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

Nature: sweet, slightly cold

Enters: Lung, Heart

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

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

Dose: 9-30g

Nature: sweet, bland, neutral

Enters: Lung, Stomach

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

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

Dose: 3-9g

Nature: salty, cold

Enters: Liver, Spleen

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

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

Dose: 9-30g

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

Dose: 3-9g

Nature: sweet, neutral

Enters: Liver, Kidney, Lung

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

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

Dose: 6-18g

Nature: sweet, salty, cold

Enters: Liver, Kidney, Heart

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

Indications:
• Stirring of wind due to liver Yang rising as a result of Yin deficiency: facial spasms, hand and foot tremors.
• Yin deficiency heat: fever.
• Kidney deficiency: weakness of the lumbar region and feet, retardation in children, poor skeletal development, failure of fontanel to close.
• Heart blood deficiency: palpitations, insomnia, anxiety, poor memory.
• Heat in the blood: uterine bleeding or excessive menstruation.
• Non-healing sores and ulcers.
• Hypertension due to Yin deficiency.
• First choice for Wei syndrome due to kidney and liver Yin deficiency
• Some ancient sources say Gui ban is contraindicated in pregnancy since it softens hardness, expels stasis, and aids in difficult births – but can be used appropriately when baby is due.
• Doctrine of signatures: the turtle is so Yin it hardly moves; regarding its ability to aid in childbirth, it helps coax the turtle (baby) out of its shell (mother).
• Crush before use.
• Frying in vinegar focuses its effects on the liver and makes it easier to crush.
• Cook 30 minutes longer than other herbs.
Dui Yao (Sionneau): Makes the heart and kidneys and the Ren Mai and Du Mai communicate.
• Better than Bie Jia at subduing Yang, but less effective at clearing deficiency heat.
• With Bie jia: See Bie jia in this category for properties and indications of the combination.
Hong-Yen Hsu (Oriental Materia Medica): Antipyretic, analgesic.
Subhuti Dharmananda:

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

Dose: 9-30g

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

Dose: 3-9g

Nature: sweet, sour, cold

Enters: Liver, Kidney

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

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

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

Nature: sweet, neutral

Enters: Liver, Kidney

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

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

Dose: 9-30g

Nature: sweet, neutral

Enters: Lung, Spleen, Kidney

Actions: Nourishes Lung Yin; tonifies spleen Qi, nourishes spleen Yin; mildly nourishes kidney Yin and Jing, generates marrow; relieves Xiao Ke (wasting and thirsting syndrome).

Indications:
• Lung Yin (and Qi) deficiency: dry cough; maybe streaks of blood in sputum; possible flushed cheeks and irritability to due heat.
• Kidney Jing deficiency: weakness and soreness in the lumbar region and knees, dizziness, weakness in the lower extremities, lightheadedness, blurred vision, prematurely grey hair.
• Spleen and stomach Qi deficiency: poor appetite, fatigue, weak pulse, lassitude.
• Spleen and stomach Yin deficiency: dry mouth, poor appetite, loss of taste, dry stool, dry, red tongue.
• Lung, stomach, and kidney Yin (and Qi) deficiency: diabetes / xiao ke / wasting and thirsting disorder (whether in upper, middle, or lower jiaos, or a combination): polyuria, polyphagia, polydipsia, emaciation, irritability, fatigue.
• Very safe, will not trap an EPI in the body, not greasy. Liu: “Typical Taoist herb.”
• Can be taken long-term.
• May lower blood pressure.
• Beneficial in tuberculosis.
• Adaptogenic effects.
• Topical (alcohol tincture) for fungal infections.
• The raw form (less used) is more of a Yin tonic than a Qi tonic.
• The prepared form (common), which is wine-steamed, is more of a Qi tonic than a Yin tonic.
• Bensky/Gamble classify this herb as a Qi tonic.
• Michael Tierra compares this herb, rather than Yu zhu, to American Solomon’s Seal (an error?), and considers American Polygonatum to be as good or better than the Chinese variety.
Dr. Wei Li (Portland, Oregon): Good non-warming immune tonic.
Chinese Medical Herbology & Pharmacology: “The ideal herb to treat yin-deficient cough, nourish the lung, and benefit Qi. In combination with other herbs or alone.”
Oriental Materia Medica (Hong-Yen Hsu): Antifungal, antibacterial, hypotensive, hypoglycemiant.
Heiner Fruehauf: An An Shen (spirit calming) herb, important in Gu Zheng (Gu parasite) formulas (because of emotional disturbance common in patients with Gu).

Dose: 6-18g

Nature: sweet, neutral

Enters: Lung, Spleen

Actions: Moistens and cool the Lungs; dissipate nodules.

