Notes on This Category

Commonly combined with:
• A. Acrid, warm herbs that relieve exterior syndromes when there is exogenous cold attack.
• B. Herbs that promote Qi circulation when there is Qi stagnation associated.
• C. Herbs that tonify spleen and/or kidney Yang when there is Yang deficiency of either organ.
• D. Herbs that tonify source Qi when there is Yang collapse.

• These herbs are to be used with caution for patients with heat, Yin deficiency, or in pregnant women.

Bi Ba – Bi Bo – Long Pepper fruit – Pippali

Nature: acrid, hot

Enters: Spleen, Lung, Stomach, Kidney, Large Intestine

Actions: Warms the middle; disperses cold from the stomach and intestines (middle and lower Jiaos); alleviates pain.

Indications:
• Stomach cold: nausea, vomiting, belching, acid regurgitation, rumbling, abdominal pain.
• Topical: as a powder for pain, especially toothache.
• Antibiotic effect.
• Usually taken directly in powder or pill form.
• Contains piperine – used as a carrier to increase absorption of other substances through digestive tract (e.g., curcumin) and slow metabolism of certain drugs.
MLT: Reverses the flow of rebellious Qi.
• The Ayurvedic mixture Trikatu (the main stimulant compound of Ayurveda) consists of equal parts Bi bo, Hu jiao and Gan jiang. Powder the herbs and mix with honey. Take for cold digestion, allergies with clear/whitish discharges, abdominal and other pains caused by cold.
Yoga: Pippali: V, K-; P+
• Stimulant (digestive and respiratory systems), expectorant, carminative, aphrodisiac, anthelmintic, analgesic.
• Colds, coughs, asthma, bronchitis, laryngitis, arthritis, rheumatism, gout, dyspepsia, abdominal distention, flatulence, abdominal tumors, lumbar pain, sciatica, epilepsy, paralysis, worms.
• Strongly heating, dispels cold, congestion, and Ama, revives weakened organ functions.
• Unlike black pepper, it is a rejuvenative, mainly for the lungs and for Kapha.
• Use as a milk decoction for degenerative lung diseases like asthma.
• Strengthens reproductive functions.
• Take 3 pods with a little honey each morning to control excess secretions, mucus, and Kapha.
Trikatu (mentioned in MLT above) rejuvenates Agni, burns away Ama, allows for the assimilation of other medicines and foods.
Hsu: Analgesic, stomachic, antibacterial.

Dose: 1.5-4.5g (usually taken directly as a powder or pill)

Chuan Jiao – Hua Jiao – Szechuan Pepper fruit – Chinese Prickly Ash – Zanthoxylum bungeanum

Nature: acrid, hot, slightly toxic

Enters: Spleen, Stomach, Kidney

Actions: Warms the middle Jiao, disperses cold, relieves pain; kills parasites.

Indications:
• Yang deficiency with cold in the spleen and stomach: epigastric and abdominal pain, vomiting, diarrhea.
• Roundworms: abdominal pain, vomiting.
• Pinworms: can be used as an enema.
• Schistosomiasis: Chuan jiao can be useful, increases appetite, reduces organomegaly. (Given in capsules in study.)
• Topical: as a poultice or compress for pain.
• Can reduce or stop lactation within 1 or 2 days postpartum.
• Overdose can cause paralysis of the diaphragm.
• Good quality Chuan jiao should cause numbness of the lips when eaten.
• Not to be combined with Li lu. Not to be used for Yang rising headaches.
• Farong Zhang: The seed inside ““ Jiao mu ““ is safe; its toxicity is in the fleshy covering.
Yoga: Tamburu: V, K-; P+
• Powerfully destroys toxins (Ama), kills worms and candida.
• Good for Sama Vata and arthritis; anti-rheumatic, increases peripheral circulation.
JC: (Z. americanum, Z. clava-herculis, Z. faxineum bark and berries. Berries are considered more effective, as they contain a volatile oil.)
• General stimulant (including cardiac), tonic, alterative, pungent, deobstruent, diuretic, antiseptic, diaphoretic, sialogogue, nervine. Plus, the volatile oil (found in the fruit) is stimulant, antispasmodic, carminative, acts principally upon mucus membranes.
• Dispels obstruction from all parts of the body.
• Asthma, cholera, cold extremities, colds, colic, diarrhea, dropsy, dyspepsia (atonic), female problems (chronic), flatulence, hepatic problems, lumbago, paralysis (including of tongue), pharyngitis, syphilis, rheumatism (chronic), scrofula, skin disease, poor circulation, mouth sores, toothache, ulcers, wounds. Can be chewed for mouth sores and toothache.
• Rheumatism liniment: mix 1 ounce [28.4g] of the herb in 4 ounces olive oil. Use with massage.
NAH: (Z. americanum, Z. clava-herculis)
• Stimulating to the circulation (the berries are reputedly more powerful than the bark, which is also used in Western herbalism) – causes blood to flow to the periphery, promotes sweating (helps reduce fevers).
• One common name is “toothache tree” since it can be chewed as a counter-irritant for toothache pain.
• Warms the stomach, stimulates the salivary glands and mucous membranes, reduces colic and flatulence, strengthens debilitated digestion, especially if the pulse is weak and the tongue is pale and flabby.
• Considerable reputation for allaying rheumatic pain.
• Reputed to have anti-cancer activity – the isolated benzophenanthridene alkaloids are reported to be destructive to cells, however, there are no accounts of adverse side-effects from medicinal doses.
Dose: 1.5-6g

 
Jiao Mu: the seed
• Bitter, acrid, cold; enters the bladder and spleen channels.
• Moves water; calms wheezing.
• Edema with fullness and distention or wheezing and cough due to congested fluids.

Dose: 1.5-6g

Ding Xiang – Clove flower bud – “Spike Fragrance”

Nature: acrid, warm

Enters: Spleen, Stomach, Kidney

Actions: Warms the middle Jiao; descends stomach Qi; warms the kidneys, tonifies kidney Yang.

Indications:
• Stomach cold: hiccups, vomiting, poor appetite, abdominal pain, diarrhea.
• Kidney Yang deficiency: impotence (Fu zi is superior), clear vaginal discharge (usually accompanied by weakness in the legs).
• Spleen or stomach cold from deficiency: lack or appetite, vomiting, diarrhea.
• Topical: fungal infections. (Treatment should not be interrupted.)
• Use as a powder locally or a rinse for toothache. Long history as a dental anaesthetic.
• Male cloves are preferred, as they provide a faster onset of action.
• Increases secretions of sputum from the gastric mucosa without increeasing acidity.
• Contraindicated in combination with Yu jin.
Hsu: Broad antibacterial, antiviral, antifungal; tranquilizing; adrenaline-antagonizing action – inhibits excitory transmission of the AV nodes of the heart; vasodilator; stimulates the uterus.
HF: A Sha Chong (kill worms or parasites) herb, important in Gu Zheng (Gu parasites) formulas.
BF: The Ben Cao Zai Xin says this herb opens the nine orifices, soothes depressed Qi, eliminates wind, and moves water.
DY: Scatters cold, stops pain.
• Male flowers, Gong ding xiang (“Spike Fragrance Father”), is reputed to be more powerful than the female flowers, Mu ding xiang (“Spike Fragrance Mother”).
• With Shi di 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.
Ding xiang you, the aromatic oil extracted from cloves, warms the stomach and scatters cold. Applied externally, it treats epigastric pain, rheumatic pain, and toothache due to cold.
Yoga: Lavanga: K, V-; P+
Rajasic.
• Analgesic, stimulant, expectorant, carminative, mild aphrodisiac.
• Topical: administer the oil in the ear for tinnitus.
JC: Stimulant; the most powerful aromatic/carminative; stomachic; expectorant; anti-emetic; antispasmodic; astringent; rubifacient; antiseptic; digestive; increases circulation, stimulates excretory organs, stimulates and disinfects the kidneys, skin, liver, and bronchial mucous membranes.
• Toothache (use the oil), vomiting (especially in pregnancy), cholera, ague, infant convulsions (use a poultice on the nape of the neck), colic/flatulence (use a poultice on the abdomen), neuralgia, diarrhea, griping, hypotension, palsy, rheumatism, zygotic disease, nausea, epilepsy.

Dose: 1.5-4.5g (0.5-1g directly as powder)

 

Clove Essential Oil (topical)
K&R:
• Key for fatigue, memory loss, depression, colitis, weak libido.
• Oxytocic, aphrodisiac, parasympathomimetic, sympatholytic.
Water: severe fatigue, anergy, depression, melancholia, memory loss, impotence, frigidity, diarrhea from chronic intestinal disease, Crohn’s disease, hemorrhagic rectocolitis, headache, UTI, edema, renal insufficiency, dental cavities, deafness.
Metal: pulmonary infection, tuberculosis, anorexia, parasites, chronic diarrhea, aerocolitis.
• Strong topical antiseptic/antifungal.
EODR:
• Phenomenally powerful antioxidant.
• Anti-aging, anti-tumor, antimicrobial, antifungal, antiviral, analgesic/anesthetic, antioxidant, anticoagulant, anti-inflammatory, stomach protectant (ulcers), lice, toothache, acne.
• Scent: mental stimulant; encourages sleep, stimulates dreams, creates a sense of protection and courage.
• Dilute 1 part EO with 4 parts fixed (seed /vegetable) oil; apply 2-4 drops on location, gums, or mouth.
• For tickling cough, put a drop on the back of the tongue.
• Caution: anti-coagulant properties can be enhanced when combined with Warfarin, aspirin, etc.

Fu Zi – Zhi Fu Zi – Prepared lateral (daughter) root of Aconite – “Appendage” or “Attached Son”

Nature: acrid, hot, toxic

Enters: Heart, Kidney, Spleen, and, according to some sources, all other meridians, too

Actions: Restores collapsed Yang; tonifies heart fire, unblocks the vessels, and improves circulation; tonifies kidney Yang; disperses cold, warms the channels, relieves pain; reaches the 12 channels.

