• These herbs are among the coldest in the Chinese herbal pharmacopeia. Many are used for Qi level or Yangming stage full heat.

• From a Western perspective, a number of these herbs are antipyretic and some are anti-inflammatory.

• Also consider, when appropriate: Huang qin, Huang lian, Huang Bai, Da huang, Tian Men Dong, Di Yu, Jue ming zi, Han shui shi, Gu jing cao, etc.

• Herbs in this category are commonly combined with:
A. Herbs that strengthen the spleen and stomach, when there is deficiency of these organs.
B. Herbs that nourish Yin, when there is injury of body fluids by heat or the patient has pre-existing Yin deficiency.
C. Herbs that tonify Zhen Qi when used for patients with a weak constitution.

Nature: sweet, bland, cold

Enters: Heart, Stomach, Small Intestine

Actions: Promotes urination; drains Ying level heat; conducts heart heat to the small intestine (conducts Ying level heat back to the Qi level); clears damp-heat; disperses upper Jiao heat; eliminates irritability or restlessness (by clearing heat from the heart, small intestine and stomach).

Indications:
• Heat patterns with irritability, restlessness, thirst.
• Concentrated, rough, burning urination. Especially for heat in the heart/small intestine with irritability and a dark red tip of the tongue.
• Stomach or heart channel heat: canker sores or tongue sores, swollen and painful gums.
• Lingering Qi level heat.
• Some use this herb for Lung wind-heat, since it is very light and can disperse heat in the upper Jiao.
• Dan zhu ye’s diuretic effect is weaker than Mu tong.
• Note: Despite the translation of its name and its similar appearance to bamboo, this herb is of the Lophatherum genus, not Bambusa (true bamboo).
Hsu: Anticarcinogenic effect; diuretic.

Dose: 6-9g

Nature: bitter, cold

Enters: Heart, Pericardium

Actions: Drains heart fire; stops bleeding, binds Jing

Indications:
• Warm-febrile disease: heat collapse into the pericardium channel causing mental confusion, delirium, mania.
• Heart fire: insomnia or irritability.
• Used as a powder for hematemesis, spermatorrhea.
• Lowers blood pressure, primarily by vasodilation.
Hsu: Dilates the coronary arteries; relaxes uterine smooth muscle.

Dose: 1.5-6g

Nature: sweet, cold

Enters: Lung, Stomach

Actions: Generates body fluids; mildly promotes urination; clears heat from the Lungs and stomach; conducts Lung heat to the bladder and discharges it; promotes expression of incomplete rashes; stops vomiting; eases restlessness; eliminates phlegm.

Indications:
• Lung heat, wind-heat, or phlegm-heat: cough, dry mouth, with or without sticky yellow sputum. Especially useful in acute stage. For phlegm-heat, Lu gen dilutes the phlegm and makes it easier to expel.
• Heat in febrile disease, stomach fire: thirst, dry tongue, fever, Shen disturbance – restlessness.
• Stomach heat: vomiting, belching, nausea.
• Heat: dark scanty urine, hematuria. Especially useful when accompanied by thirst and irritability.
• Lu gen can also drain pus and treat pulmonary abscesses.
• Febrile disease with rashes that are incompletely expressed.
• This herb is most potent when fresh (rather than dried).

Dose: 15-30 (up to 60g alone for incomplete expression of rashes)

Nature: sweet, cold

Enters: Liver

Actions: Benefits the eyes.

Indications:
• Red, swollen, painful eyes, excessively tearing, superficial visual obstruction, photosensitivity.
• Can be used in both deficiency and excess patterns.
MLT: Also for cataracts and for heat and inflammation of the face, head, throat, teeth, and gums.

Dose: 3-9g

Nature: bitter, slightly cold

Enters: Liver

Actions: Reduces liver fire to improve the vision and remove nebulas; clears wind-heat.

Indications:
• Liver fire or wind-heat affecting the eyes: red, swollen, painful eyes, poor vision, superficial visual obstruction, cataracts.
• Lowers blood pressure: recently used for hypertension associated with liver Yang rising. In one study with cases of 160-230 mm Hg systolic and 100-135 diastolic, blood pressure was reduced to 125-145 over 78-90 after one month of treatment with Qing xiang zi.
• Dilates the pupils.
• Not for liver and kidney Yin deficiency or glaucoma.
Hsu: Antiphlogistic; dilates the pupils.

