Nature: acrid, warm
Enters: Pericardium, Liver, Gallbladder
Actions: Promotes blood and Qi circulation; eliminates external wind; relieves pain; moves Qi upward.
• Blood (and Qi) stasis: irregular menstruation, amenorrhea, difficult labor, lochioschesis, and many kinds of pain, including abdominal, chest, flank, hypochondriac, dysmenorrhea, pain from traumatic injury, pain from carbuncles and boils, headaches, Bi syndrome.
• External wind disorders: headache, dizziness, painful obstructions, skin disorders; wind-damp arthritis/rheumatism.
• Reaches from the head down to the sea of blood.
• For a variety of wind patterns (wind-cold, wind-heat, wind-dampness, etc.) depending on the herbs it is combined with.
• Overdose may cause vomiting and dizziness.
Hsu: Antispasmodic, analgesic: inhibits intestinal and uterine contraction; slightly hypotensive; tranquilizer (essential oil); antibacterial, antifungal.
DY: Treats the Qi within the blood; dispels stasis; in the upper body, it goes toward the head and the eyes; in the lower body it goes toward the sea of blood (uterus [“Sea of Blood” may also indicate the Chong Mai or liver]); drying.
• For wind-cold (headache, etc.), use the uncooked form.
• For menstrual problems, pain, and inflammations, use the wine-processed form.
• With Dang gui to move the Qi and quicken the blood without damaging the blood, to nourish the blood without producing stasis, to dispel stasis and stop pain. For the following indications, both herbs should be wine-processed, though uncooked Chuan xiong may be used in the case of headaches or dermatological problems:
– 1. Menstrual irregularities, dysmenorrhea, and postpartum abdominal pain due to blood stasis that may be mixed with Qi stagnation. (Xiong Gui San)
– 2. Rheumatic pain due to wind-dampness and blood vacuity.
– 3. Headaches due to blood deficiency and/or blood stasis. (Jia Wei Si Wu Tang)
– 4. Wounds, ulcers, or enduring cutaneous inflammations due to Qi and blood vacuity with Qi and blood stagnation. (Tou Nong San)
• With Shi gao to dispel wind, clear and drain heat, quicken the blood and move the Qi, and stop pain. For headaches due to wind-heat or full heat (particularly that which is located in the Shaoyang or Jueyin channels). Use unprepared Chuan xiong. For wind-heat headaches, add herbs that dispel wind.
• Headaches: Chuan xiong is mainly used for wind-dampness and wind-cold headaches. However, it can be used for all kinds of headaches if combined appropriately. For wind-damp, add Qiang huo and Bai zhi. For wind-cold, add Fang feng and Jing jie. For wind-heat, add Ju hua and Bo he. For blood stasis, add Hong hua and Yan hu suo. For blood deficiency, add Dang gui and Ji xue teng. For full heat, add Shi gao and Zhi mu. For Qi stagnation, add Chai hu and Bai ji li. For liver Yang hyperactivity, add Tian ma and (Huai) Niu xi.
Weng Weiliang, et al: This herb is indicated in the treatment of headache, rheumatic arthralgia, abdominal pain with mass formation, pricking pain in the costal regions, swelling and pain due to traumatic injury, arthralgia due to cold, spasm of tendons, menstrual disorders, amenorrhea, dysmenorrhea.
HF: An important herb in anti-Gu therapy to move Qi (xing Qi) and break accumulation (po ji).
SD: Chuanxiong is a frequently used Chinese herb, commonly called ligusticum or cnidium. The latter name is the term most often used in the ITM literature, adopted from the common name offered by Oriental Healing Arts Institute (OHAI) in publications 30 years ago. The herb has been obtained from Ligusticum chuanxiong (= Ligusticum wallichii) in China and from Cnidium officinale in Japan; the OHAI literature was heavily influenced by Japanese herb scholars. Recent evaluation of the genetic material of these two source materials has led to the suggestion that they are, in fact, the same plant, and that Cnidium officinale should be renamed as Ligusticum chuanxiong (1).