Indications:
• Yang collapse: cold sweats, cold extremities, feeble pulse, diarrhea with undigested food (often after severe vomiting, diarrhea, or sweats). In these cases, Fu zi assists the heart Yang to unblock the vessels and improve circulation, and tonifies kidney Yang to augment fire and avoid loss of the source Yang.
• Heart, spleen, or kidney Yang deficiency: any associated patterns.
• Wind-cold-dampness: Bi syndrome, especially when cold is predominant. Also for cold blocking the organs, channels, sinews, bones, or blood vessels.
• Congestive heart failure.
• Lowers heart rate and slightly lowers blood pressure.
• Anti-inflammatory.
• Guohui Liu uses higher doses on Americans – up to 45g (so far) – and often begins with 10g.
• Guohui Liu recommends cooking Fu zi for at least 2 hours, until it no longer numbs the tongue, while Bensky/Gamble says to cook it for 30-60 minutes before adding other herbs.
• Watch for development of heat symptoms: burning urination, canker sores, bleeding, hard, dry stool.
Gan cao, Gan jiang, and honey substantially diminish Fu zi’s toxicity (as do Xi jiao, Jin yin hua, and Lu dou).
• Symptoms of poisoning: vomiting, diarrhea, palpitations, drooling, nausea, vomiting, lightheadedness, blurry vision, numbness in the mouth and extremities, premature atrial contractions, dyspnea, tremors, incontinence, stupor, reduced temperature and blood pressure, death.
• Atropine and lidocaine have been used successfully in treatment of overdose.
• Contraindicated in pregnancy or Yin deficiency.
• One form of processing renders the herb black, called Hei fu pian or Hei fu zi (“Black Appendage”). Its action is focused on the kidneys.
• Another form of processing renders the herb white, called Bai fu pian or Bai fu zi (“White Appendage”). It is used by some for treating painful obstruction (Bi syndrome).
Sheng fu zi, the untreated herb, is used – rarely – when the full force of the herb is required – usually for emergencies and topical use.
PFGC: Enters and tonifies Ming Men; is pure Yang, moves without being confined, can reach any part of the body.
• For severe cold disorders causing: cold extremities, hiccups, nausea, regurgitation of food, diarrhea, cramps, wind obstruction, masses and accumulations, disorders of the Du Mai with stiffness and rigidity of the spine, chronic infant convulsions, greyish papules, skin ulcerations that do not heal with dispersing herbs.
• Aconite opens the pores to expel wind and cold from inside.
• Some books say that in combination with blood tonics, it can moisten deficiency of original Yin (not for complete water exhaustion).
• In extreme Yin syndromes with signs of false Yang, take the decoction cool.
• Though its action is opening, it also has a strong astringing effect: for profuse sweats from Yang collapse (cold body), diarrhea from intestinal cold, Yang deficiency in the lower Jiao with escaping Yin, cold excess syndromes with spontaneous seminal emission.
• Though all Yang things have the tendency to float upwards, aconite has ability to entice fire downward.
• Boosts both the imperial and ministerial fires.
• When the surface Yang of the Taiyang system floats precariously on the outermost surface, producing fever, aconite has ability to link it with the astringing energy of the Shaoyin system and heat symptoms will naturally disappear.
• If the inner core of the Shaoyin network is diseased, aconite can entice the energy to come up from below and make the pulse reappear.
Wu tou represents the mother Yin which is already depleted of the procreative force.
Tian xiong (an aconite root which does not spread laterally, but just grows fatter) represents the solitary Yang which is unable to procreate by itself.
Fu zi is the seedling of Wu tou and Tian xiong and thus contains both Yin and Yang.
MLT: Main herb for tonifying the Ming Men.
• Antidote to poisoning: mung bean congee (also Atropine).
Hsu: (Fu zi and Wu tou) Cardiotonic – increases contraction of the heart and improves circulation to the whole body; analgesic; antiphlogistic; stimulates the adrenocortical system of the pituitary, benefits patients with dysfunction of the adrenocortical system through adrenocortical hormone-like actions.
DY: Operates within the Qi division; returns Yang and stems counterflow; strongly supplements Yang; in the exterior, it is directed to the skin to drain cold; in the interior, it is directed to the three burners to drain cold; invigorates Ming Men fire; assists Yuan Yang; acts mainly on heart Yang (upper Jiao), spleen Yang (middle Jiao), and kidney Yang (lower Jiao).
• With Gan jiang for mutual reinforcement, to return Yang and stem counterflow. For indications such as:
– 1. Loss of consciousness, cold spontaneous perspiration, cold limbs, and a minute pulse due to Yang desertion. (Si Ni Tang) Use bland Fu zi.
– 2. Pain and a feeling of cold in the stomach and abdomen, vomiting, and diarrhea due to spleen vacuity cold. (Fu Zi Li Zhong Wan) Use blast-fried Fu zi.
• With Da huang (which operates within the blood division) to warm the interior, precipitate accumulation of cold, and evacuate the stools. For constipation, abdominal pain, fear of cold, and cold limbs due to accumulation of internal full cold. (Da Huang Fu Zi Tang).
When the pair of Da huang and Fu zi is combined with Xi xin, it has shown an interesting action in the treatment of cold-damp Bi or impediment with Yang deficiency and blood stasis (use wine mix-fried Da huang for this) as well as for Bi with an accumulation of heat in the stomach and intestines with persistent constipation.
• With Huang qi for mutual reinforcement, to supplement the Qi and warm the Yang, return Yang, secure the exterior, and stop perspiration. For indications such as cold spontaneous perspiration accompanied by aversion to cold, cold limbs, lassitude of the spirit, a pale tongue with white fur, a fine, weak pulse, and in severe cases, profuse sweating, loss of consciousness, and a minute pulse due to Yang deficiency or Yang collapse.
Fu zi is incompatible with soy sauce and millet.
RW: (part of root not specified) Neuralgia (facial/ trigeminal): 5-10 drops tincture (1:5::herb:menstruum) 3 times daily (increase dosage slowly).
IBIS: Actions: sedative, anti-inflammatory, synergist.
• Dosage: Tincture: 0.5 – 8 gtt., up to t.i.d.; Root: 0.06 g.
• Therapy: irritation of mucous membranes, facial neuralgia, fever and inflammation (especially with sudden onset), acute disease with restlessness.
• Toxic amounts of alkaloids have been absorbed through the skin. (Duke, pp. 12-13)
• Internal use may result in immediate oral burning, tingling, numbness, and throat constriction; followed by salivation, gastritis, nausea and vomiting. Characteristic tingling may spread over the entire body surface. Dysarthria, ataxia, vertigo, blurred vision, paresthesias and general weakness can follow. Myotoxic effects include stimulation followed by depression of cardiac, smooth and skeletal muscle. Alkaloidal effects on CNS and peripheral nerves produce a curare-like paralysis with labored respirations spreading from upper extremities to lower. Death from cardiac arrhythmia and respiratory failure occurs within 1-8 hours. (A.M.A., p. 20; Dreisbach, p. 434; Levy and Primack, p. 120; Theines and Haley, p. 24)
• The odor has a narcotic effect and can lead to eye irritation and swelling (Tedeschi, Eckert, and Tedeschi, p. 1525).
• Treatment for overdose: body warming (internally and externally), administration of atropine 0.05 mg/kg body weight, 2 – 3 mg total dose, and a potassium permanganate (1:1000) gastric lavage (Levy and Primack, p. 120; Theines and Haley, p. 24; Cooper, et al; Turnball)
• Laboratory changes: hypocalcemia due to reduction in free Ca++ ions.
Huang Huang:
I. Fu Zi
A. We use Zhi Fu Zi (Aconiti Carmichaeli, Radix Lateralis, Preparata)
B. Family Ranunculaceae
C. Standard species: Aconitum carmichaeli Debx. (?? [??] Wü Tóu lit. “crow’s head” or “black head”)
D. Alkaloids: aconitine, hypaconitine, mesaconitine, talatisamine, monoacetyltalatis- amine, isotalatizidine, etc.
E. Decocting takes the most toxic substances and breaks it down those

II. “Fu Zi is the most useful herb and also the hardest to use”
A. Number 1 for restoring the yang & rescuing from rebellion
B. Famous doctors
1. Yan Guan in the Ming used ginger juice treated Fu Zi to the point he was called “Yang Fu Zi”.
2. Zheng Qin-An in the late Qing used Fu Zi and Gan Jiang for all yin type diseases whatever the symptom. Ex. toothache, he would see constitution as weak and would use Fu Zi.  Wasn’t paying attention to disease, but to person.  He was the of the “Fire God” (??  hu? shén) current.  Because he focused on the person, Fu Zi became popular.  This is a very old school.
3. 20th century Sichuanese physician Zhu Wei-Ju became famous when he came to Shanghai.  He used Fu Zi to treat many serious diseases & emergencies. He realized all Shanghai doctors were using Wen Bing formulas.  He had success using Si Ni Tang type formulas so nicknamed him called “Qu Fu Zi.”
4. Famous modern doctor from Yunnan, Wu Pei-Heng called “Wu Fu Zi” because he used very large dosages, up to 400g.  Used large pot to cook Si Ni Tang as one must have a large amount of water, one can’t keep adding water.  If one adds water, this method won’t break down toxic ingredients.
C. Why “Hardest to Use”?
1. Fu Zi patterns can be difficult to differentiate
2. In emergencies once can wait too long and lose the opportunity to use it.  Ex. he saw a patient who had been in extremely cold water, with extremely cold lower extremities.  He used Ma Huang Xi Xin Fu Zi Tang and it worked as he used it immediately.
3. If used when inappropriate, no therapeutic effect
4. As it is toxic, when inappropriately used can have significant side effects.  0.2mg of aconitine can lead to toxic side-effects; 3-5mg can be fatal.  It’s very powerful but very difficult to use:  He worked in an arthritis ward.  There was a very recalcitrant case of upper joint pain, old doctor wanted to use Wu Tou.  After giving her this and she had toxic reaction, and all but died, it took many emergency doctors to revive her…but the pain was gone.

III. Symptoms of Aconite Poisoning
A. Nausea, vomiting, abdominal pain, diarrhea, , blurred vision, mydriasis, burning sensation, numbness of the mouth and tongue, numbness of the limbs or the whole body, restlessness, dizziness, pallor, bilateral loss of vision, difficult respiration, tremors, low blood pressure.
B. Aconitine can directly damage the myocardium; toxicity can lead to ventricular fibrillation
C. Long use side effects:  Fire spirit school’s two main proponents died in their 40’s.  This not a good sign.  Do not take large dosages for a long time to increase longevity.  First use safely, appropriately for heart problems, edema, joint pain.  1. Does this disease respond to Fu Zi? 2. Is  patient right constitution? 3. Must have appropriate matching of other herbs, and correct dosage, and appropriate form of medicine: decoction, pills, granules.

IV. Fu Zi Presentation
A. Most importantFu Zi pulse is faint and thin.
1. Very faint, very thin; almost imperceptible; or
2. Sunken and hidden, so only palpable near the bone; or
3. Suddenly becomes floating, big, soft and empty
B. Usually occurs after profuse sweating, diarrhea, bleeding, etc.; or
C. Extreme fatigue or cold
D. Patient is constitutionally weak or
E. Tongue is moist, cannot be dry.  White coating, big, fat, swollen, dark.
F. Other related symptoms
1. Listless, extreme fatigue, faint voice;
2. Important: People withdrawn, laconic, indolent, no shen, no affect, very fatigued, don’t like to talk, voice low, hard to get history.  [If people come in and talk and talk about being cold, very agitated, and pulse agitated, this not appropriate.]
G. Cold: below elbows and knees, unformed stool, edema, fears cold, frigid extremities;
1. Loose stools or diarrhea, may have undigested food particles and also abdominal fullness and pain
2. Edema — especially pitting edema of the lower limbs swollen face, legs, ascites, pleurisy, decreased liver and kidney function.
3. Blood pressure, cardiac function, renal function all low
4. From one perspective equals yang deficiency or shaoyin disease
H. #2 Most Important Severe Pain
1. While pale and weak, white ashen face, yet also irritable and uneasy with generalized or non-fixed pain [e.g. cancer and CNS related pain]
2. Joint pain to the point of breaking out in a sweat [e.g. gout, discogenic pain];
3. Intense abdominal pain without tenderness or hardness and no redness of the tongue or yellow greasy coating;
4. Chest pain that goes through to the back with icy cold past elbows/knees like angina.
5. Sciatica type pain. Think of Gui Zhi Jia Fu Zi Tang.
6. But not for pyschogenic pain.

V. Fu Zi constitution
A. Dark, slightly puffy complexion
B. Dispirited, listless, lusterless eyes, no spirit in the eyes, shallow breathing, laconic
C. Fatigue, difficult to get out of bed
D. Chills, no thirst
D. Sunken, faint, weak pulse without force

VI. Comparison with Gan Jiang
A. Fu Zi: primarily cardiovascular issues with a sunken frail pulse; good at treating pain, while:
B. Gan Jiang: primarily digestive issues with a white, greasy tongue coating; good at treating distention and fullness of the abdomen

Fu Zi family of formulas
I. The family
A. Sì Nì Tang (Frigid Extremities Decoction)
B. Sì Nì Jia Rén Shen Tang (Frigid Extremities Decoction plus Ginseng)
C. Zhen Wu Tang  (True Warrior Decoction)
D. Fù Zi Li Zhong Wán (Aconite Accessory Root Pill to Regulate the Middle)
E. Fù Zi Xiè Xin Tang (Aconite Accessory Root Decoction to Drain the Epigastrium)
F. Wu Tóu Tang (Aconite Decoction)

Sì Nì Tang (Frigid Extremities Decoction)
N.B.: This is the most important of the Fu Zi family formulas.

I. Classical Functions
A. Restore the yang
B. Rescues from rebellion

II. Original formula dosages
Fu Zi 1 piece (If robust use a big piece)
Gan Cao 2 liang
Gan Jiang 1.5 liang

III. Classic Presentation

A. Pulse so faint as to be almost imperceptible, very low BP
B. Frigidly cold extremities and chills;
C. Incessant diarrhea with undigested food particles, with abdominal pain.

IV. Dosages based on Experience
Zhi Fu Zi 30g
Gan Jiang 15g
Zhi Gan Cao 15g
Water decocted

V. Indications
A. Shock from any cause, usually add Ren Shen [Korean Ren Shen is best]as in Si Ni Jia Ren Shen Tang.  Cardiogenic shock.  Dr. Huang has used Si Ni Tang + Zhen Wu Tang + Rou GuiFu Zi to 50g.
B. Cardiac Insufficiency marked by fatigue, shortness of breath, palpitations, weight loss, muscular atrophy, being bedridden.
C. Unrelenting diarrhea: For acute gastroenteritis, chronic colitis, or infants with rotavirus gastroenteritis — add Huang Lian; sudden turmoil disease.  Most often no significant rise in temperature, cold limbs, listless.
D. Long-standing Stomach Problems: For chronic gastritis, peptic ulcer, and functional indigestion.  One usually adds Huang Lian, Huang Qin, and Da Huang, particularly in robust men with good appetites that get full easily and have a tendency towards pain and diarrhea. N.B.: This is Si Ni Tang plus + Xie Xin Tang
Fu Zi 10
Gan Jiang 10
Gan Cao 5
Huang Lian 2
Huang Qin 5
Zhi Da Huang 5
Sometimes one may add Rou Gui 10 for abdominal pain.  There are usually signs of cold and heat: a robust person but with a dark face, a thick tongue coat, but white, can eat a lot but gets diarrhea.

VI. Constitutional Findings
A. Face: dark, pale, or dark yellow complexion; listless; appears tired; lusterless and baggy eyes; dark, washed-out, and dry lips
B. Tongue: pale, swollen, and dark with many teeth-marks; the coating is white & thick, black & moist, or white & slimy
C. Body: soft & loose flesh without tone; usually dry skin that lacks luster
D. Habitus: fears cold & attracted to warmth, cold limbs [especially lower]; easily fatigued, indolent
E. Loose, unformed stools; profuse, clear urine; no thirst or only drinks a little or fond of warm liquids
F. Weak forceless pulse.
G. Abdomen may be distended but no pain or resistance.  May not even be cold.
N.B.: If a patient presents like this no matter why he comes in, one should give him Si Ni Tang.  This presentation is not rare, due to overuse of antibiotics and intravenous infusions, overindulgence in cold foods and drink and rich food, flimsy fashions, over work, air-conditioned environments, and sedentary lifestyles.  When antibiotics kill good bacteria, this is yang xu.  They overuse them in China for everything.  Pre-modern physicians used Si Ni Tang for some problems, such as sudden turmoil, that are not that common focus at present

VII. Shu vs. Sheng Fu Zi
A. Originally used unprocessed. The classic use of unprepared Fu Zi to restore the yang should be taken seriously  However, Gan Jiang and Gan Cao were added.  These decrease toxicity as well as warm.  These three are mostly used together, they are more functional and less toxic.  If one uses a large does of Fu Zi, must combine with these other herbs.  If one uses prepared, it is not necessary to use Gan Jiang and Gan Cao.
B. If use unprocessed, should boil water first then cook longer.  Zhang boiled Wu Tou with honey.  Perhaps the honey raised the boiling temperature.
C. Wu Pei Heng used decoctions of sufficiently cooked Fu Zi or Si Ni Tang with Rou Gui for toxicity from insufficiently cooked Fu Zi.
D. Fan Zhong Lin, late 20th C, Sichuan doctor skilled in using Si Ni Tang, emphasized the tongue:  Pale red or pale and dark, swollen with teeth-marks, gray and greasy or white and slimy coat. Dr. Huang feels this is not sufficient, need pulse, face, affect, etc.

