Commonly combined with:
• A. Herbs that disperse the Lungs and resolve phlegm when there is attack of the Lungs by an EPI.
• B. Herbs that clear heat and resolve phlegm when there is Lung phlegm-heat.
• C. Herbs that clear damp-heat when there is damp-heat in the middle Jiao.
• D. Herbs that warm the interior when there is spleen cold-dampness.
• E. Herbs that promote digestion when there is food retention.
• F. Herbs that tonify spleen Qi when there is spleen Qi deficiency.
• G. Herbs that nourish liver blood and Yin and promote blood circulation when there is liver Qi stagnation.
• Since these herbs disperse Qi and tend to be aromatic and drying, they are generally used with caution for patients with Yin or Qi deficiency.
• Since the dispersing effect of many of these herbs is dependent on their volatile oils, these herbs are generally decocted for no longer than 15 minutes.
• When using Chen pi, Ju hong, Ju He, Qing pi, Zhi shi, Zhi ke, Fo shou, Xiang yuan, and other citrus herbs, remember to consider the possibility of the patient’s having a citrus sensitivity or allergy.
• The term “adjusts the middle Jiao” refers to an herb’s ability to re-establish the proper ascent and descent of Qi by the spleen and stomach.
• Also consider these Qi moving herbs from other categories, as appropriate: An Xi Xiang [Open Orifices], Bai Jie Zi [Resolve Phlegm], Bai Dou Kou [Aromatic Transform Damp], Bing Lang [Kill Parasites], Bo He [Acrid, Cool], Cao Dou Kou [Aromatic Transform Damp], Du Huo [Expel Wind-Damp], E Zhu [Move Blood], Gua Lou Pi [Resolve Phlegm], Hou Po [Aromatic Transform Damp], Jiang Xiang [Move Blood], Lu Lu Tong [Move Blood], Rou Dou Kou [Astringent], Ru Xiang [Move Blood], San Leng [Move Blood], Sha Ren [Aromatic Transform Damp], Yan Hu Suo [Move Blood], Yu Jin [Move Blood], Zi Su Ye [Acrid, Warm Release Exterior].

Nature: acrid, bitter, warm

Enters: Spleen, Lung, Stomach

Actions: Regulates Qi; adjusts the middle Jiao (acrid lifts the spleen Qi, bitter descends the stomach Qi); dries dampness; resolves phlegm; helps the spleen to transport; relieves the diaphragm; directs Qi downward.

Indications:
• Spleen/stomach Qi stagnation: distention in the epigastrium and abdomen, belching, bloating, fullness, nausea, vomiting. Also used for various other forms of nausea and vomiting.
• Accumulation of dampness in the middle Jiao: distention in the chest, epigastrium, and abdomen, stifling sensation in the chest, poor appetite, fatigue, loose stool, thick and sticky tongue coat. An important Qi-level herb of both the spleen and Lung channels, it is especially appropriate for disorders involving both channels.
• Phlegm-damp in the Lungs: cough with copious sputum, difficulty breathing, stifling sensation in the chest.
• Added to tonics to help keep their rich quality from stagnating the Qi.
• Some effectiveness as a transdermal carrier of other substances.
• Mastitis: Chen pi was used with Gan cao in one study to yield good results in 70% of the cases, usually within 2-3 days. The longer the duration of the mastitis, the less effective the treatment.
• Chen pi is aged (cured) to eliminate secondary effects and reinforce its primary actions. Generally, the older the Chen pi, the higher the quality and the more effective.
• Use with caution when there is heat.
• Can be carried to guard against taking on patients’ sicknesses.
• Compared to Qing pi, Chen pi has a more harmonious nature and tends to enter the Qi level of the spleen and Lungs. Its actions are primarily vertical and it is therefore used for both coughing and vomiting. Qing pi, on the other hand, has scattering and unblocking properties that are relatively harsh; it is accordingly prescribed for breaking up Qi stagnation. Its actions are more horizontal and it is therefore used primarily for pain.
DY: Moderately fortifies the spleen; harmonizes the stomach, stops vomiting; rectifies the Qi on the right side of the body; downbears stomach Qi counterflow.
• Three essential therapeutic methods are used to treat phlegm-dampness:
– 1. Transforming and drying existing phlegm or evacuating it through expectoration.
– 2. Moving Qi – if Qi moves with fluidity, phlegm is expelled through expectoration and stagnant dampness, which is the origin of the production of phlegm, is moved and does not accumulate – thus dampness does not congeal into phlegm.
– 3. Supplementing the spleen – to promote the transformation and transportation of water and food, and prevent the accumulation of dampness and the engenderment of phlegm.
– Chen pi possesses all three essential functions for the elimination of phlegm-dampness – it transforms phlegm, moves Qi, and fortifies the spleen.
• Zhang Zi-he of the (12^th century) Southern Song dynasty, said: “Chen pi is upbearing and floating, goes to the Lungs and spleen, influences the upper (body) and frees the flow.”
• Chen pi is often added to formulas which supplement the Qi, blood, or Yin in order to ease the assimilation of rich herbs and to avoid Qi stagnation. It can be systematically added to these types of formulas whenever spleen deficiency is suspected.
• With Ban xia for mutual reinforcement, to fortify the spleen, rectify the Qi, dry dampness, transform phlegm, and stop vomiting. For such indications as:
– 1. Cough due to an accumulation of phlegm-dampness. (Use lime-processed Ban xia.)
– 2. Chest oppression, nausea, and vomiting due to stomach disharmony and phlegm-damp stagnation. (Use ginger-processed Ban xia and stir-fried Chen pi.)
• With He zi to effectively constrain the Lung Qi, rectify the Qi, and increase the voice. For hoarse voice, loss of voice, and chronic cough (deficiency type) with loss of voice and phlegm in the throat. (He zi is contraindicated in cases of phlegm-heat or full patterns.)
• With Qing pi to soothe the liver, regulate the stomach, harmonize the liver and spleen, harmonize the liver and stomach, rectify the Qi, and stop pain. For epigastric and abdominal distention and pain, chest and lateral costal region distention and pain due to disharmony of the liver and spleen, liver and stomach, or a liver depression Qi stagnation. For these indications, uncooked or stir-fried Chen pi and vinegar mix-fried Qing pi should be used. In cases of liver-spleen disharmony, add Bai shao, Chai hu, and Bai zhu. This pair is also sometimes used to treat food accumulation in the stomach, diarrhea with abdominal distention due to liver-spleen disharmony, and premenstrual syndrome due to liver-spleen disharmony.
• With Sang bai pi to clear the Lungs and transform phlegm, rectify the Qi, stop coughing and calm asthma. For cough and asthma due to Lung heat with abundant yellow phlegm.
• With Zhu ru to clear and warm simultaneously, eliminating mixed cold and heat in the stomach. They harmonize the stomach, downbear Qi counterflow, and stop vomiting. The combination can be used in the formula Ju Pi Zhu Ru Tang for indications such as:
– 1. Nausea, vomiting, and epigastric and abdominal distention due to spleen-stomach deficiency mixed with cold and heat. (In actuality, the spleen is deficient and cold or at least benefits from the use of warm ingredients, and the stomach is hot and requires clearing with cold medicinals.)
– 2. Nausea and vomiting during pregnancy.
• Ju pi vs. Chen pi: Ju pi is the recent skin, while Chen pi is the aged skin. Ju pi is very drying and acrid, more draining and irritating to the stomach. Chen pi is moderate and more efficient. Chen pi is preferred for use in clinical practice.
Hsu: Stomachic; expectorant; anti-emetic; regulates the intestines; hemostatic – strengthens capillaries; antibacterial; increases blood pressure; stimulates the heart; inhibits GI and uterine activity; slightly inhibits urinary excretion.
HF: An important herb in anti-Gu therapy to move Qi (xing Qi) and break accumulation (po ji).

