Exergías químicas

青蒿 Qīng Hāo herba artemisiae annuae sweet wormwood

The source is from the acrial part of herbaceous annual Artemisia annua L., or A. apiacea or and other congeneric species, family Compositae. Bitter and slightly acrid in flavor and cold in nature. Alternate names include 草 蒿 Cǎo Hāo.

[Actions] Clear heat and resolve summerheat, resist malaria, and clear

deficiency-heat. It is applicable for summerheat fever and yin deficiency fever with manifestations as alternating chills and fever, or night fever abating at dawn, steaming bone fever, hectic fever, and damp-heat induced jaundice. This herb contains volatile oil that has artemisia ketone, isoarte- misia ketone, D-camphor ketone, thujone, cineole, caryophel-lene and other hemiterpene derivatives. Artemisnin, sesquiterpene lactone with peroxide group, is the major ingredient of antimalaria. Its infusion (leach liquor) has shown an inhibitory effect against certain dermatophytes.

[Quality] Impurity removed, washed clean and moistened in water, cut

into segments, and dried under sunshine. Good quality is tender, green and fragrant with many leaves.

[Indications]

1. Deficiency-heat patterns: Qīng Hāo (Herba Artemisiae Annuae) is good at clearing deficiency-heat and therefore is applicable for night fever and morning coolness with an absence of sweating caused by unre- solved deficiency-heat in late state of externally-contracted warm febrile disease and steaming bone fever, hectic fever, and afternoon tidal fever due to yin deficiency with vigorous fire in internal

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miscellaneous diseases. It can be used alone or in combination with Dì Gŭ Pí (Cortex Lycii), Zhī Mŭ (Rhizoma Anemarrhenae), and Shēng Dì (Radix Rehmanniae).

2. Summerheat and damp-heat patterns: owning to its heat-clearing and dampness-removing properties, the aromatic Qīng Hāo (Herba Artemisiae Annuae) is applicable for both summerheat and damp-heat pattern. It is combined with Xī Guā Cuì Yī (Mesocarpium citrulli) and Jīn Yín Huā (Flos Lonicerae Japonicae) for fever and sweating caused by summerheat or pediatric patient with fever in the summer; and with Huò Xiāng (Herba Agastachis), Pèi Lán (Herba Eupatorii), and Huá Shí ( Talcum) for fever induced by damp-heat.

3. Alternating chills and fever: from the perspective of traditional Chinese medicine, this type of fever is caused by pathogen in shaoyang and most likely to be found in certain warm febrile diseases and malaria. Qīng Hāo (Herba Artemisiae Annuae) is usually combined with Huáng Qín (Radix Scutellariae), Bàn Xià (Rhizoma Pinelliae), Zhú Rú (Caulis Bambusae in Taenia), and Huò Xiāng (Herba Agastachis). In recent years, artemisinin, an extractive of Qīng Hāo (Herba Artemisiae Annuae), has shown a unique therapeutic effect on malignant malaria. Also used for skin problems such as pruritus and eczema, either for oral administration or external wash.

[Usage and Dosage] Use raw in most cases, 5–12 g in decoction, up to

200 g/day when use fresh to treat malaria, and grinding into juice for oral administration to prevent the loss of anti-malarial ingredient during decocting.

[Mnemonics] Qīng Hāo (Herba Artemisiae Annuae, Sweet Wormwood):

relieve fever, cure malaria as its priority, especially when alternating chills and fever occurs.

[Simple and Effective Formulas]

1. 青蒿鳖甲汤 Qīng Hāo Biē Jiă Tāng — Sweet Wormwood and Turtle Shell Decoction form Systematic Differentiation of Warm Diseases (温 病条辨, Wēn Bìng Tiáo Biàn): Qīng Hāo (Herba Artemisiae Annuae) 12 g, Zhī Mŭ (Rhizoma Anemarrhenae) 10 g, Biē Jiă (Carapax Trionycis)

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15 g, Shēng Dì (Radix Rehmanniae) 15 g, and Mŭ Dān Pí (Cortex Moutan) 5 g; decoct in water for oral administration to treat malaria or night fever abating at dawn due to yin damage and residual heat hiding internally in later stage of warm febrile disease.

