The previous post, Aconite as a toxic narcotic herb in Early Chinese Medical Literature: The Ma Wang Dui manuscripts, set the stage for this one. In it, we looked at the uses of Monkshood/Aconite in the earliest known Chinese medical literature, the Ma Wang Dui tomb texts of 168 B.C.E. We determined that travelling back in time to get our hernias treated would suck, even though they used a mugwort-wrapped marijuana joint in treatment (to blister the top of the head to treat inguinal hernia demons).
However, the Ma Wang Dui manuscripts are not generally regarded as a “Classic” in the way that the Yellow Emperor’s Internal Classic and Divine Farmer’s Materia Medica Classic are. It could be unfair to draw conclusions about the bad idea of using high doses of Aconite in modern clinics in an attempt to “restore the science of Classical Chinese Medicine” without investigating the more highly revered Classics.
Therefore, it’s time to go directly to what’s regarded as the most important early Chinese text on herbal medicine, the _Divine Farmer’s Materia Medica_ (Shen Nong is the mythological divine farmer, and the Ben Cao Jing is the name of his book). For my intro to this book, check out this short post.
Legend has it that Shen Nong figured out all the medicinal and toxic herbs about 5000 years ago, but this text started to come together in the real world about 100 CE. Really, Tao Hong Jing (T’ao Hung-ching), who lived from 456-536, did the most work on the Shen Nong Ben Cao. He was a Taoist physician and alchemist, and retired to Mt. Mao Shan to do his textual works and play with alchemy. He’s regarded by Paul Unschuld as a main founder of the Mao Shan sect of Taoism and alchemy. I’ve written a bit about Mao Shan sleight-of-hand tricks (Mou Shan witchcraft/sorcery/black magic), especially by reviewing the book _Skills of the Vagabonds: From Where the Japanese Ninjitsu Originated_.
The Divine Farmer’s Materia Medica is very clear about its classification of herbs and how they should be used. I don’t find it particularly accurate or clinically relevant, but if one were actually trying to practice based on this Classic, it is pretty clear what the protocol is. The most scholarly translation is by medical historian Paul Unschuld, in _Medicine in China: A History of Pharmaceutics_.
The Shen Nong Ben Cao (written Shen-Nung Pen-T’sao by Unschuld, still pronounced Ben Tsao) divides herbs into three main categories:
Here is Unschuld’s translation [the brackets are all his] (Unschuld, 19):
The upper class of drugs comprises 120 kinds. They are the rulers (chün). They control the maintenance of life and correspond to heaven. They do not have a markedly medicinal effectiveness (wu-tu). The taking [of these drugs] in larger amounts or over a long period of time is not harmful to Man. If one wishes to take the material weight from the body, to supplement the influences [circulating in the body], and to prolong the years of life without aging, he should base [his efforts] on [drugs mentioned in] the upper [class of this] classic.
Please note that Arsenic and Mercury are in this ‘safe’ class of drugs. Since Unschuld’s translation is a bit academic, let’s compare it to Yang Shou-Zhong’s more popular version (page ix):
There are 120 superior class medicinals which are used as sovereigns. They mainly nourish life and correspond to heaven. They are nontoxic and taking them in large amounts and for a long time will not harm people. If one intends to make one’s body light, boost the qi, prevent aging, and prolong life, one should base [one's efforts] on the superior class.
Unschuld’s middle class:
The middle class of drugs comprises 120 kinds. They are the ministers (ch’en). They control the preservation of the human nature and correspond to Man. One part of them possesses medicinal effectiveness, another part does not. For every application, the choise of the suitable [drugs] should be considered carefully. If one wishes to prevent illnesses and to balance depletions and consumption, he should base [his efforts] on [drugs mentioned in] the middle [class of this] classic.
There are 120 medium class medicinals which are used as ministers. They mainly nurture personality and correspond to humanity. They may or may not be toxic, and [therefore,] one should weigh and ponder before putting them to their appropriate use. If one intends to control disease, supplement vacuity, and replenish exhaustion, one should base [one's efforts] on the middle class.
Unschuld’s lower class:
The lower class of drugs comprises 125 kinds. They are the assistants (tso) and aides (shih). They control the curing of illnesses and correspond to earth. They possess a markedly medicinal effectiveness (yu-tu) and must not be taken over a long period of time. If one wishes to remove cold, heat, and [other] eveil influences (hsieh-ch’i) from the body, to break constipations [of any sort] , and to cure illnesses, he should base [his efforts] on [drugs mentioned in] the lower [class of this] classic.
Note this goes back to the Chinese medical philosophy that the superior physician prevents disease and the inferior physician treats disease.
There are 125 inferior class medicinals which are used as assistants and envoys. They mainly treat disease and correspond to earth. They are usually toxic and cannot be taken for a long time. If one intends to eliminate cold and heat and evil qi, break accumulations and gatherings, and cure disease, one should base [one's efforts] on the inferior class.
A few paragraphs later, the Shen Nong Ben Cao gives specific dosage recommendations and warnings about the lower class of toxic herbs (Unsculd, 20):
In treating illnesses with drugs of a strongly medicinal effectiveness, one should first start with a dosage the size of a millet seed. If the illness is cured [with that], administration of the drug should be halted immediately. If the illness persists, the amount of the dosage should be doubled. If the illness continues even then, the dosage should be increased ten times. The cure [of the illness] should mark the limit [of the treatment].
