Nature: sweet, bitter, cool

Enters: Liver

Actions: Calms the liver and subdues yang; clears heat and promotes urination; nourishes the heart and quiets the spirit. Lowers blood pressure.

Indications:
• Liver yang rising: dizziness, hypertension, etc.
• Drunk by older people in China as a general health tonic to prevent the problems of aging.
Flaws: Luo Bu Ma (Herba Apocyni Veneti) may be unknown to many students and younger practitioners of Chinese medicine. In part, this is because it is not found in most entry-level Chinese materia medica, nor is it found any major traditional Chinese formulas. However, I think it is a good medicinal to know about. It is included in Bensky et al.’s Chinese Herbal Medicine: Materia Medica, 3rd edition (pages 976-977). In that book, Luo Bu Ma is categorized as a wind-extinguishing medicinal (xi feng yao). According to Bensky et al., it is sweet, bitter, and cool and enters the liver. (Other Chinese sources say this medicinal is bland and astringent. Such differences of opinion are common for relatively “new” Chinese medicinals). Luo Bu Ma levels or calms the liver and subdues yang, clears heat and promotes urination, and nourishes the heart and quiets the spirit (although I’m not convinced about these last functions; more to say about that below).

Luo Bu Ma was, up until recently, a folk medicinal mostly found and drunk as a healthy beverage tea in Inner Mongolia. However, recently, this medicinal has been found to lower blood pressure, lower bad cholesterol at the same time as raising high density (good) cholesterol, reduce edema due either to kidney or heart dysfunction, enhance immunity, and promote longevity. Therefore, this herb is now often drunk both preventively and remedially by the middle-aged and elderly in China and Japan. (The first anti-aging research I can find on this medicinal published in China dates from 1990.)

Research on Luo Bu Ma has been conducted in China, Korea, Japan, and several Western countries. This research shows that this medicinal definitely lowers blood pressure (by increasing nitric oxide and thus vasodilation) and has diuretic, cardiotonic, and antioxidant activity. Other research indicates that Luo Bu Ma has antidepressant potential and can reduce anxiety (in mice, equal to benzodiazapines). Yet other research shows that this medicinal is effective for hypercholesteremia and the prevention of atherosclerosis. A water infusion of this herb has been shown to be hepatoproctective in mice. As if that weren’t enough, Luo Bu Ma can reduce the formation of advanced glycation endproducts which are largely involved in the pathogenesis of diabetic vascular complications. Chinese research suggests that the active ingredients in Luo Bu Ma mainly consist of rutin, d-catechin, and quercetin. However, Japanese research shows that Luo Bu Ma contains more than 15 kinds of phenolic constituents.

The root of this plant contains cardioglycosides and is, therefore, potentially toxic. The leaves, however, do not contain the same cardioglycosides or at least contain much fewer of them. Thus the leaves are considered safe to use even long-term. In fact, Zhang Yun-ru says that its leaves are non-toxic (Bensky, p. 977).

As for Luo Bu Ma nourishing the heart and quieting the spirit, because this medicinal is antidepressant and anxiolytic, it is tempting to make that assumption. However, not all Chinese sources on this medicinal include this function, and I believe it is a species of “over-diagnosis.” The fact that Luo Bu Ma clears heat from the liver appears to be unanimous in the Chinese language Chinese medical literature, and heat ascending (mainly from the liver) to harass the heart is one of the three main proximate causes of the heart spirit stirring frenetically. By clearing this heat, the heart spirit is automatically quieted. However, this does not mean that the medicinal should be thought of a heart-nourishing, spirit-quieting medicinal. In Chinese medicine, there are two kinds of spirit-quieting medicinals: 1) those that nourish the heart and quiet the spirit and 2) those that heavily settle and quiet the heart. Heart-nourishing spirit-quieters tend to nourish and enrich heart blood and yin, and I see nothing in any descriptions of this medicinal that suggest it nourishes yin-blood. I think all this medicinal’s empirical effects can be encompassed by the functions of clearing heat, extinguishing wind, and promoting urination.

This medicinal is included in several Chinese ready-made or so-called patent medicines for hypertension. However, you might consider adding it to other standard formulas based on pattern discrimination when the major complaint is high blood pressure and liver heat, liver yang, or liver wind are playing a part in the overall disease mechanisms. It may also be drunk as a tea (infusion) as a daily beverage in the middle-aged and elderly who, by nature, tend to suffer from a surplus in the liver.

Examine.com:

This plant has similar bioactives to Hypericum perforatum [St. John’s Wort] and while drug-drug interaction tests have not yet shown adverse interactions it is highly plausible that they exist.

At this moment in time there is no optimal dose known for humans, although most of the benefits associated with this plant occur in the rat dosing range of around 25-100 mg/kg and with the water extract of the leaves (ie. the tea). This assumes an estimate human dose of:

• 270-1,100 mg for a 150lb person
• 360-1,400 mg for a 200lb person
• 450-1,800 mg for a 250lb person

These doses are well within the range one would use the leaves to make tea from, suggesting that the food product is active and supplementation may not be needed.

1. Sources and Composition

1.1. Sources

Apocynum venetum (of the family Apocynaceae) is a Traditional Chinese Medicine commonly referred to as Chinese dogbane which has traditional usage for its blood pressure reducing properties secondary to diuresis.^[1] Beyond the cardiovascular benefits, it has traditionally been touted to promote longevity^[2] and treat both nephritis and neurasthenia^[3] but more recently is associated with claims of blood pressure reduction and sedation (which opposes the stimulatory effect of green tea from camellia sinensis due to the Caffeine content).^[4] At times medicinal usage of this plant is seen as interchangeable with poacynum pictum and poacynum hendersonii (of the same Apocynaceae family) due to their visual similarity;^[4] they can be distinguished genetically^[5] or by the hyperoside content.^[6]

It should not be confused with the related plant Apocynum cannabinum (Indian Hemp) nor the related plant Apocynum androsaemifolium, both of which have traditional usage for heart health due to their Cymarin content which is therapeutic at low doses but toxic at higher doses; apocynum venetum does have a cymarin content as well (113?g/g in the leaves)^[7] which is regarded as safe^[4] although the higher levels in the aged stem (1,310?g/g) may not be.

The leaves are sometimes called ‘Luobuma’ (China) or ‘Rafuma’ (Japan), and Luobuma tea refers to the water extract of the leaves.^[8][1] The plant itself is a small herbaceous shrub 1-2 meters tall with purplish red to pink flowers, and bears fruits in autumn 7-8 months after flowering.^[4] The apocynum venetum shrub is surprisingly resistant to drought and stress (sand, winds, and salt), which may underlies its name of “Herbal for Relief of Famines” (Jiu-Huang-Ben-Cao from the Ming Dynasty).^[4]

Apocynum venetum is a small shrub which bears leaves (Luobuma) that are commonly drunk as a tea in order to reduce blood pressure and are claimed to have an added relaxing effect (somewhat opposite of a similar tasting tea, green tea from camellia sinensis); the usage of Luobuma parallels that of Roselle

1.2. Composition

Luobuma (leaves unless otherwise specified) contains:

• Apocynin A-D (very confusing as this is not the apocynin phenolic (acetovallinone) found in other plants)^[9][4]
• Cymarin at 113?g/g in the leaves, lower levels than Apocynum cannabidum^[7] although there are higher levels in the stem (367?g/g) and aged stem (1,310?g/g) as well as the root (195?g/g)^[7]
• Apocyanisode I and II (Ionone glucosides)^[10]
• (+/-)Gallocatechin and (+/-)Catechin^[11]
• (-/-)Epigallocatechin and (-)-Epicatechin^[11]
• (-/-)Epicatechin-()Gallocatechin and Epigallocatechin-()Epicatechin^[11]
• Quercetin^[12][13] and related structures such as hyperoside (Quercetin 3-Galactoside) and isoquercitrin (Quercetin 3-Glucoside);^[3] said to be in comparable levels to that of Hypericum perforatum;^[14] also contains Baimaside (Quercetin 3-O-Sophoroside),^[13] Avicularoside (Quercetin-3-Arabinoside)^[15] Rutin (Quercetin 3-Rutinoside),^[15] and Quercitronic Acid/Querciturone (Quercetin-3-Rhamnoside)^[15]
• Kaempferol^[16] and its 3-O-?-D-glucoside (Astragalin),^[15][13] Trifolin (Kaempferol 3-Galactoside),^[15]
• Apigenin biflavonoids including Amentoflavone and Biapigenin^[15]
• Hyperforin and Adhyperforin;^[15] once novel constituents of Hypericum perforatum
• Procyanidin B2^[11]
• Cinchonain Ia^[17]
• Caffeic acid and 3-O-caffeoylquinic acid^[18]
• Vanillic acid^[13] and Chlorogenic Acid^[16]
• Daucosterol^[13] and both Lupeol and Phytol in roasted leaves^[10]