VIII. Si Ni Tang vs. and Si Ni San
A. A Si Ni San presentation usually has only the hands and feet cold, tight rectus muscles and pain in the chest and hypochondrium.  The eyes are looking out and vigilant.
B. In a Si Ni Tang presentation the hands and feet cold are colder, no response below ribs, dull ribs.  The mental and emotional states are completely different, the eyes are dull.
IX. Si Ni Tang + Rou Gui
A. Si Ni Tang plus Rou Gui is the formula of choice for shock, profuse spontaneous sweating, and abdominal pain.
B. In emergencies when there is not time to prepare Si Ni Tang, first use an infusion of Rou Gui.

Sì Nì Jia Rén Shen Tang
I. Indications
A. Common addition for patients with intense diarrhea, sweating, or hemorrhage.  For acute but also chronic diarrhea.
B. Any hemorrhage.
C. Manchurian Korean ginseng is preferred.

Zhen Wu Tang 
I. Classical Functions
A. Warms the yang
B. Promotes water metabolism

III. Dosages based on Experience
Prepared Fu Zi 10-20g
Fu Ling 15-30g
Bai Shao 15-30g
Sheng Jiang 15-30g
Bai Zhu 15-30g
Water decocted

IV. Classical Presentations
A. “The person still is feverish with palpitations below the heart, the head is dizzy, and the body twitches and trembles like it is going to fall on the ground” (82)
B. Abdominal pain, urinary dysfunction, a feeling of heaviness and pain in the limbs, and diarrhea”(316)
C. “The person might cough, or have [dysfunctional] urination, or diarrhea,

V. Key Symptoms
A. Twitching & Trembling like one is going to fall down. This is like a description using only the lineaments of the person, the main outlines.  Shows a person that has vertigo-like symptoms, unsteady, head is disconnected.  Described in lots of ways, walking on cotton or clouds, feel like going to fall to one side, or as follows.
B. Often seen as being weak and unsteady
C. Patient may describe as feeling as if they are walking on cotton or clouds
D. Others may say that their heads feel heavy and their feet light

VI. Accompanying symptoms
A. Digestive complaints: abdominal pain, unformed stool, or diarrhea with no particular precipitant
B. Scanty urine
C. Systemic edema, but especially in abdomen where there is yang xu with fluid buildup.
D. Heavy and painful limbs.  It’s hard for the patient to move because of the excess fluids

VII. Constitutional Findings
A. Listless, no spirit in eyes, may be extremely fatigued, fear of cold with cold limbs from a major disease;
B. Excess water, superficial edema, or diarrhea, or urinary dysfunction, or palpitations, or tremors.  Water in a discrete place, not just in flesh, in abdomen, in head, etc.
C. Tongue is important: swollen, large, pale with white or gray coating and slimy
D. Pulse: sunken, thin or large, empty, & weak.

VIII. Usage
A. Collapse; heat exhaustion
B. Sudden nausea, dizziness, pallor, shallow breathing, cold sweat, weakness; may collapse
C. From inappropriate use of Ma Huang Tang or due to too much sweating.  If mild symptoms, just use Gui Zhi Gan Cao Tang, if more intense, use this.
Case History: Sweating from inappropriate use of Ma Huang Tang.
A male patient, with slight sweating at the onset of a disease, a weak pulse, and aversion to drafts.  After mistakenly treated with Ma Huang Tang he experienced nonstop sweating, feverishness, chest pain, jumpy with palpitations, unable to sleep at night, incoherent speech, tremors, shakes.  Dr. Xu – treated him with Zhen Wu Tang.  Main issues better after 3 packets.
N.B. Almost all instances of non-stop sweating in Shang Han Lun are due to inappropriate use of Ma Huang Tang, take Ge Gen Tang in the evening, etc.  Everything in this case history point to side effects of Ma Huang Tang.  Xu also added things to clear heat.
Case History:  Sweating from yang collapse, 1970, Hennan.  Mr. Zhang, 34 y.o.; thin and somewhat debilitated. Took exterior-releasing herbs two times for a wind-cold and then a purgative.  This resulted in profuse, continuous sweating, bedclothes soaked, listless, low fever, tight musculature, dizzy to the point of being unable to stand; excretions normal; pulse sunken & thin.  Dr. Huang: This guy was already debilitated, given too strong diaphoretic and purgative.  Too much sweating lead to yang devastation.  Dizziness is marker as well as tremors.
Formula:
Zhi Fu Zi [cooked 1st] 30g
Bai Shao 30g
Bai Zhu 30g
Fu Ling 30g
Sheng Jiang 30g
Decocted and sipped over time.

IX. Other and modern diseases
A. Dilated cardiomyopathy
Young people have an enlarged heart, this is congenital.  Often need heart transplant, but these are hard to come by, so may be willing to take Chinese meds.  They are overweight, edematous, add Huang Qi, Rou Gui, looks like Zhen Wu Tang with Huang Qi Gui Zhi Wu Wu Tang.  These probably won’t cure this but can improve the quality of life.
Case History: Congestive Heart Failure, Zhao Xi-Wu, Academy of Chinese Medicine uses Zhen Wu Tang.  This has Fu Zi but also diuretics.  This combo of strengthen heart with diuretics is very good. It is usually combined with Sheng Mai San, Wu Ling San [increases urination, if can’t urinate, feel heavy and encumbered.], Ma Xing Shi Gan Tang [Ma Huang with a weak heart is not a great idea, but used properly it is OK, especially with cough and wheeze. etc.] After taking herbs there is a significant increase in urinary output, ease of breathing, no pharmaceuticals are required.  Dr. Huang adds Rou Gui, Huang Qi, Long Gu, Mu Li. This patient couldn’t move, with wheezing, spit up pinkish sputum, left ventricular type.  Besides wheezing have enlarged liver, ascites, extreme edema of legs.  Heart problems are the main reason for death.  Most people take Western meds, but Zhao started to treat it.
Case History: Chronic Bronchitis And Asthma. A woman had chronic bronchitis and asthma , was bent over, took steroids causing a hump and edema.  Dr. Huang used Zhen Wu Tang with the above additions.  She took it ½ year, she improved slowly, and could finally walk.
N.B. Zhen Wu Tang may keep these people out of crisis, out of hospitals even if they are not much improved.
Case History: Undiagnosed Heart Problems.
Monk, 30+ years old, with irritability and oppressive sense in the chest for a few days followed by dark blood from both vomiting and diarrhea.  Sunken and faint pulse; extreme abdominal fullness, urinary difficulty, swollen limbs that are heavy and numb, 2-3 bowel movements a day, low spirits and no appetite.  Food stagnating in the chest that causes the qi to be upset when it enters the ?  May also have had ascites. He recovered very fast with Zhen Wu Tang.
N.B. Dr. Huang feels people who don’t take herbs all the time seem to respond to less and lower doses.
Case History: Hypertension
Female, 70 y.o. with hypertension for over 10 years. 1st visit 180/100mmHg, as has not taken her meds for the last couple of weeks.  Palpitations, dizziness, unsteady feet “as if walking on cotton.” Slight leg edema, lack of appetite. Tongue – pale, white slippery coat; Pulse sunken, thin, normal force.
Formula:
Fu Zi 10
Chuan Wu 10
Bai Shao 10
Fu Ling 15
Cang Zhu 10
Sheng Jiang 15
3 days later symptoms lessened, BP160/90 mmHg.  10 more packets- BP140/80mmHg; herbs stopped and at 1 year follow up was OK.
N.B. HBP not necessarily liver yang rising.  If yang xu, use Zhen Wu Tang.  These people are unsteady, dizzy, and have edema.  Get rid of excess fluid their blood pressure comes down.  Ex. a village doctor uses the classic formulas very well.  He wrote a good book, became famous, moved to big city.  Used to farm half time, because he was alone he knew how to make medicinals.  He used this strategy with success.
N.B.: Erectile Dysfunction can be a side effect of long-term Western meds, Chinese meds are better since they do not have so many side effects.  Current doctors look at numbers for results, not at how patients feel.  So if these Western meds cause these sorts of problems it is often overlooked.
B. Chronic Renal Disease
Sallow complexion, lower limb edema, unformed stool, proteinuria.  The general formula is  Zhen Wu Tang plus Yu Ping Feng San plus Wu Ling San.
Case History: Chronic Renal disease
Woman in early sixties, quite severe.  In hospital she would have gone to the renal department, but because she had a fever, they sent her to Dr. Huang.  Fever, no urination, adverse to cold and sweating.
Formula: Zhen Wu Tang plus Yu Ping Feng San + Gui Zhi.  She said it worked and tasted good, that before the Chinese herbs were terrible tasting and with huge packets of herbs, with disgusting herbs.  This was because the combinations were formulated by using the biomedically-defined functions of the herbs.  These were not formulas, just a bunch of herbs thrown together.  In comparison Dr. Huang’s were better tasting and he used many fewer herbs.  She decided to continue to see him.  She started with 3+ proteinuria and these numbers just went down.  Then her family came to see him.  She is still OK.
C. Cirrhosis with ascites
The general formula is Zhen Wu Tang with Wu Ling San ­and ­Huai Niu Xi:
The dosages are:
Fu Zi 30
Bai Shao 30
Chi Shao 30
Bai Zhu 30 up to 60
This increases diuresis, maybe it dilates blood vessels around kidney.
N.B.: Ascites, the first time a patient has it, it is easy to cure, but recurrences get harder and harder to treat.  By the time they are referred to Chinese medicine, cases may be very difficult.  Sometimes Chinese medicine can still help.
Use large doses of Niu Xi, smaller of Fu Zi, maybe 10g.  Bai Zhu takes interperineal fluids and disperses them; increases albumen in blood.  It is kind of a natural albumen, sounds like egg white in Chinese.  North of Shang Hai is the epicenter of cirrhosis, Mao Han Ping, old doctor there uses large doses of Bai Zhu with success.  Bai Shao is also very important.  It regulates immune system, unblocks obstruction of blood, dilates blood vessels.  Wang Chen Bai, Beijing military doctor, originally Western, then Chinese, is a very good liver disease doctor.  He has his own special formula, Chi Shao, Dan Shen are the main ingredients for stubborn jaundice.  Chi Shao dosage quite high, maybe up to 80g.  There is a need to break up the constraint.
Severe liver disease patients often have spasms of lower legs.  A cirrhosis patient of Dr. Huang’s had horrible restless legs, he used Xiao Jian Zhong Tang with large dosage of Bai Shao, not only did the restless leg go away, but ascites improved.  For liver disease, must use large dosages of Shao Yao, for spasms use Bai Shao, for stubborn jaundice, use Chi Shao.  Large dosages of Shao Yao may be a laxative.  A small dose is 15-20g.
Case History: Jaundice
Billiary obstruction, itchy skin, constipation.  Dr. Huang asked if there were leg spasms, patient said yes, so he used Shao Yao Gan Cao TangBai Shao 30, Gan Cao 10 per day.  This is a relatively inexpensive formula but all the patient’s functions improved, and she was astounded.  Western surmised that maybe spasms around the billiary tract was original cause, but this was uncertain.  5 years later she is OK.  If splenomegaly
Bie Jie , Long Gu, Gui Zhi.  A young patient had this with large portal vein, not only symptoms improved but portal vein became normal.  This made a big impression on Dr. Huang.
D. Cirrhosis with portal hypertension:
The general formula is Zhen Wu Tang with ­and Rou Gui, Long Gu, Bie Jia.
There is some evidence this may control the progression of the disease.
Case History: Cirrhosis (see power point for pictures of this patient.)
1st visit 2006-02-07 Chief Complaint: positive Hepatitis B tests -HbsAg,anti-HBe,antiHBc.  History of other positive Hepatitis B tests with a history of others in his family having liver disease. DISEASE  – cirrhosis, organomegaly.  Decreased appetite, averse to cold, stomachache, hypochondrial distention &pain, averse to greasy foods with diarrhea after eating them, abdominal pain post BM.  Portal vein measures 1/3-1.4cm.  HR 90 beats/min, pitting edema lower limbs;  pale, tender tongue with white, greasy coat; middle level of the pulse is empty .
Formula:
Zhi Fu Zi 6g
Bai Shao 30g
Bai Zhu 30g
3rd visit 2006-03-07:After taking the herbs his appetite increased, stool became formed, and throat pain was gone and abdominal distention is not that noticeable. Still slight edema of the legs; pale red enlarged tongue.
Formula:
Zhi Fu Zi 6g
Bai Shao 30g
Bai Zhu 60g
Fu Ling 30g
Zhu Ling 30g
Ze Xie 40g
Rou Gui 6g
Gui Zhi 10g
Gan Jiang 6g
Da Zao 30g
4th visit 2006-04-29:Complexion improved, stool is formed; leg edema; tongue pink with a thin, white coat; pulse moderate, empty, & big.
14th visit 2008-04-22:Appetite and stool are OK, has gained weight; BP140/95mmHg; slight edema of the legs; tongue enlarged and tender with a thin coating; bleeds when brushes teeth, conjunctiva are red and moist, symptoms of anemia are improved.
Told to avoid overly hot or hard food
Formula:
Zhi Fu Zi 10
Tia Xiong 10 [added by patient]
Bai Zhu 60g
Bai Shao 30g
Fu Ling 20
Gan Jiang 6
Rou Gui 10
Da Zao 20
15th visit 2008-06-03: Less sensitivity to cold, pain over liver area is not very noticeable, the spleen has gained 1mm in width over the last month.
Formula: add 15 each of Long Gu and Bie Jia
2011-06-15 Ultrasound: Diffuse changes in the liver with nodularity, thickened wall of the gallbladder, enlarged spleen, portal vein wider
Formula:
Zhi Fu Zi 10
Tia Xiong 10
Bai Zhu 60g
Bai Shao 30g
Fu Ling 20
Gan Jiang 10
Sheng Long Gu 15
Bie Jia 15
This is a two day dose.
This disease was not cured but controlled and progressing slowly.  No ascites, no vomiting of blood, no western meds.
E. Hypothyroidism:
Combine with Dang Gui Shao Yao San, if listless Ma Huang Fu Zi Gan Cao Tang.
F. Perimenopausal syndrome
With cold and painful joints, spontaneous sweating: combine with Gui Zhi Jia Long Gu Mu Li Tang
Case History: Perimenopausal syndrome
Fear of cold, sweats a lot, thyroid normal.  Patient previously used Huang Qi and Shi Gao, lots of astringents, which didn’t help much.  Dr. Huang gave her Rou Gui, a couple weeks later, sweating went down.  Still had cold throat and was cold with edema but felt better.  Used Zhen Wu Tang + Rou Gui and Hong Zao.  She got better.
With lots of cold combine with Gui Zhi Jia Long Gu Mu Li Tang. Pulse should be weak, some sunken, some floating.  Tired very easily, joint pain.  To fit this, the patient shouldn’t have emotional problems.
G. Intestinal tuberculosis, peritoneal tuberculosis:
This usage pioneered by Otsuka Keisetsu
Case History: Headache
Case of Liu Du-Zhou.  Li X, middle-aged male chauffeur . In the
summer he usually drinks large volumes of cold water or beer and developed a headache in the fall that was worse at night. To control the headaches he had to smack his head with his palm or take analgesics; he really suffered. His vision had also been cloudy for over a month. His complexion was very dark, tongue pale with a slimy coating, & pulse sunken, wiry, and moderate. DX – Yang deficiency with overflowing fluids, turbid yin scurrying upwards to veil the clear yang
Formula:
Fu Zi 12,
Fu Ling 18
Bai Zhu 9
Sheng Jiang 12
Zhen Wu Tang is great for pain.  Complexion is very important in the diagnosis: dark, no luster; and make sure the tongue is correct.  Make sure the problem is due to cold, not heat. He added Gui Zhi, and finished with Ling Gui Zhu Gan Tang.
Case History: Cervical Spine Case
Case of Hu Xi-Shu.  Vertigo, palpitations, left posterior shoulder pain, tension and pain in the left hand with aching above and below the elbow. Frequent nocturia, a pale tongue with a greasy white coat on the root, and a sunken, slippery pulse.  Diagnosis: Yang deficiency with pathogenic water attacking upwards
Formula: Unmodified Zhen Wu Tang:
Fu Ling 12
Bai Shao10
Sheng Jiang 10
Bai Zhu 10
Zhi Fu Zi 6
After 3 packets the dizziness was less, but everything was unchanged. Increased Zhi Fu Zi to10 & add Gui Zhi 10 and Zhi Gan Cao 10 for another week – shoulder and back pain was better.
N.B.:  Both these famous jing fang doctors added Gui Zhi for pain.  Both influenced by Japanese book Han Dynasty Medicine. Talked about presentation matching formulas, no zang fu, wu xing.  He is now very popular, wasn’t respected in his time, too practical, not theoretical.  He was very good, very based in SHL presentations.  Used Da Chai Hu Tang and Gui Zhi Fu Ling wan for asthma, Da Chai Hu Tang for GB stones.
H. Arthritis
Cold, painful type.
Case History: Tremors
90 y.o. man who had fallen into a river in December. For the fortnight since he had been sensitive to cold, especially at night, and also had cold tremors during which his whole body would shake uncontrollably as if he had been severely frightened. No fever or pain, he had no other major complaints, and was in relatively good spirits.  Tongue: pale and enlarged; white, greasy coat.
Formula:
Zhi Fu Zi 20
Fu Ling 20
Bai Shao 15
Bai Zhu 15
Sheng Jiang 15
After 5 packets she was cured.
N.B.: There was a student’s case history.  When you see people with shivering, shaking, tremors, see if they fit a Zhen Wu Tang constitution, must be correct constitution to work.
Case History: High Fever & Edema
86 y.o. man in hospital due to stroke had a fever of at least 39C° for a month that had not responded to any antibiotic. Not only comatose but on respirator. Ice pack on head.  Enormous abdomen, very soft, scrotum very enlarged, edema in legs, pulse irregular change from large to small.  Dr. Huang used Hong Shen, Rou Gui, with Zhen Wu Tang.  Put it down his nose.  Patient’s temperature went up, but Dr. Huang said don’t worry, take ice pack off head.  Also stop giving him so much food.  Finally his temperature, it went down 1/5 degree, stayed there for a while, but his face better, pulse better.  Dr. Huang added Huang Qi 60, and reduced Fu Zi.  Then temp start to decrease, edema decreased, returned to consciousness, scrotum got smaller.  He likes to see ICU: these patients are so sick it is apparent what is wrong, get well quickly.
I. Insomnia
Will have some Zhen Wu Tang corroborating factor.  Common in post-menopausal women, women can become yang xu with night sweats or spontaneous sweats, HA, joint pain.  Women’s sleep best in their 20-30s, body is warm, sleep best, menses copious, red lips, red tongue.  If there are mouth ulcerations, dry stool, these are from fire.  But these women are also beautiful and sex drive high, and sleep the best.  Women need this fire, after 50 as fire goes out, face turns yellow, lips dry, breasts sag, legs get thick, with insomnia.[11]
Case History: Insomnia
Woman 55, sallow complexions, unformed stool, very fatigued.  Sleeping 2 hours a night.
Zhi Fu Zi 15
Bai Shao 15
Bai Zhu 15
Fu Ling 15
Gan Jiang 10
Gan Cao 10
Long Gu 15
Mu Li 15
Gui Zhi
Gui Zhi Jia Long Gu Mu Li Tang is aimed at insomnia and sweating.  Things improved, better sleep.
Case History: Insomnia
35 year-old man.  Slept only 2 hours a night.  Tongue red, urine yellow, dizziness, lack of clarity, trembling in flesh.  Used Zhen Wu Tang, after two bags, sleeping up to 7-8 hours per night.
Case History: endometrium cancer,
Zhen Wu Tang’s usage is very broad.  Dr. Huang used it for endometrium cancer. In this case the patient had very dry stool, blood would come out with mucus.  Many would use have used Da Huang, but hers was a yang xu constitution.  Face was yellow, little fat, dark macula on face, pale lips, also had fatty liver.  Was fairly attractive.  Taking Western meds made her unattractive.  Dark complexion, no period, encumbered feeling, used drugs to stop period, these were stopping yang?  He didn’t worry about stool, just used Zhen Wu Tang with Ma Huang Gui Zhi.  Take a bag one day, then a break for one day.  This is to regulate constitution, or one bag for two days, but one cup a day.  For long term can’t use 3 cups everyday.  Mucus stopped, face better, affect better soon, then one pack every three days.  Ma Huang can unblock stools, stools became softer.
N.B.: To expel cold and damp, adding Ma Huang and Gui Zhi greatly helps, can bring on period.  Amenorrhea may be due to cold, can’t just use blood-moving herbs, need Fu Zi, Ma Huang.

