Receiving the Qì of Metal and Water
On Xià Kū Cǎo
Welcome
There have been quite a few new subscribers in the last few weeks or so, and I wanted to say welcome, and I hope you enjoy the publication. I try to post something every week or so, though sometimes life gets busy (we all know the feeling) and I end up missing a week here or there.
I have a few pieces in development, but nothing is quite ready so I decided to just randomly pick something to mulch, and perhaps you may find it interesting or otherwise beneficial.
Here is the random pick – it’s from from the Běn Cǎo Jīng Jiě (本草經解, Materia Medica Explanation), attributed to Yè Tiānshì in 1724.
【夏枯草】
氣寒。味苦辛。無毒。主寒熱。瘰癧鼠瘻。頭瘡破症。散癭結氣。腳腫濕痹。輕身。
Xià Kū Cǎo [Spica Prunellae]
Its qì is cold, its wèi [flavor] is bitter and acrid. It is non-toxic. It is mainly for cold and heat [i.e. chills and fever], scrofula and rat fistula, and head sores. It breaks concretions, scatters goiter and bound qi, treats foot swelling and damp bi, and lightens the body.
[Comment: This passage is a quote from the Shen Nong Ben Cao Jing [The Divine Farmer’s Classic of Materia Medica]. You may remember the rat fistula discussion from last week’s post. The cold, bitter, acrid qì and wèi of the herb are the same as those usually given in modern textbooks.
夏枯草氣寒。稟天冬寒之水氣。入足太陽膀胱寒水經。味苦辛無毒。得地火金之味。入手少陰心經、手太陰肺經。遇火令而枯。稟金水之氣獨全。水制火。金平木。 故專主少陽相火。風木膽經之症。氣味輕清。少陽也。
Xià Kū Cǎo’s qì is cold. It is endowed by heaven with the water qì of the winter cold. It enters the foot tàiyáng bladder cold water channel. Its flavor is bitter, acrid and non-toxic. It receives from the earth the flavors of fire and metal. It enters the hand shǎoyīn heart channel, and the hand tàiyīn lung channel. Exposure to fire causes dryness. Only in receiving the qì of metal and water will one be saved. Water controls fire, and metal balances wood. Thus this [medicinal] especially masters the shǎoyáng ministerial fire. For concretions along the wind wood gallbladder channel, [this medicinal’s] qì and wèi are light and clearing, as are [those of] shǎoyáng.
[Comment: Usually we see the channel entry of Xià Kū Cǎo limited to liver and gallbladder channels. The bladder, lung, and heart channel entry help explain its qì and wèi of being cold, acrid and bitter. The resonance with wood here is through the light, effusive and clearing action of the herb, rather than its flavor.]
太陽主表。表邪外入。則太陽有病。而惡寒發熱矣。其主之者。味辛可以散表寒。味苦可以清熱也。
Tàiyáng governs the exterior. Exterior evils enter from the outside. As a result there is illness in the tàiyáng. Furthermore, there is aversion to cold and heat effusion. [Xià Kū Cǎo] will master these cases. Its acrid flavor can scatter exterior cold, and its bitter flavor can clear heat.
[Comment: Exterior releasing indications for Xià Kū Cǎo have not survived into the present era; its relation to wind is more oriented toward internal wind, in that it is used nowadays for hypertension. Typically, the hypertension is related to liver fire; Xià Kū Cǎo is usually categorized as a clear heat/drain fire medicinal with a secondary role as a phlegm-resolving agent rather than the extinguish wind category.]
瘰癧鼠瘻。皆少陽膽經風熱之毒。夏枯草稟金水之氣味。所以專入少陽。解風熱之毒也。
Scrofula and rat fistula are all shǎo yáng gallbladder channel wind heat toxin. Xià Kū Cǎo is endowed with the qì and wèi of metal and water. So it especially enters the shǎoyáng to resolve wind heat toxin.
[Comment: As we will see momentarily, one of the primary applications of Xià Kū Cǎo today is in treating thyroid conditions. But it also has the ability to resolve fire toxin, and for example, can be used with Pú Gōng Yīng [Hb Taraxaci] to treat breast abscesses (Miào, 1625).]
頭乃太陽行經之地。膀胱濕熱則生頭瘡。其主之者。氣寒清熱。味苦燥濕也。
The head is the place where the tàiyáng channel flows. Bladder damp heat results in the growth of head sores, this masters those cases. Its qí is cold which clears heat, and its flavor is bitter which dries dampness.
積聚而有形可徵謂之症。乃濕熱結氣也。味辛可以散結。味苦可以燥濕熱。所以主之也。癭亦少陽之症。其主之者。以夏枯草專治少陽之症。而辛散之功也。
Accumulations and gatherings [jī jù] that then assume tangible form are a sign called concretions [zhēng]; this is damp heat and bound qì. The acrid flavor can scatter binds, and the bitter flavor can dry damp heat. As a result, this [medicinal] masters it. Goiters are also concretions in the shǎoyáng. It masters these cases [as well]. Use Xià Kū Cǎo especially to treat concretions in the shǎoyáng, as its acrid dispersion is effective.