The overall content of flavonoids is known to heavily rely on growing conditions.^[12]

There is a total amino acid content ranging from 81.76-83.25mg/g (leaf equivalent) but a free amino acid content of 3.85-4.04mg/g, with the most abundant amino acid being glutamic acid (9.82-10.01mg/g total amino acid and 0.29-0.31mg/g free) which was said to confer the Umami taste of the tea.^[19]

The leaves of this plant appear to be high in flavonoids, mostly some catechins (some novel and some in green tea) and a large amount of quercetin variants. There also seems to be a lot of parallels in these constituents and those seen in St.John’s Wort surprisingly, since the plants are not phylogenetically related

2. Molecular Targets

2.1. Ion Channels

Apocynum venetum, in cultured N2A neuroblastoma cells at a concentration of 20µg/mL, has been demonstrated to inhibit steady state sodium channels independent of nitric oxide and with an IC₅₀ of 18.4?g/mL; it was readily reversed with washout and voltage gated sodium channels were unaffected.^[20]

There was a mild inhibitory effect on voltage gated potassium channels (16.2+/-3.7% and 48.0+/-2.9% inhibition at 10 and 30?g/mL) yet none on ATP-sensitive channels.^[20] These effects were lost in the presence of diazoxide, a potassium channel opener.^[20]

The leaf extract of apocynum venetum appears to cause mild inhibitory effects on both potassium and sodium channels at a concentration where blood pressure reduction in noted; this is not dependent on nitric oxide formation

3. Pharmacology

3.1. Phase I Enzyme Interactions

Apocynum venetum has similar bioactives to Hypericum perforatum, raising concerns of possible drug interactions.

When fed to rats at 3.3mg/kg, Apocynum venetum leaf extract failed to alter the pharmacokinetics of nifedipine while 33mg/kg and 15mg/kg St. John’s Wort both trended to reduce plasma concentrations over the next 30 minutes.^[21] Two weeks treatment of 15mg/kg managed to reduce the AUC of nifedipine while 3.3mg/kg apocynum venetum was ineffective.^[21]

May not influence CYP3A activity, although the above study did not test higher (and more practical) doses over two weeks despite trends towards inhibition being present

3.2. Drug Interactions

Apocynum venetum at 3.3mg/kg over two weeks to rats has failed to alter the intestinal permeation of methylprednisone, suggesting no significant influence on the P-glycoprotein transporter.^[21]

No significant influence known with P-glycoprotein transporters

4. Neurology

4.1. GABAergic Neurotransmission

The anxiolytic properties of the leaf extract (100-125mg/kg in mice) doses is fully mediated by the GABA_A receptor, while lower doses (22.5-30mg/kg) are not; this is thought to be due to Kaempferol which is active at 0.02-1mg/kg oral intake.^[16]

Higher doses of this herb appear to have anxiety reducing properties secondary to the kaempferol content acting on the benzodiazepine receptors

4.2. Adrenergic Neurotransmission

A water extract of the leaves for 2-8 weeks in rats noted decreases in noradrenaline at 15-60mg/kg (but not 250mg/kg) in the hypothalamus (8 weeks) and striatum (starting at 2 weeks) by 33-44% in the hypothalamus and 22-39% in the striatum; there was no time nor dose dependence noted.^[3] The decline in noradrenaline and its metabolite (homovanillic acid) during depression, however, are fully preserved with 10 days supplementation of 50-100mg/kg (but not 25mg/kg) in mice.^[22]

While there may be a small suppressive effect on noradrenaline concentrations at rest, the decline seen during depression is greatly attenuated; this suggests a modulatory effect

Adrenergic receptor density does not appear affected.^[3]

No known interactions with adrenergic signalling beyond modifying noradrenaline levels

4.3. Dopaminergic Neurotransmission

L-Tyrosine concentrations in all brain organs does not appear affected with oral ingestion of 15-250mg/kg of the leaf extracts for 8 weeks in otherwise normal rats.^[3]

A water extract of the leaves at 15mg/kg daily for eight weeks was able to slightly reduce dopamine concentrations in the hypothalamus (20%); there was no influence of higher doses (60-250mg/kg) nor lower time frames (2 weeks) and these effects were exclusive to the hypothalamus.^[3] Elsewhere, 50-100mg/kg (but not 25mg/kg) in mice for 10 days preserved the decrease in dopamine concentrations seen in depression.^[22]

DOPAC was slightly reduced when dopamine or noradrenaline were increased^[3] but is significantly preserved in states of depression (when dopamine is also preserved.^[22] Furthermore, the antidepressant effects of 50-100mg/kg of the extract over 10 days in mice appears to be blocked by both D1 receptor antagonists and D2 receptor antagonists.^[22]

Similar to the effects seen with adrenergic signalling, there appears to be little to no effects on dopamine at rest or a small decline in dopamine levels are seen. In states of depression where dopamine would normally be reduced, however, there is a significant preservation of dopamine levels

4.4. Serotonergic Neurotransmission

15-250mg/kg of the leaf water extract for up to 8 weeks in rats does not influence concentrations of serotonin, L-tryptophan, or 5-HIAA.^[3] In depressed mice, 25-100mg/kg of the extract has failed to preserve the reduction in serotonin seen in depression.^[22]

Unlike the influence on catecholamines (dopamine and noradrenaline), the reduction in serotonin seen with depression is not prevented

The lower anxiolytic dose of the leaf extract (22.5-30mg/kg in mice) appears to be mediated by the 5-HT_1A receptors, while higher (100-125mg/kg) doses are not.^[16]

There may still be some serotonergic signalling when it comes to very low doses of this plant and possible reductions in anxiety, although more practical higher doses do not appear to be assocaited with serotonin signalling at all

4.5. Alertness

In a rat antidepressant test there did not appear to be any alterations in locomotion nor defecation (thus, no amphetamine like activity is thought to exist).^[14] In anxiolytic tests (testing for sedation from benzodiazepine like effects) the leaf extract was not significantly different from 1.5mg/kg diazepam at the active doses (22.5-30mg/kg) in altering motor function^[23] nor was the active GABAergic agent Kaempferol (0.02-0.08mg/kg).^[16]

Does not appear to have any significant sedating properties (assessed by locomotor tests) nor amphetamine-like properties when tested in rodents

4.6. Neuroprotection

Mechanistically, hyperoside at 2.5-10?g/mL appears to attenuate the increase in intracellular calcium (PC12 cells) induced by corticosterone (10?M) with a protective effect comparable to 10?M fluoxetine^[24] and thought to be secondary to this there was a preservation of BDNF and CREB activity (greater than fluoxetine but not normalized to control)^[24] associated with a relative preservation of BDNF and MAP4 mRNA levels.^[25]

In the presence of hyperoside, the neurodegenerative effects of corticosterone are attenuated and the antidepressive factors (BDNF, CREB, MAP4) are preserved somewhat

Elsewhere, in vitro with PC12 cells treated with 1-10?g/mL of the herbal extract apocynum venetum appeared to reduce lipid peroxidation to a greater extent than both Ginkgo biloba and St.John’s wort, although 100?g/mL of the extracts were comparable.^[26]

In an in vitro test of oxygen and glucose deprivation (test of benefits against ischemia-reperfusion), 5-50?g/mL of apocynum venetum showed mild protective effects not exceeding 50% cell viability (control at 100% and oxygen deprivation near 30%);^[27] higher concentrations (5-500mg/mL) were not significantly better.^[27]

500mg/kg of the extract in rats prior to ischemia has been noted to improve the neurological score when measured 24-72 hours after ischemia (250mg/kg only active after 72 hours and 125mg/kg ineffective) and was able to half infarct size relative to control.^[28] Alongside the reduced infarct size was reduced edema and brain leakage, which appeared to be associated with preservation of the blood brain barrier’s structure (and reductions of both MMP2/9 and lipid peroxidation).^[28]

Shows some promise against lipid peroxidation and oxidative stressors, and while the potency against oxygen deprivation seems to be less it is relevant in rat models of ischemia where there are minor anti-stroke properties

