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.

• 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 lecture notes: [See also his brilliant book, Ten Key Formula Families in Chinese Medicine]

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.
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.
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 .
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.
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
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
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
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.
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)


Heiner Fruehauf, director of the Classical Chinese Medicine program at the National University of Natural Medicine in Portland, Oregon, is the foremost expert (in the West, at least) on the medicinal use of aconite products, a product of his study and elucidation of the Fire Spirit School (Huoshen Pai) of Sichuan herbalism.

Fruehauf notes that aconite had a much more prominent place in Chinese herbalism historically than it occupies today, with contemporary practitioners, especially in the West rarely using it, or limiting use to just a few grams a day. Meanwhile, Fire Spirit School practitioners may use up to 200g a day, and even claimed that sometimes these high doses are less likely to produce “overheating”-type side effects than lower doses.

It is beyond the scope of this website to cover all that Fruehauf has said about the use of aconite (I suggest you search for Fruehauf+fu zi), but I have included a few excerpts from his interview by Bob Quinn, which can be found in its entirety HERE:

“Traditionally, once the aconite tuber was harvested it underwent a number of detoxification procedures involving steaming, soaking in brine, and repeated rinsing in flowing, clean water. Most of these steps are skipped in modern times. Most modern fuzi is over-brined and is not washed properly in flowing water. In the worst case scenario, and this sadly happens all too frequently, the fuzi is processed with bleach or other harsh chemicals. You can imagine that this has a very severe effect on the aconite’s healing properties. Also, modern fuzi slices tend to be small, because the plant was not grown in the right area and in the right manner.

“In the case of fuzi, the area in Jiangyou where this herb is still cultivated by local peasants has shrunk to less than 20 acres in modern times. Most aconite on the market is grown elsewhere in China and is then shipped to Jiangyou, to get a local stamp so it can appear that it was grown where it should have been grown. This is a real tragedy, since there is a real difference; just the visual appearance of the Jiangyou fuzi tuber is much larger than that of fuzi grown elsewhere. Most of the genuine fuzi is snatched up by Korean and Japanese companies who still value ancient herbal traditions. They are very much aware of the superior quality of Jiangyou fuzi, while in the west virtually nothing is known about the dramatic differences in aconite quality due to place, time, and processing. As a clinician you quickly recognize the value of genuine aconite that has been grown and processed in the traditional manner.

“With the modern fuzi most practitioners are forced to work with two things can happen: In the first scenario, the aconite is inert, as if sawdust had been added to the formula. In the second scenario, the patient may develop an allergic reaction to the aconite—and remember, this toxicity stems from improper processing, not any sort of natural toxicity of the plant—and gets some sort of uncomfortable feeling in their body. I can say with great confidence that this sort of reaction is not due to any sort of unwanted toxicity in the aconite itself.

“Genuine fuzi does unfold a powerful function in the body that is unlike other warming herbs like ginger, cinnamon, or evodia. For instance, when you want to treat severe heart failure with edema, or, say, kidney failure in patients about to go to dialysis, it is very difficult to make any progress without this herb in Chinese medicine. There is real power in this herb. The ancient Chinese were not exaggerating when they called it the “King of the 100 Herbs.” For me, as a serious herbalist who specializes in treating patients with debilitating diseases, this was a great discovery and clinical breakthrough. I am very grateful for it. I found it important enough to station a Classical Pearls employee semi-permanently in Jiangyou, to ensure proper processing of the genuinely grown and harvested fuzi. In this way, I can import the real thing for my own clinic and Classical Pearls.

“Insomnia and anxiety are typically defined as being yin-deficient conditions in TCM. Due to the depleting effect of our modern lifestyle however, there is usually an underlying yang deficiency present in these patients. Stress can be defined as a situation when we spend our (yang) life-force rather than safeguarding and storing it. The primary problem we have here is therefore one of yang storage. This is what fuzi does—it entices the yang to go back into a state of storage. When you add Suanzaoren Tang to an aconite based formula, you will thus see much better results in anxiety and insomnia patients than with Suanzaoren Tang itself. This is the approach I have taken in the design of the Peace Pearls.

“Then, considerations of dosage are important in aconite use. According to the Fire Spirit School and even Ye Tianshi, the pioneer of the fever school, heavy doses off an herb cause the qi to go to the lower burner, while light doses cause it to go to the upper burner. This is true not just for aconite, but for any herb. When asking similar questions to physicians in the Fire School lineage, they said that uprising symptoms like palpitations and dizziness—which, again, is most often caused by improper herb processing—can come from prescribing too small a dose of fuzi. Since fuzi is traditionally charged with drawing the fire of mingmen into the battery of the lower burner, higher doses are more appropriate for this purpose. In the case of the Fire Spirit School physicians, they start with 60 grams and go up to 120-200 grams of aconite per day.