There are several active constituents in chuanxiong, but one of the most interesting is the alkaloid ligustrazine, which has the chemical name tetramethylpyrazine (because it is a pyrazine ring with four symmetrically placed methyl groups); it is sometimes simply called TMP. Isolated alkaloids from chuanxiong, and purified synthetic ligustrazine, have been used in China as medicinal agents for 30 years. The initial applications were based on traditional uses of the crude herb in decoctions and pills: for vitalizing blood circulation in the treatment of cardiovascular diseases
and for treatment of headache and vertigo.
LIGUSTRAZINE BY IV ADMINISTRATION
Ligustrazine is rapidly absorbed when taken orally, but it is also rapidly excreted in the urine. In order to maintain high blood levels, oral doses must be taken every few hours. Alternatively, ligustrazine can be given by IV drip over several hours to keep the blood levels high. Such administration is typical for hospitalized patients in China who have suffered heart attack or stroke and for treatment of serious childhood diseases (it is administered to infants who can not swallow herbal decoctions or pills). However, for most non-emergency uses, the IV form of administration is not convenient; further, it is not routinely available outside of China. Still, the IV use of this compound over the past three decades, both for adults and children, illustrates the lack of toxicity from TMP.
LIGUSTRAZINE BY ORAL ADMINISTRATION
Ligustrazine as a component of chuanxiong is only present in small amounts, perhaps 1%, so that a 9-12 gram quantity of the crude herb in decoction (as might be used in modern clinical practice in China) yields about 90 mg-120 mg of ligustrazine for a one-day dose. While this quantity may provide some benefits, contributing one active component to a complex mixture, it is not adequate to get the full benefit of ligustrazine that has been described in clinical and laboratory work with the isolated compound. Oral dosing of 100 mg or more each time, at least three times a day would be necessary to get sufficient blood levels for the desired effects.
To enhance the action of ligustrazine, even when given in adequate dosage, Chinese doctors often combine it with one or more herbs that have the related therapeutic action of vitalizing blood. The main herb used in combination with ligustrazine is salvia, either alone or with tang-kuei.
The applications of ligustrazine in China are many, and at first may appear quite diverse. However, upon examining the various applications, one can appreciate ligustrazine as providing a “protective effect.” Following are brief reviews of a few of the uses of ligustrazine.
Renal failure and dialysis: Ligustrazine has been used to slow or halt the progress of renal failure in Chinese patients (2). Experimental studies have been conducted to demonstrate this effect in laboratory animals (3). One of the proposed mechanisms is the superoxide scavenging effect, one type of antioxidant action (4). Salvia has also been used to protect against renal failure (see ITM review: The use of salvia for patients with renal failure). Ligustrazine with salvia and tang-kuei have been used to aid patients undergoing renal dialysis (5). TMP is also used in conjunction with prednisone for patients with primary nephritic syndrome, which is said to function better than prednisone therapy alone (6). In the treatment of infants, ligustrazine was used to protect against the renal toxicity of gentamycin (7). Ferulic acid, possibly the primary active component of tang-kuei and one of the active components of chuanxiong, has shown benefits for treatment of patients with diabetic nephropathy (8).
Lung diseases with fibrosis: Ligustrazine is known to be a pulmonary vasodilator (9), but an area of particular interest is its action to protect against pulmonary fibrosis (10). Salvia and an active fraction of salvia (labeled IH764-3) have also been used for protection against pulmonary fibrosis (11-13), alone or with ligustrazine.
Neuroprotection for stroke: Chinese physicians have used chuanxiong and ligustrazine for treatment of stroke patients. Ligustrazine has been shown to have protective effects for the neurons, possibly based on anti-inflammatory activity (14-15). In clinical applications, ligustrazine in high dosage (480 mg/day) was found to lower fibrinogen and improve blood circulation in patients who suffered a stroke (16). Salvia is also known to confer neuroprotective effects in case of stroke (see review article: Neuroprotective herbs and active ingredients). Ferulic acid or its sodium salt (sodium ferulate) is used in Chinese medicine to treat stroke patients; in laboratory studies, it was shown to limit damage and help reactivation of impaired nerve cells (17).
In sum, ligustrazine alone or with salvia may provide protection to the kidneys, lungs, and brain through antioxidant and anti-inflammatory effects; these substances reduce fibrosis and improve blood circulation. The addition of tang-kuei, especially as a good source of ferulic acid (see structure, below), may further improve the effects.