Dose: 3-9g

 
Ju Hong: Just the red part of the peel
• Acrid, bitter, warm. Enters the Lung and stomach channels.
• Similar to Chen pi, but more drying and aromatic than Chen pi and less effective at harmonizing the middle and regulating the stomach and spleen.
• Resolves phlegm, dispels wind-cold.
• Primarily used for vomiting, belching, phlegm-damp coughs.
DY: Scatters cold, rectifies the Qi; resolves the exterior; dries dampness, transforms phlegm; disperses food stagnation and distention.
• With Zi wan to effectively dry dampness and transform phlegm without drying the Lungs, rectify the Qi, and stop cough. For indications such as:
– 1. Cough with profuse phlegm and chest oppression due to accumulation of phlegm and Qi stagnating in the Lungs.
– 2. Cough with itchy throat, low grade fever, fear of cold, and profuse phlegm due to wind evils attacking the Lungs.

 
Ju He: The seed
• Liu: Shaped like a testicle: guides to and treats testicular problems.
DY: Moves the Qi; scatters nodulation; stops pain; directed toward the Jueyin channel and the Qi division, directed toward the lower burner, into the kidney channel and treats shan. See Li zhi he in this category for notes on shan.
• With Li zhi he, these two herbs are directed toward the liver channel and especially to the region of the pelvis. They effectively scatter cold and nodulation, and stop pain. For specific indications of this combination, see Li zhi he in this category.

 
Qing Ju Ye: Bluegreen citrus leaf
• Frees liver Qi.

Nature: acrid, bitter, warm

Enters: Spleen, Stomach, Kidney

Actions: Regulates Qi, relieves pain; descends stomach Qi, adjusts the middle Jiao; directs rebellious Qi downward, regulates the middle Jiao; warms the kidneys, aids them in grasping the Qi.

Indications:
• Blood stasis or cold obstruction (including from deficiency) with Qi stagnation: distention, pain, or a feeling of pressure in the chest, epigastrium, or abdomen.
• Stomach or spleen cold (including from deficiency): rebellious Qi wheezing, vomiting, hiccups, belching.
• Kidney deficiency: asthma, wheezing, cough with difficulty breathing.
• Particularly useful for stagnation in the lower abdomen.
• The true herb is expensive, very aromatic, precious – do not cook it. It is usually powdered and taken directly.
• Powerfully inhibits M. tuberculosis, Shigella.
• Traditionally, this is not just the wood of this tree, but specifically very old wood, and, some say, wood that has been underwater for many years.
Hsu: Antibacterial – for typhoid, dysentery; analgesic, tranquilizing effects.

Dose: 1.5-3g

Nature: bitter, cold, slightly toxic

Enters: Liver, Stomach, Small Intestine, Bladder

Actions: Regulates Qi (especially liver Qi), relieves pain; kills parasites, treats fungal disease; clears heat; dries dampness.

Indications:
• Liver Qi stagnation or liver attacking the stomach: costal, hypochondriac, epigastric, or abdominal pain. Also for hernial disorders. Especially useful when there are heat signs.
• Damp-heat Qi stagnation: epigastric, abdominal, flank, or hernial pain.
• Roundworms, tapeworms: abdominal pain. More effective at treating the pain than killing the parasites.
• Particularly useful for stagnation in the flanks and lower abdomen.
• Topical: for fungal infections on the scalp.
• May irritate the stomach – when given in a large dose for a long time, it injures the mucous membrane of the stomach.
• May cause elevation of liver enzymes.
• Must be broken up before using.
Jin: Safe to use in pregnancy (when indicated). Unlike some herbs in this category, this herb is not especially drying.
Li: When used for excess conditions, it will not irritate the stomach.
• Use as a sitz bath for yeast infections, and as a wash for other fungal diseases.
DY: With Yan hu suo to clear heat, eliminate dampness, course the liver, move the Qi and blood, and stop pain. This combination (Jin Ling Zi San) is used for indications such as:
– 1. Pain in the chest, epigastrium, abdomen, and lateral costal regions due to liver depression Qi stagnation sometimes associated with liver blood stasis. (Use wine mix-fried Yan hu suo and scorched Chuan lian zi.)
– 2. Liver depression Qi stagnation transforming into liver heat or fire.
– 3. Dysmenorrhea and menstrual irregularities due to Qi and/or blood stasis. (Use scorched Chuan lian zi and vinegar mix-fried Yan hu suo.)
– 4. Heart pain due to Qi and blood stagnation. (Use wine mix-fried Yan hu suo and scorched Chuan lian zi.)
– 5. Inguinal hernia or diseases of the scrotum or testicles due to Qi stagnating in the liver channel. (Use scorched Chuan lian zi and vinegar mix-fried Yan hu suo.)
– 6. Hepatitis, cholecystitis, and angiocholitis due to damp-heat in the liver and gallbladder. (Use scorched Chuan lian zi and vinegar mix-fried Yan hu suo.)
– This combination is a major analgesic which can be added to other prescriptions when pain is a key manifestation of the disorder and especially if this pain is due to Qi stagnation and blood stasis. If there is a headache, add Chuan xiong and Hong hua. If there is chest pain, add Jie geng, Zhi ke, and Xie bai. If there is lateral costal pain, add Chai hu and Yu jin. If there is stomach and epigastric pain, add Mu xiang and Dan shen. If there is lower abdominal pain, add Mu xiang and Tao ren. If there is lower abdomen pain occurring on both sides of the abdomen in the area traversed by the liver channel, add Wu yao and Xiao hui xiang.

