In the world of medicinal herbs, Aconite stands alone. Also referred to Monkshood and Wolfsbane – and Fu Zi in Chinese herbal medicine – it was known as “the Queen of Poisons” among the ancient Greeks. On the one hand, Aconite is so poisonous that improper use can cause human respiratory paralysis, cardiac arrest, and even death. On the other, Aconite is so medicinally indispensable that herbalists throughout the centuries, from medical sage Zhang Zhongjing to modern day TCM masters, believe it can even resurrect the dead. In ancient texts, Aconite was called baiyao zhi zhang – the “King of 100 Herbs” – and is famous for tonifying Yang and rescuing it from collapse.
Both revered – and feared – for centuries, Fu Zi / Aconite has long been considered one of the most important herbs in the Chinese materia medica. Yet many herbalists are afraid to use it because of its potential toxicity. Indeed, the herb is a poster child for the effective and essential use of pao zhi, or processing methods, commonly used with Chinese herbs. Because it is highly toxic in its raw form, Fu Zi / Aconite has been demonized by many western medical researchers who usually study the root without understanding the precise processing and decoction methods it requires.
Though there are many different methods, Fu Zi is always processed – and subsequently referred to as Zh Fu Zi – in order to decrease the toxic alkaloids and increase its beneficial effects. The cultivated accessory roots of the plant Aconitum carmichaeli are used, as opposed to the cultivated main root which is much stronger and more toxic, called Chuan Wu. After harvesting, the accessory roots are generally steamed, soaked in brine, and repeated rinsed in clean water. They may then be processed by various methods, including cooking with ginger juice, baking in sand at a high heat, or most commonly, boiling with black beans and licorice until cooked through to the center. Even after that, when decocted into a tea for consumption, the prepared root slices are still cooked for an extra 30 – 60 minutes longer than the rest of the herbal formula. This combined long heating time in processing and decoction, along with substances such as licorice and ginger, renders a safe and powerful herb that activates and mobilizes the Yang, particularly of the Heart and Kidney.
Considered a “pure Yang” herb, Fu Zi primarily warms and tonifies, and is not generally appropriate for most cases of Yin deficiency with excess Yang, or true excess heat. In formulas, Aconite is used to treat heart disease as well as chronic, severe pain. Linaments or ointments containing Fu Zi / Aconite are used externally to ease neuralgia and arthritis.
In traditional Chinese medicine, Fu Zi is considered an effective stimulant for the Spleen and Kidneys, and is a popular treatment for malaise, general weakness, poor circulation, cancer and heart disease. Fu Zi is also occasionally used in very low doses by modern homeopathic practitioners as a treatment for colds, influenza, rheumatism and congestion. The herb has also been recognized as effective in treating neuralgia.
The importance of providence and processing
Because of the toxicity of the herb in the raw state, it is the processing that makes this herb effective and brings out its superlative healing properties. Most Fu Zi on the market today is not grown in the right area, nor at the right time of year, and most importantly, has not been processed appropriately. All of these factors impact the quality of the Fu Zi we have access to today. Li Shizhen, in his great Ming dynasty materia medica Bencao gangmu, very specifically points out that the right type of Fu Zi only grows in the ancient districts of Qianwei, Guanghan, and Longzhou, which refers to modern-day Jiangyou in Sichuan province. All material medica scholars emphasized this point, including Qing dynasty scholar Yang Shitai who wrote in 1833: “Fu Zi from Longzhou is the best. Even though it grows in abundance elsewhere, it is weak and not suitable for medicinal use.”
It is further said in the oral traditions of the Fire Spirit School that the seedlings of Fu Zi need to be harvested high in the mountains where they endure great cold—which may be why this herb is so powerful in driving out damp cold—and then should be planted at the winter solstice in the Jiangyou area among other crops. The plant then grows in the time of year when the Yang is in its ascendancy and is harvested at the summer solstice before the Yang starts its decline. Thus, the herb quite literally absorbs only the energy of the Yang part of the year. This attention to timing is important, but most growers now disregard this key feature.