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

Dose: 9-15g (½ to 2 pieces of fruit)

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

Nature: sweet, slightly bitter, slightly cold

Enters: Lung, Heart, Stomach

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

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

Dose: 6-15g

Nature: sweet, bitter, cool

Enters: Liver, Kidney

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

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

Dose: 4.5-15g

Nature: bitter, neutral

Enters: Liver, Kidney

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

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

Dose: 9-60g

Nature: sweet, cold

Enters: Heart, Liver, Kidney

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

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

Dose: 6-15g

Nature: sweet, bland, slightly cold

Enters: Lung, Stomach

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

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

Dose: 9-15g

Nan sha shen – Adenophora:

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

Nature: sweet, slightly cold

Enters: Stomach, Kidney

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

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

Dose: 6-15g

Nature: sweet, bitter, very cold

Enters: Lung, Kidney

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

Indications:
• Lung heat or fire and Yin deficiency: dry cough with small amount of sticky sputum or cough with bleeding.
• Injury of Yin by heat: dry mouth and thirst.
• Lung and kidney Yin deficiency: wasting and thirsting disorder, consumption, low-grade afternoon fever.
• Large intestine dryness: constipation.
• Sore throat due to kidney Yin deficiency fire or lung heat.
• Reaches the upper and lower Jiaos.
• Often used with Mai men dong to treat both the mother and son.
• Has a viscous, cloying nature – can easily produce stagnation.
• Antibiotic effects.
• May help leukemia.
• Said to engender love and compassion.
• For Lung heat and dryness, compared to Tian hua fen and Mai men dong, Tian men dong is superior when the origin is kidney Yin deficiency (Tian hua fen is best when the origin in stomach heat and Mai men dong is best when the origin is heart fire)
Dui Yao: The Art of Combining Chinese Medicinals: Compared to Mai men dong, Tian men dong is better for Lung/kidney Yin deficiency, and better for clearing and moistening.
The Yoga of Herbs: An Ayurvedic Guide to Herbal Medicine: Shatavari: “who possesses 100 husbands” – named such because it is so tonic and rejuvenative to the female reproductive organs.
• P, V-; K and ama+ (in excess); Sattvic.
• Sexual debility, especially of the female organs, infertility, impotence, menopause, diarrhea, dysentery, stomach ulcers, hyperacidity, dehydration, lung abscess, hematemesis, cough, convalescence, cancer, herpes, leukorrhea, chronic fevers.
• A rasayan for Pitta, for the female reproductive system, and for the blood.
• Demulcent for dry and inflamed membranes.
• Topical: emollient for stiff joints, neck, muscle spasm.
• Contains many female hormones.
Potter’s New Cyclopaedia of Botanical Drugs and Preparations: Diuretic, laxative, cardiac tonic and sedative.
• Also for neuritis and rheumatism.
Oriental Materia Medica (Hong-Yen Hsu): Antibacterial, antitussive, diuretic, laxative.
Chinese Medical Herbology & Pharmacology: May increase milk production in nursing mothers.
• With Bai Hua She She Cao (oral, injected) for malignant lymphoma, breast cancer, fibrocystic breasts.

Dose: 6-15g

Nature: bitter, sweet, cold

Enters: Heart, Lung, Kidney

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

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

Dose: 2.4-9g

Nature: sweet, neutral

Enters: Lung, Stomach

Actions: Nourishes Yin; moistens dryness; produces body fluids for the stomach; extinguishes wind; softens and moistens the sinews.

Indications:
• Lung and stomach Yin deficiency: dry cough, dry mouth, thirst, irritability, steaming bone disorder, wasting and thirsting with intense hunger and constipation.
• Wind-heat attack with a Yin deficient constitution: fever, sore throat, cough, thirst.
• Insufficient fluids leading to wind: pain and spasm of the sinews.
• Yin deficiency plus internal wind: dizziness.
• Not cloying, will not trap EPIs in the body.
• Use raw to clear heat.
• Steam until it turns black (more like Huang jing) to nourish Yin and tonify the middle Qi.
• Useful in treatment of second- or third-degree heart failure.
• Weaker than Shi hu at nourishing stomach Yin. Yu zhu is a better choice when there is stomach Yin xu with an EPI.
• Weaker than Tian men dong at clearing heat, but does not have the disadvantage of Tian men dong’s severely cloying nature which can easily produce stagnation.
Hsu: Laxative, diuretic, lowers blood sugar, may have adrenocortical hormone-like effects.
Yoga: Meda, Mahmeda: VPK=; K or ama+ (in excess)
• Nutritive tonic, rejuvenative, aphrodisiac, demulcent, expectorant, hemostatic.
• Tonic to Vata and Pitta and to semen and reproductive tissue.
• For debility, infertility, impotence, chronic bleeding, diabetes, consumption, dry cough, dehydration, malnutrition, burning sensation, broken bones, inflamed mucus membranes.
MW: Muscular and skeletal problems: loosens or tightens ligaments as necessary, keeps adjustments in place, corrects tension, feeds and lubricates ligaments, tendons, muscles, and attachments, joins and seals broken bones, decalcifies unhealthy deposits and spurs, strengthens and harmonizes.
• Also for bruises, burns, sores.
• Wolf medicine: wolves eat this for indigestion.
• Helps build up intestinal bacteria; soothes and coats mucosa.
• Gentle regulator of heart muscle, mild cardiac tonic.
• Its berries are poisonous.
PCBDP: Astringent, demulcent, tonic.

Dose: 9-15g