Inclining Toward Balance
Ashwagandha as a TCM Herb
One of the realities of clinical practice of Chinese medicine in the west is that we are one system of medicine in a healthcare plurality. Patients often seek help from other modalities, systems and practices alongside our own. It is also very common for patients to self-medicate on supplements that they have come across in researching their condition. In that sense, it can be useful to understand the effects and impacts of a variety of interventions in terms of Chinese medicine.
One supplement that I have heard mentioned from many of my patients is ashwagandha, (Withania somnifera), an herbal remedy that is used in the Ayurvedic system of medicine. I was recently asked what I thought of this herb, and I had to admit that I knew very little about it, as it was native to a different traditional medicine stream.
Gaps in knowledge are inevitable but quite bothersome to me, so I went looking for more information on the plant from from the vantage point of Chinese medicine. I came up mostly empty on the internet, but when I started surfing Chinese research, I found a paper that was literally just published the day before. That paper was Chen et al. (2024). Fairly lengthy at 10 pages, the article reviewed the research and posited a Chinese medicine framework for using the herb. I was quite excited to download it, and I took a screenshot of the abstract and posted it to social media. It generated some interest, and I mentioned that I might attempt to review the article’s rationale for the Chinese medicine flavor, nature, channels entered, actions, and indications. So I’m going to do that here.
What follows is a brief review of the first section of Chen et al. (2024), and then my detailed notes on part 2 of the article. This means that it reflects my understanding of the authors’ work. Any mistakes are mine and not those of the authors of the paper.
Introduction and Part 1
The paper begins by identifying the plant by its botanical name of Withania somnifera and common name of Ashwagandha. The Chinese name used for it in the article is 睡茄 shuìqié “sleeping eggplant”. The introduction discusses the process by which foreign medicinals might be categorized in Chinese medicine, and the team that wrote this article has done something similar with other herbs, such as echinacea, açai, and maca. Ashwagandha is currently being cultivated in Yunnan province, and its use is beginning to grow in Chinese medicine.
The first section of the paper reviews the herb in terms of its botany, habitat, and chemistry, and reviewed relevant research. Some of the latter is mentioned in the second section, detailed below.
2.1 Inquiry into the Chinese medicine properties of shuìqié
Chinese medicinals have four natures of cold, hot, warm and cool, however there is a balanced [平, píng] nature that is independent and apart from the “four qì”, that occupies a considerably large portion of the pharmacopeia. An important characteristic of balanced-natured medicinals is their “two-way application, depending on the dominant condition”, i.e., they have a specific property of “inclining the body toward balance,” so that in a heat pattern condition it can bring a cold or cooling nature into play, and in cold pattern conditions it can bring a hot or warming nature into play, as Zhāng Yuánsù [张元素, 1151-1234] said:
“Balanced (means) its qì is simultaneously warm, cool, cold and hot.”
[“平，其兼气温凉寒热。”]
Warm and hot medicinals can cause a state of physiologic excitement; shuìqié has the ability to enhance physical strength, increase the body’s vital functions, improve the body’s energy when a deficit appears, so consequently it has a warm or hot nature. Cold and cool medicinals can inhibit the body’s physiologic activity; shuìqié can have the effect of calming the spirit, consequently it has a cold or cool nature. Moreover, shuìqié can be used to both strengthen immunity and suppress immunity; in times of low immunity it can be used to strengthen immunity, when the body is in a hyper-immune state as in SLE [Systemic lupus erythematosus], it can lead to inhibition of the immune response. This illustrates the balanced-natured medicinal’s characteristic “two-way application, depending on the dominant condition”. Moreover, shuìqié traditionally is frequently eaten together with cow’s milk and honey; it serves both as food and medicine, indicating that it has a mild action and no specific characteristics of great cold or great heat. To sum up, shuìqié’s nature is balanced.
