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

Yi Tang – Maltose – Grain Malt Extract

Nature: sweet, warm

Enters: Spleen, Stomach, Lung

Actions: Tonifies spleen Qi; relaxes the muscles to relieve pain; moistens the Lungs; stops coughing.

Indications:
• Spleen Qi deficiency (including by overexertion): poor appetite, fatigue, shortness of breath.
• Lung Yin deficiency: dry, nonproductive cough, difficult or slow, labored breathing, weak voice.
• Spleen cold and Yang deficiency: abdominal pain (relieved by warmth and pressure), excessive salivation, pale tongue, white coating, deep, slow pulse.
• Not usually a chief herb for Qi tonification. Used to make a formula taste better.
• Weaker than Gan cao at relaxing the muscles to relieve pain.
• Compared to Dang shen, while Dang shen can be used for a deficiency-induced cough with profuse sputum, Yi tang is indicated more for a non-productive deficiency-induced cough.
• Contraindicated with vomiting, abdominal distention due to damp-heat, phlegm-heat cough, infant malnutrition.
• Preparation: barley malt is cooked with rice flour (glutinous or non-glutinous) or wheat flour.
• Rich in minerals.
• Dissolve in a strained decoction at the very end of cooking.
CDT: Made from grains such as glutinous or non-glutinous rice, wheat, millet, barley, maize, through fermentation.
• Performs functions listed above plus detoxifies.
• Spleen and stomach deficiency with loss of appetite, fatigue, abdominal pain: decoct with cinnamon twig, common peony, ginger, dates, licorice.
• Lung deficiency with dry cough, sore throat, shortness of breath: take Yi tang alone or steamed with turnip juice until it melts.
• Poisoning or unwanted reaction caused by overdose of Fu zi or Wu tou: take Yi tang immediately.
• Taken chewed, sucked, or decocted.

Dose: 30-60g