4.7. Depression

30-125mg/kg of the leaf water extract of apocynum venetum appeared to possess antidepressant effects in the forced swim test with a potency comparable to 20mg/kg Imipramine.^[14] Higher doses of the extract (250-500mg/kg) were ineffective initially but performed equally after two weeks^[14] and 50-100mg/kg of the extract, but not 25mg/kg, has elsewhere been effective in the tail suspension test (more than 5mg/kg fluoxetine) while all doses were comparable to fluoxetine in a forced swim test^[22] and prevented with dopamine receptor antagonists (D1 and D2).^[22]

There appears to be a somewhat respectable antidepressive effect associated with catecholamine metabolism, probably secondary to preventing their decline during stress

4.8. Anxiety

In an elevated maze plus test, mice given 22.5–30mg/kg and 100–125mg/kg of the leaf extract (standardized to 3.5% hyperoside and 3.2% isoquercitrin) experience a reduction in anxiety with the lower dose being more potent (to a comparable level as 1.5mg/kg diazepam and 10mg/kg buspirone).^[23][16] The lower dose hindered by 5-HT_1A receptor antagonists while the higher dose was fully blocked by benzodiazepine receptor antagonists.^[16]

There are anti-anxiety effects associated with the tea, but unlike the antidepressive properties (associated with catecholamines) these seem to be related to GABA and serotonin signalling; it occurs at lower doses than antidepressive effects

5. Cardiovascular Health

5.1. Cardiac Tissue

In isolated atria cells (guinea pig), apocynum venetum causes a cardiotonic effect at 1mg/mL (little to no response at 100µg/mL) yet this was not correlated with the cymarin content of the plant (cymarin being a known cardiac glycoside in this plant species) nor was it blocked by propanolol;^[7] it appears that components of apocynum venetum have PDE3 inhibiting properties, with 1mg/mL of the leaf, root, and stem extracts inhibiting 84-88% of PDE3 activity.^[7]

Preliminary evidence suggests a cardiotonic effect, but practical relevance is unknown (and a high concentration used in the heart, which may not apply to oral supplementation)

5.2. Blood Pressure

While the water extract of the leaves (0.1–10µg/mL) does not influence endothelial function in vitro at rest nor is it active in denuded cells, it appears to concentration dependently inhibit phenylephedrine and U46619 (Thromboxane A2 receptor agonist) in a manner fully dependent on NOS enyzmes.^[1] There is no relaxing effect against endothelium precontracted with potassium, but the effect persisted after two washes of the cells.^[1] The mechanisms are known to involve potassium channels^[29][1] although it is not clear how, although some authors^[1] have noted the atypical mechanisms are similar to both Eucommia ulmoides^[30] and Eleutherococcus senticosus^[31] and apocynum venetum has elsewhere been noted to have mild inhibitory effects on voltage gated but not ATP sensitive potassium channels (not mediated by nitric oxide).^[20]

0.3-10?g/mL apocynum venetum appears to suppress the aortic contractions induced by ACE (Angiotension II),^[32] the peptide of which its inhibition is the current blood pressure reducing therapy. This is thought to be due to inhibiting ACE induced superoxide production (ACE, via acting on the AT₁ receptor, increases NADPH oxidase and O_– production^[33][34] which suppresses nitric oxide^[35]) and induction of nitric oxide synthesis.^[32] Furthermore, the reaction of superoxide and nitric oxide is known to produce peroxynitrite (ONOO^–) which can negatively regulate NOS enzymes^[36] and apocynum venetum directly sequesters these peroxynitrite radicals via its catechins;^[37] sequestering ONOO^– is known to block its suppressive effects.^[36]

Apocynum venetum appears to have blood pressure reducing mechanisms that are within a feasible concentration range, and while the mechanisms are not fully elucidated they appear to be related to nitric oxide signalling, antioxidant effects, and calcium channels

In hypertensive rat models (spontaneously, renal, and salt fed) given 70mg of the water leaf extract of apocynum venetum daily (333-350mg/kg) for 40-100 days, the tea was able to reduce blood pressure in all three rat models more than control and while equally potent to 30mg/kg Captopril in one model (renal hypertensive) it underperformed in the other two.^[8]

In the sodium fed rats, urine output was increased with apocynum venetum (2.1 and 2.6 fold on days 20-60) which did not occur with the roasted leaves;^[8] there were no differences in the magnitude of blood pressure reduction between groups, and increased urination occurred in both groups of the renal hypertensive rats.

Blood pressure reduction has been noted with ingestion of the water extract of the leaves, and this appears to occur to a lower degree than the reference drug but up to two-fold higher doses than the antidepressant effects

5.3. Atherosclerosis

In vitro, LDL oxidation from copper is reduced by 10-100µg/mL of apocynum venetum extract with the higher dose preventing any significant differences from nonoxidized control^[38] and an IC₅₀ value of 68.1µg/mL being determined for the leaf extract (mostly due to chlorogenic acid and epigallocatechin, with IC₅₀ values of 1.9µM and 2.3µM respectively).^[17]

This potent inhibition of LDL oxidation was met with only 39% inhibition of lipid peroxidation (TBARS) and halved the increase in macrophage cholesterol accumulation when LDL and macrophages were in the same culture with copper^[38] (to assess foam cell formation, involved in the pathology of atherosclerosis). Elsewhere, TBARS from LDL oxidation was reduced in a concentration dependent manner between 2.5-200µg/mL (9.8-88.3%) with most inhibitory effects coming from hyperoside, chlorogenic acid, and epigallocatechin.^[17]

May reduce LDL oxidation due to its antioxidant properties, but practical relevance of this information is not known. Possible anti-atherosclerotic properties and reducing plaque formation on arties

6. Interactions with Glucose Metabolism

6.1. Glycation

When investigating the formation of advanced glycemic end products (AGEs) the water extract appeared to inhibit AGE formation with an IC₅₀ value of 37.2+/-0.6µg/mL, which outperformed the reference drug of Aminoguanidine (59.2+/-1.5µg/mL).^[11] This may be related to the known catechins, which had IC₅₀ values between 19.8+/-0.8µg/mL (Gallocatechin) and 9.1+/-0.2µg/mL (Epigallocatechin).^[11]

Possible antiglycative properties, which would reduce AGE formation and may be of use for diabetes or insulin resistance (reducing organ damage, rather than treating the state)

7. Interactions with Oxidation

7.1. Lipid Peroxidation

The aqueous leaf extract at 10mg/kg given to rats after liver damage (from CCl₄) failed to significantly reduce serum MDA levels relative to control, although it trended towards such^[39] and appeared to have antioxidative properties against H₂O₂ and iron in vitro in the range of 15-1,000µg/mL.^[39]

8. Interactions with Organ Systems

8.1. Kidneys

Chronic (20-60 days) ingestion of a nonroasted water extract of apocynum venetum leaves in rats at 335-350mg/kg appears to increase urine output of rats on a high sodium diet (2.1-fold and 2.6-fold on days 20 and 60); this effect was not noted with twice roasted leave.^[8] Oddly, diuresis was increased by both the roasted and unroasted leaves in rats with hypertension secondary to renal damage.^[8]

Appears to be a diuretic at the doses which reduce blood pressure

9. Safety and Toxicology

9.1. General

The LD₅₀ of apocynus venetum appears to be greater than 10g/kg in rats and preliminary genotoxic and teratogenic studies have failed to find any harm associated with the plant,^[4] and later a 30 day test failed to find any abnormalities up to 30g/kg in mice^[40] and in continuing the in vitro studies a lack of genotoxicity was repeated and no abnormalities in sperm cells were noted.^[40]

Preliminary evidence in rodents does not suggest any toxic effects from this plant even at abnormally high oral doses

 

Dose: 3-9g

These herbs each possess any of four major actions:
1. Clear Liver Heat.
2. Subdue Liver Yang.
3. Extinguish Liver Wind.
4. Calm/Anchor the Shen.
These herbs are commonly combined with:
A. Herbs that clear heat or reduce fire from the liver when there is liver heat leading to Yang rising or liver wind.
B. Liver and kidney Yin tonics when liver wind is due to Yin deficiency of the liver and kidneys.
C. Herbs that quiet the Shen when there is Shen disturbance.
D. Herbs that resolve phlegm when liver wind stirs up phlegm and blocks the channels and collaterals.

Nature: bitter, acrid, neutral

Enters: Liver, Lung

Actions: Subdues the liver, anchors the yang; frees the flow of liver Qi; eliminates external wind, dispels wind-heat; promotes vision; stops itching.