Dose: 3-9g

Nature: acrid, slightly warm

Enters: Large Intestine, Small Intestine, Stomach, Spleen

Actions: Promotes the downward movement of Qi; reduces stagnation; expels dampness; promotes urination, reduces edema.

Indications:
• Food stagnation, Qi obstruction: epigastric and abdominal distention, regurgitation of food, belching with acid regurgitation. Especially useful when these disorders are accompanied by constipation.
• Damp stagnation in the stomach and intestines.
• Abdominal distention with edema, especially superficial edema, or the symptoms of food stagnation. Also for damp leg qi.
• Strengthens the contractions and tension of the intestines.

Dose: 6-9g

Nature: acrid, bitter, warm

Enters: Liver, Stomach, Spleen, Lung

Actions: Frees the flow of liver Qi; regulates Qi; adjusts the middle Jiao; resolves phlegm; mildly dries dampness; harmonizes the stomach, strengthens the spleen.

Indications:
• Liver Qi stagnation: costal, hypochondriac, or flank pain, distention in the chest, belching.
• Spleen/stomach Qi stagnation: distention and fullness in the epigastrium and abdomen, epigastric pain, poor appetite, belching, nausea, vomiting.
• Lung phlegm: cough with copious sputum. Especially useful for unrelenting coughs with chest pain. Because its phlegm-resolving function is mild, it is not used in treating the early stages of externally-contracted coughs.
• This herb is strong at moving Qi, but weak at alleviating pain.

Dose: 3-9g

 
Fo Shou Hua: the flower
• Similar properties to the fruit, but milder.
• More effective than the fruit at directing Qi downward.
• Often used for cough and wheezing due to rebellious Lung Qi.

Nature: sweet, astringent, warm

Enters: Stomach, Liver

Actions: Regulates Qi, relieves pain; eliminates cold obstruction (particularly in the liver channel).

Indications:
• Cold obstruction of Qi in the liver channel: lower abdominal, genital, testicular, hernial pain, swelling (also for heat in the liver channel when combined with cold herbs).
• Liver Qi stagnation: epigastric pain; abdominal pain, particularly pre-menstrual or post-partum.
• Guides to the genitalia; can guide herbs to the prostate for prostatitis.
• Ringworm: powder the herb, mix with sesame oil, and apply topically.
• Must be broken up before use.
DY: Moves the Qi and blood; scatters cold; directed toward the Jueyin channel and the blood division; directed toward the lower burner, the kidney channel, and treats shan. (Shan: 1. A generic term for all disease of the scrotum and testicles. 2. Hernias, specifically inguinal hernias. 3. Severe abdominal pain associated with anuria and constipation. “Cold Shan” may indicated either of two pathologies: 1. Severe periumbilical pain and abdominal spasms together with spontaneous cold perspiration, fear of cold, cold limbs, a deep tight pulse, and sometimes, in severe cases, numbness of the limbs and generalized stiffness due to a stagnation and congelation of cold evils in the interior of the abdomen. 2. Scrotal or testicular disease due to stagnation and congelation of cold dampness in the liver channel with pain, contracture, swelling and hardening of the testicles, pain radiating toward the scrotum, worsened by cold, etc.)
• With Ju he, these two herbs are directed toward the liver channel and especially to the region of the pelvis. They effectively scatter cold and nodulation, and stop pain. For the following indications, both herbs should be salt mix-fried, because salt guides the action of these herbs toward the lower burner, toward the pelvis, and toward the kidneys. In addition, salt promotes the softening of nodulations in the treatment of shan.
– 1. Inguinal hernia, swelling and pain of the testicles, and scrotal hernia, all due to cold Qi congealing and stagnating in the liver channel.
– 2. Piercing pain in the pelvis due to Qi stagnation and blood stasis.
– 3. Masses in the pelvis (chronic salpingitis, chronic salpingo-ovaritis, chronic adnexititis, ovarian cysts, endometriosis, and fibroids) due to Qi and blood stagnation.
– 4. Abnormal vaginal discharge due to vacuity cold.
– This combination is used successfully in strangury patterns, particularly for stone strangury and Qi strangury (Qi stagnation type), in order to counteract piercingly painful urination and spasms and contractures in the pelvis. For these indications, the combination is an auxiliary treatment and should be added to other standard formulas that treat strangury.

Dose: 6-15g (24-30g for epigastric pain)

Nature: sweet, slightly bitter, warm

Enters: Spleen, Liver

Actions: Promotes Qi circulation, relieves constraint; harmonizes the blood and disperses stasis.

Indications:
• Liver/spleen disharmony: stifling sensation in the chest, pain and distention in the flanks and epigastrium, belching, poor appetite.
• Blood stasis: irregular menstruation, premenstrual breast tenderness, menstrual pain.
• Blood stasis secondary to trauma.
• Antidotes antimony poisoning.
• Often used in medicinal wines and made into pastes.
• Bensky/Gamble: When treating menstrual dysfunction, Xiang fu is preferred when there is scanty bleeding, while Mei gui hua is more ideal for excessive bleeding.
MLT: Used in Ayurveda for depression.

Dose: 1.5-6g

Nature: acrid, bitter, warm

Enters: Stomach, Spleen, Large Intestine, Gallbladder

Actions: Regulates Qi, adjusts the middle Jiao, relieves pain; strengthens the spleen, prevents stagnation (does not tonify Qi); adjusts and regulates stagnant Qi in the intestines.

