suffered from serious indigestion and kept throwing up his food. Also, his urination was inhibited, producing edema in virtually every part of his body, as well as a large and distended belly. I prescribed fine licorice powder, to be mixed with an equal amount of the Western drug Pepsinum. I had him take one qian (3g) of this mixture three times per day. After several days, the vomiting stopped, the urination returned to normal, and the swelling and distention disappeared.
My friend Wei Ziba made it a habit to put some licorice in his teapot every day, pour hot water over it, and drink it like a tea. After about ten days, he noticed that both his stool and his urination started to get quite busy, and he stopped drinking the licorice water. When he saw me later, he related this to me and asked why an herb that is usually thought of as a tonic can disinhibit urination and bowel movements. I answered: “When cooked or processed, licorice tonifies; when used unprocessed, it disinhibits. Even though you put the herb into a teapot with hot water, it never got cooked. Therefore, its effect was still close to the raw herb, and therefore could disinhibit.”
Li Zibo told the story of a child suffering from abdominal pain. The doctor said that frequent consumption of licorice decoction could cure the problem. Because the patient drank too much of the licorice decoction, urination became inhibited and symptoms of edema and abdominal distention emerged. The boy lived close to the train station, where there were always wagons loaded with licorice. His sister often brought some of it home so they could chew on it, and as this became a daily habit, his edema and distention gradually disappeared.
These examples demonstrate that the functions of unprocessed licorice and processed or cooked licorice are fundamentally different. When working with licorice, therefore, shouldn’t we always consider the raw or processed/cooked state of the herb as an integral part of the prescription?
CHA: (Karen S Vaughan, 11-17-2000):
As far as I can determine blood pressure has never been known to be raised from properly prescribed herbal preparations containing licorice root, of either the European or Chinese varieties. It has however been found to be raised in persons consuming large quantities of (real) licorice candy such as Panda licorice, at doses as low as 1 ounce candy daily and can also be attributable to (real) licorice flavored alcoholic drinks. Candy consumption and extrapolation from constituent data are the root of warnings about licorice and blood pressure. Quantity and refinement issues are both factors with licorice candy. There is a significant difference in aqueous extractions and alcohol extractions in licorice. My information is that one would need 10-45 grams per day [to raise blood pressure], which is a lot of licorice. There are cases of persons who have unusual sensitivity (almost allergy) to licorice, plain or DGL which may manifest with high blood pressure. I find oedemic, not diuretic indications for licorice in my western sources. Reduced excretion of potassium (and its replacement) can be achieved with the addition of dandelion to formulas. Some constituent information which may or may not be relevant to aqueous extractions of Gan cao: One active ingredient in licorice, glycyrrhizin, and it main gut metabolite in humans, glycyrrhetic acid, both prolong the effects of cortisol, by creating an aldosterone-like agonist effect, thereby causing sodium retention and potassium depletion at the distal tubule in the nephron. Those on blood pressure medicines such as Lasix (furosemide) or hydrochlorothiazide, heart medicines such as Lanoxin (digoxin), or cortisone-type drugs, including prednisone may be susceptible to cross-reactions from constituents in licorice, especially in concentrated extracts, candy or licorice liqueurs. For over forty years, glycyrrhizin has been a prescription drug in Japan to treat inflammatory illnesses such as ulcers and chronic liver disease. It is also used to decrease allergic reactions to other drugs. Glabridin, which is not water extracted, but may be present in other preparations, has strong antioxidant properties. Researchers using a highly refined licorice extract suggest that chemicals in glycyrrhizin called triterpenoids may be effective against cancer. They may block the production of a prostaglandin that may be responsible for stimulating the growth of cancer cells – and help get rid of cancer-causing invaders. Triterpenoids have been shown in test tubes to stunt the growth of rapidly multiplying cells, like cancer cells, and they may even help precancerous cells return to normal. Glycyrrhetic acid is also antitumoral in low doses in estrogen sensitive cancers, operating by tying up estrogen receptors. Large doses(> 300mg extract, >2 gm powder, or >4 ml fluid extract) of licorice may, however, show more of the estrogenic effects due to the higher availability of the isoflavones. The antagonistic effects occur by competing for receptor sites, but once all empty sites are filled, there is no greater antagonistic effect. There is some early indication for use in AIDS treatment but the research is difficult to interpret accurately. The American species (Glycyrrhiza lepidota) does not share the potential for blood pressure elevation in concentrated doses that European and Asian species have.

Dose: 2-12g

Huang Qi – Astragalus root – Milk-vetch

Nature: sweet, slightly warm

Enters: Spleen, Lung

Actions: Tonifies spleen Qi and Lung Qi; lifts spleen Qi (raises the Yang Qi of the spleen and stomach); tonifies defensive (Wei) Qi; protects/stabilizes the body surface and eliminates pathogenic factors from the surface; discharges pus; promotes tissue regeneration; promotes urination, relieves edema; regulates water metabolism; nourishes blood (via Qi); can connect the Lungs and spleen.

Indications:
• Lung and spleen Qi deficiency: poor appetite, loose stool, fatigue, shortness of breath.
• Spleen Qi sinking: chronic diarrhea, uterine bleeding, prolapsed rectum, stomach, or uterus.
• Wei Qi deficiency: spontaneous sweating, frequent EPI’s.
• Qi and blood deficiency: non-healing carbuncles, boils, post-partum fever; also used in recovery from severe loss of blood.
• Spleen failing to transform and Lung failing to dominate the water passages: edema, scanty urination, retention of water, dampness, obesity.
• Used often for wind-stroke (with Hong hua, Dang gui, Chuan xiong).
• When appropriate: for wasting and thirsting, paralysis, numbness of the limbs.
• Chronic ulcerations or sores due to deficiency that have formed pus but have not drained or healed well.
• Appropriately combined, it may be used for excessive sweating associated with Qi, Yin, or Yang deficiency.
• Its function to stabilize the exterior may be used to produce a therapeutic sweat when diaphoretics do not work.
• Vasodilator: lowers blood pressure.
• Compared to Dang shen and Ren shen, Huang qi focuses more on the superficial aspects of the Qi (especially Wei Qi), is better for warming and raising the Qi and tonifying the Qi to improve metabolism, whereas Dang shen and Ren shen focus more on the source Qi. Tonification is more complete when these substances are used together.
• Fry (dry or with honey) to focus the herb’s action on tonifying Qi and raising Yang (rather than securing the exterior, promoting urination, and reducing swelling).
Liu tends to use a minimum of 30g per day.
Michael & Leslie Tierra: When combined with Gan cao, it regulates blood sugar – useful for both diabetes and hypoglycemia.
Heiner Fruehauf: A supplement with an anti-Gu nature, possessing acrid, toxin-resolving qualities, useful in Gu Zheng (Gu parasites) formulas.
Botanical Influences on Illness: Enhances T-lymphocyte function, may enhance macrophage phagocytic function, increases NK cell activity.
Pearls From the Golden Cabinet: Unprocessed: fortifies the surface: will bring sweat if there is none (when the body is too weak to expel pathogens), and will astringe sweat if there is too much (by stabilizing the surface).
• Processed: produces blood, generates muscles, accelerate formation of (transformation of toxins into) and expulsion of pus – good for boils.
• Purely Yang in nature – best for the surface, Yang-collapse, weak eruptive force behind skin problems. Ginseng is more for water exhaustion and problems of Qi diffusion, while astragalus is more for fire exhaustion with the inability of Qi to reach the upper and outer regions of the body.
Hsu: Effective for nephritis, especially in treating proteinuria.
• Vasodilator, improves blood circulation to the skin, antibacterial, hypotensive, diuretic.
DY: Fills the interstices; secures the exterior; fluid and mobile.
• With Dang gui to supplement the Qi to strongly engender and transform blood, to effectively supplement the Qi and blood. For the following indications, wine mix-fried Dang gui and honey mix-fried Huang qi should be used. Also, the whole Dang gui root (Quan dang gui) or the body of Dang gui (Dang gui or Dang gui shen) should be used. The dosage of Dang gui for the following indications should be relatively low if there is Qi deficiency and weakness in the middle burner.
- 1. Delayed menstruation (a long cycle), postpartum weakness, agalactia due to Qi and blood deficiency. (Shi Quan Da Bu Tang)
- 2. Low-grade fever caused by blood deficiency. (Dang Gui Bu Xue Tang) Wu Kun of the Ming dynasty said, “When the blood is full, the body is cool. When the blood is vacuous, the body is warm.”
- 3. Sores and welling abscesses that do not heal, due to blood and Qi deficiency. (Tou Nong San)
- 4. Numbness of the limbs due to deficient blood not nourishing the sinews.
- 5. Various hemorrhages due to Qi not containing the blood within the vessels. (Dang Gui Bu Xue Tang)
• With Fang feng to supplement the defensive Qi without retaining external evils in the body, to drain external evils without damaging correct Qi and without causing perspiration, to secure the exterior, prevent invasion by external evils, and stop perspiration. This combination appears in Yu Ping Feng San for indications such as:
- 1. Spontaneous perspiration due to exterior deficiency.
- 2. Tendency to contract EPIs frequently due to defensive Qi deficiency.
- Yu Ping Feng San should not be used to treat wind affections that are already established. This combination is too astringent once the evil Qi and the defensive Qi are already struggling. Its use might, in this case, retain the external evil inside the body.
- The pair Fang feng and Huang qi, when combined with Zhi ke, yields good results in the treatment of prolapse of the rectum, external hemorrhoids, flatulence, and abdominal distention. For rectal prolapse, the best approach is to add 3g Fang feng and 6g Zhi ke to Bu Zong Yi Qi Tang.
• With Dang shen to powerfully supplement the Qi, to effectively supplement the Qi of the middle burner and the exterior defensive. For specific indications and notes, see Dang shen in this category.
• With Fu xiao mai to supplement Qi, nourish the heart, clear heat, secure the exterior, and stop perspiration. For indications such as spontaneous sweating due to exterior deficiency. (Mu Li San) Use stir-fried Fu xiao mai.
• With Fu zi for mutual reinforcement, to supplement the Qi and warm the Yang, return Yang, secure the exterior, and stop perspiration. For indications such as cold spontaneous perspiration accompanied by aversion to cold, cold limbs, lassitude of the spirit, a pale tongue with white fur, a fine, weak pulse, and in severe cases, profuse sweating, loss of consciousness, and a minute pulse due to Yang deficiency or Yang collapse.
• With (Han) Fang ji to simultaneously drain and supplement, to support the correct Qi and drain evil Qi at the same time, to regulate the upbearing and downbearing of the Qi mechanism and strongly promote diuresis. For the following indications, the combination is found in Fang Ji Huang Qi Tang:
- 1. Edema due to wind-water with fever, fear of wind, edema predominantly in the upper body and face, joint pain, scanty urination, and a floating pulse. If wind attacks the exterior and blocks the Lung Qi, this causes a disturbance in the Lungs’ diffusing and downbearing function. Therefore, because the water passageways are not regulated, dampness is not moved downward. Thus, there is accumulation of dampness in the upper body and edema appears.
- 2. Rheumatic pain due to damp Bi with heavy limbs, joint numbness, and sometimes swollen joints.
- 3. Chronic nephritis and cardiac disease with edema due to Qi deficiency and accumulation of dampness.
• With Mu li to supplement Qi, constrain Yin, secure the exterior, and stop perspiration. For indications such as:
- 1. Spontaneous perspiration due to Qi or Yang deficiency. (Mu Li San) Use calcined Mu li.
- 2. Night sweats due to Yin deficiency. (This combination is appropriate for moderate Yin deficiency. In cases of deficiency fire, this pair cannot be used alone.)
- 3. Spontaneous and nighttime perspiration due to Qi and Yin deficiency. (Mu Li San) Use calcined Mu li.
Huang qi pi is outer bark of Huang qi. It has a greater affinity than Huang qi does for the exterior, and is more potent for securing the exterior, stopping perspiration, disinhibiting urination, and treating edema.
Subhuti Dharmananda: Astragalus root (huangqi) is a commonly used Chinese herb from the Fabaceae family (legumes). It belongs to the subfamily Papilionoideae, which is the source of several popular Chinese herbs, including licorice (gancao), millettia (jixueteng), sophora (kushen), and pueraria (gegen).

The applications of astragalus underwent dramatic changes during the past 50 years because of two medical concerns: the increasing use of chemotherapy for cancer, in which case herbs to counter the immune-debilitating effects were sought, and the rise of cardiovascular diseases (e.g., heart attack and stroke). For the former, the combination astragalus with ligustrum (nüzhenzi) was most publicized due to involvement of Western investigators; for the latter, the combination of astragalus with salvia (danshen) became well known.

A look at the use of astragalus before the influences of these modern trends is offered by Smith and Stuart (1), who reported at the end of the 19th century that astragalus was “in great repute as a tonic, pectoral [alleviates disorders of the lungs and chest], and diuretic medicine…every sort of wasting or exhausting disease is thought to be benefited by it.” At that time, a frequently occurring wasting disease involving the lungs was tuberculosis, and the herbal therapies usually included astragalus. The original description of astragalus in the Shennong Bencao Jing (ca. 220 A.D.) would be hardly recognizable for someone who learns of this herb from modern literature:

It mainly treats welling and flat abscesses and enduring festering sores by expelling pus and relieving pain, great wind lai disease [leprosy], the five kinds of hemorrhoids, and “mouse fistulas.” It supplements deficiency and is good for hundreds of diseases in children.

The herb was used to treat skin disorders, superficial swellings, and children’s ailments. The editors of the modern translation quoted here (2) no doubt felt compelled to offer some information that is more in keeping with the current applications of astragalus and added a footnote quoting from Wang Haogu, an herbalist of the Jin-Yuan reform period (3), more than 700 years ago: “Astragalus replenishes the defensive and, therefore, is a medicinal for the exterior. It boosts the spleen and stomach and, therefore, is a medicinal for the center. Since it is able to treat cold damage with the cubit pulse not arriving, it supplements the kidney origin and, hence, is a medicinal for the internal.” Through this explanation, astragalus is seen as a broadly useful tonic ingredient to include in prescriptions.

A substantial number of traditional formulas indicated primarily for tonification that come to us today contain astragalus, though it may be included as a small proportion of the prescription. As an example, in the tonic section of Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (4), over 80 prescriptions are listed, including four of the ones in the above table (Yupingfeng San is placed with astringent formulas instead); about one in four of all the tonic formulas contain astragalus as an ingredient.

Two of the traditional formulas with astragalus have been adopted for modern use as “immune enhancing” prescriptions, sometimes given to patients undergoing cancer therapies: Buzhong Yiqi Tang and Shiquan Dabu Tang.

IS ASTRAGALUS STRONG OR MILD?

Some practitioners may think of astragalus as a “strong” qi invigorating herb because of its frequent use in tonic formulas; however, most traditional sources place it in a mild to intermediate category. Yang Yifan, in her book on Chinese Herbal Medicines: Comparisons and Characteristics (5), displays a scale of strength of qi tonics and places astragalus well below ginseng, but slightly above codonopsis (dangshen). In the Advanced Textbook on Traditional Chinese Medicine and Pharmacology (6), astragalus is listed with two other herbs, ginseng and codonopsis, as tonics that have the similarities of replenishing qi of the spleen and stomach. As to differences, ginseng is described as being able to “replenish primordial qi potently,” codonopsis is described as have properties similar to ginseng but with much weaker effect, and astragalus is described as “consolidating superficial defensive qi.” So, in terms of qi tonics, ginseng is considered potent, codonopsis is relatively weak, and astragalus is somewhat stronger than codonopsis, but aimed at the surface defense while codonopsis and ginseng, act on the primordial (original) qi.

There are some characteristics that may be associated with mild versus strong herbs. Mild acting herbs have these qualities: low toxicity; low incidence of adverse reactions at normal dosage; and the normal dosage is relatively high. As a contrast to mild acting herbs, there are those that have notable toxicity (such as raw aconite), those that easily cause adverse reactions (such as rhubarb causing intestinal cramping or loose stool), and those that have significant effects at low dosage (e.g., the potent heating effect of zanthoxylum at just a gram per day). Astragalus clearly fits the category of mild-acting herbs. It has a gentle warming nature, a mild, sweet taste, and can be used in doses of 30 grams or more without adverse effects. Laboratory animal studies show virtually no toxicity with administration of very high oral dosage or even with injections (7).

ASTRAGALUS INGREDIENTS AND ACTIONS

After several decades of study, three groups of active constituents have become known for astragalus: flavonoids (which give the yellow color to the root slice), saponins (a common ingredient of plants in this family), and polysaccharides (long-chain polysaccharides with potential medicinal benefit mediated by white blood cells). The quantities of these components will vary depending upon the species of Astragalus used, as well as the growing conditions and other factors. No other potential active constituents have been found in significant quantities. Of course, there are many other components of astragalus root, but they are either ordinary components found in foods (such as carbohydrates and proteins) or ingredients that are present in such small amounts as to not contribute significantly to the effect of the whole herb preparations even when the herb is used at high dosage (e.g., sterols). Those who have used astragalus root in decoction recognize that it is a very fibrous root, for which most of the material remains behind in the dregs after prolonged boiling.

FLAVONOIDS

Astragalus contains small amounts of several flavonoids, primarily isoflavones, such as formononetin (see image, below) and its glucoside, ononin, which are metabolized in the body to yield the common legume flavonoid daidzein, an ingredient in pueraria and soy beans. Flavonoids are found in all higher plants, but some plants are rich sources of them. In fact, pueraria root has flavonoids as the primary active ingredient (aside from its starches that are soothing to the gastro-intestinal system). There are numerous potential beneficial effects of flavonoids (8), but when present in modest amounts, as is the case with astragalus, the primary effect is to benefit circulation. Other actions, that are noted for high doses of flavonoids, such as anti-allergy and anti-viral activity, would not be expected from astragalus extracts.

In one recent study (9) it was noted that “In the roots, isoflavonoid content was extremely variable, but reached 3.04 mg/gram, whereas flavonol content was 0.49 mg/gram.” Modern supplements that provide flavonoids such as quercetin for therapeutic benefit have several hundred milligrams making up a one day dose, while isoflavones in soy and clover (which are essentially the same as found in astragalus), are reputed to help with menopausal symptoms and have other benefits at doses of 60-180 mg or more per day. The combined isoflavonoid and flavonol content mentioned here (using the figure given for the maximum) is 3.5 mg/gram (0.35%), so that a 15 gram daily dose of astragalus in decoction would yield only about 50 mg of these flavonoids if all were extracted. This is a small amount, and most roots have lower levels of the flavonoids, typically less than 0.1%. In commercial extracts, standardization of astragalus root concentrate is for the product at just 0.4-0.5% of the main isoflavone, a tiny amount. The astragalus flavonoids contribute the yellow color seen in the central part of the roots, which is frequently used as a monitor of root quality (those with stronger yellow coloration are considered better quality).

In sum, though the flavonoids may contribute to a general beneficial effect of astragalus, their effects are probably minor until the astragalus dosage exceeds 15 grams, as is common in modern clinical practice in China, but not as herbs are usually prescribed in the West. In the book Chinese Drugs of Plant Origin (10), flavonoids are not included in the list of astragalus active constituents; only the saponins and polysaccharides are included.

SAPONINS

The saponins of astragalus include several called astragalosides (-oside indicates that it is a glycoside, that is, has a sugar attached to an active molecule, such as a pentacyclic compound usually found in saponins). In a study of astragalus roots from China, the saponin content was found to be from 0.019 to 0.184%, with astragaloside I as the main component (10); others consider that astragaloside IV is the main component (see image, below). When astragalus extracts are made and standardized for saponin content, a 0.5% saponin level is the most that is usually attained (one Chinese source indicates a range of 0.2 to 20% saponin content available). In a previous analysis of saponin-containing herbs, it was shown that to get substantial activity for these compounds one would need to administer doses of 60-900 mg (11). Based on a maximum root content of about 0.184% saponins, a 15 gram daily dose of astragalus might yield about 28 mg total saponins, a small amount. These saponins of astragalus, if they were given in sufficient quantity, may have properties of reducing inflammation, resolving phlegm, reducing platelet sticking, and promoting cardiac function.

Ginseng (renshen) is an herb that has saponins as its primary constituent, and good quality red ginseng roots can have about 4-5% saponins in the dried material; extracts may have up to 85% saponins. Thus, the ginseng saponins are easier to get in reasonable quantities. An herb that is used like astragalus for treating abscesses and certain other skin diseases is platycodon (jiegeng); it also relies on saponins as a key active component, but it contains even more saponin than ginseng, usually over 6% in the dried roots. A traditional formula for treating abscesses that relies on both astragalus and platycodon is Qianjin Neitou San; the formula also has saponins from ginseng and licorice.

In sum, the saponins in astragalus may be present in small enough quantities that they don’t provide much therapeutic effect on their own. However, when astragalus saponins are combined with saponins from other herbs in a formula, they may contribute to getting the necessary amount for the desired therapeutic effect.

POLYSACCHARIDES

The polysaccharides of astragalus, called astragalans, may be present in relatively large quantity. It is important to recognize that polysaccharides (long chains of sugars; see image of a repeating structure, below) are not soluble in alcohol, so are not present in tinctures or other alcoholic preparations; they are soluble in hot water, but the desired high molecular weight ingredients (20,000-25,000 daltons) may be only partially extracted from the herb under normal conditions. It is relatively easy to isolate polysaccharides by first using hot water extraction and then condensing these large molecules out of solution with alcohol. Commercial astragalus extracts have been standardized to 40-50% polysaccharides; some sources claim ability to provide 70-90% polysaccharides. These levels are as high as attained with mushrooms that are used specifically for their polysaccharides (typically 40% polysaccharides in the standardized extracts, but sometimes higher percentages). A reasonable estimate for the content of the dried roots is about 10% extractable medicinally active polysaccharides (in one of the most commonly used commercial astragalus extracts made by hot water extraction, the concentrated material has just 16% polysaccharide and 0.2% flavones). The crude powdered herb may be a better source of polysaccharides than a boiled preparation, but a polysaccharide rich extract is the most convenient means of getting high doses of this component.

In a previous analysis of medicinally active polysaccharides and their applications, it was shown that a daily dosage of 3.0-3.5 grams of these components would be reasonable to attain some level of immunological activity (12). A 30 gram dose of astragalus would have about this amount of polysaccharides. The polysaccharides have the reputation of enhancing immune functions and specifically in improving white blood cell responses; the large molecules probably stimulate the white blood cells to respond just as they might to saccharide chains on the surface of bacteria; there may also be a stimulation of white blood cell production by the bone marrow. Polysaccharides have been used, especially, in attempts to overcome the immune debilitating effect of radiation and chemotherapy as used in cancer treatments. In China, astragalus is most often used in doses of 15-30 grams per day in decoction for this application.

It appears that the polysaccharides are present in sufficient quantity that the high dosage astragalus preparations could affect the white blood cell activity.

DOSAGE AND EFFECT

The analysis of active constituents present above reveals that a dose of about 15 grams of astragalus, as frequently used in decoctions, may be sufficient to attain only some of the desired effects of the known active components, but that a 20-30 gram dose would be more suitable.

The Chinese Materia Medica recommendations for astragalus dosing are 9-15 grams/day (with the understanding that astragalus is to be used in formulas with other herbs); high doses of 30-60 grams are also suggested, at least for some applications (usually not specified). When dosing at or below 15 grams, an herbalist is counting on other herbs in a formula to contribute some similar active components in order to get the desired therapeutic action. Thus, for example, a decoction made with astragalus, ganoderma (lingzhi), and red ginseng would provide polysaccharides and saponins from all three herbs, and so long as the total dosing of these three ingredients was sufficient, then astragalus at 9-15 grams/day would be acceptable.

The formula Yiqi Congming Tang has three botanically-related herbs-astragalus, licorice, and pueraria-all contributing flavonoids and saponins, as well as having ginseng with additional saponins. Thus, astragalus is not the sole herb relied on for these active components. This formula is not used for immune enhancing purposes, so the limited amount of polysaccharides from other ingredients is not a concern.

Lower doses of astragalus would not be entirely ineffective, but the action would be limited. As an example, the polysaccharides can have benefits for the stomach (e.g., alleviating ulcers) at doses below that necessary to yield the general immunological effects, because of the direct action of the full amount of the herb ingredients on the stomach before being distributed throughout the body. Thus, pills with a relatively small amount of astragalus included will have this type of action from astragalus. Following absorption from the small intestine, the astragalus ingredients are diluted into a large volume of blood and some begin to be metabolized and eliminated after just a few minutes.

The recommended high doses of astragalus, at 30-60 grams per day (sometimes as high as 120 grams/day), are used in short-term therapies to get a stronger action of the herbs, and this dosage should yield a substantial effect from both the saponins and polysaccharides, with some effect also from flavonoids. It is not known if prolonged use of these higher dosages could be detrimental, but a reasonable caution would be to limit the duration to a few days at a time when needed, rather than a continuous therapy.

TRADITIONAL INDICATIONS FOR ASTRAGALUS

In the book Chinese-English Manual of Commonly Used Herbs in Traditional Chinese Medicine (13), five major actions and associated uses are given, as well as some miscellaneous new uses (item 6):

Invigorate qi and spleen (poor appetite, loose stools, fatigue, and bleeding).
Invigorate qi to activate yang (prolapse of stomach, uterus, or rectum)
Invigorate qi to strengthen the body (common cold in debilitated patients, profuse sweating due to weakness)
Relieve skin infection and promote tissue regeneration (abscesses, skin erosion, unhealthy wound); also for erosion of stomach lining (ulcer, atrophic gastritis)
Promote diuresis and relieve edema (spleen-deficiency type edema).
Miscellaneous new uses: diabetes, hemiplegia, asthma, and leukocytopenia (low white blood cells); astragalus is indicated for these disorders in cases of qi deficiency or qi and yang deficiency.

It is important for practitioners to distinguish between traditional indications (some of which are based solely on dogma and not on careful observation) and known effective actions (which might be confirmed through clinical trials). For example, it would be a mistake to think that a prolapsed organ would go back into place merely by taking some astragalus or by using this herb in a qi tonic formula. This indication for astragalus comes from three considerations:

A prolapse indicates muscular weakness; the muscles are ruled by the spleen qi, becoming weaker with reduced qi; astragalus is a spleen qi tonic.
A prolapse represents a falling of an organ from its place; the upward flow of qi is promoted by herbs that invigorate qi and yang, hence astragalus is appropriate in that its “direction” of action is upward against the fall of the organ.
Since a prolapse often produces a heavy sensation and fullness or swelling where the organ has moved, the syndrome is like one of moisture accumulation; herbs that remove dampness, such as astragalus, may help.

These theoretical reasons for using astragalus are consistent with Chinese medical theory, but there is no evidence to show that the appropriateness of astragalus in this instance corresponds to its effectiveness in alleviating prolapse. Indeed, in order to reverse prolapse non-surgically, one usually needs to strengthen the muscles surrounding the organ, which requires doing physical exercise. If taking herbs will, by whatever mechanism, improve one’s sense of energy and capability, then the person might undertake more exercise. That added activity would, in turn, control or reverse the prolapse through strengthening the muscles. If the herbs do not aid one in pursuing the physical activity, they would be unlikely to have any substantial impact on the prolapse, other than alleviating discomfort.

While an analysis of each of the claimed activities for astragalus is beyond the scope of this article, it can be said that those which directly affect digestion, such as treating low appetite, loose stool, stomach ulcer, and atrophic gastritis, may be partly explained by direct action of the ingredients on the lining of the stomach and intestine. Saponins and polysaccharides are likely to be the main active components, potentially of benefit in small doses in contact with the stomach lining. Resolving skin infections and erosion, aiding treatment of common cold, and promoting while blood cell function are actions that would require the higher dosages discussed above. Claimed diuretic effect of herbs is an area of some difficulty to interpret, as the drinking of decoctions is, in itself, a potential means of diuresis because of the fluid consumed. Further, the body’s elimination of the chemical constituents contained in the herbs and their metabolites is primarily by diuresis. A diuretic effect may be stimulated by high levels of such chemical compounds, with relatively little specific diuretic action of the herbs included in the therapy. Low dosage pills are unlikely to have much diuretic effect, both because of the low dose and because of the lower fluid intake (unless they are swallowed down with a large amount of water or tea).

Astragalus can be an effective agent, though one must give due considerations to its preparation and dosage according to the intended application, and the practitioner must be careful about interpreting indications that appear in the traditional literature.
Huang Huang:
I. Functions

  • A. Supplement qi, strengthen the exterior, dissipate edema.
  • B. Areas of function: metabolic system, immune system, cardiac and cerebralvascular system
  • C. Treats: sweating with edema, able to eat but lack strength
  • Caveat: too much Huang Qi causes distention, can exacerbate gallstones problems.
  • The taste of Huang Qi is bean-like, it is in that family; good quality is nice and soft; it has a 3000year history of use. In Shennon Bencao Jing it is a superior class herb. It is commonly used in China. Huang Qi vs. Zhi Huang Qi: Dr. Huang does not believe Zhi Huang Qi is more supplementing than Sheng Huang Qi; one can just use the unprepared, it is actually better. Dr. Huang feels only toxic herbs should be prepared.
  • Use: What do you use it for? Spleen and Lung qi xu, but in what situation, what symptoms and patterns?

II. Patterns

  • A. Sweating
  • 1. Spontaneous sweating: relatively severe with the clothes often becoming completely soaked and with sweat stains that sometimes have a yellowish color.
  • 2. May sweat worse when eating, with significantly more sweating from the upper portion of the body.
  • 3. In addition to spontaneous sweating in the daytime, may be night sweats, wake to find entire body soaking wet as if immersed in water.
  • 4. Sometimes does not manifest with a significant amount of spontaneous sweating. However, patient usually prone to some type of sweating: readily sweats on minimal exertion, history of spontaneous or night sweating.
  • B. Edema
  • 1. Generalized edema, but worse in the lower body.
  • 2. Easy to develop. These types after long flight feet would swell. If get fatigued, walk a lot, or have salty meal it is easy for them to develop edema.
  • 3. Mornings the facial swelling is worst, but by afternoon, lower legs are worst   4. In some patients, edema is not pronounced, but flesh is soft so they appear like they have edema.
  • 5. Because of accompanying edema, often a subjective sense of the body feeling heavy and uncoordinated. Associated with discomfort, joint pain, hard to walk, a lot of fatigue, athletes must clear fluid to be comfortable. Huang Qi promotes urination.
  • 6. May also be heaviness and pain in the joints.
  • Case History: Patient had generalized edema and asthmatic breathing. Physician gave him 120g Huang Qi with congee, patient urinated copiously, edema lessoned significantly. Edema in upper body eliminated, but foot remained swollen. Sent patient back home, another doctor gave him a purgative for swollen feet, all the swelling came back with fatigue. He was debilitated, doctors felt this was intractable, thought he would die. His wife realized he was still breathing, she made up the first formula, he started urinated again, and little by little he recovered. This first formula is used commonly and successful.
  • Case History: Fan Hou Case History (100 years ago) Post partum woman very edematous. Gave her this formula, which worked.
  • Case History Yue Mei Zhong, (modern doctor) also uses this for chronic nephritis, protein in urine.
  • This is also used for pediatric patients.
  • Huang Qi and Nuo Mi (glutinous rice) modifications:
  • Yue Mei Zhong recipe
  • Sheng Huang Qi 30,
  • Yi Yi Ren 30g,
  • Chi Xiao Dou 15g, [help with percolation]
  • Ji Nei Jin powder 9 [help digestion]
  • Nuo Mi (glutinous rice) 30g,
  • 600 ml water, first cook Huang Qi, take it out, put next two in for 30 minutes, than add last two, cook over low flame until like congee, this is one day dose.
  • Take a dry pressed kumquat (with sugar), helps to pass gas. This helps get rid of gas from large dosage of Huang Qi.
  • Dr. Huang thinks simple recipe is easier and better.
  • Case History: Hu Shi, Chinese studied in US, tried to promote Western culture in China. He disliked Chinese medicine. Then he got edema from diabetes and kidney disease and had heart problems. Went to Rockefeller Western Hospital, but didn’t help. Finally went to a famous old Chinese doctor. He was known as “Mongolian Physician” because used large dosages. [Further north, larger dosages.] He used of 300g Huang Qi. This fixed him up. People asked him, “What do you think now?” He replied that there was a need to find a scientific explanation.
  • Note: Water swelling must be in fleshy exterior of body. This is only the place Huang Qi moves water from, not for water in lungs or for ascites from hepatitis, it doesn’t work for water in chest and abdomen; don’t use for thin patients.
  • Example: Sun Yet San developed ascites from liver cancer. The question was whether to use Chinese or Western medicine. They wanted Hu to treat him. Hu gave him a very large dose of Huang Qi, but he just had a big belly, and was skinny otherwise. This just caused great distention. Hu lost his reputation over this.
  • In the Shang Han Lun, Huang Qi and Ren Shen are not used together. The reason is they go in different directions; Ren Shen is for thin patients with no fluid, lost fluids, Huang Qi for large patients with too much fluid. Ex: Bai Hu Jia Ren Shen Tang for big sweat after fever. Si Ni Jia Ren Shen Tang, for lots of sweat with no pulse, fatigue, use Gui Zhi Jia Ren Shen Tang. Bu Zhong Yi Qi Tang has small quantities of Huang Qi and Ren Shen, but here these have a different function, it is not classical. Ren Shen is good with Gan Cao, Mai Men Dong, all for thin people. It is also good with Bai Zhu.
  • C. Able to eat, but lacks strength
  • 1.Generally good appetite, able to eat large quantities of food without bloating or pain. •
  • 2. Unable to tolerate getting hungry, when hungry, will sweat, feel flustered, and feel a lack of strength
  • 3. Even after eating, feel weary and lack strength
  • 4. “Able to eat but lacks strength” is a symptom, but even more it represents constitutional state
  • Huang Qi will stabilize blood sugar, help people hold off hunger longer, and they will be able to eat less but have more energy. Fatigue may be a symptom, but may be part of the constitution. Using Huang Qi we may be treating the symptom as well as constitution.

III. Huang Qi Constitution

  • A. Tend to be overweight with soft and loose musculature, relatively damp and moist.
  • B. Complexion: dull yellow or dull red
  • C. Huang Qi Abdomen
  • 1. Abdomen is soft and loose
  • 2. Muscle atrophy and fat accumulation
  • 3. Flesh accumulates so navel sinks in
  • 4. Feels soft
  • 5. No pain
  • 6. Not tight
  • D. Good appetite and no pain or distention after meals
  • E. Some may have abdominal fullness, but more a feeling of sagging
  • F. Pitting edema in lower extremity
  • G. Skin in the area is dry and may be dark
  • H. Easily fatigued, copious sweating
  • I. Easily dizzy, short of breath
  • J. Feelings worse with exercise
  • K. Easily develop edema, especially in lower leg
  • L. Easily develop numbness in hands and feet
  • M. Easily develop infections and ulcerations

IV. Common Diseases

  • A. Cerebrovascular disease: hypertension, arteriosclerosis, coronary heart disease, angina pectoris, and basilar arterial insufficiency
  • B. Joint disease: herniated discs, cervical spine disease, bone hyperplasia, frozen shoulder, joint deformity
  • C. Metabolic disease: diabetes, obesity, elevated blood lipids
  • D. Allergic disease: allergic rhinitis, colds
  • E. Immune system disease: nephritis, anemia
  • Huang Qi is more for chronic disease, not so much for acute: there are seven prescriptions with it in the Jin Kui Yao Lüe, none in the Shang Han Lun. It has a strong connection to flesh, helps body produce more flesh. The Shennong Bencao Jing recommends it for non-healing sores. Surgeons use it to help heal cuts, help mm get force. Used for numbness and lack of strength in tissue. May be a performance-enhancing herb. For weight lifters and wrestlers, makes them stronger, Sumo wrestler is example, when water disappears, the mm are stronger.

V. Common Influencing Factors

  • A. Old age
  • B. Chronic disease
  • C. Exhaustion
  • D. Insufficient exercise
  • E. Poor nutrition
  • F. Reckless use of medicines

Huang Qi Gui Zhi Wu Wu Tang
I. Constitution

  • A. Dull yellow or red complexion, enlarged tongue that is dull purple, often middle-
  • aged or elderly
  • B. Easily fatigued, dizziness, SOB, asthma from exercise, chest oppression or pain
  • C. EKG shows lack of blood flow to heart
  • D. Generalized pain, numb limbs, lumber and leg pain
  • E. Edema in lower legs

II. Indications:

  • A. Commonly used for middle-aged and elderly patients with cerebrovascular disease and joint disease. The Shang Han Lun indicates it for painful bi, blood bi. Mostly joint pain. Was used a lot for upper class people, aristocrats, who were fatter, and who didn’t work much, and were therefore weaker, with weak mm, too much fat; when they moved they sweated easily, then exterior opened and wind would invade.
  • B. Chronic degenerative joint disease and diabetes: numbness, antonymic nervous system problems
  • C. For this formula, use in elderly, not kids. Sallow complexion, flesh hangs, Sob, pain, soft abdomen, good appetite, etc. Skin will be dry but swollen. Large dark tongue with greasy thick yellow coat. (see power point picture just before “explanation”) This not due to damp, but because the elderly eat soft food, and don’t have salvia, so the coat is not worn off. So ignore coat, look at body, dark, purplish. These kind of elderly can really eat.

III. Original formula dosages

  • Huang Qi 3 liang
  • Gui Zhi 3 liang
  • Shao Yao 3 liang
  • Sheng Jiang 6 liang
  • Hong Zao 12 pieces
  • Cook from 6 cups down to 2, take three times per day
  • A. Explanation
  • 1. Gui Zhi and Bai Shao is a famous combination to regulate ying and wei. To Dr. Huang, this means regulating the circulation: Gui Zhi dilates arteries, Bai Shao dilates the veins, so circulation is increased. These two work systemically, esp. when combined with Huang Qi.
  • 2. Sheng Jiang: Don’t underestimate the importance of Sheng Jiang. Here in the originally formula used 6 liang, double of others. It promotes peripheral circulation, warms the body, can induce sweating, dispels wind and cold, and can unblock blood impediment. Patients should keep warm after taking it and can use Sheng Jiang in food regularly. Must not wear shorts, lower legs must be covered. Careful, can’t use too much or bloating. (If bloating, the first consideration is are they Huang Qi type?) But if correct, they will bloat but will feel good. You can add lemon, Chen Pi, citrus eaten during day. Use preserved orange peel to keep digestion going.

IV. Dr. Huang’s dosage

  • Huang Qi 30
  • Gui Zhi 15
  • Chi Shao 15
  • Sheng Jiang 15
  • Hong Zao 20g
  • Water decoction: For acute must use full dosage, but for chronic, or for long-term use, one can use less. This tastes good and so patient compliance is high. One can use less for cheap patients or with granules.
  • A. Modifications:
  • 1. Dr. Huang adds Ge Gen up to 30g [equal to Huang Qi] and Chuan Xiong 15 [up to Gui Zhi dose]. Ge Gen raises yang, why use it for hypertension? Ge Gen raising the clear qi, not evil qi. When the clear doesn’t rise one has dizziness etc., due to insufficient circulation to head. These increase blood supply to brain. Also these people have tight nape of neck and further back, an indication for Ge Gen. When blood pressure decreases this feels better. Need to use large dosages to lower blood pressure. Chuan Xiong for HA.
  • 2. Add Ge Gen and Chuan Xiong for cervical spine disease, from head to lower back spine use Niu Xi,.
  • 3. Add Chi Shao, Huai Niu Xi, Dan Shen, Shi Hu for lower leg numbness from diabetes
  • 4. Add Shao Yao Gan Cao Tang and Ma Huang Fu Zi Xi Xin Tang for sciatic pain, severe lower leg pain, and difficulty walking.
  • 5. For distention, citrus eaten during day. Use preserved orange peel to keep digestion going.

V. Classical formula pattern

  • A. In Blood Impediment, yin and yang are both faint, cun and guan are both faint, while the chi is a little tight, the exterior symptoms show numbness on the skin, just as Wind Obstruction, and Huang Qi Gui Zhi Wu Wu Tang governs.
  • B. Explanation:
  • 1. Blood impediment: ancient disease name,
  • 2. Symptoms: inflexible joints, muscle aches
  • 3. Occurs often in patients who are well fed, who lack physical exercise, are fleshy, lack physical strength, fatigued easily, sweat easily
  • C. Common Diseases
  • 1. Hypertension
  • 2. Atherosclerosis
  • 3. Basilar artery insufficiency
  • 4. Strokes
  • 5. Head aches, fatigue, dizziness.
  • Case History: End stage hypertension
  • Shen, 62, BP: 180/100 even though he takes lots of pharmaceuticals (12-15 pills per day.) Swollen leg, soft belly, good appetite. Big nose, big lips. Hematuria (+++). Renal disease and leg pain from diabetes, lower leg edema. Dizzy, very tired, low back sore, dry mouth, swollen tongue with slimy fur in center.
  • Huang Qi 60 (minimum 30g some use 120)
  • Rou Gui 6g (add last)
  • Gui Zhi 10
  • Chi Shao and Bai Shao15g
  • Huai Niu Xi 30
  • Shi Hu 30
  • Dan Shen 12g
  • Ge Gen 30
  • Gan Jiang 6
  • Hong Zao 20g
  • After two months BP stable at 140/80. No fatigue, legs had strength, no LBP, etc.
  • Case History Multiple problems
  • 63 year old man 2004 March
  • 1.Pituitary tumor 2.Severe sleep apnea 3.Mesangial proliferative glomerulonephritis
  • 4.Diabetes 5.Hypertension. Hematuria(+++) As of 2005 November: 180/100mmHg
  • BP. Medication for HTN ineffective.
  • Symptoms: Dizziness, as if drunk or feverish, fatigue, low back soreness, dry mouth,
  • soft loose abdomen, strong appetite, enlarged tender tongue with slimy fur in center
  • Formula:
  • Huang Qi 60g
  • Rou Gui 6g (add last)
  • Gui Zhi 10g
  • Chi Bai Shao each 15g
  • Huai Niu Xi 30g
  • Shi Hu 30g
  • Dan Shen 12g
  • Ge Gen 30g
  • Gan Jiang 6g
  • Hong Zao 20g.
  • After more than two months, BP stable at140/80 mmHg. No fatigue, lower legs have strength, no low back soreness, good complexion.

