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Herbs to Quell Fire

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Andrew Flower

on 21 October 2018

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Transcript of Herbs to Quell Fire

Herbs to Quell Fire, Cool the Blood, & clear Heat and dry Dampness
Revision of Heat conditions
Quell Fire herbs
Herbs to cool the Blood
Herbs to clear heat and dry Dampness
Basic theory
Heat
Heat can be considered external and internal; excess and deficient

External heat is associated with acute respiratory infections and has been covered in herbs to treat the exterior.

There is a spectrum of intensity from Heat...to Fire...to Fire toxin.

Heat can be Empty-resulting from Yin xu or Full-the result of pathogenic excess.

Fire suggests stronger Heat and requires colder more potent herbs.

Fire toxin is the most extreme-it is often characterised locally by red, swollen and purulent lesions and systemically by fever and inflammation that is active, aggressive and recalcitrant.
Heat and the Zang Fu
Heat in the Heart and Small Intestine
Heat in the Heart presents with fever, thirst, dry mouth + bitter taste and restlessness, insomnia and irritability. There may also be tachycardia or palpitations + mouth ulcers. T: red tip + yellow coat P: rapid and strong

Heat may be transmitted from the Heart through the Small Intestine (both Fire) to the Bladder (Tai Yang) causing dark, scanty, burning urination and frequency.
Heat in the Liver
Heat may invade the Liver from the exterior but it is commonly generated internally by emotional constraint and frustration...leading to Qi stasis...which in turn can produce Heat.

Symptoms of Liver Heat/Fire include:
Red face, splitting headache, dry, red and painful eyes, disturbed sleep, irritability and anger, hypochondriac pain, menstrual disturbances etc

Damp-Heat in the Liver and Gall Bladder can manifest as itchy skin conditions (eg eczema), jaundice, gall stones, or gynae problems eg leukorrhoea.
Heat in the Spleen and Stomach
Heat in the Stomach can arise from excess Hot food, Food stagnation, Qi stagnation, and from External pathogens entering the Yang Ming level.

The Spleen is more commonly afflicted with Damp-Heat caused by poor diet, external invasion, emotional stress etc.

Stomach Fire presents with eg > thirst/appetite, constipation, bad breath, mouth ulcers. headache/toothache, Haematemesis if v. severe.

D/H in the Spleen/Middle Jiao presents with nausea, anorexia, diarrhoea, abd distension etc.
Heat in the Lung and Large intestine
Heat invading the Lung can cause cough, SoB, wheezing, thirst, sore throat, acne etc

In the Large Intestine Heat causes constipation, abdominal pain etc
Heat in the Kidney and Bladder
Empty Heat can lead to further depletion of the Yin/Jing with symptoms of night sweats, LBP, low grade fever, dry mouth, insomnia, scanty urination etc

Heat in the Bladder frequently combines with Dampness leading to D/H which may in turn progress to Fire toxin
Heat in the 4 levels
The Defensive level
Initial stages of EPF invasion causing fever, aversion to wind and cold,aching, runny nose, thirst, sore throat, headache etc

Use pungent cool or bitter cool herbs eg Chai Hu, Ju Hua, Bo He, Jin Yin Hua etc
Heat in the Qi level
High fever, sweats, aversion to Heat, cough, wheezing, thirst, rapid full pulse etc

May relate to flu...but also very active eczema

Herbs: eg Shi Gao, Zhi Mu, Zhi Zi, Xia Ku Cao
Heat at the Ying level
Fever > at night, dry mouth with no desire to drink, insomnia, restlessness, skin rash, clouding of consciousness, delerium.

T: deep red and no coating
P:thready and rapid

Herbs eg Sheng Di Huang, Qing Hao, Mu Dan Pi, Xuan Shen, Bai Wei etc.
Heat at the Blood level
High fever, purple-red skin rashes, bleeding from nose, stomach, bowels, urine.

Manic behaviour, convulsions, coma

T: Red and no coating
P: Wiry-rapid

Eg meningitis...also psoriasis

Herbs eg Shui Niu Jiao, Sheng Di Huang, Xuan Shen, Da Qing Ye etc
Common Characteristics of herbs to clear Heat
(adapted from Yi Fan Yang's book on CHM-Comparisons and Characteristics)
Pungent and Cold herbs
Cold herbs tend to move inwards and downwards (contractive-Yin). If used alone to clear Heat they may suppress Heat and drive it deeper into the body...from where it can re-emerge when the cold herbs are stopped. This can be seen also with antibiotic use.

Pungent herbs tend to move upwards and outwards (expansive-Yang) to prevent this constraint to help Cold disperse and expel the Heat.

Eg. Xia Ku Cao, Shi Gao, Mu Dan Pi, Bai Jiang Cao
Sweet, cold herbs
Sweetness tonifies and harmonises. When combined with a Cold nature these herbs are useful for clearing Heat and helping to protect the Body Fluids and Yin from damage. They can alleviate thirst and help regenerate damaged fluids

They may also be used when Heat is at the Qi + Ying levels during acute infection.

Eg herbs Shi Gao, Lu Gen, Sheng Di Huang, Tian Hua Fen etc.
Salty and Cold herbs
Salty taste softens hardness, descends and may purge.

Salty cold herbs clear Heat and descend Fire.

Used for Heat when it is in the Ying and Blood level or when Heat is associated with hot swellings eg lymphadenopathy.

Eg herbs Xuan Shen, Kun Bu/Hai Zao,
Bitter and Cold herbs
Bitter herbs tend to drain, descend, dry Damp and clear Heat.

Bitter, cold herbs descend Heat, reduce Fire and eliminate Fire toxin. Many of the commonly used herbs for acute and chronic infection, and hot skin diseases have a bitter, cold nature.

Their bitter, cold nature can damage the Yang of the Stomach

Eg Huang Lian, Huang Qin, Ku Shen, Long Dan Cao
Summary
As well as the Qi of the herb also check out the channels entered so that the herb can target the affected organ.

Remember the empirical use of cold herbs

Combine different flavours to make a more effective treatment of heat eg combine Cold and Bitter with some Cold and pungent herbs to prevent Heat constraint.