Indications:
• Qi stagnation in the stomach/spleen and/or intestines (including from food retention): distended epigastrium, borborygmus, lack of appetite, epigastric or abdominal pain, nausea, vomiting, diarrhea or dysentery with tenesmus. Because of its slightly astringent quality, this is a common herb for treating tenesmus.
• Liver or gallbladder Qi stagnation: flank pain, distention, or soreness.
• Damp-heat: distending pain in the costal/hypochondriac region, bitter taste in the mouth, yellowish tongue coat.
• Spleen/stomach Qi deficiency: distended epigastrium, poor appetite, vomiting, diarrhea.
• Often included (as with tonics) to facilitate absorption of rich or heavy substances. Especially useful when the transformative and transportative functions of the spleen are weak.
• Particularly useful for paraumbilical stagnation and stagnation in the upper abdomen.
• The unprepared herb is used for stopping pain, while the prepared form (fried with wheat bran) is better for treating diarrhea.
• Some sources say this herb is so aromatic and bitter that it can cause dryness.
• This herb should only be cooked for 5 minutes (or less).
• Chuan mu xiang – Vladimiria – is sometimes substituted for Mu xiang. It is similar to Mu xiang, but weaker.
MLT: This herb’s action comes from its volatile oils [which will evaporate from extended exposure to heat], therefore, add it during the last 5 minutes of cooking.
• A small amount helps prevent griping from purgatives.
Hsu: Acts on the vagus nerve – stimulates the large intestine, increases peristalsis, moderates pain and gas in the GI tract; antibacterial properties.
HF: An important herb in anti-Gu therapy to move Qi (xing Qi) and break accumulation (po ji).
DY: Dries dampness; arouses the spleen, disperses food stagnation.
• With Bing lang to move the Qi, disperse food stagnation, and stop pain. For such indications as:
– 1. Lack of appetite, abdominal and epigastric distention and pain aggravated by pressure, difficult defecation or dry stools due to food stagnation in the stomach and intestines. (Bing lang should be stir-fried until scorched.)
– 2. Dysentery or diarrhea with tenesmus and abdominal pain due to Qi stagnation. (Use scorched Bing lang and roasted Mu xiang.)
– 3. Constipation or difficult defecation due to Qi stagnation. (Use scorched Bing lang.)
• With Huang lian to rectify the Qi, drain heat, dry dampness, and treat dysentery. This combination is used in Xiang Lian Wan for indications such as diarrhea, bloody and purulent dysentery, abdominal pain, and tenesmus due to damp-heat and Qi stagnation in the large intestine. Roasted Mu xiang should be used.

Dose: 1.5-9g

Nature: bitter, acrid, warm

Enters: Liver, Gallbladder, Stomach

Actions: Frees the flow of liver Qi (particularly in the lower Jiao); strongly regulates Qi, breaks up stagnant Qi, dissipates clumps; disperses accumulation of pathogens; eliminates food retention; dries dampness, transforms phlegm.

Indications:
• Liver Qi stagnation: pain – costal, hypochondriac, breast, lower abdomen, genital, hernial, flank.
• Food retention: distention, pain, or a stifling sensation in the epigastrium. Can be used for severe cases.
• Stagnant Qi/blood: masses, lumps, liver Qi stagnation surrounding food retention.
• Phlegm-dampness with malarial disorders. Especially useful for breast abscesses with this etiology.
• Raises blood pressure.
• Much stronger than Chen pi.
• Compared to Chen pi, Qing pi has scattering and unblocking properties that are relatively harsh; it is accordingly prescribed for breaking up Qi stagnation. Its actions are more horizontal and it is therefore used primarily for pain. Chen pi, on the other hand, has a more harmonious nature and tends to enter the Qi level of the spleen and Lungs. Its actions are primarily vertical and it is therefore used for both coughing and vomiting.
• Guohui Liu: Compared to Chai hu, which mainly addresses liver Qi stagnation in the upper Jiao and costal region, Qing pi mainly addresses liver Qi stagnation in the lower Jiao (though neither herb’s action is entirely limited to that area).
DY: Sinking, drastic; drains the liver and gallbladder Qi; disperses lump glomus; moves the Qi on the left side of the body.
• Its drastic action of breaking Qi contraindicates its long term use.
• 3g rectifies the Qi, 6g moves the Qi, 9g breaks the Qi.
• Zhang Zi-he of the (12^th century) Southern Song dynasty, said: “Qing pi is downbearing and sinking, goes to the liver and gallbladder, influences the lower (body) and drains.”
• In combination with Chen pi to soothe the liver, regulate the stomach, harmonize the liver and spleen, harmonize the liver and stomach, rectify the Qi, and stop pain. See Chen pi in this category for specific indications and notes.
• When Qing pi is small, the whole fruit is used. It is then called Xiao qing pi or Xin qing pi.

Dose: 3-9g

Nature: bitter, astringent, neutral

Enters: Lung, Stomach

Actions: Descends rebellious Qi, eases hiccups and belching.

Indications:
• Stomach Qi rebellion: hiccups, belching. For either hot or cold patterns, depending on the herbs with which it is combined.
DY: With Ding xiang to effectively warm the middle burner and scatter cold, downbear Qi counterflow, and stop hiccups. For indications such as:
– 1. Hiccups due to cold in the stomach.
– 2. Nausea and vomiting due to deficiency cold in the spleen and stomach.
– For these indications, this pair is present in Shi Di Tang. For hiccups, add Chen xiang.

Dose: 6-12g

Nature: acrid, warm

Enters: Lung, Spleen, Stomach

Actions: Regulates Qi, adjusts the middle Jiao; disperses cold, relieves pain.