2. 蒿芩清胆汤 Hāo Qín Qīng Dăn Tāng — Sweet Wormwood and Scutellaria Gallbladder-Clearing Decoction from Popular Guide to the

‘Treatise on Cold Damage’ (通俗伤寒论, Tōng Sú Shāng Hán Lùn):

Qīng Hāo (Herba Artemisiae Annuae) 12 g, Huáng Qín (Radix Scutellariae) 10 g, Chén Pí (Pericarpium Citri Reticulatae) 5 g, Bàn Xià (Rhizoma Pinelliae) 10 g, Zhĭ Qiào (Fructus Aurantii) 5 g, Zhú Rú (Caulis Bambusae in Taenia) 6 g, Fú Líng ( Poria) 12 g, and Bì Yù Săn (Jasper Jade Powder) 15 g; decoct in water for oral administration to treat patients with unremitting fever, slight aversion to cold with fever, sweating but without any improvement of the condition, heaviness of the head, lack of strength of the limbs, and chest oppression and full- ness. Also applicable for biliary tract infection, urinary tract infection and common cold in summer.

地骨皮 Dì Gŭ Pí cortex lycii Chinese wolfberry root-bark

The source is from the cortex of deciduous shrub Lycium chinense Mill, or L. barbarum L., family Solanaceae. Sweet in flavor and cold in nature. Alternate names include 枸杞根皮 Gǒu Qǐ Gēn Pí.

[Actions] Clear heat and cool the blood, clear deficiency heat, and clear

the lung and subdue fire. It is applicable for fever due to yin deficiency, steaming bone fever, tidal fever, tidal fever, night sweating, cough caused by lung heat, hemoptysis, epistaxis, and wasting-thirst due to internal heat. This herb contains melissic acid, linoleic acid, β-sitosterin, and betaine. Its preparation has a hypoglycemic effect on rabbits, mild antihy- pertensive, and angiectatic effects. Its water and ethanol extractive have shown an antipyretic effects. It has shown anti-allergic and anti-inflamma- tory effects.

[Quality] Impurity and the woody core of root removed, slightly washed,

sun-dried, and cut into segments. Good quality is large, thick, and without heartwood.

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[Indications]

1. Hemoptysis: Dì Gŭ Pí (Cortex Lycii) is suitable for cough and hemop- tysis due to lung heat or fire exuberance due to lung yin deficiency with accompanying cough, wheezing, unremitting low grade fever, and night sweating. It is combined with Sāng Bái Pí (Cortex Mori), Huáng Qín (Radix Scutellariae), Mài Dōng (Radix Ophiopogonis), Băi Hé (Bulbus Lilii), and Yù Zhú (Rhizoma Polygonati Odorati) in accord- ance with the condition of deficiency or excess.

2. Fever due to yin deficiency: see the manifestations in the section of Qīng Hāo (Herba Artemisiae Annuae). However, Dì Gŭ Pí (Cortex Lycii) is particularly suitable for deficiency fever with accompanying sweating during sleep, and often combined with Qīng Hāo (Herba Artemisiae Annuae), Yín Chái Hú (Radix Stellariae), and Hú Huáng Lián (Rhizoma Picrorhizae).

3. Internal heat and wasting-thirst: manifestations include thirst, polydip- sia, and emaciation. It is commonly seen in diabetes and internal mis- cellaneous diseases. Dì Gŭ Pí (Cortex Lycii) is often combined with Tiān Huā Fĕn (Radix Trichosanthis), Mài Dōng (Radix Ophiopogonis), Shí Gāo ( Gypsum Fibrosum), and Shēng Dì (Radix Rehmanniae). It has also been reported recently that its decoction is used for treating hypertension. It is combined with Xú Cháng Qīng (Radix et Rhizoma Cynanchi Paniculati) in the treatment of chronic urticaria, drug erup- tion, anapylactoid purpura, and contact dermatitis.

[Usage and Dosage] Use raw in general, 10–15 g in decoction.

[Mnemonics] Dì Gŭ Pí (Cortex Lycii, Chinese Wolfberry Root-bark): sweet; good at clearing deficiency-heat, and can arrest thirst, restlessness, and night sweating.

[Simple Formulas]

1. 泻白散 Xiè Bái Săn — White Draining Powder from Key to Diagnosis

and Treatment of Children’s Diseases (小儿药证直诀, Xiăo Ér Yào

Zhèng Zhí Jué): Dì Gŭ Pí (Cortex Lycii) 12 g, Sāng Bái Pí (Cortex

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Mori) 12 g, and Gān Căo (Radix et Rhizoma Glycyrrhizae) 3 g; decoct in water for oral administration to treat pediatric lung heat, dyspnea, cough, and sputum containing blood. Also applicable for bronchitis and severe cough with scanty phlegm.