VI. Cardiac diseases

  • Angina pectoris: This is chest bi, easily sweat with activity, swollen legs. One can at least reduce symptom severity and frequency. Add Ge Gen Chuan Xiong Dan Shen, Shi Hu and Huai Niu Xi. For cardiac diseases, one must add Rou Gui in a large dose. Usually more than 20 g . One can use Rou Gui and Gui Zhi together. For these cases substitute Chi Shao for Bai Shao.
  • Case History: Cardiac disease
  • Mr. Wang, govt. official, 58, Nov 2004. Very stressful life, smoke and drink a lot. Had heart attack, did bypass. After surgery, fat, can’t walk, tired, SOB, palpitations. Chief complaint: palpitations and chest oppression for ten years, exercise-induced asthma for 3 years. On oxygen. In 2002 coronary artery bypass surgery; 2004 polymyositis. Frequent weakness in extremities, minimal activity brings on palpitations and SOB. Only able to walk for short stretches. On oxygen for 5 hours a day. Tranquilizers and oxygen before bed. Life activities very limited.
  • Formula:
  • Huang Qi 80
  • Gui Zhi 20
  • Rou Gui 10 (put in at end)
  • Chi Shao 40
  • Bai Shao 20
  • Dan Shen 20
  • Dan Pi 12 for psoriasis
  • Tao Ren 20
  • Huai Niu Xi 60
  • Zi Cao 20
  • Sheng Jiang 4 pc
  • Hong Zao 20
  • Water decoction, take twice a day. Advised to increase exercise as possible.
  • Wang continued on basic formula until 2005 (over 300 packs). Increased physical activity significantly and exercising every day, strength in the extremities, no shortness of breath or palpitations, no breathing difficulty, spirit significantly improved. He lost 18 pounds. However, even though he had quit smoking when he had his operation and led a less prodigal life, last year he died of lung cancer.
  • Case History: Spontaneous sweating in cardiac disease
  • Mr. Jiang, 80,2008 February. Many years of hypertension and heart disease, sweats easily with even minimal activity, copious sweat, after sweating feels cold, cough. Hospitalized for heart disease- improved, but sweating persisted. Relatively strong body, moist skin, asthmatic, lower leg edema, enlarged tongue, pale tongue, floating large pulse
  • Formula:
  • Huang qi 60g
  • Gui Zhi 15g
  • Rou Gui 10g
  • Chi Shao 15g
  • Gan Jiang 10g
  • Hong Zao 30pc
  • 5 packs.
  • After one week, patient said: “Sweating very much better, easier to climb stairs”
  • Dr. Huang increased Huang Qi to 100g, no other changes. After 10 more packs, there was continued improvement.

VII. Musculoskeletal diseases

  • A. Lumbar disc herniation, cervical spine disease, bone hyperplasia,
  • frozen shoulder
  • B. Body pain, weakness, stiffness, difficulty with movement, muscular atrophy
  • C. Modifications: Add Huai Niu Xi, Ge Gen, Bai Zhu
  • Case History: Lumbar spinal stenosis
  • 39 year-old woman: 3 years of numbness and pain in lower extremities, lumbar pain for six months, when fatigued feels as though walking on cotton, knee pain, lameness, low back pain worse with weather changes, dull pale-red tongue, thin moist fur, soggy pulse, spinal stenosis and disc protrusion (L4-5)
  • Formula:
  • Huang Qi 30g
  • Gui Zhi 12g
  • Bai Shao 12g
  • Da Zao 15g
  • Sheng Jiang 40g
  • Bai Zhu 12g
  • Gan Cao 10g
  • Fu Ling 30g
  • 5 packs.
  • After two packs, feeling of heat in back, feeling of qi moving down to feet,
  • subjective symptoms improved. After 5 more packs, even though weather changes, low back not painful, only slight numbness in legs but no pain, knees achy with fatigue but not painful, feeling of walking on cotton very reduced. Continued for 5 more packs

VIII. Other diseases
A. Vascular obliterans. arteritis; peripheral vascular disease: For these add Si Miao Yong An Tang: Dang Gui, Xuan Shen, Jin Yin Hua, Gan Cao.
B. Chronic kidney disease, uremia [because of edema] For people who must use dialysis, or may be able to delay dialysis. Huang Qi Gui Zhi, Bai Shao, have a diuretic effect, but also increase circulation to kidneys, help kidney function.
C. Post-stroke: Can combine with Bu Yang Huan Wu Tang.
D. Diabetic peripheral neuropathy: Numbness of the limbs, decrease in sensation. One can combine this with Si Wei Jian Bu Tang: Huai Niu Xi, Chi Shao, Shi Hu, Dan Shen.
E. Varicose veins: Combine with Gui Zhi Fu Ling Wan.
F. Diabetes: Most patients have a good appetite but are weak, with peripheral neuropathy, sores, hypertension, renal failure, heart problems. This is probably for type 2 diabetes.
Add Ge Gen, Chuan Xiong that reduce blood plasma glucose level. This has cerebral protective effects, heart protection, kidney protection. Makes body work better, lowers hunger.
G. Post-partum disease: spontaneous sweating or night sweating, generalized pain, numbness in the hands, atrophy in the legs
H. High fever or colds in the elderly
Case History: High fever of unknown origin
90 year-old man with diabetes, Parkinson’s, atrial fibrillation, and BPH, but mentally clear and physically fit. Previous spring, high fever with cold shivers, had septicemia, after using antibiotics the fever lowered, but then spiked again, he tried this several times with the same results. Happened once a month. Hospitalized and on various meds but no resolution. Current exam: hand trembling, legs unsteady, swollen legs, thick dry tongue fur, dull pale tongue, lower extremity edema, moderate pulse with occasional irregularity
Formula:
Huang Qi 60g.
Gui Zhi 10g.
Rou Gui10g.
Chi Shao 10g.
Bai Shao 10g.
Gegen 60g
Gan Jiang 10g.
Hong Zao 20g.
Water decoction, one bag for 2-3days.Take for 3 months.
From the time began herbs, temperature was normal. After 3months, no more fevers. Had ringworm of the nails that also resolved.

Fang Ji Huang Qi Tang
I. Indications

  • A. Traditionally used for lower extremity edema with soft, loose flesh and lack of strength

II. Original formula dosages

  • Han Fang Ji 4 liang
  • Gan Cao 2 liang
  • Huang Qi 5 liang
  • Sheng Jiang 3 liang
  • Bai Zhu 3 liang
  • Strongest for promoting urination, effective for pain. For a Huang Qi constitution, urination will increase to varying degrees. Dosage of Huang Qi and Fang Ji (30-60g each per day) must be large, Gan Cao very small, but this is original rx, don’t take Gan Cao out completely. Fang Ji important for joint pain in lower extremities, arthritis and gout, promotes urination, important for edema. Use large quantities.
  • Bai Zhu also promotes urination, expels water from whole body including interior.

III. Classical formula pattern

  • A. Original wind water
  • 1. Edema from waist down, heavy feeling in body.
  • 2. Copious sweating, aversion to wind, floating pulse.
  • 3. Joint pain, low back, knees, ankles, difficulty walking.
  • 4. This is wind water: the floating pulse indicates the exterior. The person may sweat from the head. No other exterior disease. The disease includes heaviness in the lower body. From the lumbar up, all is well. From the lumbar down is edematous and inflexible.
  • B. Important symptoms
  • 1. edema that is more distinct from the lumbus down and heavy body
  • 2. sweating and aversion to wind
  • 3: joint pain, especially knees and ankles, may also be heaviness in the joints, inhibited movement, and inflexibility

IV. Dr Huang’s dosages

  • Han Fang Ji 15g
  • Gan Cao 3g
  • Huang Qi 30g
  • Sheng Jiang 10 pc or Gan Jiang 10g
  • Bai Zhu 15g
  • Hong Zao 20g

V. Diseases

  • A. Idiopathic edema, common in women, may combine with Wu Ling San, very effective. Hormone function of client is OK. Get lots of urine. May need to add Yue Bi Tang from Jin Kui Yao Lüe. Ma Huang with Huang Qi potentiate each other.
  • B. Musculoskeletal problems: arthritis of joint with deformity, rheumatoid and rheumatic arthritis, gouty arthritis, lower edema often present. If there is pitting edema, will probably work.
  • C. Lumbar disc herniation: can use with Huang Qi Gui Zhi Wu Wu Tang plus Huai Niu Xi
  • D. Gout: add Wu Ling San, this helps excrete uric acid, basic for gout.
  • E. Hypertension In cases with dull yellow complexion, edema in the lower limb, add Ge Gen, Huai Niu Xi, and Ze Xie . Use a very low dosage of Gan Cao if at all. If using Gan Cao one must add Ze Xie to counteract it.
  • F. Various diseases described in case histories below: intractable knee pain, lower body sweating, obesity, diabetes, diabetic ulcerations on lower extremities, body odor, and excessive sweating.
  • Case History: Intractable knee pain
  • Ms. Zhao, 54; multiple year history of bilateral knee pain that did not respond to acupuncture, tui na, herbs, Western meds, and Chinese herbs. Lower leg edema and knee tissue felt soggy, lack of strength, sweating, overweight, pale complexion, loose stool,
  • some redness in the legs. This was a very difficult case, there wasn’t much hope. She was Huang Qi constitutional type, overweight, sweat easily, etc.
  • Formula:
  • Fang Ji 10
  • Huang Qi 30
  • Bai Zhu 25
  • Gan Cao 3,
  • Sheng Jiang 2
  • Da Zao 10
  • Niu Xi 30
  • Dan Shen 15
  • Shi Hu 12
  • Chi Shao 15
  • Ze Lan 10
  • Ze Xie 10
  • Di Long 6
  • 7 packs.
  • Commentary: This was a case of a student of Dr. Huang. The first formula is the classical one, the next 4 additions are those of Dr. Huang’s for the legs, the last additions are those of the student. 2nd visit: edema and pain both reduced. He added Mu Li and Lu Xian Cao. After 14 packs all symptoms reduced, including sweating.
  • Case History: Sweating
  • 33 year-old man had surgery for tibial fracture and ligament tear. After had abnormal sweating from the same leg and pain. Patient well-built, skin of left leg was darker and sweat was copious, so pants and socks were wet. Dull red tongue with thick slimy yellow fur. Pulse small, soft, and slightly rapid. They tried Si Miao San plus Qin Jiao, Wei Ling Xian, and Wei Mao. This helped with pain, but sweating was mostly the same. The sweat was copious, but not foul-smelling, tongue fur had become thin.
  • They changed the formula to: Fang Ji Huang Qi Tang
  • Fang Ji 10
  • Huang Qi 12
  • Cang Zhu 10,
  • Zhi Gan Cao 5
  • Sheng Jiang 4 pc
  • Hong Zao 3 pc.
  • After 3 packs, sweating reduced. Added Wei Ling Xian 15 for 4 more packs.
  • Case History: Obesity
  • Ms. Wang, 46, last year after her period came found she had gained 8 kg. Symptoms included shortness of breath, copious sweating that was worse with exercise, heaviness of the limbs, lack of mental clarity, poor appetite, hypersomnia, loose stools, easily caught cold. Pale enlarged tongue with tooth marks and a white slimy fur. Slippery pulse.
  • Formula:
  • Fang Ji 60
  • Huang Qi 60
  • Bai Zhu 30
  • Cang Zhu 15
  • Fu Ling 15
  • Ze Xie 15
  • Jiao Shan Zha 20
  • Yin Chen Hao 20
  • Gan Cao 6,
  • Chen Pi 10
  • The patient was extremely obese so needed very large dosages. Upper body sort of OK, but middle body big and legs swollen with pitting edema. Can add Wu Ling San.
  • Case History: Diabetes
  • (This has not been translated, see the power point) Report from Japan, 11 cases of overweight diabetic patients. Used granules for six months, blood sugar, cholesterol, glyiscerides improved with significant weight loss.
  • Case History: Diabetic ulcerations on lower extremities
  • (See power point and picture) Report from Japan Edo period. Ulcers can go to bone, clear pus coming out, loose flesh, but with edema. We see this today. Need large dosage of Huang Qi to reduce swelling and generate new flesh. Dr. Huang would use this and his 4 herb addition.
  • Case History: Body Odor
  • Formula:
  • Fang Ji 30
  • Huang Qi 30
  • Bai Zhu 15
  • Gan Cao 6
  • Sheng Jiang 9
  • Da Zao 20
  • Used to treat 12 cases of body odor, all cured in 2-6 months. Report of 15-year case of body odor, patient obese, soft loose flesh, underarm sweating copious, fatigue.
  • After 2nd day on this formula, large amount of urine and sweating reduced. Symptoms gradually abated.
  • Case History: Excessive sweating
  • 24 year-old woman with excessive armpit sweating that stained her clothing yellow and was foul-smelling. Worse around period and in summer. Reduced taste, poor appetite, fatigue, loose stool, late period with pale blood, obese, liked to eat rich foods, pale tongue with turbid white fur, floating slippery pulse.
  • Formula:
  • Fang Ji 30
  • Huang Qi 30
  • Bai Zhu 15
  • Cang Zhu15
  • Fu Ling Pi 20
  • Ze Xie 20
  • Che Qian Zi 12
  • Che Qian Cao 12
  • Gan Cao 6
  • After more than 20 packs, was cured. Used Fang Ji and Huang Qi up to 60g. This can be used for underarm sweating, especially in summer. Effective because reduces sweat? Odor itself hard to deal with, but reducing sweating helps the situation.

VI. Constitution

  • A. Copious sweating, easily sweating, sweat is yellow and/or foul-smelling
  • B. Edema, especially in the lower extremity, often accompanied with knee pain
  • C. Large, soft abdomen, buttocks and legs soft and saggy
  • D. Common in middle-aged and elderly women

VII: Explanation

  • A. The formula promotes urination. Huang Qi constitution: person is like a bag of water. After using this formula, urination will increase to varying degrees.
  • B. Dosage of Huang Qi and Fang Ji must be large (60 g or more), but Gan Cao should be small ( 3-6 g).

Yu Ping Feng San
I. Indications

  • A. Traditionally used to consolidate the exterior and stop sweating
  • B. Used for fatigue, spontaneous sweating, aversion to wind

II. Original formula dosages

  • Fang Feng 1 liang
  • Huang Qi 1 liang
  • Bai Zhu 2 liang

III. Dr. Huang’s dosages

  • Huang Qi 15g
  • Bai Zhu 20
  • Fang Feng 15
  • Cook in 1000ml of water for 40 minutes to get 2300 ml. Divide and take 2-3 doses. Can also be used as a powder

IV. Constitution

  • A. Layered over normal Huang Qi type: sweat easily, aversion to wind, easily, allergic, nasal congestion, cough or asthma, colds, easily becomes itchy, i.e. more respiratory problems than previous rx.
  • B. Easily has diarrhea or stool that is not fully formed
  • C. Easily develops edema, especially in the lower leg

V. Suitable Diseases

  • A. Copious sweating following chemotherapy or radiation for cancer: use with Zhen Wu Tang and Huang Qi Gui Zhi Wu Wu Tang for low-grade fever and copious sweating following chemo for myeloma
  • B. Post-surgical abnormal sweating :with Huang Qi Gui Zhi Wu Wu Tang for
  • sweating or slow wound healing after appendectomy.
  • Case History: Myeloma
  • Dr. Huang’s patient had many myelomas, very difficult therapy. She was very afraid of cold, sweating, fever. She said was done with chemo, not afraid to die, used Yu Ping Feng San with 60g of Huang Qi, plus Zhen Wu Tang and Gui Zhi. [and Huang Qi Gui Zhi Wu Wu Tang?.] After a week much better. Continued to treat her, she also had proteinuria from chemo damage, gave her that congee formula. She recovered.
  • Case history: Post surgical abnormal sweating.
  • Abdominal surgery, wound not healing, lots of sweating, added Huang Qi Gui Zhi Wu Wu Tang to get wound to close.

VI. Other Diseases

  • A. Pediatric diabetes: may add Gou Qi Zi to keep insulin stable
  • B. Recurrent respiratory infections in children or the elderly: can be considered like Chinese medicine gamma globulin
  • C. Pediatric allergic rhinitis
  • D. Chronic kidney disease: Use with Zhen Wu Tang and Huang Qi Gui Zhi Wu Wu Tang for proteinuria from chronic nephritis
  • E. Also for diabetic kidney disease and copious sweating in diabetics
  • Case History: Fissures in the skin of the hands and feet
  • Elderly farmer with cracked skin on hands and feet for months that were itchy and painful, severely affecting life quality. He was yellow and swollen.
  • Formula: Yu Ping Feng San plus Huang Qi Gui Zhi Wu Wu Tang with Huang Qi @ 60g
  • After 2 packs, no more itching or pain. After one week, fissures had healed. After 2 weeks, skin was healthy looking.

VII. Explanation

  • A. Small dosage, long duration.
  • B. According to Yue Mei Zhong: treated a patient for exterior deficiency with spontaneous sweating using large dose in decoction. After 3-5 packs, symptoms stopped. Then recurred and same formula again produced effect. Then recurred
  • again. Seemed like formula could not produce lasting effect. Saw Pu Fu Zhou
  • treat a similar pattern with powdered formula, 9 g per day, taken for 1 month.
  • Sweating stopped and did not recur.

VIII. Yu Ping Feng San vs. Huang Qi Gui Zhi Wu Wu Tang

  • A. Both formulas treat spontaneous sweating
  • B. Yu Ping Feng San: immune system irregularity, diarrhea, yellow complexion, edema, respiratory and kidney diseases common, more common for pediatrics
  • C. Huang Qi Gui Zhi Wu Wu Tang: irregularity in neurovascular system, muscle pain, dizziness,
  • palpitations, dull purple tongue, vascular and joint diseases common, more common for elderly

IX. Yu Ping Feng San vs. Fang Ji Huang Qi Tang

  • A. Both treat copious sweating and edema
  • B. Yu Ping Feng San: fear of wind, nasal congestion: problems related to respiratory system: wind in the upper
  • C. Fang Ji Huang Qi Tang: lower extremity joint pain: damp in the lower

X. Fang Feng

  • A. Fang Feng is very useful:
  • 1. Joint pain with Bai Shao , Gan Cao, Qiang Huo, for joint pain, both arthritis.
  • 2. Itching, anti-allergic, with Chai Hu and Jing Jie and Bo He to work like this. Pollen allergies, itchy.
  • 3. Immune system disorders with Huang Qi, Bai Zhu and can add Chai Hu. Xiao Chai Hu Tang, Shan Yao Gan Cao tang + Fang Feng is especially good for liver disease. Sjogrens, autoimmune disease, since Fang Feng acts on the immune system.
  • 4. Abdominal pain, Tong Xie Yao Fang, with Bai Shao, Chai Hu , Gan Cao.

Eric Brand on Raw vs Processed Huang Qi:

Huang Qi was initially processed by simply discarding the “neck” of the root, a practice that dates back to the Jin Gui Yao Lue (“Essential Prescriptions from the Golden Cabinet”). Steaming was added a few centuries later in the Lei Gong Pao Zhi Lun (“Master Lei’s Treatise on Drug Processing”). Honey-processing for Huang Qi developed in the Song dynasty (960-1280 CE). Other adjuvants for Huang Qi processing came later, such as wine, ginger juice, rice water, and even human breast milk. Today, the two most popular forms of Huang Qi on the market are the crude form and the honey processed form.

Honey-processed Huang Qi is made by mixing purified honey with water (in Chinese medicine, honey is often boiled before use to make “purified honey,” known as Lian Mi). The water-honey mix is used to briefly soak the Huang Qi, and then the Huang Qi is dry-fried until it becomes deep yellow and is no longer sticky. A toaster oven is often used in the modern day; the honeyed astragalus is simply baked at a low temperature until it becomes deep yellow and dry.

Unprocessed Huang Qi, called Sheng Huang Qi or simply Huang Qi, is the best form for boosting the defense qi to secure the exterior. It is also preferred for drawing toxin and engendering flesh. Finally, unprocessed Huang Qi is best for disinhibiting urination to reduce swelling. It is generally used for spontaneous sweating or the tendency to catch common colds easily due to insecurity of the exterior with weak defense qi (wei qi). It is also indicated for qi vacuity patterns of water swelling and for flat- and welling-abcesses that fail to rupture or rupture and fail to close. Exemplary formulas include Yu Ping Feng San (Jade Wind-Barrier Powder), Fang Ji Huang Qi Tang (Fangji and Astragalus Decoction), and Tou Nong San (Pus-Outthrusting Powder).

Honey-processed Huang Qi, called Zhi Huang Qi, Mi Huang Qi or Huang Qi (Mi), tends to be moistening and is best for boosting qi and supplementing the middle burner. It is used for spleen-lung qi vacuity with reduced food intake, sloppy stool, shortness of breath, and lack of strength. It is also indicated for center qi fall manifesting in enduring diarrhea, rectal prolapse or uterine prolapse. For bleeding due to spleen qi failing to contain the blood, the honey-processed form is also preferred. Exemplary  formulas include Gui Pi Tang (Spleen-Returning Decoction) and Bu Zhong Yi Qi Tang (Center-Supplementing Qi-Boosting Decoction).

Jiao Shu-De sums up the differences succinctly in his Ten Lectures on Medicinals text: “used raw, Huang Qi moves in the exterior…used mix-fried its emphasis is on the interior.” Despite these stated differences and the emphasis from pao zhi texts, there are a few discrepancies around. For example, multiple pao zhi texts state that the action desired for the formula Yu Ping Feng San is best accomplished with the crude product, but the original source text for the formula specified honey-processed Huang Qi.

Link to Thorne Monograph

 

Dose: 9-60g

Ren Shen – Ginseng root – Panax ginseng – “Man Root”

Nature: sweet, slightly bitter, slightly warm

Enters: Spleen, Lung   (some say also Kidney and Heart)

Actions: Powerfully tonifies the source Qi; tonifies Lung Qi; tonifies spleen and stomach Qi; generates body fluids, eases thirst; benefits heart Qi; calms the Shen; slightly nourishes Yin; improves wisdom; the red form (steamed) tonifies Yang.

Indications:
• Qi collapse (as after severe vomiting, diarrhea, bleeding): cold sweats, shallow breathing, shortness of breath, cold limbs, weak and feeble pulse.
Ren shen can be used alone after severe blood loss.
• Spleen Qi deficiency: fatigue, poor appetite, distended epigastrium, chest, or abdomen, vomiting, chronic diarrhea, prolapse of stomach, uterus, or rectum.
• Lung Qi deficiency: shortness of breath, spontaneous sweating, weak pulse, labored breathing, wheezing (usually also a concurrent failure of the kidneys to grasp the Qi).
• Body fluid injury: thirst, wasting and thirsting disorder, injury of body fluids by high fever and profuse sweats.
• Heart Qi/blood deficiency: palpitations, anxiety, insomnia, forgetfulness, restlessness, lots of dreams.
• Adaptogenic: long-term use makes one better able to deal with stressors (temperature changes, fatigue, infection, etc.).
• Has both stimulatory and sedative effects on the CNS.
• Accelerates transmission of nerve impulses, shortens latency period of nerve reflexes.
• Can improve myocardial utilization of nutrients and cardiac function.
• Increases synthesis of proteins and nucleic acids.
• Diabetes: may lower blood sugar and glucosuria, seems to act synergistically with insulin.
• Cultivated forms of ginseng are called Yuan shen.
• Ginseng cured in rock candy, Bai shen/Tang shen is used for Qi and Yin deficiency patterns, especially for the spleen/stomach.
• The small inexpensive rootlets are called Shen xu.
• Fresh-dried ginseng, Sheng shai shen can nourish Yin, and is similar to Xi yang shen (American Ginseng).
• When cured by steam, ginseng turns red – Hong shen – and is warmer, for Qi and Yang deficiency (can rescue devastated Yang).
• Most Korean ginseng is stronger than Chinese and is usually the red form.
• The white form is generally cooler than red.
• Quality is difficult to determine. One measure is that tap root and all lateral rootlets are intact and unbroken, though others dispute the significance of this factor. Another measure is the straightness of the root (where straighter is better). Size and age are the most general indicators of potency. Wild is considered better than cultivated.
• Because of its expense, the herb is often decocted separately in small amounts of water in a double boiler.
• The antidote for ginseng overdose (with symptoms such as headache, insomnia, palpitations, and a rise in blood pressure) is mung bean soup.
Jin: Use 30-50g alone (especially the red form) to stop bleeding from (spleen) deficiency.
PFGC: Can be used for fevers: where the patient’s righteous Qi is constitutionally weak and pathogens are trapped inside.
• Can be used for any deficiency – even with heat or bleeding.
• With Sheng ma, it can drain Lung fire.
• With Fu ling, it can drain kidney fire.
• With Mai men dong, it can boost the pulse.
• With Huang qi and Gan cao, it can lower fever.
• Useful for deficiency pain.
• The imperial herb for slight Yin deficiency with severe Yang deficiency leading to steaming sensations due to the Yin not being able to contain the vital fire.
• Can nourish Yin and produce blood.
• (In the proper context:) it boosts earth to generate metal, brightens the eyes, opens the heart, invigorates mental clarity, nourishes the Jing, supplements the Shen, controls palpitations, resolves thirst, dispels restlessness, opens the channels, boosts the pulse, breaks up accumulations, eliminates phlegm, cures all conditions involving Qi deficiency and blood injury.
• Not for Yin deficiency fire causing asthma and coughing.
HF: Patients with Gu Zheng (Gu parasites) tend to react negatively to Ren shen.
Hsu: Acts synergistically with insulin to lower blood sugar; antidiuretic; lowers blood cholesterol; increases protein synthesis; stimulates sex hormones; cardiotonic.
CHA: (Al Stone, 9-26-2000)
I. Yuan Shen (“Garden Ginseng,” meaning cultivated ginseng)
A. Hong Shen (“Red Root”) Its color is brown and red. It is slightly transparent. After cleaning, it is steamed two to three hours, then oven dried or sun dried. This is the most common variety of Yuan shen. Its smell is very pleasant, with a slight bitter taste.
B. Bian Tao Shen (“Edge Long Root”) Similar to red ginseng in color and quality. It is longer that red ginseng with a greater diameter. Its branch, too is longer and wider. This suggests a better quality medicine than red ginseng. C. Tang Shen (“Sugar Root”) First the Yuan shen is placed into boiling water for 3 to 7 minutes, then placed into cold water right away to soak for about 10 minutes, then sun dried. Liu huang (sulfur) is burnt beneath the ginseng to smoke it. The essence of the Liu huang passes into the ginseng via the smoke. This may be a preservative for the ginseng to keep it free of worms. They use a special needle to puncture tiny holes in the root. Then they place the ginseng into highly concentrated sugar water for more than 24 hours. Then the ginseng is placed under direct sunlight to dry it out. Then they beat the ginseng with a wet towel to soften, and repeat the process from the punching of the holes. Once it has been in the sugar water again for 24 hours it is rinsed off and sun- or oven-dried. The color becomes a lighter yellow/white. The smell is pleasant. The taste is sweet and slightly bitter.
D. Bai Ren Shen (“White Man Root”) Quality and shape is a kind of like sugar shen. Most of the time it has a good shape (straight) and is very white. It is longer than red ginseng. The ginseng’s beard (the long hairy roots at the end of the branches) is short, but very brittle.
E. Sheng Shai Shen (“Raw Sun-dried Root”) This kind of ginseng is washed until clean and then partially dried by placing in the sun for one day (one full day of very clear, brilliant sunshine). The next day, it is smoked with Liu huang, possibly as a preservative. Then the sun-drying process is continued until completely dried. The color is mostly yellow, a little brown. It is crisp and lighter now. The smell is pleasant. The taste is bitter.
F. Bai Gan Shen (“White Dry Root”) The superficial skin of the root is scratched off. The color is light yellow or white. It is called “white” because it has been made lighter by the scraping of the skin. Quality and shape are similar to Sheng shai shen. G. Qia Pi Shen (“Strangled Skin Root”) The method of preparation is similar to Tang shen: Put ginseng into boiling water for 3 min, then remove until cold, then replace into the boiling water. Repeat until the it has been bathed three times. At this point, root will be 30% done. Then, put the it into boiling water for 20 minutes. Remove it, let it cool, and punch tiny holes in it as with Tang shen. Then place it into slightly sweetened sugar water (nowhere near as concentrated as for Tang shen). Then remove and oven dry. This will cause the skin to separate from the meat. Then use a bamboo knife to make small indentations into the root, very superficial. The smell if pleasant. The taste is slightly sweet and slightly bitter as typical ginseng.
H. Da Li Shen (“Great Force Root”) Take fresh raw ginseng for several seconds and remove. [sic] Then dry very well beneath the sun (as many days as necessary until fully dry). This is the most natural form of ginseng. This kind of ginseng is not often exported because it has a short shelf life. It is the strongest and least prepared. It has a slightly yellow color and is slightly transparent. The beard and branches are cut off to leave only the best part of the ginseng, however the head is left on for consumers to better assess the quality of the herb. This root is hard and crisp. Smell is pleasant, taste is bitter.
II. Ye Shan Shen (“Wild Mountain Grown Root”)
The shape looks like garden ginseng. The body of the root is wider and shorter. Usually there are two major branches to the body, which makes the root look like a body with two legs. In the head you will find numerous concentric wrinkles. The legs tend to be curved, not straight like garden ginseng. The root beard (small rootlets) is much longer than that of garden ginseng – one or two times the length of the “legs” of the root. The beardy roots also have pearly spots on them. This is the biggest difference between wild and cultivated ginseng – them pearly whites. Wild ginseng’s color (of the whole body) is a light yellow. The skin of the root is very soft. Its natural smell (before cooking) is stronger than garden ginseng. It is sweet, with a light bitter quality also. The preparation procedures are different. There are three methods of preparation (see above for details): 1. Sheng shai shen 2. Tang shen 3. Qia pi shen
Wild Ginseng of the best quality is very large and juicy, full of liquid. Wrinkles that are small and compact are better than wide and thick wrinkles. Longer head is better than a short one. The more pearls on the beard roots the better.
III. Korean Ginseng [Gao Li Shen or Chao Xian Shen]: Korean ginseng, of course, grows in Korea. It, too, comes in both wild and garden varieties. The more northern, the better, though it is grown in the South as well.
Bei Zhi Shen (“Fork in the Road Straight Root”). Probably named because the herb is a little bigger and the legs resemble a “Y” in the road. These roots have a stronger tonification function.
Production: There is Korean red ginseng and Korean white ginseng. Red is better, stronger than white. Preparation is the same as Chinese ginseng.
SD: Ginseng (Panax ginseng) has been a prominent herb in Chinese medicine for at least twenty centuries. Due to scarcity of the herb at various times, its use has been restricted and substitute herbs have replaced it in certain prescriptions. For example, in China, most prescriptions that would otherwise contain ginseng are made with the less-expensive herb codonopsis.
Classically, ginseng is used to restore vital energy (qi) and to generate fluids (especially for the stomach). A major use was for the recovery from debilitating feverish diseases which parched the body fluids and drained energy. It was also relied upon as a sedative and longevity tonic. Through extensive experience with its use, the number of indications for it increased. The diversity of ginseng actions that were claimed was the basis for its original description as a panacea by Western visitors to China centuries ago. The official genus name, Panax, comes from the word panacea. When Western-style research was initiated in the Orient on a large scale following World War II, ginseng became the primary subject. Its chemical constituents were analyzed, and numerous physiologic actions were determined. These include reduction of stress reaction, normalization of blood pressure and blood sugar levels, increase in endurance, improved mental functions, resistance to disease (and to chemicals and radiation), longer life span, and anti-tumor activities.
Much of the ginseng research during the past few years has done little more than reconfirm previous findings about ginseng’s ability to normalize body functions. These general findings are displayed in Appendix 1. Different
dosages, methods of preparation, and testing situations are tried out in some of the recent studies. Sometimes the results appear contradictory, but as the information accumulates, many of the results can be reasonably explained. The current thrust of research is in three areas: immune system actions, cardiovascular effects, and hormonal effects.
IMMUNE SYSTEM STUDIES
At the Institute of Traditional Chinese Medicine in Jilin Province (where ginseng is grown), researchers in the pharmacology department evaluated the effects of ginseng on immune responses. The immune responses of mice were tested with different dosages of ginseng extracts obtained either from the leaf or the root of ginseng. Significant changes in the response of the reticuloendothelial (RES) system were found,especially with moderate doses of the root extracts. Larger doses did not improve the response. RES cells are the immune system components that devour foreign organisms without leaving their original sites in the liver, spleen, and other tissues of the body. When tumors were implanted in mice, the response of the immune system was notably improved by the ginseng extracts and this caused a reduction of tumor weight by 1/3 to ½. Levels of antibodies in the blood were also significantly increased when the mice, injected with foreign blood cells, had received ginseng pre-treatment. In these experiments, ginseng was administered daily for five to ten days prior to testing the immune system responses. In human patients undergoing cancer therapies with radiation or chemical agents, it was shown that the anti-cancer effects of these therapies were increased. Ginseng administration accelerated recovery of the immune system and the function of the bone marrow (producing red blood cells) in these patients. As a result of these investigations, ginseng extracts are now used to treat patients with chronic hepatitis (who often suffer further depression of immunity due to steroid treatment) and those who have undergone cancer therapies.
A distant relative of ginseng, eleuthero ginseng (Eleutherococcus senticosus), is used in Chinese hospitals to treat cancer patients undergoing chemotherapy. It protects the immune system and is used in the Soviet Union as a preventive for colds and flu.
THE HORMONAL SYSTEM
It was established by modern research in the 1970′s that ginseng relieves stress on the adrenal glands. It has recently been proven that both ginseng and deer antler, a Chinese health tonic often combined with ginseng, affect luteinizing hormone (LH). In laboratory experiments at the Department of Physiology at Jianxi Medical College, animals were given ginsenosides from ginseng and the active fraction from deer antler. Luteinizing hormone secretion increased dramatically, about ten fold. This hormone influences the menstrual cycle in women and it stimulates testosterone secretion in men. Ginseng and antler extracts were also shown to increase testosterone secretion in males; this can help overcome impotence and will have an influence on muscular development. In the laboratory experiments, a 45″“ 90% increase in testosterone levels was found. Ginseng and deer antler have been used for centuries in Chinese remedies for menstrual disorders and for male impotence; this research confirms their efficacy. Luteinizing hormone is produced by the pituitary gland, so it is proposed that ginseng and deer antler ingredients do not have a direct hormonal action but instead influence the production of hormones by the body. In Italian studies of ginseng activity on the glands and hormone secretions in mice, the findings suggested that ginseng has a strong influence on the hypothalamus and pituitary glands, and that the adrenal effects of ginseng that are often noted were linked to these glands. Ginseng extracts of varying strength were given to normal rats and to rats who had their adrenal cortex removed. Based on the biochemical and histological evaluation of their spleen, liver, thymus, and other organs, it was suggested that ginseng induced the pituitary to release ACTH (a steroid hormone also produced by the adrenal cortex), which influenced the functions of the organs. It is generally agreed by researchers today that ginseng exerts its effects on what is called the “pituitary, hypothalamus, adrenal axis.” The term indicates the coordinated functions of these three glands in regulating metabolism, response, and homeostasis. Furthermore, this set of interacting glands may have been indirectly recognized for centuries by the Chinese as a functional unit influencing stress, aging, sexual function, and overall vitality. In the translation of Chinese medical terminology to Western terminology, this functional unit has been assigned to the “kidney.” Hence, one hears Chinese medical specialists frequently speaking of kidney functions we never otherwise associate with the kidney. In fact, the functional unit appears to rely heavily on the pituitary, hypothalamus, adrenal axis. As a result of the hormone research, we have a clearer picture of the ancient science of Oriental medicine. The hormonal effects are usually noted with higher dosages of ginseng. In one of the Swiss studies of athletes using relatively low ginseng dosage (equal to 1.0 grams of ginseng per day), hormone levels were monitored and no significant change was observed. Studies demonstrating a strong hormonal effect used the equivalent of about 3.0 grams per day of ginseng. During a double-blind study of the effects of ginseng conducted by the Institute for Traditional Medicine in the U.S., it was noted that large doses of ginseng (3.0″“4.5 grams per day) appeared to influence the menstrual cycle of women. Reports of altered cycle length or change in bleeding pattern during menstruation were made by 29% of the women receiving ginseng daily for three weeks. For the purpose of regulating menstruation, ginseng is usually combined with tang-kuei and other Chinese herbs, and not used alone.
CARDIOVASCULAR IMPACT
Until recently, Chinese dogma held that ginseng was to be reserved for those who were ill and for those who are showing the effects of aging. Korean and Japanese experience, however, suggests that ginseng can be taken everyday as a preventive health tonic. Now, research shows clearly that one need not be ill to use ginseng: even the healthiest among us may have cause to use it. Athletes, whether beginning joggers or Olympic contenders, agree that ginseng helps them overcome the strain and drain of exercise. A recent Swiss study conducted by Dr. Anton Kirchdorfer shows how ginseng helps. Thirty athletes were given exercise tests on a programmed exercycle to assure a specific level of muscle work. The heart rate and lactate concentration in the blood was measured before, immediately after, and for several minutes following the exercise. Strong exertion for eight minutes raised the athletes heart rate from an average value of about 70 to 155. During recuperation, their heart rate slowly returned to normal over a period of about 20 minutes; their heart rates fell below 100 after 4″“5 minutes. The athletes were then given ginseng daily for 9 weeks. The material used was a standardized extract of active constituents called “ginsenosides.” The tests were conducted again, using the same amount of exercise. Their pulse rates this time increased to only 140, and during recuperation their heart rates fell below 100 within just 3 minutes, and were back to normal in 5 minutes. Lactate (the by-product of muscular oxygen utilization that causes pain following exercise) was measured during the same tests. Before using ginseng, the lactate levels of the athletes increased from 2.0 before exercise to 10.5 afterwards, without returning to normal levels even after 20 minutes. Following 9 weeks of ginseng administration, lactic acid levels only reached 6.2 at their highest point, and decreased to normal in about twenty minutes. The lower heart rate and quicker return to normal suggests improved oxygen utilization and faster clearance of lactate. Additional measurements taken during this same research program demonstrated that reaction time was improved and pulmonary function was greatly enhanced. The effects of ginseng given for 9 weeks persisted for about three weeks after ginseng use was ceased. This persistence of herbal effects following long-term administration has been shown with other herb products. Traditionally, herbalists recommend a short break of one to two weeks when patients are using herbs for an extended period of time. This may be one way of getting the maximum advantage of the herbs used. The findings in this Swiss research are consistent with a previous double-blind study using the same ginseng extracts with 120 members of sports clubs. In that study, conducted by I. Forgo in Switzerland, significant improvements in pulmonary function, reaction time, and overall vitality (as self-evaluated) were found. These effects were especially noted in the 40″“60 age group, less so in the 30″“40 age group. The study lasted 12 weeks. The results obtained with athletes confirm laboratory animal studies that have been conducted in the past. Animals forced to perform vigorous exercise utilized less of their stored glycogen, fatigued less quickly, and generally performed better if they were first administered ginseng. Ginseng has been shown to increase the time which animals could keep up vigorous exercise by as much as 100%. Athletic-oriented research was conducted in China with tien-chi ginseng. Tien-chi ginseng is a close relative to ordinary ginseng, but it grows in a different climate, produces a harder root, and has somewhat different active constituents. The following is a summary of findings: 1. Under usual circumstances, pulse rates of weight lifters the morning after a day of intensive weight lifting did not return to normal levels. If they took tien-chi ginseng, on the other hand, their morning pulse did return to normal. 2. The pulse rate of swimmers following a medium-load training session was about 170, and after 2″“3 minutes rest, it was reduced to about 120. But if tien-chi ginseng was taken, the pulse right after swimming only reached about 125, and returned to normal rates (about 70) after 2″“3 minutes. 3. Differences between those not taking tien-chi ginseng and those taking tien-chi ginseng increased as use of the ginseng was continued over a longer period of time. The experiments were continued for 7 weeks (compared to 9 and 12 weeks for the Swiss studies). The study results with Panax ginseng and tien-chi ginseng are clearly similar to each other; further, they are similar to those obtained by Soviet researchers with eleuthero ginseng. Eleuthero ginseng is a distant relative of these plants; it is a woody shrub, with significantly different chemical constituents, but is used in much the same way as Panax ginseng. Soviet athletes regularly use eleuthero ginseng extract as a health tonic. With regard to oxygen consumption, these three types of ginseng have all been successfully tested in the treatment of oxygen deficit among Chinese workers transferred to the high plateau of Tibet (average altitude: 14,000 feet). This application follows up laboratory animal studies measuring response and survival rate of animals subjected to very low pressure atmosphere. Thus, it does not seem to be a critical concern as to which kind of ginseng is used for this purpose. Some athletes prefer to use several types of ginseng at once. Tien-chi ginseng has the advantage of resolving bruises and other injuries that often occur during sports activities, so it may be especially useful to those just starting an exercise program and those involved in more vigorous sports for that reason. It is gratifying for researchers to see human trials yielding results similar to those obtained during laboratory animal tests; this suggests that the models used in the laboratory were properly chosen.
THE ACTIVE CONSTITUENTS OF GINSENG
One problem with earlier ginseng research is that each scientist might utilize a different quality of ginseng and there may be no data indicating the content of the material that was used. Today, there are established chemical assays to assure that ginseng used in studies is of good quality. In fact, for the purpose of scientific precision, most researchers are using standardized ginseng extracts (the amount of selected active ingredients are standardized). Nearly all ginseng researchers claim that ginseng’s actions are attributable to the combined effect of its glycoside components called ginsenosides (they were previously called panaxosides). These components have a structure similar to steroid hormones, but as indicated by research cited above, they do not have a direct hormonal action; rather, they influence the production of hormones. Eleutherosides, the glycoside components found in eleuthero ginseng, generally do not have a steroid structure. There are at least ten ginsenosides present in Panax ginseng and tien-chi ginseng in quantities that can have a notable physiologic effect. Eleuthero ginseng contains at least seven eleutherosides. If the ginsenosides are isolated individually and tested in laboratory animals, it is found that each has a somewhat different, and sometimes opposite effect. The balancing action of ginseng””for example, lowering blood pressure in those with hypertension and raising blood pressure in those with hypotension””is thought to be due to the complex interaction of different glycoside effects. Thus, to get the desired balancing action of ginseng, it is necessary to utilize the complete set of glycosides. Depending upon the species of ginseng and other factors, its content of glycosides ranges from about 4% to 12% (tien-chi ginseng has the highest levels). White ginseng has the lowest levels of ginsenosides because, during the drying process, enzymes in the ginseng roots break down these active ingredients. Red ginseng is prepared by a steaming process that prevents this breakdown of constituents. Ginsenoside content, both total amount and distribution amongst the different types of ginsenoside, is used as a measure of ginseng quality. Chinese researchers working with flowers of eleuthero ginseng at the Department of Pharmacology, Shanghai College of Traditional Chinese Medicine, demonstrated that the oil fraction had a high activity in reducing stress. Laboratory animals exposed to low oxygen environment or high levels of physical activity performed much better if they received eleuthero flower oil than if they did not. Thus, the oil components, which are different than the glycosides, may be of importance. All parts of the ginseng plant contain a small amount of oils. Furthermore, polysaccharides have been isolated from ginseng and eleuthero ginseng. These components are valuable in enhancing immune system functions. Polysaccharides of similar nature found in medicinal mushrooms such as ganoderma and shiitake, and in Chinese herbs with actions similar to ginseng, such as astragalus, have all been shown to boost weakened immune responses. It is important to note that the same polysaccharides that enhance immune responses also tone down aberrant immune responses associated with autoimmune diseases. Interestingly, a plant unrelated to ginseng, Gynostemma pentaphyllum, was recently shown to contain several ginsenosides. This plant has become an important therapeutic agent in China during the 1990′s, being used to help improve immune system functions in cancer patients. The clinical benefits of this herb suggests that the ginsenosides are the most important of the immune-enhancing agents in ginseng.
From the information presented above, it should be evident that ginseng is to be taken for a period of time before one expects to see substantial results. Some people experience immediate effects, but in general, the use of a ginseng product should continue for at least one week to one month before one looks for notable changes in health and performance. A two to three month period of use may be ideal. Nearly everyone can use ginseng, but experienced Chinese herbalists recommend that persons with the following conditions do not use ginseng except under the advice of a professional: persons with extremely high blood pressure, those who tend to get spontaneous nose bleeds, women with excessive menstrual bleeding, and persons who experience a hot and dry feeling frequently. Ginseng is one of the few Oriental herbs that can be used by itself with good results. However, outside of Korea, where it is frequently used as a single herb remedy, ginseng is most often used in combination with other herbs.
Effects of Ginseng from Earlier Research Studies
Blood Pressure: hypertension patients experience a reduction of blood pressure using low to moderate doses of ginseng; hypotensive patients experience an increase of blood pressure using moderate to large doses of ginseng.
Blood Sugar: diabetic patients experience some lowering of blood sugar with prolonged use; at least one month.
Central Nervous System: calming action in cases of insomnia in low dosage, stimulant action in cases of lethargy, poor digestion, chill, and mental dullness in larger doses.
Stress: reduces stress reaction, including depletion of vitamin C, glycogen, and protein, and preserves life against many physical (e.g., temperature, low oxygen, radiation), chemical (e.g., liver toxins), and biological (e.g., viral) stresses.
Active Constituents of Ginseng
Panaxosides and Eleutherosides: these are glycosides that have been intensively studied. They seem to have many of the central nervous system and cardiovascular effects.
Polysaccharides: these are highly branched chains of sugar molecules; they appear to have a normalizing effect on immune system functions.
Phenolic Compounds, other complex alcohols, and organic acids: these have been recently studied; it is suggested that they contribute an anti-aging effect and reduce fatigue.
Fixed and Volatile Oils: these have an anti-stress effect and are sedative in nature.
Vitamin and Mineral Components: ginseng contains B vitamins and a number of minerals; however, it is unlikely that the amounts contained in the average daily dose of ginseng have much health impact. Nonetheless, ginseng can be classified as a nutritious food. Some authorities believe that ginseng was originally eaten raw or in soups as a food which provided energy and quenched thirst.