Indications:
• Cold obstruction, Qi stagnation: chest and abdominal pain.
• Stomach cold: thin, clear, watery vomit.
• Promotes activation of local immune system. Some people hang a small bag of it over the chest to prevent EPI’s.
• Recently used for coronary artery disease.
• Precious and expensive. When used in decoctions, it should be added near the end of cooking, to preserve its aromatic compounds. Often used as a powder. Choose cultivated sandalwood, as the wildcrafted product is endangered.
DY: With Dan shen to regulate and rectify the Qi and blood, move the Qi and blood, free the flow of the network vessels, and stop pain. For the following indications, wine mix-fried Dan shen should be used:
– 1. Chest Bi or impediment, heart diseases with severe cardiac pain due to Qi and blood stasis. If heart blood stasis is severe, add San qi, Hong hua, and Yan hu suo. If Qi stagnation is severe, add Chen xiang and Qing mu xiang. If there is phlegm-damp obstruction in the chest, Gua lou pi, Jie geng, and Zhi ke. If there is chest Yang deficiency, add Xie bai, Gui zhi, and Fu zi. If there is Qi deficiency, add Huang qi, Zhi gan cao, and Ren shen.
– 2. Stomach pain due to Qi and blood stasis.
Yoga: Chandana: P, V-; K or Ama+ (in excess)
• Bitter, sweet, astringent/cooling/sweet.
• Alterative, hemostatic, antiseptic, antibacterial, carminative, sedative, refrigerant.
• Eye diseases, cystitis, urethritis, vaginitis, acute dermatitis, herpes zoster, bronchitis, palpitations, gonorrhea, sunstroke.
• Calms and cools the body and mind; stops sweats; reduces fever.
• Applying the oil on the third eye relieves heat and thirst and is good for fever or overexposure to the sun.
• Helps the awakening of intelligence, special function to help open the third eye, increase devotion, and promote meditation.
• Aids in the transmutation of sexual energy.
• Good for most inflammation; good anti-Pitta herb.
• External: as a paste or oil for infectious sores, ulcers.
Hsu: Diuretic; increases WBC count.

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

The Essential Oil:
K&R: Urinary antiseptic.
• Water: UTI (in deficient patient), impotence, frigidity.
• Metal: Chronic bronchitis, tuberculosis, chronic or severe diarrhea.
KAD: An active substance of agreeable odor employed in the treatment of subacute and chronic affections of mucous tissues, particularly gonorrhoea after the active symptoms have been mitigated. Chronic bronchitis, with fetid expectoration, chronic mucous diarrhoea, chronic inflammation of the bladder and pyelitis are also said to be benefitted by it. It occasionally disturbs the gastrointestinal tract, and, like copaiba, which it was introduced to supersede, it will occasion cutaneous eruptions. The dose ranges from 5 to 20 drops, in capsules or emulsion. (Note, this essential oil is often adulterated, due to its expense. Only genuine, steam-distilled oil should ever be taken internally.)
EODR: Anti-tumor, antiviral, immune stimulant
• Cancer, viral infections (herpes simplex – cold sores, herpes zoster, HPV, etc.), acne, wrinkles, scars.
• Enhances deep sleep, may remove negative programming from the cells. High in sesquiterpenes that stimulate the pineal gland and the limbic system of the brain, the center of emotions. Can be grounding and stabilizing.
• Apply 2-4 drops directly on location.

Nature: acrid, warm

Enters: Lung, Spleen, Kidney, Bladder

Actions: Regulates Qi, relieves pain; warms the kidneys; disperses cold; spreads and unblocks the Qi mechanisms, smooths the flow of Qi, facilitates the middle.

Indications:
• Cold obstruction with Qi stagnation: distention in the chest; costal, hypochondriac, epigastric, abdominal and hernial pain; dysmenorrhea; borborygmus.
• Kidney/bladder yang deficiency cold: frequent urination or incontinence.
• While generally more restricted to cold problems, Wu yao treats a wider area than most herbs – for pain anywhere in the trunk from the genitals to the chest.
• Particularly useful for paraumbilical stagnation and stagnation in the lower abdomen.
MLT: Contains borneol – very penetrating and analgesic.
Hsu: Increases intestinal peristalsis, expels gas.
DY: Its area of pronounced action is the abdomen in general and the lower abdomen in particular. It can guide herbs to this area.
• Warms and scatters cold in the liver and kidney channels.

Dose: 3-9g

Nature: acrid, slighty bitter, slightly sweet, neutral (some say warm)

Enters: Liver, San Jiao

Actions: Frees the flow of liver Qi; regulates menstruation; relieves pain.