2. 地骨皮饮 Dì Gŭ Pí Yĭn — Lycii Decoction from Comprehensive

Recording of Divine Assistance (圣济总录, Shèng Jì Zŏng Lù): Dì Gŭ

Pí (Cortex Lycii) 12 g, Tiān Huā Fĕn (Radix Trichosanthis) 15 g, Mài Dōng (Radix Ophiopogonis) 12 g, Lú Gēn (Rhizoma Phragmitis) 15 g, and Dà Zăo (Fructus Jujubae) seven pieces; decoct in water for oral administration to treat wasting-thirst drinking water all the time. Also applicable for diabetes.

[Precautions] Dì Gŭ Pí (Cortex Lycii) is cold in nature and should be used

with caution in cases of deficiency cold in the spleen and stomach mani- fested as pale tongue, body cold, and loose stool. Its injection may cause dangerous side effects when it is injected too quickly into the vein and blood pressure suddenly drops too low.

Daily practices

1. What are the similarities and differences between Qīng Hāo (Herba Artemisiae Annuae) and Dì Gŭ Pí (Cortex Lycii) in terms of actions and indications?

2. What are the differences between medicinals that clear deficient heat and those clear excessive heat in terms of curing fever?

PURGATIVES

Purgative medicinals are those that either cause diarrhea or lubricate the intestinal tract to facilitate defecation.

Defecation, as a normal physiological function of human, is the act of by which organisms eliminate waste feces from the intestinal tract. Physically, people have bowel movements at fairly regular intervals; in the course of disease, more wastes have been held within the body and defe- cation is one of the most important ways to discharge. Feces, indigestive

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food retention in the intestinal tract, water retention or blood stasis accu- mulation can be expelled in defecation-promoting way with purgatives.

Because the actions and indications of downward-draining herbs are dissimilar, they are divided into three major categories, namely.

1. Purgatives.

Most of these herbs are bitter and cold in nature, while few acrid and hot with rather strong defecation-promoting effect with accompanying heat-clearing and fire-draining properties.

2. Moist laxatives.

They are often oily substances, sweet in flavor and moistening in nature. These substances are mild in nature and lubricate the intestines to promote defecation.

3. Harsh expellants (cathartics).

These are very strong drugs that induce pronounced watery diarrhea with abdominal pain. Most of these herbs are bitter and cold with toxic- ity. Some of these herbs are also diuretics and useful in the treatment of ascites, hydrothorax, and severe edema.

When using purgatives, the following precautions should be taken: 1) for healthy qi insufficiency or those debilitated by chronic diseases since most laxatives have violent effects; and for women during menstrua- tion, pregnancy and postpartum as some laxatives can also activate blood circulation. 2) constipation caused by yang qi and intestinal fluid insuffi- ciency, especially for the elderly or patient in the recovery phase. The disease should be managed according to its etiology and abuse of purga- tives is discouraged. 3) the herbs of draining downward are often com- bined with other medicinals in prescriptions according to the state of illness. They, for instance, are used together with medicinals that clear heat and drain fire for constipation due to heat accumulation; with medici- nals that warm the interior for constipation due to cold accumulation; with medicinals that clear and relieve damp-heat for constipation due to damp- heat accumulation in the intestinal tract; with medicinals that invigorate blood and dissolve stasis when accompanied with blood stasis and heat- blood stagnation; with tonics if accompanied with healthy qi insuffi- ciency; and with medicinals that move qi as smooth qi movement will facilitate smooth bowel movement.

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From the perspective of traditional Chinese medicine, the method of draining downward is an important therapy with an instantaneous effect. However, a practitioner needs to be more experienced to prevent the side effects and beginners should be more cautious.

大黄 Dà Huáng radix et rhizoma rhei rhubarb root and rhizome The source is from the radix and rhizome of herbaceous perennial Rheum

palmatum L., R. tanguticum Maxim ex Balf, or Rheum officinale Baill,

family Polygonaceae. Bitter in flavor and cold in nature. It is so-called as its cross-section is yellowish brown and taking it turns urine bright yellow. Alternate names include 将军 Jiāng Jūn (for its vigorous action of dispel- ling pathogens) and 川军 Chuān Jūn (mainly from Sichuan).