Dose: 1-9g (or more for shock) For Qi collapse, cook 30-60g for one hour and drink

 
Ren Shen Lu: the neck/head of root
• Mild emetic (rare use): used to induce vomiting to eliminate phlegm for epilepsy.
• Also for food stagnation and phlegm with deficiency.

 
Ren Shen Ye: the leaf
• Bitter, slightly sweet, cold.
• Clears summer-heat; generates body fluids.
• Treats deficiency heat/fire.
• Summer-heat with thirst.
• Injury to fluids from febrile disease.
• Lung heat: hoarseness.
• Stomach Yin deficiency fire: toothache.
• Drunkenness.

Shan Yao – Dioscorea opposita tuber – Chinese Yam – “Mountain Herb”

Nature: sweet, slightly astringent, neutral

Enters: Spleen, Lung, Kidney

Actions: Tonifies spleen, stomach, Lung, and kidney Qi and Yin; slightly controls body fluids; benefits both the Yin and the Yang of the Lungs and kidneys.

Indications:
• Spleen Qi deficiency: poor appetite, loose stool, fatigue, spontaneous sweating.
• Lung Qi/Yin deficiency: cough, difficulty breathing.
• Kidney Qi deficiency: seminal emission, copious leukorrhea, frequent urination.
• Slowly lowers blood sugar.
• For diabetes (Lung, stomach, kidney Qi deficiency or Qi and Yin deficiency): up to 250g per day, decocted and taken as a tea.
• Powder and make into jook to build spleen Qi and appetite.
• Use raw to tonify the Yin, dry-fry to strengthen the spleen.
• In some damp patients, Shan yao’s astringent quality contraindicates its use.
Li: Useful for nasal dripping – astringes.
PLB: Recent studies indicate that orally consumed diosgenin is not converted to progesterone in the human body. Does not have hormonal effects.
Yoga: Aluka: V, P-; K+ (in excess)
• Nutritive tonic, aphrodisiac, rejuvenative, diuretic, antispasmodic, analgesic.
• For impotence, senility, hormonal deficiency, infertility, colic, nervous excitability, hysteria, abdominal pain, cramps.

Dose: 9-60g (up to 250g/day for wasting and thirsting disorder)

Tai Zi Shen – Pseudostellaria root – “Prince Root” or “Child Root” or “Son of the Emperor Root”

Nature: sweet, slightly bitter, neutral

Enters: Spleen, Lung

Actions: Tonifies Lung Qi and spleen Qi; produces body fluids.

Indications:
• Spleen and Lung Qi deficiency: poor appetite, fatigue, palpitations, spontaneous sweating.
• Lung Yin deficiency: cough and thirst.
• Thirst and injury to fluids after a febrile disease.
• Unrelenting fever or summer-heat in children.
• Used with Wu wei zi to treat “neurasthenia”: fatigue, lassitude, depression, anxiety, etc.
• Similar to Xi yang shen, but gentle – weaker than Xi yang shen at tonifying both Qi and Yin.
• Can often be used as a substitute for Ren shen, especially in cases of liver Yang rising.
• Contraindicated for use with Li lu.
MLT: Very similar to Starflower (Trientalis borealis) of the Pacific Northwest United States.

Dose: 9-30g

Notes on This Category

• Herbs in this category are rich and tend to be greasy. Use caution when there is accumulation of dampness in the middle Jiao.
• These herbs are commonly combined with Qi tonics since Qi is necessary for blood production. They may also be combined with herbs to support their digestion (e.g., sha ren, chen pi, mu xiang, ji nei jin, shen qu, etc.) by promoting Qi circulation in the middle jiao.

The two major approaches to nourishing blood are:
1. Build blood directly with blood tonics.
2. Strengthen the digestive system (spleen Qi) to enhance the body’s own production of blood.
(A formula such as Dang Gui Bu Xue Tang, which is just Huang Qi [30g] and Dang Gui [9g], is a simple example of both approaches.)

• Also consider, as appropriate: Qi tonics, Yin tonics, Jing tonics; Gou qi zi, Sang shen, Bai zi ren, Ji xue teng, Dan shen, etc.

Bai Shao Yao – White Peony root

Nature: bitter, sour, slightly cold

Enters: Liver, Spleen

Actions: Nourishes blood; astringes Yin; softens the liver (by nourishing and astringing liver blood); relieves pain; subdues liver Yang rising; regulates the menses; adjusts the Ying and Wei; separates a mixture of Yin pathological factors.

Indications:
• Blood deficiency: irregular menstruation, abdominal cramps during menstruation, uterine bleeding, vaginal discharge.
• Yin deficiency leading to floating Yang: night sweats, spontaneous sweating.
• Liver blood deficiency: hypochondriac pain, costal pain, spasm in the limbs.
• Liver Qi stagnation, liver attacking the spleen/stomach: flank, chest, epigastric, or abdominal pain.
• Liver Yang rising: dizziness, headache.
Ying/Wei disharmony: exterior wind-cold from deficiency patterns with continuous sweating that does not resolve the problem.
• Painful spasms in the abdomen, cramping pain or spasms in the hands and feet, abdominal pain associated with dysenteric disorders.
• Vaginal discharge, spermatorrhea.
• The liver, the general, can easily become stiff, stagnant, overpowering – Bai shao softens it.
• This herb has a downward energetic.
• May lower blood pressure.
• Use raw to pacify the liver. Dry-fry the herb to nourish the blood and harmonize the Ying and Wei.
• Never to be combined with Li lu.
• Compared to Dang gui, both are used for pain and blood deficiency patterns. Bai shao is more appropriate for blood deficiency accompanied by heat, while Dang gui is used more for blood deficiency accompanied by cold.
MLT: Antispasmodic, blood moving.
• King’s American Dispensatory (Lloyd/Felter)lists indications of this herb as “chorea, epilepsy, spasms, various nerve affections”
PFGC: Can astringe heat that has floated to the upper warmer and entice it down and drain it via urine.
• Due to its bitter essence, it can enter the gallbladder and boost bile production.
• Excellent at purging liver/gallbladder heat, eliminating tenesmus in dysentery or treating eye disorders involving swelling and pain.
• With Fu zi, it can astringe escaping original Yang and entice it back to the lower Jiao (must use a high dose of Bai shao in this case).
HF: A supplement with an anti-Gu nature, possessing acrid, toxin-resolving qualities, useful in Gu Zheng (Gu parasites) formulas.
Hsu: Anti-spasmodic, analgesic, CNS sedative, antibacterial, may help prevent development of gastric ulcer.
DY: Harmonizes the constructive Qi; constrains and protects Yin; nourishes the blood and constrains Yin without attracting nor blocking evils in the interior; nourishes stomach Yin; relieves tension, stops pain; tropism: the Yin division.
• With Chai hu to drain the liver without damaging liver Yin, nourish the liver without causing liver depression Qi stagnation, regulate the spleen, stop pain effectively, harmonize the interior and exterior, and constrain Yin while upbearing Yang. For such indications as:
- 1. Liver depression Qi stagnation causing disharmony between Qi and blood.
- 2. Vertigo, unclear vision, chest and lateral costal oppression, pain, and distention due to liver depression Qi stagnation or to disharmony between the exterior and interior.
- 3. Menstrual irregularities, dysmenorrhea, breast distention, low-grade fever during the menses, premenstrual syndrome, and fibrocystic breasts, all caused by liver depression Qi stagnation or disharmony between the liver and spleen.
• The combination of Bai shao and Chai hu is effective for the treatment of liver and digestive problems caused by liver depression Qi stagnation or liver-spleen or liver-stomach disharmony, such as subacute or chronic hepatitis, hepatomegaly, cholecystitis, gallstones, enteritis, and colitis.
• With Chi shao to nourish the blood, constrain Yin, stop pain, cool the blood without causing blood stasis, and drain and nourish the liver. For indications such as:
- 1. Persistent low-grade fever due to heat in the blood. (Add Sheng di, Di gu pi, and Mu dan pi.)
- 2. Dry mouth and tongue, red and painful eyes due to insufficiency of fluids or Yin caused by residual heat. (Wine mix-fry both herbs and add Xiang fu and Dang gui.)
- 3. Lateral costal and chest pain, abdominal pain and conglomerations due to blood stasis or liver depression Qi stagnation.
- 4. Menstrual irregularities or amenorrhea caused by blood stasis, blood deficiency, and/or liver depression Qi stagnation.
• With Gan cao to engender Yin (sour + sweet), calm the liver, fortify the spleen, supplement Qi and blood, harmonize the liver and spleen, soothe the sinews, and stop pain. In this combination, 6-10g Gan cao and 10-15g (up to 60g) of Bai shao can be used. For indications such as:
- 1. Weakness in the lower limbs and spasms and pain in the limbs due to disharmony between the Qi and the blood which causes inadequate nourishment of the sinews and vessels.
- 2. Abdominal pain due to liver-spleen disharmony. If either disorder is accompanied by cold signs, use wine mix-fried Bai shao and mix-fried Gan cao. If the disorder is accompanied by heat signs, use raw Bai shao (or Chi shao) and raw Gan cao.
- 3. Headaches due to blood deficiency. (Add He shou wu, Bai ji li, and Jiang can.)
• The combination of Bai shao and Gan cao is very effective for numerous problems accompanied by spasms and pain, such as gastritis or colitis, spasm of the gastrocnemius muscle in the leg, contraction of the limbs, tendinitis, lateral costal pain, and hiccups or stubborn vomiting caused by spasm of the diaphragm.
• With Gui zhi to harmonize Yin and Yang, the Qi and the blood, and the constructive and the defensive. This combination drains without damaging Yin, while constraining without retaining evils. They harmonize the vessels, relieve tension and stop pain, as well as support stomach Yin and spleen Yang, while regulating the spleen and stomach. For indications such as:
- 1. Common cold with fever, shivers, slight perspiration, no thirst, headache, thin white tongue fur, and a floating, moderate pulse or, in other words, a wind-cold exterior pattern with disharmony between the constructive and the defensive. (Take Gui Zhi Tang. 10 minutes later, eat very hot rice porridge, and stay well covered in bed to promote perspiration.)
- 2. Spontaneous perspiration and/or night sweats accompanied by fear of wind and cold, a cold feeling in the low back, and frequent catching of colds due to disharmony between the constructive and the defensive. (Use stir-fried Gui zhi.)
- 3. Chest and cardiac area pain due to heart Yang deficiency and disharmony between the Qi and blood. (Use 15-30g Gui zhi. In case of very cold limbs, Fu zi can be added.)
- 4. Abdominal pain with spasms and cramps due to deficiency cold and disharmony between the Qi and blood. (Dose Bai shao:Gui zhi::2:1. Use honey mix-fried Gui zhi and wine mix-fried Bai shao.)
- 5. Pain and/or numbness of the limbs due to disharmony between the Qi and blood. (Use stir-fried Gui zhi and wine mix-fried Bai shao.)
- 6. Vomiting and weakness during pregnancy accompanied by fear of cold, lack of appetite, nausea and a weak pulse in the cubit position due to disharmony of the spleen and stomach and the constructive and defensive. (Use stir-fried Gui zhi and wine mix-fried Bai shao.)
- 7. Weakness in the elderly, during convalescence, postpartum, and post-operatively with fatigue and lack of strength, fear of wind, and slight perspiration due to disharmony between the constructive and the defensive. (Use stir-fried Gui zhi.)
• In cases of vertigo, uncooked Bai shao should be used.
• In cases of liver-spleen disharmony causing diarrhea, Bai shao should be stir-fried until yellow.
• In cases of gynecological problems, wine mix-fried Bai shao should be used.
• In cases of chest or lateral costal pain, abdominal pain, or pain in the stomach area, wine mix-fried Bai shao should be used.

Dose: 6-30g

Dang Gui – Angelica sinensis root – “State of Return”

Nature: sweet, acrid, warm

Enters: Liver, Heart, Spleen

Actions: Nourishes blood; promotes blood (and Qi) circulation; harmonizes the blood; relieves pain; moistens the large intestine; regulates the menses; disperses cold; reduces swelling; expels pus; generates flesh.

Indications:
• For any form of blood deficiency.
• Blood deficiency and stagnation: irregular menses, dysmenorrhea, amenorrhea.
• Blood deficiency: ashen face, tinnitus, blurry vision, palpitations.
• Blood deficiency with chronic wind-damp Bi syndrome.
• Blood deficiency and cold: abdominal pain.
• Blood stasis (especially with cold from deficiency): pain, traumatic injury, Bi, carbuncles/boils.
• Blood deficiency leading to large intestine dryness: constipation.
• Useful for some sores or abscesses (where blood deficiency and stasis are involved).
Dang gui’s combination of nourishing and moving qualities means that it can nourish blood without blocking it and it can move blood without depleting it.
• Injected into acupoints in China for pain (neuralgias, ischemic, arthritis – this form of therapy is not used for acute pain, tumors, infections).
• May reduce vascular plaque formation.
• Compared to Bai shao, both are used for pain and blood deficiency patterns. Bai shao is more appropriate for blood deficiency accompanied by heat, while Dang gui is used more for blood deficiency accompanied by cold.
• Doctrine of signatures (to my eye, anyway [PLB]): shaped like a uterus.
• The four parts of Dang gui:
Dang Gui Tou: head of the root. Most tonifying, less ability to promote blood circulation. DY: Quickens the blood and stops bleeding. Often stir-fried until carbonized to reinforce its hemostatic action.
• Dang Gui Shen: body of the root. Slightly more tonifying than moving.
• Dang Gui Wei: tail of the root. More moving than tonifying. DY: Quickens the blood and breaks blood stasis. This part if often wine-processed to reinforce its action.
Dang Gui Xu: the beard of Dang gui – the rootlets of the main and secondary roots. DY: Dang gui xu quickens the blood and frees the flow of the network vessels. This part is often wine-processed to reinforce its action.
Quan Dang Gui: the entire root, which includes the four parts mentioned above. DY: It harmonizes the blood. Li Dong Yuan said, “The head stops bleeding and is directed upwards. The body nourishes the blood and is fixed to the center. The tails break the blood and flow downward. The whole root quickens the blood and treats everything.”
MLT: Rich in nutrients, including vitamin B-12, folic acid, biotin.
• Stimulates hematopoeisis; also has antiplatelet action.
• One compound stimulates the uterus while another relaxes it and increases DNA synthesis and growth of uterine tissue.
• For all forms of anemia, including pernicious.
BII: Regulates estrogen, tones the uterus.
Yoga: Choraka: VPK=; P+ (in excess)
• Tonic, emmenagogue, rejuvenative (especially for Vata), diaphoretic, antispasmodic, analgesic, anti-arthritic.
• Topical: for wounds, ulcers, itching, and to nourish and beautify the skin.
Hsu: The non-volatile water-soluble compounds stimulate uterine muscle, while the volatile oil inhibits (relaxes) uterine muscle.
• Therefore, to contract the uterus, decoct for a long time (cook off the volatile oil).
• To relax the uterus, add Dang gui at the end and cook over low heat and/or for short duration.
PFGC: Li Dong Yuan said the head of Dang gui controls bleeding and entices its effect to go upward, the body nourishes blood and keeps its effect in the central region, and the tail cracks blood and causes its effect to go down. The entire plant [taken as a whole] vitalizes blood but does not much move around the body.
• With Chuan xiong, Dang gui gains the momentum of budding growth and nourishment.
• With Bai shao, the combination is an essential remedy to rescue Yin and astringe Yang.
Dang gui can harmonize blood in cases of Qi rebellion resulting in coughing – once the blood is harmonized, the Qi will descend.
Dang gui can disperse cold stasis causing diarrhea, abdominal pain, lumbar pain, or headache.
• For disorders of the Chong Mai manifesting in Qi counterflow and internal distress.
• Disorders of Dai Mai manifesting in abdominal pain and a sensation of the lumbar region being submerged in water.
• Dry skin due to undernourished flesh and muscles.
• Can moisten Lung dryness, can smooth aggravation of liver wood.
• Its moistening effect reaches all tissues and muscles.
• Can move blood and control bleeding – useful for hematemesis and epistaxis (for this use, it is best to fry it in vinegar to emphasize its descending effect.
• Its ability to disperse the surface is weak, but it is still an excellent remedy to dispel wind (by moving blood) – good for post-partum seizures.
HF: A supplement with an anti-Gu nature, possessing acrid, toxin-resolving qualities, useful in Gu Zheng (Gu parasites) formulas.
DY: Dispels stasis; downbears the Qi, stops cough, and calms asthma.
Dang gui is probably the best Chinese herb for treating blood stasis due to blood deficiency or accompanied by blood deficiency.
Dang gui, or rather Quan dang gui (whole Dang gui), harmonizes the blood. Harmonizing the blood is a term which (in the Chinese materia medica) is almost specific to Dang gui. This is because Dang gui is one of the few medicinal substances which nourishes and moves the blood simultaneously (other substances which possess both properties only mildly nourish the blood).
• To stop cough and calm asthma, the whole herb (Quan dang gui) should be used.
Dang gui and Shu di are probably the two most effective medicinal substances for treating constipation due to blood deficiency. Dang gui you, the oil extracted from Dang gui, is particularly indicated for nourishing the blood, moistening dryness, moistening the intestines, and promoting defecation.
• With Chuan xiong to move the Qi and quicken the blood without damaging the blood, to nourish the blood without producing stasis, to dispel stasis and stop pain. For the following indications, both herbs should be wine-processed, though uncooked Chuan xiong may be used in the case of headaches or dermatological problems:
- 1. Menstrual irregularities, dysmenorrhea, and postpartum abdominal pain due to blood stasis that may be mixed with Qi stagnation. (Xiong Gui San)
- 2. Rheumatic pain due to wind-dampness and blood vacuity.
- 3. Headaches due to blood deficiency and/or blood stasis. (Jia Wei Si Wu Tang)
- 4. Wounds, ulcers, or enduring cutaneous inflammations due to Qi and blood vacuity with Qi and blood stagnation. (Tou Nong San)
• With Huang qi to supplement the Qi to strongly engender and transform blood, to effectively supplement the Qi and blood. For the following indications, wine mix-fried Dang gui and honey mix-fried Huang qi should be used. Also, the whole Dang gui root (Quan dang gui) or the body of Dang gui (Dang gui or Dang gui shen) should be used. The dosage of Dang gui for the following indications should be relatively low if there is Qi deficiency and weakness in the middle burner.
- 1. Delayed menstruation (a long cycle), postpartum weakness, agalactia due to Qi and blood deficiency. (Shi Quan Da Bu Tang)
- 2. Low-grade fever caused by blood deficiency. (Dang Gui Bu Xue Tang) Wu Kun of the Ming dynasty said, “When the blood is full, the body is cool. When the blood is vacuous, the body is warm.”
- 3. Sores and welling abscesses that do not heal, due to blood and Qi deficiency. (Tou Nong San)
- 4. Numbness of the limbs due to deficient blood not nourishing the sinews.
- 5. Various hemorrhages due to Qi not containing the blood within the vessels. (Dang Gui Bu Xue Tang)
• With Shu di to nourish blood, enrich Yin, supplement the liver and kidneys, downbear the Lung Qi and promote Qi intake by the kidneys, stop cough, and calm asthma. For indications such as:
- 1. Chronic cough and/or asthma due to Yin deficiency of the kidneys associated with blood deficiency. If there is blood deficiency, Qi lacks its root. This can create an imbalance in the upbearing and downbearing function of the Qi with Lung Qi deficiency. If the kidneys are weak, they cannot insure their function of Qi intake. This then results in Qi counterflow and asthma. For these indications, this combination can be found in Jin Shui Liu Jun Jian.
- 2. Blood deficiency. (Si Wu Tang)
- 3. Constipation due to blood deficiency.
PCBDP: In a clinical trial, it was shown to be effective in improving abnormal protein metabolism in 60% of patients with chronic hepatitis or cirrhosis of the liver, and it increased the erythrocyte and platelet count in many patients.

Dose: 3-15g

E Jiao – Ass Hide Gelatin

Nature: sweet, neutral

Enters: Lung, Liver, Kidney

Actions: Stops bleeding; nourishes blood; nourishes Lung Yin and moistens the Lungs.

Indications:
• Any bleeding leading to blood deficiency: hematemesis, hemafecia, epistaxis, uterine bleeding, consumptive disorders with coughing of blood.
• Blood deficiency: dizziness, palpitations, sallow face, vertigo, insomnia.
• Liver Yin deficiency: restlessness, insomnia.
• Lung Yin deficiency: dry cough, asthma.
• Increases WBC’s for cancer, anemia.
• Greasier than Shu di (commonly combined with herbs such as Pei lan, Huo xiang, etc.).
• The substance of choice for blood deficiency with concurrent loss of blood.
• Usually dissolved into a strained decoction or wine, or used in pills.
MLT: Regularly taken by older women to counteract symptoms of dryness associated with aging.
Hsu: Aids in blood clotting, increases RBC count and amount of hemoglobin in the blood, aids against shock due to external wounds.
DY: With Huang lian to drain fire and enrich Yin according to the method of draining the south (i.e. fire) and supplementing the north (i.e. water), reestablish the interaction between the heart and kidneys, quiet the spirit, and treat dysentery damaging Yin. For indications such as:
- 1. Vexation, agitation, and insomnia due to febrile disease which has damaged Yin, deficiency fire, or heart and kidneys not communicating. (Huang Lian E Jiao Tang) Unprepared, or, even better, wine-processed Huang lian should be used.
- 2. Dysentery which damages Yin with pus and blood in the stools due to damp-heat in the large intestine.
- This is a key pair for heart-kidney disharmony, with symptoms mentioned above, plus many psychological disorders, loss of memory, profuse dreams, and tendency to wake up easily and frequently.
• Some treatises say that when E jiao is stored and aged, it is of superior quality. It is then called Chen e jiao.
E jiao has a remarkable ability to promote red blood cell production.

Dose: 3-15g

He Shou Wu – Polygonum multiflorum root – “Mr. He’s Black Hair”

Nature: bitter, sweet, astringent, slightly warm

Enters: Liver, Kidney

Actions: Nourishes blood; augments the Jing; secures the Jing and stops leakage; tonifies the liver and kidneys; eliminates toxicity and treats malaria; relieves fire toxicity; moistens the large intestine and promotes bowel movement; eliminates internal wind and expels wind from the skin (through nourishing blood).

Indications:
• Jing and blood/Yin deficiency: dizziness, blurry vision, early greying of the hair, weakness of the lumbar region and knees, soreness in the extremities, insomnia, seminal emission, uterine bleeding.
• Jing leakage: nocturnal emission, premature ejaculation, vaginal discharge.
• Jing and blood deficiency: chronic malaria, carbuncles, lumps, constipation.
• Fire toxicity: carbuncles, neck lumps, goiter, sores, scrofula.
• Blood deficiency: wind rash with itching.
• Bensky/Gamble: compared to Shu di, He shou wu is thought to focus more on the liver, while Shu di focuses more on the kidneys.
PLB: when He shou wu is prepared with black beans, its action is focused more on the kidneys.
He shou wu is drier than Shu di. It does not have Shu di’s viscous, cloying properties, does not impair digestion, and is acceptable for use with mild dampness.
• Weaker than Shu di at nourishing blood, stronger than Shu di at nourishing Jing.
• Use the prepared form to nourish Jing and blood and tonify the liver and kidneys.
• Use the dry form to moisten the large intestine for constipation and for its anti-inflammatory action.
• Lowers serum cholesterol.
• Widely used for hypertension and coronary heart disease.
• Do not cook this herb in a steel vessel – it alters the chemistry of the herb.
• This herb is also known (mistakenly) as Fo ti tieng.
MLT: Often steamed with black soy beans and yellow rice wine (giving it a reddish-brown color) to increase its tonic properties.
• Its chemistry resembles human adrenocorticoids.
• Contains much lecithin (may be responsible for the herb’s cholesterol-controlling effects).
• Reduces the heart rate while slightly increasing circulation of blood through the heart.
• Very good for lumbar pain from blood/Jing deficiency.
HF: A supplement with an anti-Gu nature, possessing acrid, toxin-resolving qualities, useful in Gu Zheng (Gu parasites) formulas.
BF: In He Shou Wu Lu (Song of He Shou Wu), it is said that this herb boosts the Qi.
• In Dian Nan Ben Cao, it is said that this herb astringes the Jing and hardens the kidneys.
• In Kai Bao Ben Cao, it is said that this herb mainly treats scrofula, disperses welling abscesses and swellings, treats head and face wind sores and the five kinds of hemorrhoids, stops heart pain, boosts the blood and qi, blackens the hair, brightens the color of the cheeks, and also treats various women’s postpartum and abnormal vaginal discharge diseases (several of these patterns involve damp-heat).
Yoga: P, V-; K and ama+ (in excess)
• Tonic, rejuvenative, aphrodisiac, astringent, nervine.
• For anemia, neurasthenia, impotence, low back pain, enlarged lymph glands, arteriosclerosis, diabetes.
• With Gotu kola to counteract aging (He shou wu for the tissues, Gotu kola for the mind).
Hsu: Purgative (by anthraquinone derivatives) – stimulates intestinal peristalsis; inhibits increase in serum cholesterol, decreases absorption of cholesterol from the alimentary canal, prevents retention of lipid in serum or inhibits deposition of lipid on inner membrane of arteries; antiviral; cardiotonic.

Dose: 9-30g

Long Yan Rou – Longan fruit – “Dragon Eye Flesh”

Nature: sweet, warm

Enters: Heart, Spleen

Actions: Tonifies Qi and nourishes blood of the spleen and heart; calms the Shen.

Indications:
• Heart and spleen blood and Qi deficiency: insomnia, palpitations, poor memory, dizziness.
• Especially for problems associated with excessive pensiveness or overwork.
• Often eaten alone or taken as an infusion.
LL: Very warm.

Dose: 6-15g (to 30)

Part One Begins Here – Herbs That Quiet the Shen and Nourish the Heart

Herbs in both parts of this category (nourishing herbs that quiet the shen and heavy/anchoring herbs that quiet the shen) are commonly combined with:
A. Herbs that nourish blood and Yin when there is Yin or blood deficiency of the heart.
B. Herbs that clear heat from the heart when there is excess heart heat or fire.
C. Herbs that subdue liver Yang when there is liver Yang rising.
D. Herbs that clear heat from the Stomach, when there is Stomach heat/fire disturbing the Shen.

 

Also Consider, When Appropriate, Herbs From Other Categories That Nourish and Quiet or Anchor the Shen:
Bai He [Nourish Yin], Da Zao [Tonify Qi], Dai Zhe Shi [Subdue Liver], Dan Shen [Move Blood], Fu Ling/Shen [Drain Damp], Fu Xiao Mai [Astringent], Lian Zi [Astringent], Long Yan Rou [Nourish Blood], Mu Li [Subdue Liver], Ren Shen [Tonify Qi], Shi Chang Pu [Open Orifices], Tian Zhu Huang [Resolve Phlegm], Wu Wei Zi [Astringent], Xi Xian Cao [Expel W-D], Xi Jiao [Cool Blood], Zhen Zhu [Subdue Liver],  Zhen Zhu Mu [Subdue Liver].

Bai Zi Ren – Biota seed = Thuja orientalis = Platycladus – Chinese Arborvitae

Nature: sweet, neutral

Enters: Kidney, Large Intestine, Heart, Spleen

Actions: Nourishes heart blood; quiets the Shen; moistens the large intestine, promotes bowel movement.

Indications:
• Heart blood deficiency: insomnia, palpitations, forgetfulness, anxiety, irritability (most effective herb for heart blood deficiency insomnia).
• Large intestine dryness due to Yin or blood deficiency: constipation, especially in the elderly, debilitated, and in post-partum women.
• Yin deficiency: night sweats.
• More oily than Suan zao ren – caution with loose stools, phlegm.
• This herb must be crushed before cooking.
• When used topically, it is dry-fried until the oil seeps out.
DY: Supplements heart Qi and blood; quiets the Hun, Po, and Shen; boosts the intelligence.
• With Suan zao ren for mutual reinforcement, to effectively nourish both the liver and the heart, tranquilize the heart, and quiet the spirit. For indications such as:
- 1. Palpitations, profuse dreams, and insomnia due to heart blood (and Qi) deficiency. (Tian Wang Bu Xin Dan) Defatted Bai zi ren and stir-fried Suan zao ren should be used.
- 2. Constipation with dry stools due to blood deficiency and intestinal fluid insufficiency.

Dose: 6-18g

He Huan Pi – Albizzia bark – Mimosa tree – “Collective Happiness Bark”

Nature: sweet, neutral

Enters: Heart, Liver

Actions: Quiets the Shen; relieves mental stress and depression; relieves constraint; promotes blood circulation; dissipates swelling; alleviates pain; calms the five organs and promote happiness.

Indications:
• Anger, restlessness, insomnia, poor memory, constrained emotions, irritability (when using it for insomnia, it is especially indicated when due to Qi problems [usually constraint]).
• Blood stasis: trauma, carbuncle, internal abscess, pain and swelling.
Li: Nourishes heart blood.
Hsu: Tonic, stimulant, analgesic, anthelmintic, diuretic, oxytocic action.

Dose: 9-30g

 
He Huan Hua: the flower
• Sweet, neutral.
• Same functions as the bark, though generally stronger overall, more moving to the Qi, and promotes the free flow of stagnant liver Qi.
• Primarily for depression, constrained emotions, irritability, insomnia, especially when accompanied by epigastric pain and feelings of pressure in the chest.
• There are at least four different plants used as this herb, including albizzia flower, which consists of many pink hairs when fresh and becomes brown when dry, and several unrelated others. Many practitioners prefer the substitute species to the “true” herb.

Dose: 6-15g

Ling Zhi – (Chi Zhi, Dan Zhi) – Ganoderma mushroom – Reishi

Nature: bitter, sweet, warm

Enters: Heart, Liver, Lung

Actions: Chen: Nourishes the heart and calms the Shen; stops coughing and arrests wheezing, dispels phlegm; tonifies Qi and nourishes blood.

Indications:
• Restless Shen, spleen Qi and heart blood deficiency: insomnia, forgetfulness, fatigue, listlessness, poor appetite.
• Cough and asthma, difficulty sleeping due to dyspnea, profuse sputum. With Ku shen and Gan cao in the simplified ASHMI formula for asthma.
• Qi and blood deficiency, weak digestion: poor appetite, listlessness, loose stools, fatigue, dizziness, soreness of lower back. Can be used alone.
• Antineoplastic activity: by enhancing immune function. Increases monocytes, macrophages, and T-lymphocytes. Increases production of tumor necrosis factor, interleukin, and interferon.
• Cardiovascular: increases cardiac contractility, lowers blood pressure, increases resistance of cardiac muscle to hypoxia.
• Antibiotic properties, broad spectrum, and inhibits E. coli, B. dysenteriae, Pseudomonas spp., pneumococci, streptococci (type A), staphylococci, and others.
• Hepatoprotective, antidiabetic, antitussive, expectorant, sedative, analgesic, and anti-asthmatic effects.
Hsu: Nourishes, supplements, tonifies, eliminates toxicity, astringes, disperses accumulation.
• For deficiency fatigue, neurasthenia, insomnia, bronchial cough in elderly, cancer.
SNBCJ: The six colors of Ling zhi are the first six herbs listed in the superior class section of the Shen Nong Ben Cao Jing. [only red and black are commonly available in the U.S.] The color of the mushroom indicates its flavor and affinities, based on five element correspondences.
• Of all varieties, the SNBCJ says, “Protracted taking may make the body light, prevent senility, and prolong life so as to make one immortal.”
Qing zhi (green/bluegreen) is sour and mainly affects the liver.
Huang zhi (yellow) is sweet and mainly affects the spleen.
Bai zhi (white) is acrid and mainly affects the Lungs.
• Purple also exists (Zi zhi), which is not associated with any single element.
Hei zhi (black) is salty and balanced. It mainly treats urinary dribbling block, it disinhibits the water passageways, boosts kidney Qi, frees the nine orifices, and sharpens the hearing
Chi zhi (red) [the most common form available, and the one which is used to calm the Shen] is bitter and balanced. It mainly treats binding in the chest, boosts the heart Qi, supplements the center, sharpens the wits, and [causes people] not to forget. Its other name is Dan zhi (Cinnabar Ganoderma).
GIRI: Enhances the immune system; contains carcinostatic component (β-(1-3)-D-Glucan); antitumor (interferon-inducing) activity; reduces blood pressure; lowers serum cholesterol; lowers serum glucose; inhibits platelet aggregation; treats hepatitis; promotes robustness.
• Historical reputation as a cancer cure.
• Appearance varies tremendously, based on culture conditions – six major colors, four major shapes.
• Once extremely rare. Now mass cultivated on bed logs or sawdust.
Amato: Anti-inflammatory. May reduce the inflammation which is a critical factor in Alzheimer’s and cardiovascular disease.
CHA: (Karen S Vaughan, 8-26-2000): The ganodermas (black G. lucidum, red G. lucidum, G. oregonense, G. tsuga, G. adspersum and G. applanatum) are tonic, immune strengthening, protect against cancer, have anti-tumor properties, calm the spirit, protect and clear heat from the central nervous system, open the heart, lower serum cholesterol and are good for adrenal fatigue and for depression and anxiety. They enter all five zang organs. They have anti-allergic effects, inhibiting histamine production and stabilizing immunoglobulin levels. They lower blood pressure, are antioxidant, antiviral and antibacterial. Combining with astragalus, atractylodes and Ren shen increase phagocytosis, promote immune globulin formation, promote lymphocyte transformation, and induce the generation of interferon. Chinese mountain climbers use Ling zhi to alleviate altitude sickness by oxygenating the blood.
I learned from a Thai doctor with a cancer practice, Santi Rosswong, to make a water decoction of Ganoderma lucidum (Ling zhi) with 10% cordyceps [Dong chong xia cao] for stamina. But since the polysaccharides in ganoderma are quite long, it has been shown to be more effective if the decoction is taken with not less than 500 mg of vitamin C, and 5 mg of folic acid each time. (The vitamin C is based upon Japanese research by Morishige and the folic acid is based upon Santi’s clinical experience.) Take several tablespoons (or more) every three hours. The most important dose is just before retiring, which should be larger. Take the folic acid and vitamin C with each dose.
There are two types of tinctures. One uses a concentrated decoction and adds alcohol to stabilize it. When I make it, I learned from Chris Hobbs to shoot for 25% alcohol to protect the polysaccharides, to ensure that I got between 22% and 28%, the lower number for spoilage and the upper number being a maximum for the polysaccharide protection. This appears to be the best formulation for immune system effects. The other way is to use a high alcohol formation to get the triperetenes, but I understand that this destroys the polysaccharides and differs significantly from the constituents extracted in traditional uses or from powdered extracts. It may have stronger CNS effects however. I know several herbalists who make a high alcohol tincture and add it to the subsequently decocted marc to get the best of both (and they understand that the high alcohol just makes the polysaccharides clump together but does not destroy them). There is not a consensus.
Ling zhi has various steroidal compounds, long chain polysaccharides, bitter triperetenes such as ganodermic acid and some volatile oils. Unlike Echinacea which activates macrophages, ganoderma is not believed to stimulate the immune system directly. It is probably an immune regulator rather than an immune stimulant. Ling zhi mushrooms get to the bone marrow and induce the marrow to put on more nucleated marrow cell mass, according to Jia. The marrow then increases B-cell production, which in turn increases antibodies. The DNA and RNA made in the bone marrow increases production of lymphocytes. This very deep immune nourishing means that it may be appropriate for AIDS patients although the patient should not suffer from undue dampness. For cancer therapy, combined with other fu zheng herbs, Ling zhi can be quite useful, even for patients undergoing chemo and radiation. Hobbs recommends low dose decocted ganoderma with cinnamon bark and orange peel as a tonic drink (for those not suffering from undue dampness) and I find that preparation, with roasted dandelion or chicory, combines well with coffee, helping neutralize coffee’s negative effects.
PLB: Some sources (including Subhuti Dharmananda of ITM) indicate that when ethanol is introduced to a water extract of Ling zhi (at greater than 25% by volume) the polysaccharides are not destroyed, but precipitated. Therefore, in a bottle of Ling zhi extract with over 25% ethanol, the polysaccharides are likely to be stuck to the sides of the bottle or settled at the bottom (or they are still stuck in the manufacturer’s vessels). When attempting to deliberately concentrate the polysaccharides, this is a useful phenomenon. Water extracts may be treated with up to 99% ethanol so polysaccharides – a greyish-white powder – can be claimed. For normal use, hot water extracts are best, and should be preserved with less than 25% ethanol (or as much glycerine as you like).
Weng Weiliang, et al.:

Effects on central nervous system
ling zhi preparation could reduce spontaneous activity of mice, strengthen the inhibitory effects of reserpine and chlorpromazine on nerve center, antagonize the excitatory function of benzedrine on nerve center, prolong the pentobarbital sodium induced sleep time, strengthen hypnogenesis effect of pentobarbital sodium at sub-threshold dose, antagonize electrical convulsion. Besides, it also had analgesic effect.
Effects on respiratory system
ling zhi had obvious antitussive effect, it could prolong the latent period of cough induced by ammonia stimulation, or decrease the times of cough significantly. chi zhi preparation had spasmolytic effect on smooth muscle contract of isolated trachea induced by histamine, and the effect was directly proportional to the medicine concentration.
Effects on cardiovascular system
ling zhi could significantly increase the cardiac contraction, decrease the heart rate in isolated toad heart, increase the contraction force of in situ rabbit heart. chi zhi liquid (3g/kg) could antagonize acute myocardial ischemia caused by hypophysin, significantly lower the high T wave in ECG.
Hot water extract of ling zhi could lower blood pressure, this effect was the most obvious 3 hours after oral administration. Initial clinic test also proved its blood pressure lowering effect and fat lowering effect. The blood pressure lowering effect of mycelin extracted from the mycelium of ling zhi had the characteristics of taking effect quickly, short action time, and dosage dependence.
ling zhi could also antagonize blood coagulation, prevent the thrombus formation, inhibit the platelet aggregation, and increase the deformability of aged RBC.
Effects of improving anoxia tolerance
chi zhi preparation could increase the anoxia tolerance of normal mice and mice pre-treated isoprenaline under lower pressure and normal pressure circumstance. Dried powder of fermented ling zhi could also increase the anoxia tolerance ability of mice, particularly the ability of cardiac muscle, and lower the oxygen consumption whole animal, improve the cardiac metabolism of anoxic animals.
Effects of lowering blood sugar
Ethanol extract of chi zhi had no influence over the increase of insulin secretion 10 minutes after oral administration of glucose, but had inhibitory effect on the continuous decrease of plasma insulin 30 minutes after the administration. It could also inhibit the increase of blood sugar induced by injection of adrenalin or oral administration of glucose. Polysaccharides of ganoderans A, B, C and heteroglycan isolated from ling zhi were injected intraperitoneally to mice at the dosage of 100mg/kg, the results showed that it could blood sugar.
Effects of protecting liver and detoxification
The increase of serum GPT and accumulation of liver triglyceride in mice induced by CCl4 injection could be obviously improved by oral administration of ethanol and ether extract of fruit body onload=”highlight();” of zi zhi and chi zhi. Besides, the extract could also relieve fatty liver caused by ethionine, promote the liver regeneration and strengthen the detoxifying function.
Immune hepatic injury was markedly induced by BCG or BCG plus inflammatory cytokines in BALB/c mice in vivo and in vitro. Under BCG-stimulated condition, augment of the liver weight and increase of the serum/supernatant ALT level were observed, as well as granuloma forming and inflammatory cells soakage were observed by microscopic analysis within liver tissues. Moreover, NO production was also increased by BCG or/and CM stimuli in the culture supernatant, and a lot of iNOS positive staining was observed in BCG-prestimulated hepatic sections. Application of Ganoderma lucidum polysaccharide (GLP)significantly mitigated hepatic tumefaction, decreased ALT enzyme release and NO production in serum/supernatant, improved the pathological changes of chronic and acute inflammation induced by BCG-stimuli in mice. Moreover, the immunohistochemical result showed that GLP inhibited iNOS protein expression in BCG-immune hepatic damage model. The study indicates that NO participates in immune liver injury induced by Mycobacterium bovis BCG infection. The mechanisms of protective roles by GLP for BCG-induced immune liver injury may be due to influence NO production in mice.
Effects on smooth muscle
chi zhi preparation could inhibit the smooth muscle activity of isolated rabbit intestines and isolated ileum of Guinea pig, and the effect increased with the increase of medicine concentration. Concentrated solution of fermented chi zhi could also obviously inhibit the contraction of isolated rat uterine.
Effects of immune regulation
Extract of mycelium of bo gai ling zhi could significantly promote the phagocytosis rate of celiac macrophages and activity of lysosome in mice, obviously inhibit DNA synthesis in lymphocytes and T and B lymphocyte transformation induced by ConA and bacillus coli endotoxin. ling zhi polysaccharide had certain immunoenhancing effect.
The polysaccharide component with a branched (1–>3)-beta-D-glucan moiety from G. lucidum (PS-G) has shown evidence of enhancement of immune responses and of eliciting anti-tumor effects. Annexin V staining and MTT assays reveal that PS-G is able to inhibit spontaneous and Fas-induced neutrophil apoptosis, and this effect of PS-G is enhanced by the presence of zVAD (a caspase inhibitor) and GM-CSF. The antiapoptotic effect of PS-G is diminished by the presence of wortmannin and LY294002 (two PI-3K inhibitors), but is not altered by PD98059 (a MEK inhibitor). Western blotting indicates the stimulating effect of PS-G on Akt phosphorylation and its inhibition of procaspase 3 degradation, which occurs in neutrophils undergoing spontaneous apoptosis or triggered death by Fas. Taken together, PS-G elicitation of antiapoptotic effects on neutrophils primarily relies on activation of Akt-regulated signaling pathways.
A fucose-containing glycoprotein fraction which stimulates spleen cell proliferation and cytokine expression has been identified from the water-soluble extract of Ganoderma lucidum. Proteomic analysis of mouse spleen cells treated with this glycoprotein fraction showed approximately 50% change of the proteome. Further studies on the activities of this glycoprotein fraction through selective proteolysis and glycosidic cleavage indicate that a fucose containing polysaccharide fraction is responsible for stimulating the expression of cytokines, especially IL-1, IL-2 and INF-gamma.
Anti-allergic effect
ling zhi could obviously inhibit the allergic reaction of Guinea pig passively sensitized by egg albumen antiserum, tetanus toxoid antiserum on antigen attack, it could also significantly inhibit the release of allergic mediators such as histamine and SRS-A by lung tissue of Guinea pig actively sensitized by egg albumen antiserum or tetanaus toxoid antiserum on antigen attack. This effect would strengthen with the increase the dosage of ling zhi.
Anti-tumor effect
Water decoction of ling zhi could inhibit the growth of tumor. Hot water extract of mycelia of artificially cultured chi zhi had inhibitory effect on the growth of fibrosarcoma and metastasized focus of lung. Ganodenic acid, a kind of triterpene isolated from chi zhi, had cell toxicant on cultured liver carcoma in vitro.
The triterpene-enriched fraction, WEES-G6, was prepared from mycelia of G. lucidum by sequential hot water extraction, removal of ethanol-insoluble polysaccharides and then gel-filtration chromatography. It’s found that WEES-G6 inhibited growth of human hepatoma Huh-7 cells, but not Chang liver cells, a normal human liver cell line. Treatment with WEES-G6 caused a rapid decrease in the activity of cell growth regulative protein, PKC, and the activation of JNK and p38 MAP kinases. The changes in these molecules resulted in a prolonged G2 cell cycle phase and strong growth inhibition. None of these effects were seen in the normal liver cells. This findings suggest that the triterpenes contained in G. lucidum are potential anticancer agents.
A study was designed to investigate the protective effect of a dietary water-soluble extract from cultured medium of Ganoderma lucidum (Rei-shi or Mannentake) mycelia (designated as MAK) on the induction and development of azoxymethane (AOM)-induced colon tumors in male F344/Du Crj rats. A total of 80 animals were divided into five groups at six weeks of age, groups 2, 3 and 4 being given weekly subcutaneous injections of AOM (15 mg/kg body onload=”highlight();” weight) for the initial 3 weeks to induce colon tumors. Rats in group 1 and 5 were injected with the vehicle, 0.9% (w/v) saline, following the same schedule. Rats in groups 1, 2, 3, 4 and 5 were fed MF, MF, 1.25% MAK, 2.5% MAK and 2.5% MAK diets, respectively, starting 1 week before AOM treatment and throughout the six-month experimental period. There were no significant differences in number of ACF, total AC and AC per site among groups 2 to 4, but the tumor incidence was significantly lower, and tumor size was smaller in group 4 (AOM + 2.5% MAK) than in group 2 (AOM + MF). Additionally, beta-catenin positive tumor cell nuclei were significantly decreased in the MAK-fed rats (groups 3 and 4), which also demonstrated lowering of the PCNA labeling index and a shortened germinal region in the colon. The present results thus indicate that dietary MAK could act as a potent chemopreventive agent for colon carcinogenesis.
Spores or dried fruiting body onload=”highlight();” of G. lucidum inhibit constitutively active transcription factors AP-1 and NF-kappaB in breast MDA-MB-231 and prostate PC-3 cancer cells. Furthermore, Ganoderma inhibition of expression of uPA and uPA receptor (uPAR), as well secretion of uPA, resulted in the suppression of the migration of MDA-MB-231 and PC-3 cells. The data suggest that spores and unpurified fruiting body onload=”highlight();” of G. lucidum inhibit invasion of breast and prostate cancer cells by a common mechanism and could have potential therapeutic use for cancer treatment.
Different concentrations of Ganoderma lucidum(Leyss ex Fr) Karst Compound(GLC) (from 4 mg/ml to 12 mg/ml) could promote human bone marrow granulocyte-macrophage colony forming unit (CFU-GM) proliferation, but suppressed the growth of K562 leukemic cell colonies, and IC50 was 9.2 mg/.ml. The data from liquid culture demonstrated that GLC could suppress K562 cells proliferation in a dose-dependent(from 4 mg.ml-1 to 20 mg.ml-1) and time-dependent(from 1-5 days) manner. K562 cells could be induced to differentiate into more mature erythrocytic cells by 4 mg/.ml and 8 mg/ml GLC. It is concluded that GLC may be a good medicine for leukemia therapy.
Anti-aging effect
Water extract of chi zhi could prolong the average life span of drosophilas, but it could neither lengthen the maximum life time, nor inhibit the brain MAO-B activity in mice.
Antiviral effect
To investigate antiherpetic substances from Ganoderma lucidum, various protein bound polysaccharides, GLhw, GLhw-01, GLhw-02, GLhw-03, were isolated by activity-guided isolation from water soluble substances of the carpophores. These substances were examined for their antiviral activities against herpes simplex virus type 1 (HSV-1) and type 2 (HSV-2) by plaque reduction assay in vitro. Among them, the acidic protein bound polysaccharide, GLhw-02 of a brownish substance, exhibited the most potent antiherpetic activity with 50% effective concentrations (EC50) of 300 approximately 520 microg/ml in Vero and HEp-2 cells, and its selectivity indices (SI) were more than 20. GLhw-02 was identified to consist mainly of polysaccharide (approximately 40.6%) and protein (approximately 7.80%) by anthrone test and Lowry-Folin test, and showed the usual molar ratio (C:H:O = 1:2:1) of carbohydrates by elemental analysis. These results suggest that GLhw-02 possesses the possibility of being developed from a new antiherpetic agent.
A new highly oxygenated triterpene named ganoderic acid alpha has been isolated from a methanol extract of the fruiting bodies of Ganoderma lucidum together with twelve known compounds. The structures of the isolated compounds were determined by spectroscopic means including 2D-NMR. Ganoderiol F and ganodermanontriol were found to be active as anti-HIV-1 agents with an inhibitory concentration of 7.8 micrograms ml-1 for both, and ganoderic acid B, ganoderiol B, ganoderic acid C1, 3 beta-5 alpha-dihydroxy-6 beta-methoxyergosta-7,22-diene, ganoderic acid alpha, ganoderic acid H and ganoderiol A were moderately active inhibitors against HIV-1 PR with a 50% inhibitory concentration of 0.17-0.23 mM.
Mucosal healing effect
Fruiting bodies of Ganoderma lucidum (GLPS) at 250 and 500 mg/kg by intragastric input caused ulcer-healing effect in the rat; this was accompanied with a significant suppression of tumor necrosis factor (TNF)-alpha gene expression, but with an increased ornithine decarboxylase (ODC) activity. In RGM-1 cells, GLPS at 0.05, 0.25 and 1.0 mg/ml significantly enhanced [3H]thymidine incorporation and ODC activity in a concentration-dependent manner. However, these effects were abrogated by the addition of the ODC inhibitor, DL-alpha-difluoromethyl-ornithine (DFMO). GLPS at 0.25-1.0 mg/ml also increased mucus synthesis, as indicated by the increased D-[6-3H]glucosamine incorporation in RGM-1 cells. Furthermore, GLPS at 0.05-1.0 mg/ml increased the c-Myc protein expression. These findings indicated that GLPS produced a mucosal healing effect in the rat model, perhaps due partly to the suppression of TNF-alpha and induction of c-myc and ODC gene.
Antiperoxidative, antiinflammatory, and antimutagenic effects
The ethanol extract of the mycelium of Ganoderma lucidum occurring in south India showed significant inhibition of Fe2+-induced peroxidation of lipid in rat liver (IC(50) 510 +/- 22 micro g/ml) and 37% inhibition of croton oil-induced peroxidation on the mouse skin at 20 mg/0.1 ml/skin. Carrageenan-induced acute and formalin-induced chronic inflammatory edema were inhibited by 56 and 60%, respectively, by the extract at 1,000 mg/kg body onload=”highlight();” wt (i.p). The extract at a concentration of 5 mg/plate showed inhibition of mutagenicity elicited by direct acting mutagens, NaN(3) (55.5 and 75.7%) and MNNG (50.0 and 57.5%) for S. typhymurium strains TA100 and TA102, respectively. The extract at the same concentration also inhibited mutagenicity elicited by NPD (52.4 and 64.2%) and B[a]P (60.7 and 59.6%) for TA98 and TA100 strains, respectively. The B[a]P was activated in the presence of rat liver microsomal (S9) fraction. The results revealed that ethanol extract of Ganoderma lucidum mycelium possessed significant antiperoxidative, antiinflammatory, and antimutagenic activities. The findings suggest a medicinal use for the ethanol extract of the mycelium of G. lucidum occurring in South India.
Mice peritoneal macrophages were injured by reactive oxygen species (ROS), derived from tert-butylhydroperoxide (tBOOH). The survival rate of macrophages was measured by MTT assay, and the morphological changes of macrophages were observed under light and electron microscopes. It was found Ganoderma lucidum polysaccharides peptide (GLPP) (50, 100, 200 mg/kg, ip for 5 d) could inhibit the foam cell formation and necrosis of macrophages. The survival rate of macrophages was increased. GLPP (3.125, 12.5, 50, 200 mg/L) given to the cultured macrophages brought the same protective effects. Under the electron microscope it was found that GLPP (100 mg/kg, ip, for 5 d) could protect the organelle such as mitochondria against injury by tBOOH. The results indicated that GLPP had significant scavenging ROS and antioxidant effects.
Hot water extract of Ganoderma lucidum dose-dependently exhibited antioxidative effect on mouse liver and kidney lipid peroxidation; this indicated that hepatic and renal homogenates have a higher malonic dialdehyde level in an ethanol administered group than in the Ganoderma lucidum treated group. It was concluded that the hepatic and renal protective mechanism of Ganoderma lucidum, might be due at least in part to its prominent superoxide scavenging effect. Ganoderma extract could protect the liver and kidney from superoxide induced hepatic and renal damages.
The amino-polysaccharide fraction (designated as ‘G009′) from Ganoderma lucidum was tested for the ability to protect against oxidative damage induced by reactive oxygen species (ROS). G009 significantly inhibited iron-induced lipid peroxidation in rat brain homogenates and showed a dose-dependent inactivation of hydroxyl radicals and superoxide anions. It also reduced strand breakage in phiX174 supercoiled DNA caused by UV-induced photolysis of hydrogen peroxide and attenuated phorbol ester-induced generation of superoxide anions in differentiated human promyelocytic leukaemia (HL-60) cells. These findings suggest that G009 from Ganoderma lucidum possesses chemopreventive potential.
Hot-water extract of Ganoderma lucidum had good radioprotective ability, as well as protection against DNA damage induced by metal-catalyzed Fenton reactions and UV irradiation. Water-soluble polysaccharide isolated from the fruit body onload=”highlight();” of Ganoderma lucidum was as effective as the hot-water extract in protecting against hydroxyl radical-induced DNA strand breaks, indicating that the polysaccharide compound is associated with the protective properties.

• Coronary heart disease: ling zhi preparation had therapeutic effects on angina pectoris and increased blood fat in coronary heart disease to a certain degree, it could lower serum cholesterol, triglyceride and b-lipoprotein. 20% Ling Zhi Tincture, 10ml tid was used to treat 30 cases of angina pectoris for consecutive more than half a year, the results were 17 markedly effective, 18 effective, 4 ineffective.
• Arrhythmia: Ling Zhi Injection was used to treat 53 cases of various types of arrhythmia, the results showed that arrhythmia disappeared completely in 20 cases, 13 improved, 7 had a relapse, and 13 were ineffective.
• Chronic bronchitis: ling zhi preparation had quite good therapeutic effect on chronic bronthitis, but it took effect slowly, usually 1~2 week after administration. It also had good long-term therapeutic effect.
• Bronchial asthma: Infantile patients with bronchial asthma were treated with Ling Zhi Injection im 1~2 ml for consecutive 1 month. 27 cases were treated, and 9 were markedly effective, 14 effective, and 4 ineffective.
• Viral hepatitis: ling zhi preparation was used to treat hepatitis of various types, the total effective rates were 73.07%~97%, markedly effect rates were 44%~76.4%. Generally speaking, it had better effects on acute hepatitis than on chronic hepatitis.
• Leukopenia: Artificially cultured ling zhi was used to treat 52 cases of leukopenia caused by various reasons, the results: 11 cases were markedly effective, 12 effective, 21 improved, the near-term effective rate was 84.6%, the total number of WBC increased by 1088/mm3.
• Malignant hemopathy: Lao Jun Xian (ling zhi) Oral Liquid combining chemotherapy was used to treat 26 cases of malignant hemopathy, the total effect rate was 88.9%.
• Impotence: Sliced ling zhi, 6g per day, was decocted with water to get concentrated juice. The juice was taken when getting up early with empty stomach, or 1 hour before meals. 36 cases were treated, the total effective rate was 93.94%.
• Infantile idiopathic thrombocytopenic purpura: Ling Zhi Syrup (each ml contained 0.175g raw drug), 10~15mg, tid, a course of treatment consisted of 2 weeks ~ 2 months. 30 cases were treated, and 27 cases had an over half year follow-up survey, among them, 19 markedly effective, 3 effective, 1 improved, and 4 ineffective. The increase of platelet increase by more than 100,000/mm3 in 12 cases, 6~90,000/mm3 in 6 cases, 4~50,000/mm3 in 8 cases and 2~30,000/mm3 in 1 cases.

 

Dose: 1.5-15g or more (some say 15g is the minimum effective daily dose)

Suan Zao Ren – Zizyphus seed – Sour Jujube seed – “Sour Date Seed”

Nature: sweet, sour, neutral

Enters: Heart, Liver, Gallbladder, Spleen

Actions: Nourishes heart Yin and liver Yin/blood; quiets the Shen; astringes sweat.

Indications:
• Heart and liver blood or Yin deficiency: insomnia, palpitations.
• Liver Yin deficiency with Yang rising: irritability.
• Weak constitution: spontaneous or night sweats.
• Sedative, hypnotic.
• Tolerance develops (abates with a break).
• Lowers blood pressure.
Raw: stronger sedative; can clear heat and treat insomnia due to Yin deficiency heat. May make some patients too sleepy.
Dry-fried: more effective for spontaneous sweats.
• Often combined with Hou po (Suan zao ren:Hou po ::2:1), Chen pi, or other herbs to counteract its greasiness.
• Can be taken alone, 4g 1-2 hours before bed for insomnia.
• Should be ground, or at least broken, before use.
Hsu: Stimulates the uterus, caution in pregnancy; inhibits the CNS.
BII: Suan Zao Ren Tang is as effective as some benzodiazepenes for nervousness, anxiety.
DY: Nourishes heart Yin and blood; quiets the Hun and Shen; supplements the liver and gallbladder; treats heart palpitations due to gallbladder deficiency.
• With Bai zi ren for mutual reinforcement, to effectively nourish both the liver and the heart, tranquilize the heart, and quiet the spirit. For indications such as:
- 1. Palpitations, profuse dreams, and insomnia due to heart blood (and Qi) deficiency. (Tian Wang Bu Xin Dan) Defatted Bai zi ren and stir-fried Suan zao ren should be used.
- 2. Constipation with dry stools due to blood deficiency and intestinal fluid insufficiency.

Dose: 9-20g

Shou Wu Teng (Ye Jiao Teng) Polygonum multiflorum vine (aerial portion of He Shou Wu) – “Vine to Pass Through the Night”

Nature: sweet, slightly bitter, neutral

Enters: Heart, Liver

Actions: Nourishes the heart and blood; unblocks the channels; quiets the Shen; alleviates itching.

Indications:
• Yin or blood deficiency: insomnia, irritability, and especially dream-disturbed sleep
• Blood deficiency (with channel blockage): general weakness, soreness, pain, numbness.
• Topical: use as a wash for itching and rashes.
• I have found it unusually effective, even as a single herb, for insomnia.
MLT: Sore, aching, tired limbs from blood deficiency with internal wind.

Dose: 9-30g

Yuan Zhi – Polygala root – Chinese Senega – “Profound Will” or “Long-term Memory”

Nature: acrid, salty, slightly warm

Enters: Lung, Heart, maybe Kidney

Actions: Quiets the Shen; relieves mental stress; resolves phlegm; opens the orifices of the heart; disperses swelling; reduces abscesses; improves the memory; supports the Jing; disperses stagnant heart Qi, helps the heart and kidney communicate.

Indications:
• Insomnia, palpitations, disorientation, poor memory, mental stress, restlessness, especially with brooding or constrained, pent-up emotions.
• Blockage of orifices of the heart by phlegm: mental disorders, fuzzy- headedness, epilepsy, emotional and mental disorientation.
• Lung phlegm: cough with copious sputum, especially when difficult to expectorate.
• Carbuncles, boils, abscesses, sores, swollen and painful breasts: (uncommon use) – used in powdered form and applied topically or taken with wine.
• Stimulates animal uteri.
• Excessive amounts can cause nausea and vomiting.
• Caution with peptic ulcer, gastritis.
Li Shi Zhen: This herb reaches the kidneys, improves the memory, supports the Jing.
Li: Warm and drying – caution with Yin deficiency.
DY: Use honey-fried or licorice-processed to avoid irritation to gastric mucous membranes and nausea.
MLT: Similar to various Western species, including Western Senega Snake root.

Dose: 6-9g

Part Two Begins Here: Heavy Substances That Anchor the Shen

These substances are all minerals, with the exception of Hu Po (amber). Their “heavy” quality can be thought of through the doctrine of signatures as conferring an anchoring effect on the Shen. In the case of amber, although it’s not a mineral (instead, old, hardened sap), its qualities of being  old and very slow to form perhaps contribute to a similar quality.

These herbs are all somewhat difficult to digest and are minimally soluble in water. For this reason, it doesn’t exactly make sense to purchase them as granules. They are as potent as they can get in their raw form. Unlike a plant herb, where something can be extracted and potentiated, a decoction or granule is going to be much, much weaker than the raw substance. It’s like taking a 1 gram calcium tablet, boiling it in water, straining the liquid, and dumping out the calcium powder that’s at the bottom of the pan. How much do you think made it into the water? Just a fraction of what was in the pill. The only possible advantage to using any of these herbs as granules might be that they’re easier to digest than the raw powder, but this is only because they’re mostly starch and very little mineral. For much less money, you could have just used the raw powdered medicinal at a dose of something like 10-20% of what you would have used in granule form (you’ll have to figure out the actual math on this).

Ci Shi – Magnetite – (Oxides of Iron, also Magnesium and Aluminum) – “Magnetic Stone”

Nature: acrid, salty, cold

Enters: Heart, Liver, Kidney

Actions: Anchors and quiets the Shen; subdues liver Yang rising; nourishes the kidneys and liver; brightens the eyes and promotes hearing; brings Qi from Lung to the kidneys (aids the kidneys in grasping the Qi).

Indications:
• Hyperactive liver Yang due to liver Yin deficiency: restlessness, insomnia, palpitations, dizziness, headache, convulsions, tremors.
• Fear: convulsions in children.
• Liver/kidney Yin deficiency: blurry vision, tinnitus, poor hearing or deafness.
• Kidney Qi deficiency: asthma.
• Caution for long term use: probably contains heavy metals.
• Very difficult to digest.
• Be cautious of damage to the (anatomical) liver and heart.
• Usually prepared by being fired, dipped in vinegar, then pulverized.
• Generally cooked 20-30 minutes longer than other herbs.
DY: Should be systematically combined with Shen qu (which “enables the digestion of metals”) so it can be digested.
• With Shi chang pu to enrich the kidneys, calm the liver, diffuse impediment, open the portals, and sharpen the hearing. For indications such as:
- 1. Tinnitus and/or deafness due to Yin deficiency or deficiency fire. (Use vinegar dip-calcined Ci shi.)
- 2. Headaches, vertigo, heart palpitations, vexation and agitation, and insomnia due to Yin deficiency causing Yang hyperactivity. (Use unprepared Ci shi. However, it is important to know this form can cause abdominal pain. Therefore, the dosage should be moderate [15g] and it should be combined with Shen qu.)
Hsu: Inhibits the CNS; stimulates formation of blood cells (hemopoietic).

Dose: 9-30g (1-3g directly as powder)

Hu Po – Amber – Succinum

Nature: sweet, neutral

Enters: Heart, Liver, Bladder

Actions: Anchors and quiets the Shen; relieves convulsions, tremors, and palpitations; promotes blood circulation; dispels blood stasis; promotes urination; reduces swelling and promotes healing.

Indications:
• Shen disturbance: insomnia, palpitations, excessive dreams, forgetfulness, anxiety, seizures; also for childhood convulsions and seizures.
• Blood stasis: amenorrhea, pain from trauma, palpable immobile masses; coronary heart disease.
• Scanty, difficult urination or retention of urine, hematuria.
• Sores, carbuncles, ulcerations of the skin, swelling and pain around the scrotum or vulvular area.
• Generally not cooked.

Dose: 0.9-3g (directly as powder or pill)

SD: Not all amber is derived from pine resin, as other trees also release similar resins, but pines are considered a primary source. Pine resin contains a number of aromatic compounds: the terpenes, such as pinene, carene, sabinene, limonene, etc., which may be lost during the period of aging to become amber. There are also molecules that give the resin its sticky quality, such as those that make up the hardened pine resin product called colophonium (rosin), mainly abietic acid (image above) and pimaric acid.

These compounds found in pine resin are either pure hydrocarbon (pinene is an example of a pure hydrocarbon, containing only carbon and hydrogen), or hydrocarbons with small amounts of oxygen. There is very little of any other element in the resin (some resins may contain sulfur; a small amount of minerals might be present).

When the tree resin resides in the ground for millions of years, it hardens as moisture is lost and as some of the hydrocarbons cross-link (polymerize) to form longer chains. Pine resin has a relatively low cross-linking capability, so the process is slow and limited. The resulting amber is still chemically similar to the original resin, but it contains more of an essentially inert hydrocarbon mass, which is what gives it the hardness and glass-like nature that is appreciated when using amber for decorative items. Amber still contains some of the larger terpene molecules (4). In a single study of Baltic amber reported in 1877, but repeated by most modern authors, it was said to have 3-8% succinate (succinic acid), which is probably a derivative of the original simple terpenes.

MEDICINAL USES IN CHINA

Succinum is classified in China as being sweet in taste (though, in fact, it has barely any taste, being only slightly bitter and sweet; it has no fragrance), and neutral in nature. It is useless in decoction because so little material is extracted in boiling water (there is some extraction into alcoholic media). Mainly, Chinese amber is ground to powder and swallowed down with water or, more commonly, with a decoction of herbs that make up a formula with the succinum. It is also combined into pills made with powder or extract of the other ingredients. Typical dosing for succinum is 1.5-3.0 grams for one day. Because the powder is very fine, to avoid getting it stuck in the throat or inhaled, it is common to stir the powder into the warm decoction and swallow it down; being soaked in the liquid, the powder won’t cause any problems.

In the Materia Medica (5), succinum is listed among the “settling” or “heavy” sedatives, which are mainly mineral materials; in fact, amber is organic and quite light weight. There is an ancient saying in China that “when the tiger dies, its soul enters the earth and transforms into stone,” referring to the droplets of amber. So the material is called tiger’s soul: hupo (the po is the bodily soul; there are also spirit souls, called hun, that can roam about, but the po goes into the ground). Another sedative used by the Chinese is called fu-shen (spirit of poria), which is a segment of pine root with a solid fungus, poria (also called hoelen), that grows on it. In terms of sedative effects, fu-shen and amber are attributed similar properties. The properties of amber are also shared with other, chemically unrelated, fossil materials such as dragon bone and dragon teeth (mainly fossilized remains of mastodons and other large animals from the ice age period; they are mainly composed of calcium carbonate and other mineral components).

The calming effect of succinum is only one of the claimed properties, which include these main areas:

Subduing fright, tranquilizing the mind, and relieving convulsion. Succinum is used in the treatment of palpitation, amnesia, dreaminess, insomnia, epilepsy, etc. According to Jiao Shude (6), it is mainly used to treat epilepsy; this is typically first diagnosed during childhood, so amber is used in pediatric formulas. According to the traditional Chinese viewpoint (which differs markedly from the modern medical interpretation in this regard), epilepsy is caused by children becoming frightened when they see a strange sight or hear a strange sound. An example of a Chinese treatment for epilepsy in babies and young children is the ancient Hupo Zhenjing Wan (Amber Fright-Settling Pill), a formula of 25 ingredients (7), including minerals (pearl, cinnabar, realgar; the latter two are based on heavy metals), animal parts from endangered species (rhino horn, musk), as well as ordinary herbs (mentha, angelica, uncaria, etc.). A smaller version of this formula is called Hupo San (Amber Powder), with 14 ingredients, but including the cinnabar and musk, as well as other substances of concern; several of its ingredients must be swallowed as powder, the others made into tea. A more suitable formula incorporating amber for modern use is Hupo Duomei Wan (Amber Sleep-improving Pill), made with just five ingredients: amber, codonopsis, hoelen, licorice, and antelope horn (an endangered animal species, that can be substituted by their domestic water buffalo horn); this formula is not indicated for epilepsy, however.

Alleviating water retention and relieving stranguria (difficult urination). Succinum is applied to the urinary disorders such as stranguria complicated by hematuria (blood in the urine), particularly when caused by pathogenic heat. Succinum is considered to be like hoelen, with which it is often combined, in promoting urination through its bland nature. A formula for kidney and bladder stones, with blood in the urine, is called Hupo San (Amber Powder; different than the formula by the same name mentioned above), with amber, plantago seed, juncus, and mentha (the three herbs are made as tea, which is then used to swallow down the amber powder). A modern formula, produced in Taiwan (Kaiser Pharmaceuticals) and sold worldwide, is Hupo Huashi Pian (Amber Stone-Transforming Tablets), which is used for kidney and bladder stones with blood in the urine; the formula includes imperata and san-chi (notoginseng; also called tien-chi ginseng) for stopping or preventing bleeding, and diuretic herbs for promoting the passage of stones. Some of the ingredients of the tablet, such as desmodium, lygodium spore, and orthosiphon, are reputed to shrink stones. In a Chinese clinical report (8), a formula called Paishi Decoction was given to 215 patients with renal, urethra, or bladder stones every four hours, resulting in elimination of stones in nearly 60% of the patients. The formula included amber, dianthus, plantago seed, gardenia, lysimachia, gallus (jineijin), rehmannia, achyranthes, lygodium spore, phellodendron, akebia, and licorice. A similar formula (9), called Rongshi Decoction (replacing dianthus, rehmannia, and phellodendron with malva, talc, bamboo leaf, and rhubarb), was given twice daily to 32 patients with stones in the urinary system. This method required an average treatment time of 45 days, but it was claimed that 30 patients had passed their stones. A third formula of similar nature (10), called Hupo Shiwei Decoction, using pyrrosia, talc, lysimachia, and lygodium spore as the main diuretic herbs, and with several blood vitalizing herbs (e.g., red peony, sparganium, zedoaria, and vaccaria) to accompany the amber, was given three times daily to 51 patients having urolithiasis. It was reported that 35 were cured, and that stones were found in the urine of many of the patients, the largest stone passed was 1.6 x 0.8 cm. In the Chinese clinical work, patients were told to drink plenty of water and also to do jumping exercises to try and help move the stones down.

Promoting blood circulation to remove blood stasis. Succinum is used in the treatment of amenorrhea and abdominal mass caused by blood stasis and stagnation of vital energy. Amber is also recommended for lower abdominal pains affecting the genitalia, such as pain of the testes, prostate, uterus, or vulvar region. Amber is included in the 28-ingredient formula Da Tiaojing Wan (Major Menstruation-Regulating Pill) for irregular and painful menstruation (7). A clinical report (11) described a formula for benign prostate swelling, called Bushen Sanjie Decoction, derived from the traditional Rehmannia Eight Formula with addition of tonic herbs, such as codonopsis, astragalus, and asparagus, and blood vitalizing herbs, including amber, pangolin scale, eupolyphaga. It was claimed that following treatment for 6-12 months, 25 of the 30 patients so treated showed some improvement. Recently, amber has been included in some formulas for treatment of heart disease, because of its claimed blood vitalizing effects; for example, it was combined with ginseng and notoginseng in the treatment of angina (12). Yang Yifan (13) also mentions the use for heart disease, saying: “In clinical practice, it is used for patients with heart diseases when the blood is not circulating properly, and at the same time the patient has palpitations and restlessness, such as seen in coronary heart disease.” The same formula with amber, ginseng, and notoginseng has been prescribed in cases of chronic liver disease to normalize the blood conditions (14). Jiao Shude (6) mentions that amber “frees the orifices” which is designation for treating conditions such as atherosclerotic blockage of the arteries and blood clots that can cause angina, heart attack, and stroke.

Other internal uses: Amber is used as an ingredient in tonic formulas, often along with pearl powder. A qi and blood tonic formula for lowering blood lipids-Jianyanling-is comprised mainly of amber, astragalus, pearl, rehmannia, ho-shou-wu, polygonatum root, and American ginseng; in addition to lowering lipids, it is used as an anti-aging formulation and a treatment to aid recovery for cancer patients after undergoing standard medical therapies (15, 16). Succinum is used in treating stomach ache, also in formulas with pearl. An example is the formula designated Weibao; the basic formula is comprised of pearl and amber with alisma, indigo (qingdai), mume, bletilla, licorice, san-chi, and rhubarb. To this, various additions would be made according to the presenting signs. In the study report of 100 patients treated with the Weibao formulas for chronic gastritis, about 80% of patients were said to show significant improvement of symptoms when using the herbs for 3-6 months (17).

Topical applications: Astringing ulcers and promoting tissue regeneration. Used externally, it is efficacious in the treatment of ulcers, boils, swellings, etc.

Since this fossil resin has ingredients in common with those of the original resin, a look at other Chinese pine materials that contain the resin may shed light on the actions of amber. Aside from fu-shen (mentioned previously), there are two of them still used today (5):

Colophonium (pine resin; rosin; originally called songzhi = pine teeth, and now called songxiang = pine fragrance) is said to be sweet and warm, and having the properties of drying dampness and dispelling wind and wind-damp (e.g., treats rheumatism). It is mainly used topically.

Pine Nodes (songjie = pine node) is described as bitter and warm, having the properties of dispelling wind, drying dampness, and strengthening tendons and muscles. It is often used for “rheumatism.”

Further, if one examines other resins, such as “dragon’s blood” (xuejie), used in Chinese medicine, they are typically recommended for vitalizing blood and alleviating pain, and applied topically to heal wounds.

Long Gu – Fossilized Bone (usually mammal vertebrae and extremities) – “Dragon Bone”

Nature: sweet, astringent, slightly cold

Enters: Heart, Liver, Kidney

Actions: Anchors and quiets the Shen; subdues the liver; suppresses liver Yang rising; astringes and controls any body fluids.

Indications:
• Heart/shen agitation: insomnia, palpitations, epilepsy, depression, mania, anxiety.
• Liver Yang rising: dizziness, restlessness, irritability, easily angered, blurry vision, vertigo.
• Deficiency/weak body constitution: spermatorrhea, leukorrhea, uterine bleeding, night sweats, spontaneous sweating, vaginal discharge.
• Topical: powdered and calcined for non-healing carbuncles, furuncles, sores and ulcerations.
• Its sedative property is probably due, in part, to its richness in calcium.
• Drier than Mu li and stronger to settle the Shen, better for tremors.
• Often used with Mu li to harness rising Yang.
• Use Long gu raw to settle and calm the Shen.
• Use the calcined form as an astringent for preventing leakage of fluids and for non-healing sores.
• Cook 20-30 minutes longer than other herbs.
Hsu: Anti-inflammatory, expectorant, hemostatic, astringent.
DY: Quiets the Hun.

Dose: 15-30g

 
Long Chi: fossilized teeth
• Astringent, cool.
• Basically same as Long gu, but more sedating, and especially good for palpitations with anxiety, insomnia, and dream-disturbed sleep.

Dose: 9-15g

Sheng Tie Luo – Iron filings – “Raw Iron Leavings”

Nature: acrid, cool

Enters: Heart, Liver

Actions: Calms the liver; sedates the Shen.

Indications:
• Withdrawal-mania, delirium from febrile disease, palpitations, insomnia, being easily startled or prone to anger.
• Decoct for an extra 60-90 minutes.
• Note high doses of iron are toxic, particularly to children. Even in adults, excess iron may contribute to an increased risk of heart disease and colon cancer.

Dose: 9-30g

Zhu Sha – Cinnabar – Mercuric Sulfide – “Vermillion Sand”

Nature: sweet, cold, toxic

Enters: Heart

Actions: Anchors and quiets the Shen; clears heat and eliminates toxicity from the heart; sedates the heart; prevents putrefaction; expels phlegm and clears heat.

Indications:
• Shen disturbance / hyperactive fire in the heart: insomnia, hot sensation in the chest, palpitations, restlessness, anxiety, convulsions. Depending on the herbs with which it is combined, it can be used for treating patterns of heat excess, phlegm-heat, or blood deficiency.
• Heat and toxicity: carbuncles.
• Topical: mouth sores, sore throat, snake bite, carbuncles.
• Wind-phlegm dizziness and Lung heat
• Especially indicated in cases resulting from fright and anxiety.
• Antiseptic
• Use only the recommended dosage, take for a short time.
• Contraindicated in patients with a Western diagnosis of liver or kidney disease.
• To avoid mercury poisoning, DO NOT HEAT this herb.
Jin: Can substitute Hu po when Zhu sha is unavailable or inappropriate. [Or illegal]
Liu: Temporary use of appropriate dose when indicated is harmless.
Li: “[When overused] this herb makes people stupid.”

Dose: 0.3-2.7g (directly as powder or pill, or added to strained decoction)

Notes on This Category

• These herbs are to be used only for excess conditions (heat, toxicity, phlegm, etc.). They are forbidden for Yang or Qi collapse.
• These herbs are very acrid and have the potential to damage the Qi.
• Also consider: Niu huang, Zao jiao, Yu jin, Yuan zhi, herbs that resolve phlegm (Bai fu zi, Dan nan xing…)
• These herbs are commonly combined with:
A. Herbs that clear heat and eliminate toxicity when loss of consciousness is due to (Xue level) heat and toxicity.
B. Herbs that disperse cold and promote Qi circulation when loss of consciousness is due to cold phlegm (this is not common).

An Xi Xiang – Benzoin – (Resin of Styrax benzoin and other Styrax species) – “Peaceful Rest Fragrance”

Nature: acrid, bitter, neutral

Enters: Heart, Liver, Spleen

Actions: Opens the orifices; promotes Qi circulation; promotes blood circulation.

Indications:
• Delirium or coma with a stifling sensation and focal distention in the chest and abdomen.
• Qi and blood stagnation: pain in the chest and abdomen.
• Tinctures of the herb have been shown to directly stimulate the mucosa of the respiratory tract and promote expectoration.
• Difficult to procure in the U.S.
Hsu: Stimulates CNS; stimulating expectorant – when dissolved in hot water and inhaled, directly stimulates the mucosa of the respiratory tract, increases secretions, promotes discharge of phlegm.
• Inhaling too high a concentration can irritate the nose, eyes, and throat.
PCBMP: Antiseptic, expectorant, astringent.
• Topical: on wounds, ulcers (including of the mouth) to protect and disinfect.
• Inhale for coughs, bronchitis, colds.

Dose: 0.3-1.5g (in pills and powders)

Bing Pian – Borneol – (Natural form is extracted from Dryobalanops aromatica or Blumea balsamifera) – “Ice Slice”

Nature: acrid, bitter, slightly cold

Enters: Heart, Spleen, Lung

Actions: Clears heat; relieves pain; dissipates nodules and stagnant fire; alleviates itching; aromatically opens the orifices, revives the spirit.

Indications:
• Used topically (especially for heat) for eye, throat, skin, and mouth problems: toothache, sore throat, pain and swelling of the throat, mouth ulcers, carbuncles, eczema (with Qing dai, Shi gao, sesame oil), sores, scabies, neuralgia, photophobia, excessive tearing. Commonly used topically to regenerate flesh.
• Loss of consciousness and convulsions due to various causes, primarily heat and toxicity.
• Mildly stimulates the peripheral sensory nerves.
• Has a stimulatory effect on the higher centers of the brain.
• Similar in action to She xiang, but weaker.
• Never cook or expose to heat.
• Natural borneol is Mei pian. It is safe, most effective, but difficult to procure. Most borneol is synthetic and should probably not be taken internally, except perhaps in very small doses.
Hsu: Antibacterial, antifungal; stimulates CNS.
SD: The Chinese traditionally obtained their borneol (as an isolate) mainly from Dryobalanops aromatica and from Blumea balsamifera. The latter is used as the herb Ainaxiang (fragrant herb that looks like artemisia), which is rich in borneol and also contains limonene, camphor, and other terpenoid compounds. The extracted borneol (longnaoxiang; fragrant dragon’s brain; also known as bingpian [ice slice] referring to the appearance of the finished product) is considered to be suitable for abdominal and chest pains, intestinal parasites, phlegm congestion, and fevers. Blumea is in the same plant family (Labiatae) as capillaris, chrysanthemum, and saussurea, which also contain important terpenes.
Borneol and bornyl acetate are ingredients in the following herbal materials: cardamon, magnolia, nutmeg, turmeric, ginger, liquidambar, lindera, camphor oil. These herbs are all used in the treatment of pain syndromes.
Three forms of borneol were mentioned in the Bencao Gangmu: aifen (powdery borneol), the crude product aipian (the refined substance, now known as bingpian), and aiyu, a by-product of distillation. The material was obtained from Blumea grown in the southern part of China, primarily Hainan Island (near Canton), or from imported material (from Borneo in Indonesia) derived from Dryobalanops. Borneol was originally used as a carminative to reduce fevers and alleviate digestive distress. It was also said to inhibit worms. Another name given to borneol was longnaoxiang (dragon camphor fragrance), referring to its alchemical applications (the term “nao” also means brain).
Today borneol is classified as an agent for opening blocked orifices, and is described as pungent, bitter, and slightly cold. It is indicated for severe obstruction of the orifices (that may cause coma or convulsive diseases), for heat syndromes, and for pain. Although not often mentioned as useful for this purpose, borneol is a common addition to treatments for lung diseases in modern clinical practice. It is also applied topically (usually with other substances) for a wide range of conditions, mainly for swelling in the throat, mouth sores, ear infections, cervical erosion, psoriasis, boils, pain, and eye diseases.
Because the resin is strongly aromatic and, partly, because of its historically high price (which has been reduced in recent years, in part due to the availability of the synthetic version), the recommended dosage is quite small. Many herb guides list the internal dosage as 30 to 100 mg, taken in powders or pills (if added to a decoction, it will all evaporate). The Pharmacopeia of the PRC indicates 150 to 300 mg per day. It appears that Chinese Herbal Medicine: Materia Medica by Bensky and Gamble has an error in reporting of dosages, indicating 300 to 900 mg per day, a higher recommendation than virtually all other sources.
TOPICAL APPLICATIONS OF BORNEOL
Borneol is used in greater frequency for topical applications than for internal use. Those applications are numerous, but especially apply to injuries, burns, rheumatic pains, hemorrhoids, skin diseases, and ulcerations of the mouth, ear, eye, and nose. Borneol (or camphor) is almost always used in complex formulas, and typically comprises 1.6 to 8.5 percent of the total prescription. Because topical preparations are often difficult to make in convenient form on the spot, they are frequently used as patent remedies.
In the English-Chinese Encyclopedia of Practical Traditional Chinese Medicine, vol. 4, a recipe for treating purulent otitis media is:
borneol 20% , dragon bone 33%, alum 20%, kaempheria (camphor root) 27% , one pig gallbladder. The powdered materials are applied in the ear once per day. Kaempheria (shannai) is a relative of ginger that contains borneol and camphor. Traditionally, kaempheria is used topically for toothache and internally for warming the spleen and stomach to treat cold pain in the abdomen, vomiting, and diarrhea.
The Manual of Dermatology in Chinese Medicine provides the following examples of special preparations with borneol for application to the skin:
Luhui Binz Zhu Weifu Ji: 1 fresh aloe-vera leaf, 0.3-1.0 grams borneol, a pinch of pearl powder: mash the ingredients together and apply 1-2 times daily for herpes zoster sores.
Bing Shi Dan: 30g calcined gypsum powder, 0.6g borneol powder: combine and apply to herpes zoster pustules.
Di Yu Er Cang Hu Gao: 18g each of phellodendron, red atractylodes (cangzhu), and xanthium, 36g sanguisorba, 3g menthol, and 1.5g each of calomel and borneol: grind to powder, combine with petroleum jelly, and apply to skin 2-3 times daily for atopic dermatitis.
Dong Chuang You: combine 5g borneol and 15g camphor with 100g dried chili peppers: grind the borneol and camphor into powder and add to a hot water extract of chili pepper (steep peppers in hot water for 10 hours in closed container, string and then add alcohol to precipitate solids that are removed). Add glycerine and apply the ointment 3-4 times daily to the affected area (but not ulcerated lesions) for treating frostbite.
Qing Liang Fen: combine powdered talcum (120g), licorice (20g) and borneol (12g): sprinkle on affected area 3-5 times daily for treatment of sunburn causing erythema, wheals, or itching.
Dahuang Bingpian Fang: combine 100g rhubarb powder and 20g borneol in 250g table vinegar: let steep for 7 days; apply to affected sites 3 times daily for seborrheic dermatitis.
Dingxiang Bingpian San: combine 30g cloves with 6g borneol: grind to powder and apply to underarms 1-2 times daily to treat sweat odor.
TOXICITY
The California Health Department, Food and Drug Branch, has raised concerns about the safety of borneol in patent remedies. Guanxin Suhe Wan, because it is currently available in the form of small capsules, might be accidentally taken in some overdose, but it seems unlikely that anyone would consume several times the 3 capsule recommended amount.
For references purposes, borneol is included in the amount of either 1% or 2% in some of the Seven Forests herb formulas made available from ITM for prescription by practitioners. In 700 mg tablets, this corresponds to 7-14 mg of borneol per tablet. With daily dosing of 6-18 tablets (the upper dose being the highest recommended in the ITM literature and twice the highest amount suggested on the label), the amount of borneol taken in one day can range from 42 mg (6 tablets, 1%) to 252 mg (18 tablets, 2%). The amount of borneol is either below or within the range suggested by the Chinese Pharmacopoeia (100-300 mg), and corresponds well with recommendations in various Materia Medica guides (which have dosages as low as 30 mg). The Seven Forests formulas, used as examples of traditional-style prescriptions, have about the same concentration of borneol (1-2%) as does ordinary cardamon seed. Cardamon, including sharen and baidoukou, commonly used as a medicinal as well as food spice, typically contains 2-3% essential oil, for which borneol and camphor, as well as closely related chemical compounds, are the primary constituents.
The concern about borneol apparently stems from a worry about camphor oil.

Dose: 0.3-0.9g (taken directly)

She Xiang – Musk (Secretions from the Musk Deer)

Nature: acrid, warm

Enters: Heart, Spleen, Liver

Actions: Promotes blood circulation, relieves pain and swelling, dissipates clumps; intensely opens the orifices, revives the spirit, unblocks closed disorders; induces labor, hastens delivery, facilitates passage of stillborns.