In cases where Heat is mild, deficient, or has damaged the Yin, then consider Cold and sweet or Cold and salty herbs.
Shi Gao-Gypsum fibrosum
Gypsum is a soft sulfate mineral composed of calcium sulfate dihydrate, with the chemical formula CaSO. 4· 2H2O. It is used as a fertilizer, and as the main constituent in many forms of plaster, blackboard chalk and wallboard.

Good quality-big, white and pure pieces with a fibrous structure and no contaminants.
Properties
Sweet, Pungent, very Cold

Enters Lung and Stomach

Dose15-60g. Currently prohibited in the UK for internal use. May be used externally, usually calcined, to clear heat and generate flesh. Cook with the other herbs.
Primary actions
1. Clears Heat and drains Fire for Ext. Heat invading Yang Ming ('4 Bigs') or the Qi level causing high fever, profuse sweating, intense thirst, flooding pulse, yellow tongue fur. (eg Bai Hu Tang)

2. Clears Heat from Lungs and stops cough and wheezing

3. Clears Stomach Fire-toothache, headache, gingivitis

4. Clears Heat in the skin and promotes healing of sores eg Eczema burns
Bai Hu Tang
Shi Gao 30-90g
Zhi Mu 9-15g
Zhi Gan Cao 3-6g...nowadays Gan Cao
Jing Mi (rice) 9-15g...nowadays eg Shan Yao
Clears Qi level/Yang Ming heat, drains Stomach fire, generates fluids and alleviates thirst.
Ma Xing Shi Gan Tang
Ma Huang 9-12g
Xing Ren 9-12g
Shi Gao 20-30g-I substitute with Lu Gen
Gan Cao 6g

Descends rebellious Lung qi and stops cough and calms wheezing. See also Ma Xing Er San Tang in lectures on the treatment of asthma.
Cautions
A very cold herb that can damage the Stomach and Spleen with long term use

Not suitable for Yin xu + empty Heat
Key points
Used for Excess Cold-particularly in the Lungs (incl. skin) and Stomach-for both exterior and interior conditions.

Its pungent nature helps it vent heat from the Qi/muscle layer and its sweet taste helps to protect the Yin

It is not currently legal in the UK. I substitute it with a large dose of Lu Gen 20-30g for cough and Zhi Mu 9-15g for Stomach Fire
Zhi Mu-Anemarrhena asphodeloides
Botany
Rhizoma of a clump forming perennial herb 20-100cm tall.

In the wild grows in scrub, steppe and open sandy grasslands from sea level to 1,500m throughout China.

Good quality: large, soft and compact-yellowish white in section with a hint of green.
Properties
Bitter, Sweet and Cold & moistening

Enters Lung, Stomach and Kidney (NB operates in all 3 jiao)

Dose: 9-15g

Preparation: it may be dry stir fried (Chao) to moderate its cold nature in weaker or elderly patients

It may also be stir fried in Honey (Mi Zhi-moderating and making it more tonifying); Vinegar (Cu Chao)-to focus on the Lungs; Salt (Yan Chao)-to focus action on the Kidneys, clearing empty heat, and cooling and draining Ministerial Fire
Primary actions
1. Clears Heat and drains Fire-for Qi level Heat and Yang Ming patterns


2. Nourishes Yin, generates fluids and moistens Dryness (eg wasting and thirsting disease.


3. Clears Empty Heat as in liver/kidney Yin xu. A key herb in Zhi Bai Di Huang Wan...a very useful base to help alleviate eg menopausal symptoms

4. Can be used to balance the formula in the presence of warm/hot and drying herbs.
Cautions
Be careful in long term use because of its bitter cold nature which may weaken Stomach fire and Kidney Yang
Key points
I use this herbs frequently for signs of Yin Xu + empty Heat or in acute exterior conditions where Heat has damaged the fluids of the Stomach and Lung.
Lu Gen-Phragmitis australis
Botany
Rhizoma of a perennial reed up to 2m tall

Commonly grows in damp places eg marshes, lakeside, stream sides throughout China.

Good quality: broad, yellow and lustrous rhizomes.
Properties
Sweet and cold

Enters Lung and Stomach

Dose: 15-30g
Primary actions
1. Clears Heat and generates fluids-for febrile disease damaging the fluids causing thirst, irritability etc

2. Clears heat from Lungs and dispels Phlegm and pus-used for acute/chronic cough.

3. Clears Stomach fire causing nausea, vomiting, haematemesis, thirst etc
Secondary actions
1. Clears Heat and promotes urination for Hot Lin diseases (ie it also works on all 3 jiao-used for wasting and thirsting disease).

2. May vent incompletely expressed rashes due to EPF eg measles, viral rashes

3. Relieves food poisoning caused by fish and crab.



Caution
Take care if there is cold in the Stomach
Key Points
I use this herb instead of Shi Gao to treat acute and chronic coughs where there is Heat or Phlegm Heat obstructing the Lungs. Remember 15-30g!

In China one experienced doctor recommended it was used together with Ma Huang...but you can use it instead with eg Zi Su Ye + Xing Ren for similar effect.

May be used with Bai Mao Gen ('Er Gen') for haemoptysis in eg lung cancer.
Tian Hua Fen-Radix Trichosanthis kirilowii
'heavenly flower powder'
Botany
Long root tuber of a climbing herb that grows throughout China in open forest, scrub & grassland.

Good quality herbs have large, heavy, white and powdery roots.

NB The whole fruit (Gua Lou), the peel of the fruit (Gua Lou Pi), and the seeds of the fruit (Gua Lou Ren) are also commonly used herbs
Properties
Bitter, sl sweet, cold-but mild in taste and temperature, ascending and descending

Enters Lung and Stomach

Dose 9-30g
Primary actions
1. Clears Heat and generates Fluids-due to internal heat damaging Lung or Stomach Yin eg wasting and thirsting, dry mouth, irritability etc

2. Clears Heat from Lungs & transforms (hot) Phlegm

3. Resolves toxicity and dispels pus-for carbuncles, breast abscess (used externally and internally)

4. Also has a mild blood moving property.
Secondary actions
Trichosanthin-an extract from the root-is injected to induce abortion in early pregnancy...but this protein is denatured after cooking and is not present in decoction or granules.