2.2 Inquiry into flavor
The five flavors are principally differentiated from the taste organs, but are also determined by their clinical effects. “When it enters the mouth, one knows its flavor, when it enters the belly, one knows its nature” [“入口则知味，入腹则知性”]. Medicinal flavor includes the taste of the substance in the mouth along with the Chinese medical function of the flavor. The sweet flavor has the function of supplementing and boosting [补益], relaxing tension and relieving pain [缓急止痛], harmonizing the nature of medicinals [调和药性], and harmonizing the center [和中]. Shuìqié can improve the body’s vitality and increase muscle strength, and it has a supplementing and boosting effect. Pharmacology research has indicated that shuìqié posseses pain-relieving effects, so it can relax tension and relieve pain. Therefore, shuìqié has a sweet flavor. Besides that, shuìqié contains substances such as alkaloids, lactone glycosides, flavonoids, etc. Generally speaking, bitter-flavored medicinals often contain alkaloid and glycoside types of components, and beyond that there are still some flavonoid types of components; these substances are the active ingredients that exert heat-clearing and fire-draining effects, but shuìqié doesn’t have very strong heat clearing and fire draining effects. By that combined with the flavor of the herb in the mouth we can infer that shuìqié’s flavor is slightly bitter. Therefore, shuìqié’s flavor is sweet and slightly bitter.
2.3 Inquiry into channel entry
Shuìqié can treat insomnia; it has a tranquilizing action, and with regard to healthy population as well as insomniac population has function of improving sleep. Chinese medicine believes that “the heart stores the spirit, it governs the bright spirit” [“心藏神，主神明”] , in disquieted heart spirit, the heart is deprived of nourishment, so the spirit is unsettled, and insomnia is likely to occur along with vexation and agitation, etc. Pharmacologic research confirms that shuìqié has sleep-inducing and calming effects. Therefore shuìqié goes to the heart channel.
Shuìqié has anxiolytic and anti-depressant actions. Wáng Mèngyīng’s case reports [Wáng Mèngyīng yī àn 王孟英医案] says: The liver governs the body’s qì, diseases of the seven affects surely arise from the liver.” [“肝主身之气，七情之病必由肝起。”]. The liver governs coursing and discharging, it has the function of regulating and facilitating the affect-mind, inclining toward orderly reaching and averse to depression. If liver qì is depressed and bound, the affect mind will easily fall ill with anxiety, depression patterns, visceral agitation [脏躁zàngzào], insomnia, etc. Clinical research indicates that shuìqié can alleviate patients’ symptoms of anxiety, and experimental research has verified that it has anti-depressant effects. Therefore shuìqié goes to the liver channel.
Shuìqié can treat sexual dysfunction and improve reproductive capacity. Chinese medicine believes that “the kidney stores essence, and governs reproduction” [“肾藏精，主生殖”]. The Origin and Indicators of Disease, Vacuity-taxation and Yīn-wilting Conditions [Zhūbìng yuánhòu lùn, Xūláo yīnwěi hòu 诸病源候论·虚劳阴萎候, by Cháo Yuánfāng 巢元方, c. 610 CE] says: “The kidney opens at the yīn orifices, if there is taxation damage to the kidney, [there will be] kidney vacuity with inability to provision the yīn organ [i.e., genitalia], therefore there is wilting and weakness.” [“肾开窍于阴，若劳伤于肾，肾虚不能荣于阴器，故萎弱也。”]. Therefore, sexual dysfunction and infertility are pathologies of the kidneys. Shuìqié can alleviate symptoms of menopause in women; Chinese medicine believes that for women entering menopause the kidney qì is growing weaker and the tiānguǐ is almost exhausted, the essence-blood is insufficient, and the location of the pathology is in the liver and kidney.
Shuìqié can improve the strength of one’s memory. Scholars who data-mined available information on characteristics of Chinese prepared medicine products to improve memory found that most of the medicinals in those products enter the kidney channel. Chinese medicine theory believes that memory loss is closely correlated to the kidney, and the essence of the kidney viscus governs the bones and engenders marrow, the brain is the sea of marrow. If the essence qì in the kidney is depleted, one’s memory capacity diminishes; when the the essence qì in the kidney is abundant, the brain and marrow are nourished, which strengthens the memory capacity. Therefore, shuìqié enters the kidney channel.