Chinese herbal formulas featuring Fu Zi
The nature of Fu Zi is spicy, sweet, hot and toxic. It goes to the Heart, Kidney and Spleen meridians. Indications for the herb’s use include: rescuing / restoring the Yang, tonifying Fire to raise Yang energy, and eliminating Cold to stop pain.
The primary indications for which Fu Zi is effective include: Yang depletion, cold extremities and faint pulse, impotence, cold uterus, cold pain at the heart or abdomen, cold vomiting and diarrhea, cold edema, Yangdeficiency (not as severe as depletion), exogenous cold and damp pain, and other chronic, severe cold diseases.
Fu Zi Li Zhong Tang. This formula comes from Qi Xiao Liang Fang (Effective and Good Prescriptions) and is primarily designed for Spleen-Kidney-Yang deficiency, cold-dampness epigastric and abdominal cold pain, loose stools and diarrhea, etc. Other herbal ingredients in this formula include: Ren Shen (Ginseng), Bai Zhu (White Atractylodes), Gan Jiang (Dried Ginger Root), and Zhi Gan Cao (Honey Fried Licorice Root).
Gancao Fu Zi Tang. This formula comes from Shang Han Lun (On Cold Damage) and is formulated to treat arthritis aggravated by cold and any other joint pains caused by the combination of pathogenic wind, cold, and damp. Other major herbs include Gan Cao (Licorice Root), Bai Zhu (White Atractylodes), and Gui Zhi (Cinnamon Twig).
Fu Zi Gui Zhi Tang. This formula, also from On Cold Damage, is mainly used for Yang-deficiency induced arthralgia syndrome. The two other herbs in the formula are Gui Zhi (Cinnamon Twig) and Gan Cao (Licorice Root).
Fu Zi Geng Mi Tang. This prescription comes from Jin Gui Yao Lue (Essential Prescriptions of the Golden Coffer) and it is an important remedy for abdominal fullness and distention due to deficiency-cold in Spleen and Stomach, as well as water and dampness retention. Additional herbs in the formula include: include Ban Xia (Pinellia Rhizome), Gan Cao (Licorice root), Da Zao (Jujube), and Geng Mi (Rice).
Hui Yang Ji Jiu Tang. This formula comes from Shang Han Liu Shu (Supplement of Treatment of Febrile Diseases) and is an effective treatment for cold limbs, aversion to cold, curled up on the bed, stomach ache accompanied with vomiting and diarrhea, and a deep, weak pulse. Other vital herbs include Ren Shen (Ginseng) and Rou Gui (Dried Cinnamon Bark).
Clinical applications of Fu Zi in TCM
Although care and consideration must be used when prescribing a medicinal formula that features Fu Zi as a chief or “emperor” herb, there are several crucial TCM pattern diagnoses where the inclusion of Fu Zi can make or break clinical success in treating a patient and restoring their health.
Yang collapse
Symptoms: faint pulse, spontaneous cold sweat throughout the entire body, extremely cold limbs, extreme sweat, vomiting
Kidney deficiency
Symptoms: aversion to cold, extremely cold limbs, weak Spleen Yang, abdominal pain, loose stools, impotence, frequent urination
Wind cold dampness bi syndrome
Symptoms: whole body pain, joint pain, arthritis
Modern pharmacological application of Aconite
In addition to its well known use in TCM clinics, western research and medicine is increasingly recognizing the benefits and clinical application of Aconite to help treat cardiac (and other symptoms) and heal patients.