X. Explanation
A. Traditional formula to warm the yang and facilitate water metabolism “yang deficiency with [pathogenic] water.”
B. Yang deficiency = sunken, thin, weak pulse; listless, cold limbs with sensitivity to cold. This occurs in major illnesses.
C. [Pathogenic] water = extra fluids, e.g. edema, diarrhea, urinary dysfunction, palpitations, etc. with an enlarged tongue that has a slimy coat. Sometimes we can see the water, sometimes cannot see it.  Dizziness, unsteadiness, twitching, flustered heart, are also from invisible water in interior.  Can usually see this on the tongue, enlarged and slippery coat.
XI Compared to Wu Ling San
A. Zhen Wu Tang condition is more severe (heart, liver, brain reduced)
B. Yang deficiency is at another level and has effected cardiac and renal functions
C. Psychoemotional state is listless or even stuporus, while in Wu Ling San it is basically normal;
D. Edema is less superficial than for Wu Ling San.
N.B. Wu Ling San types are not listless and withdrawn, just water, no yang xu, but both can have palpitations.  Wu ling San has water in abdomen, gurgling, vomiting of fluids, lots of diarrhea.  In Zhen Wu Tang water is not in the intestines, no gurgling.  Can use these together for lots of water, severe thirst, and vomiting.  For fatty liver, Wu Ling San as a powder helps, since this is damp and cold in liver.

XII. Additions:
A. Ren Shen (Ji Li) add for shock, desertion disease, cardiac insufficiency
B. Rou Gui for palpitations, irregular heart, and for sweat, abdominal pain (below umbilicus, has to do with intestinal spasms.)  Tongue is purplish or dark.
C. Long Gu and Mu Li for palpitations, copious sweating and insomnia.  Pulse will be more floating but without force.  Chi pulse superficial.  Palpitations in lower abdomen, use Long Gu, in heart and chest use Mu Li.  Most often use them together.
D. Ma Huang and Gan Cao not too common because lots of these types of patients have heart problems.  If you want to add them, they should have a healthy heart.  Period not present or scanty, skin is dry and sallow, patients are heavier and robust.

Fu Zi Li Zhong Tang
I. Dosages
A. Equal amounts of:
Zhi Fu Zi large
Ren Shen,
Pao Jiang,
Zhi Gan Cao
Bai Zhu
Coarsely grind into a powder and take 4qian in 1.5 cups of water and cook until .7 of a cup is left; remove the dregs and take.

II. Presentation in Source
A. For deficiency cold of the Spleen and Stomach with abdominal pain, decreased food intake, diarrhea, vomiting, clenched jaw with inversion of the limbs which can lead to cold inversion with deep-set cold, sudden turmoil with toxic viscera, yin macules with miasmic toxin, swollen and ulcerated throat, sores of the mouth and tongue; and a sunken, slow or sunken, thin pulse; also treats overabundant yin that barricades the yang.
B. Formula is what disease does it treat, what kind of constitution is going to have this disease.  Lecture focuses on patient and disease.  This may be an acute disease, fainting, vomiting, diarrhea, severe throat pain.  Then there are chronic diseases: deep set cold problems.
C. Constitution is reflected in the sunken pulse.  Pulse is emphasized because of constitution.  Can have irritability.  Xu cold affecting stomach spleen and overabundant yin barricades yang.

III. Typical Dosages
Zhi Fu Zi 10
Dang Shen 10g
[or Hong Shen 5 g]
Gan Jiang 10g
Bai Zhu 10g
Zhi Gan Cao 5g
These are Dr. Huang’s conservative dosages.  Can use pills, Henan brand.

IV. Indication #1 — Diarrhea
A. Frequent diarrhea with undigested food particles
B. Worse with cold
C. Acute: enteritis, rotavirus gastroenteritis
D. Chronic: post antibiotic diarrhea, post chemotherapy diarrhea
E. Infantile diarrhea with indigestion of milk and stool (frothy) that can be green, white, or light yellow; often seen in summer or fall.  [If unable to administer to a breast-feeding child, give to the mother.]
F. Dr. Huang frequently takes this while traveling to prevent diarrhea that can occur due to fatigue on trips.
Case History: Diarrhea
By Wang Meng-Ying [1808-67?].  Summertime, lots of people getting wen bing.  Doctors were using clear-heat resolve-toxin formulas.  But an older women had diarrhea and vomiting, and Wang decided was not the same as the epidemic, hers was actually cold damp problem.  Why?  Tongue was very dark.  Sometimes this indicates Da Cheng Qi Tang.  Why not here?  Pulse was sunken, very weak and she feared cold and her mouth was not dry, and she was heavy.  So he used Fu Zi Li Zhong Wan with success.
N.B.:  One can often use this for overweight patients with sunken weak pulse.  Look for tongue dark or black, but mouth not dry and there is no thirst.

V. Indication #2 — Abdominal Cold & Pain
A. Seen is chronic gastritis, IBS, acute enteritis, stomach flu, indigestion
B. Also used to treat abdominal pain in horses and donkeys.  Can treat animals, will lie down and get up, listless, legs and ears will be cold, mouth will be white, lots of saliva, then use this.  This is more in late fall and winter, or a cold spring when eating spoiled or damaged forage.
Case Study: ?????????1987?03? ??????????????????6?,?????
Chinese Veterinarian Journal: 1987, 3rd quarter.  Yue Rufu reports he used Fu Zi Li Zhong Tang to treat cold pain in six instances with satisfactory results.

VI. Indication #3 — Digestive Tract Cancer
A. Pancreatic cancer, liver cancer, colon cancer, etc. with bloating, lack of appetite, etc.
B. Especially useful after chemotherapy when the vast majority of patients have no appetite, nausea, vomiting, distention, and diarrhea.
C. If there is intense cancer pain, need at least 30g of Fu Zi
D. Often adds Hong Shen to help gain weight, helps spirit and appetite.

VII. Indication #4 — Bleeding
A. Besides bleeding from the upper digestive tract, also used for dysfunctional uterine bleeding, subcutaneous bleeding, epistaxis.
B. Blood will be thin & dark; the person will be averse to cold and sweat. .
C. Fan Wen-Hu from Ningbo uses to treat vomiting of blood
Case History: Shock
Dr. Huang used this plus Rou Gui to treat his wife who suddenly went into shock from upper digestive tract bleeding while visiting Germany. She ate something wrong, no BM, then black BM.  Said was OK, Dr. Huang went to class.  Wife had cold sweat, fatigue, couldn’t feel pulse.  Luckily was in a clinic, wanted to call ambulance.  Dr. Huang said no.  They had Fu Zi Li Zhong Wan  in granules, he wanted Rou Gui in addition, also sugar.  She has xu cold constitution, dusky lips, no spirit.  Put hot water on belly in place of moxa.  30 minutes later she started coming back.  2 hours later she much better.  Then went to Munich, rested two days, was OK.  Also used congee at lunch.
Case History: Coughing of Blood
Case history of Ning bo.  Coughing of blood, pulse deep, tongue pale.  Ning said must take warm herbs or die.  He used this with Dang Shen 24g and added Pao Jiang 6, Fu Ling 10 g, and 2 bowls of child’s urine (staunches bleeding).  He eventually added San Qi and E Jiao.  He eventually returned  to his original formula plus Dang Gui.   Dr. Huang felt the same about wife, if he had used cold herbs she would have died, with the hot herbs she got better.