Commonly used in the treatment of diabetes to address symptoms of thirst...but may actually increase blood sugar levels!
Cautions
Take care if a person has deficient cold in the Spleen and Stomach.
Key Points
This herb is similar to Lu Gen...but Lu Gen is better in the acute stages of a cough whilst Tian Hua Fen is better when heat has damaged Lung or Stomach Yin and has a stronger Phlegm resolving action.

It's is also used for toxic swellings
Dan Zhu Ye-Lopatherum gracile
'Bland bamboo leaf'
Originally Dan Zhu Ye referred to common bamboo (Phyllostachys nigra Munro) but after Li Shi Zhen's 'Ben Cao' was published in the 16th century Lopatherum gracile was seen as better and used instead.
Botany
Dan Zhu Ye is a perennial grass that resembles common bamboo leaves but it is a short, shrub-like plant without the stiff central stem of common bamboo.

Grows in shady places along forest margins and disturbed ground.

Good quality-large, green leaves without roots or flowering parts.


Properties
Sweet, bland and Cold

Enters Heart, Small Intestine, Stomach

Dose: 9-15g
Primary actions
1. Clears Heat from Heart and Stomach and relieves irritability, thirst, mouth ulcers etc

2. Promotes urination and leaches out Dampness...a FH for Lin Disease (or UTIs) caused by Heart-Small Intestine-Bladder connection. See Dao Chi San
Dao Chi San-Guide out the Red powder
Sheng Di Huang

Mu Tong (may be substituted by Qu Mai)

Dan Zhu Ye

Gan Cao

Clears Heat from the Heart, promotes urination and protects the Yin
Dan Zhu Ye and Zhu Ye
Dan Zhu Ye is more diuretic than Zhu Ye-which is more used to clear Heat in the Stomach, Heart and Lungs causing tongue ulcers, insomnia, irritability, and a cough
Cautions
Use with caution during pregnancy
Key Points
A relatively mild herb but very useful for clearing Heat affecting the Heart & Stomach whilst simultaneously draining Damp.

Used for urinary tract disorders-especially when there is a Heart involvement but may also be used in eg D/H skin conditions caused by emotionally triggered Heat
Zhi Zi-Gardenia jasminoides
Botany
Fruit of a small, dense evergreen shrub (up to 3m).

Wild species grow in C & E China in forest, scrub, fields and along stream sides

Good quality is plump, reddish orange fruits with a thin fruit wall

May be stir fried brown (Chao)-to moderate its cold action on the Stomach or charred black (Zhi Zi Tan)-to enter the Blood, clear heat and stop bleeding (however the best way to optimise the haemostatic action is to stir fry for 10 mins in a wok)
Properties
Bitter and Cold and sinking

Enters Heart, Lung, Stomach, Liver and Triple Heater

Dose: 9-15g
Primary actions
1. Sedates Fire and relieves irritability-clears Fire in the Heart (eg insomnia, restlessness, palpitations), in the Stomach (heartburn, epigastric pain, thirst etc) and Liver (irritability, headache etc)

2. Drains Damp and Heat from all 3 jiao eg (a) EENT
b) jaundice/nausea/loose bowels c) painful urination. Also v useful for d/h skin diseases eg atopic eczema

3. Clears Heat, cools blood and stops bleeding-the partially charred herb is better.

4. Reduces swelling and pain-can powder and mix with egg white and apply topically


Cautions
A cold herb so caution with Spleen and Stomach qi xu
Key Points
A bitter cold herb that enters the tripple burner and clears Heat and Damp from the 3 jiao.

Good at relieving irritability, agitation etc but also physical Fire symptoms.

Partially charred to clear Heat from the blood and stop bleeding.


Jue Ming Zi-Cassia obtusifolia
'unhampered clarity seeds'
Botany
Cassia seed is the ripe seed of the annual plant Cassia obtusifolia L., or Cassia tora L., of the Leguminosae family

Widely cultivated in China, and mainly produced in provinces like Anhui, Guangxi, Sichuan, Zhejiang and Guangdong

Good quality: dry, full, brown and glossy seeds of a consistent size.
Properties
Bitter, sweet
, salty and slightly cold

Enters Liver, Large Intestine, Kidney

Ascending and descending action. Moistens, nourishes and clears Heat

Dose 9-30g
Primary actions
1. Clears Liver Heat and benefits the eyes-for painful, red, swollen eyes, and other eye problems eg photo-sensitivity caused by interior or exterior Heat in the Liver channel (use together with Ju Hua, Man Jing Zi etc)

2. Calms the Liver and anchors Yang-for Liver Yang rising-also used for hypertension (also use Gou Teng, Ju Hua, Xia Ku Cao etc)
Secondary actions
1. As a moistening, oily seed Jue Ming Zi can moisten the bowel and alleviate constipation (enters large intestine channel)

2. May also help to lower blood cholesterol levels (use with Jiao Gu Lan, Xue Zhi Kang) and alleviate atherosclerosis (use with Dan Shen, San Qi for CHD)
Cautions
May stimulate uterine contractions so avoid in pregnancy.

Cold in nature so caution with people of Spleen and Stomach xu and loose stools

Care if patient has hypotension
Key points
A FH for Heat invading the Liver organ and channel and damaging the eyes.

Also commonly used in the Tx of Hypertension and high cholesterol.
Mi Meng Hua-Buddleja officinalis
Buddleia flower bud
Botany
A commonly found shrub 1-3m high


Good quality-dense inflorescences, with greyish brown, soft smooth flower buds and no stalks

Properties
Sweet
and slightly
cool

Enters Liver

Dose: 9-15g

Toxicity: Slight toxicity due to containing acacetin so avoid overdose (although it is used as a flavouring and colouring for rice dishes...)