Indications:
• Heart misted by phlegm or heat, heat entering the pericardium in warm-febrile disease, or other disorders which impair consciousness: loss of consciousness, coma, convulsions, delirium, fainting, stupor, closed disorders, tetanic collapse, phlegm collapse, seizures.
• Blood stasis: pain – acute chest and abdominal pain, Bi syndrome, trauma, toxic sores, carbuncles, immobile palpable masses, coronary artery disease, angina pectoris – comparable to nitroglycerine. For blood stasis disorders, it is used topically (in plasters, compresses) as well as internally.
• To discharge the placenta or fetus, combine with it with Rou gui.
• Powerfully anti-inflammatory.
• Thought to stimulate the CNS in small doses and inhibit it in large doses.
• Strongly stimulates the uterus; stimulates the heart.
• Possesses male hormone-like effects.
• Raises blood pressure.
• Musk deer are endangered and importation is illegal. Most commercially available musk is synthetic or is collected from raised deer.
• Due to its expense, this herb is never cooked.
• This is the most intensely aromatic and penetrating substance in the materia medica.
• Contraindicated in pregnancy and in cases of Yin deficiency heat.
• Helps other herbs cross the blood-brain barrier. Useful for brain conditions such as cancer and migraines.

Dose: 0.6-1.5g

Shi Chang Pu – Acorus rhizome (A. gramineus) – Related to and similar to the American species A. calamus (Calamus, Sweetflag)

Nature: acrid, warm

Enters: Heart, Stomach, Liver

Actions: Opens the orifices; calms the Shen; vaporizes phlegm; resolves damp; adjusts the stomach/harmonizes the middle Jiao; brightens the eyes; improves hearing; benefits muteness; mildly induces resuscitation.

Indications:
• Damp-phlegm obstruction of the heart and sensory orifices: fuzzy head, loss of consciousness, dizziness, forgetfulness, dull senses, seizures, stupor, phlegm blockage of the ears including deafness.
• Damp accumulation with Qi stagnation: chest, epigastric, and abdominal fullness and pain.
• Damp/phlegm in the middle Jiao which disturbs the mind.
• Used internally or externally for wind-cold-dampness: Bi syndrome, trauma, sores.
• Potential use in ADD/ADHD (e.g., Seven Forests Acorus Tablets).
• Increases digestive secretions, relaxes intestinal spasm.
• Ulcerations of the cornea: with Hu po, Gou qi zi, and Ju hua.
• Hoarseness with accompanying sputum in the throat or swollen, edematous vocal cords: with Jie geng and Shi hu.
• This herb’s ability to open the orifices is secondary to its general, aromatic action in vaporizing phlegm.
• Powdered herb can be blown up the nose in emergency situations.
• Used in Ayurveda to antidote marijuana.
• Contains β-asarone, which has been show to be carcinogenic to animals in laboratory studies. These studies do not conclusively demonstrate any danger from standard therapeutic doses in humans. Also, β-asarone is destroyed by prolonged cooking. Traditionally, Shi chang pu is long-cooked with other herbs.
DY: Some materia medica maintain that Shi chang pu opens the nine portals (the seven sensory orifices plus the anus and urethra). It is particularly effective for sensory or psychological problems such as deafness, tinnitus, nasal obstruction, blurred vision, loss of consciousness, slow-wittedness, loss of memory, dementia, and psychoses.
Shi chang pu is incompatible with meat, lamb’s blood, and Yi tang.
• With Chan tui to effectively rouse the spirit and open the portals. For vertigo, tinnitus, and deafness due to obstruction of the portals.
• With Ci shi to enrich the kidneys, calm the liver, diffuse impediment, open the portals, and sharpen the hearing. For indications such as:
- 1. Tinnitus and/or deafness due to Yin deficiency or deficiency fire. (Use vinegar dip-calcined Ci shi.)
- 2. Headaches, vertigo, heart palpitations, vexation and agitation, and insomnia due to Yin deficiency causing Yang hyperactivity. (Use unprepared Ci shi. However, it is important to know this form can cause abdominal pain. Therefore, the dosage should be moderate [15g] and it should be combined with Shen qu.)
Shi chang pu is a generic name which covers three distinct medicinal substances:
- 1. Jiu jie chang puAnemone altaica: Transforms phlegm; eliminates wind-phlegm; opens the orifices. To treat sensory or psychological disorders due to phlegm confounding the orifices of the heart, Jiu jie chang pu is the most appropriate and effective of these various medicinals.
- 2. Xian chang pu or Xi ye chang puAcorus gramineus var. pulsillus: Is prescribed fresh (Xian) and clears heat; transforms phlegm-heat; used for loss of consciousness due to febrile disease or accumulation of phlegm-fire.
- 3. Shi chang puAcorus gramineus: Transforms phlegm; eliminates dampness; stimulates hunger.
- Bai chang pu or Shui chang puAcorus calamus [Sweetflag] is substituted for Shi chang pu by the majority of importers. This has a similar action to Shi chang pu, but is less powerful.
HF: A Sha Chong (kill worms or parasites) herb, important in Gu Zheng (Gu parasites) formulas.
Hsu: Stimulates secretion of digestive juices, prevents abnormal fermentation in the GI tract; analgesic – relieves spasms of intestinal tract smooth muscle; sedative; antifungal; diuretic.
JTCM: For insomnia, particularly after history of using sleeping pills which have blocked the orifices of the heart with phlegm: use Wen Dan Tang plus Shi chang pu, Yuan zhi, He huan pi. In Ben Cao Gan Mu, Shi chang pu is said to tonify the heart Qi.
• Somnolence: when due to spleen Qi sinking, preventing the clear Yang from reaching the head, add Shi chang pu to Bu Zhong Yi Qi Tang. When due to phlegm-heat flaring up and blocking the orifices of the heart, add Shi chang pu to Huang Lian Wen Dan Tang.
• Fresh Shi chang pu juice can be dropped into the ear to unblock the ear and disperse EPIs.
• Tongue stiffness after wind-stroke.
• Hoarse voice, loss of voice, difficulty speaking: fresh herb gives better results than dry – use 15g fresh slices in tea (particularly effective with Chao yi, Xuan shen, Ma bo).
• Leukorrhea: in Ben Cao Gan Mu, it is said that Shi chang pu can treat uterine bleeding and leukorrhea. Use Hua Zhuo Tiao Jin Tang for dampness and imbalance of the Chong and Dai Mai: Shi chang pu 15g/day, Chao yi ren 30, Cang zhu 10, Bai zhu 10, Che qian zi 10, Chao huang qin 12.
• Inhibits growth of fungus. Especially good for women with both digestive disorders and leukorrhea.
• Short cook to preserve the volatile oil which calms the mind.
MLT: With Yu jin for mental derangement, the effects of intoxicating drugs such as marijuana, and lack of focus.
Yoga: Vacha, meaning “speaking” the power of the word, of intelligence or self-expression that this herb stimulates.
• Pungent, bitter, astringent/heating/pungent; V, K-; P+
• Stimulant, rejuvenative, expectorant, decongestant, nervine, antispasmodic, emetic.
• Colds, coughs, asthma, sinus headache, sinusitis, arthritis, epilepsy, shock, coma, memory loss, deafness, hysteria, neuralgia.
• Used by Vedic seers.
• Rejuvenates the brain and nervous system, purifies and revitalizes.
• Rejuvenates Vata and secondarily, Kapha.
• Clears the subtle channels of toxicity and obstructions.
• Promotes cerebral circulation, increases sensitivity, sharpens the memory, enhances awareness.
Sattvic nature.
• Helps transmute sexual energy, feeds Kundalini.
• Apply paste to the forehead for headaches, on joints for arthritis.
• Take nasally for congestion, polyps, to revitalize prana.
• Take with fresh ginger to counter its emetic properties.
• Take powder nasally to resuscitate from shock or coma.
• Caution with bleeding.
Weng Weiliang, et al:
• Epilepsy: shi chang pu extract was used to treat 90 cases of grand mal epilepsy and epileptiform discharge in EEG. Dosage for adult: 50mg, tid, 30 days as a course of treatment. In the clinical observation for 3 months ~ 2 years, the effective rate was 83.3%.
• Pulmonary encephalopathy: shi chang pu was made into injection. Mild pulmonaryencephalopathy was treated with intravenous injection of 10ml this injection mixed with 20ml 5% glucose, bid. For severe cases, the dosage was increased. 5~7 days as a course of treatment. 279 cases were treated, and the total effective rate was 74.89%.
• Coronary heart disease, pectoris angina: shi chang pu, xuan shen, chuan lian zi, long yan rou, sheng shan zha, chao mai ya, dang gui, long gu, mu li, chao zao ren, shu di, water decoction. 82 cases of pectoris angina due to coronary heart disease were treated, after days, 92.68% was relieved, and the EKG improving rate was 65.85%.
• Atrophic gastritis: dang shen, shi chang pu, e zhu, dang gui, pu gong ying, gan cao were used to treat 61 cases of atrophic gastritis, 27 cases were markedly effective, 14 effective.
RW: Aromatic bitter; powerful stomach tonic, encourages its secretions; stimulates the appetite for any type of anorexia.
• Chew the herb to help quit smoking.
• Tonic effect on the mucus membranes of the mouth and throat, and stimulates saliva.
• Put bits of the herb into a piece of cloth for a teething baby to chew on.
• Topical: the oil is refreshing and stimulating – for tired feet, varicose veins, more.
PCBMP: Chinese studies show the herb to be anti-arrhythmic, hypotensive, vasodilatory, anti-tussive, antibacterial, and expectorant.
• The American variety may be preferable to the Chinese kind, since it contains less or no β-asarone (a carcinogen) and is also more aromatic, with superior spasmolytic activity.
MW: Opens the sinuses (as in nasya oil) and third eye.
• Good for slow speaking, voice sounding impacted, or when the voice is wearing out, especially due to smoking or singing. Acts on the trachea.
• Post-stroke: inability to speak.
• Joint pain.
IBIS: (A. calamus)
• Qualities: aromatic, pungent, bitter, sweet, warm, dry.
• Affinities: mucous membranes.
• Actions: carminative, diaphoretic, sialogogue, spasmolytic, stomachic.
• Therapy: encourages secretory action of stomach; anorexia nervosa; lack of appetite in asthenic, young girls; children with umbilical colic; children with appetite disorders; tones mucous membrane lining mouth and throat; to stop smoking; teething children (Weiss, pp. 44-45); acute and chronic dyspepsia; gastritis; gastric ulcer; intestinal colic (British Herbal Pharmacopoeia, p. 14). Increases appetite, improves digestion.
• Use with caution during pregnancy due to emmenagogue effect (Lust, Farnsworth)
• Potential hallucinogen (Kinghorn; Lewis and Elvin-Lewis; Schultes and Hofmann, p. 201) [large dose of the fresh herb]
• Isolated constituents, beta-asarone and safrole, have been shown to be carcinogenic (Duke, pp. 14-15)
CHA: (Karen S Vaughan, 8-30-2001)
(Regarding the concern of beta-asarone carcinogenicity:)
Traditionally, in Mideastern and European herbalism, the Acorus calamus was candied, thus cooked for a long period, which would reduce the beta-asarone. Native Americans did chew the raw root as well as infuse and decoct it, but the dosage would tend to be self-limited as the taste can become unpleasant after prolonged chewing. (And I believe that the native American calamus species are somewhat milder.) However, in large doses sweet flag can be mildly hallucinogenic and quite emetic.
The Mongolians, who brought calamus to Russia in the 13th century, were known for planting the stronger Indian and Chinese versions of the root near water sources in order to keep the drinking water pure. It’s nickname “Mongolian Poison” appears to be a slur against the Mongols rather than a reference to the plant, which was considered benign. However, this tradition made more use of the antiseptic qualities of calamus.
The live plant was introduced into Europe in 1565 and widely distributed by the botanist Clausius. It was decocted for food stagnation, and for problems of the liver, gallbladder, kidney, bladder and for malaria. Leaves were burned as an aromatic disinfectant and insectide. The roots were burned to clear the air from typhus, cholera and influenza. It was used topically and in alcohol solution as a disinfectant, for scrofula and for ulcerous skin conditions.
In Ayurveda, Acorus calamus is known as Vacha and is generally used as a dried powder. This probably leads to a partial dispersion of the essential oils. It is considered light and drying and is frequently used for epilepsy and as a gargle for acute tonsilitis. It can be boiled with milk to reduce the mucous-producing properties of the milk. It is also used to counteract the effects of constant marijuana smoking.
One note which may account for the California ban: sweet flag oil is widely used as an aromatic wine adulturant.
The FDA frowns upon the sale and use of calamus and has issued directives to certain herb dealers not to sell it to the public. (An FDA directive is simply a polite word for a threat of hassling without a law to back it.) At present there are no federal laws against calamus.

Dose: 3-9g (up to 15g)

Notes on This Category

These herbs each possess any of four major actions:
1. Clear Liver Heat.
2. Subdue Liver Yang.
3. Extinguish Liver Wind.
4. Calm/Anchor the Shen.
These herbs are commonly combined with:
A. Herbs that clear heat or reduce fire from the liver when there is liver heat leading to Yang rising or liver wind.
B. Liver and kidney Yin tonics when liver wind is due to Yin deficiency of the liver and kidneys.
C. Herbs that quiet the Shen when there is Shen disturbance.
D. Herbs that resolve phlegm when liver wind stirs up phlegm and blocks the channels and collaterals.

Bai Ji Li (Ci Ji Li) – Tribulus fruit – Puncture vine – Caltrop – Tribulus terrestris

Nature: bitter, acrid, neutral

Enters: Liver, Lung

Actions: Subdues the liver, anchors the yang; frees the flow of liver Qi; eliminates external wind, dispels wind-heat; promotes vision; stops itching.

Indications:
• Liver yang rising: headache, dizziness, vertigo, hypertension.
• Liver Qi stagnation: distention in the chest, costal region, and flanks, postpartum galactostasis or insufficient lactation.
• Wind: skin eruption with itching, hives, vitiligo.
• Wind-heat: red, swollen, painful eyes, increased tearing; nasal congestion.
• Promotes urination.
• Lowers blood pressure.
• Recent Western use as “herbal Viagra” to improve libido and erectility.
• Guohui Liu: Useful for Liver attacking transversely, causing bloating, etc. (15-30g)
Yoga: Gokshura: sweet, bitter/cooling/sweet; VPK=
• Diuretic, lithotriptic, tonic, rejuvenative, aphrodisiac, nervine, analgesic.
• Cools and soothes the membranes of the urinary tract; stops bleeding.
• Rejuvenative to Pitta, calms Vata. Invigorating for postpartum women.
• Difficult or painful urination, edema, kidney or bladder stones, chronic cystitis, nephritis, hematuria, gout, rheumatism, lumbago, sciatica, impotence, infertility, seminal debility, venereal disease, cough, dyspnea, hemorrhoids, diabetes.
Hsu: Hypotensive, sedative.
DY: Upbearing and dispersing; calms the liver, resolves depression.
• With Sha yuan zi to regulate upbearing and downbearing and the liver and kidneys. Together, they course the liver and rectify Qi, resolve depression and calm the liver. They harmoniously supplement the liver and kidneys – they enrich the kidneys and secure the essence, nourish the liver and brighten the eyes. For such indications as:
- 1. Vertigo, unclear vision due to liver and kidney deficiency. (Use salt mix-fried Bai ji li – this alleviates the draining and dispersing characteristics of the herb and reinforces its supplementing aspect.)
- 2. Lumbar pain, seminal emission, premature ejaculation, frequent urination due to kidney deficiency. (Use salt mix-fried or stir-fried Sha yuan zi.)
- 3. Abnormal vaginal discharge due to kidney deficiency.
Examine.com’s literature review concluded: “Tribulus Terrestris is a herb commonly sold as an aphrodisiac, sexual performance enhancer, and testosterone booster. Currently, it seems that it does have scientific grounds to claim it is an aphrodisiac and perhaps high doses could be seen as a sexual performance enhancer.
“Science on Tribulus and testosterone is mixed and trending towards being ineffective. Currently three human studies have been conducted on the matter and found no fluctuations in testosterone with doses between 200-450mg Tribulus daily for up to 8 weeks. Higher doses in rats that correlate to 750mg in humans routinely find testosterone increases in castrated rats, and a single study exists to suggest that this testosterone boost at the same high dose can apply to normal rats.
“Beyond those claims, Tribulus is claimed to be a heart healthy compound and a large dose (3g) has been demonstrated to reduce blood pressure over the course of 4 weeks, with noticeable improvement at one week, in persons with hypertension.”

 

Dose: 6-12g

Dai Zhe Shi – Hematite – “Red Stone from Dai County”

Nature: bitter, cold

Enters: Liver, Heart, Pericardium

Actions: Subdues the liver, suppresses liver Yang rising; clears liver heat; descends the Qi of the Lungs and stomach, strongly directs rebellious Qi downward; cools the blood; stops bleeding; anchors the Shen.

Indications:
• Stomach Qi rebellion: belching, hiccups, vomiting. Use when Ban xia is not enough. This herb is not appropriate for morning sickness of pregnancy.
• Failure of Lung Qi to descend: wheezing, asthma.
• Liver Yang rising, liver fire: headache, dizziness, tinnitus, pressure around the eyes.
• Hematemesis, epistaxis. Primarily for bleeding due to heat, but can also be used for bleeding due to cold from deficiency when combined with appropriate herbs.
• Should be boiled for approximately 30 minutes before adding other herbs.
• Often calcined or pulverized after soaking in vinegar.
• Major known constituents include diferric trioxide, aluminum, silicon, magnesium, tin.
• Bensky/Gamble classifies this with herbs that anchor the Shen.
MLT: For short term use only – likely contains traces of arsenic.

Dose: 9-30g

Di Long – Earthworm – Lumbricus – “Earth Dragon”

Nature: salty, cold

Enters: Liver, Spleen, Bladder, Lung

Actions: Removes obstructions from the channels and collaterals; relieves asthma, calms wheezing; clears heat; extinguishes liver wind; stops spasms and convulsions; promotes urination.

Indications:
• Lung heat obstruction: asthma, wheezing. Clears Lung heat.
• Liver wind: convulsions with high fever, seizures – can be used alone.
• Damp-heat: Bi syndrome with red, painful, swollen joints.
• Obstruction of channels and collaterals: hemiplegia, sequelae of wind-stroke, for either hot or cold (with appropriate combination) Bi.
• Bladder heat: painful urination or retention of urine, cystitis, urinary stones, edema.
• Liver Yang rising: hypertension. Lowers blood pressure. Over 90% effective for essential hypertension in one study.
• Hot, manic type schizophrenia. (Recent use)
• Temporarily lowers men’s sperm count.
• May temporarily lengthen the penis.
• May inhibit the effects of histamine on smooth muscle.
• This herb’s effectiveness is enhanced by washing it in wine.
• This herb’s ability to treat spasms and convulsions (compared to Ling yang jiao and Gou teng) focuses mainly on its ability to open up and penetrate.
• Doctrine of signatures: earthworms’ (and other insects’) ability to remove obstructions is indicated by their skill at wriggling through small places or plowing right through the earth.
• Contains the fibrinolytic enzyme lumbrokinase. May have benefit in cardiovascular disease. One study showed “Oral lumbrokinase improves regional myocardial perfusion in patients with stable angina.”
• A very safe herb.
MLT: Insects [and worms] represent the essence of pure neurological instinct reaction that is akin to the manifestation of involuntary reflexes such as spasms, shaking, and stroke. Described as “strange proteins,” they seem to have a corrective effect on the nervous system. Customarily administered as a powder in capsules.
Hsu: Antipyretic, hypotensive (probably by direct action on CNS), bronchodilator, stimulates the uterus, small intestine and large intestine.

Dose: 5-15g

Gou Teng – Uncaria stem and thorns – Uncaria rhynchophylla, U. sinensis, and related species – “Hook Vine”

Nature: sweet, slightly cold

Enters: Liver, Pericardium, Heart

Actions: Clears liver heat; subdues liver yang; extinguishes liver wind, alleviates spasms; releases the exterior.

Indications:
• Liver wind: convulsions, tremors, seizures, eclampsia. Especially useful when due to intense heat.
• Liver heat: distention and pain in the head, red eyes.
• Liver Yang rising (including Yin deficiency patterns): dizziness, vertigo, irritability, blurry vision.
• Wind-heat: fever, headache.
• Lowers blood pressure. For hypertension take 30g twice a day. Especially useful when due to liver Yang rising. If there is liver Yin deficiency, combine with Bai shao – 2:1::Gou Teng:Bai Shao (i.e. 15g Bai shao BID). Gou teng’s hypotensive effect diminishes if it is cooked too long. Old stems, without thorns, have no hypotensive effect.
• Similar to Ling yang jiao, but while antelope horn enters the blood level, Gou teng enters the Qi level and is especially useful for problems secondary to externally-contracted wind-heat.
• Do not cook longer than 10 minutes.
• It is traditionally believed that the more hooks and less stems, the stronger the herb.
• Contains rhynchophylline – a non-competitive NMDA receptor antagonist (anesthetic) and calcium channel blocker.
Hsu: Hypotensive – inhibits vasomotor center, dilates peripheral blood vessels; sedative, inhibits the CNS; prevents epilepsy; antiviral – especially against respiratory viruses.
From “Antihypertensive and neuroprotective activities of rhynchophylline: the role of rhynchophylline in neurotransmission and ion channel activity.”:
• RESULTS: Rhynchophylline was the main constituent of several components identified from Uncaria species. Rhynchophylline mainly acts on cardiovascular and central nervous system diseases, including hypertension, bradycardia, arrhythmia, sedation, vascular dementia, epileptic seizures, drug addiction, and cerebral ischemia. Rhynchophylline also has effects on anticoagulation, inhibits vascular smooth muscle cell proliferation, and has been shown to be anti-endotoxemic. The active mechanisms are related to modulation of calcium and potassium ion channels, protection of neural and neuroglial cells, and regulation of central neurotransmitter transport and metabolism. More studies are necessary to verify the pharmacological activities and determine the exact mechanisms of rhynchophylline activity.
• CONCLUSIONS: Rhynchophylline treatment of cardiovascular and central nervous system diseases has a strong linkage with traditional concepts and uses of Uncaria species in ethnopharmacological medicine, such as treatment for lightheadedness, convulsions, numbness, and hypertension. As a candidate drug for several cardiovascular and central nervous system diseases, rhynchophylline will attract scientists to pursue the potential pharmacological effects and mechanisms with new technologies. Relatively few clinically relevant studies of rhynchophylline have been conducted. Thus, more in vivo validations and investigations of antihypertensive and neuroprotective mechanisms of rhynchophylline are necessary.

Dose: 6-15g

 

 

On the related herb Cat’s Claw / Una de Gato – Uncaria tomentosa:
This species grows much larger than the Chinese forms. The bark is used.
Its similarity (or lack thereof) to Gou teng has not been clearly established.
Major claims are that it is an immune enhancer, antiviral/antibiotic, anti-inflammatory, antispasmodic. Extracts (under the trade name Samento or Saventaro) are commonly used to treat Lyme disease. Shown in studies to fight the progression of Alzheimer’s disease (better when combined with Ginkgo leaf and Gotu Kola).
Recently, there has been some controversy over the constituents TOA’s (tetracyclic oxindole alkaloids) and POA’s (pentacyclic oxindole alkaloids). Numerous sources claim TOA’s are ineffective or even harmful, while the medicinal potency of the plant comes from the POA’s. Consequently, there are products which claim to be TOA-free and/or which maximize POA’s.
SD: Cat’s claw is one of several dozen herbs being promoted these days as an effective treatment, even a potential cure, for cancer, AIDS, chronic fatigue syndrome, candida infection, arthritis, and other disorders for which modern medicine is often unsatisfactory. The broad spectrum of action claimed for these herbs is not an impossibility, as the disorders that are said to be treated involve the immune system: there could be a central regulatory mechanism affected by a natural compound that leads to improvements for many patients with various diseases. The suggestion that the herbs produce dramatic effects or are curative rather than merely helpful is more problematic, as clinical evaluations of several such materials have failed to confirm many of the claims that were based on individual case studies.
Cat’s claw seems exotic because it is a native Indian remedy from the mountains of Peru. Yet, there is no evidence that it is any more valuable than less exotic items from China, India, Europe, or the U.S. which were previously considered exotic. Apparently, the root bark of the plant has been used by the aborigines in the area where it grows for gastric distress, skin diseases, arthralgia, and cancer. It is not clear how accurately cancer was diagnosed (in most medical traditions, cancers, abscesses, and non-malignant swellings were lumped together), nor what effect this herb had in native hands, nor whether it was only one of several remedies provided in combination to the patient. The “claw” which characterizes this vine may have been selected by “doctrine of signatures” as something that could penetrate and puncture a lump or grab the cause of localized pain. In China, the related plant Uncaria rhynchophylla (gouteng), is said by native healers to effectively treat headaches: the hook on the vine indicates that it can go in and grasp the pain to pull it out. This explanation may also come after the observation of effects, as an aid to memory: Chinese research confirms that the herb can treat certain types of headache, especially that associated with hypertension.
The active components of cat’s claw are mainly alkaloids, glycosides (triterpenes and procyanidins), and tannins. The oxindole alkaloids of the stem (including the hooks) are the same as those found in the Chinese plant that is far more intensively analyzed. Rhynchophylline, the main alkaloid, has been made into a drug in China for treating hypertension and headache due to vascular constriction. The alkaloids in the root bark of cats’ claw are in the same category as rhynchophylline, but are slightly differently. The claim made by some investigators appears to be that these unique alkaloids are responsible for the ability of the plant to treat cancer and to inhibit viral infections. Enhancement of phagocytosis in vitro was reported in 1985 by Wagner, a European researcher who has focused efforts on revealing immune-enhancing actions of natural products (his work with echinacea, eleutherococcus, and the liver-protective herb sylibum is frequently reported in the alternative medicine literature). However, it is not clear that sufficient amounts of such alkaloids are consumed so that one would obtain this effect nor how strong the effect might be. Based on his research experience, Wagner believes that polysaccharides, terpenoids, alkaloids, and polyphenolic compounds from plants have immunostimulating activity.
The triterpenoids of cat’s claw have been shown to have an anti-inflammatory effect. This effect is not surprising: dozens of plants with triterpenoids have an anti-inflammatory action; triterpenoid compounds often have a steroidal structure. Other materials have been isolated from the herb, such as oleanolic acid (which has anti-allergy actions), but the amounts are so small as to make their presence insignificant in relation to the herbal activity in clinical practice. Clearly, one can find numerous compounds in this plant and attribute healthful activities based on in vitro tests that require large amounts of the compounds, but that doesn’t mean one is likely to obtain those effects from oral consumption of recommended amounts (e.g., 20 grams by decoction or infusion, much less by ingestion of encapsulated powders) of the crude herb.
In a patent application for use of cat’s claw alkaloids for immune-modulatory effects against cancer, other alkaloids with similar effects obtained from other plants are mentioned, such as berbamine and matrine, ingredients identified from common Chinese herbs (e.g., hu-chang and sophora) that boost certain immune responses and which can be used in the treatment of cancer (Chang and But 1987). The question that arises is this: is it worthwhile collecting a species that has a limited growing range for which the root bark may be the key ingredient, and which is quite expensive, rather than using readily available plants that are less expensive and are already cultivated and which have far more supporting research for the intended application? The patent application also lists more than a dozen phenols/quinones and terpenes as examples of natural substances “with stimulating effect on the immunological system.”
That aside, one can examine carefully the research to date. In one study (Aquino, et al. 1991), anti-inflammatory compounds were isolated. In rat paw inflammation experiments (usually used in the study of potential anti-arthritis remedies), dosages of 2 g/kg of the dried bark (corresponds to typical human dosage of 140 grams of the herb) were used, and the most active isolated fractions were able to inhibit the rat paw edema by about 40%. Aspirin is a lot easier to use and more effective and although aspirin may cause gastric irritation, so might the isolated components of cat’s claw. The common, cultivated Chinese herb tang-kuei, has an anti-inflammatory action that is slightly greater than that of aspirin, weight for weight.
Antiviral activity of quinovic acid glycosides from cat’s claw were also analyzed (Aquino, Simone, and Pizza, 1989). As the authors of the study report: “an inhibitory effect against VSV [vesicular stomatitis virus] was evident for all the nine compounds tested, although at relatively high concentrations with respect to the toxic dose….” In other words, the antiviral activity was weak unless you approach the point where the herbal components would kill the cells as well. Before one reaches cell killing by a compound, severe side effects would tend to be observed clinically. The authors continue: “almost all these quinovic acid glycosides were inactive against rhinovirus type IB infection….” These same authors mention in their introduction the antiviral action of glycyrrhizin (from licorice). This and other components from readily-available and inexpensive herbs have been demonstrated effective in treating viral infections; for example, glycyrrhizin can cure a portion of clinical cases of chronic hepatitis B infection and it has been shown, in vitro, to inhibit HIV.
The potential antitumor activity of cat’s claw remains pure speculation. In a paper about the constituents of various Uncaria species in Peru, it was suggested (de Matta, et al.) that catechin in the root bark may be responsible for the effect. Catechin is believed to be anticarcinogenic, but it is obtained from dozens of other herbs (it is often found in barks) that are much more easily obtained (rhubarb is the main source used in Chinese anticancer studies). In a recent evaluation of antimutagenic effects (Rizzi, et al., 1992), it was speculated that cat’s claw acts as an antioxidant, thus potentially reducing the incidence of transformation to cancer cells via an oxidation reaction. Yet, there are dozens of antioxidants already identified which have this property, many of which have useful nutritional benefits (e.g., vitamins C and E, selenium, cysteine) and which are inexpensive and readily available. While these are thought to be useful in reducing cancer risk, their impact on existing cancers is minor.
To get around the rather poor outcomes found in laboratory experiments and the availability of alternative sources for materials for which similar claims could be made, promoters of cat’s claw resort to hyperbole. Philip Steinberg, a nutritional consultant, proclaims it a “wondrous herb from the Peruvian Rainforest,” and refers to an article by a chiropractor, Brent Davis, who proclaims it a “world class herb.” The patent issued more than five years ago is trotted out as primary evidence of its value. Indeed, cat’s claw has been sold in Europe, but an analysis of the capsules of product show that it is extremely low in the supposed active components compared to reference samples from Peru (Stuppner, Sturm, and Konwalinka, 1992) so that any claims made for it are likely placebo effects.
To promote the product, “The Cat’s Claw Quarterly” was generated. As illustration of its irresponsible reporting, the 10 page first issue carries not one author’s name. Keplinger, the holder of the above-mentioned patent is reported to have been treating AIDS patients in Europe. He proclaims benefits were observed as follows: “within twenty days treatment there were positive signs in the immune system.” Anyone working with AIDS knows that the manifestations of the disease is highly variable and that few, if any, patients stick to only one remedy at any time; besides that, there was no way to show “positive signs” in the immune system within twenty days back then (in 1987, two years before this first issue of the newsletter). An herbal correspondence course devotes lesson 26 to cat’s claw, as part of the larger section on “killing cancer.” All that is offered is a rambling narrative of the author’s attempt to track down information on cat’s claw (one section is headed “very little written about cat’s claw”). As an example of successful use of the herb for cancer, here is one story he relates from Austria, where Keplinger works: Male 14-year-old [with lymph leukemia]. Chemotherapy was applied. However, patient suffered extreme discomfort. Cat’s claw given. Three week’s later, blood values improved. Patient more active. Since the blood condition improved so much, they thought this was because of the chemotherapy. So they increased the dosage of chemotherapy. The blood test did not reveal further pathology. The patient is now considered a mostly healthy child.” That certainly shows that cat’s claw is effective against cancer by the contorted reasoning methods employed by such writers. Chemotherapy, which is effective in many cases of childhood leukemia, by this reasoning came out poorly in this report. In a letter to Townsend Letter for Doctors (an informal and unreviewed magazine), Steinberg claims that one Peruvian physician spoke at an international congress on traditional medicine “about his and his colleagues’ successes with Uncaria tomentosa and other herbs in treating 14 types of accurately diagnosed cancer in 700 patients.” The suggestion to be taken by the unsuspecting reader is that it was this herb that was responsible for the undefined successes. One wonders what these physicians actually did and what was actually said about the results.
Cat’s claw may indeed be a good remedy for gastritis (one wouldn’t be able to determine that from the current literature, however: gastritis isn’t as interesting as cancer and AIDS). Herbal therapies for gastritis are relatively easy for native herbalists to select, because the effects are usually prompt. There are hundreds of other gastritis remedies available; its just a matter of whether or not the gastritis sufferer will try them. If the first they try is cat’s claw, it may well be one they can say works for them.
At this time, there is no evidence that cat’s claw has significant immunological properties. It may have such properties, but there are potential problems with promoting it for this application. First, it appears that the tops of the plant, which mainly contain rhyncophylline in the stem and tannins in the leaves, are probably not effective for this purpose. In China, where immune regulators are a central area of concern, Uncaria species are not counted among them. When purchasing powdered materials, it is difficult to know if one is getting the right species (importers already caution that you buy their species of cat’s claw and not an alternative one, Uncaria guaianensis, available on the Peruvian market), much less the right plant part. If the root bark, which may have relatively unique compounds, is to be used, then the plants must be dug up, and we have one more case of damage to the rain forest plants. It has been suggested that the upper bark might have the same activity as the root bark, and it is possible, with vines, to collect the tops and still have the plant grow back. However, a careful analysis of the vine bark must be made and one must be assured of getting just this part (there isn’t much bark on this plant). But, why bother? There are so many established immune-regulating herbs already available that putting great effort into this one seems unappealing.
What about the current research status? In the U.S., this is being trusted to practitioners of natural medicine untrained or poorly trained in clinical evaluations who are to report on the effects in their patients (who are almost certainly taking other remedies at the same time) under the general heading of conducting a “clinical trial.” These practitioners will no doubt claim benefits seen in numerous patients, as they have in the past for each remedy that has been brought out for informal evaluation by practitioners untrained in research methodology. In Austria, Dr. Keplinger is said to be using a medicine extracted from the vine along with AZT in AIDS patients. His results (from the past eight years of experience) are being reported not in medical journals but in newspapers, such as El Comercio (Lima). In Peru, researchers are making a sincere effort to analyze the ingredients and effects of the plant. As reported in journals, the observed effects have been quite limited and the activities can be explained by compounds and mechanisms that do not require one use cat’s claw. Yet, an American distributor says that “Cat’s claw promises to become a major therapeutic agent worldwide in the very near future due to its unusual and significant health-stimulating properties.”
It is quite unfortunate that the diligent efforts of Peruvian researchers are being largely ignored in favor of the outlandish claims of chiropractors, nutritional consultants, and writers of informal correspondence courses. Desperate AIDS and cancer patients, as well as others, may be taken in by this (that is, after all, what the effort is all about), and spend their limited resources on this potentially endangered rain forest remedy when better-studied, more effective, and less expensive remedies are available to them. This is the ongoing problem with alternative medicine: uncritical acceptance of remedies promoted by persons with limited knowledge, but strong financial interests, and unreliable enthusiasm. If cat’s claw is a legitimate contributor to treatment of serious illnesses, then let the scientific knowledge be compiled and analyzed and then compared to what is known about other plant remedies before it is touted as the newest remedy for cancer and AIDS.
Appendix: Other Uncaria Species
Uncaria vines are native to Japan, China, Vietnam, and the Malaysian peninsula. Among the species used in China, interchangeably, are U. rhyncophylla, U. macrophylla, U. hirsuta, U. sessifructus, U. formosana, and U. scandens. The branch and stem are used for their nerve-inhibiting actions, associated with the alkaloid components. They are thus applied as a sedative, anticonvulsant, hypotensive, and analgesic. In Vietnam, U. tonkinensis is used; the bark of the vine is considered useful in lowering fever; it is said that the bark contains no alkaloids, but does contain catechin and catechutannic acid. In Malaysia, Uncaria gambir is used. The top of the plant is rich in tannins and is not very suitable for internal use (except temporarily to treat dysentery). Rather, it is applied topically for its antiseptic action (attributable to tannins) and some analgesic effects (probably due to the alkaloids). The roots are considered a remedy for intestinal inflammation, which is a common application of tannins. Such compounds may also have a positive effect on gastritis and urethritis, conditions for which cat’s claw has been claimed to be of use.

Jiang Can – (Bai Jiang Can) – Silkworm (Bombyx) infected with Beauveria bassiana

Nature: salty, acrid, neutral

Enters: Liver, Lung

Actions: Eliminates external wind, eases itching and relieves pain; extinguishes liver wind, relieves spasms and convulsions; resolves phlegm, dissipates nodules; clears heat, dissipates stagnant heat.

Indications:
• Wind: skin eruption with itching.
• Liver wind or wind-phlegm-heat: convulsions, facial paralysis, deviation of the mouth and eyes in wind-stroke, seizures.
• Liver heat or attack of the liver channel by wind-heat: headache, red eyes, sore, swollen throat, loss of voice.
• Stagnant heat: carbuncles, sore throat, toothache.
• Phlegm accumulation: lumps, scrofula, nodules.
• Use raw for dispersing wind-heat, otherwise dry fry.
• Compared to Wu gong and Quan xie in the treatment of wind and spasms, Jiang can is most appropriate for those due to phlegm-heat.
• Pound before cooking.
Hsu: Hypnotic, antispasmodic, stimulates adrenal cortex.
Dose: 3-9g (0.9-1.5g as powder or pill)

Jue Ming Zi – Cassia seed – Fetid Cassia seed – “Seeds of Realized Brightness”

Nature: sweet, bitter, slightly cold

Enters: Liver, Large Intestine, Kidney

Actions: Clears liver heat; expels wind-heat; promotes vision; moistens the large intestine, promotes bowel movement.

Indications:
• Liver heat or liver channel wind-heat: red, swollen, itchy, painful eyes with photophobia and increased tearing. Especially useful when liver heat is accompanied by constipation.
• Heat or dryness in the large intestine (especially from liver Yin deficiency): constipation.
• Used to prevent atherosclerosis: lowers blood pressure and serum cholesterol.
• Hypercholesterolemia: in one study of 100 patients (mean value 246.9 mg%, and as high as 484) given Jue ming zi decoction, 85% had normal values within 2 weeks. 98% were normal within 4 weeks. However, the value of total serum cholesterol as a measure of morbidity/mortality is questionable.
• Can counteract the constipating effects of some other herbs in this category (such as Mu li).
• Compared to Ju hua, Jue ming zi is better at clearing liver fire and benefiting the kidneys; Ju hua more effectively pacifies the liver and disperses wind-heat.
• Dry fried: tonifies the liver and is used for eye problems due to liver and kidney deficiency.
• Antibiotic effect.
• Bensky/Gamble classifies with herbs that drain fire.
• Bensky/Gamble: Do not use with Huo ma ren; not recommended when there is diarrhea or hypotension.
MLT: Pan roast and powder, and use as a coffee substitute for hypertension.

Dose: 9-15g (up to 30g alone)

Ling Yang Jiao – Antelope Horn

Nature: salty, cold

Enters: Liver, Heart

Actions: Clears liver heat; subdues liver yang (remarkably); extinguishes liver wind; promotes vision; clears heat and toxicity; clears damp-heat; quiets the Shen.

Indications:
• Liver wind: convulsions, spasms – infant, epilepsy, other seizure disorders, including for recalcitrant fevers, internal wind due to intense heat.
• Liver Yang rising: dizziness, vertigo, headache, blurry vision, red eyes, photophobia, hypertension, spasms, convulsions.
• Liver fire: red eyes, headache.
• Heart blockage by heat and toxicity with liver wind stirring: high fever, unconsciousness, delirium, involuntary limb movement.
• Wind-damp-heat: Bi syndrome.
• Doctrine of signatures: Antelopes and mountain goats live (and thrive) at high altitudes. The herb is useful for Yang that rises, like the peak of a mountain, and also for mountain sickness – increases resistance to a low oxygen environment.
• Less effective than Xi jiao (rhinoceros horn) at clearing heat and toxicity, but more effective at relieving spasms and extinguishing wind. The two horns are used together in severe cases of coma and convulsions due to high fever (however, rhinoceros horn should no longer be used, given rhinos’ endangerment).
• Take directly as powder or pills.
• Ling yang jiao is similar to Gou teng, but while Gou teng enters mainly the Qi level, Ling yang jiao enters the blood level, relives toxicity, and treats heat in the blood
Hsu: Antipyretic, anticonvulsive – tranqulizing, antispasmodic – inhibits CNS.

Dose: 0.9-3g (directly)

 
Shan Yang Jiao: Mountain Goat horn
• For ecological considerations, this herb may be used in place of Ling yang jiao.
• Mountain goat horn is much weaker – use 10 times the dose of antelope horn that would be used.

Dose: 9-60g

Mu Li – Oyster Shell

Nature: salty, astringent, slightly cold

Enters: Liver, Heart, Kidney

Actions: Subdues the liver and suppresses rising liver yang; anchors the Shen; benefits the Yin and anchors floating Yang; softens and disperses hardness, nodules, stagnation of phlegm and fire; astringes and controls body fluids; neutralizes acid (calcined form) and alleviates (stomach) pain.

Indications:
• Liver yang rising (including with Yin deficiency): restlessness, insomnia, palpitations, dizziness, vertigo, tinnitus, bad temper, red, flushed face
• stagnation of phlegm and fire: masses, lumps, swollen lymph nodes and glands, scrofula, goiter.
• Weak constitution (deficiency only – steaming bone disorder or following a warm febrile disease): seminal emission, leukorrhea, uterine bleeding, spontaneous or night sweats.
• Acidity: heartburn, excessive stomach pain with sour taste (Bensky/Gamble recommends the calcined form for this, while Liu says to swallow 10g uncooked, non-calcined Mu li). Note: Mu li contains a high amount of calcium carbonate. The carbonate acts as a pH buffer in the stomach, but calcium is a stimulus for acid secretion in the stomach (because it is soluble only at a low pH). At best, Mu li is a branch treatment for acidity. As antacids go, Mu li – and all antacids which contain calcium – may be inferior to those comprised of other mineral carbonates (such as sodium bicarbonate – baking soda).
• Muscle cramps: by “softening hardness” – anecdotally useful as a standalone herb, even in the common form of oyster shell calcium pills. Also beneficial for restless legs.
• Useful in treating night sweats due to tuberculosis.
• Weaker than Long gu to quiet the Shen, but stronger than Long gu to subdue liver Yang.
• “Slipperier” than Long gu.
• For astringing body fluids, use the calcined form, Duan mu li. For all other purposes use the unprepared form (note Bensky/Gamble says to use the calcined form for neutralizing acid).
• Cook for 20-30 minutes longer than other herbs.
• Bensky/Gamble classifies with herbs that anchor the Shen.
• Some sources claim Mu li works synergistically with Bei mu, Gan cao, Niu xi, and Yuan zhi, and that it has adverse effects when combined with Ma huang, Wu zhu yu, and Xi xin.
Hsu: Astringent, sedative, analgesic, antioncotic.
• Use 90-120g for neck lymphadenitis.
DY: With Huang qi to supplement Qi, constrain Yin, secure the exterior, and stop perspiration. For indications such as:
- 1. Spontaneous perspiration due to Qi or Yang deficiency. (Mu Li San) Use calcined Mu li.
- 2. Night sweats due to Yin deficiency. (This combination is appropriate for moderate Yin deficiency. In cases of deficiency fire, this pair cannot be used alone.)
- 3. Spontaneous and nighttime perspiration due to Qi and Yin deficiency. (Mu Li San) Use calcined Mu li.