VIII.  Indication #5 Shock
A. Cardiogenic shock after an MI with profuse cold sweat. Need a very large dose.
B. Dr. Huang fears this, esp. from fatigue, when he can’t eat regularly, so he always carries the patent and eats it.
C. Also from cold pain from diarrhea with cold sweat, can alleviate pain, let BP rise.

IX. Indication #6 Oral cavity disease
A. Drooling in children, halitosis, oral ulcers, swollen& painful lips, periodontal disease.
B. Usually accompanied by cold, diarrhea, copious, clear urine, neither thirst nor a dry mouth, listless. Lips are gums are usually purplish.
C. Mouth related to stomach. Their state of health usually not good, long clear urine, diarrhea, tired, etc.  Fu Zi Li Zhong Wan may bring pus out of gums and help them heal.
Mouth ulcers, can’t always use heat-clearing herbs, but may add them.  May add Huang Lian to Fu Zi Li Zhong Wan for this.  For drooling, Fu Zi Li Zhong Wan can deal with fluids.

X. Indication #7 Excessive bile after surgery on the Gall Bladder
A. After GB surgery have lots of thin bile leaking out, clear and watery.  This is for cold excretions.

XI. Constitutional Findings
A. Sallow, dark complexion, listless, pigmented skin on the limbs;
B. Decreased appetite, abdominal distention, diarrhea, abdominal pain;
C. Pulse lacks force;
D. White, greasy tongue coating
E. Cold wintry constitution.

XII. Compared with Si Ni Tang
A. Fu Zi Li Zong tang warms and tonifies; the patients are usually thin, have a poor appetite; problems are usually chronic and affect the digestive tract.
B. Si Ni Tang is commonly used to treat acute and serious diseases by restoring the yang and rescuing from rebellion.
C. Fu Zi Li Zhong Wan can be used this way in big dosage.

XIII. Compared with Li Zhong Tang
A. In addition to fear of cold and the digestive symptoms such as diarrhea that mark the Li Zhong Tang presentation, this formula also warms the yang to treat withdrawal, a weak pulse, and other systemic signs and symptoms.
B. “From first to second floor.”  Li Zhong Tang only digestion problem, adding Fu Zi also treats listlessness, a weak pulse, and heart and kidney problems.

XIV: Compared to Zhen Wu Tang
A. With Fu Zi Li Zhong Tang there is free flowing of urine and no edema.

XV. Modifications & additions:
A. For a dark, pale tongue, palpitations, and sweating add Rou Gui, Fu Ling
B. If thin without an appetite and a dry mouth, add Hong Shen
C. For intense pain, increase the dosage of Fu Zi to at least 30g and add Xi Xin.
D. For complexes of cold and heat, can be combined with herbs such as Huang Lian.
E. Can be used for constipation, but only if the stools are first hard then loose and watery.

Fu Zi Xie Xin Tang
I. Introduction and Functions
A. An ancient emergency formula, used for such urgent conditions as vomiting of blood, collapse, and food poisoning.
B. Unblocks the yang and drains focal distention
C. Treats focal distention, chills, listlessness, sweating
D. Used very commonly for the weak, yang xu with bleeding.
E. Do hot and cold herbs cancel each other?  They do their own thing.  Their cooperation helps resolve situation.  Dr. Huang cooks all the medicinals together without the steeping of cold and boiling of hot.  Try this for robust people that don’t respond well to either hot or cold

II. Original dosages and preparation
Da Huang 2 liang
Huang Lian 1 liang
Huang Qin 1 liang
Zhi Fu Zi 1 piece [decocted separately]
Take the above 4 ingredients, chop [the first] three and steep in 2 sheng of water that is just beginning to boil. Wring out [the juice].  Remove the dregs and add Fu Zi juice.  Divide and take warm twice a day.   [Fu Zi is cooked separately, just use infusion of other ones, they are just steeped in boiling water.]
Explanation: The original formula uses boiling water to steep the “three yellows,” Fu Zi is boiled separately.  This method is from Zhang Zhong Jing’s experience, but his rational is not clear.  Perhaps at that time he considered that the three yellows’ [essence] was easily brought out by boiling, however Fu Zi needs to be cooked a long time and therefore must be cooked separately.

III. Classic Presentations
A. With focal distention below the heart, if there is also chills and sweating, Fu Zi Xie Xin Tang masters it. (Shang Han Lun, line 155)

IV. Constitutional Perspective
A. Can be seen as a combination of a Fu Zi presentation with a Xie Xin Tang presentation.
B. While the original text only mentions chills and some sweating, the patient should also be listless or constantly drowsy.
C. Yakazu Domei used this formula for people with a Da Huang Huang Lian Xie Xin Tang presentation who had slightly cold hands and feet and were…

V. Typical Dosages
Zhi Fu Zi 15g
Da Huang 10g [Wine Fried]
Huang Lian 5g
Huang Qin 5g

VI. Constitutional Aspects
A. Discomfort in the upper abdomen, listless or drowsy, irritable and restless, palpitations, easily flustered, laconic or unclear of speech, chills, cold hands and feet, easily sweat;
B. Dry, greasy tongue coating; sunken pulse; and white as well
C. Sallow dark complexion
D. Usually have a history of gastric disorders or hypertension;
E. Most common in the middle-aged to elderly
F. Mental problems indicate may have brain problem to point of infarction
G. History of heart disease
H. Xie Xin Tang is for vomiting of blood, nose bleeds, focal distention.  Fu Zi is for listlessness, weak pulse, fear of cold, etc. tired to the point of hard to eat.  So this is a mixture of hot and cold, xu and shi.

VII. Indication #1 Hemorrhage
A. Hemorrhage from the upper digestive tract, vomiting of blood, epistaxis, cerebral vascular accident.
B. “This is appropriate for stomach disorders or vomiting of blood/nosebleeds whenever the pattern is excessive and hot with a yang deficient constitution.” Zheng Qin-An

VIII. Indication #2 – Stroke
A. Much on this in the Japanese literature.
B. The modern author Long Ye Yi Xiong [????] uses this for strokes where the exterior is cold and the interior hot. This is marked by irritability & incoherent speech.  C. May also have intermittent shaking of the head or spontaneous movements of the hands. For a Xie Xin Tang presentation but with a complexion that is not flushed, average color blood or anemia, cold hands and feet, perhaps a sunken pulse, and usually tension in the epigastrium.
D. Odai Yodo [mid 19th century]
“In the elderly with food stoppage, when they have a feeling of oppression and faint, they are unconscious, have epigastric fullness, icy cold extremities, a blood-drained complexion, cold sweat on the forehead, a hidden pulse that is almost impalpable, it looks as if they have had a stroke. This is called ‘food constraint’ or ‘food inversion’ and Fu Zi Xie Xin Tang is appropriate.”
N.B. Expansion of the ???  This is a pre-operative therapy approach.  Odai’s account may be MI, also GB problems affecting heart. Typically in elderly.

IX. Indication #3–Stomach Diseases
A. Stomach diseases in patients with yang deficient constitutions. Usually the person is robust, swarthy, and has a big belly and an enlarged tongue.
B. Good appetite but easily gets abdominal distention and diarrhea.
C. Usually add Gan Jiang and Gan Cao
NB: Dr. Huang uses this formula mostly for stomach diseases

X. Indication #4 Polycystic Ovary Syndrome
A. Usually with amenorrhea, diarrhea, poor sleep, flushed face with acne

XI. Indication #5 Recurrent oral ulcers
A. This is a sign one can use this formula, if cold constitution

XII. Food allergies
A. Can add Wu Ling San or Ping Wei San
B. If with severe diarrhea, Li Zhong Wan

Dose: 1.5-15g (to 45g or more)

HF: Some practitioners of the Warming Yang school use doses up to 150g a day. It has even been claimed that these high doses are less likely to produce “overheating”-type side effects than lower doses.

Wu Tou: main root
• Includes two types: Chuan wu, Sichuan aconite, the garden variety (the form that is commonly used), and Cao wu, the wild variety (even stronger and more toxic, rarely used internally).
• Acrid, bitter, warm, very toxic; enters the heart, liver, spleen, kidney.
• Expels wind-damp, disperses cold, alleviates pain.
• Cold-dampness: Bi syndrome, cold and pain in the chest and abdomen, intense headaches, pain from trauma.
• Severe migratory arthralgia.
• Heart pain that radiates toward the back.
• Better at dispelling cold, eliminating obstruction, and alleviating pain than Fu zi, but less tonifying and more toxic.
• Must be cooked at least 30-60 minutes before adding the rest of the herbs (some say 60-90 minutes).
• Frequently used topically for pain.
• Traditionally not to be combined with Bai mu, Gua lou, Bai ji, Ban xia, Bai wei.

Dose: 1.5-9g

Gan Jiang – Dry Ginger rhizome – Zingiber

Nature: acrid, hot

Enters: Spleen, Stomach, Heart, Lung

Actions: Warms the middle Jiao; rescues collapsed Yang; expels interior cold; warms the Lungs, resolves harmful body fluid, transforms phlegm; warms the channels, stops bleeding.

• Yang collapse: very weak pulse, cold limbs, etc. Gan jiang alone cannot be counted on. Combine it with Fu zi.
• Yang deficiency cold: hemorrhage of various types, especially uterine bleeding – only when the bleeding is chronic, pale in color, with cold limbs, white face, and a soggy, thin pulse.
• Spleen and stomach cold (either Yang deficiency or externally-contracted excess cold): cold and pain in the epigastrium and abdomen, vomiting, diarrhea.
• Lung cold: cough with thin white sputum, difficulty breathing, cold in the back.
• Raises blood pressure (by acting on central sympathetic centers).
• Downregulates some detoxification genes ““ may prevent some drugs from working
DY: Gan jiang is often used to reinforce the action of Fu zi. As a pair, they are used to return Yang and stem counterflow. For specific indications and notes on this combination, see Fu zi in this category.
Gan jiang warms the spleen and stimulates its functions of transformation and transportation. This has the effect of promoting the upbearing of the clear toward the Lungs and the downbearing of the turbid toward the large intestine. Furthermore, it prevents development of phlegm which the spleen tends to discharge into the Lungs. It transforms cold phlegm (the Chinese word for transform literally means “to melt”) in the Lungs by warming the Lungs. This then promotes diffusion and downbearing [by the Lungs]. In turn, this has the effect of regulating and freeing the flow of the water passageways in order to prevent the development of new phlegm, and downbearing the rebellious Lung Qi.
Gan jiang has clearly demonstrated its efficacy for cold-type asthma in clinical practice. It is, therefore, often systematically added to reinforce the impact of conventional treatments for this pattern of cough and asthma.
• With Wu wei zi: While Gan jiang treats the disease mechanism (see previous bullets), Wu wei zi treats the branch manifestations (i.e. cough and asthma) by securing the Lung Qi by its astringent nature. As a pair, Gan jiang andWu wei zi effectively warm the Lungs, transform phlegm, stop cough, and calm asthma. For indications such as cough and/or asthma with profuse, clear, and white phlegm due to cold in the Lungs, Lung Yang deficiency, or phlegm-cold. For these indications, the combination is used in Xiao Qing Long Tang accompanied by Xi xin.
• With Huang lian to eliminate cold accumulation and depressive heat, drain mixed cold and heat, in order to stop vomiting and diarrhea. The pair allows one to regulate upbearing and downbearing, to harmonize Yin and Yang, and to treat mixed cold and heat. The ratio of the two herbs can be adjusted (3-10g each) depending on whether heat or cold is predominant (use equal doses if heat and cold exist in equal proportion). For indications such as:
– 1. Vomiting, acid regurgitation, belching, epigastric pain or distention, and clamoring stomach (a feeling of hunger, burning, emptiness, unease, and sometimes pain in the stomach with nausea and acid regurgitation) due to a mixture of cold and heat in the stomach. (Ban Xia Xie Xin Tang) Use stir-fried Huang lian unless heat is severe.
– 2. Diarrhea, dysentery, and stomach rumbling due to mixed heat and cold and/or disharmony between the stomach and intestines. (Use stir-fried Huang lian unless heat is severe.)
– 3. Glossitis, stomatitis, and chronic, recalcitrant mouth ulcers due to spleen Yang deficiency and stomach fire.
Yoga: Sunthi, Nagara (dry), Ardraka (fresh): V, K-; P+
• Pungent, sweet/heating/sweet. The most Sattvic spice.
• With honey, it relieves Kapha.
• With rock candy, it relieves Pitta.
• With rock salt, it relieves Vata.
• Dry ginger is better than fresh as a stimulant and expectorant for reducing Kapha and increasing Agni.
• Fresh ginger is a better diaphoretic, better for colds, cough, vomiting and deranged Vata.
• The herb is also a heart tonic.
• Use as a paste for pain and headache.
BII: Carminative, intestinal spasmolytic.
• For all symptoms of motion sickness, and also for morning sickness in pregnancy.
• Some anti-inflammatory effects.
• Useful for migraines, arthritic conditions.
• Also useful in: atherosclerosis, headaches, inner ear dysfunction, nausea, vomiting, osteoarthritis, pain (rheumatic), rheumatoid arthritis.
Hsu: Raises blood pressure – reflexively stimulates the vasomotor center and stimulates the sympathetic nervous system.
• Anti-emetic, anti-diarrheal.
DY: This herb is specifically the older, more mature (dried) rhizome.