Actions
1. Clears Liver Heat and brightens the eyes.
(Its coldness clears Heat from the Liver channel and its sweetness nourishes Liver Blood and Yin.)

Can be used for excess and deficiency Heat and interior or exterior pathogens.

Alleviates red, swollen and painful eyes, gradual loss of sight, excessive tearing etc.
Caution
Mildly toxic. Overdose can cause digestive upset, dizziness, numbness, tremors.
Key points
Always nice to use a local herb...a useful herb for eye problems especially when caused by deficiency of Liver and Kidneys with empty Fire flaring...but may also be used for Excess conditions.
Qing Xiang Zi-Celosia argentea
Celosia seeds
Properties
Bitter, slightly cold, descending action

Enters Liver

Dose: 9-15g
Actions
1. Drains Liver Fire, clears Wind-Heat and benefits the eyes-for external/internal heat causing red, painful, swollen eyes and visual obstruction.

2. Sedates Liver Fire and lowers blood pressure.

3. May relieve W/H related headaches
Cautions
May dilute the pupil so use with caution in conditions eg glaucoma. Although Chen says it can reduce intra-ocular pressure...
Key points
Unlike Mi Meng Hua which is sweet, Qing Xiang Zi is bitter (Bensky gets this wrong) so it is better suited for draining Fire, descending Yang and less nourishing to the eyes.
3 herbs for the eyes
Lian Zi Xin-Nelumbo nucifera
Lotus plumule
Botany
This is the green plumule (embryonic shoot in the seed) within the ripened lotus seed, which is separated and dried.

Good quality is large and blueish green in colour
Properties
Bitter and Cold

Enters Heart and Pericardium

Dose 1.5-3g
Actions
1. Drains Heart Fire-for exterior or interior conditions affecting the heart and pericardium (eg 6 Channels) manifesting with mental confusion, delirium, mania, mouth ulcers etc.

2. May also relieve Heart Fire related insomnia, restlessness and irritability.

3. May be powdered and used to stop bleeding.
Summary and Questions
Questions
1. A man presents with an acute cough with yellow mucous and a fever. Which of the herbs would you select?

a) Xia Ku Cao b) Zhi Zi c) Lu Gen d) Dan Zhu Ye


2. Which of the following herbs does not help to resolve hot phlegm?

a) Tian Hua Fen b) Shi Gao c) Xia Ku Cao d) Zhi Zi


3. Which of the following herbs would you use for red, painful eyes from Heat due to Liver Yin xu?

a) Jue Ming Zi b) Qing Xiang Zi c) Xia Ku Cao d) Mi Meng Hua


4. Which two of the following herbs would you select for acute cystitis caused by Heart Fire?

a) Lian Zi Xin b) Dan Zhu Ye c) Tian Hua Fen d) Zhi Zi


5. If there was empty Fire causing night sweats, insomnia etc which herb would you select?

a) Shi Gao b) Xia Ku Cao c) Lu Gen d) Zhi Mu.


6. What range of dose would you apply to the following herbs
(A=3-9g: B=9-15g: C=15-30g)

a) Xia Ku Cao b) Lian Zi Xin c) Zhi Zi d) Lu Gen e) Dan Zhu Ye
Sheng Di Huang-Rehmannia glutinosa
Chinese foxglove root
Botany
Root of a short perennial herb growing widely in China in mountain grasslands and disturbed places.

Best quality comes from Henan province.

Good quality: large, thick, heavy, pliable tubors that are black and lustrous inside.

NB Sheng Di Huang can either be steamed or cooked in rice wine to produce Shu Di Huang-which has a Yin and Blood nourishing function
Properties
Sweet, bitter, cold & moistening

Enters Heart, Liver and Kidneys

Dose: 15-30g
Primary actions
1. Clears Heat and cools the Blood
-for exterior invasion into the Ying and Blood levels causing high fever, thirst and scarlet red tongue (see Xi Jiao Di Huang Tang-using Shui Niu Jiao NOT Xi Jiao!)
-and for Interior Heat affecting the Blood and causing eg bleeding, hot skin diseases (eg Xiao Feng San), mental restlessness (I use it together with Huang Lian, Yuan Zhi for Heart Fire related insomnia) etc

2. Nourishes the Yin and generates fluids-for post fever depletion of Yin, wasting and thirsting disorder or for chronic conditions of Yin deficiency Heat.
Secondary actions
Its moistening nature make it a useful herb for alleviated constipation caused by dryness and Heat

It may also be used for Lin Disorders where heat is transmitted from the Heart to the Bladder via the small intestine. See Dao Chi San

Research suggests Sheng Di Huang has an anti-inflammatory effect, possibly an immuno-suppressive effect, and may increase plasma levels of cortisol by slowing down catabolism in the liver.

Sheng Di Huang may also have a protective effect against radiation and should therefore not be used during cancer radiotherapy.
Cautions
Sheng Di is a greasy herb that can be difficult to digest and may lead to Damp symptoms including nausea, abdominal bloating and diarrhoea.

If the digestion is weak then moderate the dosage and stir fry the herb in fresh ginger or cook with Sha Ren to help prevent Damp stagnation

Do not use during radiotherapy and be aware that it may increase corticosteroid levels in patients taking steroid medicines
Key Points
This is a very widely used herb to clear heat from the Blood and to nourish the Yin. It is a mainstay of many formulae for hot skin diseases such as eczema and psoriasis and is often used in combination with Mu Dan Pi and Chi Shao in these instances.

Sheng Di can often be used as an addition to, or substitute for, Shu Di in formulae if the Heat is intense and the Yin is compromised (eg Si Wu Tang, Liu Wei Di Huang Wan etc)

Be aware of its potential to produce loose stool. However some schools of thought suggest that transient increase in bowel movements is one of the ways in which this herb can clear Heat
Mu Dan Pi-Paeonia suffruticosa (in reality P. ostii) Tree Peony
Botany
Roots of a small shrub or tree peony endemic to China growing wild (now critically endangered) in deciduous forests and thickets.

Medicinal plants are usually Paeonia ostii (not suffruticosa) and are grown in farms reputedly producing this herb for 1,000 years.