Dose: 3-15g

Nature: acrid, sweet, very cold

Enters: Lung, Stomach

Actions: Clears heat and reduces fire from the Lungs and stomach; eases restlessness and thirst; the calcined form promotes tissue regeneration.

Indications:
• Lung/stomach, Yangming stage, or Qi level heat: big, forceful pulse, high fever, restlessness, thirst, profuse sweats, red tongue, yellow coat.
• Stomach channel fire: headache, swollen and painful gums, toothache.
• Lung heat: cough, wheezing, fever, thick, viscous sputum.
• Topical: use the calcined form for eczema, burns, ulcerated sores, non-healing carbuncles. This herb may also be taken internally for these conditions.
• This herb should be crushed and cooked 20-30 minutes longer than other herbs.
• Shi gao is stronger at clearing Lung and stomach heat than Zhi mu or Lu gen.
• Shi gao is commonly combined with Ma huang. Ma huang’s acrid quality helps to disperse Lung Qi, and its warm nature mitigates Shi gao’s coldness. Shi gao lessens Ma huang’s diaphoretic action, and its heavy quality helps Ma huang more effectively descend Lung Qi. Together, they effectively diffuse the Lungs and calm asthma, disinhibit urination and disperse swelling, clear heat and drain fire.
Li– “Shi gao is like Tylenol.” Can relieve pain and lower the body temperature.
MLT: Potent for lowering fever: high fever, including that associated with meningitis, encephalitis.
• Shi gao has little or no antibiotic properties.
• If necessary for long term, repeated use (e.g. reddening of the face from food allergies), Shi hu may be a better choice.
Hsu: Reduces thirst; hypotensive; antiphlogistic; tranquilizing effect.
DY: Heavy, downbearing, draining; engenders fluids, alleviates thirst; resolves heat from the muscles and from the exterior.
• For inflammatory rheumatism or hot Bi, use 150g per day, and in severe cases, up to 250g/day.
• With Zhi mu to strongly clear and drain replete heat (from the Lungs and stomach) while protecting fluids and Yin. For such indications as:
– 1. Persistent high fever, great thirst and desire for cold drinks, dry tongue, vexation, profuse perspiration, and a surging, big pulse due to heat in the Qi division. (Use Bai Hu Tang.)
– 2. Upper thirsting and wasting with polydipsia, a dry mouth and tongue, and great thirst due to replete Lung heat damaging fluids. (Use stir-fried Zhi mu.)
• With Chuan xiong 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. Usual dosage of Shi gao for these indications is 30-60g.
• With Gui zhi to clear heat, free the flow of the network vessels, stop pain, and treat heat Bi or impediment. For such indications as rheumatic pain of the heat type with redness, heat, swelling, and severe pain in the joints. (Bai Hu Gui Zhi Tang)

Dose: 9-30g (to 90g for very high fevers)

Nature: bitter, slightly sweet, cold

Enters: Lung, Stomach

Actions: Strongly clears heat from the Lungs and stomach; strongly drains pus and relieves swelling; transforms phlegm; generates body fluids, moistens Lung dryness; relieves toxicity.

Indications:
• Heat injures the body fluids: restlessness, irritability, thirst, cough, dry tongue coat, wasting and thirsting disorder.
• Heat in the Lungs: cough, including dry cough, or coughing blood-streaked sputum
• Heat and toxicity: red, swollen, painful carbuncles, boils, other swellings, sores. Especially useful for breast abscess (both internally and topically).
• Diabetes: heat in the Lungs and stomach with strong hunger and extreme thirst. Use 60-90g or more.
• Abortifacient (used 2^nd trimester) – applied via a tea-soaked tampon or IM injection (also with She xiang) – takes 3-6 days to have an effect.
• compared to Mai men dong and Tian men dong, Tian hua fen is best for Lung For heat and dryness, Tian hua fen is most useful for when the origin is stomach heat. Mai men dong is superior when the origin is heart fire, and Tian men dong is superior when the origin is kidney Yin deficiency.
• Tian hua fen is much stronger than Lu gen at relieving swelling and draining pus.
• Bensky/Gamble and MLT classify this with herbs that resolve phlegm-heat.
• Some people are allergic to this herb.