Indications:
• Liver Qi stagnation (including with liver/spleen disharmony): pain – costal, hypochondriac, breast, epigastric, abdominal.
• Liver Qi stagnation: irregular menstruation, dysmenorrhea.
• Any “women’s” Qi stagnation problem.
• Particularly useful for stagnation in the upper abdomen.
• Xiang fu’s volatile oils contain an estrogen-like substance.
• Bensky/Gamble: When treating menstrual dysfunction, Xiang fu is preferred when there is scanty bleeding, while Mei gui hua is more ideal for excessive bleeding.
• Frying it in vinegar enhances the herb’s ability to enter the liver channel and alleviate pain.
• Frying it in wine enables it to penetrate all the channels.
Yoga: Musta: pungent, bitter, astringent/cooling/pungent; P, K-; V+ (in excess)
• Stimulant, carminative, astringent, alterative, emmenagogue, antispasmodic, anthelmintic.
• Dispels premenstrual congestion of blood and water, menstrual regulator; especially good for emotional problems of PMS.
• Good digestive stimulant for Pitta-types; liver stimulant.
• Improves absorption in the small intestine; stops diarrhea; useful for gastritis.
• Kills parasites; may help candidiasis.
• Chronic fever.
MLT: Amazonian tribes use it as birth control, maybe because an ergot-like fungus with oxytocic properties grows on the root hairs (especially in the jungle).
Hsu: Analgesic; inhibits contraction of uterus.
DY: With Gao liang jiang to warm the stomach and drain cold, move the Qi, and stop pain. For indications such as pain in the epigastrium alleviated by warmth and pressure, chest and lateral costal distention, and nausea due to cold in the stomach and Qi stagnation. For these indications, the combination is used in Liang Fu Wan. Vinegar mix-fried Xiang fu should be used. In cases of severe cold, a larger dose of Gao liang jiang should be used. In cases of severe Qi stagnation (as evidenced by epigastric distention and pain aggravated by pressure), a greater quantity of Xiang fu should be prescribed.
SD: Cyperus is known in Chinese as xiangfu or xiangfuzi. The term xiang means fragrant, and usually is applied to strong and pleasant fragrances, such as those occurring in culinary spices, perfumes, and incenses. The character fu is the same as that used to describe aconite (fuzi); the term was likely used because the appearance of the cyperus rhizomes, the part used, reminded herbalists of the aconite roots. In much of the rest of the world, cyperus is referred to as nutgrass or purple nutsedge (sedge is a term indicating blade-like leaves and rush-like stems and is often applied to the plants of the entire Cyperaceae family); the nut is the rhizome (or tuber), which forms rounded or elongated balls along a tangle of thin roots.
The plant is considered an invasive weed; it has been called “the world’s worst weed.” The plant requires sun and moist conditions, though it grows in sandy soil (one of the old Chinese names for it was shacao, meaning sand weed), as well as in loamy moist fields and in tropical rainforests. It has a vast growing range, crossing the globe and particularly noted in the Pacific Islands (where its leaves are used for weaving) as well as along coastal regions. It is especially prevalent in southern India, where its essential oil is used in perfumery. As an invasive weed, it is considered troublesome in 92 countries and adversely affects more than 50 crops, including sugar cane, corn, cotton, rice, and many vegetables. Cyperus grows rapidly and fills the soil with its tangle of roots and rhizomes; this one species (C. rotundus) can produce up to 40,000 kg/hectare of underground plant material. In addition to taking up nutrients and physical space, the plant produces sesquiterpenes, accumulating in the rhizomes, which inhibit the growth of other plants.
For medicinal use in China, the underground portion is collected in autumn, cooked for a short time in boiling water or steamed, with the fibrous roots burnt off; the rhizomes are sliced in half down the center, and dried in the sun.
Cyperus, like other plants, has numerous chemical constituents, many of which may show pharmacological activity, but the main active components appear to be the sesquiterpenes. These are aromatic, spicy tasting molecules. Among the main sesquiterpenes identified in cyperus rhizomes thus far are:
alpha-cyperone, beta-selinene, cyperene, cyperotundone, patchoulenone, sugeonol, kobusone, and isokobusone.
Cyperus also contains other terpenes, such as the commonly occurring plant component pinene (a monoterpene), and several derivatives of the sesquiterpenes, such as cyperol, isocyperol, and cyperone.
These active constituents are found in the volatile oil of cyperus rhizomes, which makes up only about 0.5-1% of the dried rhizome; prolonged cooking of the herb will cause loss of some portion of these constituents. Their main pharmacological actions may be antispasmodic and analgesic effects.
APPLICATIONS
Cyperus is considered by many traditional practitioners to be the best Chinese herb for alleviating depression of qi circulation. According to Jiao Shude (1):
Acrid and slightly bitter in flavor and neutral in nature, cyperus is the most commonly used qi-rectifying and depression opening medicinal. It is diffusing in nature and is able to free the qi aspect of the 12 channels and 8 vessels. In older literature, it was said to govern all qi, resolve the six depressions (qi, blood, phlegm, food, damp, and fire), and regulate menstruation. Cyperus is aromatic, acrid, and dissipating. It regulates qi, soothes the liver, and resolves depression. It treats liver qi depression due to inhibited emotions, which manifests in abdominal fullness and distention, rib-side distention and pain, no pleasure in eating, and oppression in the chest with a liking for long exhalation [sighing]…Cyperus moves qi and frees stagnation; when there is free flow, there is no pain. Cyperus is most commonly used for qi stagnation and stomach pain (caused by anger, or stomach pain exacerbated by bad moods…)…. Because cyperus is a qi-moving medicinal that can also enter the blood aspect, it is traditionally called a qi-in-blood medicinal. It rectifies qi and regulates menstruation, and it is effective for signs such as menstrual irregularities, overdue periods, and abdominal pain during menstruation that are due to liver qi depression in emotionally-inhibited women.
The six depressions (liuyu) mentioned for the older literature were discussed by Zhu Danxi (13th Century). These were outlined by Liu Yiren in the 19th Century book Heart Transmission of Medicine (2); the term depression, as used here, refers to stagnation of circulation, rather than the mental condition we think of today, though there may be a mental correlation to the physical disorder:
Danxi said: ‘So long as the qi and blood enjoy harmonious flow, none of the hundreds of diseases can arise. Once they are depressed and suppressed, various diseases are produced.’ In general, depression is part of any disease. If depression endures, it will generate disease, or, if a disease has endured, depression will be generated. Therefore, to treat any disease, one has to take depression into account in the treatment scheme.
There are six categories of depression: qi, blood, dampness, heat, food, and phlegm. Qi depression manifests as chest and rib-side pain and a deep, choppy pulse. Blood depression manifests as lack of strength in the four limbs and ability to take in food, reddish stools, and a deep pulse. Dampness depression manifests as migratory pain around the body or pain in the joints that starts in wet and cold weather, and a deep, thin and moderate pulse. Heat depression manifests as visual distortion, oppression (chest discomfort), reddish urine, and a deep, rapid pulse. Food depression manifests as acid belching, persistent satiety and fullness, and no liking of food….Phlegm depression manifests as panting and fullness arising on movement and a deep, slippery pulse in the inch opening.
Another view of cyperus is presented by Yang Yifan (3):
Cyperus is a very commonly-used herb to regulate the liver qi. It is pungent, sweet, slightly bitter, and warm, and enters the liver and triple burner meridians. Cyperus is an effective and gentle herb for regulating the qi. It is warm and pungent but without a harsh and drying nature. It promotes liver qi movement, but without the possibility of injuring the yin and blood of the liver. It is slightly bitter, so it can reduce the slight liver heat that is generated by liver qi stagnation. The sweetness can soften the liver and moderate the speed of the qi movement. All these characteristics match the pathological changes in the syndrome of the liver qi stagnation. Because it also enters the triple burner meridian, which is the passage of the qi and water, it can effectively spread the qi throughout the entire body. In clinical practice, cyperus is used for treating syndromes and symptoms associated with liver qi stagnation, such as distention in the hypochondria region, feelings of tightness in the chest, irritability, depression, irregular menstruation, dysmenorrhea, distention and pain in the breasts, and infertility. Since cyperus is so effective for regulating the qi, it is regarded in TCM as the chief of all herbs that regulate the qi and the first-line choice for treating gynecological disorders.
USE IN FORMULAS
Cyperus is included in dozens of traditional herb formulas. To help illustrate its contribution, we look to the formulas comprised of just a few ingredients (4). Yueju Wan (Pills to Relieve Stagnancy of All Kinds) was presented by Zhu Danxi as a treatment for the six depressions. It is comprised of just 5 herbs: cyperus, red atractylodes (cangzhu), cnidium (chuanxiong), shen-chu (shenqu), and gardenia (zhizi), in equal proportions, powdered and taken 6-9 grams each time. The formula treats qi stagnation as the primary syndrome (relying on cyperus) with herbs for secondary manifestations: damp accumulation (red atractylodes); blood stagnation (cnidium); food accumulation (shen-chu); and heat stagnation (gardenia); the sixth entity, phlegm, is resolved by clearing damp, food, and heat. Typically, the syndrome involves abdominal fullness and pain, often accompanied by digestive reactions, such as acid regurgitation, indigestion, vomiting, or diarrhea. Yueju Wan may be utilized in cases of liver-gallbladder diseases. An expanded version of this formula is Liuyu Tang, which adds chih-ko (zhike) citrus (chenpi), perilla stem (sugeng), forsythia (lianqiao), scute (huangqin), and licorice (gancao).
Another example is the two herb formula Liang Fu Wan, pills of galanga (liangjiang) and cyperus (xiangfu). The two herbs are used in equal proportion, ground to powder and taken 6 grams each time. Galanga helps treat pain; this simple formula has uses similar to Yueju Wan, but is applied when pain is the primary manifestation of stagnation. A decoction, Xiang Ju Tang, made from equal parts cyperus (xiangfu), aurantium (juhong), and pinellia (banxia), plus a smaller amount of licorice, is also used for abdominal stagnancy, with a focus on symptoms of dull sensation and distention associated with damp accumulation. And a final example would be Zhengqi Tianxiang San (Heavenly Fragrance Powder for Normalizing Qi), made with cyperus as the primary ingredient and smaller amounts of lindera (wuyao), citrus, perilla leaf (zisuye), and dry ginger (ganjiang). This is powdered and taken 3 grams each time; it is particularly recommended for qi stagnation with sense of uprushing qi affecting the chest and for qi stagnation associated with persistent emotional distress. In all these cases, cyperus is combined with herbs having an acrid taste derived from essential oils, enhancing the aromatic qi-regulating aspect of cyperus. Sesquiterpenes are found in citrus materials (e.g., chenpi, juhong, and zhike) and in ginger family plants (e.g., ganjiang and liangjiang). One of the cyperus ingredients, ?-selinene, is also found in red atractylodes (cangzhu).
CYPERUS IN AYURVEDIC MEDICINE
Cyperus rotundus is thought to have originated in India and then spread from there during the past 2,000 years (it first appeared in a Chinese medicine book around 500 A.D.). The rhizome is used in Ayurvedic medicine, usually called musta, mustak, or mustaka, and is mentioned in the ancient Caraka Samhita (ca. 100 A.D.). Its uses in modern Ayurvedic medicine are primarily for treating fevers and digestive system disorders (diarrhea, vomiting, indigestion, etc.). It is also known as an emenagogue (treats delayed menstruation) and an analgesic useful for dysmenorrhea (painful menstruation). Cyperus is considered a diuretic, but it must be combined with other diuretics to yield a desired result in treating urinary disorders. It is classified as being bitter and astringent, light and dry, cold, pungent (aromatic), and pacifying kapha and pitta (5, 6). Cyperus is an ingredient in popular Ayurvedic formulas such as the herbal honey Chyawanprash, and the women’s blood tonic and uterine regulating formula Ashokarishta. It may also be used as a single herb remedy.