Indications:
• Liver yang rising: headache, dizziness, vertigo, hypertension.
• Liver Qi stagnation: distention in the chest, costal region, and flanks, postpartum galactostasis or insufficient lactation.
• Wind: skin eruption with itching, hives, vitiligo.
• Wind-heat: red, swollen, painful eyes, increased tearing; nasal congestion.
• Promotes urination.
• Lowers blood pressure.
• Recent Western use as “herbal Viagra” to improve libido and erectility.
• Guohui Liu: Useful for Liver attacking transversely, causing bloating, etc. (15-30g)
Yoga: Gokshura: sweet, bitter/cooling/sweet; VPK=
• Diuretic, lithotriptic, tonic, rejuvenative, aphrodisiac, nervine, analgesic.
• Cools and soothes the membranes of the urinary tract; stops bleeding.
• Rejuvenative to Pitta, calms Vata. Invigorating for postpartum women.
• Difficult or painful urination, edema, kidney or bladder stones, chronic cystitis, nephritis, hematuria, gout, rheumatism, lumbago, sciatica, impotence, infertility, seminal debility, venereal disease, cough, dyspnea, hemorrhoids, diabetes.
Hsu: Hypotensive, sedative.
DY: Upbearing and dispersing; calms the liver, resolves depression.
• With Sha yuan zi to regulate upbearing and downbearing and the liver and kidneys. Together, they course the liver and rectify Qi, resolve depression and calm the liver. They harmoniously supplement the liver and kidneys – they enrich the kidneys and secure the essence, nourish the liver and brighten the eyes. For such indications as:
– 1. Vertigo, unclear vision due to liver and kidney deficiency. (Use salt mix-fried Bai ji li – this alleviates the draining and dispersing characteristics of the herb and reinforces its supplementing aspect.)
– 2. Lumbar pain, seminal emission, premature ejaculation, frequent urination due to kidney deficiency. (Use salt mix-fried or stir-fried Sha yuan zi.)
– 3. Abnormal vaginal discharge due to kidney deficiency.
Examine.com’s literature review concluded: “Tribulus Terrestris is a herb commonly sold as an aphrodisiac, sexual performance enhancer, and testosterone booster. Currently, it seems that it does have scientific grounds to claim it is an aphrodisiac and perhaps high doses could be seen as a sexual performance enhancer.
“Science on Tribulus and testosterone is mixed and trending towards being ineffective. Currently three human studies have been conducted on the matter and found no fluctuations in testosterone with doses between 200-450mg Tribulus daily for up to 8 weeks. Higher doses in rats that correlate to 750mg in humans routinely find testosterone increases in castrated rats, and a single study exists to suggest that this testosterone boost at the same high dose can apply to normal rats.
“Beyond those claims, Tribulus is claimed to be a heart healthy compound and a large dose (3g) has been demonstrated to reduce blood pressure over the course of 4 weeks, with noticeable improvement at one week, in persons with hypertension.”

Dose: 6-12g

Nature: bitter, cold

Enters: Liver, Heart, Pericardium

Actions: Subdues the liver, suppresses liver Yang rising; clears liver heat; descends the Qi of the Lungs and stomach, strongly directs rebellious Qi downward; cools the blood; stops bleeding; anchors the Shen.

Indications:
• Stomach Qi rebellion: belching, hiccups, vomiting. Use when Ban xia is not enough. This herb is not appropriate for morning sickness of pregnancy.
• Failure of Lung Qi to descend: wheezing, asthma.
• Liver Yang rising, liver fire: headache, dizziness, tinnitus, pressure around the eyes.
• Hematemesis, epistaxis. Primarily for bleeding due to heat, but can also be used for bleeding due to cold from deficiency when combined with appropriate herbs.
• Should be boiled for approximately 30 minutes before adding other herbs.
• Often calcined or pulverized after soaking in vinegar.
• Major known constituents include diferric trioxide, aluminum, silicon, magnesium, tin.
• Bensky/Gamble classifies this with herbs that anchor the Shen.
MLT: For short term use only – likely contains traces of arsenic.

Dose: 9-30g

Nature: salty, cold

Enters: Liver, Spleen, Bladder, Lung

Actions: Removes obstructions from the channels and collaterals; relieves asthma, calms wheezing; clears heat; extinguishes liver wind; stops spasms and convulsions; promotes urination.

Indications:
• Lung heat obstruction: asthma, wheezing. Clears Lung heat.
• Liver wind: convulsions with high fever, seizures – can be used alone.
• Damp-heat: Bi syndrome with red, painful, swollen joints.
• Obstruction of channels and collaterals: hemiplegia, sequelae of wind-stroke, for either hot or cold (with appropriate combination) Bi.
• Bladder heat: painful urination or retention of urine, cystitis, urinary stones, edema.
• Liver Yang rising: hypertension. Lowers blood pressure. Over 90% effective for essential hypertension in one study.
• Hot, manic type schizophrenia. (Recent use)
• Temporarily lowers men’s sperm count.
• May temporarily lengthen the penis.
• May inhibit the effects of histamine on smooth muscle.
• This herb’s effectiveness is enhanced by washing it in wine.
• This herb’s ability to treat spasms and convulsions (compared to Ling yang jiao and Gou teng) focuses mainly on its ability to open up and penetrate.
• Doctrine of signatures: earthworms’ (and other insects’) ability to remove obstructions is indicated by their skill at wriggling through small places or plowing right through the earth.
• Contains the fibrinolytic enzyme lumbrokinase. May have benefit in cardiovascular disease. One study showed “Oral lumbrokinase improves regional myocardial perfusion in patients with stable angina.”
• A very safe herb.
MLT: Insects [and worms] represent the essence of pure neurological instinct reaction that is akin to the manifestation of involuntary reflexes such as spasms, shaking, and stroke. Described as “strange proteins,” they seem to have a corrective effect on the nervous system. Customarily administered as a powder in capsules.
Hsu: Antipyretic, hypotensive (probably by direct action on CNS), bronchodilator, stimulates the uterus, small intestine and large intestine.

Dose: 5-15g

Nature: sweet, slightly cold

Enters: Liver, Pericardium, Heart

Actions: Clears liver heat; subdues liver yang; extinguishes liver wind, alleviates spasms; releases the exterior.

Indications:
• Liver wind: convulsions, tremors, seizures, eclampsia. Especially useful when due to intense heat.
• Liver heat: distention and pain in the head, red eyes.
• Liver Yang rising (including Yin deficiency patterns): dizziness, vertigo, irritability, blurry vision.
• Wind-heat: fever, headache.
• Lowers blood pressure. For hypertension take 30g twice a day. Especially useful when due to liver Yang rising. If there is liver Yin deficiency, combine with Bai shao – 2:1::Gou Teng:Bai Shao (i.e. 15g Bai shao BID). Gou teng’s hypotensive effect diminishes if it is cooked too long. Old stems, without thorns, have no hypotensive effect.
• Similar to Ling yang jiao, but while antelope horn enters the blood level, Gou teng enters the Qi level and is especially useful for problems secondary to externally-contracted wind-heat.
• Do not cook longer than 10 minutes.
• It is traditionally believed that the more hooks and less stems, the stronger the herb.
• Contains rhynchophylline – a non-competitive NMDA receptor antagonist (anesthetic) and calcium channel blocker.
Hsu: Hypotensive – inhibits vasomotor center, dilates peripheral blood vessels; sedative, inhibits the CNS; prevents epilepsy; antiviral – especially against respiratory viruses.
From “Antihypertensive and neuroprotective activities of rhynchophylline: the role of rhynchophylline in neurotransmission and ion channel activity.”:
• RESULTS: Rhynchophylline was the main constituent of several components identified from Uncaria species. Rhynchophylline mainly acts on cardiovascular and central nervous system diseases, including hypertension, bradycardia, arrhythmia, sedation, vascular dementia, epileptic seizures, drug addiction, and cerebral ischemia. Rhynchophylline also has effects on anticoagulation, inhibits vascular smooth muscle cell proliferation, and has been shown to be anti-endotoxemic. The active mechanisms are related to modulation of calcium and potassium ion channels, protection of neural and neuroglial cells, and regulation of central neurotransmitter transport and metabolism. More studies are necessary to verify the pharmacological activities and determine the exact mechanisms of rhynchophylline activity.
• CONCLUSIONS: Rhynchophylline treatment of cardiovascular and central nervous system diseases has a strong linkage with traditional concepts and uses of Uncaria species in ethnopharmacological medicine, such as treatment for lightheadedness, convulsions, numbness, and hypertension. As a candidate drug for several cardiovascular and central nervous system diseases, rhynchophylline will attract scientists to pursue the potential pharmacological effects and mechanisms with new technologies. Relatively few clinically relevant studies of rhynchophylline have been conducted. Thus, more in vivo validations and investigations of antihypertensive and neuroprotective mechanisms of rhynchophylline are necessary.

