On February 19, 2009 Heiner Fruehauf, Ph.D., L.Ac. sat down with his colleague Bob Quinn, DAOM, L.Ac., to discuss the importance of aconite (fuzi) in classical Chinese medicine. The discussion also covers aspects of the fuzi story not covered elsewhere in the west, namely its proper processing. Heiner also touches on some of the “nuts and bolts” of the Sichuan Fire Spirit School of herbal prescribing. As Heiner explains, fuzi used to be referred to as the “King of the 100 Herbs.” This information is crucial to understanding the scholarship and clinical power behind the Classical Pearls formulas that contain aconite.
With Heiner Fruehauf
National University of Natural Medicine, College of Classical Chinese Medicine
Born into a German family of medical doctors specializing in natural healing modalities, Heiner Fruehauf studied sinology, philosophy and comparative literature at several prestigious universities and earned a doctoral degree in East Asian Languages and Civilization. He went on to complete two years of post-doctoral training at Chengdu University of Traditional Chinese Medicine, mentored by Deng Zhongjia, one of China’s primary experts in the fields of formula studies and classical Chinese medicine. Presently, Heiner serves as Founding Professor of the School of Classical Chinese Medicine at National College of Natural Medicine in Portland, Oregon and director of the Heron Institute, a non-profit institution for the research and preservation of traditional life science. In private practice, he focuses on the complementary treatment of difficult and recalcitrant diseases, including cancer, heart disease, and chronic digestive disorders.
We are very grateful to Heiner Fruehauf for permission to offer this article, and for his generosity and ready willingness to provide great articles for our newsletter Please visit his website to read more articles and learn about his upcoming seminars: www.classicalchinesemedicine.org
Heiner is interviewed here by Bob Quinn
QUINN: Heiner, thanks for making the time for this interview
HEINER: I am happy always to talk about this medicine.
QUINN: I want to touch on various aspects of aconite prescribing, including its proper growing and processing. Perhaps we can start with the basic question as to why aconite is so important an herb. What sets it apart? Can you talk about this briefly?
HEINER: Certainly. 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. At first, I did not pay too much attention to this very obvious discrepancy between what I was reading in classical case studies and what I was seeing in my teachers’ clinics. It was not until I encountered the so-called Fire Spirit School (Huoshen Pai) of Sichuan herbalismthrough Dr. Liu Liong and some of the representatives of this lineage who still practice in Sichuan province [see below for links to more detailed information by Drs. Liu Lihong and Lu Chonghan on this approach to herbal prescribing] that 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.
QUINN: Can you talk a bit about the processing of aconite?
HEINER: Because of the toxicity of the herb in the raw state, it is the processing that makes this herb usable and brings out its superlative healing properties. The experiences of modern doctors are, for the most part, patterned by the potential side effects that fuzi has in modern times. Most fuzi on the market today is not grown in the right area, is not grown at the right time of year, and most importantly, has not been processed appropriately. All these factors impact the quality of the fuzi we have to use these days. Li Shizhen, in his great Ming dynasty materia medica Bencao gangmu, very specifically points out that the right type of fuzi 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, like theQing dynasty scholar Yang Shitai who wrote in 1833: “Aconite from Longzhou is the best. Even though aconite 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 aconite need to be harvested high in the mountains where they endure great cold—maybe this is 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 aconite 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. This herb thus very 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. I believe very strongly that it is these types of detailed practical instructions that make Chinese medicine a science in its own right, and that it is important that they be heeded, whether modern laboratory verification has been able to perceive any benefits or not.
QUINN: What happens when aconite is harvested?
HEINER: 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.
QUINN: I know there is a network of growers in the U.S. experimenting with organic cultivation of Chinese herbs. Can it be that we can grow this here? For that matter, although the organic movement is in its infancy in China, there are also certified organic farms there. Would it be OK to grow the fuzi somewhere where the soil has been rebuilt?
HEINER: The principle that involves herb cultivation in the right place and harvesting at the proper time of year is called didao yaocai. This term means “genuine,” and expresses the proper yin and yang properties of the herbs due to correct attention to planting in the right place (di: yin) at the right time (dao: yang). Only then can this herb considered to be genuine. It is not just a matter of correct species identification.