Dose: 4.5-12g

Nature: acrid, slighty bitter, sour, warm

Enters: Liver, Spleen, Lung

Actions: Frees the flow of liver Qi; regulates Qi; adjusts the middle Jiao; resolves phlegm; mildly dries dampness; harmonizes the stomach, strengthens the spleen.

Indications:
• Liver Qi stagnation: costal, hypochondriac, or flank pain, distention in the chest, belching.
• Spleen/stomach Qi stagnation: distention and fullness in the epigastrium and abdomen, epigastric pain, poor appetite, belching, nausea, vomiting.
• Lung phlegm: cough with copious sputum. Especially useful for unrelenting coughs with chest pain.

• Compared to Fo Shou, this herb is milder at moving Qi, but stronger at resolving phlegm.

Dose: 3-9g

Nature: acrid, bitter, warm

Enters: Lung, Stomach, Large Intestine

Actions: Activates Yang/unblocks the Yang Qi; disperses accumulation of cold, phlegm, and dampness; regulates Qi, disperses Qi stagnation, promotes the movement of Qi and blood, and alleviates pain; directs Qi downward.

Indications:
• Obstruction of cold, phlegm, damp in the chest preventing the dissemination and flow of Yang Qi: chest pain, difficulty breathing, stifling sensation in the chest, flank or upper back pain, coughing, wheezing. Also for blood obstructing the heart channel, and such Western presentations as angina and coronary heart disease.
• Stomach Qi stagnation or damp stagnation in the large intestine: dysentery with tenesmus.
• Cold stagnant Qi: epigastric fullness, distention, abdominal pain.
• Do not use long term in cases of peptic ulcers.
DY: Modern research shows this herb lowers serum cholesterol.
• With Gua lou to effectively free the flow of Yang and move the Qi, loosen the chest and clear the Lungs, transform phlegm and scatter nodulation, stop pain, moisten the intestines, and free the flow of the stools. For indications such as:
– 1. Constipation due to fluid dryness of the large intestine and/or Qi stagnation.
– 2. Yin binding constipation. (Constipation due to spleen-kidney Yang deficiency or sometimes due to dryness in the large intestine caused by an essence-blood deficiency with pale lips, white tongue fur, and clear, copious urination.)
– 3. Chest Bi with oppression of the chest and epigastrium, cough, profuse phlegm, piercing pain in the chest radiating toward the back, and shortness of breath due to accumulation of turbid phlegm blocking the Qi and Yang of the chest. (Gua Lou Xie Bai Ban Xia Tang – which can be favorably combined with Er Chen Tang) Use Gua lou which has been stir-fried until scorched.
– 4. Chest Bi and cardiac disease with intense heart pain due to heart Qi and blood stasis and deficiency of heart Yang. (Gua Lou Xie Bai Bai Jiu Tang) For these indications, the combination can be favorably reinforced by adding Dan shen, San qi, Tan xiang, and Gui zhi. The Gua lou should be stir-fried until scorched.

Dose: 4.5-9g (30-60g when used fresh)

Nature: bitter, cool

Enters: Spleen, Stomach (according to Wei Li, also enters San Jiao)

Actions: Moves/regulates Qi; directs Qi downward; eliminates food retention (particularly in the large intestine), breaks up stagnation and accumulation; resolves phlegm; relieves distention; unblocks the bowels. In all respects, milder than Zhi shi.