Dose: 6-15g

On the related herb Cat’s Claw / Una de Gato – Uncaria tomentosa:
This species grows much larger than the Chinese forms. The bark is used.
Its similarity (or lack thereof) to Gou teng has not been clearly established.
Major claims are that it is an immune enhancer, antiviral/antibiotic, anti-inflammatory, antispasmodic. Extracts (under the trade name Samento or Saventaro) are commonly used to treat Lyme disease. Shown in studies to fight the progression of Alzheimer’s disease (better when combined with Ginkgo leaf and Gotu Kola).
Recently, there has been some controversy over the constituents TOA’s (tetracyclic oxindole alkaloids) and POA’s (pentacyclic oxindole alkaloids). Numerous sources claim TOA’s are ineffective or even harmful, while the medicinal potency of the plant comes from the POA’s. Consequently, there are products which claim to be TOA-free and/or which maximize POA’s.
SD: Cat’s claw is one of several dozen herbs being promoted these days as an effective treatment, even a potential cure, for cancer, AIDS, chronic fatigue syndrome, candida infection, arthritis, and other disorders for which modern medicine is often unsatisfactory. The broad spectrum of action claimed for these herbs is not an impossibility, as the disorders that are said to be treated involve the immune system: there could be a central regulatory mechanism affected by a natural compound that leads to improvements for many patients with various diseases. The suggestion that the herbs produce dramatic effects or are curative rather than merely helpful is more problematic, as clinical evaluations of several such materials have failed to confirm many of the claims that were based on individual case studies.
Cat’s claw seems exotic because it is a native Indian remedy from the mountains of Peru. Yet, there is no evidence that it is any more valuable than less exotic items from China, India, Europe, or the U.S. which were previously considered exotic. Apparently, the root bark of the plant has been used by the aborigines in the area where it grows for gastric distress, skin diseases, arthralgia, and cancer. It is not clear how accurately cancer was diagnosed (in most medical traditions, cancers, abscesses, and non-malignant swellings were lumped together), nor what effect this herb had in native hands, nor whether it was only one of several remedies provided in combination to the patient. The “claw” which characterizes this vine may have been selected by “doctrine of signatures” as something that could penetrate and puncture a lump or grab the cause of localized pain. In China, the related plant Uncaria rhynchophylla (gouteng), is said by native healers to effectively treat headaches: the hook on the vine indicates that it can go in and grasp the pain to pull it out. This explanation may also come after the observation of effects, as an aid to memory: Chinese research confirms that the herb can treat certain types of headache, especially that associated with hypertension.
The active components of cat’s claw are mainly alkaloids, glycosides (triterpenes and procyanidins), and tannins. The oxindole alkaloids of the stem (including the hooks) are the same as those found in the Chinese plant that is far more intensively analyzed. Rhynchophylline, the main alkaloid, has been made into a drug in China for treating hypertension and headache due to vascular constriction. The alkaloids in the root bark of cats’ claw are in the same category as rhynchophylline, but are slightly differently. The claim made by some investigators appears to be that these unique alkaloids are responsible for the ability of the plant to treat cancer and to inhibit viral infections. Enhancement of phagocytosis in vitro was reported in 1985 by Wagner, a European researcher who has focused efforts on revealing immune-enhancing actions of natural products (his work with echinacea, eleutherococcus, and the liver-protective herb sylibum is frequently reported in the alternative medicine literature). However, it is not clear that sufficient amounts of such alkaloids are consumed so that one would obtain this effect nor how strong the effect might be. Based on his research experience, Wagner believes that polysaccharides, terpenoids, alkaloids, and polyphenolic compounds from plants have immunostimulating activity.
The triterpenoids of cat’s claw have been shown to have an anti-inflammatory effect. This effect is not surprising: dozens of plants with triterpenoids have an anti-inflammatory action; triterpenoid compounds often have a steroidal structure. Other materials have been isolated from the herb, such as oleanolic acid (which has anti-allergy actions), but the amounts are so small as to make their presence insignificant in relation to the herbal activity in clinical practice. Clearly, one can find numerous compounds in this plant and attribute healthful activities based on in vitro tests that require large amounts of the compounds, but that doesn’t mean one is likely to obtain those effects from oral consumption of recommended amounts (e.g., 20 grams by decoction or infusion, much less by ingestion of encapsulated powders) of the crude herb.
In a patent application for use of cat’s claw alkaloids for immune-modulatory effects against cancer, other alkaloids with similar effects obtained from other plants are mentioned, such as berbamine and matrine, ingredients identified from common Chinese herbs (e.g., hu-chang and sophora) that boost certain immune responses and which can be used in the treatment of cancer (Chang and But 1987). The question that arises is this: is it worthwhile collecting a species that has a limited growing range for which the root bark may be the key ingredient, and which is quite expensive, rather than using readily available plants that are less expensive and are already cultivated and which have far more supporting research for the intended application? The patent application also lists more than a dozen phenols/quinones and terpenes as examples of natural substances “with stimulating effect on the immunological system.”
That aside, one can examine carefully the research to date. In one study (Aquino, et al. 1991), anti-inflammatory compounds were isolated. In rat paw inflammation experiments (usually used in the study of potential anti-arthritis remedies), dosages of 2 g/kg of the dried bark (corresponds to typical human dosage of 140 grams of the herb) were used, and the most active isolated fractions were able to inhibit the rat paw edema by about 40%. Aspirin is a lot easier to use and more effective and although aspirin may cause gastric irritation, so might the isolated components of cat’s claw. The common, cultivated Chinese herb tang-kuei, has an anti-inflammatory action that is slightly greater than that of aspirin, weight for weight.
Antiviral activity of quinovic acid glycosides from cat’s claw were also analyzed (Aquino, Simone, and Pizza, 1989). As the authors of the study report: “an inhibitory effect against VSV [vesicular stomatitis virus] was evident for all the nine compounds tested, although at relatively high concentrations with respect to the toxic dose….” In other words, the antiviral activity was weak unless you approach the point where the herbal components would kill the cells as well. Before one reaches cell killing by a compound, severe side effects would tend to be observed clinically. The authors continue: “almost all these quinovic acid glycosides were inactive against rhinovirus type IB infection….” These same authors mention in their introduction the antiviral action of glycyrrhizin (from licorice). This and other components from readily-available and inexpensive herbs have been demonstrated effective in treating viral infections; for example, glycyrrhizin can cure a portion of clinical cases of chronic hepatitis B infection and it has been shown, in vitro, to inhibit HIV.
The potential antitumor activity of cat’s claw remains pure speculation. In a paper about the constituents of various Uncaria species in Peru, it was suggested (de Matta, et al.) that catechin in the root bark may be responsible for the effect. Catechin is believed to be anticarcinogenic, but it is obtained from dozens of other herbs (it is often found in barks) that are much more easily obtained (rhubarb is the main source used in Chinese anticancer studies). In a recent evaluation of antimutagenic effects (Rizzi, et al., 1992), it was speculated that cat’s claw acts as an antioxidant, thus potentially reducing the incidence of transformation to cancer cells via an oxidation reaction. Yet, there are dozens of antioxidants already identified which have this property, many of which have useful nutritional benefits (e.g., vitamins C and E, selenium, cysteine) and which are inexpensive and readily available. While these are thought to be useful in reducing cancer risk, their impact on existing cancers is minor.
To get around the rather poor outcomes found in laboratory experiments and the availability of alternative sources for materials for which similar claims could be made, promoters of cat’s claw resort to hyperbole. Philip Steinberg, a nutritional consultant, proclaims it a “wondrous herb from the Peruvian Rainforest,” and refers to an article by a chiropractor, Brent Davis, who proclaims it a “world class herb.” The patent issued more than five years ago is trotted out as primary evidence of its value. Indeed, cat’s claw has been sold in Europe, but an analysis of the capsules of product show that it is extremely low in the supposed active components compared to reference samples from Peru (Stuppner, Sturm, and Konwalinka, 1992) so that any claims made for it are likely placebo effects.
To promote the product, “The Cat’s Claw Quarterly” was generated. As illustration of its irresponsible reporting, the 10 page first issue carries not one author’s name. Keplinger, the holder of the above-mentioned patent is reported to have been treating AIDS patients in Europe. He proclaims benefits were observed as follows: “within twenty days treatment there were positive signs in the immune system.” Anyone working with AIDS knows that the manifestations of the disease is highly variable and that few, if any, patients stick to only one remedy at any time; besides that, there was no way to show “positive signs” in the immune system within twenty days back then (in 1987, two years before this first issue of the newsletter). An herbal correspondence course devotes lesson 26 to cat’s claw, as part of the larger section on “killing cancer.” All that is offered is a rambling narrative of the author’s attempt to track down information on cat’s claw (one section is headed “very little written about cat’s claw”). As an example of successful use of the herb for cancer, here is one story he relates from Austria, where Keplinger works: Male 14-year-old [with lymph leukemia]. Chemotherapy was applied. However, patient suffered extreme discomfort. Cat’s claw given. Three week’s later, blood values improved. Patient more active. Since the blood condition improved so much, they thought this was because of the chemotherapy. So they increased the dosage of chemotherapy. The blood test did not reveal further pathology. The patient is now considered a mostly healthy child.” That certainly shows that cat’s claw is effective against cancer by the contorted reasoning methods employed by such writers. Chemotherapy, which is effective in many cases of childhood leukemia, by this reasoning came out poorly in this report. In a letter to Townsend Letter for Doctors (an informal and unreviewed magazine), Steinberg claims that one Peruvian physician spoke at an international congress on traditional medicine “about his and his colleagues’ successes with Uncaria tomentosa and other herbs in treating 14 types of accurately diagnosed cancer in 700 patients.” The suggestion to be taken by the unsuspecting reader is that it was this herb that was responsible for the undefined successes. One wonders what these physicians actually did and what was actually said about the results.
Cat’s claw may indeed be a good remedy for gastritis (one wouldn’t be able to determine that from the current literature, however: gastritis isn’t as interesting as cancer and AIDS). Herbal therapies for gastritis are relatively easy for native herbalists to select, because the effects are usually prompt. There are hundreds of other gastritis remedies available; its just a matter of whether or not the gastritis sufferer will try them. If the first they try is cat’s claw, it may well be one they can say works for them.
At this time, there is no evidence that cat’s claw has significant immunological properties. It may have such properties, but there are potential problems with promoting it for this application. First, it appears that the tops of the plant, which mainly contain rhyncophylline in the stem and tannins in the leaves, are probably not effective for this purpose. In China, where immune regulators are a central area of concern, Uncaria species are not counted among them. When purchasing powdered materials, it is difficult to know if one is getting the right species (importers already caution that you buy their species of cat’s claw and not an alternative one, Uncaria guaianensis, available on the Peruvian market), much less the right plant part. If the root bark, which may have relatively unique compounds, is to be used, then the plants must be dug up, and we have one more case of damage to the rain forest plants. It has been suggested that the upper bark might have the same activity as the root bark, and it is possible, with vines, to collect the tops and still have the plant grow back. However, a careful analysis of the vine bark must be made and one must be assured of getting just this part (there isn’t much bark on this plant). But, why bother? There are so many established immune-regulating herbs already available that putting great effort into this one seems unappealing.
What about the current research status? In the U.S., this is being trusted to practitioners of natural medicine untrained or poorly trained in clinical evaluations who are to report on the effects in their patients (who are almost certainly taking other remedies at the same time) under the general heading of conducting a “clinical trial.” These practitioners will no doubt claim benefits seen in numerous patients, as they have in the past for each remedy that has been brought out for informal evaluation by practitioners untrained in research methodology. In Austria, Dr. Keplinger is said to be using a medicine extracted from the vine along with AZT in AIDS patients. His results (from the past eight years of experience) are being reported not in medical journals but in newspapers, such as El Comercio (Lima). In Peru, researchers are making a sincere effort to analyze the ingredients and effects of the plant. As reported in journals, the observed effects have been quite limited and the activities can be explained by compounds and mechanisms that do not require one use cat’s claw. Yet, an American distributor says that “Cat’s claw promises to become a major therapeutic agent worldwide in the very near future due to its unusual and significant health-stimulating properties.”
It is quite unfortunate that the diligent efforts of Peruvian researchers are being largely ignored in favor of the outlandish claims of chiropractors, nutritional consultants, and writers of informal correspondence courses. Desperate AIDS and cancer patients, as well as others, may be taken in by this (that is, after all, what the effort is all about), and spend their limited resources on this potentially endangered rain forest remedy when better-studied, more effective, and less expensive remedies are available to them. This is the ongoing problem with alternative medicine: uncritical acceptance of remedies promoted by persons with limited knowledge, but strong financial interests, and unreliable enthusiasm. If cat’s claw is a legitimate contributor to treatment of serious illnesses, then let the scientific knowledge be compiled and analyzed and then compared to what is known about other plant remedies before it is touted as the newest remedy for cancer and AIDS.
Appendix: Other Uncaria Species
Uncaria vines are native to Japan, China, Vietnam, and the Malaysian peninsula. Among the species used in China, interchangeably, are U. rhyncophylla, U. macrophylla, U. hirsuta, U. sessifructus, U. formosana, and U. scandens. The branch and stem are used for their nerve-inhibiting actions, associated with the alkaloid components. They are thus applied as a sedative, anticonvulsant, hypotensive, and analgesic. In Vietnam, U. tonkinensis is used; the bark of the vine is considered useful in lowering fever; it is said that the bark contains no alkaloids, but does contain catechin and catechutannic acid. In Malaysia, Uncaria gambir is used. The top of the plant is rich in tannins and is not very suitable for internal use (except temporarily to treat dysentery). Rather, it is applied topically for its antiseptic action (attributable to tannins) and some analgesic effects (probably due to the alkaloids). The roots are considered a remedy for intestinal inflammation, which is a common application of tannins. Such compounds may also have a positive effect on gastritis and urethritis, conditions for which cat’s claw has been claimed to be of use.