Dose: 15-30g

Quan Xie – Scorpion – Buthus

Nature: acrid, salty, neutral, toxic

Enters: Liver

Actions: Extinguishes liver wind, relieves convulsions; eliminates external wind; cleans and dissipates stagnation of (fire) toxicity, dissipates nodules; removes obstruction from channels and collaterals, relieves pain.

Indications:
• Liver wind, wind-phlegm: convulsions (acute or chronic infant), tetany, tics, deviation of the mouth and eye in wind-stroke, tremors, opisthotonos, seizures. This herbs is among the most effective at eliminating wind.
• External wind: convulsions due to tetanus (wind invades wound).
• Stagnation of toxicity: carbuncles, lumps, toxic sores, swellings – includes topical use – follows the theory “use toxin to attack toxin.”
• Obstruction of channels and collaterals (blood stasis): stubborn headaches, migraines, Bi syndrome.
• Lowers blood pressure; tranquilizer.
• Weaker anticonvulsive effect than Wu gong. Compared to Wu gong and Jiang can in the treatment of wind and spasms, Quan xie is most appropriate when there is heat.
• Start with a very low dose and slowly raise it (if necessary).
• Often combined with Wu gong.
• Contraindicated for internal wind due to blood deficiency; pregnancy.
LL: Essential for a serious headache – always consider this herb.
MLT: For cancer/tumors: powder Quan Xie with Wu gong and Jiang can, suspend in water in a cloth bag while cooking an egg in the water. Eat the egg and drink the broth.
Hsu: Antispasmodic (weaker than Wu gong), antifungal, sedative.

Dose: 2-5g or 0.9-1.5 of just the tail (0.6-0.9g directly as a powder)

Shi Jue Ming – Abalone shell – Haliotis – “Stone Sense Brightness”

Nature: salty, cold

Enters: Liver, Kidney

Actions: Clears liver heat; subdues the liver and suppresses rising liver yang; promotes vision, dispels superficial visual obstruction.

Indications:
• Liver yang rising: dizziness, vertigo, headache, hypertension.
• Liver fire: red and swollen eyes, nebulas, blurry vision, optic neuritis, photophobia, pterygium.
• Topical ophthalmic: apply as a very fine powder to eyes.
• If the digestion is poor, use only 15g.
• Decoct for about one hour longer than other herbs.

Dose: 9-30g

Tian Ma – Gastrodia rhizome – “Heavenly Hemp”

Nature: sweet, neutral

Enters: Liver

Actions: Subdues the liver and suppresses liver Yang rising; extinguishes liver wind, relieves convulsions; eliminates wind-damp; relieves pain.

Indications:
• Wind-phlegm or liver Yang rising: dizziness, also headaches, migraines. This is perhaps the best herb for dizziness in the pharmacopeia.
• Liver wind: convulsions, trembling, epilepsy, tonic-clonic spasms, opisthotonos, tetany, wind-stroke – including with hemiplegia, dizziness, and numbness of the extremities.
• Wind-damp: Bi, pain and numbness of the lower back and extremities.
• High doses can cause nausea and vomiting.
• Since this herb is expensive, some deceitful sellers in China will steam potatoes to shrink them and then sell them as Tian ma.
• Some advise against using this herb in cases of Yin deficiency (such as liver wind due to liver Yin deficiency), claiming that it is warm and dry, however, MLT says: similar to Gou teng, but its sweet flavor gives it Yin tonic properties.
Hsu: Anticonvulsive, cholagogue.
SD: Gastrodia refers to the tuber of an orchid, Gastrodia elata. This plant has an unusual requirement for survival: it must have the Armillaria mellea mushroom mycelia incorporated into the tuber in order to maintain its maturation and growth, and it requires another fungus, Mycena osmundicola, to sprout the seeds. When supplies of the crude gastrodia became rare in the 1970’s, attempts at cultivating the herb repeatedly failed until this complex synergistic plant/mushroom relationship was determined. Then, cultivation became easy, though it was not until the late 1980’s that an adequate cultivated supply of gastrodia was developed.
Interestingly, the medicinal benefits of gastrodia were found to be mainly the metabolites of the Armillaria mushroom. In other words, if one could grow the mushroom, the gastrodia tuber could be dispensed with and one could use just the mushroom material in place of gastrodia. This mushroom cultivation (by batch fermentation) was accomplished and the material was tested in the 1970’s; today, gastrodia mushroom (Armillaria) is frequently used instead of cultivated gastrodia. In the meantime, wild gastrodia, along with all other wild orchids, has been put on the endangered species list.
Gastrodia was listed in the ancient Shennong Bencao Jing (ca. 100 A.D.) and was later classified by Tao Hong as a superior herb, meaning that it could be taken for a long time to protect the health and prolong life (as well as treating illnesses). It was originally called chiqian, meaning red arrow, because of its red stem shaped like an arrow. Later it was named tianma, or heavenly hemp (ma, usually translated as hemp, refers to many plants that have fibrous stems, such as the well-known mahuang).
The traditional use of gastrodia is to calm internal wind and dispel invading wind, and invigorate circulation in the meridians; thereby treating headache, dizziness, vertigo, convulsions, paralysis, and arthralgia. In the book Chinese English Manual of Commonly-Used Herbs in Traditional Chinese Medicine, the three basic indications are reduced to this elaborated pair:
1. Calm the liver wind: For syndrome of liver-wind stirring inside, such as infantile convulsion, tetanus, epilepsy, as well as dizziness and headache due to excess of liver yang or the attack of wind-phlegm; recently it is also used for treatment of neurasthenia, nervous headache, and hypertension;
2. Expel wind evil and alleviate pain: For migraine, arthralgia due to wind-dampness, numbness of extremities, and general fatigue.
According to research reports, the main active ingredients include gastrodin, a complex glycoside, plus vanillyl alcohol and vanillin, which, as their names suggest, are related to the flavor vanilla (vanilla comes from the fruit of another orchid, Vanilla planifolia, and the primary flavor is vanillin, which is synthetically produced as the standard flavor substitute). Vanillin has been shown to have anticonvulsive effects. There have been numerous other compounds identified in both Armillaria and the gastrodia tuber, with roles that are not yet established.
The gastrodia mushroom, Armillaria (also listed as Armillariella), is known in China as tianma mihuanjun.
Like many other medicinal mushrooms, Armillaria contains immune-enhancing polysaccharides, but the amount of the gastrodia mushroom usually ingested is not sufficient to provide a substantial immune-enhancing action. Gram for gram, the armillaria mushroom is more potent than the gastrodia tuber, mainly because it is the primary source of the active constituents. An exact quantitative comparison has not been determined, and may vary with the different therapeutic applications, but, generally speaking, the dosage of armillaria to be used is about half that of gastrodia tuber. Because these products are safe to use, armillaria can be used in the same amount as the gastrodia rhizome it
replaces in order to attain superior effects.
Gastrodia tuber is traditionally given in decoction in doses of 3.0–10.0 grams per day; the gastrodia mushroom (fermentation product) or gastrodia tuber is given in the form of a powder in doses of 1.0–1.5 each time, 2–3 times per day (total dosage of 2.0–4.5 grams/day).
According to Icones of Medicinal Fungi, Armillaria fermentation products “are found to produce satisfactory effect in treatment of dizziness caused by hypertension, insufficient blood supply to the arteries’ cone base, Meniere’s syndrome, as well as functional disorders in autonomic nervous system. They are also effective in improving numbed limbs, insomnia, tinnitus, epilepsy, vascular headache, and apoplectic sequela [post-stroke syndrome].”
The Advanced Textbook on Traditional Chinese Medicine and Pharmacology mentions that “This herb is mild, and can subdue hyperactive liver yang, eliminate wind, and remove obstruction in the collaterals, and is indicated for all kinds of wind syndromes, either cold or heat type or due to internal or external wind. For such cases, it is combined with other herbs according to the specific conditions. It is an important herb to treat dizziness.”
Examples of combining gastrodia with other herbs include these, from the Textbook:
¨ For dizziness and headache due to hyperactive liver yang, combine with uncaria and haliotis.
¨ For upward disturbance of wind-phlegm, combine with pinellia and atractylodes.
¨ For migraine, combine with cnidium.
¨ For convulsion due to irritation by liver wind, combine with antelope horn and uncaria.
¨ For tetanus [tonic convulsion, a wind-phlegm disorder due to external wind] combine with arisaema and siler.
¨ To relieve wind and remove obstruction in the collaterals [luo vessels], producing rheumatic pain and numbness
of the limbs, combine with chin-chiu, chiang-huo, and achyranthes.

Dose: 3-10g (0.9-1.5g directly as powder)

Wu Gong – Centipede – Scolopendra

Nature: acrid, warm, toxic

Enters: Liver

Actions: Extinguishes liver wind, relieves convulsions; eliminates external wind; cleans and dissipates stagnation of toxicity; removes obstruction from channels and collaterals, relives pain, dissipates nodules.

Indications:
• Wind, tetanus: acute or chronic infant convulsions, opisthotonos, spasms, seizures, lockjaw.
Stagnation of toxicity: carbuncles, lumps, nodules, neck lumps, sores, poisonous snake bites, stings. Used internally and topically.
• Blood stasis, obstruction of channels: stubborn headaches, migraines, Bi syndrome, impotence. Directs herbs to the penis.
• Very effective at treating diphtheria (used with Gan cao in study).
• Antifungal.
• Possesses anti-tumor effects (in vitro).
• Effective for submandibular lymphadenitis.
• Some sources say to remove the legs and head – only use the trunk and tail.
• May cause stomach upset.
• Often combined with Quan xie.
• Stronger than Quan xie and Jiang can for wind and spasms. Since it is warm, is most appropriate for wind-cold. It is superior to the other two in the topical treatment of toxic swellings.
• Doctrine of signatures: Its form indicates its ability to direct to the penis and treat impotence. Liu: “Like an arrow that directs herbs to the penis.” Bugs, in general, are adept at squirming into small places, and are useful for opening blockages and freeing the channels.
• Usually taken directly in powder form (often in capsules).
• Contraindicated in pregnancy.
Hsu: Antibacterial, hypotensive, antispasmodic.

Dose: 0.9-3g (0.6-1g as powder or pill)

Zhen Zhu – Pearl – Margarita

Nature: sweet, salty, cold

Enters: Liver, Heart

Actions: Anchors the Shen; clears liver heat; eliminates superficial visual obstructions; sedates the heart; settles tremors, convulsions, and palpitations; astringes, promotes tissue regeneration; enhances the skin.

Indications:
• Shen disturbance or liver wind: palpitations, childhood convulsions, seizures.
• Disharmony of heart and Shen: easily frightened or angered.
• Liver heat: red, swollen eyes, nebulas, pterygium, blurred vision.
• Skin: take 1-2g internally daily to enhance skin.
• Topical: for non-healing ulcers, macerated areas (usually throat or gums); applied to the eyes as a very fine powder or in eye drops for nebulas; applies to the skin to soften, refine, and enhance its color.
• Often cooked with tofu and water for two hours prior to being ground into powder.
• Bensky/gamble classifies with herbs that anchor the Shen.
Hsu: Antihistamine, anti-allergic, diuretic.

Dose: 0.3-1g usually directly as powder/pill

Notes on This Category

These herbs promote proper circulation and dispel stasis for the recovery of normal blood circulation. According to Guohui Liu, with normal use, they will not move blood in an aberrant manner (with a few possible exceptions). Most of the herbs in the category are not anticoagulants.

Commonly combined with:
A. Herbs that warm the interior and disperse cold when blood stagnation is caused by cold obstruction.
B. Herbs that clear heat and cool the blood when blood stasis is due to congealing of the blood by heat.
C. Herbs that eliminate wind, cold, and damp when the channels are obstructed by invasion of these factors.
D. Qi tonics when Qi is deficient, and also to protect the Qi from damage by these herbs.
E. Blood tonics when blood is deficient, and also to protect the blood from damage by these herbs.
F. Herbs that resolve phlegm when blood stasis is caused by phlegm.

Other Herbs that Promote Proper Blood Circulation, to Consider When Appropriate:
An Xi Xiang [Open Orifices], Bie Jia [Nourish Yin], Chi Shao [Cool Blood], Da Huang [Promote BM], Dang Gui [Nourish Blood], Du Huo [Dispel Wind-Damp], Fu Zi [Warm Interior], Gu Sui Bu [Tonify Yang], Gui Zhi [Acrid, Warm], He Huan Pi [Calm Shen], Hong Teng [Clear Heat & Toxicity], Jing Jie Tan (charred) [Acrid, Warm], Lu Jiao [Tonify Yang], Mu Dan Pi [Cool Blood], Mu Tong [Drain Damp], Pu Huang [Stop Bleeding], Qian Cao Gen [Stop Bleeding], San Qi [Stop Bleeding], She Xiang [Open Orifices], Wa Leng Zi [Topical Herbs], Xie Bai [Move Qi], Xu Duan [Tonify Yang], Xue Yu Tan [Stop Bleeding], Xue Jia [Topical Herbs], Zao Jiao Ci [Resolve Phlegm], Zi Cao [Cool Blood].

Chuan Shan Jia – Pangolin scales – “Penetrate Mountain Scales”

Nature: salty, slightly cold

Enters: Liver, Stomach

Actions: Promotes blood circulation and dispels blood stasis from the channels; promotes lactation; relieves swelling; drains pus; unblocks menstruation; expels wind-dampness from the channels.

Indications:
• Pangolins are threatened (some species endangered). Attempts to raise them in captivity have failed. You can get the job done with another medicine.
• Blood stasis: amenorrhea, masses, Bi syndrome, early stage carbuncles/boils or with pus that does not drain, lumps, dysmenorrhea, lack of or insufficient lactation.
• Galactostasis after childbirth.
• Toxic swellings: abscesses, boils. Can dissolve as yet unformed pus, but it is more useful for suppurative lesions. Can be used topically.
• Wind-damp obstruction of channels: pain, stiffness or spasms in the limbs, pain that prevents bending and stretching.
• When the patient lacks breast milk and is Qi deficient, do not count on this herb to promote lactation.
• Excellent success as a hemostatic in surgery.
• May be useful for the treatment of hematuria.
• May raise WBC count.
• Traditionally this herb is powdered and taken directly. Too expensive to cook.
• Contraindicated in pregnancy.
• Liu: This herb can go anywhere in the body, and conducts other herbs to the appropriate area.
• The unprepared form is black. The prepared form has been fried until yellowish.
• Though sometimes referred to as “anteaters,” pangolins are not true anteaters.
HF: A Sha Chong (kill worms or parasites) herb, important in Gu Zheng (Gu parasites) formulas.
BF: Useful when there is concomitant damp-heat. Stasis with damp and heat is very common in women with endometriosis.

Dose: 3-9g

Chuan Xiong – Ligusticum root – Szechuan Lovage – Cnidium

Nature: acrid, warm

Enters: Pericardium, Liver, Gallbladder

Actions: Promotes blood and Qi circulation; eliminates external wind; relieves pain; moves Qi upward.

Indications:
• Blood (and Qi) stasis: irregular menstruation, amenorrhea, difficult labor, lochioschesis, and many kinds of pain, including abdominal, chest, flank, hypochondriac, dysmenorrhea, pain from traumatic injury, pain from carbuncles and boils, headaches, Bi syndrome.
• External wind disorders: headache, dizziness, painful obstructions, skin disorders; wind-damp arthritis/rheumatism.
• Reaches from the head down to the sea of blood.
• For a variety of wind patterns (wind-cold, wind-heat, wind-dampness, etc.) depending on the herbs it is combined with.
• Overdose may cause vomiting and dizziness.
Hsu: Antispasmodic, analgesic: inhibits intestinal and uterine contraction; slightly hypotensive; tranquilizer (essential oil); antibacterial, antifungal.
DY: Treats the Qi within the blood; dispels stasis; in the upper body, it goes toward the head and the eyes; in the lower body it goes toward the sea of blood (uterus ["Sea of Blood" may also indicate the Chong Mai or liver]); drying.
• For wind-cold (headache, etc.), use the uncooked form.
• For menstrual problems, pain, and inflammations, use the wine-processed form.
• With Dang gui to move the Qi and quicken the blood without damaging the blood, to nourish the blood without producing stasis, to dispel stasis and stop pain. For the following indications, both herbs should be wine-processed, though uncooked Chuan xiong may be used in the case of headaches or dermatological problems:
- 1. Menstrual irregularities, dysmenorrhea, and postpartum abdominal pain due to blood stasis that may be mixed with Qi stagnation. (Xiong Gui San)
- 2. Rheumatic pain due to wind-dampness and blood vacuity.
- 3. Headaches due to blood deficiency and/or blood stasis. (Jia Wei Si Wu Tang)
- 4. Wounds, ulcers, or enduring cutaneous inflammations due to Qi and blood vacuity with Qi and blood stagnation. (Tou Nong San)
• With Shi gao to dispel wind, clear and drain heat, quicken the blood and move the Qi, and stop pain. For headaches due to wind-heat or full heat (particularly that which is located in the Shaoyang or Jueyin channels). Use unprepared Chuan xiong. For wind-heat headaches, add herbs that dispel wind.
• Headaches: Chuan xiong is mainly used for wind-dampness and wind-cold headaches. However, it can be used for all kinds of headaches if combined appropriately. For wind-damp, add Qiang huo and Bai zhi. For wind-cold, add Fang feng and Jing jie. For wind-heat, add Ju hua and Bo he. For blood stasis, add Hong hua and Yan hu suo. For blood deficiency, add Dang gui and Ji xue teng. For full heat, add Shi gao and Zhi mu. For Qi stagnation, add Chai hu and Bai ji li. For liver Yang hyperactivity, add Tian ma and (Huai) Niu xi.
Weng Weiliang, et al: This herb is indicated in the treatment of headache, rheumatic arthralgia, abdominal pain with mass formation, pricking pain in the costal regions, swelling and pain due to traumatic injury, arthralgia due to cold, spasm of tendons, menstrual disorders, amenorrhea, dysmenorrhea.
HF: An important herb in anti-Gu therapy to move Qi (xing Qi) and break accumulation (po ji).
SD: Chuanxiong is a frequently used Chinese herb, commonly called ligusticum or cnidium. The latter name is the term most often used in the ITM literature, adopted from the common name offered by Oriental Healing Arts Institute (OHAI) in publications 30 years ago. The herb has been obtained from Ligusticum chuanxiong (= Ligusticum wallichii) in China and from Cnidium officinale in Japan; the OHAI literature was heavily influenced by Japanese herb scholars. Recent evaluation of the genetic material of these two source materials has led to the suggestion that they are, in fact, the same plant, and that Cnidium officinale should be renamed as Ligusticum chuanxiong (1).
There are several active constituents in chuanxiong, but one of the most interesting is the alkaloid ligustrazine, which has the chemical name tetramethylpyrazine (because it is a pyrazine ring with four symmetrically placed methyl groups); it is sometimes simply called TMP. Isolated alkaloids from chuanxiong, and purified synthetic ligustrazine, have been used in China as medicinal agents for 30 years. The initial applications were based on traditional uses of the crude herb in decoctions and pills: for vitalizing blood circulation in the treatment of cardiovascular diseases
and for treatment of headache and vertigo.
LIGUSTRAZINE BY IV ADMINISTRATION
Ligustrazine is rapidly absorbed when taken orally, but it is also rapidly excreted in the urine. In order to maintain high blood levels, oral doses must be taken every few hours. Alternatively, ligustrazine can be given by IV drip over several hours to keep the blood levels high. Such administration is typical for hospitalized patients in China who have suffered heart attack or stroke and for treatment of serious childhood diseases (it is administered to infants who can not swallow herbal decoctions or pills). However, for most non-emergency uses, the IV form of administration is not convenient; further, it is not routinely available outside of China. Still, the IV use of this compound over the past three decades, both for adults and children, illustrates the lack of toxicity from TMP.
LIGUSTRAZINE BY ORAL ADMINISTRATION
Ligustrazine as a component of chuanxiong is only present in small amounts, perhaps 1%, so that a 9-12 gram quantity of the crude herb in decoction (as might be used in modern clinical practice in China) yields about 90 mg-120 mg of ligustrazine for a one-day dose. While this quantity may provide some benefits, contributing one active component to a complex mixture, it is not adequate to get the full benefit of ligustrazine that has been described in clinical and laboratory work with the isolated compound. Oral dosing of 100 mg or more each time, at least three times a day would be necessary to get sufficient blood levels for the desired effects.
To enhance the action of ligustrazine, even when given in adequate dosage, Chinese doctors often combine it with one or more herbs that have the related therapeutic action of vitalizing blood. The main herb used in combination with ligustrazine is salvia, either alone or with tang-kuei.
APPLICATIONS
The applications of ligustrazine in China are many, and at first may appear quite diverse. However, upon examining the various applications, one can appreciate ligustrazine as providing a “protective effect.” Following are brief reviews of a few of the uses of ligustrazine.
Renal failure and dialysis: Ligustrazine has been used to slow or halt the progress of renal failure in Chinese patients (2). Experimental studies have been conducted to demonstrate this effect in laboratory animals (3). One of the proposed mechanisms is the superoxide scavenging effect, one type of antioxidant action (4). Salvia has also been used to protect against renal failure (see ITM review: The use of salvia for patients with renal failure). Ligustrazine with salvia and tang-kuei have been used to aid patients undergoing renal dialysis (5). TMP is also used in conjunction with prednisone for patients with primary nephritic syndrome, which is said to function better than prednisone therapy alone (6). In the treatment of infants, ligustrazine was used to protect against the renal toxicity of gentamycin (7). Ferulic acid, possibly the primary active component of tang-kuei and one of the active components of chuanxiong, has shown benefits for treatment of patients with diabetic nephropathy (8).
Lung diseases with fibrosis: Ligustrazine is known to be a pulmonary vasodilator (9), but an area of particular interest is its action to protect against pulmonary fibrosis (10). Salvia and an active fraction of salvia (labeled IH764-3) have also been used for protection against pulmonary fibrosis (11-13), alone or with ligustrazine.
Neuroprotection for stroke: Chinese physicians have used chuanxiong and ligustrazine for treatment of stroke patients. Ligustrazine has been shown to have protective effects for the neurons, possibly based on anti-inflammatory activity (14-15). In clinical applications, ligustrazine in high dosage (480 mg/day) was found to lower fibrinogen and improve blood circulation in patients who suffered a stroke (16). Salvia is also known to confer neuroprotective effects in case of stroke (see review article: Neuroprotective herbs and active ingredients). Ferulic acid or its sodium salt (sodium ferulate) is used in Chinese medicine to treat stroke patients; in laboratory studies, it was shown to limit damage and help reactivation of impaired nerve cells (17).
In sum, ligustrazine alone or with salvia may provide protection to the kidneys, lungs, and brain through antioxidant and anti-inflammatory effects; these substances reduce fibrosis and improve blood circulation. The addition of tang-kuei, especially as a good source of ferulic acid (see structure, below), may further improve the effects.

Dose: 3-10g

Dan Shen – Salvia miltiorrhiza root – Red Sage – “Cinnabar Root”

Nature: bitter, slightly cold

Enters: Heart, Pericardium, Liver

Actions: Promotes blood circulation and dispels blood stasis; cools the blood; relieves swelling; mildly nourishes blood; calms the Shen; unblocks the menses.

Indications:
• Blood stasis: irregular menstruation, amenorrhea, abdominal pain after childbirth, pain in the chest, abdomen, epigastrium, masses and pain in the limbs, lochioschesis.
• Blood stasis with liver Qi stagnation: pain in the ribs or hypochondria.
• Heat in the blood and blood stasis: carbuncles, boils.
• Febrile disease (including Ying level): restlessness, delirium, high fever, eruptions, red tongue.
• Heat and blood stasis in the heart: insomnia, palpitations, irritability, restlessness. Also for heart/kidney Yin deficiency heat patterns.
• Primary herb for coronary heart disease in China. (Particularly in combination with San qi, Gui zhi, Shan zha, etc.)
• For immune system disorders Liu combines with Dang gui.
• For CNS-mediated pain, including post-stroke, combine with Huang qi in doses of 15-30g of each (when Qi deficiency and blood stasis are present)
• Promotes tissue regeneration; opens coronary arteries; reduces blood sugar; reduces serum cholesterol; protects the liver; enhances the immune system; vasodilator; relieves angina pectoris.
• Wine-frying the herb enhances its blood circulating properties.
• This herb can be compared to the formula Si Wu Tang, though Dan shen is weaker at nourishing blood and stronger at moving blood than Si Wu Tang.
• Do not use large doses in patients predisposed to bleeding.
• Note: the Salvia genus contains many herbs with drastically different properties – e.g., culinary sage – Salvia officinalis (also a diaphoretic), and the hallucinogenic drug Salvia divinorum. “Salvia” alone is not a sufficient name.
BII: May improve visual acuity in glaucoma.
MLT: Regulates cholesterol, triglycerides. Premiere herb for heart problems, especially angina.
Hsu: Dilates peripheral blood vessels, lowers blood pressure; strong antibacterial properties.
DY: Engenders new tissue; nourishes the heart.
• With Mu dan pi to quicken the blood and dispel stasis, cool the blood, and eliminate deficiency heat. For indications such as:
- 1. Hematemesis, epistaxis, metrorrhagia, purpura, and also rubella and pruritis due to heat in the blood division.
- 2. Menstrual irregularities, dysmenorrhea, amenorrhea, dark purple menstrual blood with clots, and postpartum abdominal pain due to heat in the blood which causes blood stasis.
- 3. Continuous, low-grade fever due to Yin deficiency heat. In this case, if there are night sweats, use Di gu pi instead of Mu dan pi.
- 4. Hot, red, swollen, painful joints due to hot Bi or impediment.
• With San qi to quicken the blood, dispel stasis, nourish the heart, open the network vessels, stop pain, and settle palpitations. For indications such as chest Bi or impediment, i.e. cardiac problems with pain and severe palpitations. For these indications, wine mix-fried Dan shen should be used. This combination treats heart pain no matter what the cause. This action may be reinforced by adding Shi chang pu, Xie bai, Gua lou pi, Gui zhi, and Tan xiang.
• With Tan xiang to regulate and rectify the Qi and blood, move the Qi and blood, free the flow of the network vessels, and stop pain. For the following indications, wine mix-fried Dan shen should be used:
- 1. Chest Bi or impediment, heart diseases with severe cardiac pain due to Qi and blood stasis. If heart blood stasis is severe, add San qi, Hong hua, and Yan hu suo. If Qi stagnation is severe, add Chen xiang and Qing mu xiang. If there is phlegm-damp obstruction in the chest, Gua lou pi, Jie geng, and Zhi ke. If there is chest Yang deficiency, add Xie bai, Gui zhi, and Fu zi. If there is Qi deficiency, add Huang qi, Zhi gan cao, and Ren shen.
- 2. Stomach pain due to Qi and blood stasis.
Dan shen has “very interesting action” on coronary heart disease, circulatory system diseases, and hypercholesterolemia.
Dan shen only mildly nourishes blood. To reinforce its supplementing action, it should be prepared with pig or tortoise blood.
Dan shen is incompatible with vinegar or any other very sour or acrid food.
IBIS: Occasional hypersensitivity may lead to excessive bleeding or fever.
Weng Weiliang, et al: Clinical studies excerpted from Weng Weiliang, et al., Clinical Chinese materia medica, Henan Science & Technology Press, 1998, retrieved HERE:
• Viral myocarditis: Experiential formula Si Shen Yin which consisted of dan shen 12g, hai er shen 12g, nan sha shen 9g, ku shen 9g, zhi gan cao 3g, guang yu jin 9g, chao zao ren 9g, lian zi xin 2g was made into granules to treat viral myocarditis. Twice daily, 1 pack every time. 39 cases were treated, the courses of treatment ranged between 20 to 60 days, and the clinic symptoms improved to different extent.
• Acute myocardial infarction: Dan Shen Injection 10g~24g was added into 500ml 5% glucose or low molecular dextran for intravenous drip. Once daily, 7~14 days as a course of treatment. 388 cases of acute myocardial infarction were treated, the incidence rate of heart failure was 29.9%, the mortality rate within hospitalization was 27.2%, which were lower that those in the control group but without statistic significance. The mortality rate in males was 16.2% and was significantly lower than that of the control group. No difference in female group.
• Diabetes: Compound Dan Shen Injection 8~12ml was added into 500m 0.9% NaCl Injection for intravenous injection, once daily, for 28 to 43 days. 120 cases of diabetes were treat, 50 cases were markedly effective, 55 improved, 15 had no changes.
• Hepatocirrhosis: 20ml Compound Dan Shen Injection was added into 250ml low molecular dextran for intravenous drip, once daily, 30 days as a course of treatment. 43 cases of hepatocirrhosis were treated, 10 were markedly effective, 28 effective, and 5 ineffective..
• Chronic simple rhinitis: 2ml Compound Dan Shen Injection (each ml contains 2g dan shen and 2g jiang xiang) was mixed with 2ml physiological saline solution for nasal drip to treat chronic simple rhinitis. Three times daily, 2 drops each side every time. 4 weeks as a course of treatment. 38 cases were treated, 22 were cured, 10 markedly effective, 3 improved, and 3 ineffective.
WIKI: Results from animal and human studies support the use of Danshen for circulatory disorders to some extent because it is known to decrease the blood’s ability to clot in at least two ways. First, it limits the stickiness of blood platelets. It also decreases the production of fibrin, the threads of protein that trap blood cells to form clots. Both these effects help to improve blood circulation. In addition, chemicals in danshen may relax and widen blood vessels, especially those around the heart. In animal studies, chemicals in danshen may also have protected the inner linings of arteries from damage. Some other research suggests it may increase the force of heartbeats and slow the heart rate slightly.
• In animal studies, Danshen has appeared to interfere with the development of liver fibrosis — the formation of scar-like fibers in the liver. Because the nonfunctioning fibers crowd out active liver tissue, liver function decreases gradually as the amount of fibrous tissue increases. Having chronic hepatitis and habitually drinking large amounts of alcoholic beverages are the major causes of liver fibrosis, which could also result from exposure to chemicals or certain drugs. Danshen may also increase blood flow into the liver, so the length of time that potentially damaging substances stay in the liver may be reduced, also reducing the possible injury they may cause. Results from a few animal studies showed it may also protect kidney tissues from damage caused by diabetes. In China, danshen has also been studied for treating acute pancreatitis, a painful and possibly dangerous inflammation of the pancreas. [23]
Salvia miltiorrhiza inhibits alpha-glucosidase activity.[24]
• Danshen may stop the spread of several different cancer cell types by interrupting the cell division process[25] and also by causing cancer cells to undergo cell death (apoptosis).[15] In contrast, the cerebrovascular protective effect of Salvianolic acid has been found to be due to prevention of apoptosis.[9]
• For HIV, chemicals in Danshen may block the effectiveness of an enzyme, HIV-1 integrase, that the virus needs to replicate.[26]
• Salvia may stimulate dopamine release and has protective effects against free radical-induced cell toxicity.[27][28]
S. miltiorrhiza stimulates increased osteogenesis in vivo (bone cell growth).[29]
• Salvianolic acid B could possibly facilitate the repair of tubular epithelial structures and the regression of renal fibrosis in injured kidneys.[30]
• Danshen has been shown to potentiate the effects of the common anticoagulation drug warfarin, leading to gross anticoagulation and bleeding complications. Danshen should be avoided by those using warfarin.[31]

Dose: 6-15g (up to 60g when used alone or in treating vasculitis)

E Zhu – Zedoaria rhizome – Curcuma zedoaria, C. aromatica, or C. kwangsinensis

Nature: acrid, bitter, warm

Enters: Liver, Spleen

Actions: Strongly promotes blood and Qi circulation and dispels blood stasis; dissolves accumulations, eliminates food retention; relieves pain.

Indications:
• Blood stasis: amenorrhea with abdominal pain and masses, ovarian cysts, fibroids, epigastric masses.
• Food retention: fullness, constriction, distention, pain in the epigastrium, chest, and abdomen.
• Childhood nutritional impairment.
• Controls some cancers – particularly cervical (especially grade II and below).
• Stimulates motility of GI tract.
• Its powerful nature can damage the Qi (do not use for long periods).
• This is the strongest herb in the pharmacopeia to eliminate food retention.
• Much stronger than Ru xiang and Mo yao to move blood and relieve pain.
• Often combined with San leng. Liu says E zhu is stronger than San leng at moving blood, but weaker than San leng at moving Qi. Bensky/Gamble says just the opposite.
• Fry with vinegar to enhance its blood circulating properties and stop pain.
• Kamto: San leng + E zhu is a great combination for treating depression.
RW: Carminative (a type of turmeric).
Li: (Often with San leng) for blood stasis in difficult skin conditions.
PCBDP: Aromatic; stimulant; treats some tumors.
Hsu: Some antihistamine effects; promotes resorption of coagulated blood; inhibits cancer cell growth; stomachic.
HF: An important herb in anti-Gu therapy to move Qi (xing Qi) and break accumulation (po ji).
DY: Breaks the Qi and quickens the blood; treats the blood within the Qi; treats Qi stagnation which causes blood stagnation; tropism: liver, spleen, and Qi division.
• With San leng to strongly and effectively break both the Qi and blood, regulate and rectify the Qi and blood, stop pain, and reduce food accumulation. (Note that breaking the Qi and breaking the blood are both attacking methods that can damage the Zhen Qi if used inappropriately, too much, or for too long.) For indications such as:
- 1. Abdominal lump glomus, hepatomegaly, splenomegaly due to blood and/or Qi stasis. (E Leng Zhu Yu Tang)
- 2. Amenorrhea, dysmenorrhea, menstrual clots, and infertility due to blood stasis. (San Leng Wan) Both herbs should be vinegar mix-fried for these indications.
- 3. Abdominal pain due to food accumulation. (E Zhu Wan) Vinegar mix-fried E zhu should be used.

Dose: 3-9g

Hong Hua – Carthamus flower – Safflower – “Red Flower”

Nature: very acrid, warm

Enters: Heart, Liver

Actions: Promotes blood circulation, dispels blood stasis from the channels, opens the channels; alleviates pain; unblocks the menses.

Indications:
• Blood stasis: dysmenorrhea, amenorrhea, postpartum abdominal pain or dizziness, abdominal masses, lochioschesis, traumatic injury – wounds and pain, painful obstruction of the chest, non-suppurative sores, carbuncles.
• Heat and blood stasis: dark red skin eruptions, suppressed rashes, including measles.
• Beneficial in coronary artery disease. May also lower cholesterol.
• For Berger’s disease, combine with Ru xiang, Mo yao, Dang gui, Tao ren.
• For angina pectoris, often combined with Tao ren, Dan shen, Chuan xiong.
• Usually added near the end of cooking a decoction – should not be cooked long.
• Contraindicated in pregnancy.
• Bensky/Gamble: To harmonize the blood, use 0.9-1.5g.
Chen: Used successfully in one study to treat peptic ulcer.
DY: In a small dose (1-2g), it can slightly nourish blood. In a moderate dose (3-5g), it harmonizes the blood. At the usual dose (6-10g), it quickens the blood. At a high dose (10-15g), it breaks blood [stasis].
• Tends to dispel stasis in the upper part of the body and in the channels.
• With Tao ren: Hong hua is stronger than Tao ren at moving blood, while Tao ren is stronger at dispelling stasis. Together, they complement and reinforce each other to effectively quicken the blood, dispel stasis, engender blood, and stop pain. For such indications as:
-1. Cardiac and chest pain due to heart blood stasis. (Add San qi, Dan shen, Xie bai, and Gua lou pi.)
- 2. Amenorrhea, dysmenorrhea, menstrual irregularities, and dark menstrual blood with clots due to blood stasis. (Tao Hong Si Wu Tang)
- 3. Fixed, stabbing, and severe pain aggravated by pressure due to blood stasis. The combination appears in many formulas for these indications, based on the location and nature of the pain (Xue Fu Zhu Yu Tang, Tong Qiao Zhu Yu Tang, Fu Yuan Huo Xue Tang, Shen Tong Zhu Yu Tang, etc.).
- 4. Traumatic injuries with pain and swelling due to blood stasis. (Xiao Zhong Zhi Tong Tang)
MLT: Similar to, but stronger than Western Calendula.
PCBDP: Laxative, diuretic.
Hsu: Stimulates the uterus to contract rhythmically/tonically – particularly effective in pregnancy – fast, long lasting effect.
Dose:  3-10g (0.9-1.5 to harmonize blood) See comments from Dui Yao above.

Hu Zhang – Bushy Knotweed root and rhizome – Polygonum cuspidatum – “Tiger’s Cane”

Nature: bitter, cold

Enters: Liver, Gallbladder, Lung

Actions: Promotes blood circulation; relieves pain; eliminates toxicity; clears heat; drains dampness; resolves phlegm; stops coughing; slightly promotes bowel movement.

Indications:
• Especially indicated for a combination of phlegm, damp, heat, and blood stasis.
• Blood stasis: amenorrhea, traumatic injury, Bi syndrome.
• Damp-heat: jaundice, turbid vaginal discharge, painful urination.
• Heat-toxicity: burns, snake bites, skin infections, carbuncles. Often the fresh ground herb is applied topically.
• Lung phlegm-heat: cough.
• Heat accumulation: constipation (use 30g – discharges heat, toxicity).
• Guohui Liu: especially useful for hepatitis.
• Many constituents (resveratrol, piceatannol, polydatin, emodin) with medicinal properties elucidated through modern research:
- (from the scholarly folks at Herbal Vitality of Sedona) Anti-angiogenic (vitro), antibacterial against streptococci (vitro)/ vibrio (vivo), decreases histamine release (vitro), decreases COX-2 expression (vitro), anti-oxidant (vitro), antiviral – hepatitis B (vitro), anti-inflammatory (vivo), anti-allergenic (vivo), protects against burns (vivo), tyrosine kinase inhibitor, decreases oncogene function (vitro), neuroprotective (emodin / vivo), decreases leukopenia due to radiation (emodin / vivo), polydatin is cardioprotective (vitro) and decreases CAM expression (vivo), resveratrol has glucose regulating properties (vitro), inhibits cancer cell lines (vitro), decreases VEGF activity (vivo), decreases expression of NF-KappaB, COX-2, MMP9 (vivo), protects against bone loss (vivo), and is anti-inflammatory (vivo); piceatannol is hypolipidemic (vivo); stilbenes cause apoptosis of leukemic cells (vitro).
• Antiviral, antibacterial.
• Promotes leukocyte proliferation for leukopenia (particularly due to radiation or toxic chemicals).
• Contraindicated in pregnancy.

Dose: 9-30g

Ji Xue Teng – Millettia or Spatholobus root and vine

Nature: bitter, slightly sweet, warm

Enters: Liver, Heart, Spleen

Actions: Promotes blood circulation; mildly nourishes blood; relaxes the tendons; activates the collaterals, dispels stasis from the channels and collaterals; unblocks the menses.

Indications:
• Blood stasis: irregular menstruation, slow menstrual flow, dysmenorrhea, Bi syndrome.
• Blood stasis with blood deficiency: amenorrhea.
• Wind-dampness with blood deficiency or blood stasis: numb extremities, lumbar pain, knee pain, generalized joint soreness.
• Blood stasis or wind-stroke: weak extremities in the elderly, or paralysis and vertigo.
• For leukopenia from chemotherapy, radiation, aplastic anemia – combined with Dang gui, Bai shao, Shu di huang.
Hong teng – Sargentodoxa – (an herb that clears heat and eliminates toxicity) is used as this herb in many parts of China. It has none of Ji xue teng’s blood-nourishing properties or the ability to relax the tendons. Efforts should be taken to procure the correct herb if Ji xue teng’s unique properties are desired.
Hsu: Hypotensive.
Subhuti Dharmananda: May help antidote lead poisoning.
Millettia is the common name that has been selected to refer to the stems, obtained from several climbing legume shrubs containing a red resin, that are labeled as jixueteng in Chinese. The Chinese name describes the material as a stem (teng) with a sap having a color, which is reddish brown, reminiscent of dried chicken’s blood (ji = chicken; xue = blood). The main species used as sources of this herb are:
1. Spatholobus suberectus (most common species traded today and the official species in the Pharmacopoeia of the People’s Republic of China); see Figure 1; additionally Spatholobus harmandii and Spatholobus sinensis are used as substitutes.
2. Millettia dielsiana, Millettia nitida, Millettia speciosa, Millettia gentliana, Millettia reticulata, Millettia pachycarpa.
3. Mucuna birdwoodiana, Mucuna sempervirens, Mucuna castanea.
This group of plants represents a relatively recent addition to the Chinese Materia Medica, first recorded two centuries ago in the Bencao Gangmu Shiyi (Omissions from the Grand Materia Medica, 1765 A.D.), where it was said that it “activates blood, warms the waist and knees, and cures paralysis caused by wind.” This herb is not included in any of the commonly mentioned traditional herb formulas from the Qing Dynasty (1644–1911 A.D.).
Jixueteng did not have a strong reputation among traditional herbalists during the 20th century prior to the 1980’s. In Medicinal Plants of East and Southeast Asia (1), a compilation of information gathered during 1959–1961, the genera listed above are mentioned:
· Under the heading Mucuna it is stated that “Mucuna is scarcely worth mentioning medicinally.” The limitedinformation for this genus is that it “is a tonic.”
· Under the heading Millettia, it is stated that it “has few uses from the Malay Peninsula and Indonesia;” some mention of the leaves and root are made, but not of the stem; as to Chinese use, it is mentioned that Millettia dielsiana is “employed locally in Yunnan as anti-anemic; a new compound was isolated from the reddish bark; Millettia pachycarpa is used as a tonic and to induce the growth of red blood cells.”
· For Spatholobus, Chinese uses are not mentioned, though applications in Burma and Indonesia include: “ingestion of the sap as a treatment for faulty menstruation and uterine hemorrhage; an infusion of the stem is taken also to treat cough and fever.”
Jixueteng was deemed inconsequential enough that it was not included in the Synopsis of the Pharmacopoeia (2) prepared at the American College of Traditional Chinese Medicine in 1984, though the authors mentioned the herb in some sample prescriptions for recovering the hemopoietic system in their 1980 booklet Treatment of Toxic Side Effects Resulting From Radiation and Chemotherapy by Traditional Chinese Medicine (17). The herb is also absent from many of the illustrated Materia Medica guides that were compiled during the 1980’s. In the
book Aging and Blood Stasis (32), written by a physician who worked from the 1930’s to the 1980’s, jixueteng, commonly classified as an herb for promoting blood circulation and treating blood stasis, is not included in any of the prescriptions. The situation has changed dramatically in recent years: millettia has been elevated to one of the commonly used herbs of modern Chinese medicine.
TRADITIONAL ACTIONS AND INDICATIONS
The traditional actions of jixueteng mentioned in modern works, such as Chinese-English Manual of Common-Used Herbs of Traditional Chinese Medicine (3), are: “To enrich the blood and promote blood circulation, relax tendons and activate meridians.” Traditional indications are: “For blood deficiency and blood stasis syndrome manifesting as anemia, menalgia (painful menstruation), menoxenia (menstrual bleeding), or soreness, numbness, and immovability of extremities.” As another example, in Modern Study and Application of Materia Medica (43), its actions are: “To tonify the blood and activate its circulation, relieve rigidity of muscles and joints, and promote menstruation.” The indications are “Arthralgia due to wind and dampness, aching pain in the waist and knees, numbness of the extremities, malnutrition of the muscles and tendons, and irregular menstruation and amenorrhea due to deficiency of the blood.”
Depending on the source book consulted, jixueteng is found classified either as a blood nourishing herb, along with tang-kuei, peony, rehmannia, and ho-shou-wu, or as a blood vitalizing herb, along with salvia and red peony. In recent attempts to classify the blood vitalizing herbs into subgroups, Li Lianda (21) placed millettia along with tangkuei, moutan, salvia, raw rehmannia, and red peony as “mildly active herbs, nourishing the blood to promote circulation.”
C.S. Cheung (24) explained the close relationship of generating blood and vitalizing blood this way: The essence of fluid and grain is injected into the meridians and forms yingqi. It then circulates to the heart and transforms into blood. The blood flows to every part of the body and moistens and lubricates all tissues. When there is insufficiency of yingqi, the vaporization [dispersement] of qi is endangered. Thus, the blood does not flow smoothly, encouraging the formation of blood stasis and ecchymosis [congealed blood, outside the vessels]. New blood is unable to be generated when obstructed by stasis and ecchymosis. Consequently, therapeutic measures are taken to remove the obstruction and regenerate blood.
For this function, Cheung mentions the herbs tang-kuei, salvia, millettia, and turtle shell. Under millettia, he describes the functions as “tonifies and circulates blood, loosens ligaments, vitalizes the luo vessels, eliminates blood stasis and ecchymosis, and generates new blood and tissue.” The indications given are “blood deficiency diseases involving the meridians, draft wetness, numbness, cold pain.”
Qin Bowei (23), a famous herbalist of the 20th century, stated that: In harmonizing the blood, jixueteng is best at quickening the network vessels and freeing the channels. Cooked into paste, it is referred to as Jixueteng Jiao and is particularly strong. Yu Nanzhi [a famous herbalist] refers to this as a great supplementer of qi and blood, being most appropriate in geriatric and gynecological illnesses.
References to “activate meridians,” “vitalize the luo vessels,” and “free the channels” are translations of the Chinese term tongmai. Mai is the general term that means a vessel, channel, meridian, or a passageway, and the term is used in the modern medical sense of blood vessel. Tong means to be able to pass through or, as an activity, to make passable. Thus, tongmai indicates that use of the herb makes it possible for the qi and blood to flow through the meridians without obstruction. Where there is obstruction, one can experience pain, numbness, swelling, and stiffness. In general, the method of activating meridians is based on warming up the yangqi to promote vigorous movement.
The ability of millettia to supplement qi and blood, vitalize blood, alleviate cold pain, and free the channels brings to mind a traditional formula with similar properties: Huangqi Guizhi Wuwu Tang (Astragalus and Cinnamon Five Herb Combination) comprised of astragalus, peony, cinnamon, ginger, and jujube. Designed long before millettia was added to the Chinese Materia Medica, this formula is from the Jin Gui Yao Lue (ca. 220 A.D.). A modification of the formula was recommended by Wang Weilan (25) for treating soreness and weakness in the back and knees and numbness of the extremities in persons with qi and blood deficiency. To the traditional formula, he added tang-kuei, millettia, red peony, citrus, and chin-chiu (this last herb is often prescribed when there is a wind-damp syndrome in persons of deficiency constitution). He  particularly favored the combination of millettia with red peony in formulas for bi syndrome (arthralgia, numbness) to vitalize the blood, open the luo vessels, relax the ligaments, and relieve pain. In explaining bi syndrome, he stated that:
Deficiency of the normal qi is the basis of the internal factor and leads to the looseness of the cutaneous tissue [openness to external influence] and the lowering of the body’s resistance. If the external factor is the contraction of cold in winter, then the cold evil can take the opportunity to enter the weak and deficient body and to directly strike at the ligaments and bones, thus causing internal damage to the blood and the meridians, qi stagnation, blood stasis and ecchymosis, and limitation of movements….
According to this interpretation, herbs that enhance qi and blood, dispel the cold, and vitalize blood are of particular importance; hence, millettia is a key herb in treating bi syndrome in persons with deficiency syndrome.

