Qì Cannot Return to the Source
On Shā Rén
Work continues at CMHQ on prep for two herb courses, which means a lot of materia medica review; hence another post on the subject (I will put up acupuncture content soon, I promise). This is not a #ghostherb screed, but it does have a common theme; namely herb functions which seem to have gone forgotten.
The subject of our little investigation this time around is Fructus Amomi Villosi, better known to us as Shā Rén.
Modern View
A summary of the basics on Shā Rén taken mostly from Wiseman and Brand (2020):
• Warm, acrid (+ aromatic) / enters SP, ST
• Transforms dampness and moves qi: Spleen-stomach qi stagnation with dampness, or food stagnation.
• Warms the center, stops vomiting and diarrhea: Spleen-stomach vacuity cold vomiting.
• Quiets the fetus: Restless fetus, morning sickness due to stagnant qi.
• Added to supplementing formulas to prevent stagnation
• Contraindicated: yīn vacuity heat.
• 1.5-6 g Add at end of decoction.
Pretty much every English-language materia medica I’ve seen closely resembles this entry.
Something Different
Over 20 years ago, I procured a very useful book by Philippe Sionneau, entitled Dui Yao: The Art of Combining Chinese Medicinals. There is a lot of interesting information in this book. I bought it before I really knew much about Chinese herbs, and when one is first learning something, early impressions often stick. So when I started teaching Chinese herbs, I often slipped into the lecture things I learned from this book. Among them was this passage (Sionneau, 1997, p. 120):
Sha Ren
Moves the qi and rectifies the middle burner
Transforms dampness and warms the middle burner
Arouses the spleen and stimulates the appetite
Guides the qi toward the kidneys
The duì yào combination in the entry was Shā Rén with Shú Dì Huáng (Rx Rehmanniae Praeparatae). The combination was indicated for “Liver-kidney or essence vacuity, blood vacuity associated with weakness of the spleen and stomach, particularly due to the loss of control over their movement and transformation functions.” Appended to the entry was a note to use mixed and steamed Shā Rén seeds with the Dì Huáng, along with a comment that “Sha Ren focuses the action of Shu Di on the kidneys.”(Sionneau, 1997, p. 121)
Where did that come from?
So, when I became an herbal medicine instructor, I would drop that little tidbit into the lecture. But I never had any source beyond Dr. Sionneau. The students (bless ‘em) never called me on it – they were probably not terribly happy to have yet another data point about a minor herb to digest – but I always felt kinda sorta a little bit bad about it. Like I would take a snapshot of the passage from the Dui Yao book and post it with the course materials as if to say “hey, folks, I swear I’m not making this up.”
Because, quite frankly, it’s kind of a cool idea, that this humble spice holds the key to the kidneys, and furthermore it is curious that this little item didn’t make it into the standard materia medicas. So, going through the 300-single-herb exam list, and dusting off the old powerpoint slides, I was reminded again of this curiosity. Except this time, I decided to look into it a bit further.
Confirming the source
I started looking through some old texts, first from the Qing. I came up empty on the first few, but found a reference in Běn Cǎo Bèi Yào (Essentials of Materia Medica) by Wāng Áng (1694). I’ve translated the whole entry here (brackets mine).
砂仁
即縮砂蔤
宣，行氣，調中
辛溫香竄。補肺益腎，和胃醒脾，快氣調中，通行結滯。
治腹痛痞脹（痞滯，有傷寒下早裡虛邪入而痞者；有食壅痰塞而痞者；有脾虛氣弱而痞者。須分虛實治之，不宜專用利氣藥，恐變為鼓脹。鼓脹，內脹而外有形；痞脹，惟覺痞悶而已，皆太陰為病也），噎膈嘔吐，上氣咳嗽，赤白瀉利（濕熱積滯，客於大腸，砂仁亦入大小腸經），霍亂轉筋，奔豚崩帶。祛痰逐冷，消食醒酒，止痛安胎（氣行則痛止，氣順則胎安），散咽喉口齒浮熱，化銅鐵骨鯁（王好古曰：得檀香、豆蔻入肺，得人參、益智入脾，得黃柏、茯苓入腎，得赤石脂入大、小腸。
Shā Rén [Fr Amomi villosi]
Also called Suō Shā Mì
Diffuses, moves qì, regulates the center
Acrid, warm, aromatic, and penetrating. Supplements the lung and boosts the kidney, harmonizes the stomach and arouses the spleen, disinhibits qì and regulates the center, unblocks and moves binding stagnation.