Nature: salty, acrid, neutral

Enters: Liver, Lung

Actions: Eliminates external wind, eases itching and relieves pain; extinguishes liver wind, relieves spasms and convulsions; resolves phlegm, dissipates nodules; clears heat, dissipates stagnant heat.

Indications:
• Wind: skin eruption with itching.
• Liver wind or wind-phlegm-heat: convulsions, facial paralysis, deviation of the mouth and eyes in wind-stroke, seizures.
• Liver heat or attack of the liver channel by wind-heat: headache, red eyes, sore, swollen throat, loss of voice.
• Stagnant heat: carbuncles, sore throat, toothache.
• Phlegm accumulation: lumps, scrofula, nodules.
• Use raw for dispersing wind-heat, otherwise dry fry.
• Compared to Wu gong and Quan xie in the treatment of wind and spasms, Jiang can is most appropriate for those due to phlegm-heat.
• Pound before cooking.
Hsu: Hypnotic, antispasmodic, stimulates adrenal cortex.
Dose: 3-9g (0.9-1.5g as powder or pill)

Nature: sweet, bitter, slightly cold

Enters: Liver, Large Intestine, Kidney

Actions: Clears liver heat; expels wind-heat; promotes vision; moistens the large intestine, promotes bowel movement.

Indications:
• Liver heat or liver channel wind-heat: red, swollen, itchy, painful eyes with photophobia and increased tearing. Especially useful when liver heat is accompanied by constipation.
• Heat or dryness in the large intestine (especially from liver Yin deficiency): constipation.
• Used to prevent atherosclerosis: lowers blood pressure and serum cholesterol.
• Hypercholesterolemia: in one study of 100 patients (mean value 246.9 mg%, and as high as 484) given Jue ming zi decoction, 85% had normal values within 2 weeks. 98% were normal within 4 weeks. However, the value of total serum cholesterol as a measure of morbidity/mortality is questionable.
• Can counteract the constipating effects of some other herbs in this category (such as Mu li).
• Compared to Ju hua, Jue ming zi is better at clearing liver fire and benefiting the kidneys; Ju hua more effectively pacifies the liver and disperses wind-heat.
• Dry fried: tonifies the liver and is used for eye problems due to liver and kidney deficiency.
• Antibiotic effect.
• Bensky/Gamble classifies with herbs that drain fire.
• Bensky/Gamble: Do not use with Huo ma ren; not recommended when there is diarrhea or hypotension.
MLT: Pan roast and powder, and use as a coffee substitute for hypertension.