[Actions] Purge accumulations and remove stagnation, drain fire and pro-

mote defection, and clear heat and invigorate the blood. It is applicable for constipation due to excess heat, accumulation in the intestine, abdominal pain, incomplete defecation, damp-heat jaundice, blood heat hemorrhage, red eyes, sore throat, intestinal abscess, carbuncle, swellings, sores, ulcers, amenorrhea and dysmenorrhea caused by static blood, injuri es from falls, fractures, contusions and strains with blood stagnation, and scalding and heat-toxin carbuncle and swelling when applied externally. Its major active ingredients are tannin and anthraquinone derivatives including chrysophanol, aloe-emodin, rhein, rheum emodin, and physcion. This herb can stimulate large intestine, increase peristalsis, and promote defe- cation. It has shown potent antibacterial and inhibitory effects against virus and fungus. It has spasmolytic, choleretic, hypolipidemic, antihyper- tensive, bleeding-stanching, and antitumor effects.

[Quality] Washed clean in water, obtained and covered by stupe until

moistened thoroughly, cut into slices, and dried under sunshine. Sichuan has the largest output of 南大黄 Nán Dà Huáng, also known as 川大黄 Chuān Dà Huáng, and is regarded as the commonly used quality goods. While 西宁大黄 Xi Níng Dà Huáng produced in Qinghai is recommended as a genuine regional medicinal marked by yellowish and brownish red outer surface, visible whitish rhombic and reticular veins formed by gray- ish white parenchymatous tissues interlacing with brownish red rays, and aligned stripes inside like brocade. For this reason, it is also known as 锦

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纹大黄 Jǐn Wén Dà Huáng. It is the best with optimal curative effects and without side effects.

[Indications]

1. Constipation due to heat accumulation: Dà Huáng (Radix et Rhizoma Rhei), cold in nature, is capable of washing away intestinal accumula- tions and suitable for excess heat constipation. Clinical manifestations are constipation with abdominal fullness and pain, or stinking water stool with severe abdominal pain, fullness and resistance feeling while pressing, unpleasant, pressing and distending pain in the abdomen upon heavier pressure. In most cases, patients present vexing fever, or red face and eyes, or rave and talkativeness with loud voice, or hot sensa- tion in the body with profuse sweating, or feeling of lightweight body and activeness. This is interior excess heat pattern and Dà Huáng (Radix et Rhizoma Rhei) must be used to purge heat accumulation and unblocking downwards. Other medicinals should be used together according to accompanying symptoms. For instance, Dà Huáng (Radix et Rhizoma Rhei) should be combined with Zhĭ Shí (Fructus Aurantii Immaturus) and Hòu Pò (Cortex Magnoliae Officinalis) for abdominal distention, fullness and pai n as if being covered by tiles with feeling of hardness upon pressure; with Máng Xiāo (Natrii Sulfas) for hot body with sweating, constipation lasting for five or six days, hardness and fullness of the abdomen as if clusters of pebbles when pressing, and dry mouth and tongue; with Gān Suì (Radix Kansui) for hardness, fullness and pain from the heart to lateral aspect of the lower abdomen that refuses pressure; with Zhī Zĭ (Fructus Gardeniae) and Yīn Chén (Herba Artemisiae Scopariae) for hot body, dry and greasy mouth, general jaundice, and slight fullness of abdomen; with Máng Xiāo (Natrii Sulfas) and Táo Rén (Semen Persicae) for sudden pain in lateral aspect of the lower abdomen and manic; and with Huáng Lián (Rhizoma Coptidis) and Huáng Qín (Radix Scutellariae) for epigastric pĭ, hemate- mesis, and epistaxis.

For healthy qi deficiency with heat accumulation, Dà Huáng (Radix et Rhizoma Rhei) should be prescribed together with medicinals that reinforce healthy qi in order to avoid injuring healthy qi while

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dispelling pathogens. For instance, it is used together with Shēng Dì (Radix Rehmanniae), Xuán Shēn (Radix Scrophulariae), and Mài Dōng (Radix Ophiopogonis) for yin fluid insufficiency of the intestines; with Rén Shēn (Radix et Rhizoma Ginseng) and Dāng Guī (Radix Angelicae Sinensis) for qi and blood insufficiency; and with yang-warming medicinals such as Fù Zĭ (Radix Aconiti Lateralis Praeparata) and Gān Jiāng (Rhizoma Zingiberis) for cold accumulation-induced constipa- tion with accompanying spleen yang deficiency.