Strengthen the heart
Aconite has been shown to enhance myocardial contractility, speed up the heart rate and cardiac output, and increase myocardial oxygen consumption
Impact blood vessels and blood pressure
Aconite can either increase or decrease blood pressure depending on its percentage of components
Anti-shock
Modern day shock indications such as extreme cold limbs, profuse sweating and faint pulse mirror those associated with the TCM pattern diagnosis of Heart-Kidney Yang
Anti-cardiac arrhythmia
Aconite has a significant effect on anti-bradycardia
Anti-cold
Aconite can help improve the ability to withstand hypoxia
Anti-inflammatory and analgesic effect
Aconite has been shown to help reduce inflammation as well as pain in certain instances
Sedation
Aconite can help calm the spirit in certain instances
Toxic side effects and contra-indications
The toxic component of Aconite (aconitine) primarily acts on the myocardium, vagus nerve, and peripheral nerve excitation, resulting in poisoning symptoms that manifest as tongue numbness, limb numbness, tingling, dizziness, blurred vision, nausea and vomiting. Its curare-like effect can block neuromuscular transmission, manifested as arrhythmia, hypotension, hypothermia, respiratory depression, muscle paralysis and central nervous system dysfunction. As little as two milligrams of Aconitine taken internally may cause severe symptoms, while larger doses can cause systemic and respiratory paralysis symptoms. Death may occur in severe cases. Therefore, Aconite should be strictly processed, cooked, and used based on the prescribed dosage. Aconite should not be used during pregnancy, breast feeding, or and in case of Yin deficiency and Yang excess.
Regarding the toxicity of Aconite, Dr. Wu Rongzu offered: “Aconite is like electricity: lightning can kill people, but if you tame or manipulate it, it can benefit mankind. Aconite is an excellent herb to treat cold disease, but it worsens heat disease because applying Aconite on a patient with hot disease is like adding fuel to a fire. Syndrome differentiation is the core of Chinese medicine, and is especially essential to the correct application of Aconite.”
Fu Zi – poison or cure?
The Chinese word for poison is du. Unlike its negative meaning today, ancient texts written 2,000 years ago used the word to denote potency, or its ability to both harm and heal. There was no categorical distinction between poisons and non-poisons in traditional Chinese medicine – instead, they were viewed as acting on a continuum defined by level of potency. Overall, poisons made up about 20% of the medicine used in the ever-expanding Chinese pharmacopeia throughout the Imperial Era, highlighting their crucial role in healing.
One way that Chinese doctors used poisons for healing was through the principle of using poison to attack poison (yi du gong du). According to the ancient sages, these powerful substances could target and eliminate specific disease entities like worms inside the body. They believed the strong sensations induced by poisons marked a process of purifying the body of its harmful burdens.
Doctors in China were keenly aware of how the effect of a poison varied greatly depending on its dose, its preparation, and how it was administered. Accordingly, they developed a variety of methods – mixing with other ingredients and other drug processing techniques – to mitigate a poison’s potency while still preserving its efficacy.
Using a poison outside of its prescription often proved deadly. For instance, Five Stone Powder or Wushi San, a psychedelic drug that contains arsenic, was one of the most popular medicines in medieval China. Despite medical recommendation that it be used only as a last resort to treat emergencies, many at the time regularly consumed it to invigorate their bodies and illuminate their minds. Unsurprisingly, this misuse led to numerous deaths. Going beyond its restricted usage, a poison can easily kill.
The paradox of healing with poisons in traditional Chinese medicine reveals a key message: there is no essential, absolute or unchanging core that characterizes or defines a medicine. Instead, the effect of any given drug is always relational – contingent on how it is used, how it interacts with a particular body, and its intended effects.
Poisons today typically evoke notions of harm and danger – the opposite of medicines for healing. Yet TCM, which has been in practice for over two millennia, has used a large number of poisons to treat a variety of illnesses. Ancient Chinese sages discovered that what makes a drug therapeutic isn’t just its active ingredient – but it’s context and dose.
This blurred boundary between poison and medicine is not unique to traditional Chinese medicine. Chemotherapy uses toxic drugs to treat cancer. And the U.S. opioid offers a sobering reminder of how a class of FDA-approved medicine used to treat chronic pain became a lethal poison through improper administration. Conversely, certain psychedelics deemed illegal today have ignited new interest in the medical community as potential treatments for anxiety, addiction and depression.
Chinese doctors in the past recognized the healing capacity of poisons such as Fu Zi while being fully aware of their potential to kill. Understanding this practice should compel modern biomedicine to reconsider how “medicine” is defined today.