QUINN: Talk about this Jiangyou area of Sichuan that is so key in the view of the classics you cited.
HEINER: 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.
QUINN: I suspect that many TCM practitioners are shy about prescribing fuzi from hearing stories of toxicity from their teachers, stories about patients getting palpitations and dizziness. Do you encounter challenges in your teaching about aconite? Do you come up against resistance due to the TCM training about this herb and the fear of toxicity? Do people believe you when you that the toxicity is due to improper processing and not the herb itself?
HEINER: As with every other topic in Chinese medicine, I find that education is so important. Humans get patterned quickly into certain beliefs and preferences, whether we have had actual experiences with a situation or substance or not. I can only put the integrity of my own words behind the claim that genuine fuzi is safe, as my teachers did with me. They were able to convince me with their sense of certainty and their case stories, and I found what they said corroborated in the classics. Now, of course, I am seeing the benefits in my own patients. Of course you can’t give aconite to everyone. If you have someone with leukemia, for instance, with an exploding white blood cell count and severe heat symptoms, you do not want to give them aconite.
QUINN: I know you do prescribe aconite formulas, though, in many instances when TCM practitioners would not; in fact they would in many such instances give yin tonics. Can you talk about this a bit?
HEINER: 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.
QUINN: You are talking bulk doses?
HEINER: Yes, crude herbs in decoction per day. This involves the labor-intensive procedure of first soaking the aconite in water to wash off the remaining brine, and then cooking it for two hours before the other herbs are added to the formula. For greater convenience, I have taken the step to manufacture properly processed Jiangyou fuzi into granules, and found this to be most appropriate for chronically ill patients in the US and Europe. We cannot expect chronic patients to spend 2 hours every day preparing their medicine.
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 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.
QUINN: Heiner, you mentioned Fuzi Lizhong Tang a moment ago. Can you talk about the other aconite-based formulas you favor in this style of prescribing?
HEINER: 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 Tang. Sini Tang, as I use it, consists of aconite in one of its medicinal forms, whether it is fuzi, wutou, 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.
QUINN: Correct me if I’m wrong, Heiner, but I don’t think the readers of this interview will find Qianyang Dan in Bensky or other formula manuals.
HEINER: Right, Qianyang Dan is an example of a clinical gem that, alongside other formulas with a strong local history, has not been included in standard textbooks. Keep in mind that the most voluminous handbook of Chinese formulas contains 96,000 traditional remedies, and Qianyang Dan is not even included in that. Another formula to mention here, also based on a modification of Fuzi Lizhong Tang minus baizhu, is Wenpi Tang (Warm the Spleen Decoction). As with Sini Tang, people are theoretically familiar with this formula, but it has clearly prolapsed into a state of underuse. This formula is excellent for many chronic patients suffering from constipation. This is very often the case in menopausal women with thyroid problems, and lots of cancer patients have this symptom. Cancer patients are often yang-deficient and damp underneath the toxicity. There is no better herb than dahuang to purge the toxicity from the cells and the body, therefore it is included in the famous anti-cancer Essiac formula. The more raw version of rhubarb will have greater laxative qualities, while the dahuang that has been cooked longer or processed with alcohol will have more blood-moving qualities. Both versions have a strong anti-toxin effect. Another formula we use at my clinic is Zhenwu Tang, which primarily targets the Heart and the Kidney. Patients who need Zhenwu Tang often have dizziness and edema, especially elderly patients.
QUINN: Just to be real clear here, Heiner, we started our discussion talking about the proper and improper processing of aconite. What you just spoke of, these basic formulas you use in the Fire Spirit School—if this interview succeeds in convincing someone to incorporate this approach into their practice, these formulas are not going to deliver the desired outcomes unless genuine aconite that has been processed in traditional ways is used. Is that what I am to understand from this whole discussion? And to be as clear as possible, by real aconite I mean the type that is grown in Jiangyou in the traditional manner and processed according to classical guidelines. Are there any other suppliers for genuine aconite out there that you know of?