Indications:
• Milder, perhaps more often used than Zhi shi, especially for weak or deficient patients – less energy than the unripe fruit and less potential to damage the Qi.
• Frequently used to move Qi and reduce distention and pressure.
• Stifling sensation in the chest with belching.
• Particularly useful for stagnation in the flanks.
• Zhi shi is more appropriate than Zhi ke when there is constipation.
Li: Zhi ke is more liver-oriented than Zhi shi, which is more spleen-oriented.
[Bensky/Gamble corroborates this idea, stating that Zhi shi is used for stagnant Qi of the spleen and stomach while Zhi ke is used for constrained liver Qi with symptoms of stagnant Qi.]
Hsu: Stomachic; contracts the uterus; increases blood pressure.
DY: This is one of six medicinals which have been traditionally aged for the purpose of reducing secondary effects and reinforcing their therapeutic actions. Generally, the longer it is kept, the more efficient.
• With Jie geng to effectively regulate upbearing and downbearing, regulate the upper and middle burners, diffuse the Lung Qi, and loosen the chest and diaphragm. For indications such as:
– 1. Chest and diaphragm oppression or distention or chest Bi due to accumulation of phlegm and Qi stagnation. (Jie Geng Zhi Ke Tang)
– 2. Epigastric distention, stomach rumbling, and difficult defecation due to disturbance of ascending and descending. Note: Zhi ke and Jie geng do not moisten the intestines, do not soften the stools, and do not precipitate the bowels. However, Zhi ke moves and descends the Qi in the large intestine in order to improve evacuation of the stools, while Jie geng disperses and descends Lung Qi. When the Lung Qi correctly descends, the large intestine Qi does the same. Therefore, although Zhi ke and Jie geng do not have a direct action on peristalsis, they can treat constipation due to Lung-large intestine Qi stagnation. Hence, this pair may be used to advantageously reinforce any formula that specifically treats constipation.

K&R: (maturity not stated) Sedative (CNS), antispasmodic, expectorant, eupeptic, sympatholytic.
• Bitter-cooling; fire excess, wood excess.
• Fire: tachycardia, anguish, nervousness, anxiety, insomnia, epilepsy.
• Wood: aerophagia, dyspepsia, digestive spasms, tachycardia of emotional origin, anxiety, insomnia.
• Good for cooling liver fire stemming from heart fire.

Dose: 3-9g

Nature: bitter, acrid, slightly cold

Enters: Spleen, Stomach, Large Intestine

Actions: Strongly moves/regulates Qi; directs Qi downward; eliminates food retention (particularly in the large intestine), breaks up stagnation and accumulation; resolves phlegm; relieves distention; unblocks the bowels

• Accumulation and stagnation: epigastric or abdominal pain and distention or indigestion with focal distention or gas.
• Accumulation and stagnation, including due to food retention in the large intestine: distention in the abdomen, constipation or diarrhea with tenesmus.
• Phlegm obstruction with Qi stagnation: distention and fullness in the chest and epigastrium.
• Particularly useful for stagnation in the chest and upper back.
• Lifts prolapse of the stomach, uterus, or rectum. Used with Qi tonics for gastriectasis, gastroptosis, rectal prolapse, uterine prolaspe, etc.
• Raises blood pressure.
• Contains cirantin (inhibits activity of periovicular hyaluronidase) which may account for its reported contraceptive effect.
• Recent use in Western OTC weight loss products.
• The herb may have some use in treating cardiogenic shock.
Liu: For urinary stones, Zhi shi helps the urethra relax.
Hsu: Stimulates GI motor activities, increases digestion; contracts the uterus; purgative; raises blood pressure.
DY: With Bai zhu 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.

K&R: (maturity not stated) Sedative (CNS), antispasmodic, expectorant, eupeptic, sympatholytic.
• Bitter-cooling; fire excess, wood excess.
• Fire: tachycardia, anguish, nervousness, anxiety, insomnia, epilepsy.
• Wood: aerophagia, dyspepsia, digestive spasms, tachycardia of emotional origin, anxiety, insomnia.
• Good for cooling liver fire stemming from heart fire.

Dose: 3-9g

Examine.com on synephrine:

A recommended dosage is 10-20mg, taken thrice a day.

Acute dosages of 50mg are also frequently used, although not thrice a day.

1. Sources and pharmacology

Synephrine is found from the Bitter orange plant, latin name Citrus aurantium. The plant contains a few active ingredients, namely para-synephrine(p-synephrine) and octopamine.^[1][2] Although meta-synephrine and ortho-synephrine could exist in fruits, they have not been observed in C.aurantium.^[3]

Typically, ‘synephrine’ in supplements refers to P-synephrine despite m-synephrine (also known as phenylephrine) having many of the same properties.^[4]

2. Effects on fat metabolism

2.1. Mechanisms

P-synephrine is a beta-agonist compound similar to Ephedrine^[5][6]. It can increase the metabolic rate via increasing lipolysis and basal metabolic rate.^[1] These effects are independent of diet for the most part, and can exert a passive increase in basal metabolic rate to produce weight loss over an extended period of time.

Synephrine also has alpha-adrenergic antagonist capabilities. Affecting both the A1 and A2 receptors, albeit with a different potency.^[7] In both the cases of alpha and beta agonism, the effects of both forms of synephrine are much less than that of noradrenaline.

2.2. Human studies

It has been implicated in increasing the thermic effect of food, but one study noted this effect only in women.^[8]

3. Potential Synergism

P-synephrine (50mg) was shown to be highly synergistic with both the Bioflavonoids naringin and hesperidin, but not both, in regards to increases in basal metabolic rate.^[9]

Like Ephedrine, P-synephrine also shows synergism with Caffeine and is more pronounced in naive caffeine users.^[10]

 4. Safety profile

P-synephrine does not seem to be a causative agent in increasing blood pressure^[11][12][8]

The Bitter Orange itself (the parent plant) has been linked to increased systolic and diastolic blood pressure.^[13] Additionally, a common patented blend of P-synephrine known as Advantra-Z (which contains active bioflavonoids such as naringen and Hesperidin) has been linked to an increase in blood pressure.^[11]

Overall, usage of P-synephrine appears to be quite safe and free of most adverse side effects.^[14]