[Comment: Xià Kū Cǎo is especially useful for concretions [zhēng] which are formed masses that appear in a fixed location, particularly in the shǎoyáng aspect, as in the lateral neck nodes (such as the rat fistulas), or nodulation along the thyroid.]
濕邪傷下。腳腫濕痹。無非濕也。苦能燥濕。所以主之。且入肺與膀胱。而有祛濕之力。濕勝則身重。既有祛濕之功。所以能輕身也。
Damp evil injures the lower burner with foot swelling and damp bì. This is simply dampness. Bitter can dry dampness and therefore masters it. Moreover it enters the lung along with the bladder and strongly eliminates dampness. If dampness is victorious it results in body heaviness, if then one achieves the elimination of dampness, the body can feel lighter.
[Comment: Another indication for Xià Kū Cǎo that has gone by the wayside is treating lower body dampness and damp impediment. However, as we will see, its use in other cultures reinforces its reputation as an antirheumatic.]
制 方:
夏枯草末。治血崩不止。及赤白帶下。夏枯草可代柴胡升發。可代甘菊清肝。同白茯、白朮、黃柏。治濕熱。同連翹、金銀花、貝母、元參、薄荷、花粉、紫背天葵、甘草。治瘰癧有功效。用數兩煎湯。煮甘菊紫花地丁、金銀花、連翹、白芨、白蘞、甘草、生地、白芷、半枝蓮。消一切腫毒甚神。
Formulations:
Regarding Xià Kū Cǎo, it treats bleeding and spotting that won’t stop, as well as red and white vaginal discharge. Xià Kū Cǎo can replace Chái Hú [Rx Bupleuri] in ascending and effusing and can replace Gān Jú [Fl Chrysanthemi] for clearing the liver. Together with Bái Fú [Poria], Bái Zhú [Rz Atractylodis Macrocephalae], and Huáng Bǎi [Cx Phellodendri] it treats damp-heat. Together with Lián Qiáo [Fr Forsythiae], Jīn Yín Huā [Fl Lonicerae], Bèi Mǔ [Blb Fritillariae], Yuán Shēn [Rx Scrophulariae], Bò Hé [Hb Menthae], Huā Fěn [Rx Trichosanthis], Zǐ Bèi Tiān Kuí [Hb Semiaquilegiae], Gān Cǎo [Rx Glycyrrhizae] it treats scrofula quite effectively. Use several liǎng to decoct, cook with Gān Jú, Zǐ Huā Dì Dīng [Hb Violae], Jīn Yín Huā, Lián Qiáo, Bái Jī [Rz Bletillae], Bái Liǎn [Rx Ampelopsis], Gān Cǎo, Shēng Dì [Rx Rehmanniae], Bái Zhǐ [Rx Angelicae Dahuricae], Bàn Zhī Lián [Hb Scutellariae Barbatae]. It eliminates all toxic swelling as if by magic.
[Comment: An interesting possibility for substitution in cases where liver depression transforming heat is complicated by phlegm is to substitute Xià Kū Cǎo for Chái Hú. The scrofula prescription example above is largely a combination of wèi aspect/ wind-heat herbs with cooling phlegm-resolving medicinals. We will look at a similar formula in a moment.]
Xià Kū Cǎo in Other Cultures
Xià Kū Cǎo is the flowering spike of the Prunella Vulgaris, better known in Western herbal traditions as self-heal, heal-all, and woundwort. It grows in temperate climates all over the world, and its use as a medicinal plant spans several continents. Pan et al (2022) note that in Europe, the applications include throat soreness, fevers, and treating wounds; in Turkey, it is used as an antirheumatic, as well as treating colds and heart problems; in Japan as a diuretic; in Persian medicine for pneumonia, dysentery and hemorrhoids, along with diabetic diseases and (as in Chinese medicine) for eye inflammation and headaches.
Modern Research and Applications
Hypertension
Despite its inclusion in the Shen Nong Ben Cao Jing, which makes it one of the more longstanding medicinals in the pharmacopoeia, Xià Kū Cǎo appears to be largely absent from the standard formulary. A quick search of the herb in the Tài Píng Huì Mín Hé Jì Jú Fāng (Imperial Grace Formulary of the Tai Ping Era) comes up empty, for example. In more modern formulas, Xià Kū Cǎo is frequently included in prescriptions to treat hypertension, such as the patent formula Luó Bù Má Piàn. One available formulation of this product (from Golden Flower) from is as follows:
· Luó Bù Má Yè [Fm Apocyni]
· Xià Kū Cǎo
· Gōu Téng [Rm Uncaria Cum Uncis]
· Zé Xiè [Rz Alismatis]
· Shān Zhā [Fr Crataegi]
· Jué Míng Zǐ [Sm Cassiae]
· Jú Huā
· Huái Niú Xī [Rx Achyranthis]
The formula is indicated for Internal Wind due to Liver Fire with a background of phlegm; a patient with this pattern might present as having a biomedical diagnosis of atherosclerotic hypertension, as one example. Thus the herbs for addressing elevated cholesterol like Shān Zhā and Jué Míng Zǐ. Xià Kū Cǎo, which is both heat-clearing and phlegm-resolving, treats both aspects of this pattern.