Dose: 9-30g
Contains Compound Q/Trichosanthin/GLQ223 – a protein which has been utilized in the treatment of various kinds of ulcers, as an abortifacient, and to treat diseases of trophoblastic origin, such as hydatiform mole, invasive mole, choriocarcinoma. It appears to inhibit HIV-1 replication in acutely infected T-lymphoblastoid cells and chronically infected macrophages, and appears to selectively kill HIV-infected cells.
It produces an anaphylactic reaction in 10-20% of users. Pharmaceutical companies have produced chemically modified variations for greatly reduced allergenicity.
CHA: (Harriet Beinfield, Efrem Korngold, March 7, 2001):
Weidong Lu, MD, L.Ac., Chairman of the Chinese Herbal Medicine Department at the New England School of Acupuncture, explains that trichosanthin is a type of protein that is inactivated by digestive enzymes or by decocting the herb in boiling water. Trichosanthin cannot be absorbed as an active protein by the intestine from either the crude herbal material or the water extract. He further states that trichosanthin can only exert toxicity via intravenous or intramuscular injection, and that overdoses of injected Trichosanthes root may cause allergic reactions that include malaise, sore throat, headache, swelling, itching, and rashes. He maintains that Trichosanthes root is non-toxic when consumed orally in appropriate doses.

Nature: bitter, acrid, cold

Enters: Liver, Gallbladder

Actions: Clears liver fire; brightens the eyes; disperses stagnant phlegm and fire, dissipates nodules.

Indications:
• Liver fire: red, swollen, painful eyes, lots of tears, dizziness, photophobia, headache.
• Liver deficiency: eye pain that increases in the evening, especially when the eyes are neither red nor swollen.
• Stagnant phlegm-fire: neck nodules, lipomas, swollen glands, scrofula, goiter. Also for similar nodules in the inguinal groove or other parts of the body.
• Mildly reduces hypertension (probably through vasodilation), especially when accompanied by liver fire or Yang rising.
• Broad antimicrobial (tuberculosis, shigella, salmonella, E. coli, pseudomonas, strep, many other fungi and bacteria).
Li: Softens hardness: thick blood, lumps (including hyperthyroidism), hardened skin in eczema.
MLT: Also for conjunctivitis; some cancers.
PCBDP: Astringent, vulnerary.

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

Nature: acrid, cold

Enters: Liver

Actions: Clears the liver and improves vision.

Indications:
Night blindness, superficial visual obstruction, cataracts.
Also used for childhood nutritional impairment.
Doctrine of signatures: bats are blind, fly at night – for vision, especially at night.

Dose: 3-9g

Nature: bitter, sweet, cold

Enters: Lung, Stomach, Kidney

Actions: Mildly nourishes Yin, moistens dryness; clears heat and reduces fire from the Lungs, stomach, and kidneys.

Indications:
• Extreme heat in the Lungs and stomach, Yangming stage or Qi level: high fever, restlessness, irritability, thirst, big, rapid, forceful pulse.
• Lung heat (including Yin deficiency): cough, including with thick, yellow sputum.
• Kidney (and Lung) Yin deficiency: tidal fever, night sweats, restlessness, steaming bone disorder, irritability, warmth in the five centers, bleeding gums.
• Also for kidney heat signs such as spermatorrhea, nocturnal emissions, and an abnormally elevated sex drive.
• Lung, stomach, and kidney Yin deficiency: excessive thirst, hunger, and urination – diabetes (often used with Tian hua fen).
• Treats both excess and deficiency heat.
• For excess Lung heat, it is often combined with Huang qin. For Lung Yin deficiency heat, it is often uses with Mai men dong. For excess stomach heat, it is commonly combined with Shi gao. For stomach Yin deficiency heat, it is used with Tian hua fen. For kidney Yin deficiency heat, it is often used with Huang bai and Shu di.
• Fry it in salt water to strengthen its ability to nourish the kidneys and to direct the actions of a formula downward.
Li: Can lower the body temperature.
DY: Treats all three Jiaos; clears the Qi division; drains deficiency fire from the lower burner, drains [aberrant] ministerial fire.
• If thirst is predominant, bran stir-fried or honey mix-fried Zhi mu should be used.
• If dry cough is predominant, Zhi mu should be stir-fried until scorched.
• With Bai he 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.
• With Chuan bei mu to clear and moisten the Lungs, enrich Yin, drain fire, transform phlegm, and stop cough. For such indications as:
– 1. Enduring dry cough with little phlegm and difficult expectoration, sometimes fever, dry mouth, and a dry, red tongue due to water deficiency causing rising fire or due to Lung Yin deficiency. (Use stir-fried Zhi mu)
– 2. Cough due to Lung heat which causes Lung dryness.
• With Huang bai to clear heat, enrich Yin, drain deficiency fire, resolve toxins, and eliminate dampness in the lower burner. For such indications as:
– 1. Evening fever, steaming bones, and night sweats caused by Yin deficiency. – 2. Seminal emission, premature ejaculation, easy erection, excessive thinking about sex, sexual hyperexcitability, erotic dreams, nymphomania due to deficiency fire and hyperactive ministerial fire.
– 3. Dysuria due to Yin deficiency and to Yang losing its ability to transform (at the level of the bladder). For all these indications, both herbs should be salt mix-fried to guide their action toward the lower burner and kidneys.
• With Shi gao to strongly clear and drain replete heat (from the Lungs and stomach) while protecting fluids and Yin. For such indications as:
– 1. Persistent high fever, great thirst and desire for cold drinks, dry tongue, vexation, profuse perspiration, and a surging, big pulse due to heat in the Qi division. (Use Bai Hu Tang.)
– 2. Upper thirsting and wasting with polydipsia, a dry mouth and tongue, and great thirst due to replete Lung heat damaging fluids. (Use stir-fried Zhi mu.)
MLT: Broad spectrum antibiotic; has a downward energy, helps lubricate the kidneys.
• For heat with thirst unrelieved by drinking.
Hsu: Reduces blood sugar; antibacterial.