Dose: 3-12g
Pao Jiang: Quick-fried Ginger (or fried until slightly blackened)
• Bitter, astringent, warm. Enters the liver and spleen. Warms the channels, stops bleeding, alleviates pain.
• Stops bleeding associated with cold from deficiency: bleeding with defecation or uterine bleeding due to Spleen Qi/Yang deficiency such that blood is not held in the vessels.
• Less potent than Gan jiang at warming the interior, though may be better at treating lower abdominal disorders.

Gao Liang Jiang – Galanga rhizome – Alpinia officinarum

Nature: acrid, hot

Enters: Spleen, Stomach

Actions: Warms the middle Jiao, relieves pain.

Indications:
• Cold in the spleen and stomach: pain in the epigastrium and abdomen, vomiting, diarrhea, hiccups.
DY: With Xiang fu 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.
Gao liang jiang is very acrid and drying. Its action is drastic, and it should not be prescribed over a long period of time, for fear of damaging stomach Qi and Yin.
PCBDP: Carminative, stimulant.
• Dyspepsia.
• In a paste with bloodroot [Sanguinaria] to treat periodontal diseases (including gingivitis) and skin cancer.
• Has anti-ulcer activity, possible anti-tumor activity.
Hsu: Stomachic, analgesic (stronger than Gan jiang), broad antibacterial.

Dose: 1.5-9g

Hu Jiao – Black Pepper – “Barbarian Pepper”

Nature: acrid, hot

Enters: Large Intestine, Stomach

Actions: Warms the middle; disperses cold; alleviates pain.

Indications:
• Stomach cold: vomiting, diarrhea, abdominal pain.
• Diarrhea (chronic, non-infectious studied) – can be used orally or applied to the navel in a plaster.
• Nephritis: In one study, 10 patients were given two steamed eggs daily into which Hu jiao was placed prior to steaming. All but one patient (who had nephritis for 10 years) were cured.
• A large dose can be used for pain associated with malignancies.
• When prescribed in large doses (up to 30g), it must be cooked at least 2 hours.
• Contains piperine – used as a carrier to increase absorption of other substances through digestive tract (e.g., curcumin) and slow metabolism of certain drugs.
Yoga: Marich: The Sun, named because it contains large amounts of solar energy. Pungent/heating/pungent; K, V-; P+
• Stimulant, expectorant, carminative, febrifuge, anthelmintic.
• Chronic indigestion, toxins in the colon, degenerated metabolism, obesity, sinus congestion, fever, intermittent fever, cold extremities.
• Take nasally in ghee for sinus congestion, headache, seizures.
• Burns up Ama; energizes Agni.
• Good antidote for cold/raw food.
• With honey it is a powerful expectorant and mucus cleanser, dries up secretions.
• Excessive amounts can be an irritant – it is Rajasic in nature.

Dose: 1.5-4.5g

Rou Gui – Inner bark of Vietnamese Cinnamon (Cinnamomum loureirii)

Nature: acrid, hot

Enters: Kidney, Spleen, Heart, Liver

Actions: Tonifies heart fire and kidney Yang; disperses cold to relieve pain; warms, activates, and unblocks the channels; conducts floating Yang back into kidneys; encourages the generation of Qi and blood.

Indications:
• Kidney Yang deficiency, waning at the Ming Men: cold extremities, intolerance of cold, weak lumbar region and knees, impotence, frequent urination.
• Spleen and Kidney Yang deficiency: cold and pain in the epigastrium and abdomen, poor appetite, loose stools.
• Cold-dampness: low back pain, Bi syndrome.
• Failure of the kidneys to grasp the Lung Qi: wheezing.
• Yang deficiency: carbuncles.
• Qi and blood deficiency with cold: ulcers resistant to healing
• Floating Yang: flushed face, severe sweats, wheezing, weak and cold lower extremities, a deficient and rootless pulse (i.e. conditions of (false) heat above, cold below). Also used for other conditions where the upper part of the body is hot (e.g. dry mouth, sore throat, or toothache that become worse at night) and the lower part is cold (e.g. lower back pain, cold lower extremities, diarrhea, weakness in the proximal position of the pulse). To conduct floating Yang back to the kidneys, a tiny dose is used – 0.1 to 0.5g.
• Deep cold causing Qi or blood stasis: cold in the blood causing amenorrhea or dysmenorrhea; yin-type boils (concave, usually ooze a clear fluid), abscesses or sores that do not heal.
• With Qi and blood tonics as an auxiliary herb for chronic deficiency of Qi and blood.
• Injected into BL-13 for asthma. Clinical trials showed it to be very effective.
• Antibacterial and antifungal properties.
• Crush into small pieces before using.
• Weaker than Gui zhi at warming, activating, and unblocking the channels.
• Decoction causes loss of the volatile oils which are responsible for much of its effect. Usually taken directly as a powder, pill, or tincture (can also be added to a strained decoction).
• Recently used to treat blood sugar dysregulation and diabetes.
Yoga: Twak: pungent, sweet, astringent/heating/sweet; Sattvic; V, K-, P+
• Stimulant, diaphoretic, carminative, alterative, expectorant, diuretic, analgesic.
• Colds, sinus congestion, bronchitis, dyspepsia.
• Relieves pain of toothache, and muscular pain.
• Strengthens the heart, promotes Agni.
• Is less likely to aggravate Pitta than ginger is.
• Good general drink for Vata.
Hsu: Vasodilator, diaphoretic, alleviates pain due to GI spasms, inhibits abnormal fermentation processes in intestines.
DY: Supplements the source Qi.
• By supplementing source Qi, it assists in the engenderment of Qi, blood, and essence (as in Shi Quan Da Bu Wan [Ba Zhen Tang + Huang qi and Rou gui]).
• Real Rou gui is very expensive. Many importers sell the culinary quality – Gui pi – which has little medicinal value. It focuses on the middle burner. It does not reinforce kidney Yang or Ming Men fire.
• With Huang lian (3-6g each) to harmonize Yin and Yang, drain the south (heart fire) and supplement the north (kidney Yang), and re-establish the interaction between the heart and kidneys. For indications such as:
– 1. Insomnia, vexation, and agitation due to heart and kidneys not communicating. (Such as for kidney Yang deficiency which cannot move and upbear kidney water, which then becomes dead and stagnant, and fails to nourish heart Yin and control heart fire which rises upward. Use Jiao Tai Wan.)
• As a powder (Rou gui mo or Rou gui mian), some expense can be spared, as it needs only be prescribed at a dose of 1-2g daily, taken directly or added to a decoction within the last 5 minutes of cooking.
Dose: 1.5-4.5g (to conduct floating Yang back to the kidneys, use 0.1-0.5g)

 

Guan Gui: the thinner bark of trees that are 6-7 years old
• This bark has less oil than Rou gui, and is considered to be drier.
• Weaker than Rou gui for supplementing the original Qi, but better for warming the middle and drying dampness. Guan gui is mainly for the middle burner and spleen.
• Less tonifying for Yang Qi than Rou gui.
Dose: 4.5-9g
Rou Gui Xin (Gui Xin): the heart of Rou gui
• This is cinnamon bark which has been cleaned of its fine, superficial layer.
• It is believed to be superior for reinforcing heart Yang and for re-establishing the interaction between the heart and kidneys.

 

Also consider…
Essential Oil of Cinnamon 
K&R: Key for fatigue, weak digestion, weak libido.
• Sympathomimetic, adrenal cortex stimulant, carminative, astringent, antibacterial, oxytocic, antispasmodic.
Earth: flu, parasitosis, digestive mycosis, fatigue after infection, spastic colitis, obsessions, contracts uterus for labor, stimulates sexual appetite, stimulates CNS.
Metal: flu, hemoptysis, melancholy, stimulates psychic functions.
EODR: Cinnamon Bark Essential Oil: anti-inflammatory (COX2 inhibitor), powerfully antibacterial, antiviral, antifungal, anticoagulant, circulatory stimulant, stomach protectant (ulcers), antiparasitic (worms).
• Cardiovascular disease, infectious diseases, viral infections (herpes, others), digestive complaints, ulcers, warts.
• Dilute 1 part essential oil in 4 parts vegetable/seed (fixed) oil; apply 1-2 drops on location.
• May irritate mucus membranes if inhaled undiluted.

Wu Zhu Yu – Evodia fruit

Nature: acrid, bitter, hot, slightly toxic

Enters: Liver, Spleen, Stomach, Kidney

Actions: Warms the middle Jiao, disperses cold, relieves pain; stops diarrhea; frees the liver Qi; redirects rebellious Qi, stops vomiting; warms the liver channel and organ; dries dampness; expels damp-cold; leads fire downward (topically).

Indications:
• Yang deficiency cold in the middle Jiao: severe pain in the epigastrium and abdomen.
• Liver and/or stomach channel disorders from cold or phlegm: headaches, epigastric pain, nausea, drooling, reduced taste sensation, pale tongue, wiry or weak pulse.
• Cold in the liver channel: hernial disorders.
• Liver Qi stagnation, Qi rebellion, or Liver attacking the stomach: vomiting, acid reflux, flank pain, severe vertex headache. For liver/stomach disharmony (liver channel heat attacking the stomach), Zuo Jin Wan is commonly used – 6 parts Huang lian with 1 part Wu zhu yu. Indications: hypochondriac pain, indeterminate gnawing hunger, epigastric focal distention, vomiting, acid regurgitation, belching, bitter taste in the mouth, dry mouth, red tongue, yellow coat, wiry, rapid pulse.
• Topical: Grind the herb to a powder. Combine it with water or vinegar (vinegar is stronger) to form a mud. Apply it to the soles of the feet (covering K-1) and cover it with plastic wrap. Put socks on and walk on it for up to 6 hours. This tonifies/warms the kidneys for kidney deficiency; leads fire downward – for rising Yang, mouth or tongue sores, toothache; speeds up metabolism (helps weight loss); lowers blood pressure (in 12-24 hours). This method of application may lose efficacy (particularly for weight loss) after several consecutive treatments.
• Irritable bowel syndrome: powder the herb, mix it with vinegar, and apply it to the navel.
• Useful for early and subacute eczema, childhood eczema, and localized neurodermatitis.
• Antibiotic and antiparasitic effects; analgesic.
• The constitutents evodiamine, evodol, and rutaecarpine are anti-inflammatory via COX-2 enzyme inhibition.
• Very drying. Can injure the Qi. Not for long term use.
• Administering a Gan cao decoction before this herb can reduce its side effects.
• Contains small amount of 5-MeO-DMT (about 0.21% in aerial parts), a powerful psychedelic (also one of the active ingredients [through different plant sources] in Ayahuasca).
Hsu: Constricts the uterus; anthelmintic; antifungal; analgesic; stimulates blood circulation.
• Large doses cause CNS stimulation and hallucinations [probably due to DMT content].
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 it becomes.
• With Huang lian to effectively drain liver fire, harmonize the stomach, downbear counterflow, and stop pain, acid regurgitation, and vomiting. For indications such as:
– 1. Lateral costal pain and distention, nausea, vomiting, acid regurgitation, belching, clamoring stomach, and a bitter taste in the mouth due to liver depression transforming into fire which disturbs the stomach. (Zuo Jin Wan)
– 2. Diarrhea and dysentery due to damp-heat.
– The usual dosage for this pair is 3-10g Huang lian and 2-5g Wu zhu yu. Traditionally, the combination is for liver fire causing liver-stomach disharmony which, in turn, leads to nausea, vomiting, and acid regurgitation. In this case Huang lian should be prescribed in a larger quantity and Wu zhu yu in a lesser amount. However, this pair can also be used in patterns where cold and heat are mixed. In this case, if heat is predominant, the dosage of Huang lian should be proportionately more. If there is concomitant stomach Yin deficiency, add Shi hu. If cold is predominant, the dosage of Wu zhu yu should be proportionately more. If there is concomitant Qi deficiency, add Dang shen. If cold and heat are present in identical proportions, the quantities of both herbs should be equal.

Examine.com:

1. Sources and Composition

1.1. Sources

Evodia Rutaecara, the dried unripe fruit of which is also known as Wu zhu yu (Wu Chu Yu, interchangeably) or Evodia Fruit, is a herb used in Traditional Chinese Medicine at doses of 3-9 grams (of the berries) for the purposes of warmth, intestinal comfort (specifically; to alleviate abdominal pain, acid regurgitation, nausea and diarrhea), dysmenorrheal, and fighting inflammation and infections.[1] It is frequently used in a combination supplement called Wu Zhu Yu Tang, which consists of Evodia fruit with Jujube Fruit and Panax Ginseng (1:1:1 ratio) and Ginger root (twice the amount of any one other ingredient) which is a decoction used for hypertension or as Zuo jin wan which is used for gastrointestinal distress alongside Rhizoma Coptidis at a 1:6 ratio (Evodia:Coptidis). Another decoction exists called Fan zuo jin wan, which is Rhizome Coptidis and Evodia in the inverse ratio.