Good quality: root bark thick, white and starchy and strongly aromatic.
Properties
Pungent and aromatic, Bitter and sl Cold

Enters Heart, Liver and Kidney

Dose: 9-15g
Primary actions
1. Clears Heat and cools the Blood. For both Exterior and Interior related Heat:
A) Exterior-when Heat enters the Blood level causing high fever, bleeding, delerium, skin rashes etc
B) Interior heat caused by e.g. Qi stagnation, Yin deficiency, diet and lifestyle, and also due to a chronic retained pathogenic factor (smoldering) at the Blood level.

2. Moves the Blood and dispels blood stasis-for musculoskeletal pain, gynaecological problems eg amenorrhoea, endometriosis etc

Mu Dan Pi is said to 'cool without congealing and to move without spilling'
Secondary actions
A useful herb to treat allergic rhinitis (15-30g)

Clears Liver Fire-for H/A, eye pain etc (see Dan Zhi Xiao Yao San)

Can be used to help drain pus and reduces swelling in skin diseases but also in intestinal abscesses or appendicitis (see Da Huang Mu Dan Tang).

Anti-inflammatory effect-possibly by inhibiting prostaglandin synthesis and by decreasing the permeability of the blood vessels
Cautions
May cause transient nausea

Also take care if patients are pregnant or have excessive bleeding (although Mu Dan Pi is contained in Gui Zhi Fu Ling Wan-which is designed to treat a restless foetus caused by blood stasis)
Key Points
Another commonly used herb to cool the Blood and treat a wide variety of skin and gynaecological disorders.

It is a FH for allergic rhinitis and for clearing Yin deficiency heat (use together with herbs like Sheng Di Huang, Chi Shao and Qing Hao)
Xuan Shen-Scrophularia ningpoensis
ningpo figwort root
Botany
Roots of an upright perennial herb that is now cultivated but grows throughout central and southern China in the wild in bamboo forests, tall grasslands, and by streamsides.

Good quality: large roots, black internally and un-fissured.
Properties
Salty, sweet, bitter and Cold & moistening

Enters Kidney, Lung and Stomach

Dose: 9-15g
Primary actions
The primary actions of the herb can be deduced from the properties of the herb

A) Its bitter, cold property clears Fire and eliminates toxins

B) Its sweet-cold property (mildly) nourishes Yin

Xuan Shen therefore clears heat from Blood and Ying level (high fever < at night, restlessness, faint skin rash etc) and Nourishes the Yin for Exterior and Interior conditions. (see Qing Ying Tang-a really fabulous formula!)

C) It's salty cold property-softens hardness and clears toxic hot swellings and nodules eg scrofula, goitre, skin lesions, sore throat with assoc. swollen lymph nodes etc (See Xiao Luo Wan)
Secondary actions
May lower blood glucose levels and be used in the treatment of diabetes

A FH for acute / chronic, excess / deficient sore throat

Xiao Luo Wan (Xuan Shen, Zhe Bei Mu, and Mu Li) is used by some doctors to help resolve the hot Phlegm aspect of some cancers.

A useful herb in dermatology when the heat has become less intense but the skin is dry. This herb moistens the skin but also clears the residual heat.
Cautions
It is cold and moist in nature so take care in patients with weak digestive systems and Damp.
Key Points
Xuan Shen is a versatile herb that can clear Heat, eliminate toxins, nourish the Yin and disperse swellings.

It is a FH for sore throats and is also used for chronic, Yin deficient Heat patterns-especially if they lead to the development of Fire-toxins.
Chi Shao-Paeonia lactiflora
Red Peony
Botany
Roots of perennial Peony plants. Wild sourced herbs (Di Dao-Inner Mongolia) are favoured but recently cultivated. Bai Shao (White Peony) has been long produced from cultivated plants of the same species.

Grows in the wild across Northern China in temperate forests, forest margins and grasslands (400-2,300m altitude)

Good quality: long, thick and 'powdery': internally pinkish or yellowish white in colour.
Properties
Bitter, slightly sour, slightly cold
(Bai Shao is sour and slightly bitter)

Enters Liver and Spleen

Dose 9-15g
Primary actions
1. Clears Heat and cools the Blood-for EPF's entering the Blood level and for Blood Heat causing gynaecological problems eg menorrhagia or skin problems eg psoriasis/eczema etc

2. Invigorates the Blood, dispels stasis, and alleviates pain-for eg amenorrhoea/ dysmenorrhoea; bruising, swelling and pain from trauma etc
Secondary actions
1. Reduces swelling from sores/abscesses

2. Can clear Liver heat and relieve eye pain

3. Can clear heat in the Bladder for dysuria, Lin diseases
Cautions
Caution with anticoagulant medication like warfarin.

Use with care in cases of deficiency, and Blood xu.

Traditionally contraindicated with Li Lu (Radix et Rhizoma Veratri)
Key Points
A commonly used herbs for many gynae and skin conditions. Whereas Bai Shao nourishes the Blood, astringes Yin and softens the Liver, the predominantly bitter Chi Shao cools and moves the Blood.

Often used with Sheng Di Huang and Mu Dan Pi to cool the Blood...maybe used with Bai Shao as 'Er Shao' to cool, move and nourish the Blood and alleviate pain.
Zi Cao-Arnebia euchroma
(aka Lithosperma euchromon)
Botany
Roots of a perennial herb replete with a purple dye.

Grows in the wild in gravelly marshes and meadows, and on scree and rocky slopes. Now an endangered species in the wild.

Good quality: large, long soft, purplish roots with small creamy-white centre.
Properties
Sweet, cold and moistening (some texts also describe it as bitter and salty-see Bensky-Comparisons and Contraindications)

Enters Heart and Liver

Dose: 9-15g
Primary actions
1. Clears Heat and cools the Blood and resolves Fire toxins-for skin diseases, especially when there is incomplete expression of rashes eg measles, chicken pox. Also for skin diseases where there is congestion due to Heat.