Thyroid Diseases
In line with its indications in the literature beginning with the Shen Nong Ben Cao Jing, Xià Kū Cǎo has been the subject of some research into its efficacy on treating thyroid conditions as shown in a literature review by Zhang et al. (2022). A meta-analysis by Han et al. (2021), showed Xià Kū Cǎo can be an effective adjuvant to conventional treatment in reducing the size of thyroid nodules.
A while back, I had a patient diagnosed with Graves’ Disease who alerted me to a formula she had read about on the internet, and asked if I would look into it. The formula turned out to be Yingliu Mixture [Yǐng Liú Hé Jì 瘿瘤合剂], which was found to improve the efficacy of hyperthyroid treatment when combined with methimazole versus methimazole alone. (Yang et al., 2016). The formula includes Xià Kū Cǎo. The ingredients given were as follows:
· Huáng Qí [Radix astragali]
· Yuán Shēn [Rx Scrophulariae]
· Mài Mén Dōng [Radix Ophiopogonis]
· Zhī Mŭ [Rz Anemarrhenae]
· Lián Qiáo [Fr Forsythiae]
· Xià Kū Cǎo [Spica prunellae]
· Mǔ Lì [Concha Ostreae]
· Zhè Bèi Mǔ [Bulbus fritillariae thunbergii]
· Bá Qià [Rz Smilacis Chinae]
· Bái Jiè Zǐ [Sm Sinapis]
· Jí Xìng Zǐ [Sm Impatientis]
Most of the ingredients should be familiar to any 3rd-year TCM student, with a couple of exceptions: Bá Qià dispels wind-damp, disperses swelling, and is indicated for goiters; Jí Xìng Zǐ breaks blood, disperses accumulation and softens hardness (Wiseman & Brand, 2020).
Conclusion
Xià Kū Cǎo is an herb with a long history and widespread use. It is mild enough to be considered a food-grade herb but it can be used to treat some serious diseases (Pan et al., 2022). It is familiar to herbalists around the world, and sits easily in various systems of medicine, including modern integrative medicine, as it may be used in conjuction with biomedical pharmaceuticals. It is certainly a medicinal worth getting to know better.
Okay, that’s all for now. As always, 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
Han, Q., Xu, N., Chen, B., Wu, W., Sheng, L. (2021). Safety and efficacy of Prunella vulgaris preparation in adjuvant treatment of thyroid nodules: A meta-analysis. Medicine 100(41):p e27490, October 15, 2021. | DOI: 10.1097/MD.0000000000027490
Miào, X. (1625). Shén nóng běn cǎo jīng shū. https://jicheng.tw/tcm/book/%E7%A5%9E%E8%BE%B2%E6%9C%AC%E8%8D%89%E7%B6%93%E7%96%8F/index.html
Pan, J., Wang, H., & Chen, Y. (2022). Prunella vulgaris L. - A review of its ethnopharmacology, phytochemistry, quality control and pharmacological effects. Frontiers in pharmacology, 13, 903171. https://doi.org/10.3389/fphar.2022.903171
Tài píng huì mín hé jì jú fāng. (1078). Retrieved February 7, 2024, from https://jicheng.tw/tcm/book/%E5%A4%AA%E5%B9%B3%E6%83%A0%E6%B0%91%E5%92%8C%E5%8A%91%E5%B1%80%E6%96%B9/index.html
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.
Yang, H., Cong, Y., Wu, T., Tang, H., Ma, M., Zeng, J., … Yang, X. (2016). Clinical efficacy of Yingliu mixture combined with metimazole for treating diffuse goitre with hyperthyroidism and its impact on related cytokines. Pharmaceutical Biology, 55(1), 258–263. https://doi.org/10.1080/13880209.2016.1260595
Yáo, Q. (1926). Jīng xiào Yè Tiānshì běn cǎo jīng jiě. Guǎng Yì Book Company. Retrieved December 14, 2022, from https://jicheng.tw/tcm/book/%E6%9C%AC%E8%8D%89%E7%B6%93%E8%A7%A3/index.html
Zhang, W., Wuhan, Q., Na, M., Hu, R., Mu, Q., & Bao, X. (2022). Emerging therapeutic role of Prunella vulgaris in thyroid disease. Chinese herbal medicines, 14(3), 403–413. https://doi.org/10.1016/j.chmed.2021.12.005