HEINER: No. 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. In our times, I find it important that people with the knowledge of traditional herb quality, proper processing techniques (paozhi), and the very real danger of environmental pollutants get involved in the herb trade for the benefit of the whole Chinese medicine community. The more I learn about the current state of the herb industry, the more convinced I am that it is necessary for scholars with both knowledge and integrity to get involved. By stepping in personally with the production of real fuzi, other companies will hopefully become inspired and expand into the growing and processing of other genuine herbs. When I realized that there was no aconite of the quality I wanted to work with, I teamed up with my colleague Dr. Liu Lihong from the Institute for the Clinical Research of Classical Chinese Medicine in Nanning. We dispatched several people to stay in Jiangyou for three months throughout the entire harvest and processing period to make sure that the order was done to specifications, something you unfortunately cannot take for granted in modern-day China. The peasants may remember the traditional procedures, but they are much more labor intensive for them. We took every precaution that shortcuts were not taken.
QUINN: There is a cost discrepancy between your fuzi and what is currently available.
HEINER: Yes, that is because we pay four times as much for our crude fuzi as compared to what is paid for other types of aconite in China.
QUINN: That is an enormous difference.
HEINER: Yes, it takes a great deal of time to process aconite properly. I also explained earlier that it has to be grown by mixing it in with other crops, another feature that makes the harvest more time-consuming. Please note that we don’t ourselves charge four times the going price for aconite granules, but by rights we should. I need to point out that the senior practitioners of the Fire Spirit lineage say that it is better to not use aconite at all if you only have access to inferior quality material. In other words, someone maybe hearing this and thinking, “Well, I will use what is available and simply accept slightly less desirable outcomes; maybe my treatment will just take a little longer than if I spent the money for the fancy stuff.” If that is the case, one should better use something other than aconite, such as ginger or cardamon. But remember, fuzi is the “King of the 100 Herbs.” It really cannot be replaced by anything. I wish our aconite here at Classical Pearls could be offered at the same price as what is available from other companies, but that is simply not possible. We’d lose our shirt.
QUINN: Just to complete the picture then of how this properly processed aconite becomes granules…
HEINER: Right—we send this traditionally processed aconite to a state-of-the-art factory to be made into granules and powdered extracts according to our specifications. This factory has three different GMP (Good Manufacturing Practices) certifications. It is not only an herb manufacturer but also a supplement manufacturer and a drug manufacturer. You would be hard pressed to find a better factory in China. They have agreed to produce the extracts just as we want them. We have two types: an 8:1 powdered extract that has no starch carrier at all, and a 5:1 form of granules made with a very small amount of protective starch carrier coating that the aconite decoction is sprayed on to. Great care has been taken in the selection of this starch. We deliberately do not use cheaper starch carriers made from corn or potato, for instance. Some people have allergic reactions to those. We use a starch derived from the herb and tonic food item shanyao (dioscorea), which is also a yang tonic. The 5:1 is of similar strength to other herb granules that practitioners generally have in their pharmacies, so people do not have to do any fancy math. The 8:1 would be used in slightly smaller amounts possibly, such as 12g per weekly formula rather than the customary 18g.
QUINN: Is there any point at which you will run out of material if a strong demand develops? I can see this could well catch on.
HEINER: We try to think ahead and be mentally prepared for a wider demand. We have been working directly with the peasants in Jiangyou, who know that we may need to buy much more of this specially processed aconite in coming years. We are mentally prepared to meet increased demand. As you know, my primary goal is to help restore the clinical power of classical Chinese medicine, and I believe that this herb can play a key role in that mission. So, the supply problem needs to be solved. I would be happy if other companies joined in and started offering this kind of genuine medicinal grade aconite as well.
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. At our clinic, we really do rely on those aconite-based formulas I listed earlier. Again, to be clear, there might well be a number of yin tonics or even small amounts of heat clearing herbs in the same formula, but a large percentile of our constitutional prescriptions are based on Fuzi Lizhong Tang or one of its variations. More recently, we have also been using a lot of the aconite containing Classical Pearl patents that are based on Fuzi Lizhong Tang or Qianyang Dan. It was therefore a prime motivation for me to prescribe this top-grade fuzi to my own patients. At the same time, I wish to use the opportunity of having a direct line to the peasants in Jiangyou to make genuine aconite available to the wider TCM community, since it does not seem to be available through any other company.
QUINN: Heiner, we need to end here. I want to thank you for your time.
HEINER: It was a pleasure.
© 2009 Heiner Fruehauf