Shuìqié has a notable anti-fatigue action combined with an ability to increase muscle strength and stamina. Sù wèn: Treatise on wilting [素问·痿论篇] says “the spleen governs the muscles and flesh of the body,” [“脾主身之肌肉”] . The muscles and flesh of the whole body depend on the spleen and stomach to transport and transform the subtle essence of water and grain, which brings nourishment so that the muscles of the four limbs will be strong. Beyond that, shuìqié can lower blood sugar, lower blood fats, and is used in diabetes and hyperlipidemia diseases. Chinese medicine believes that for this reason these two diseases develop together with spleen and stomach vacuity unable to transport, transform, convey, and distribute, indicating the disease is located in the spleen. Therefore, shuìqié goes to the spleen channel.
To summarize, in terms of channel entry, we can infer that shuìqié enters the heart, liver, kidney, and spleen channels.
2.4 Inquiry into actions and indications
2.4.1 Calm spirit, boost intelligence
Sù wèn: Six periods and visceral manifestation treatise [素问·六节藏象论] says “when the heart spirit is unsettled, it causes insomnia” [“心神不安，则生不寐。”]. Jingyuè Quánshū [Complete Compendium of Zhāng Jingyuè 景岳全书, 1624] says: “Sleep is rooted in yīn, the spirit is its master, if the spirit is calm there will be sleep, if the spirit is not calm there will be sleeplessness.” [“盖寐本乎阴，神其主也，神安则寐，神不安则不寐。”] Clinical research confirms that shuìqié can treat insomnia, while in healthy people it improves sleep quality. Pharmacology studies indicate shuìqié can shorten the sleep onset latency period, at the same time it has a calming pharmacological action, which shows that shuìqié has spirit calming effects and is used in insomnia and patterns of vexation and agitation, etc. In Lèizhèng Zhìcái [Differentiation and Classification of Patterns and Treatments 类证治裁, 1839] it is written: “The brain is the palace of the original spirit [yuán shén], the sea of marrow, and is in fact the place on which memory depends.” [“脑为元神府，精髓之海，实记忆所凭也。”] The human’s ability to recall relies on normal brain function. In the Qing dynasty Wáng Qīngrèn in Yī Lín Gǎi Cuò [Correction of Errors among Physicians, 医林改错, 1830] wrote: “If the brain and marrow lose nourishment, it will make one feeble-minded.”[ “脑髓失养，发为痴呆。”] The brain is the palace of the original spirit, and the commander of all the spirits, loss of fullness in brain and marrow is the principle etiology of Alzheimer’s disease. Shuìqié can significantly decrease amyloid beta [Aβ, a chief component of brain plaques] in the brains of middle and old age APP/PS1 transgenic mice [which are genetically altered rodents used to study Alzheimers’ disease], and accelerate elimination of Aβ through up-regulation of the liver low-density lipoprotein receptor related protein (LRP) and reverse the model’s observed behavioral deficits. Therefore shuìqié has the effect of boosting intelligence [益智] and is used for forgetfulness.
2.4.2 Course the liver and resolve depression
The liver governs coursing and discharging, and is in charge of the body’s internal movement of the qì dynamic, and inclines toward orderly reaching and is averse to depression. When the liver qì is depressed and bound, the internal movement of the qì dynamic is obstructed, and the normal function of each of the organs will follow under its influence. Anxiety disorder is frequently brought on by binding depression of liver qì, resulting in the inhibited flow of qì and blood, which gives rise to symptoms of anxiety disorder. Clinical trials verify that shuìqié can treat anxiety disorder, alleviate patients’ stress, and reduce serum cortisol levels. Liver depression qì stagnation is one of depressive disorder’s chief patterns, with chaotic movement of the qì dynamic, abnormal conveyance and transportation, easily vexed and agitated, easily angered, emotional constraint and other types of depressive symptoms. Pharmacological research indicates that shuìqié has an antidepressant action. Therefore we can infer that shuìqié has a liver-coursing, depression-resolving effect, useful in liver depression qì stagnation with symptoms of fullness and oppression in the chest and ribside, emotional tension, gloom and unhappiness, etc.