2. Fire-heat exuberance patterns: owning to potency in clearing heat and resolving toxins, Dà Huáng (Radix et Rhizoma Rhei) is particularly suitable for diseases and patterns of fire-heat flaming upwards, such as headache, red eyes, swollen and painful throat, swollen and painful gum, and ulcers in the mouth and tongue, especially when accompa- nied with constipation. It can be used alone or together with other medicinals that clear heat and resolve toxin. This substance is com- bined with Lóng Dăn Căo (Radix et Rhizoma Gentianae), Shēng Dì (Radix Rehmanniae), Zhī Zĭ (Fructus Gardeniae) and Xià Kū Căo (Spica Prunellae) for liver and gallbladder exuberant fire; and with Shí Gāo ( Gypsum Fibrosum), Sāng Bái Pí (Cortex Mori) and Yú Xīng Căo (Herba Houttuyniae) for vigorous fire in the lungs. It is also signifi- cantly effective in the treatment of scalding, burns, and heat-toxin induced carbuncles, swellings, ulcers, and sores.

3. Damp-heat patterns: Dà Huáng (Radix et Rhizoma Rhei) is capable of clearing and removing damp-heat and therefore applicable for jaun- dice, strangury and dysentery caused by damp-heat. It is combined with Zhī Zĭ (Fructus Gardeniae), Yīn Chén (Herba Artemisiae Scopariae), and Huáng Băi (Cortex Phellodendri Chinensis) for jaundice; and with Mù Tōng (Caulis Akebiae), Chē Qián Zĭ (Semen Plantaginis), Qú Mài (Herba Dianthi), and Gān Căo (Radix et Rhizoma Glycyrrhizae) for strangury. This substance is also used in the treatment of dysentery, either alone or together with other medicinals that clear and drain damp-heat.

4. Internal accumulation of blood stasis: Dà Huáng (Radix et Rhizoma Rhei) is potent in invigorating blood and dissolving stasis and thus has been widely used to treat different diseases and patterns of static blood, such as abdominal pain due to postpartum blood stasis, or abdominal

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fullness and pain caused by inhibited menstruation, or traumatic injury resulting in blood stasis blockage in the channels and collaterals mani- fested as abdominal and lower back pain, hardness and pain in lateral aspect of the lower abdomen when pressing, and restlessness, or irrita- bility, or paraphasia, or restless sleep in most cases. In this case, Dà Huáng (Radix et Rhizoma Rhei) is combined with medicinals that inv igorate blood and remove stasis, such as Táo Rén (Semen Persicae), Mŭ Dān Pí (Cortex Moutan), Chì Sháo (Radix Paeoniae Rubra), and Hóng Huā (Flos Carthami) to break up blood and move stasis.

5. Frenetic movement of hot blood: owning to its ability to clear blood heat and stanch bleeding, Dà Huáng (Radix et Rhizoma Rhei) is quite suitable for different types of hemorrhagic disorders caused by blood heat. It can also invigorate blood and remove stasis, thus it can stanch bleeding without retaining blood stasis. This substance can be used alone or in a combination with other medicinals that cool blood and stanch bleeding. Recently, it has been effectively used in a powder form for upper gastrointestinal hemorrhage.

To sum up, this herb is applicable to a wide range of diseases in the clinic and its actions of purgation, clearing heat, invigorating blood and stanching bleeding are interconnected.

[Usage and Dosage] Different preparation methods exert different influ-

ences on this herb, namely using raw as a purgative; applying the pro- cessed to clear heat, invigorate blood, and remove blood stasis; treating with wine when used to clear fire-heat in the head and face; and using charred one to strengthen its bleeding-arresting action. Use 5–10 g in decoction, increase the dosage for heat-toxin or in severe case of heat accumulation, and 2–3 g as in pill and powder. For decocting, this medici- nal can be added later, decocted first, or cooked together with other herbs. When used as a purgative, it should be added at the end since prolonged cooking will reduce its purgative effect. While for clearing heat, it should be cooked together with other herbs. In recent years, it has been prepared into injection to alleviate discomfort in the stomach induced by oral administration and eliminate the purgative effect. Other preparation forms such as tablet and syrup are also available. The dosage of Dà Huáng

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(Radix et Rhizoma Rhei) should be prescribed in line with different pro- cessing methods, usages, indications and compatibilities. For instance, give 3–15 g for decoction, and up to 15–30 g when used to expel heat accumulation in the intestines by purgation; decrease the dosage when taken with water or powder as 1 g/time can even cause loose and frequent stool; decrease its dosage when added later due to its potent purgative effect; increase the dosage when using processed Dà Huáng (Radix et Rhizoma Rhei) as it is inferior to the raw one in purgation. Taking 1 g in decoction or less than 0.3 g in powder each time would not cause diarrhea.