RECENT APPLICATIONS OF MILLETTIA
It is the purported ability of millettia to aid the production of blood cells that has captured the attention of several Chinese researchers. A formula was developed for this purpose called Tang-kuei and Millettia Combination (Danggui Jixueteng Tang), recorded in the book Zhongyi Shanke Xue (Chinese Medicine for Blood Disorders) and relayed in Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine (4):
Tang-kuei and Millettia Combination
Tang-kuei 15 g
Millettia 15 g
Rehmannia 15 g
Salvia 9 g
Peony 9 g
Longan 6 g
This formula follows the principle of vitalizing blood to generate new blood and nourishing blood to aid circulation of blood; it is indicated for “advanced stage of bone [marrow] injuries with qi and blood deficiency, or for the tumors with white blood cell or platelet reduction during chemotherapy or radiation therapy (4).” In modern practice, astragalus is often included in formulations of this type to treat the qi deficiency and aid in the generation of blood, even though millettia has been said to have the ability to generate qi.
A number of basic preparations of millettia have been described in recent literature. Millettia paste was mentioned in the Annals of Shunning Fu (40), where it was stated that: “When combined with carthamus, tangkuei, and oryza, and cooked into paste, jixueteng is a sacred herb for blood diseases.” Millettia Wine and Millettia, Shouwu, and Longan Wine are mentioned as treatments of wind diseases and blood deficiency syndrome: millettia, as a single herb, for bi syndrome (arthralgia and myalgia), and the three-ingredient wine for “lassitude of extremities,
dizziness, palpitation, insomnia, early greying of hair, and pallor due to deficiency of both qi and blood (41).”
Millettia Sugar Broth, in which jixueteng is decocted and combined with 40% its weight of sugar, and used for treating loss of blood and anemia, is mentioned in Chinese Medicinal Herbs (40). Millettia usage in food therapy has also been described (44, 45). Millettia is boiled with eggs (after the egg is hard boiled, the shell is removed, and the egg returned to the decoction for continued cooking); sometimes jujube is included. Then, the eggs are eaten and the decoction drunk as a treatment for anemia. A tablet made of jiexueteng extract as the sole ingredient, Jixueteng Qingao Pian, is produced by the Shanghai Native Medicine Works; it is described as a treatment for bi syndrome; amenorrhea or dysmenorrhea due to deficiency of blood and/or stagnation of blood; and increasing white blood cell count in cancer patients who suffer leukopenia due to chemotherapy or radiation (42). Jixueteng injection has also been prepared in China (37). In Dictionary of Chinese Medicine (40, 43), the simple decoction of 30 grams millettia given daily on a long term basis was reported helpful for leukopenia induced by radiation therapy. During the 1980’s and up to the present, several clinical trials were conducted involving treatment of leukopenia and thrombocytopenia in which millettia was included in the herbal formulas and results of the therapy were reported in Chinese medical journals.
REVIEW OF HERB THERAPIES TO COUNTERACT CHEMOTHERAPY-INDUCED LEUKOPENIA
In an extensive review article (Countering the side effects of modern medical therapies with Chinese herbs), the use of formulas that had been reported, according to the results of clinical trials, as successfully countering leukopenia was presented. The descriptions of formulas that contained millettia and the results claimed from giving them to patients are relayed again here, with slight editing of information from the previous article and a few additions.
The Astragalus-Jujube Combination (Qi Zao Granule) was applied to treating white blood cell suppression from various causes (5). The formula is comprised of 18 grams each of astragalus, jujube, millettia, and hoelen, concentrated into extract granules. According to the clinical report, patients with white blood cell counts below 3.5 were treated for 20–30 days with this mixture: 56% of the patients had their white cell counts increased by at least 4.0 above the initial value and 24% had the white cell counts increased at least 1.0 above the initial value; granulocytes similarly increased. The figures for the response of the control group were 25% and 5% respectively. The same formula was used in the treament of cor pulmonale (22), with lymphocyte transformation rate depressed by the treatment, indicating that the primary effect in leukopenic patients was to benefit white blood cell production.
An expanded version of that formula was clinically tested for cancer patients with impaired immune functions (6). The prescription, Shengxue Tang (Generate Blood Decoction), is made with 30 grams each of astragalus and millettia, and 10–15 grams each of hoelen, lycium fruit, pseudostellaria, ligustrum, and cuscuta (the latter four herbs replacing jujube in the Astragalus-Jujube Combination). According to the clinical report, 242 cancer patients, mostly having stomach or intestinal cancer, and being diagnosed as having spleen-qi deficiency, were administered this formula. After only a few days of treatment (each course of therapy was only 2–3 days), macrophage phagocytosis, lymphocyte transformation rates, E-rosette formation rates, and killing ability of natural killer cells of peripheral blood were significantly increased.
Although reversal of leukopenia was not a direct outcome measure for the study of Shengxue Tang, the prescription is similar to others that were demonstrated to have that outcome. For example, another version of this formula, labeled Fuzheng Zengxiao Fang, was reported to ameliorate leukopenia, as well as to significantly reduce the experience of fatigue and gastro-intestinal distress in cancer patients undergoing chemotherapy (7). The formula is comprised of astragalus, millettia, lycium fruit, ligustrum, pseudostellaria, atractylodes, asparagus, and carthamus (thus, hoelen and cuscuta in Shengxue Tang are replaced by atractylodes, asparagus, and carthamus).
In another study, patients completing treatment with chemotherapy and radiation therapy (mainly for lung and esophageal cancers) were then administered a modified version of Shiquan Dabu Tang (Ginseng and Tang-kuei Ten Combination), with the added herbs: millettia, polygonatum, lycium fruit, ho-shou-wu, cornus, lotus seed, and dioscorea. After 30 days administration of the herbs to 60 patients, it was reported (8) that there were statistically significant improvements in total white blood cells, natural killer-cell rate, and ratios of CD2, CD4, and CD8.

Another formula of similar nature was used in a study (9) on the side effects of cancer therapy in patients with many types of cancer. The formula is:
Huten Tang
astragalus 40 g
millettia 30 g
hoelen 30 g
hu-chang 30 g
cuscuta 20 g
lycium fruit 15 g
psoralea 15 g
tang-kuei 15 g
atractylodes 12 g
licorice 10 g
Hu-chang and millettia (both used to boost white blood cells) were deemed the main herbs in the formula. The herb therapy was initiated 3–5 days prior to starting chemotherapy and continued until one week after finishing chemotherapy. The effectiveness of the therapy was evaluated by considering a broad set of indicators, such as red and white blood cell levels, extent of gastro-intestinal reactions, avoiding loss of hair, and improving tumor shrinkage. According to the author, 39% of the patients had an excellent outcome, and 43% had a notably effective response,
while only 7% failed to respond at all. This prescription is an elaboration of one described for leukopenia due to radiotherapy (40), which is comprised of 30 grams each of hu-chang, millettia, and tang-kuei (all used for building blood), along with 9 grams of licorice.
A formula relying on similar key herbs and the same basic therapeutic principle was used for 60 cases of leukopenia (38), given astragalus, millettia, hu-chang, psoralea, gelatin, polygonatum, rubia, and jujube. It was reported that 52 of the patients had marked improvement in the lymphocyte counts, and that the average hemoglobin and platelet counts also increased.
The same basic principle of therapy was utilized in another trial (11) involving patients being treated mainly for tumors of the lung, breast, and stomach, with the following formulation:
Fuzheng Guben Fang
astragalus 40 g
ho-shou-wu 40 g
millettia 30 g
oldenlandia 30 g
pseudostellaria 30 g
gelatin 20 g
licorice 20 g
ligustrum 20 g
rehmannia 20 g
atractylodes 15 g
peony 15 g
tang-kuei 15 g
The formula was modified to address specific symptoms. The herbs were given along with chemotherapy, while a control group received Western drugs, vitamins, and berbamine (an herbal leukocyte raising alkaloid derived from sankezhen: Berberis soulieana) along with their chemotherapy. According to the report, the formula prevented the decline in leukocytes better than the control treatment, and the patients also had fewer other side effects, such as nausea and weariness.
In a review (12) of herbal treatments for granulocytopenia (a type of leukopenia), 28 recipes that were reported to be highly effective were analyzed. It was found that the most commonly used herb ingredients were astragalus (in 21 formulas) and jixueteng (in 20 formulas), followed by salvia (in 13 formulas), psoralea (in 12 formulas) and tangkuei (in 11 formulas). Other herbs that were used repeatedly but in fewer than 10 formulas each were ligustrum, jujube, lycium fruit, epimedium, licorice, and hu-chang. A tablet made primarily with the commonly used herbs,
including psoralea, epimedium, ligustrum, astragalus, jujube, tang-kuei, salvia, millettia, and hu-chang, and also containing placenta, cornus, and sanqi (13), was given to cancer patients who suffered leukopenia due to cancer chemotherapy as well as others suffering from leukopenia due to other causes (e.g., chronic hepatitis, drug poisoning, radiation, and unknown causes). According to the report, after a course of treatment of two weeks (15 tablets per day, each tablet 1.85 grams of herb material), leukopenia was completely reversed in 49% of patients and another
29% showed marked improvement in leukocyte counts.
In a mouse study of herbal effects on cyclophosphamide-induced leukopenia, a mixture of astragalus, hu-chang (hu zhang), and millettia (Huanghuji Mixture) was compared to the effect of hu-chang alone and with the effect of vitamin B4. According to the report (14), hu-chang had the greatest effect, with the Huanghuji mixture slightly less effective, and vitamin B4 having a relatively weak effect.
According to a review of cancer therapy approaches used in China (27), the herbal combination Dao Jing Tong #17, with main ingredients millettia, salvia, and curcuma, was reported to enhance the action of the anti-cancer drug camptothecin against leukemia and it protects against pulmonary fibrosis caused by radiation therapy (these effects were reported in mice studies). It was also reported that “Various preparations for raising the white cell count have been made with the following ingredients: Illicium verum (dahuixiang), sophora, and millettia. They have been used in hundreds of cases of radiation and chemotherapy induced agranulocytosis.” These three herbs are in the legume family (see: Legumes).
THROMBOCYTOPENIA
Millettia has been incorporated into several modern prescriptions for treating thrombocytopenia. For example, in a series of reports (10, 33), Fu Xian Tang, also called Sanyao Fang: a decoction made with 30 grams each of millettia and agrimony, and 9 grams of rumex (suanmogen), was given for treatment of thrombocytopenia (33). It was reported that 57 of 62 cases had their platelet count raised to over 100,000. This response occurred within one week for most patients. As another example, a decoction of 15–30 grams each of astragalus, millettia, and codonopsis, 10–30 grams each of tang-kuei and cnidium, 8–10 grams carthamus, and 10–30 grams each of red peony and leonurus, was given one dose per day to patients for an average of one month each (range: one week to two months). In all of the 18 cases of idiopathic thrombocytic purpura (ITP), the platelet count increased to greater than 100,000, but the effects were short-lasting in all but 5 cases (15).
In a study of 46 cases of ITP, patients were divided into two groups: those with blood stasis syndrome and those with spleen deficiency syndrome (26). For the former group, the general prescription given (which could be modified for individual cases) was comprised of millettia, red peony, rubia, tang-kuei, salvia, codonopsis, jujube, eclipta, and rehmannia (separately, a cup of tea made from notoginseng flowers was given). Of the 30 cases with the blood stasis type, the treatment was deemed markedly effective or effective in half the cases, and there was some improvement in all but three cases. The average course of therapy was 12 weeks.
A study of three treatments for ITP was conducted using either prednisone, coenzyme A, or a Chinese herb decoction (29) made with 20 grams each of astragalus and polygonatum plus 12 grams atractylodes to tonify qi, 15 grams each of millettia and tang-kuei to nourish and vitalize blood; 12 grams each of red peony and moutan to vitalize blood and cool blood heat; and 10 grams of carthamus to vitalize blood and resolve stasis. Treatments were administered for 4–8 weeks. According to the study report, prednisone had the strongest effect (82% rate of improvement), Chinese herbs had a good effect (65% rate of improvement), and coenzyme A had only a slight effect (35% improvement, but none markedly effective).
Patients with advanced gastric adenoma undergoing chemotherapy were treated (16) with Shengxue Tang, a decoction containing astragalus, millettia, ligustrum, cuscuta, lycium, pseudostellaria, atractylodes, and hoelen; it was reported that six weeks administration along with the chemotherapy resulted in increased platelet counts.
Patients with acute leukemia often suffer from thrombocytopenia, since the cancerous stem cells that produce leukocytes crowd out the cells that produce platelets. In a study of combined Chinese medical and Western medical treament of acute leukemia (49), 30 patients received standard chemotherapy alone (as a control) or in combination with a decoction made from two types of jixueteng (30 grams each of Spatholobus and Mucuna) and 15 grams of another member of the legume family that has similar actions, moghania (yitiaogen), plus a complex formula
containing cynanchum, frankincense, phragmites, hoelen, cissus, pueraria, rehmannia, polygonatum, ligustrum, and oldenlandia (each herb in dosages of 10–30 grams). According to the report, in addition to improving the level of platelets and red blood cells, the herbs contributed to a higher rate of remission than in the control group (83% vs. 63%) and a longer average duration of remission (390 days vs. 268 days).
DOSAGE AND COMBINING
The dosage recommendations for millettia vary among the Materia Medica descriptions. The frequently cited dosage ranges are 9–15 grams per day or 15–30 grams per day, but some sources mention up to 60 grams per day. In one book describing individual species (45), for Millettia nitida, a therapy using 60–120 grams per day was mentioned for anemia. Among the clinical reports reviewed here for which dosage was mentioned, 30 grams per day seems to be the standard amount used, though some formulas included only 15–18 grams. Millettia is frequently incorporated into prescriptions of 8 or more ingredients, but in four of the clinical reports mentioned above, it was used in small formulas with only 2–3 other herbs. Most commonly, millettia was combined with astragalus, lycium fruit, ligustrum, rehmannia, and tang-kuei in formulas for generating blood cells.
TOXICITY, ADVERSE EFFECTS, AND CONTRA-INDICATIONS
No reports of toxicity or adverse reaction to millettia have appeared in the Chinese literature available to ITM. In one report (37) on the safety of jixueteng injection (with Spatholobus suberectus specified as the source material), it was stated that its tolerance dose in mice was 200 times the therapeutic dose and that the LD50 in mice was over 100 g/kg, a huge amount. No irritation was induced by injecting the drug into different sites in rabbits. It did not cause allergic reaction in guinea pigs. If injected into mice at high dosage for several days after initiation of
pregnancy, it reduced the pregnancy rate; this effect was not observed in rats, however. High doses of millettia (15– 30 grams/day or more), such as used in correcting leukopenia, should not be used during pregnancy; in general, Chinese literature recommends avoiding blood-vitalizing herbs during pregnancy, with certain limited exceptions.
ACTIVE CONSTITUENTS
At this time, it is not clear which active constituents of jixueteng are responsible for the claimed effects of the herb in complex formulas, though it appears likely that the flavonoids are the dominant constituent of interest. There is a deficiency in information about the constituents and pharmacology in the literature that may reflect the fact that there are so many different source species involved. The Leguminoceae, family to which all the jixueteng species belong, provides four basic types of active constituents:
1. Flavonoids, which are the dominant group of active constituents for this plant family—found in most of the species in significant quantities—such as those from soybeans (e.g., genistein and diadzein) that have become well-known (see: Flavonoids for health; Soybeans for health). Psoralea, which is used with some frequency in the formulas for treating leukopenia, is a legume that is rich in flavonoids.
2. Alkaloids, such as oxymatrine and matrine found in sophora root, which also have the effect of protecting bone marrow functions (see: Sophora);
3. Saponins, including triterpenes, that are reputed to promote blood circulation, improve oxygen utilization, and protect against adverse influences (adaptogenic effect); and
4. Polysaccharides, such as those contained in astragalus, that are reported to counteract the bone marrow suppression induced by chemotherapy and to enhance macrophage functions (see: The physiological responses to immunologically-active polysaccharides);
Thus far, there have been no reports of medicinally active polysaccharides or alkaloids in jixueteng. Several flavonoid compounds have been identified for Millettia pachycarpa (18) and for Millettia reticulata (19). These are polymethoxyflavones, isoflavones, and flavonoid alcohols. Spatholobus suberectus, the most commonly used source of jixueteng in China today, was analyzed to reveal the following constituents (34, 40):
· Isoflavones similar to genistein (these are found also in pueraria flower and root, sophora tops, licorice root, wisteria, and soy bean): formononetin, ononin, afromosin, diadzein
· Chalcones (a group of flavonoids, found also in licorice root and sophora tops): isoliquiritigenin, tetrahydroxychalcone, licochalcone
· Coumestans (a group of flavones, found also in sophora tops, better known in alfalfa): medicagol
· Condensed flavonoids (also known as tannins and found in many herbs, notably green tea): epicatechin
· Other flavonoids: pruetin, cajinin, methoxyhydroflavonol
· Triterpenes: friedelan, taraxerone
· Sterols: beta-sitosterol, daucosterol, methoxycoumesterol, camphesterol, stigmasterol
· Phenolic organic acids: protocatechuic acid
Flavonoid compounds similar to those in Spatholobus have been found in other herbs that are reputed to have blood-vitalizing activity, such as dragon’s blood (Daemonorops draco: xuejie), sappan (Caesalpinia sappan; sumu) and dalbergia (Dalbergia odifera: jiangxiang); the latter two herbs are in the same plant family as millettia. Like the jixueteng vines, these other herbs have red resins; in fact, sappan was long known in Europe as brasil wood, which means “red dye” wood (the country of Brazil, where this plant was found growing, is named after it). The millettia flavonoids have platelet aggregation inhibiting effects and coronary dilating activity that helps explain their use in treating cardiovascular diseases (19). While many flavonoids are colorless, there are some that are pigments, such as afromosin in Spatholobus and brasilin in sappan. It is possible that the traditional Chinese focus on red colored herbs—originally selected because of the ancient concept that these were affiliated with blood circulation—has resulted in use of a group of herbs with highly effective blood-vitalizing flavonoids, some of which are red pigments.
NON-LEGUME SUBSTITUTES FOR JIXUETENG
A study of market materials used for jixueteng reveals that the following are also used (30, 31): Kadsura interior, Kadsura heteroclita, and Schizandra propinqua of the Schizandra Family (formerly included in the Magnolia family) and Sargentodoxa cuneata (of the Lardizabalaceae). Kadsura species are widely used in Chinese medicine; for example, kadsura bark (zijingpi) is said to invigorate blood circulation, disperse swelling, remove toxin, clean blood, regulate menstruation, and promote urination; kadsura rhizome (haifengteng) is said to remove wind and
dampness and promote the flow of meridians; and kadsura root (hongmuxiang; meaning fragrant red wood) is reported to move qi, invigorate blood, and control pain. These are properties attributed to jixueteng as well. Schizandra, a close relative, is usually used as a source of medicinal fruits, but it is the stem that is used for jixueteng. Sargentodoxa cuneata is known as hongteng (red stem) or as xueteng (blood stem) and is said to remove toxins and furuncles, invigorate blood circulation, promote the flow of channels, dispel wind, and kill intestinal parasites. Like the legumes that give rise to jixueteng, these plants have a red color and are reputed to promote circulation of blood. The active constituents have not been analyzed.
MECHANISM OF ACTION ON HEMOPOIETIC SYSTEM
In a recent study (20) of treatment of aplastic anemia, two formulas with jixueteng (one for invigorating yang, one for nourishing yin) were evaluated (dosages are in grams per day):
Jixueteng Zhengyang Tang
Millettia 100
Astragalus 60
Eclipta 30
Ligustrum 30
Ho-shou-wu 24
Cuscuta 18
Epimedium 18
Psoralea 12
Tang-kuei 12
Fenugreek 6
Placenta 6
Ginseng 3
Jixueteng Yijing Tang
Ligustrum 100
Eclipta 100
Rehmannia 90
Millettia 30
Ho-shou-wu 30
Astragalus 30
Salvia 24
Cuscuta 12
Gelatin 9
Lycium 9
Psoralea 6
Tang-kuei 6
The formulas were administered according to the primary diagnosis of either dominant yang deficiency or dominant yin deficiency. In certain circumstances, additional herbs and/or hormone therapy would be used as deemed necessary. Red blood cells, white blood cells, and platelets all increased significantly after patients received the herb treatment for several months (up to 2 years for this study). Bone marrow biopsies were used to evaluate the condition of the bone marrow before treatment (in 106 patients) and then after treatment in 45 patients who had good results based on their blood picture. According to the authors:
Before treatment, there were nucleated cells in 84% (89/106) among the cases with low hemopoietic tissue in the bone marrow, which had been replaced by fatty tissue. Re-examination of 45 cases after treatment showed hyperactive proliferation of bone marrow in 40 cases (89%), the lipid cells decreased, the percentage of granulocytic, erythroblastic, and megakaryotic series increased significantly, and the islands of erythroblastic series could easily be seen. The marrow vascular network was significantly reduced before treatment, even to the extent that no small vessel or capillary was found in sections from 22/106 cases (21%), and expanded and broken sinuses were found. After treatment, the number of vessels significantly increased and the morphology of the sinuses and capillaries became normal with intact wall structure. The reticulofibrosis (RF) of marrow increased after treatment and most of them were fine in appearance, distributed scantily in tissues. No cases showed RF of high degree [diffuse fibroreticulation accompanied with either scattered coarse fibers or local collagen fibrosis]….Study of the bone marrow matrix showed that the increase of vascular network, restoration of vascular structure, and proliferation of RF may be due to the more active new vessels and increased secretion of RF from adventitial reticulocytes to construct the matrix skeleton.
Although aplastic anemia differs from bone marrow suppression via chemotherapy or radiation, it is possible that improved microcirculation in the marrow vascular network could also explain some of the effects of millettia on the cancer therapy induced bone marrow suppression. In the cancer cases, the physical damage to the bone marrow is less than in aplastic anemia (at least, initially), but the impairment of stem cell activity might be accompanied by reduced microcirculation. Along these lines, it is of interest to note that another herb, hu-chang, frequently used with millettia in the formulas, has been classified as a blood vitalizing herb in several Chinese texts (sometimes, it is classified among the heat and toxin clearing herbs). In the Bencao Gangmu Shiyi where millettia was first recorded, it is commented that (40): “the decoction of hu-chang is effective for diseases of the bone joints and blood stasis.” It is possible that these two herbs are useful in the complex prescriptions for bone marrow disorders because of their contribution to bone marrow microcirculation. When accompanied by other herbs, such as those that contain
polysaccharides that may stimulate the bone marrow cells (e.g., astragalus, lycium, epimedium), the bone marrow may be able to function optimally within the limits imposed by the potent activity of the anticancer drugs or repeated radiation exposure.
In a study of mechanism of action of herbs on the bone marrow (28), researchers administered herbs to mice with cyclophosphamide-induced marrow suppression in three combinations:
1. A blood vitalizing combination comprised of 15 grams each millettia and salvia.
2. A kidney tonifying combination comprised of 30 grams each rehmannia and ho-shou-wu, plus 15 grams each of ligustrum, psoralea, and cistanche.
3. A combined therapy group with all seven of the above herbs.
According to the study analysis, the kidney tonification herbs (#2 above) enhanced the growth of marrow progenitors for granulocyte-macrophages (thus benefited leukocytes), while the blood-vitalizing group promoted the erythroid progenitors (thus increased red blood cells) and improved marrow stroma function (which benefits the granulocyte-macrophages). The combined therapy produced greater increases in each of the bone-marrow cell-lines than the component parts. The combination kidney-tonifying and blood-vitalizing therapy was given to 50 patients suffering from aplastic anemia (most patients also received stanazol); it was reported that 41 of them (82%) responded well, an improvement compared to the 57% of patients responding well to stanazol alone. Among 9 patients who received only the herbs, 5 had remission and 2 showed marked improvement.
Proposed mechanisms by which the bone marrow was restored by the herbal treatments included removal of sialic acid from cell membranes resulting in proliferation signaling, increase in cytokines that stimulate the stem cells, and restoration of superoxide dysmutase function. Electron microscope studies indicated that the blood-vitalizing herbs and the combined kidney-tonic and blood-vitalizing therapy were better than the kidney-tonifying therapy alone at recovering the micro-environment [capillary bed] of the bone marrow.
OTHER USES
In recent practice, jixueteng appears in several formulas reported in Chinese clinical trials for treating cardiovascular diseases, liver fibrosis, rheumatoid arthritis, sciatica, and skin diseases. However, the formulas are quite large, and several of the herbs contained in them are known to have the desired effects, so the role of millettia in these treatments is unclear.
As an example of the applications to treat skin ailments, following are two prescriptions with millettia from a literature review related in the book Treatment of Psoriasis with Traditional Chinese Medicine (35):
· Jinyin Huzhang Tang: 15 grams each of lonicera, hu-chang, salvia, millettia; 12 grams each of raw rehmannia, red peony, sophora flower, 9 grams isatis leaf
· Buxue Qufeng Tang: 30 grams each of astragalus, millettia, and polygonum stem; 15 grams each of raw rehmannia, and dictamnus; 12 grams each of codonopsis, tang-kuei, trichosanthes, and isatis leaf; 9 grams clematis; and 5 grams each of angelica, siler, and citrus.
Following is a formula that was reported useful for treating vitiligo in a clinical trial involving 30 cases (36):
· Huoxue Qufeng Tang: salvia, cnidium, millettia, tang-kuei, moutan, tribulus, schizonepeta, saussurea, magnetite (proportions not given).
The next formula was prescribed for chronic skin ulcers (39):
· Guizhi Tang Jiajian: cinnamon, peony, ginger, jujube, licorice, millettia, smilax, coix, tang-kuei, atractylodes, cyathula (proportions not given); it was reported that 41 of 48 patients suffering from skin ulcers due to persisting wound infections, burns, or varicose veins were cured.
In all of these treatments for skin ailments, millettia is combined with tang-kuei or salvia or both. These herbs are used to nourish blood and vitalize blood circulation.
As examples of using millettia to treat bi syndromes, a review of formulas in the book Bi Syndromes (46) provides the following modern modifications of traditional formulas (name of traditional formula given, followed by ingredients of modified version):
· Sanbi Wan: tu-huo, chin-chiu, clematis, stephania, chaenomeles, trachelospermum, eucommia, astragalus, cyathula, millettia, loranthus, tang-kuei, siler, cinnamon, and baked licorice. This is recommended for early stage arthritis, involving influence of wind, cold, and dampness (the three inducers of bi, sanbi).
· Fangfeng Tang: siler, ma-huang, tang-kuei, chin-chiu, pueraria, chiang-huo, schizonepeta, millettia, trachelospermum. This is indicated for “wandering bi,” in which the painful sensation migrates, rather than being always in a fixed location.
· Tao Hong Siwu Tang: astragalus, tang-kuei, codonopsis, cnidium, salvia, rehmannia, persica, carthamus, millettia, earthworm. This is used for skin bi, such as scleroderma, in persons with qi deficiency and blood stagnation syndrome.
· Shiquan Dabu Tang: ginseng, astragalus, rehmannia, tang-kuei, cinnamon, salvia, hoelen, millettia, baked licorice. This is used for blood vessel bi, such as arteritis, in persons with qi and blood deficiency syndrome.
· Shentong Zhuyu Tang: persica, carthamus, frankincense, myrrh, tang-kuei, cnidium, millettia, cyathula,liquidambar, chiang-huo. This is used for tendon bi, such as contracting pain in the limbs, in persons with blood stagnation syndrome.
· Wang Qiuzhou Tang: morus twig, kadsura, millettia, siegesbeckia, cinnamon, cnidium, peony, red peony, myrrh, frankincense; this is used for tennis elbow.
In addition, a patent remedy developed during the 1980’s, Yao Tong Ling (Anti-Lumbago Tablets, different than the one commonly marketed in the U.S.) is mentioned. It is comprised of tu-huo, chiang-huo, chin-chiu, kadsura, millettia, carthamus, tang-kuei, cnidium, asarum, cinnamon, eucommia, and rehmannia. Millettia has been included in other recent patent products, such as Duzhong Hugu Wan for chronic bi syndrome due to liver and kidney deficiency, and Mugua Wan for limb numbness and weakness (42, 48).
In all of these formulas for bi syndromes, millettia is accompanied by some of the ingredients of Siwu Tang, Tang-kuei Four Combination.
To treat multiple sclerosis, which involves limb numbness and paralysis, Chinese physicians have recommended formulas that include millettia (47). As examples:
· For deficiency of qi and weakness of the kidney: astragalus, morinda, cibotium, ophiopogon, cuscuta, pueraria, chaenomeles, achyranthes, tortoise shell, and millettia.
· For deficiency of kidney and liver, with phlegm-obstruction of the channels: tang-kuei, curcuma, rehmannia, hoelen, acorus, silkworm, ho-shou-wu, salvia, chaenomeles, peony, cnidium, millettia, and zizyphus.
In these formulas, millettia is combined with chaenomeles to treat stiffness of the extremities.
It can be seen, from the limited presentation of modern uses of millettia, that this herb has rapidly moved from obscurity to prominence in the practice of herbal medicine. No doubt, the increasing reliance on millettia will lead to further analysis of its constituents, pharmacology, and clinical application.
Dose: 9-15 (to 30g in severe cases)

 

Ji Xue Teng Jiao:
• This is Ji xue teng made into an enriched syrup by concentrating it and adding malt sugar syrup and extracts of Hong hua, Niu xi, Xu duan, and black beans.
• Slightly sweet, astringent, aromatic, warm.
• Similar effect to Ji xue teng, but stronger at nourishing blood.
• Dissolve it into a strained decoction.
Dose: 4.5-9g

Jiang Huang – Turmeric rhizome – Curcuma longa – “Ginger Yellow”

Nature: acrid, bitter, warm

Enters: Liver, Spleen, Stomach

Actions: Strongly promotes blood circulation; dispels blood stasis from the channels and collaterals; relieves pain; unblocks menstruation; disperses wind-cold; promotes Qi circulation.

Indications:
• Blood stasis: pain in the shoulder, chest, hypochondria, abdomen, and amenorrhea, dysmenorrhea. Especially effective for shoulder pain.
• Wind-cold-dampness: Bi syndrome, especially in shoulders, limbs.
• Blood stasis due to cold from deficiency.
• Topical: stops bleeding and pain.
• Can be made into an ointment with oil.
• Cholagogue.
• Stimulates the uterus.
• Lowers blood pressure.
• Curcuminoids, thought to be the primary active components (with curcumin being the most researched), are notoriously poorly absorbed. In Ayurveda, turmeric is often routinely combined with pippali (Bi Bo) and/or black pepper (Hu Jiao), to help its absorption. Interesting, a number of classic martial arts hit formulas (die da jiao) include the combination of Jiang Huang and Bi Bo. It’s now known that Bi Bo and Hu Jiao contain piperine, which enhances absorption of other compounds (and is used commercially as an absorption enhancer with a variety of nutritional supplements).
• One study showed piperine (the active pungent compound in black pepper – hu jiao – and pippali – bi bo) can dramatically increase the absorption of curcumin (perhaps as much as 2000%). [Planta Med. 1998 May;64(4):353-6. Influence of piperine on the pharmacokinetics of curcumin in animals and human volunteers.]
MLT: Increases bile flow, reduces liver enzymes SGOT and SGPT, prevents and dissolves gall stones.
• Anti-inflammatory, analgesic for sports injury, musculoskeletal trauma, inflammatory bowel disease, arthritis, rheumatoid arthritis.
BII: Contains curcumin – a powerful and safe anti-inflammatory; protective against cancer development.
• Possible uses in: atherosclerosis, cancer, gallbladder disease (curcumin increases bile acid output over 100%, and greatly increases the solubility of bile – may prevent and treat gall stones), rheumatoid arthritis, general inflammation.
Yoga: Haridra: K-; P, V+ (in excess)
• Stimulant, carminative, alterative, vulnerary, antibiotic while improving digestive flora.
• Gives the energy of the Divine Mother and grants prosperity.
• Cleanses the chakras, purifies the channels of the subtle-body.
• Helps stretch the ligaments, good for the practice of hatha yoga.
• Promotes proper metabolism.
• Topical: sprains, strains, bruises, itching.
Hsu: Increases the detoxifying abilities of liver.
• Stimulates the uterus to contract (paroxysmally).
• The ethanol extract is hypotensive.
CHA: (Karen S. Vaughan, 8-30-2001) Fungal infections of the feet: soaking the feet in a turmeric footbath is part of Ayurveda and is also done in traditional Hawaiian medicine.
Weil: Knee arthritis: This research, from Italy, was a three-month trial involving 50 patients diagnosed by x-ray with osteoarthritis of the knee. The Italian team was investigating the effect on arthritis symptoms of a special formulation of turmeric designed to improve its absorption by the body. Half the participating patients took the turmeric formulation in addition to standard medical treatment; those in the second group continued following their physicians’ recommendations.
After 90 days, the researchers found a 58 percent decrease in overall reported pain and stiffness as well as an improvement in physical functioning among the turmeric group compared to the controls. These changes were documented with a standard medical scoring method used to assess symptoms of knee and hip osteoarthritis. In addition, another scoring method showed a 300 percent improvement in the emotional well being of the turmeric patients compared with the others. And blood tests showed a 16-fold decline in C-reactive protein, a marker for inflammation. Patients in the turmeric group were able to reduce their use of non-steroidal anti-inflammatory drugs by 63 percent, compared to the other group.
Results of this study are very good news for the millions of people worldwide who suffer from osteoarthritis and haven’t been adequately helped by available treatments. The dose of the turmeric formulation used in the study was one gram per day. It is now commercially available in the United States and Europe.
Turmeric may also be useful for prevention of symptoms of rheumatoid arthritis, but this evidence comes from animal studies, not human trials.
Research also suggests that turmeric may prevent changes that lead to Alzheimer’s disease, and animal studies have shown that turmeric may be effective in the prevention or treatment of colon, breast and prostate cancers.

Dose: 3-9g

On Curcumin/Curcuminoids from Examine.com:
Curcumin is the yellow pigment associated with the curry spice, Turmeric, and to a lesser extent Ginger. It is a small molecule that is the prototypical ‘curcuminoid’, and has effects similar to other polyphenols but unique in a way as it is a different class of polyphenol (relative to the other classes of ‘flavonoid’, ‘stilbene’, etc.)

It exerts potent anti-inflammatory effects, and these anti-inflammatory effects seem to be quite protective against some form of cancer progression. However, curcumin has additional anti-cancer effects that are independent of its anti-inflammatory effects and thus is a heavily researched molecule for both cancer prevention and treatment.

Other areas of interest as it pertains to curcumin are alleviating cognitive decline associated with aging, being heart healthy by both electrical means and reducing lipid and plaque levels in arteries, and both reducing the risk of diabetes and being a good treatment for the side-effects associated with diabetes.

It has a poor oral bioavailability (a low percentage of what you consume is absorbed) and thus should be enhanced with other agents such as black pepper extract, called piperine. This is unless you want the curcumin in your colon (as it is a colon anti-inflammatory and can help with digestion), in which case you wouldn’t pair it with an enhancement.

Doses up to 8g curcuminoids in humans have been shown to not be associated with much adverse effects at all, and in vitro tests suggest curcumin has quite a large safety threshold.

A good general intake of curcumin, as a supplement, would be 500mg of curcuminoids that is enhanced in some manner. 500mg of curcumin with 20mg piperine, or 500mg of curcumin microsomes or curcumin phosphatidylcholine.

For any effects on colon and intestinal tissue (colon cancer prevention, reducing inflammation associated with Crohn’s, etc.) it would be good to use a dose of 2-4g curcumin or turmeric without any enhancement.

Benefits have been seen with as little as 100-200mg turmeric sprinkled on curry, so even if you don’t supplement it would be prudent to use some turmeric in daily life.

1.1. Sources

Curcumin (Diferuloylmethane) is the main active ingredient of the spice Turmeric (also known as Curcuma Longa or JiangHuang), which consists of Curcumin as well as thee other curcuminoids (Demethoxycurcumin , Bisdemethoxycurcumin, and Cyclocurcumin)[1][2] in which curcumin can consist of up to 80% of curcuminoids by weight, dependent on location of growth.[3] Both curcumin and Ginger belong to the family of Zingiberaceae known as the ‘Ginger Family’.

Curcuminoids appear in the entire Curcumin genus, although most commonly in Longa. Curcumoinds exist in:

Curcuma Longa (Turmeric, or JiangHuang) at around 22.21-40.36mg/g in the rhizomes and 1.94mg/g in the tuberous roots
Curcuma Phaeocaulis at 0.098mg/g in the rhizomes
Ginger
Shampoo ginger (Zingiber zerumbet L)

Other names for curcumin can be NCB-02 (a standardized mixture of curcuminoids), E100 (code used for food coloring), MERIVA (curcumin bound to soy lecithin, or phosphatidylcholine) and THERACURMIN (curcumin microsomes).

Commercially available extracts of ‘curcumin’ may not be wholly curcumin, but a blend consisting of 77% curcumin (17% demethoxycurcumin, 3% bisdemethoxycurcumin, last 3% not classified but assumed to possess a cyclocurcumin content).[11]

1.2. Structure and Properties

The structure of curcumin, officially known as diferuloylmethane, is two ferulic acid moeities bound together with an additional carbon to abridge the carboxyl groups. It can exist in a enol form (pictured below) or a keto form, which is molecularily symmetrical with two ketone groups on the backbone.