When consuming Wu Zhu Yu Tang in a traditional manner, the estimated intake of Rutaecarpine is 16mg daily (extrapolated from the average intake of 9g berry extract taken thrice a day) and slightly higher levels of evodiamine.[2][3]

Traditionally eaten when you are cold; apparently warms you up real nicely while making your stomach and intestines happy. Also supposedly fights cancer

1.2. Composition

  • Evodiamine[4] and dehydroevodiamine, two forms of one of the main compounds belong to the ‘quinazolinocarboline alkaloid’ class [5] Evodiamine is found in the range of 0.2-1.6%, with the lower range of the samples tending to have more dehydroevodiamine (0.12-0.86%), suggesting interconversion[6]
  • Rutaecarpine and its metabolite 10-hydroxyrutaecarpine (as well as the former’s glycoside, rutaecarpine-10-O-rutinoside[7]) the forms of the other main quinazolinocarboline alkaloid.[5] Rutaecarpine is at around 0.15-0.55% in evodia fruit.[6]
  • Other quinazolinocarboline alkaloids such as wuchuyine and rhetsinine[8][9] and Evodiamide, which is at around 0.005-0.08% usually, although some plants have been noted as high as 0.4-0.6%[6]
  • The quinoline alkaloids Evocarpine, Dihydroevocarpine, 1-methyl-2-n-nonyl-4(1H)quinolone[5] as well as a large amount (17+) of others[10]
  • Wuzhuyuamide-I[7] at low levels (0.00003%)[11] and Wuzhuyuamide-II, two similarly structured compounds to evodiamine and rutaecarpine[12]
  • Flavonoids and flavonoid glycosides such as isorhamnetin-7-O-rutinoside and diosmetin-7-O-?-d-glucopyranoside[5]
  • Acylgluconic acids such as trans-feruloylgluconic acid and trans-caffeoylgluconic acid[11] at 0.00003% and 0.0006% whole fruit, respectively (although can be isolated in a methane-ethanol extraction)[11]
  • Limonoid compounds such as Limonin[13] (not to be confused with Limonene) as well as evodirutaenin, evodol, and shihulimonin A[14]
  • Myo-Inositol[11] at 8g per 299.5g sample (2%)[11]
  • Pthalic acid dibutyl ester at 8mg per 299.5g (miniscule)[11]
  • Essential oils of ?-pinene (72.82%), 1R-?-pinene (8.90%), and ?-myrcene (1.99%)[15]

Despite the similarities in action to Capsaicin, which is hot pepper extract; isolated evodiamine possesses no significant taste nor spiciness. A large amount of crystal data for evodiamine can be found here.[4]

2. Pharmacology

2.1. Serum values

After oral administration of a Wu zhu yu decoction (Evodia, Panax Ginseng, and Jujubae Fructus at a 1:1:1 ratio, and Ginger at twice the amount of any one ingredient; ethanolic extract) given at 12g/kg orally (2.4g/kg Evodia ethanolic extract) the following parameters were found for various compounds in Evodia Rutaecarpa.[5]

  • Evodiamine had a half-life of 0.93 ± 0.45 hours, a Tmax of 1.49 ± 0.22 hours, a Cmax of 19.52 ± 8.17ug/mL, and an AUC of 71.27 ± 15.52ug/h/mL.[5] Another study finding a Cmax of 49 ± 19ng/mL after 500mg/kg ingestion evodiamine in isolation,[17] along with the former pinpoint a bioavailability of pure evodiamine at around 0.1% in isolation and slightly higher as Evodia Rutaecarpa. Another study using basic Evodia ethanolic extract found that 40mg/kg of an extract (35% evodiamine by weight, so 14mg/kg) conferred a Cmax of 164.8 ± 65.1ug/mL;[18] relative to the previous study, this suggests that a dose of 35.7-fold lower, if taken in an ethanolic berry extract, has an average peak blood concentration 3.36-fold higher. The Tmax in all studies seems to hover between 30-60 minutes, however.[17][18][5]
  • Rutaecarpine had a half-life of 0.98 ± 0.39 hours, a Tmax of 1.26 ± 0.23 hours, a Cmax of 13.46 ± 7.03ug/mL, and an AUC of 62.44 ± 18.85ug/h/mL.[5] Another study found low bioavailability of Rutaecarpine in isolation (Concentration of 2.4 ± 3.0ng/ml 30 minutes after 40mg/kg crude drug[19]) but administering Rutaecarpine as a solid dispersion (mechanical technique) increased the concentration in the blood 7.5-fold (to 18.1 ± 1.8ng/mL[19]) Nanoemulsions have also shown benefit in increasing the absorption rates.[20] A basic concentration ethanolic extract of Wu Chu Yu (pre-ripe) berries (40% of a 40mg/kg oral ingestion, so 16mg/kg), reaches blood levels of 215.3 ± 80.4ug/mL in rats.[18] The improvement in bioavailability is similar to that seem with evodiamine, where an oral dose 2.5-fold lower can have a blood concentration 89.7-fold higher if consumed in the form of a concentrated berry ethanolic extract. Similar to evodiamine, Tmax of all studies hovered around 30-60 minutes regardless of the Cmax.[5][19][18]
  • Dehydroevodiamine had a half life of 0.79 ± 0.21 hours, a Tmax of 1.07 ± 0.15 hours, a Cmax of 7.64 ± 0.63ug/mL, and an AUC of 12.39 ± 2.71ug/h/mL.[5] In isolation, dehydroevodiamine appears to have better bioavailability than the previous two molecules (averaged at 15.35% in rats[9]) yet at least one study has investigated Dehydroevodiamine and its circulating levels in conjunction with other plants, and consumption of Evodia alongside Rhizoma Coptidis (1:6 ratio, combination known as Zuojinwan) appears to preserve the Tmax (1.6 hours without, 1.8 hours as Zuojinwan) yet elevate the Cmax 2.66-fold (15,383 ± 7166 to 40,992 ± 21,052) while reducing the Tmax (3.5 ± 3.0 hours to 1.5 ± 1.1) and causing a large increase in the AUC to infinity by 174% (68,134 ± 19,162 to 186,715 ± 39,211).[21]

The three main components of Evodia Rutaecarpa all appear to be highly subject to herb-herb interactions, where their absorption and circulating levels are much higher when in the form of the whole plant rather than isolated chemical and even higher when paired in Traditional Chinese Medicine decoctions. It may be worthless to supplement evodiamine or rutacarpine in isolation if your goal is to get it to your blood (fine if you want it in the colon) due to poor bioavailability

  • 10-hydroxyrutaecarpine had a Cmax of 0.76 ± 0.16ug/mL and a Tmax of 0.50 ± 0.25 with an AUC of 9.32 ± 2.93ug/h/mL, but an undetectable half-life.[5]
  • 1-methyl-2-n-nonyl-4(1H)quinolone had a Cmax of 3.16 ± 1.28ug/mL at a Tmax of 0.77 ± 0.15 hours, its AUC was 9.83 ± 1.51ug/h/mL and half-life was 2.18 ± 0.47 hours.[5]
  • Evocarpine had a half-life of 0.53 ± 0.18 hours and a Tmax of 0.88 ± 0.17 hours, with a Cmax of 11.53 ± 6.97ug/mL and an AUC of 33.66 ± 10.52ug/h/mL.[5]
  • Dihydroevocarpine had a half-life of 0.49 ± 0.21 hours and a Tmax of 0.79 ± 0.15 hours, a Cmax of 6.05 ± 2.87ug/mL and an AUC of 16.53 ± 5.79ug/h/mL.[5]
  • Isorhamnetin-7-O-rutinoside had a half-life of 0.67 ± 0.30 hours, a Tmax of 0.95 ± 0.25 hours, a Cmax of 2.21 ± 0.32ug/mL, and an AUC of 7.54 ± 1.03ug/h/mL.[5]
  • Diosmetin-7-O-?-d-glucopyranoside had a half-life of 0.95 ± 0.51 hours, a Tmax of 1.53 ± 0.17 hours, a Cmax of 1.73 ± 0.51ug/mL, and an AUC of 9.41 ± 3.57ug/h/mL.[5]

In general, all compounds tend to have low to moderate bioavailability and relatively rapid pharmacokinetic profiles; hitting their peak concentrations in the blood before or at an hour after administration. Evodiamine and Rutaecarpine seem to really benefit from being ingested as a whole berry rather than isolated compounds

2.2. Systemic Distrubution

Evodiamine appears to be carried in the blood and distributed into organs, and one study in rats found the volume of distribution to be 560ml/kg[22] and found evodiamine (and metabolites) to be deposited in the liver, kidneys, heart, lung, and adipose tissue at a concentration higher than plasma, and other tissues it diffused in were at lower levels relative to plasma.[22]

2.3. Brain Distribution

When investigating dehydroevodiamine, it has been demonstrated that this molecule can cross the blood brain barrier of the rat and enter the brain via linear kinetics.[23] When a plasma level of 4.82 ± 1.55 ?g/mL was measured in rats, the concentrations in the brain were 1.11 ± 0.4 (cortex), 0.93 ± 0.24 (hippocampus), 0.64 ± 0.28 (striatum), 1.13 ± 0.33 (cerebellum), 1.04 ± 0.3 (brain stem), and 1.18 ± 0.18 ?g/g (everything else).[9] On average, concentrations of dehydroevodiamine that circulate in the brain are 3-4x lower than plasma levels.[9]

2.4. Metabolism and Enzymatic Interactions

Dehydroevodiamine appears to be subject to P450, and its circulating metabolites consist of five glucuronides (two identified ones at the 10 and 11 carbon) and one sulfate (Dehydroevodiamine-12-sulfate) in freely moving rats.[9]

Rutaecarpine is metabolites mostly by cytochrome P450 1A2 (aromatase) at the 10, 11, and 12 carbon positions, although 3 is not unheard of[24][25] and into the four metabolites of 3, 10, 11, or 12-hydroxyrutaecarpine.[26] Metabolism into 3- and 10- hydroxyrutaecarpine is strongly inhibited by ketoconazole, suggesting it is metabolized by CYP3A4; the other two metabolites (11- and 12-hydroxyrutaecarpine) are metabolized by CYP1A but can also be metabolized by CYP3A4 and CYP2D6.[3]

Interestingly, Rutaecarpine’s metabolite 10-hydroxyrutaecarpine, which is produced by CYP3A4, can act as an aromatase inhibitor, inhibiting CYP1A1 and CYP1A2 (two aromatase isomers) with IC50 values of 2.56 ± 0.04uM and 2.57 ± 0.11uM, respectively.[3] Rutaecarpine also shares aromatase inhibitory potential with preference for CYP1A2,[27] but prolonged (3 days) ingestion of rutaecarpine,[28] Evodia,[2] or a Wu Zhu Yu Tang mixture of which effects are attributable to Evodia[2] may cause CYP1A induction and thus the opposite effects of inhibition.

Rutaecarpine technically is an aromatase inhibitor, but causes increased aromatase activity relatively quickly

CYP1B1 is also inhibited by 10-HRT at 0.09 ± 0.01uM.[3] CYP3A4 seems to be unaffected by rutaecarpine.[28]

2.5. Excretion

24 hours after administration of evodiamine, 82% of evodiamine and its metabolites are excreted with 23% of that excretion occuring via the urine and the rest via feces.[22]

After an oral bolus of 500mg/kg bodyweight dehydroevodiamine, most of it is conjugated by P450; the amount of unchanged metabolite in the urine and feces are 0.5% and 6% of the initial oral dose, respectively.[9]

Rutaecarpine has a large amount of fecal excretion (~42%) after oral ingestion, and its main urinary metabolite is 10-hydroxyrutaecarpine, which is the result after rutaecarpine interacts with the CYP1A2 enzyme.[26]

3. Mechanisms of Action

3.1. Vanilloid Receptors

Evodiamine is an agonist of the vanilloid receptor,[29] a property also seen with the red pepper extract Capsaicin. It appears to be slightly less potent than capsaicin, requiring thrice the concentration in vitro to maximally stimulate the receptors.[29][30]

Through interactions with vanilloid receptors, Evodia Rutacarpa possesses antinocioreceptive (pain relieving) effects.[31]

4. Interactions with Fat Mass and Obesity

4.1. Thermogenesis

Evodia Rutacarpa has been investigated for its effects on body fat due to it being used traditionally as a warming agent and as a ‘hot herb’; references to thermogenesis in the Chinese literature.

1-3mg/kg bodyweight evodiamine administered subcutaneously was able to drop core body temperature by 1C in fasted mice, while fed mice required 10mg/kg to achieve the same effect.[32] These drops in internal temperature were matched with extra heat dissipation from the rat tail, indicative of thermogensis, almost immediately.[32] The ability of evodiamine’s mechanisms of action, TRPV1 activation, to make areas tolerant to the cold is also a possibility; cold hyposensitivty (responding less to the cold) indirectly increases perceptions of heat.[33]

This heat production, however, is not the sole reason for evodiamine’s fat burning effects.[34]

Evodiamine has been traditionally used to increase warmth, and it appears it might increase both heat production and reduce the perception of cold. However, the studies from which this data is drawn are not suited to human oral consumption of Evodia

4.2. Effects in adipocytes

When incubated in preadipocytes, evodiamine is able to activate the MAPK cascade, which reduces insulin-induced phosphorylation of Akt and also PPAR? activity, which thus decreases preadipocyte differentiation.[34] The classical mechanisms of evodiamine, as agonist of TRPV1 receptors,[35] can also work to reduce preadipocyte differentitation;[36] thus there may be two similar mechanisms of action occurring.