2. Clears Damp-Heat from the Skin.

3. Applied topically to alleviate burns (with eg Di Yu, Da Huang etc) and side effects of radiotherapy Tx.
Secondary actions
Moistens the intestines and moves the bowels

Promotes urination.
Cautions
Use carefully if there is Spleen qi xu with diarrhoea

Contains pyrrolizidine alkaloids so long term use could potentially lead to liver damage/cancer.
Key Points
A FH (feature herb) for Heat in the Blood causing purple skin lesions eg psoriasis, or for incomplete expression of rashes-especially if associated with constipation or dysuria.

Externally used to cool and moisten the skin and in the treatment of burns.

Contraindicated for long term use because of potential liver toxicity.
Shui Niu Jiao-water buffalo horn
Properties
Salty and cold (+ Bitter)

Enters
Heart
, Liver and Stomach

Dose: 30-60g + (9-15 if powdered)
Actions
1. Clears Heat, cools Blood and resolves Fire toxins-especially when they affect the Heart channel-for warm pathogenic factors entering the Blood level causing eg purple skin rashes, bleeding, encephalitis, convulsions, delerium etc.

Nowadays used to clear extreme Heat in the Blood causing skin diseases eg eczema, internal Wind eg tremors, jaundice, and some recalcitrant fevers eg end stage cancer.
Key Points
Shui Niu Jiao is used as a replacement for the illegal (and immoral!) Xi Jiao-rhino horn. Which has similar actions to Shui Niu Jiao but is far more potent (and was used as a life saving treatment for high fever-not as an aphrodisiac as reported in the media!)
Questions
Huang Qin-Scutellaria baicalensis
Baical skullcap root
Botany
Roots of a herbaceous perennial usually cultivated


Wild plants grow widely in grassland and disturbed places


Good quality: large, firm golden yellow roots with no hollow or withered core. Blueish-green roots are considered to be poorly processed.
Properties
Bitter
and
Cold

Enters Lung, Large Intestine, Stomach, Gall Bladder

Dose 9-15g
Primary Actions
1. Clears Heat and dries Dampness-for D/H in the Intestines and Stomach causing diarrhoea, nausea, epigastric pain, toothache etc; for external invasion of D/H-fever, chest oppression + thirst with no desire to drink + jaundice; for D/H in the Bladder causing dysuria, UTIs etc.

2. Clears Heat and resolves toxins-especially in the Lung-for acute cough-see Qing Qin Hua Tan Wan etc

3. Clears heat and calms the restless foetus to prevent miscarriage (use the milder Chao Huang Qin)
Secondary actions
1. Clears Heat, cools the Blood and stops bleeding-eg haemoptysis, blood in the stool etc-NB use Huang Qin charred black for this.

2. Settles Liver Yang rising

3. Clears Fire toxins-especially if used in conjunction with Huang Bai or Huang Lian-for skin diseases, ulceration etc
Has a mild antibiotic effect that appears to be synergistic with some antibiotics.
Caution
Cold and Bitter-can damage the Spleen and Stomach if used incorrectly.
Key Points
It's very cold nature clears heat and its Bitter taste helps to drain Damp. Traditionally said to focus on the upper jiao

Commonly used for Lung Heat causing coughs, sore throat, for D/H in the middle and lower burners including jaundice, diarrhoea and UTIs. Clrs heat from the Qi level see (Xiao Chai Hu Tang).

Used to settle the restless fetus-when heat is causing agitation and threatening miscariage.
Huang Lian-Coptis chinensis
"yellow links'
Botany
Rhizoma of a small perennial herb (15-25cm) usually cultivated

In the wild grows in shady, forested valleys, in C, S & W China

Good quality: rhizomes with short or absent internodes and no rootlets or stems. Interior orange-yellow and v bitter taste.
Properties
Extremely Bitter and very cold and drying

Enters Heart, Stomach, Large Intestine and Liver

Dose: 3-12g
Primary actions
1. Clears Heat and drains Damp for D/H in the intestines causing diarrhoea + pus and blood, abdominal pain etc. Use for acute food poisoning and for chronic conditions eg ulcerative colitis
(see Ge Gen Huang Qin Huang Lian Tang, Bai Tou Weng Tang, Xiang Lian wan, and Shao Yao Wan)

2. Clears Stomach Heat causing nausea, vomiting, epigastric pain, toothache (see Zuo Jin Wan and Ban Xia Xie Xin tang)

3. Clears Heart Fire-for insomnia, restlessness, mouth ulcers, irritability, mania etc etc

4. Clears Fire toxin-for a wide range of skin diseases

5. Sedates Liver fire-H/A, dizziness, irritability, insomnia etc
Secondary actions
Contains relatively high levels of the alkaloid berberine which has demonstrated anti-bacterial, anti-viral and anti-inflammatory actions. Berberine can also lower blood sugar, reduce cholesterol, lower blood pressure, and may have a role in the treatment of metabolic syndrome and PCOS. There is in vitro evidence showing berberine may induce apoptosis and have a cytotoxic effect on some cancer cells.

Consequently Huang Lian has a broad spectrum anti-microbial action against bacteria, fungi and viruses.

Also used for the treatment of eye diseases caused by liver fire. May be used as an eye wash with wild Chysthanthemum (Ye Ju Hua) for acute conjunctivitis.

Also useful for urinary tract infections
Cautions
Extremely cold and bitter so may be difficult to take and prolonged use may damage Spleen and Stomach qi

It may cause transient diarrhoea, nausea, epigastric discomfort etc.
Key Points
This is one of the coldest and most bitter tasting of Chinese herbs. It powerfully clears Heat, drains Damp, and resolves toxicity affecting the Heart, Stomach, Large intestine, Liver, skin etc.

Traditionally said to focus on the middle jiao.

When used in conjunction with Huang Qin or Huang Bai its Fire toxin clearing property is enhanced.

It is a useful anti bacterial, anti fungal and anti-viral herb.