Curcumin is the compound in Turmeric which exert the characteristic bright, yellow color of Turmeric. Due to its intense coloration, it is sometimes used as a food additive with the code of E100.[12][8]

Curcumin is lipophilic and highly insoluble in water, and is acid-stable when measured around the pH of the stomach.[13]

2. Pharmacology

2.1. Absorption

Due to the poor intestinal absorption, however, curcumin is effective in reaching colonic tissue. An oral dose of 3.6g curcumin (which has been shown to increase plasma levels to 11.1+/-0.6nmol/L[14]) is able to increase the levels of curcumin in colorectal tissue to 7.7+/-1.8nmol/g (normal) and 12.7+/-5.7umol/g (malignant).[14]

2.2. Systemic

Curcumin, due to its lipophilicity, is transported in the blood via transports; most likely binding to Human Serum Albumin.[15]

Without aiding absorption, an oral dose of 500mg/kg bodyweight in rats results in peak plasma levels of 1.8ng/mL.[16]

When investigating humans oral dosages of 2, 4, and 8g curcumin daily for 3 months results in circulating levels of 0.51+/-0.11, 0.63+/-0.06, and 1.77+/-1.87uM; respectively. These Cmax values were attained around 1-2 hours post-administration and then rapidly declined.[17] Another human study found that 3.6g of curcumin resulted in levels of 11.1+/-0.6nmol/L an hour after consumption, with the lower dose tested (0.45g) not able to influence serum levels of curcumin;[14] this dose is about 1/45th the circulating amount of the 4g curcumin dosage in the previous study, and the reason for discrepancy is unclear.[17][14][18] Higher dosages induce a Cmax of 2.30+/-0.26 ?g/mL (10g) and 1.73+/-0.19 ?g/mL (12g); the reason for the drop in Cmax is unknown, but hypothesized to be due to saturation of the transporters.[19]

Increasing the oral dose to 10g induces an AUC of 35.33+/-3.78 ?g/mL, and a 12g dose induces an AUC of 26.57+/-2.97 ?g/mL.[19]

2.3. Bioavailability

The efficiency of an oral dose in increasing plasma levels of curcumin (bioavailability) is poor;[20] due to this, methods are being investigated to increase bioavailability. One clinical toxicology study in humans looking at oral curcumin found that doses below 8,000mg didn’t influence serum levels significantly, but only doses of 10g or 12g[21] (although some studies do note serum spikes at 4g).[17]

Pairing Curcumin with Piperine, a black pepper extract that is also an inhibitor of glucuronidation enzymes in the intestines and liver, is able to increase bioavailability 20-fold (2000% of baseline values) when 20mg piperine is paired with 2g curcumin.[22]

Complexing curcumin with phospholipids (a phosphatidylcholine-curcumin complex known as Meriva) can increase its incorporation into lipophilic membranes, increasing Cmax and AUC five-fold in rats[23] and making 450mg Meriva as effective as 4g curcumin in humans (unpublished trial).[18] Other trials suggest a factor of 29-fold higher absorption in humans, although said enhanced absorption favors demethoxycurcumin rather than curcumin.[24]

Beyond Piperine and Phospholipids, nanoparticle emulsions show promise. THEACURCUMIN emulsion (nanoparticles) possesses a 40-fold higher AUC (Area-under-Curve) when compared to basic curcumin power in rats, and a 27-fold higher AUC in humans.[10] although another study found merely a 10-fold increase in AUC and a 40-fold increase in Cmax in rodents.[25] This increased bioavailability is, in part, due to increased water-solubility.[26] Usage of nanoparticles can be used up to 210mg without any apparent saturation in absorption, and increase to Cmax to 275+/-67ng/mL, an AUC of 3,649+/-430 ng/ml/h, and a half-life of 13+/-3.3 hours.[26]

For any systemic purpose, it would be wise to increase curcumin bioavailability; either by taking it with a meal and piperine (Black Pepper) or one of the enhanced delivery systems. If using curcumin for any effects on the colon, poor bioavailability is desirable (if not absorbed, it heads to the colon) and no measures for bioavailability enhancement should be made

2.4. Metabolism

The major metabolites of curcumin in humans are curcumin sulfate (via sulfation enzymes of P450) and curcumin glucuronide (via glucuronidation by P450).[16][14][19]

In the bile, tetrahydrocurcumin and hexahydrocurcumin have been noted in rats, and to a lesser degree dihydroferulic acid and ferulic acid.[27]

2.5. Excretion and Clearance

One study using an intravenous dose of curcumin at 40mg/kg bodyweight in rats noted that the dose of curcumin was essentially cleared from plasma after one hour.[16]

3. Longevity and Life Extension

3.1. Autophagy

Autophagy is a Longevity associated process involving selective destruction of damaged cellular organelles, sometimes described as cellular housekeeping or maintenance;[28][29] autophagy appears to activated by many polyphenols[30] including curcumin, Resveratrol, silybin (from Milk Thistle), Quercetin, and catechin (common, but usually known to be a component of the four Green Tea Catechins).

Curcumin (and the metabolite tetrahydrocurcumin [31]) appear to induce autophagy via Akt/mTOR/p70S6K and ERK1/2 signalling pathways (inhibition and activation, respectively[32]) and so far has been detected in glioma,[32] uterine,[33] oral cancer,[34] and leukemic cells.[31] In drosophilia, flies with mutations in the osr-1, sek-1, mek-1, skn-1, unc-43, sir-2.1, or age-1 genes fail to have life extension from curcumin[35] although mev-1 and daf-16 appear to be indepednent.[35]

Beyond the possible roles in longevity, autophagy promotion from curcumin is thought to be protective against gliomas[36][37] as glioma cells are resistant to apoptosis but readily destroyed by autophagy.[38][39] Parkinson’s pathology may be attenuated with curcumin via preservation of autophagy[40]

Curcumin appears to induce autophagy secondary to beneficial modulation of mTOR and ERK1/2 signalling (inhibition and activation, respectively) which may underlie both longevity promoting and select anti-cancer effects

3.2. Interventions

In drosophilia, curcumin can induce longevity via antioxidative properties[35] independent of caloric restriction yet is not complementary with caloric restriction (suggesting acting upon the same pathway)[41][42][43] with most efficacy at 100mM of the feed.[41] Interesting, administration of curcumin for an entire lifespan has been shown to have a possible suppressive effect on longevity but administration for youth (drosophilia health span, which is about the first 30% of life) prolonged median and maximum lifespan by 49% while administration during middle age (up to 45% of lifespan) had less promotion and administration in older age (senesence) reduced median lifespan by 4% (although maximum still increased 11%).[41]

Curcumin has been shown to promote longevity independent of caloric restriction in fruit flies, and appears to have more potency in youth than in older individuals (where some suppressive effects on lifespan are noted)

The metabolite of curcumin, tetrahydrocurcumin, appears to promote longevity in male mice by 11.7% at a dietary intake of 0.2% tetrahydrocurcumin, but is dependent on administration as youth.[44] This study failed to note an effect when mice started curcumin feeding at 19 months (the above results noted with earlier feeding at the 13th month), suggesting the youth requirement extends to mammals.[44] Longevity enhancement in mice has been noted elsewhere.[45]

Conversely, one mouse study has noted a failure of curcumin to enhance lifespan when given at similar doses and times in F1 hybrid mice, despite caloric restriction being effective[46] and lifetime administration of curcumin (0.2%) starting at 4 months has also failed to promote lifespan in UM-HET3 mice.[47] Assuming a food intake of around 8.55g/45g bodyweight[48] and body weights around 45g for the majority of the life[46][47][44] an estimated intake of curcumin daily would be 17.1mg (converting to 380mg/kg bodyweight and an estimated human dose[49] of 22.8mg/kg or 1.5g for a 150lb person)

There is some promising, but currently mixed, evidence to support the role of curcumin in anti-aging. This may follow the same motifs of requiring ingestion of curcumin in youth or at least prior to midlife,

It is an unproven but attractive theory that curcumin works via Chaperone-mediated autophagy (covered on the Longevity page) due to both being prolongevity yet less effective in aged subjects (due to decreasing LAMP-2A expression)

4. Cellular Mechanisms

Curcumin is able to induce effects either directly (the first domino in a series) or downstream of the primary effect (subsequent dominoes). This section serves to differentiate the two and harmonize mechanisms.

4.1. Direct

AP-1, a class of transcription factors made of dimerizations of c-Fos, c-Jun and related proteins that is involved with cell proliferation, survival, and differentiation[50] bind to their receptor on the cell nuclear (TPA response element) to induce effects associated with AP-1.[51][52] The effects of AP-1 differ depending on the proteins that make it up, but curcumin is able to interfere with the AP-1 released by tumor promoters[53] and is able to enhance some phase II (anti-oxidant) enzymes by moderating some better AP-1 confirmations.[54]

Curcumin is also seen as a direct mTOR inhibitor, able to prevent the association of the raptor subset with the TOR protein, inhibiting mTORC1 activity directly without significant influence from AMPK-TSC or Protein Phosphatase A2.[55][56]

Curcumin can also directly inhibit DNA polymerase lambda,[57] focal adhesion kinase (FAK),[58] Src,[58] Protein Kinase C,[59] p300 (CREB Binding Protein),[60] Thioredoxin reductase,[61] Lipoxygenase (LOX),[62] and tubulin.[63]

It may also directly affect (negatively) 17beta-HSD3[64] and 5-alpha reductase.[65]

Curcumin has been noted to directly and potently inhibit the Glycogen Synthase Kinase-3? (GSK3?) enzyme with an IC50 of 66.3nM.[66]

4.2. Junction points

Junction points are defined as proteins or receptors that, by their activation or inactivation, influence a great deal of related proteins.

nF-kB, a proinflammatory transcription factor, is inhibited by curcumin via a two-fold mechanism of preventing p65 translocation to the nucleus, and by preventing the degradation of the molecule which holds nF-kB in a dormant state, IkB.[67] The co-activator of nF-kB, Notch-1, is also suppressed by curcumin although abnormally high levels of Notch-1 can reduce the inhibitory effects of curcumin on nF-kB.[68] nF-kB moderates over 200 related proteins related to cell proliferation, invasion, metastasis, chemoresistance, and/or inflammation.[69][11]

As mentioned previously, the proteins of AP-1 are also seen as a sort of junction point mediating cell proliferation and survival.[50]

4.3. Indirect/Downstream

The main proteins and molecules that are downstream of nF-kB, and thus are reduced in potency when nF-kB is inhibited, are Bcl-2, Bcl-xL, cyclin D1, interleukin-6 (IL6), cyclooxygenase 2 (COX2) and matrix metallopeptidase-9 (MMP9).[70][71][72]

5. Cardiovascular Health

5.1. Cardiac Tissue

Curcumin is suspected to be able to protect against cardiac hypertrophy, inflammation, and thrombosis via inhibition of the protein p300, a Histone acetyltransferase (HAT) and it’s downstream pathways. This inhibition has been shown to prevent heart failure in rats.[73]

5.2. Endothelium

Via induction of Heme-Oxygenase 1 (HO-1), curcumin can prevent the endothelial (blood vessel) dysfunction associated with high blood glucose in a dose dependent manner and may offer protection from side-effects associated with diabetes.[74] In an animal model of diabetes, curcumin has also preserved a degree of endothelial health during disease progression (although it was unable to, at 200mg/kg bodyweight, prevent changes).[75]

This protective effect has also been demonstrated with LPS insult, a pro-inflammatory condition, and curcumin dosed at 50-100mg/kg bodyweight in rats;[76] changes in endothelial contractability (via TNF-a) have also been reduced with curcumin.[77] Protection from L-NAME induced hypertension has also been seen.[78]

In regards to blood pressure, one human study has noted significant decreases in blood pressure but was conducted in a nephritic disease state.[79] Not much human evidence looks at the effects on blood pressure in otherwise healthy individuals.

Appears to hold protective effects on blood vessels, but its clinical significance is not known; seems promising, and most likely mediated through Heme Oxygenase-1

5.3. Triglycerides

500mg curcumin daily has been shown to reduce triglycerides by 47% (110+/-21mg/dL to 58+/-9mg/dL) over 7 days, while a higher dose of 6g reduces triglycerides by 15% (93+/-13mg/dL to 79+/-11mg/dL); the cause for the lowered efficacy of high doses is not known.[80] These were seen in otherwise normal weight and healthy young subjects.[80]

5.4. Cholesterol

500mg curcumin daily has been demonstrated to reduce total cholesterol levels by 17% while a higher dose of 6,000mg reduces total cholesterol by 5% in otherwise healthy subjects.[80]

6. Interactions with Neurology

6.1. Cognition

One study assess curcumin and cognitive injury noted that, in control rats that were not injured, curcumin at 500ppm was able to increase BDNF levels to approximately 140% of control; this was independent of significant changes to CREB (105%) and phosphorylated CREB (93%).[81]

6.2. Stress

In vitro, curcumin can abolish the induction of the NMDA receptor subunit R2B mRNA by corticosterone[82] when corticosterone is incubated at 0.1mM and curcumin at concentrations as low as 0.62uM;[83] this may be related to the ability of curcumin in vitro to prevent corticosterone-induced neuronal death.[83]

Curcumin at 5, 10, and 20mg/kg was fed to rats daily for 21 days, and upon being subject to acute stress and subsequent cognitive testing; curcumin dose-dependently reduced the negative influence of stress on spatial memory with both higher doses (10, 20mg/kg) being significant and slightly less effective than 10mg/kg imipramine.[83]

6.3. Neuronal Injury

Curcumin at 500ppm in rats (a dose similar to some anti-Alzheimer’s dosages[84]) for 4 weeks on either a high fat or normal diet who were then subject to a fluid percussion injury noted that the increased oxidation in the brain (139% normal diet, 239% high fat diet; high fat did not induce oxidation without neural injury) was reduced to 45-47% in both groups and BDNF was normalized despite its inherent reduction in neural injury,[81] and other proteins that tend to be reduced in this form of injury are somewhat normalized with curcumin.[85] Cognitive performance was declined after injury, and the reduction was attenuated but not normalized.[81]

6.4. Alzheimer’s Disease

Curcumin is able to inhibit aggregation of beta-amyloid proteins in the brain, and thus prevent neural inflammation which would normally be downstream from said aggregation. The former has been noted in vivo[86] and has been hypothesized to be the reason as to why higher circulating levels of Beta-Amyloid have been noted (statistically insignificant) with curcumin supplementation[87] as beta-amyloid is prevented from aggregating in the brain,[88] and thus must circulate somewhere.

Mechanistically, curcumin may be able to reduce Beta-amyloid build-up in neural tissue

In a rodent model with advanced Alzheimer’s Disease characterized by beta-amyloid accrual, curcumin was able to attenuate the decline in neural performance and was synergistic with DHA; a component fatty acids from Fish Oil.[89] This synergism may be related to how both agents can reduce beta-amyloid aggregation, but by differing mechanisms;[90][91] some authors hypothesize that this synergism may be further enhanced by exercise[92] due to an interaction with exercise and fish oil on neuronal plasticity.[93]

A 6-month trial has been conducted on Curcumin and Alzheimer’s, using basic curcumin at either 1 or 4g daily for 6 months in a population of 50+ year old chinese persons suffering from cognitive decline for at least 6 months prior to trial onset. Scores on the MMSE, a rating scale for Alzheimer’s, increased progressively in the placebo (indicating cognitive decline) but were mostly static in both curcumin groups.[87] This trial is limited in statistical power due to its sample size of 27 completions and multiple confounds, however.[87]

Some therapeutic promise, but evidence is limited

7. Implications for Digestion and the Intestines

Curcumin tends to be most relevant to the colon due to its poor oral bioavailability. Oral bioavailability is a measure of how much of a molecule as a percentage is absorbed from the gut, and whatever is left over (in this case, a large amount) is carried on to the colon where it may interact with colonic microflora or the colonic walls.

7.1. The Colon and Ulcerative Colitis

One double-blinded multicenter study noted that, in conjunction with standard therapy for Ulcerative Colitis, 2g of curcumin daily (1g with two different meals) was able to confer significant protection against colonic inflammation and improve symptoms of Ulcerative Colitis for as long as it was used.[94] Less mortality and relapse was noted with curcumin usage, but the difference was not significant 6 months after cessation of usage like it was for the 6 months it was being used for.[94] These effects were seen earlier in both Ulcerative Colitis and Crohn’s Disease, two human conditions associated with intestinal inflammation.[95]

8. Interactions with Glucose Metabolism

8.1. Mechanisms

In liver cells, Curcumin at 20uM appears to activate Adenosine Monophosphate Kinase (AMPK) to the same degree as Metformin (2mM), which is 400-fold more potent on a concentration basis.[96] Although glucose uptake into cells tends to be secondary to AMPK activation[97] and has been noted with both Metformin and another potent AMPK activator Berberine, this study noted that Curcumin failed to induce glucose uptake, instead noting a trend to reduce glucose uptake.[96] This inhibition of glucose uptake has been noted elsewhere, where 100uM Curcumin was shown to inhibit insulin-stimulated GLUT4 translocation[98] despite curcumin twice being shown to not significantly interact with the insulin receptor itself (not cell type specific).[99][96]

Remarkably potent AMPK activator, yet seems to fail at inducing glucose uptake into cells (and thus undermines many of the inherent benefits of AMPK as it pertains to diabetes)

8.2. Blood glucose

The effect of curcumin to lower blood glucose was one of the first effects to be seen with curcumin, seen in 1972.[100][101]

One of the mechanisms of this blood glucose lowering effect is by stimulating Adenosine Monophosphate Kinase (AMPK) in skeletal muscle, drawing in glucose.[102] This effect is enhanced with the presence of insulin, and since insulin also activates the PI3K pathway curcumin appears to be synergistic with insulin in regards to reducing blood sugar levels.[103] Curcumin can also activate AMPK in other cells, such as liver cells[96] and some cancer cells.[104]

8.3. Diabetes

Curcumin is able to alleviate the downstream inflammatory reactions that occur during times of diabetes and metabolic syndrome in rats[105] and, vicariously through its anti-inflammatory effects, improve insulin resistance.[106][105]

9. Interactions with Fat Mass

9.1. Mechanisms

Curcumin has been noted to attenuate lipolysis induced by TNF-? and isoproterenol (representative of catecholamines) in 3T3-L1 adipocytes, which was thought to be secondary to suppression of ERK1/2 activation.[107] ERK1/2 is known to be regulated by AMPK[108] which curcumin has been found to activate[109] (in liver cells, this was noted to be of comparable potency to Metformin but requiring 20uM to Metformins 2mM[96]); all of these events being similar to the known AMPK activator Berberine.

Fatty Acid Synthase (FAS) is inhibited by Curcumin with an IC50 of 26.8?M (59.1?M in regards to ?-ketoacyl reduction); the inhibition was noncompetitive when NADPH was the substrate, but mixed competitive with either acetyl or malonyl Coenzyme A[110] and had both slow and fast acting components in a concentration and time dependent manner.[110] 20uM of Curcumin abolished lipid accumulation in isolated 3T3-L1 cells undergoing differentiation, which may have been due to downregulation of PPAR? and CD36;[110] another study notes that PPARy activation by Curcumin is dependent on AMPK activation.[109]

Curcumin appears to be a potency activator of AMPK

9.2. Inflammation (Adipose Tissue)

Inflammation appears to play a role in obesity, particularly one cytokine known as TNF-?; adipose of genetically obese mice overexpress TNF-? which is also seen in adipocytes of overweight individuals[111] and TNF-? expression appears to negatively correlate with LPL activity.[112] TNF-? itself does exert lipolytic activity,[113] so its elevation in obesity may be as a biomarker of underlying dysregulation rather than a per se contributor; the possibility of TNF-? resistance (a phenomena similar to insulin resistance, as TNF-? has its own receptor class on adipocytes[114]) also being possible.[111] TNF-? is a potent activator of nF-kB (nuclear receptor) which mediates many of its effects,[115] and overactivity of nF-kB and TNF-? in adipocytes are both highly correlated with metabolic syndrome and obesity.[111]

In general, excessive inflammation in adipocytes (assessed by looking at biomarkers thought to be representative of inflammation such as TNF-?) is highly correlated with obesity and metabolic syndrome; interventions which reduce inflammation in adipocytes tend to also be those that can reduce fat mass in persons suffering from excessive inflammation

A reduction in immune cell infiltration in adipose tissue has been noted in vivo when mice are given 3% curcumin in the diet for up to 4 weeks, as assessed by histological examination.[105]

9.3. Adipokines

Curcumin appears to be associated with an increased FOX01 transcription activity and increased adiponectin production in vivo (with higher circulating levels of adiponectin noted in both genetic and diet induced obesity, but lean control mice did not experience an increase);[105] FOXO1 is known to positively influence adiponectin transcription in fat cells.[116][117]

Leptin secretion from adipocytes appears to be suppressed with 12 and 24 hour incubation with Curcumin in a concentration and time dependent manner.[118]

9.4. Interventions

In obese mice given curcumin (3% of feed), despite noting an increase in food intake relative to control; this reduction in body fat was not observed in normal mice.[105]

9.5. Side-effects related to Obesity

In a study on rats, sympathetic activation from circulating fatty acids (commonly seen in obesity) is reduced via curcumin’s lipid lowering effects; the resulting state is cardioprotective independent of weight loss.[119]

Curcumin can also suppress angiogenesis in rat fat cells, a longer term adaptation associated with prolonged obesity.[120] This is a general mechanism that applies to more cell types as well.[121]

10. Oxidation and Anti-Oxidation

When comparing 500mg curcumin against 6g curcumin, the anti-oxidative potential of the two does not significantly differ; if anything, 500mg curcumin seems superior due to insignificantly higher AUC of the increase in anti-oxidant abilities as measured by ORAC.[80] This is thought to be due to a possible pro-oxidant effect of curcumin at higher dosages, seen with other anti-oxidants.[122][123]

11. Interactions with Inflammation and Immunology

11.1. Mechanisms

One of curcumin’s most well-researched effects on inflammation is inhibiting TNF-a induced activation and nuclear translocation of nF-kB, a protein that influences the genetic code to produce inflammatory cytokines. This has been seen in immune cells after oral ingestion of 150mg curcumin (Resveratrol at 75mg, Green Tea Catechins at 150mg, and soy at 125mg as confounders)[124] but also in isolation in vitro[125] and in vivo.[126][127][128][129] Activation of nF-kB can increase protein content (amounts) of Cyclooxygenase-2 (COX-2), a pro-inflammatory enzyme; pretreatment with curcumin reduces COX-2 upregulation induced by inflammatory cytokines.[130] Other pro-inflammatory enzymes that are suppressed by curcumin are iNOS, LOX (directly inhibited), and Phospholipase A2 (directly.)[131]

Curcumin appears to be able to suppress most adhesion molecules investigated, including E-selectin and P-selectin, ICAM-1, VCAM-1, and ELAM-1, the latter three are due to nF-kB inhibition downstream of Akt.[132][133]

Curcumin can reduce inflammation through a variety of means; preventing pro-inflammatory signals from acting on the nucleus (nF-kB related), reducing the ability of immune cells to get to sites of inflammation (adhesion related), and reducing the exacerbation of already present inflammation by reducing the activity of inflammatory enzymes (COX2, LOX related).

11.2. Treatment of Arthritis

Curcumin is associated with reducing a variety of inflammatory signals, and a lot of them that are associated with arthritis and inflammatory joints.[134]

When dosed equally (200mg/kg in rats), curcuminoids from turmeric are 4.6-8.3% more effective than the active components of Ginger in suppressing inflammation associated with cytokine release in arthritis.[135] Both herbs are more potent than indomethacin.[135]

12. Bacteria and Viral interactions

12.1. Virus replication

One study found that curcumin was able to suppress replication of the Rift Valley fever virus and its fully virulent form (ZH501) in vitro.[136] A modification to the IKK-? protein (which inhibits I?B? and serves to enhance nF-kB signalling) keeps IKK-? in an active state and exacerbates inflammatory signalling, curcumin can bind to IKK-? and allow I?B? to suppress nF-kB activation and inflammation, which prevents virus replication.[136]

13. Implications in Cancer Metabolism

13.1. General (Not mechanisms)

Curcumin has the ability to protect DNA from oxidation via the heavy metal arsenic[137], and this protection has been demonstrated in human trials after oral ingestion 1g of a 20:1 curcumin:piperine (Black Pepper) combination for 3 months.[138] Blood lymphocytes were the biomarker for DNA damage.

In rats fed a low dose of curcumin (0.03% of the diet), curcumin was able to prevent formation of adducts in hepatic DNA induced by an injection of the carcinogenic benzo(a)pyrene.[139] Curcumin also prevented adducts in colonic cells when administered at 2% of the diet with meals.[140]

13.2. General (Mechanisms)

One of the mechanisms under investigation for chemoprotective effects of curcumin is the inhibitory effect on nF-kB, a protein that can influence genetic coding and transcription when activated. Normally, TNF-a (a pro-inflammatory cytokine) positively influences nF-kB activity and induces cell growth, survival, and inflammation. Curcumin can inhibit the interaction between the two molecules without reducing TNF-a levels, and aside from the inhibition of cytoprotection the elevated levels of TNF-a can induce cellular death via Fas-associated protein cell death and caspase-8.[141] This mechanism appears to ‘sensitize’ cells to cell death induced by TNF-a by inhibiting cellular survival via nF-kB[142][143] and is most likely due to curcumin’s ability to prevent or reduce activation of p38 in the face of other activators.[144][145][146]

Curcumin is also able to suppress a transcription factor associated with nF-kB, the Notch family of proteins; this potentiates the suppressive effects on nF-kB, but Notch-1 overexpression is able to act in reverse and attenuate curcumin’s suppressive effects on nF-kB.[68]

Other notable products downstream of nF-kB that are reduced by curcumin administration are cyclooxygenase-2 (COX-2), cyclin D1, adhesion molecules, MMPs, inducible nitric oxide synthase, Bcl-2, Bcl-xL, and tumor necrosis factor (TNF); most of which are associated with cancer metabolism in some manner.[72][71][130] Curcumin appears to directly inhibit IKK? as the method of reducing nF-kB translocation.[147]

In a B-CLL cell culture, curcumin was able to induce apoptosis with an IC50 of 5.5uM while its effects in healthy mononucleated (non-cancerous) cells were associated with an IC50 of 21.8uM.[125]

13.3. Prostate Cancer

Secondary to inhibiting expression of the cytokines CXCL1 and CXCL2 (a downstream effect of nF-kB translocation inhibition), curcumin appears to negatively regulate several factors that can lead to prostatic tumor meta-stasis (COX2, SPARC and EFEMP) which can lead to less metastasis in vivo.[147] As siRNA inhibition of CXCL1/2 also had these effects, this appears to be the metabolic lever of concern.[147]

14. Interactions with Hormones

14.1. Testosterone

Curcumin, at 100mg/kg bodyweight in rats, has been shown to preserve testosterone levels when coadministered with a drug (Metronidazole) that causes testosterone reductions and worsens parameters of sperm.[148]

Protective effects on the testes have also been noted with curcumin in regards to alcohol, where curcumin (80mg/kg bodyweight) was able to preserve testicle structure and testosterone levels despite alcohol consumption,[149] most likely though preventing the oxidation of ethanol to acetylaldehyde.[150] Other compounds that damage the testicles and reduce testosterone, but are protected against by curcumin, include excessive chromium levels[151] and cadmium.[152]

When looking at the 17beta-HSD3, the final step in testicular testosterone synthesis, curcumin was found to be a noncompetitive inhibitor with an IC50 of 2.3uM, and brought Luteinizing-Hormone stimulated testoterone levels down to 34% of control at a concentration of 10uM.[64] This effect was not dose-dependent, and concentrations of 1uM were not significantly different from 0.1uM and control cells.[64]

Curcumin may also possess inhibitory actions against 5-alpha reductase, the enzyme that converts testosterone into the more potent androgen DHT. The IC50 value is reportedly between 5-10uM.[65]

Given the above two mechanisms (17beta-HSD3 and 5AR inhibition) are anti-androgenic in nature, it would be prudent to observe in vivo effects of curcumin. The only current study on the matter used injections of PEG-curcumin at 0.5mg (giving a Cmax of 7ug/mL to then decline to 1ug/mL) noted a decrease in circulating testosterone levels and function of seminal vesicles, although testicle weight did not decline.[153]

In regards to aromatase, the enzyme that converts testosterone to estrogen (and thus higher activity would mean a more anti-androgenic profile), curcumin does not directly inhibit aromatase in vitro[154] but appears to reduce the catalytic activity of aromatase (also known as CYP1A) in mice.[155] Clinical relevance of these effects is not known.

Curcumin appears to have protective effects on testicular functions, but possesses anti-androgenic activity. The concentration required for inhibition is high, but it appears to occur in vivo when it is met; it is uncertain what oral dose is needed for these effects, but it might occur with superloading and increasing bioavailability. Low doses of curcumin may have no adverse effect whatsoever

14.2. Estrogen

In regards to possible anti-estrogen effects, the lack of inhibition on aromatase[154] but potential to reduce catalytic activity of aromatase[155] suggests some interactions may exist at this stage. One study comparing normal rats versus a Menopausal model (ovariectomized) noted that 10mg/kg oral ingestion in the normal mice was able to reduce circulating estrogen levels.[156]

100nM of Curcumin is able to act as an agonist at estrogen receptors in MCF7 breast cancer cells, but has low activation of target genes relative to estradiol, although more potent than Quercetin and Enterolactone (from Sesamin).[157] It is possible that Curcumin may act as a Selective Estrogen Receptor Modulator (SERM) and compete for the more potent estradiol, as it has been noted to reduce estrogen-induced cell proliferation elsewhere (was not tied directly to the estrogen receptor in this study).[158]

In regards to anti-estrogenic activity, limited but theoretical potential of Curcumin to be antiestrogenic via either reducing the effects of aromatase or via acting as a SERM (not yet wholly established)

A pegylated curcumin derivative (similar bioactivity, designed for ingections) at 500mg in rats is able to exert estrogenic effects as assessed by sex organs (uterine changes indicative of estrogenicity in females).[153]

High doses appear to be estrogenic

15. Interactions with Skeletal Muscle

15.1. Acute Protective Effects

Through it’s anti-oxidant effects, curcumin can ameliorate oxidative damage to skeletal muscle via Ischemia/Reperfusion when preloaded at 100mg/kg (I.P injection) to rats, with a potency greater than Vitamin E.[159] Curcumin also ameliorates the increase in inflammatory cytokines associated with Ischemia/Reperfusion injury.[159][160]

As for the mechanisms of the above, curcucmin (5-10uM) appears to increase Glucose-Regulated Protein 94 (Grp94) expression, which regulates calcium homeostasis; this regulation of calcium homeostasis appears to precede the standard inhibition of nF-kB activation and reduce the state of oxidation when an oxidative insult is produced.[161] Interestingly, curcumin can also inhibit upregulation and damage from lead via preventing Grp94 upregulation,[162] and general protection against cadmium as well.[163]

15.2. Catabolism/Anabolism

Curcumin (via injection) is also implicated in increasing the recovery of skeletal muscle capacity associated with deloading, although it was not able to preserve skeletal muscle mass during deloading.[164] These results differ from earlier ones showing a 100mg/kg oral dose of curcumin in rats was able to reduce muscular atrophy while a higher dose of 250mg/kg actually improved skeletal muscle weight.[165]

Curcumin is able to inhibit Atrogin1/MAFbx and its subsequent ubiquitin ligase activity in vitro at 25uM,[166] which induces skeletal muscle catabolism downstream of p38/MAPK induced by TNF-a. This has been confimed in rats with injections of 10-60ug/kg curcumin daily for 4 days which preserved lean mass in the face of LPS, by preventing p38 activation and the subsequent Atrogin1/MAFbx activation.[166]

15.3. Glucose metabolism

Skeletal muscle, via glucose uptake and oxidation, is a tissue regulator of glucose metabolism.

Some fatty acids, such as palmitic acid, can activate (phosphorylize) IRS-1 which causes negative feedback to the insulin receptor and desensitizes muscle cells to insulin-stimulated glucose uptake; curcumin appears to prevent this from occurring.[167] This effect is shared by Green Tea Catechins.[167] Improvements in this mechanism of insulin resistance have been seen in vivo with dose-dependent oral doses of curcumin at 50, 150, and 250mg/kg bodyweight.[168] AMPK activation appears to be a key intermediate in these effects.[168][102] Beyond acting upon IRS, curcumin may also increase glucose uptake into skeletal muscles by acting on muscarinic acetylcholine receptors and then through PLC and PI3K.[169]

Curcumin has been implicated in reversing some abberations in skeletal muscle associated with type II diabetes, such as upregulation of beta-adrenergic receptors and Akt,[170] the downregulation of NRF2 and Heme Oxygenase-1,[171] and downregulation of AMPK and CPT-1.[168] At least one study has suggested that the state of diabetes may be a prerequisite, and although it didn’t measure all above parameters it did note no effects of curcumin in non-diabetic mice.[172]

16. Interactions with other Organ Systems

16.1. Liver

Curcumin appears to be able to reduce diet-induced liver fat builded (steatohepatitis) at 0.15% of the diet which is thought to be secondary to activation of AMPK and induction of PPAR?.[173]

16.2. Kidneys

At least one human intervention showed that curcumin was able to suppress diabetic nephropathy (related to kidney function) and decrease proteinuria at a dose of 500mg turmeric (22.1mg curcumin) thrice a day with meals for 2 months. The mechanism of action appears to be suppressing pro-inflammatory cytokines like TGF-b and IL-8. These benefits have been shown to extend to nephritis associated with lupus at the same dosing protocol in humans.

Curcumin exerts this apparent kidney protection via suppressing inflammation and related cytokines or mRNA associated with inflammation (MCP-1, IL-8, nF-kB). Curcumin at 5mg/kg bodyweight (rats) is able to prevent histological changes (related to macrophage infiltration) in kidney structure associated with experimental LPS injections when administered simultaneously and in delaying the inevitable progression of renal failure.

Some protective changes are also present, as curcumin can upregulate Heme-Oxygenase 1 in kidney cells partially via nF-kB suppression and this mechanism is linked to kidney protection effects.

Demonstrated to have protective effects on the kidneys in clinical settings, and animal studies suggest this may extend to preventative measures as well

17. Nutrient-Nutrient Interactions

17.1. Piperine

Pairing Curcumin with Piperine, a Black Pepper extract that is also an inhibitor of glucuronidation enzymes in the intestines and liver, is able to increase bioavailability 20-fold (2000% of baseline values) when 20mg piperine is paired with 2g curcumin.

The pairing of the two has been demonstrated synergistic in attenuating benzo(a)pyrene toxicity in various tissues[179][180] as well as mitigating DNA damage.

Interestingly, this synergism does not seem to apply to preventing hypertension induced by L-NAME; both compounds are effective in attenuating high blood pressure from a lack of Nitric Oxide, but their effects are not even additive.

17.2. Ginger

Ginger and Turmeric are both plants in the same family of plants, and may have related phytonutrient profiles due to this association.

One study investigating the combination of 6-gingerol enhanced ginger and turmeric topical solution (at 3% and 10% respectively) found enhanced wound healing with both compounds in isolation and slightly better recovery with the combination, although not synergistic.

The combination appears to be more effective than either compound in isolation in suppressing some adverse blood parameters associated with metabolic syndrome, such as high blood sugar and lipids.

17.3. Soy Isoflavones

The soy isoflavones, particularly genistein and daidzein, appear to be synergistic with curcumin as it pertains to reducing androgen receptor content and circulatin Prostate-Specific Antigen (PSA) levels in otherwise healthy men; insinuating the combination could be useful against prostate cancer. The dosages used were fairly low in this study, 40mg of isoflavones (66% daidzein, 10% genistein) and 100mg curcumin daily for 6 months, and dropped PSA from 18.8+/-12.4 to 10.2+/-6.2ng/mL.

17.4. Docosahexaenoic acid

One component of Fish Oil, docosahexaenoic acid (DHA), exert synergistic effects in anti-cancer signalling in breast cancer cells which is apparently unique when looking at the mechanisms of either compound in isolation. This synergism apparently extends over into each compounds anti-inflammatory effects, and this mechanism extends to EPA.

17.5. Vincristine

Curcumin at 1uM concentration in cancerous leukemia cells has been shown to synergistically enhance the actions of Vincristine, an alkaloid isolated from Madagascar Periwinkle (not to be confused with Vinpocetine, from another species of Periwinkle). This occurred in 4 out of 5 samples when Vincristine was incubated at 10uM.

17.6. Rolipram

Curcumin shows synergism with Rolipram (a potent PDE4 inhibitor); PDE4 inhibitors increase cAMP levels via PKA in cancerous leukemia cells. Additive in 1 out of 5 tested samples and synergistic in the other four.

A nutraceutical PDE4 inhibitor (at the moment, synergism untested) is Resveratrol.

17.7. Iron

A wide variety of phenolic compounds (of which curcumin is one) are able to bind to dietary non-heme iron and inhibit its absorption; this is seen with Green Tea Catechins and Quercetin mostly. Curcumin has been found to interact with some ions after digestion.

When testing for the interaction of turmeric and iron, whole turmeric at 0.5g was found to not adversely affect iron absorption.

17.8. Itself

Curcumin is one of the four curcuminoids, a curcuminoid being defined as a molecule with two ferulic acid moieties bound together. At least one study has looked at the effects of each ingredient in isolation and the combination, and in regards to its nematocidal effects the four curcuminoids show synergism with each other.

17.9. Garcinol

Garcinol is a polyisoprenylated benzophenone chalcone molecule that is found in Garcinia Indica, a plant in the mangosteen family of fruits. It was found synergistic in inducing apoptosis in pancreatic tumor cells with an apparent synergism 2-10 fold higher than the sum of the two.

18. Safety and Toxicology

18.1. General Safety

According to human interventions investigating anti-cancerous effects of curcumin, doses up to 10g daily of curcumin are not associated with any acute or salient signs of toxicity. When using enhanced formulations to increase circulating levels of curcumin, 1g of MERICA (Curcumin bound to lecithin) over 8 months is not associated with any side-effects.

18.2. Side-effects

Dosages of 6g daily have been associated with minor flatulence and a yellowing of the stool, both of which stopped after supplement cessation.

Jiang Xiang – Dalbergia heartwood – “Descending Fragrance”

Nature: acrid, warm

Enters: Heart, Liver, Spleen, Stomach

Actions: Promotes blood and Qi circulation, dispels blood stasis; stops bleeding; relieves pain.

Indications:
• Blood stasis: pain in the chest, hypochondria, pain and bleeding in trauma, fractures, sprains, contusions.
• Spleen and stomach Qi stagnation: epigastric and abdominal pain.
• Topical: for lacerations.
• Coronary heart disease.
• Bensky/Gamble classifies this with herbs that stop bleeding.
HF: An An Shen (spirit calming) herb, important in Gu Zheng (Gu parasite) formulas (because of emotional disturbance common in patients with Gu).

Dose: 6-9g (1.5-3g directly as powder)

Liu Ji Nu – Artemisia anomala – Anomala – “Liu’s Resident Slave”

Nature: bitter, warm

Enters: Heart, Spleen

Actions: Dispels blood stasis; unblocks menstruation; alleviates pain.

Indications:
• Blood stasis: amenorrhea, post partum abdominal pain; falls, fractures, contusions, sprains.
• Acute viral hepatitis: icteric or anicteric phase. Rapidly improves the appetite.
• Topical: as a powder/ointment for contusions, bleeding from wounds, and especially burns. In one study, an ointment made from the herb was beneficial in treating all 24 cases of second- and third-degree burns, with healing occurring in three days to three weeks.

Dose: 3-9g

Lu Lu Tong – Sweetgum fruit – Liquidambar – “All Roads Open”

Nature: bitter, neutral

Enters: Liver, Stomach

Actions: Promotes blood and Qi circulation; opens the middle Jiao; unblocks the channels; promotes urination.

Indications:
• Stagnation: Epigastric pain, abdominal distention, irregular, scanty menses.
• Wind-damp Bi syndrome with pain and stiffness of the lumbar region and knees.
• Edema with difficult urination.
• Doctrine of signatures: resembles a pollen grain or mast cell – useful for allergic disorders. Also, Li: its tiny points indicate its ability to guide to small places (sinuses, channels, etc.).
Hsu: Anti-allergic effect, cures urticaria and allergic rhinitis.

Dose: 3-9g

Mao Dong Qing – Ilex root – Rough-haired Holly – Ilex pubescentis

Nature: bitter, astringent, neutral

Enters: Heart

Actions: Clears heat and toxicity; invigorates blood circulation; promotes flow of the channels.

Indications:
• Wind-heat EPI.

• Lung heat: cough, water distention in the larynx, swollen painful throat, tonsillitis.

• An ingredient in the popular patent remedy Gan Mao Ling.
• Dysentery.
• Coronary disease; thrombotic infarction; vasculitis.

• Topical: burns.
• Anti-tussive; bacteriostatic; expectorant; hypotensive; dilates coronary arteries; probably has antiviral properties.
Dose: 30-120g (to 500g for phlebitis)

Meng Chong – Tabanus – Gadfly

Nature: bitter, slightly toxic, slightly cold

Enters: Liver

Actions: Powerfully promotes blood circulation and removes blood stasis.

Indications:
• Blood stasis: amenorrhea, traumatic injury, masses.
• May cause diarrhea (which can be beneficial if there is blood stasis in the intestines).
• This is the strongest herb to promote blood circulation in the pharmacopeia.
Hsu: Anticoagulant and hemolytic effects.

Dose: 1.5-3g

Mo Yao – Myrrh – Commiphora myrrha resin

Nature: bitter, neutral

Enters: Heart, Liver, Spleen

Actions: Promotes blood circulation, dispels blood stasis, relieves pain; relieves swelling; promotes tissue regeneration; relaxes the tendons.

Indications:
• Blood stasis: dysmenorrhea, amenorrhea, epigastric pain, Bi syndrome, traumatic injury, carbuncle pain, appendicitis, immobile abdominal masses, abdominal pain, chest pain, sores, swellings.
• Topical: non-healing carbuncles, ulcers, sores.
• Stomatitis, gingivitis, laryngitis.
• Stronger for severe pain (e.g. angina pectoris) than Ru xiang.
• Better than Ru xiang at removing blood stasis.
• May lower cholesterol and prevent plaque.
• Stimulates gastrointestinal motility.
• Antifungal.
• Fry with vinegar to enhance its blood circulating properties.
• Related to the Ayurvedic herb Guggul.
JC: Tonic, stimulant, powerful antiseptic and disinfectant (mucus membranes), vulnerary (healing), expectorant, emmenagogue, astringent, carminative, purgative (large dose), cardiac stimulant.
• Increases WBC count.
• Enhances the eliminative function of the mucus membranes of the bronchi and genitourinary tract.
DY: The uncooked herb is irritating to the stomach and mucus membranes.
Yoga: Bola: K, V-; P+ (in excess)
• Bitter, astringent, sweet/heating/pungent.
• Alterative, emmenagogue, astringent, expectorant, antispasmodic, rejuvenative, analgesic, antiseptic; prevents decay, reverses aging, rejuvenates the mind and body.
• Closely related to Guggul (Commiphora mukul).
• Dispels old, stagnant blood from the uterus.
K&R: Anti-inflammatory, astringent, immune stimulant, epitheliogenic.
• Metal: clears phlegm from the mucus membranes.
• For bronchitis, urinary tract infections, pharyngitis, gingivitis, skin ulcers.
• Increases WBC count.
PCBDP: Lowers lipids, cholesterol; inhibits platelet aggregation; appears to activate the thyroid gland (animal studies).
IBIS: Anticatarrhal, antimicrobial, antiseptic, astringent, carminative, expectorant, stimulant.
• [Western] Dosage: tincture: 2 – 5 mL.
• Mucous membranes pale and lax; tonsils enlarged and spongy; throat pale and tumid; chronic bronchitis with profuse secretion of mucus or muco-pus, difficult to expectorate; soreness and sponginess of gums; ptyalism; weight and dragging in pelvis in females; leukorrhea; muscular debility (Felter and Scudder, p. 483)
• External: spongy and bleeding gums; sore throat with aphthous or sloughing ulcers; chronic pharyngitis with tumid, pallid membranes and elongated uvula; spongy, enlarged tonsils (Felter and Scudder, p. 483)
• Internal: enfeebled conditions with excessive mucous secretion, especially in the bronchial and renal mucosa; chronic bronchitis; chronic gastritis; atonic dyspepsia (Felter and Scudder, p. 483); pharyngitis; respiratory catarrh; common cold; furunculosis; mouth ulcers; gingivitis (British Herbal Pharmacopoeia, p. 73)
• Contraindicated during pregnancy (Felter and Lloyd, p. 1300) due to its emmenagogue and abortifacient effects (Brinker, Farnsworth)

Dose: 3-12g

 
BII (Guggulipid, from Guggul, Commiphora mukul): Lowers cholesterol and triglycerides – cholesterol typically will drop 14-27% in 4-12 weeks while triglycerides will drop 22-30%.
• Increases the liver’s metabolism of LDL and uptake of LDL from blood.
• Standard dosage is 25 mg of guggulsterone [a component] TID.
• Non-toxic, safe in pregnancy.
• Beneficial in acne vulgaris.
• May inhibit platelet aggregation.
• Useful in atherosclerosis, however the high dosage required of the crude herb or extracts can lead to side effects and therefore pure guggulipid (guggulsterone) should be used.