Let’s go back to Yang’s version for the basic treatment principles (page xiii):
To treat cold, one should use hot medicinals. To treat heat, one should use cold medicinals. For nondispersion of drink and food, one should prescribe ejecting and precipitating medicinals. For demonic influx and gu toxins, one should prescribe toxic medicinals.
My next post will be “The Woo of Gu.” I’m looking forward to writing it, so do stay tuned.
It looks like the Shen Nong Ben Cao offers clear and accessible advice about practicing Classical Chinese herbal medicine. Again, I don’t find the advice to be that “true” or “useful” in the modern medical sense, but it is very historically important. It does seem like timeless wisdom to only use very small doses of toxic herbs, only when really necessary, and then discontinue them as soon as possible. For those who aren’t familiar with millet, it has grains smaller than rice.
Now that the theoretical stage is set and we are all clear on the 3 categories, the cautions around the lower class of toxic herbs, and the tiny doses that should be carefully given, we can find out where Aconite is in the Divine Farmer’s Materia Medica and see what it was recommended for.
It’s not in the superior class of safe herbs (like Arsenic and Mercury). It’s not in the middle class of generally OK herbs (like Ephedra and Asbestos fibers). There it is, in the Inferior class of toxic herbs, page 72 and 73 of Yang Shou-Zhong’s translation! There are 3 different forms of Aconite listed there:
Wu Tou (Radix Aconiti) is acrid and warm. It is toxic, treating mainly wind stroke and aversion to wind as after a soaking. It promotes sweating, eliminates cold damp impediment and cough and counterflow qi ascent, breaks accumulations and gatherings, and [relieves] cold and heat. The decoction of its juice is called She Wang (Shooting Net), and it can kill birds and beasts. Its other name is Xi Du (Extraordinary Toxin). Another name is Ji Zi (Immediate Child). It is also called Wu Hui (Black Beak). It grows in mountains and valleys.
Tian Xiong (Radix Lateralis Aconiti Carmichaeli) is acrid and warm. It mainly treats great wind, cold damp impediment, joint-running pain, hypertonicity, and slackness and tension. It breaks accumulations and gatherings, [treats] evil qi and incised wounds, fortifies the sinews and bones, and makes the body light and the walk strong. Its other name is Bai Mu (White Curtain). It grows in mountains and valleys.
Fu Zi (Radix Lateralis Praeparatus Aconiti Carmichaeli) is acrid and warm. It is toxic. It mainly treats wind cold, cough and counterflow, and evil qi. It warms the center, [treats] incised wound, breaks concretions, hardness, accumulations, gatherings, and blood conglomerations, and [relieves] cold dampness, crippling wilt, hypertonicity, and pain in the knee with inability to walk. It grows in mountains and valleys.
This wraps up my rather extensive writings on Aconite. I’ve looked at a large amount of modern research, most of the current textbooks of Chinese herbal medicine, and now gone back to the most important early texts in direct translation. I haven’t done this solely to show off my awesome book collection, but as a critical investigation of the claims of those who are heavily promoting (for profit) Aconite to be used in large doses in modern clinical practice, claiming that they are deriving this from scholarly attention to the spiritual science of the ancient Classical and Canonical Chinese medical masters. Since what the classics actually say is fresh in your mind, dear reader, I will close with a few quotes from the main modern marketer of Aconite as a “Classical” herbal therapy which you will hopefully be able to evaluate from a more informed point-of-view than you would have before encountering my blog.
Excerpts From: The Importance of Aconite (fuzi), an interview with Heiner Fruehauf.
As you know, it has been a consistent focus in my life to help restore the clinical power of classical Chinese medicine to where it was before, namely a medicine that can treat serious disease, not just shoulder pain and acute injuries. In this context, I found that fuzi features prominently in ancient texts. It was called baiyao zhi zhang, the “King of the 100 Herbs.” In modern times, however, I have not seen this herb used very often, and that includes my observation time with most of my Shanghan lun teachers in China.
I realized that the main problem was not the fear of toxicity of the herb itself, but the non-traditional processing that this herb undergoes in the modern era.
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.
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 [1800's], heavy doses of 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.
In my own clinical practice, I generally prescribe 18-30 grams of these fuzi granules in formulas designed to last a week [this works out to an average of 17 gms bulk herb equivalent per day. There are probably 10 millet seeds per gram. --K]. 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.
It was the complete lack of sources for medicinal grade aconite in the West that motivated me, a self-described scholar nerd, to jump into the herb industry. I could not find a true aconite anywhere to work with in my clinic. I found some sources to be better than others, but none rose to the level of the real thing, and many were outright useless or even dangerous.
Maybe it would be instructive here to talk about how much aconite we use in one day in my own clinic, so people can see the potential dimensions of aconite use for chronic disorders—I probably go through ten bottles of aconite granules in a single day; in other words, an entire kilogram of the extracts I have just described [5 to 1 and 8 to 1 concentrates, so 5-8 kg (11-17.6 pounds of aconite per day)]. At our clinic, we really do rely on those aconite-based formulas I listed earlier.