2.4.3 Supplement kidney, boost essence
The kidney stores essence and governs reproduction; reproductive function along with sexual function have an affinity with kidney essence and kidney qì. If the kidney essence is abundant, one will be full of vigor, with normal reproductive function. Clinical studies have shown shuìqié can increase sperm motility as well as quality, and at the same time can treat sexual dysfunction. Therefore, shuìqié has the function of supplementing the kidneys and boosting essence, useful for vacuity taxation and loss of essence, and lack of libido.
Chinese medicine believes that “the kidneys govern the bones, engender marrow and join with the brain, and the brain is the sea of marrow” [“肾主骨生髓而通于脑，脑为髓之海”], and if kidney essence is sufficient, the sea of marrow gets nourishment, and the brain will operate with normal physiological function. Clinical studies have demonstrated that shuìqié can improve recall as well as cognitive ability and can increase cerebral processing speed. Therefore we can infer that shuìqié has the function of supplementing the kidney and boosting essence, and is effective in improving memory and cognitive ability.
2.4.4 Boost qì, fortify spleen
Sùwèn: Treatise on wilting [素问·痿论篇] says “Spleen governs the muscles and flesh of the body.” Sùwèn: Treatise on engenderment of the five viscera [素问·五脏生成篇] says “Spleen governs transporting and transforming the essence of water and grain, to nourish the muscles and flesh, and therefore governs the flesh” [“脾主运化水谷之精，以生养肌肉，故主肉”], this illustrates that the spleen and bodily movement have a relationship that is too close to be separated. If spleen qì has strong transportation, then the muscles and flesh of the body will be well developed and strong. Clinical research indicates that shuìqié can increase muscle strength and endurance, and can improve the symptoms of fatigue in breast cancer patients. Therefore shuìqié can boost qì and fortify the spleen, and is useful in qì vacuity lack of strength, lassitude of spirit and fatigue.
Conclusion
So, to sum up, in the opinion of the authors (Chen et al., 2024), ashwagandha’s properties in terms of Chinese medicine are as follows:
Nature: Balanced
Flavor: Sweet, slightly bitter
Channels entered: Heart, liver, kidney, spleen
Actions: Calms the mind and boosts intelligence, courses the liver and resolves depression,, supplements the kidney and boosts essence, boosts qì and fortifies the spleen
Indications: Insomnia and forgetfulness, liver depression qì stagnation, vexation and agitation, fidgetiness, kidney vacuity and essence depletion, poor libido, qì vacuity and lack of strength, lassitude of the spirit and fatigue.
This is, of course, the opinion of one team of researchers who have an established method for analyzing the data on a given herb and inferring TCM principles from that. As we all know, there are always a variety of opinions on virtually everything in Chinese medicine, so this article shouldn’t be taken as the final word on ashwagandha as a TCM herb. That said, I do find it very helpful moving forward to understand better how the herb is used, and even to recommend it myself if it seems like it would be of benefit.
Okay, that’s it for now. Thanks for reading.
Note: this publication is for information purposes only and is not intended as medical advice. Please seek the opinion of a health care professional for any specific medical issues you may have.
References
Chen, Y., Zhang, J.J., Wang, L.Y, Li, Y.P., He, J., Li, L.Z., Wang, C., Guo, B.L., Yang, B.R., Du, J., & Chen, L. (2024). 新外来药用资源睡茄的“中药化”研究 (Study on the "Chinese medicine" of the new foreign medicinal resource Ashwagandha). Global Traditional Chinese Medicine. doi：10.3969/j.issn.1674-1749.2025.04.001
As someone who studied Ayurved before delving into Chinese Medicine, I appreciate the cross-pollination of materia medica here. Nice write-up!
Ashwagandha (which, fun fact, is Sanskrit for "horse-smelling") is a useful herb for calming, supplementing and strengthening especially in weak, deficient, chilly patients. It's an unusual example of a calming (as opposed to stimulating) adaptogen.
Worth noting that the main contraindication for it in Ayurvedic terms is pitta disorders, which we can gloss generally as heat conditions. Ashwagandha is after all in the hot-natured nightshade family (along with peppers, eggplant, etc.) and some people are just sensitive to this plant family.
Ayurveda often recommends that Ashwagandha be given with or in milk, something you'd never see in Chinese medicine, but which effectively enhances its nutritive, restorative properties. Different strokes!