Treat abdominal pain, glomus and distension (glomus stagnation, from cases of injury due to using cold precipitation too early thus causing interior deficiency so that evils enter and glomus results; cases of food congestion and phlegm blockage causing glomus; cases of spleen deficiency with weak qì causing glomus. Vacuity and repletion must be separated in treatment, it is inadvisable to exclusively use qi-disinhibiting medicinals, for fear of transformation to drum distension. In drum distension, the interior distension becomes visible to the exterior; in glomus distension, one only feels the glomus and oppression, nothing more; each is a tàiyīn disease),
Dysphagia-occlusion, vomiting and retching, qì ascent cough, red and white diarrhea and dysentery (damp-heat accumulation and stagnation, settling in the large intestine, Shā Rén also enters the large and small intestine channels), cramping from sudden turmoil disorder, flooding and vaginal discharge. Dispels phlegm and expels cold, disperses food and arouses from drunkenness, relieves pain and quiets the fetus (qì moves and pain stops, qì is normalized and the fetus is quieted); scatters floating heat in the throat, mouth and teeth, dissolve with copper and iron for bones in the throat (Wáng Hǎogǔ said: “[with] Tán Xiāng [Lignum Santali Albi] and Dòu Kòu [Fr Amomi Rotundus] it enters the lung, [with] Rén Shēn [Rx Ginseng] and Yì Zhì [Fr Alpiniae Oxyphyllae] it enters the spleen, [with] Huáng Bǎi [Cx Phellodendri] and Fú Líng [Poria] it enters the kidney, [with] Chì Shí Zhī [Halloysitum Rubrum] it enters the large and small intestine.
This is pretty much in keeping with the information we all learned, except for a couple of kidney references. But the entry goes on:
《醫通》曰：辛能潤腎燥，引諸藥歸宿丹田，地黃用之拌蒸，亦取其能達下也。《經疏》曰：腎虛氣不歸元，用為嚮導。殆勝桂、附熱藥為害）。
出嶺南，研用。
“Yī Tōng” says: acrid, can moisten dryness of the kidney; it conducts all medicinals to return to the dāntián, if used mixed and steamed with Dì Huáng, it also receives the ability to reach the lower [burner]. “Jīng Shū” says in kidney vacuity, qì cannot return to the source, use it to act as a guide. Danger, overcomes Guì [Cx Cinnamomi], Fù [Rx Aconiti] [type of] hot medicinals, can cause harm).
Produced in Lǐngnán, grind to use.
Okay, so right there is confirmation of the footnote in Sionneau (1997). But I wanted to know if the idea went back any further. I went digging a little deeper and found this entry from a Sòng dynasty text, Běn Cǎo Yǎn Jù (Extended Materia Medica, 本草衍句), attributed to Kòu Zōngshì in 1116. Here is the relevant passage, reproduced in Wāng Áng, but with some subtle differences. The lines here are not punctuated, so I inserted my best guess in the translation; but the parentheses are in the source I used:
砂仁 辛溫潤腎快氣調中香竄醒脾和胃補肺引諸藥歸宿丹田（地黃用之拌蒸取其能下達也經疏云腎虛氣不歸元用為嚮導殆勝桂附熱藥為害）
Shā Rén
Acrid and warm. Moistens the kidneys, disinhibits qì, regulates the center. Its aroma penetrates and awakens the spleen; it harmonizes the stomach, and supplements the lungs; it conducts all medicinals to return to the dān tián (if used mixed and steamed with Dì Huáng, it receives the ability to reach the lower [burner]. “Jīng Shū” says in kidney vacuity, qì cannot return to the source, use it to act as a guide. Danger, it overcomes Guì [Cx Cinnamomi] and Fù [Rx Aconiti] [type of] hot medicinals, and can cause harm).
After sifting through the subtle differences between the two passages above that include the reference to Dì Huáng, is still not clear to me if the implication is that Shā Rén itself can guide to the dān tián, or if it needs to be prepared with Dì Huáng to do so. Sionneau’s writings would seem to indicate that Shā Rén itself can guide or focus the actions of other herbs on the kidneys, and so it would not be a stretch to assume that would also include the dān tián.
Formulation possibilities
This would certainly open up possibilities in formulas like Shēn Líng Bái Zhú Sǎn (Ginseng, Poria, and Atractylodes Macrocephala Powder), which I’ve always felt had a lot of water-phase undertones to it anyway. In that sense, Shā Rén is included in the formulation with a specific purpose, and its substitution with another aromatic, qì-regulating or food-abducting herb to merely improve the digestability of the formula would result in losing a vital function of the prescription.
Furthermore, its partnership with Mù Xiāng (Rx Aucklandiae) may open more possibilities for using Xiāng Shā Liù Jūn Zǐ Tāng (Aucklandia and Amomum Six Gentlemen Decoction); combining a medicinal that guides to the dān tián with one that strengthens the will and opens the triple burner to accompany a spleen-supplementing phlegm-resolving formula may be especially effective for the water-within-earth types, for example.
Conclusion
I feel a little more settled now that I have at last found a reference for Dr. Sionneau’s footnote. As to the question of why these traditional functions of Chinese herbs don’t make it into the modern materia medica literature, we can only speculate. To my herb students, the answer is no, I won’t test you on these little historical anomalies, but it may come up in a lecture or infographic at some point.
As always, thanks for reading.
Note: this newsletter 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
Kòu, Z. (1116). Běn cǎo yǎn jù. Retrieved November 4, 2023 from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E8%A1%8D%E5%8F%A5/index.html
Sionneau, P. (1997). Dui yao: The art of combining Chinese medicinals (Trans: Bernard Côté). Blue Poppy Press.
Wāng, A. (1694). Běn cǎo bèi yào. Retrieved October 22, 2023 from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E5%82%99%E8%A6%81/index.html
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.