It's also strong tasting and very expensive....
Huang Bai-Phellodendron chinense
(often substit. with P. amurense)
Botany
Bark of a deciduous tree (5-20m)

Mainly cultivated. Wild species grow in mixed, broad leaved deciduous forests in S,C & E China

Good quality thick, clean bark, with light yellow cross section and fine longitudinal striation.
Properties
Bitter and Cold and drying and descending

Enters Kidney and Bladder

Dose: 9-15g
Primary actions
1. Clears Heat and drains Damp-
a) for D/H in the lower jiao-causing diarrhoea, Lin Syndrome, vaginal discharge (eg Bai Tou Weng Tang) and in the middle jiao causing eg Jaundice (see Yin Chen Hao Tang)

b) for Bi syndrome (eg San/Si Miao San)

2. Clears deficiency Heat caused by Kidney Yin xu-night sweats, insomnia, steaming bone etc (use salt fried Huang Bai) eg Zhi Bai Di Huang Tang.

3. Drains D/H, clears Fire and resolves Fire toxins affecting the skin-use internally and/or topically.
Cautions
Its cold and bitter nature can damage the Spleen and Stomach qi

Although it is used for Yin deficiency Heat patterns it does not possess yin tonifying actions...it is by clearing the Heat that the herb facilitates the recovery of Yin.
Key Points
Traditionally Huang Qin affects the upper jiao, Huang Lian the Middle Jiao and Huang Bai the lower jiao. In clinical practice these distinctions tend to break down.

Huang Bai is a useful herb for D/H affecting the digestive tract, for clearing hot, damp, toxic skin diseases and has a particular action in clearing heat caused by Kidney Yin xu.
Ku Shen-Sophora flavescens
"Bitter root"
Botany
Root of a perennial herb 1-2m tall native in scrub and fields throughout China and both cultivated and wild crafted.

Good quality: roots intensely bitter and yellowish white in cross section.
Primary actions
1. Clears Heat and dries Dampness-for D/H in the lower jiao causing eg eczema, diarrhoea, leukorrhoea, jaundice and urinary tract infecrtions / Lin diseases.

2. Dispels Heat and promotes urination.

3. More recently used in conjunction with Ling Zhi as a treatment for asthma.

4. A FH for the treatment of cardiac arrhythmia
Properties
Very Bitter and very Cold, descending

Enters Bladder, Heart, Liver, Stomach, Small intestine and Large Intestine (NB each of the 5 phases)

Dose 6-15g
Secondary actions
1. Dispels wind, relieves parasites and stops itching-for D/H skin diseases with chronic itching, seeping and bleeding. May be used internally but also externally as a wash eg for genital eczema.

2. Ku Shen also has immune stimulating properties, broad spectrum antibacterial actions, and some anti-cancer properties

3. NB Ku Shen (aka Bitter Ginseng) is the most Yin of the 'Shen' family-a group of herbs with powerful therapeutic actions.
Cautions
It's cold and bitter nature may damage the Spleen and Stomach if used inappropriately.


Key points
I think Ku Shen is a fabulous, versatile and clinically important herb. It has great value for Skin diseases, especially those in the lower jiao, and for other conditions caused by D/H eg diarrhoea, UTIs, and vaginal discharge.

I also use it a lot in the treatment of cancer where it's anti-neoplastic and immune enhancing effects are useful.

It is strong tasting and I always mitigate this by using with Gan Cao.
Long Dan Cao-Gentiana scabra
"Dragon's gall bladder herb"
Botany
There are at least 3 species of gentian used for Long Dan Cao

Roots of a perennial plant that grows in temperate, mountainous regions, with a characteristic deep blue flower.

Good quality: thick, full, long, straight roots with an intensely bitter taste, a soft texture and yellow colour.
Properties
Very bitter & cold & sinking

Enters Liver, Gall Bladder & Stomach channels

Dose: 6-12g
Primary actions
1. Clears Heat and drains Dampness-from the Liver and Gall Bladder channel to treat:
upper jiao: red eyes, ear disorders
middle jiao: jaundice, hepatitis
lower jiao:for STD's, genital rashes, scrotal lesions

2. Also used for D/H skin diseases eg eczema.

3. Pacifies Liver Fire-causing headache, tinnitus, red eyes, irritability/anger, insomnia, fever etc...and which may lead to Liver Wind + convulsions, spasms, vertigo etc

Key formula: Long Dan Xie Gan Tang:



Long Dan Xie Gan Tang
Long Dan Cao 6-9g
Huang Qin 9-15g
Zhi Zi 9-15g
Chai Hu 9g
Sheng Di Huang 15-30g
Mu Tong (use Tong Cao) 9g
Che Qian Zi 9-15g
Ze Xie 9-15g
Dang Gui 9g (often excluded from formula)
Gan Cao 6g

The formula to clear Fire and D/H from the Liver & Gall Bladder. Commonly used as a basis for the treatment of D/H eczema-often with the removal of Dang Gui which protects the Yin but may aggravate acute D/H.
Cautions
Very cold and bitter so inappropriate use may damage the Spleen and Stomach.

Small dose may act as a 'bitter' and stimulate digestive juices so taken before meals. Sensitive stomachs may need to take with or immediately after food.

Can cause acute toxic reaction at high dose (abdominal pain, nausea, vomiting, vertigo etc)
Key points
One of the coldest and most bitter herbs in the materia medica (in competition with Chuan Xin Lian, Huang Lian, and Ku Shen).

Its primary actions are to clear D/H from the Liver and Gall bladder and to pacify Liver Fire.

A useful herb to be applied with caution.
Qin Pi-Fraxinus rhynchophylla
Korean Ash tree bark
Properties
Bitter, cold and astringent

Enters Large Intestine, Gall Bladder, Liver, & Stomach.

Dose: 9-15g
Primary Actions
1. Clears Heat, dries Damp, and eliminates toxins-for diarrhoea due to D/H + toxic heat eg ulcerative colitis, Crohns

See Bai Tou Weng Tang.


Secondary actions
1. Clears Liver Fire and benefits the eyes-may be used as eye drops

2. Descends Lung Qi and relieves cough and wheezing.

3. Can be used for hot/wind/damp bi syndrome

4. By clearing D/H may benefit spermatogenesis

Cautions
Use carefully in patients with Spleen and Stomach deficiency.
Key Points
It is cold, bitter and astringent which makes it particularly useful for cases of severe diarrhoea-such as ulcerative colitis.