Dose: 6-12g

Nature: bitter, very cold

Enters: Heart, Lung, Stomach, San Jiao, Liver

Actions: Clears heat in all three Jiaos; mildly drains dampness; cools the blood; stops bleeding; eliminates toxicity; reduces fire from the heart, Lungs, and stomach to ease restlessness; topically reduces swelling and blood stasis due to trauma.

Indications:
• Heat in the Lungs, stomach, or heart: restlessness, irritability, fever, stifling sensation in the chest, insomnia, delirious speech.
• Liver/gallbladder damp-heat (and constraint): jaundice, fever, scanty urination.
• Lower Jiao damp-heat: painful urinary dysfunction.
• Damp-heat in the gallbladder and san jiao channels of the face, affecting the nose and eyes or causing sores in the mouth or facial region.
• Heat in the blood: hematemesis, hematuria, hemafecia, epistaxis. Usually partially charred for this use.
• Topical: powder the herb and mix it with egg white or vinegar for swelling and blood stasis due to trauma.
• Increases contraction of the gallbladder 20 to 40 minutes after ingestion.
• A paste made of ground Zhi zi, water, and alcohol was used in an uncontrolled study of 407 acute sprains. The paste was changed every 2-5 days. 80% of patients had no pain within 24 and 97% were pain free within 48 hours. Swelling and restoration of function were also improved.
• Though Wei Li freely uses 9g/day, Guohui Liu is often more conservative with the dosage, cautioning that it is very bitter and cold and can nauseate some patients.
• This herb should be pounded before cooking.
• Partially char the herb when using it to cool the blood and stop bleeding.
• Chao zhi zi is Zhi zi which is dry-fried until it turns yellow. It is less likely than plain Zhi zi to cause nausea or vomiting.
Li: Can lower the body temperature.
MLT: Also promotes blood circulation; relieves pain.
• Liver damp-heat: jaundice, hepatitis, boils, sores.
• Sometimes called the “happiness herb” because it relieves irritability associated with heat and liver stagnation.
Hsu: Cholagogue, lowers blood bilirubin; hypotensive; antibacterial.
DY: This is one of the bitterest substances in the Chinese pharmacopeia.
• The outer layer (epicarpium) of Zhi zi (Shan zhi ke) moves blood and clears external heat. The seeds inside (Shan zhi ren) clear internal heat. The seeds with the epicarpium are superior for draining Lung fire. The seeds without the epicarpium are superior for draining heart fire.
• With Dan dou chi, the two herbs unite to form the clearing and diffusing and out-thrusting method to eliminate evils from the exterior and interior. Together, they effectively promote perspiration, drain evils from the exterior, clear and out-thrust heat from the interior, and eliminate vexation due to full heat. For indications such as:
– 1. Vexation and agitation, insomnia, and irritability during or after a warm disease. (Zhi Zi Chi Tang) Use stir-fried Dan dou chi.
– 2. External contraction of wind-heat or a febrile disease.

Dose: 3-12g