Inhibition of preadipocyte differentiation has been noted elsewhere relatively dose-dependently, but most significantly at 4uM concentration or above[37] and in vivo following injections of evodiamine.[38] The authors mentioned this was ‘negative crosstalk’ with insulin signalling, which interferes with its effects.[34]

Evodiamine appears to exert anti-obesity effects via inhibiting preadipocyte differentiation

4.3. Interventions

One study on mice fed 0.03% evodiamine and rats fed 1.35% evodia extract (standardized to 0.02% evodiamine) in their obesity causing diets over 21 days showed no difference in food intake compared to control (important to note, as the adverse taste of Capsaicin screws with food intake in animal studies) but a small reduction in fat mass on mice (28% reduction of perirenal fat, 11% less epididymal fat) and decreases in weight (-10.3% relative to control) and increased thermogenesis; suggesting evodiamine may exert an anti-obesity effect.[32] Another study investigating mechanisms fed 0.03% evodiamine for 6 months and noted significant anti-obesity effects by reducing the rate of weight gain, and this persisted in UCP1 knockout mice who were unable to produce heat from evodiamine.[34]

Evodiamine has been shown to prevent fat gain to a degree in mice fed a diet that induces fat gain, but has not yet been demonstrated to induce fat loss. The heat producing effects of evodiamine may not be related to attenuation of fat gain

5. Interactions with Inflammation

5.1. Endothelium

When evodiamine is incubated with endothelial cells, it is able to inhibit IL-1? (at 10uM) and Thromboxane B2 (TXB2) secretion (at 10uM) in response to inflammatory signals (LPS) and was able to decrease the levels of E-selectin on endothelial cells; although no response was dose-dependent.[39]

5.2. Macrophages

Both evodiamine and rutaecarpine have been shown to inhibit PGE(2) production in macrophages that are stimulated by LPS (a pro-inflammatory signal)[40] and in macrophages undergoing hypoxia.[41] Evodiamine was further able to prevent upregulation of COX-2, a pro-inflammatory enzyme, while rutaecarpine was ineffective at doing so.[40] Dehydroevodiamine can also reduce COX-2 activity and mRNA translation[42] while rutaecarpine seems to be more of a direct inhibitor rather than manipulating protein content of COX enzymes, able to inhibit both COX-1 and COX-2 with IC50 values of 8.7uM and 0.28uM, respectively.[43]

Another compound, goshuyuamide II, was demonstrated to be able to inhibit 5-LOX and reduce synthesis of leukotrienes.[40]

5.3. Cytosolic Signalling

The combination decoction of Evodia Fructae and Coptidis Chinensis 1:6 (Zuo Jin Wan) has been shown in vitro to inhibit both nF-kB translocation and AP-1 signalling in HepG2 (liver) cells with IC50 values of >200 and 22.9?g/ml for AP-1 and nF-kB, respectively for the combination.[15] Berberine was able to inhibit AP-1 and nF-kB with IC50 values of 9.5 and 50?M, respectively, while Evodiamine was only inhibitory on AP-1, and to lesser potency than Berberine.[15]

Evodiamine has been shown to inhibit nF-kB activation in macrophages at 1-10uM concentration in response to pro-inflammatory signals.[40]

6. Interactions with Cancer

6.1. Topoisomerase Inhibition

Topoisomerases (I and II) are enzymes that regulate the separating of DNA strands so DNA can be replicated. DNA gets unwound when a phenolic nucleophile attacks the 3′ end of DNA, causing it to bind to Tyr723 on the TopoI enzyme, which allows DNA to unwind and relax; it is eventually then attacked by the 5′ end of the DNA and the two ends reunite in a process called religation. Topoisomerase I basically holds the 3′ end for a bit while DNA gets replicated.[44] Topoisomerase I inhibitors can prevent DNA from religating, and induce cytotoxicity (cell death); which is actually a good idea for cancer cells that overexpress Topoisomerase I as they die much faster than regular cells.

Evodiamine has an IC50 value of 6.02uM in MCF-7 breast cancer cells, which express high levels of Topoisomerase I, and only slightly less cytotoxic than Camptothecin which is a research standard drug.[45] Evodiamine is able to prevent DNA religation in a concentration-dependent manner in a similar manner to Camptothecin, by making a complex with Topoisomerase I and the 3′ DNA strand it holds.[45] Evodiamine has demonstrated cytotoxixity in breast cancer cells elsewhere[46] and was shown in adriamycin-resistant breast cancer cells to induce cell death both in vitro and in vivo with a potency greater than that of paclitaxel.[47]

Evodiamine is a dual catalytic topoisomerase I and II inhibitor,[48] and shows efficacy against some cells that are resistant to the more potent topoisomerase I inhibitor Camptothecin,[48] and does not seem to induce DNA damage.[48] A flavanoid from evodiamine also possesses dual inhibitory potential.[46]

A mechanism by which Evodia Fructs may be anti-cancer; awaits more studies to see its overall clinical relevance, but its dual inhibition is novel and promising at least

6.2. Apoptosis

Apoptosis, or the event of cell death, is an important biomarker in cancer therapy.

Evodia components have been demonstrated to induce apoptosis in gastric cancer cells (SGC-7901)[49][50][51] and (N-87),[10] Breast cancer cells (MCF-7)[52][46][45] and (NCI/ADR-RES),[53] Liver cells (HepG2),[10][54] Leukemia cells (HL-60)[10] (THP-1)[52] and (U937),[55] Lung (H-460)[10] and (LLC),[56] Colon (COLO-205),[57][58] Thyroid (ARO),[59] Melanoma (A375-S2),[60][61][52][62] and (B16-F10),[56] Cervical Cancer (HeLa),[63][52] fibrosarcoma (L929),[52] and has been demonstrated in vivo to inhibition the Sarcoma-180 tumor model when fed as the decoction Zuo jin wan.[64][65] More often than not, these effects are attributed to Evodiamine and its metabolites although in some instances flavanoid glycosides are to credit.

7. Nutrient-Nutrient Interactions

7.1. Caffeine

When rutaecarpine (active indole in Evodia) is fed to rats, the AUC and Cmax values of Caffeine are significantly reduced; meaning rutaecarpine can reduce the exposure of caffeine to the body.[66][67] This also extends to the similar xanthine compound theophylline.[68] These effects extend to consumption of Evodia itself, and combination decoctions such as Wu Chu Yu-Tang.[67]

This effect is rather significant; pretreatment of 80mg/kg oral Rutaecarpine daily for 3 days (a high dose, but its bioavailability is unaugmented) in rats reduced the Cmax to 31% of the control group, the Tmax to 22%, the AUC to 5% of control, and reduced the half-life from 0.73+/-0.07 hours to 0.27+/-0.1 hours.[66] Similar trends were seen for all metabolites of caffeine (paraxanthine, theophylline, theobromine)

Rutaecarpine is able to induce (increase) activity of various hepatic enzymes such as CYP1A2, CYP2B, and CYP2E1;[28][69] CYP2E1 induction is seen at 80mg/kg oral ingestion in rats while only 20mg/kg is needed for CYP1A2.[67] As Caffeine is highly metabolized by CYP1A and CYP2E1, their increased activity causes greater metabolism of caffeine in a shorter time frame and thus limits systemic exposure.

Rutaecarpine appears to potently suppress the circulating levels of caffeine via increasing hepatic and intestinal degradation; a highly antagonistic compound

7.2. Rhizoma Coptidis

The pair of Evodia fruit and Rhizoma Coptidis (rhizome of Coptis chinensis) is known as Zuo jin wan and is a Traditional Chinese Medicine decoction for gastrointestinal distress. It is paired with 6 parts Rhizoma Coptidis to 1 part Evodia Fructus (6:1 ratio). Conversely, reversing the ratio and favoring Evodia in the 6:1 ratio is the basis for Fan zuo jin wan, another Chinese decoction.[70]

Coptis and Evodia form a dichotomy of cold and hot (Yin and Yang), respectively, where Coptis reportedly induces a cold state and a seeking process for a warm environment while Evodia induces heat and the seeking behavior for a cold environment.[71] Coptis seems to be able to reduce internal body temperature and oxygen consumption in mice and prolong time spent in a warm environment (as assessed by warm pads) while Evodia increases time in a cold environment, and increases both oxygen consumption and body temperature.[71] Zuo jin wan is classified as cold whereas Fan zuo jin wan is classified as warm.[70][71] The only currently known biomarker for this temperature preference is liver ATPase activity.[72][73]

Coptis Chinensis and Evodia Fructus appear to be mostly antagonist to each other in how they are seen to affect temperature; yet they are used together in decoctions and mixtures (some Yin Yang stuff I guess). The historical reports of Evodia’s ‘heat’ and Coptis’s ‘cold’ properties actually do seem to have some merit, as evidenced by the rat preference tests trying to bioregulate their temperature

When looking at the pharmacokinetics of the combination, Rhizoma Coptidis appears to benefit the pharmacokinetics and circulating levels of some bioactives in Evodia such as dehydroevodiamine[21] by about 274% of the value of Evodia alone despite the same oral dosage (AUC value).[74] Evodia seems to either not significantly affect the pharmacokinetics of some Coptidis molecules such as coptisine (acutely)[21] yet increase general absorption[75] but can reduce the AUC of various alkaloids (coptisine, palmatine, jateorrhizine) after prolonged ingestion and reduce the AUC and Cmax values of the Berberine content of Coptidis Rhizoma either chronically[75] or acutely.[74] This was hypothesized to be secondary to Evodia Fructus pretreatment enhancing the expression of hepatic UGT1A1, a sulfation enzyme, which conjugated compounds in Coptidis Rhizoma.[75]

Coptidis chinensis rhizome enhances the bioavailability and circulating amount of co-ingested Evodia fruit, but Evodia fruit hinders the absorption and circulating amount of the active ingredients of Coptidis Chinensis; almost as if the former is sacrificing itself for the latter

7.3. Paeoniflorin

Paeoniflorin is the main bioactive found in the herb Paeonia Lactiflora, and its bioavailability and circulating amounts are enhanced by various herbs. Although not to the same degree of Fennel fruit (which increases bioavailability to 226.02% of the level of Paeoniflorin in isolation), consumption of Paeoniflorin alongside Evodia fruit elevates relative absorption to 123.62%.[76]

Paeonia Lactiflora doesn’t do much for Evodia, but Evodia enhances the absorption of Paeonia Lactiflora bioactives

Dose: 3-9g

Xi Xin – Asarum root – Often referred to as “Wild Ginger,” though unrelated to ginger – “Thin Acrid”

Nature: acrid, warm, slightly toxic

Enters: Lung, Kidney

Actions: Alleviates pain; releases the exterior, eliminates wind, disperses cold; warms the Lungs, resolves harmful fluid, transforms phlegm; opens the nose; mildly promotes sweating.

Indications:
• Wind-cold or any exterior cold pattern, especially with the addition of dampness or underlying Yang deficiency: headache (especially Shaoyin, radiating to the teeth), toothache, body aches, Bi syndrome, other pain.
• Cold and harmful fluid in the Lungs: cough with thin, whitish sputum, difficulty breathing.
• Nasal congestion – various types.
Shaoyin syndrome, fever, deep pulse.
• Topical: in powder, mixed with water and glycerine, and applied to the navel (for at least 3 days) for oral lesions.
• Better at warming the interior than releasing the exterior.
• For nasal and oral problems, it is often powdered and sucked directly into the affected areas.
• Antipyretic; analgesic.
• Liu: Can be used in doses as high as 10g daily for body aches. Monitor the patient for signs of toxicity – not for prolonged use at higher doses.
• Bensky/Gamble classifies this herb with acrid warm herbs that release the exterior.
• Contains aristolochic acid in aerial parts. Use only the root

• Caution in patients with renal problems. May be restricted by FDA.
Hsu: Local anesthetic, analgesic; antitussive.
DY: Powerful analgesic. Despite its warm quality, it can be combined with appropriate herbs for any pain pattern.
• Toxic at doses over 5g per day.
IBIS: Carminative, diaphoretic.
• Avoid in stomach inflammation and/or intestinal inflammation due to its spicy stimulant effects (Brinker).
• Avoid during pregnancy due to its emmenogogue and abortifacient effects (Lewis & Elvin).

Dose: 1-3g

Xiao Hui Xiang – Fennel seed

Nature: acrid, warm

Enters: Liver, Kidney, Stomach, Spleen

Actions: Disperses cold, relieves pain; regulates Qi, harmonizes the stomach; frees the liver Qi, warms and moves the liver channel and lower Jiao, warms the kidneys.

Indications:
• Cold in the liver or kidneys: severe pain in the lower abdomen and testes, especially in cases of hernia. Useful for any kind of lower abdominal pain due to cold. In one study of 26 cases of incarcerated hernia, Xiao hui xiang was given orally and then patients were asked to lie supine with their knees bent. The hernia and symptoms were reduced in 22 cases, usually within a half hour. The longer the incarceration, the less effective the treatment.
• Stomach cold: vomiting, poor appetite, indigestion, distending pain in the epigastrium or abdomen. (Wu zhu yu and Ding xiang are superior.)
• Regulates intestinal peristalsis, reducing emptying time and increasing the passage of gas. It also relieves spasms of the intestines.
• Topical: powder the herb, heat it (under a TDP lamp, in a microwave, or by dry-frying it), put it in a tea bag, and place it over a hernia or an area with a sensation of cold or pain.
• Hydrocele of the tunica vaginalis: Xiao hui xiang was given (with salt and other ingredients) at bedtime with rice wine. 59 of 64 cases were cured at six weeks and 1 was improved.
K&R: Carminative, eupeptic, expectorant, antispasmodic, galactagogue, diuretic (azoturic), urinary antiseptic.
• Earth deficiency, water deficiency, metal deficiency.
Earth: digestive insufficiency, colic, pediatric abdominal pain.
Metal: intestinal colic, colitis, pediatric- expectorant for bronchitis, asthma.
Water: oliguria, renal calculi, amenorrhea, frigidity, impotence, urinary infection.
• Use with a laxative for constipation with poor intestinal tone.
• Sedative and carminative for excitable children with indigestion.
Yoga: Shatapushpa: sweet, pungent/slightly cooling/sweet; VPK=
• Carminative, stomachic, stimulant, diuretic, antispasmodic.
• Indigestion, low Agni, abdominal pain, cramps or gas, difficult or burning urination, children’s colic.
• Stops griping from purgatives.
• Helps promote menstruation and lactation.
• Good for all constitutions. Strengthens Agni without aggravating Pitta.
• The aroma acts on the mind, produces alertness.
Hsu: Expectorant, stomachic.

Dose: 3-9g