I often combine Bai Tou Weng Tang (Bai Tou Weng, Huang Lian, Huang Bai, Qin Pi) with Ge Gen Huang Qin Huang Lian Tang (Ge Gen, Huang Qin, Huang Lian, Gan Cao)
1. A patient presents with a subjective sensation of heat that is worse at night and is associated with a sore throat, thirst and swollen cervical glands. Which of the following herbs is the most suitable?

a) Sheng Di Huang b) Mu Dan Pi c) Xuan Shen d) Mu Dan Pi


2. A woman presents with severe menopausal symptoms including night sweats, insomnia, and restlessness. Which would be your primary herb to clear Heat and nourish Yin in this instance?

a) Shui Niu Jiao b) Sheng Di Huang c) Chi Shao d) Zi Cao


3. Which herb is described as being able to "cool without congealing and move without spilling"?

a) Sheng Di Huang b) Chi Shao c) Mu Dan Pi d) Xuan Shen


4. A woman presents with menorrhagia and dysmenorrheoa. Which herb would you select?

a) Chi Shao b) Sheng Di Huang c) Zi Cao d) Xuan Shen


5. A man presents with a purplish red skin lesion and has thirst and constipation. Which herb would be most suitable for this case?

a) Shui Niu Jiao b) Sheng Di Huang c) Xuan Shen d) Zi Cao
Questions
1. Match a) Huang Lian, b) Huang Bai, & c) Huang Qin to the following area of activity:
i) Bladder and Kidneys
ii) Heart
iii) Lung
iv) Large Intestine
v) Stomach

2. Ku Shen is particularly indicated to clear damp-heat skin rashes from which area?
i) face and neck
ii) the axilla
iii) the groin
iv) the legs

3. A man presents with colitis and asthma which of the following herbs would you select?
i) Huang Qin ii) Huang Bai iii) Long Dan Cao iv) Qin Pi

4. Which of the following actions is not facilitated by Long Dan Cao?
i) relieving a liver fire headache
ii) helping D/H style eczema
iii) treating jaundice
iv) nourishing liver Yin

5. Name 4 important actions of Ku Shen?

6. A man presents with arrthymia, insomnia and anxiety. Which 2 clear Damp Heat herbs would you consider using?

Xia Ku Cao-Prunella vulgaris
selfheal / "summer dried herb"
Botany
Aerial parts of a perennial herb growing widely in China, N America and Europe...in your lawns!

The young leaves and stems can be eaten raw in salads; the plant in whole can be boiled and eaten.

Good quality: reddish brown, long (5cm) spikes with short stalks.
Properties
Bitter, pungent and Cold

Enters Gall Bladder and Liver

Dose 15-30g
Actions
1. Clears Liver Fire and brightens the eyes-for red, painful swollen eyes, H/A, irritability. Also used for enlargement and inflammation of the liver eg. hepatitis.

2. Clears Heat and resolves Phlegm to dissipate nodules eg scrophula, lymphadenopathy, some forms of cancer.

3. Anti-hypertensive-quick but short lived action.
Cautions
May damage Spleen and Stomach if used for too long.

Some reports of allergic reaction.
Key Points
Combines Fire Clearing with Phlegm resolving which makes it useful for treating swellings such as lymphadenopathy, some forms of cancer, goitre etc.

Widely used to reduce blood pressure and to clear Liver Fire
Identify Heat/Fire/Fire toxins
a) A man presents with irritability, insomnia and headaches. There are red dots on the side of the tongue and the pulse is wiry.


b) A man presents with extreme irritability, a red face, a splitting headache, red eyes, a bitter taste in the mouth. T: red P: rapid and wiry
a) A woman presents with an acute UTI. She has burning on urination, frequency, urgency and some haematuria. T: Yellow coat at rear P: slippery and rapid.


b) A woman presents with recurrent UTIs...constant pain and soreness, frequency and urgency. She has had multiple courses of antibiotics to no lasting relief. She feels hot and exhausted. Tongue and pulse as above.
Case History
A 37 year old man presents with an acute headache that has persisted for the past 2 weeks. It is severe, and stabbing and located on the right hand side of the head. He also complains of red, sore eyes, irritability, insomnia, constipation and a bitter taste in his mouth and mentions that he has recently been diagnosed with high cholesterol and high blood pressure. His work is very stressful and he can't switch off.
T: Markedly red sides and tip
P: Wiry and rapid
Dx, Tx, and Rx + dose please.
Qing Ying Tang
Shui Niu Jiao 30
Sheng Di Huang 15
Xuan Shen 9
Jin Yin Hua 9
Lian Qiao 9
Huang Lian 6
Dan Zhu ye 3
Dan Shen 9
Clears Ying level heat, relieves Fire toxins and nourishes Yin
Case
A 26 year old man presents with ulcerative colitis and extensive weeping eczema. He has up to 10 bowel movements/ day with blood and mucous and some cramping pain. His appetite is OK but he is bloated. His colitis is worse for stress and bad food.
His eczema is widespread, with clearly defined,lesions on the arms, legs, trunk and behind the ears. It is itchy and weeping and has formed a yellow crust. His sleep, thirst, temperature, etc are otherwise normal.
T: thick sticky yellow fur, red sides: P: slippery and rapid

What is your diagnosis, treatment principle, and formula (+ dose) to treat this man?
Which of the 3 'Huangs' would you use for the following conditions:

a) acute cough
b) insomnia
c) gastric ulceration
d) Yin xu night sweats
e) a restless foetus
f) ulcerative colitis
g) Thrush
h) An acute UTI
i) weeping eczema
Bai Tou Weng Tang
Bai Tou Weng 15-30
Huang Qin 9-15
Huang Lian 6-12
Qin Pi 9-15

Use for hot dysenteric disorder-diarrhoea + mucous and blood, burning around anus, abdominal pain, thirst etc

May be used for acute infection or chronic disease eg colitis, crohns etc.
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