“I personally don’t think that extremely high fuzi doses in the amounts I just mentioned are absolutely necessary. In my own clinical practice, I generally prescribe 18-30 grams of these fuzi [concentrated] granules in formulas designed to last a week. Of course, the amount used should match the purpose of the formula. Bamboo Pearls, my main formula for arthritis, rheumatoid arthritis, aching fracture sites and other types of body pain is based on Guizhi Shaoyao Zhimu Tang. This formula deliberately features just 9 grams of fuzi, because the aconite is used here for its function of being the “opener of the twelve channels.” In medium amounts, fuzi drives out body pain. However, if you want to treat severe anxiety, severe insomnia, severe damage to the Heart-Kidney shaoyin layer, severe damage to the taiyin layer that aconite also enters, you need to use higher doses. Note that some classics originally refer to fuzi as a sweet herb; we see this digestive-strengthening focus and taiyin affinity in Fuzi Lizhong Tang for instance. It is also interesting here to note that the Heart was originally labeled as an earth organ before the fire organ designation was added. Even in English we have that convention, by saying that someone is a “sweetheart.” Fuzi is thus primarily an herb to warm, tonify and bolster the yang qi of both postnatal taiyin and prenatal shaoyin network functions.

An important thing I learned from Drs. Lu Chonghan and Liu Lihong is the image of dribbling the ball in soccer. In the game of soccer, you eventually want to shoot a goal, meaning that the sole point of dribbling is to get the ball into scoring position. In this analogy, scoring a goal is to reinforce the vital fire of mingmen with aconite. Dribbling is to remove qi and blood stagnation, resolve phlegm, etc., with other herbs. From the perspective of the Fire Spirit School, all chronic patients will eventually need an aconite formula, even if we see a lot of heat in a patient at first. Eventually, all treatments get to the stage where we need to get between the goal posts by penetrating the Gate of Life (mingmen), also referred to as Kidney yang, and fuzi is the main herb for doing this.

“I find the following formulas most useful for this purpose: First, the aconite base formula in the Fire Spirit School is the historically all-important yet nowadays rarely used remedy Sini TangSini Tang, as I use it, consists of aconite in one of its medicinal forms, whether it is fuziwutou, or even caowu (if there is pronounced body pain); plus a form of ginger, either ganjiang (dry ginger), shengjiang (fresh ginger), paojiang (roasted ginger), or even gaoliangjiang (galanga); and finally some form of licorice, either gancao (unprocessed licorice) or zhi gancao (honey-baked licorice), most commonly the zhigancao. We know this formula as the Shanghan lun approach to life-threatening situations where the spirit needs to be anchored in the body, but in the Fire Spirit School it is the base formula for all chronic conditions once meridian stagnation has been resolved.

“The other aconite formulas I want to mention here are all derivatives of Sini Tang. There is Fuzi Lizhong Tang, a classical modification of the Shanghan lun formula Lizhong Tang, which allows us to affect both prenatal and postnatal realms in the body. It is very suitable to be used as one of those “shoot the goal” formulas—possibly with the addition of some yin tonics and a tiny amount of huanglian, as I have done for yin-yang balance in the Vitality Pearls. Another formula that I frequently use in this context, which originates directly from the Fire Spirit tradition, is Qianyang Dan. This formula, which literally translates as “Submerge the Yang Pellet,” was created during the 19th century by Zheng Qin’an, the Qing dynasty master of the Fire Spirit School. Qianyang Dan is basically Fuzi Lizhong Tang minus baizhu plus amomum/cardamon in the form of sharen or baidoukou. Dr. Zheng and his disciples in the Lu and Peng family lineages look upon sharen and baidoukou in the same way as aconite—an herb that warms, dispels dampness, and most importantly, causes the qi to go back down into storage. Different from the regular definition of these herbs as aromatic appetite enhancers, they are here recognized as key minister herbs for aconite, helping it with the all-important job of getting the yang-qi back into the box. Peace Pearls, one of the aconite formulas recently created for the Classical Pearls line, is essentially a combination of Qianyang Dan with Suanzaoren Tang. The Peace Pearls primarily treat anxiety and insomnia. Qianyang Dan is also at the core of Guanyin Pearls, a remedy addressing hot flashes and other menopausal complaints. Similar to Peace Pearls, Guanyin Pearls combines the yang bolstering effect of Qianyang Dan with the yin tonic elements of Erzhi Wan and Erxian Tang. If just the regular approach of using yin tonics was used to treat these disorders, the primary problem of yang leakage would remain unaddressed. I find that until there is a clear therapeutic focus on this leakage of source yang, it is difficult to make lasting progress in the treatment of anxiety, insomnia, hot flashes, and other conditions involving the upflaring of qi.”

See complete interview and Fruehauf’s many other resources. 

Wu Tou: Aconite 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

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

  1. Heiko Lade says:

    Thank you Peter for compiling this piece on Fu zip and sharing it. Most appreciated. Heiko Lade

  2. Jerry says:

    This is the first reference I can find suggesting long term use of Fu Zhi is a danger. (all other sources refer primarily to the short term toxicity of aconitine but mention nothing in cautions of long term use or long term buildup of anything, ie comparable to dai zhe with arsenic or other known things that build up in the body) Could you provide some further comments on Fire Spirit school and those two founders? (perhaps what doses they were taking for how long) Or if there any insights into why it might’ve been harmful?

    (reason: i’m a TCM student and also patient who only seems to respond to formulas with fu zhi to be functional for more than a year now and am concerned about my own health)

    • Peter Borten says:

      Hi Jerry, I see that you wrote this 4 years ago, but better late than never, right? Anyway, the reference to long term use I think you’re referring to was in notes from Huang Huang, and that was a specific case where intensive use of Fu Zi wasn’t indicated for the patient – just sparing use once a day or every other day. Not because of Fu Zi’s toxicity, but simply that its heating effect was only needed in moderation with this patient’s constitution.

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