Fù zî (附子) : Clinical Applications ( II ).
In the Shang Han Lun(傷寒論), Zhang Zhong-Jing(張仲景) uses fù zî in 34 formulas. Depending on its purpose, Zhong-Jing uses either raw (unprepared) or prepared fù zî. Because of its toxicity, raw fù zî is not commonly sold by herbal distributers. In Taiwan and China a wider variety of fù zî preparations are available and they all have somewhat different applications. My teacher, Dr. Lee, prefers tian xiong or hei fù zî. In the United States, there are less choices regarding fù zî preparation and you need to ask your supplier how their fù zî is prepared. For the purposes of this article, all fù zî mentioned refers generally to ‘zhì’ fù zî or prepared fù zî (Aconiti Radix lateralis preparata).
In my practice, my use of fù zî is strongly influenced by the Shang Han Lun. I commonly use fù zî for pain management, yang blockage, cold bi and moving stagnant fluids. On occasion, I have had opportunity to prescribe it for cold or deficiency diarrhea, blood stasis and heart insufficiency.
Pain management: pain, according to Chinese medicine, is a result of blockage. When something doesn’t move, it creates a logjam and discomfort. The quality of the pain depends on what is being blocked—blood, Qi, yang, etc. Fù zî is one of the most moving herbs in the common Chinese material medica. In the Qing Dynasty’s Ben Cao Bei Yao (本草備藥), it says of fù zî that, “its application is to move and not guard in one place. It moves through and opens all 12 channels. There is nowhere that it does not reach.” (其用走而不守，通行十二經，無所不至.) Because of its nature and action, fù zî can be invaluable for pain, especially chronic or intractable pain.
Often when patients complain of pain in any part of an extremity, including shoulder, elbow, wrist, knees, etc., I often pick an appropriate Guì zhï Täng (Cinnamon Twig Decoction) based formula, such as Gé gën Täng (Kudzu Decoction), Huáng qí Guì zhï Wû Wù Täng (Astragalus and Cinnamon Twig Five-Substance Decoction), or Huáng qí Jiàn Zhöng Täng (Astragalus Decoction to Construct the Middle) , and add a little fù zî to it. In a boiled decoction, I might start at a conservative dose of 3 to 6g and gradually increase 2-3g every week or two weeks. Usually 12 to 20 grams is sufficient to achieve noticeable clinical results. In granule formulations, in a 3-4g dose (3 times per day), I will add 0.5g to 1g of fù zî (or Sì Nì Täng (Frigid Extremities Decoction) ) with 2 to 3 grams of the base formula.
Many practitioners prefer using blood-moving herbs for pain, such as Shen Tong Zhu Yu Tang. This is also fine. But consider adding a little fù zî to whatever formula you choose to augment its moving and pain reducing quality and speed up healing.
Cold in the extremities (or in the interior)
Because fù zî is a ‘very hot and pure yang’ (大熱純陽) herb, it is commonly used for patients with pathologically cold hands and feet. This can present simply in some ‘spleen deficient’ types, or more radically in Raynaud’s syndrome or certain neuropathies or blood insufficiencies. In the former case, fù zî can prove dramatically effective. Raynaud’s, however, is often a result of auto-immune disease which can produce false cold signs. If you add fù zî to such patients and the condition seems to worsen, it is prudent to reduce or remove the fù zî (or other warm herbs) and see if the condition changes for the better or worse. Usually adding 2-3g of fù zî as a test will not cause any radical changes, but it will be enough to measure the suitability of its inclusion...
Moving fluids, expelling dampness
This application is similar to dispelling cold. Fluids are, by their nature, always cold. I once treated a patient with pericardial effusion. This elderly patient was semi-comatose for a week and the hospital was planning to drain fluids by inserting a shunt into the chest. The family asked if Chinese herbs would be effective. I prescribed a formula primarily based on Si Ni Tang with shän zhü yú (Corni Fructus), and sheng (unprocessed) mû lì (Ostreae Concha). The decocted formula was administered through a naso-gastric tube. After only a few days, the patient regained consciousness and went home.
Augmenting the effect of any formula for a deficiency condition
This is an important application of fù zî that Dr. Lee has mastered well. The skillful ability to control the dose of fù zî within other formulas can be a game changer in the clinic. Often when a formula proves ineffective, practitioners will switch to another formula and keep switching until they find something that works. That is certainly viable. However, there are instances where a formula may be perfectly suitable but because the patient has developed a tolerance to the formula, or the patient has passed a certain threshold of deficiency or cold, that the formula itself stops being as effective. This effect is common in severe or complicated cases such as cancer, geriatric cases (especially when the patients are taking other medications), certain autoimmune conditions, neuropathies, diabetes, menopause, and so forth.
Let’s suppose a general base formula is prescribed, say Chái Líng Täng (Bupleurum and Poria Decoction), Bû Zhöng Yì Qì Täng (Tonify the Middle to Augment the Qi Decoction), or Xuè Fû Zhú Yü Täng (Drive out Stasis from the Mansion of Blood Decoction), for a cancer patient. The patient responds well for a while, energy is good, blood counts hold steady. However, after prolonged chemotherapy or radiation therapy, the patient’s blood counts start to drop or the patient lacks energy, or tumor markers that were originally heading down suddenly start to increase again. This is often a good time to add a little fù zî into the formula, to try to reverse the condition. Again, dosing can start small and build up gradually.
This strategy can work not only with Yang or Qi deficiency, but also with blood stagnation or when Yin is not able to move into deeper regions. The Ben Cao Bei Yao states, “[fù zî] is able to guide tonifying Qi herbs to restore scattered and lost Source Yang. It is able to guide tonifying blood herbs to nourish insufficient True Yin. It is able to guide expressing and dispersing herbs to open the interstices and pores (cou li) to chase [away] exterior wind and cold. It is able to guide warming herbs to reach the lower jiao to expel interior cold and damp.” (能引補氣藥以復散之元氣；引補血藥以滋不足之真蔭；引發散藥開腠理以逐在表之風寒；引溫暖藥達下焦以祛在裡之寒濕。)
The application of fù zî is actually quite broad. It should not be viewed as strictly a ‘yang tonic’. It helps move, it opens and unblocks passages. It revitalizes and restores organ system function so that Yin, Blood, Qi or Yang can be properly processed.
Upcoming : Fù zî (附子) : Dosing & Countering heat and toxicity (III)
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