Dose: 9-15g (up to 30g alone)

Nature: salty, cold

Enters: Liver, Heart

Actions: Clears liver heat; subdues liver yang (remarkably); extinguishes liver wind; promotes vision; clears heat and toxicity; clears damp-heat; quiets the Shen.

Indications:
• Liver wind: convulsions, spasms – infant, epilepsy, other seizure disorders, including for recalcitrant fevers, internal wind due to intense heat.
• Liver Yang rising: dizziness, vertigo, headache, blurry vision, red eyes, photophobia, hypertension, spasms, convulsions.
• Liver fire: red eyes, headache.
• Heart blockage by heat and toxicity with liver wind stirring: high fever, unconsciousness, delirium, involuntary limb movement.
• Wind-damp-heat: Bi syndrome.
• Doctrine of signatures: Antelopes and mountain goats live (and thrive) at high altitudes. The herb is useful for Yang that rises, like the peak of a mountain, and also for mountain sickness – increases resistance to a low oxygen environment.
• Less effective than Xi jiao (rhinoceros horn) at clearing heat and toxicity, but more effective at relieving spasms and extinguishing wind. The two horns are used together in severe cases of coma and convulsions due to high fever (however, rhinoceros horn should no longer be used, given rhinos’ endangerment).
• Take directly as powder or pills.
• Ling yang jiao is similar to Gou teng, but while Gou teng enters mainly the Qi level, Ling yang jiao enters the blood level, relives toxicity, and treats heat in the blood
Hsu: Antipyretic, anticonvulsive – tranqulizing, antispasmodic – inhibits CNS.

Dose: 0.9-3g (directly)

 
Shan Yang Jiao: Mountain Goat horn
• For ecological considerations, this herb may be used in place of Ling yang jiao.
• Mountain goat horn is much weaker – use 10 times the dose of antelope horn that would be used.

Dose: 9-60g

Nature: salty, astringent, slightly cold

Enters: Liver, Heart, Kidney

Actions: Subdues the liver and suppresses rising liver yang; anchors the Shen; benefits the Yin and anchors floating Yang; softens and disperses hardness, nodules, stagnation of phlegm and fire; astringes and controls body fluids; neutralizes acid (calcined form) and alleviates (stomach) pain.

Indications:
• Liver yang rising (including with Yin deficiency): restlessness, insomnia, palpitations, dizziness, vertigo, tinnitus, bad temper, red, flushed face
• stagnation of phlegm and fire: masses, lumps, swollen lymph nodes and glands, scrofula, goiter.
• Weak constitution (deficiency only – steaming bone disorder or following a warm febrile disease): seminal emission, leukorrhea, uterine bleeding, spontaneous or night sweats.
• Acidity: heartburn, excessive stomach pain with sour taste (Bensky/Gamble recommends the calcined form for this, while Liu says to swallow 10g uncooked, non-calcined Mu li). Note: Mu li contains a high amount of calcium carbonate. The carbonate acts as a pH buffer in the stomach, but calcium is a stimulus for acid secretion in the stomach (because it is soluble only at a low pH). At best, Mu li is a branch treatment for acidity. As antacids go, Mu li – and all antacids which contain calcium – may be inferior to those comprised of other mineral carbonates (such as sodium bicarbonate – baking soda).
• Muscle cramps: by “softening hardness” – anecdotally useful as a standalone herb, even in the common form of oyster shell calcium pills. Also beneficial for restless legs.
• Useful in treating night sweats due to tuberculosis.
• Weaker than Long gu to quiet the Shen, but stronger than Long gu to subdue liver Yang.
• “Slipperier” than Long gu.
• For astringing body fluids, use the calcined form, Duan mu li. For all other purposes use the unprepared form (note Bensky/Gamble says to use the calcined form for neutralizing acid).
• Cook for 20-30 minutes longer than other herbs.
• Bensky/Gamble classifies with herbs that anchor the Shen.
• Some sources claim Mu li works synergistically with Bei mu, Gan cao, Niu xi, and Yuan zhi, and that it has adverse effects when combined with Ma huang, Wu zhu yu, and Xi xin.
• The nacre in oyster shells is composed primarily of calcium carbonate in a crystal form known as aragonite.
Hsu: Astringent, sedative, analgesic, antioncotic.
• Use 90-120g for neck lymphadenitis.
DY: With Huang qi to supplement Qi, constrain Yin, secure the exterior, and stop perspiration. For indications such as:
– 1. Spontaneous perspiration due to Qi or Yang deficiency. (Mu Li San) Use calcined Mu li.
– 2. Night sweats due to Yin deficiency. (This combination is appropriate for moderate Yin deficiency. In cases of deficiency fire, this pair cannot be used alone.)
– 3. Spontaneous and nighttime perspiration due to Qi and Yin deficiency. (Mu Li San) Use calcined Mu li.

Dose: 15-30g

Nature: acrid, salty, neutral, toxic

Enters: Liver

Actions: Extinguishes liver wind, relieves convulsions; eliminates external wind; cleans and dissipates stagnation of (fire) toxicity, dissipates nodules; removes obstruction from channels and collaterals, relieves pain.

Indications:
• Liver wind, wind-phlegm: convulsions (acute or chronic infant), tetany, tics, deviation of the mouth and eye in wind-stroke, tremors, opisthotonos, seizures. This herbs is among the most effective at eliminating wind.
• External wind: convulsions due to tetanus (wind invades wound).
• Stagnation of toxicity: carbuncles, lumps, toxic sores, swellings – includes topical use – follows the theory “use toxin to attack toxin.”
• Obstruction of channels and collaterals (blood stasis): stubborn headaches, migraines, Bi syndrome.
• Lowers blood pressure; tranquilizer.
• Weaker anticonvulsive effect than Wu gong. Compared to Wu gong and Jiang can in the treatment of wind and spasms, Quan xie is most appropriate when there is heat.
• Start with a very low dose and slowly raise it (if necessary).
• Often combined with Wu gong.
• Contraindicated for internal wind due to blood deficiency; pregnancy.
LL: Essential for a serious headache – always consider this herb.
MLT: For cancer/tumors: powder Quan Xie with Wu gong and Jiang can, suspend in water in a cloth bag while cooking an egg in the water. Eat the egg and drink the broth.
Hsu: Antispasmodic (weaker than Wu gong), antifungal, sedative.

Dose: 2-5g or 0.9-1.5 of just the tail (0.6-0.9g directly as a powder)

Nature: salty, cold

Enters: Liver, Kidney

Actions: Clears liver heat; subdues the liver and suppresses rising liver yang; promotes vision, dispels superficial visual obstruction.

Indications:
• Liver yang rising: dizziness, vertigo, headache, hypertension.
• Liver fire: red and swollen eyes, nebulas, blurry vision, optic neuritis, photophobia, pterygium.
• Topical ophthalmic: apply as a very fine powder to eyes.
• If the digestion is poor, use only 15g.
• Decoct for about one hour longer than other herbs.

Dose: 9-30g

Nature: sweet, neutral

Enters: Liver

Actions: Subdues the liver and suppresses liver Yang rising; extinguishes liver wind, relieves convulsions; eliminates wind-damp; relieves pain.

Indications:
• Wind-phlegm or liver Yang rising: dizziness, also headaches, migraines. This is perhaps the best herb for dizziness in the pharmacopeia.
• Liver wind: convulsions, trembling, epilepsy, tonic-clonic spasms, opisthotonos, tetany, wind-stroke – including with hemiplegia, dizziness, and numbness of the extremities.
• Wind-damp: Bi, pain and numbness of the lower back and extremities.
• High doses can cause nausea and vomiting.
• Since this herb is expensive, some deceitful sellers in China will steam potatoes to shrink them and then sell them as Tian ma.
• Some advise against using this herb in cases of Yin deficiency (such as liver wind due to liver Yin deficiency), claiming that it is warm and dry, however, MLT says: similar to Gou teng, but its sweet flavor gives it Yin tonic properties.
Hsu: Anticonvulsive, cholagogue.
SD: Gastrodia refers to the tuber of an orchid, Gastrodia elata. This plant has an unusual requirement for survival: it must have the Armillaria mellea mushroom mycelia incorporated into the tuber in order to maintain its maturation and growth, and it requires another fungus, Mycena osmundicola, to sprout the seeds. When supplies of the crude gastrodia became rare in the 1970’s, attempts at cultivating the herb repeatedly failed until this complex synergistic plant/mushroom relationship was determined. Then, cultivation became easy, though it was not until the late 1980’s that an adequate cultivated supply of gastrodia was developed.
Interestingly, the medicinal benefits of gastrodia were found to be mainly the metabolites of the Armillaria mushroom. In other words, if one could grow the mushroom, the gastrodia tuber could be dispensed with and one could use just the mushroom material in place of gastrodia. This mushroom cultivation (by batch fermentation) was accomplished and the material was tested in the 1970’s; today, gastrodia mushroom (Armillaria) is frequently used instead of cultivated gastrodia. In the meantime, wild gastrodia, along with all other wild orchids, has been put on the endangered species list.
Gastrodia was listed in the ancient Shennong Bencao Jing (ca. 100 A.D.) and was later classified by Tao Hong as a superior herb, meaning that it could be taken for a long time to protect the health and prolong life (as well as treating illnesses). It was originally called chiqian, meaning red arrow, because of its red stem shaped like an arrow. Later it was named tianma, or heavenly hemp (ma, usually translated as hemp, refers to many plants that have fibrous stems, such as the well-known mahuang).
The traditional use of gastrodia is to calm internal wind and dispel invading wind, and invigorate circulation in the meridians; thereby treating headache, dizziness, vertigo, convulsions, paralysis, and arthralgia. In the book Chinese English Manual of Commonly-Used Herbs in Traditional Chinese Medicine, the three basic indications are reduced to this elaborated pair:
1. Calm the liver wind: For syndrome of liver-wind stirring inside, such as infantile convulsion, tetanus, epilepsy, as well as dizziness and headache due to excess of liver yang or the attack of wind-phlegm; recently it is also used for treatment of neurasthenia, nervous headache, and hypertension;
2. Expel wind evil and alleviate pain: For migraine, arthralgia due to wind-dampness, numbness of extremities, and general fatigue.
According to research reports, the main active ingredients include gastrodin, a complex glycoside, plus vanillyl alcohol and vanillin, which, as their names suggest, are related to the flavor vanilla (vanilla comes from the fruit of another orchid, Vanilla planifolia, and the primary flavor is vanillin, which is synthetically produced as the standard flavor substitute). Vanillin has been shown to have anticonvulsive effects. There have been numerous other compounds identified in both Armillaria and the gastrodia tuber, with roles that are not yet established.
The gastrodia mushroom, Armillaria (also listed as Armillariella), is known in China as tianma mihuanjun.
Like many other medicinal mushrooms, Armillaria contains immune-enhancing polysaccharides, but the amount of the gastrodia mushroom usually ingested is not sufficient to provide a substantial immune-enhancing action. Gram for gram, the armillaria mushroom is more potent than the gastrodia tuber, mainly because it is the primary source of the active constituents. An exact quantitative comparison has not been determined, and may vary with the different therapeutic applications, but, generally speaking, the dosage of armillaria to be used is about half that of gastrodia tuber. Because these products are safe to use, armillaria can be used in the same amount as the gastrodia rhizome it
replaces in order to attain superior effects.
Gastrodia tuber is traditionally given in decoction in doses of 3.0–10.0 grams per day; the gastrodia mushroom (fermentation product) or gastrodia tuber is given in the form of a powder in doses of 1.0–1.5 each time, 2–3 times per day (total dosage of 2.0–4.5 grams/day).
According to Icones of Medicinal Fungi, Armillaria fermentation products “are found to produce satisfactory effect in treatment of dizziness caused by hypertension, insufficient blood supply to the arteries’ cone base, Meniere’s syndrome, as well as functional disorders in autonomic nervous system. They are also effective in improving numbed limbs, insomnia, tinnitus, epilepsy, vascular headache, and apoplectic sequela [post-stroke syndrome].”
The Advanced Textbook on Traditional Chinese Medicine and Pharmacology mentions that “This herb is mild, and can subdue hyperactive liver yang, eliminate wind, and remove obstruction in the collaterals, and is indicated for all kinds of wind syndromes, either cold or heat type or due to internal or external wind. For such cases, it is combined with other herbs according to the specific conditions. It is an important herb to treat dizziness.”
Examples of combining gastrodia with other herbs include these, from the Textbook:
¨ For dizziness and headache due to hyperactive liver yang, combine with uncaria and haliotis.
¨ For upward disturbance of wind-phlegm, combine with pinellia and atractylodes.
¨ For migraine, combine with cnidium.
¨ For convulsion due to irritation by liver wind, combine with antelope horn and uncaria.
¨ For tetanus [tonic convulsion, a wind-phlegm disorder due to external wind] combine with arisaema and siler.
¨ To relieve wind and remove obstruction in the collaterals [luo vessels], producing rheumatic pain and numbness
of the limbs, combine with chin-chiu, chiang-huo, and achyranthes.

Dose: 3-10g (0.9-1.5g directly as powder)

Nature: acrid, warm, toxic

Enters: Liver

Actions: Extinguishes liver wind, relieves convulsions; eliminates external wind; cleans and dissipates stagnation of toxicity; removes obstruction from channels and collaterals, relives pain, dissipates nodules.

Indications:
• Wind, tetanus: acute or chronic infant convulsions, opisthotonos, spasms, seizures, lockjaw.
• Stagnation of toxicity: carbuncles, lumps, nodules, neck lumps, sores, poisonous snake bites, stings. Used internally and topically.
• Blood stasis, obstruction of channels: stubborn headaches, migraines, Bi syndrome, impotence. Directs herbs to the penis.
• Very effective at treating diphtheria (used with Gan cao in study).
• Antifungal.
• Possesses anti-tumor effects (in vitro).
• Effective for submandibular lymphadenitis.
• Some sources say to remove the legs and head – only use the trunk and tail.
• May cause stomach upset.
• Often combined with Quan xie.
• Stronger than Quan xie and Jiang can for wind and spasms. Since it is warm, is most appropriate for wind-cold. It is superior to the other two in the topical treatment of toxic swellings.
• Doctrine of signatures: Its form indicates its ability to direct to the penis and treat impotence. Liu: “Like an arrow that directs herbs to the penis.” Bugs, in general, are adept at squirming into small places, and are useful for opening blockages and freeing the channels.
• Usually taken directly in powder form (often in capsules).
• Contraindicated in pregnancy.
Hsu: Antibacterial, hypotensive, antispasmodic.

Dose: 0.9-3g (0.6-1g as powder or pill)

Nature: sweet, salty, cold

Enters: Liver, Heart

Actions: Anchors the Shen; clears liver heat; eliminates superficial visual obstructions; sedates the heart; settles tremors, convulsions, and palpitations; astringes, promotes tissue regeneration; enhances the skin.

Indications:
• Shen disturbance or liver wind: palpitations, childhood convulsions, seizures.
• Disharmony of heart and Shen: easily frightened or angered.
• Liver heat: red, swollen eyes, nebulas, pterygium, blurred vision.
• Skin: take 1-2g internally daily to enhance skin.
• Topical: for non-healing ulcers, macerated areas (usually throat or gums); applied to the eyes as a very fine powder or in eye drops for nebulas; applies to the skin to soften, refine, and enhance its color.
• Often cooked with tofu and water for two hours prior to being ground into powder.
• Bensky/gamble classifies with herbs that anchor the Shen.
Hsu: Antihistamine, anti-allergic, diuretic.

Dose: 0.3-1g usually directly as powder/pill

Nature: salty, cold

Enters: Liver, Heart

Actions: Subdues the liver and suppresses any type of liver Yang rising; clears liver heat; promotes vision; anchors the Shen.

Indications:
• Liver Yang rising and liver Yin deficiency: headache, dizziness, vertigo, tinnitus, restlessness, insomnia, seizures.
• Liver Yin deficiency: blurry vision.
• Liver heat: red eyes, photophobia.
• Topical: promotes healing of canker sores.
• Commonly used as a cheap substitute for Zhen zhu, though it is much less effective.
• Must be cooked longer than other herbs.
• Difficult to digest (like all shells and minerals).
• Bensky/Gamble classifies with herbs that anchor the Shen.
• As a topical facial exfolliant. One source claims machine grinding produces a powder too fine to exfolliate effectively. Hand grinding may be preferable.
MLT: Promotes healing, generates flesh.
• Topical for acne/blemishes.

Dose: 15-30g