Track Wind, Scatter Stasis
On Chuān Xiōng
Work continues at CMHQ on preparing courses on treatment of headache and pain management. One of the mainstays of clinical practice, for centuries, has been Rhizoma Ligusticum Chuanxiong, better known to us as just plain Chuān Xiōng. It is an important herb for pain, found in a wide variety of blood-moving formulas (largely due to its inclusion in Sì Wù Tāng) as well as wind-damp formulas such as Qiāng Huó Shèng Shī Tāng (Notopterygium Decoction To Overcome Dampness) and of course Chuān Xiōng Chá Tiáo Sǎn (Ligusticum Chuanxiong Powder to Be Taken with Green Tea).
Wiseman and Brand (2020) gives the basics:
· Acrid, warm; enters liver, gallbladder, pericardium channels
· Quickens the blood and moves qì ; treats pain from qì stagnation and blood stasis
· Dispels wind and relieves pain: wind damp impediment pain.
While Chuān Xiōng is quite useful for all types of pain, including gynecological pain, it is especially known for its ability to treat headaches. Wiseman & Brand (2020) mention the original name Xiōng Qióng [芎藭] and note the similarity of Xiōng/Qióng [芎] with Qióng/Qiōng [穹], the latter meaning "elevated and arched" or "sky" (Wiktionary, 穹), indicating the herb's particular tropism for the head.
Perspectives from the Qīng Era
Here are a couple of excerpts, both written in the Qīng era, on Chuān Xiōng. First, from the Běncǎo Jīng Jiě (Materia Medica Explanation), attributed to Yè Tiānshì in 1724.
川芎
氣溫。味辛。無毒。主中風入腦頭痛。寒痹筋攣。緩急金瘡。婦人血閉無子。川芎氣溫。稟天春和之木氣。入足厥陰肝經。味辛無毒。得地西方之金味。入手太陰肺經。氣味俱升。陽也。風為陽邪而傷於上。風氣通肝。肝經與督脈會於巔頂。所以中風。風邪入腦頭痛也。其主之者。辛溫能散也。寒傷血。血澀則麻木而痹。血不養筋。筋急而攣。肝藏血而主筋。川芎入肝而辛溫。則血活而筋舒。痹者愈而攣者痊也。緩急金瘡。金瘡失血。則筋時緩時急也。川芎味辛則潤。潤可治急。氣溫則緩。緩可治緩也。婦人稟地道而生。以血為主。血閉不通。則不生育。川芎入肝。肝乃藏血之藏。生髮之經。氣溫血活。自然生生不已也。
制 方:
川芎同白芍、歸身、生地。名四物湯。治血虛。同甘菊、歸身、生地、白芍、甘草。治血虛頭痛。同歸身、桂心、牛膝。治子死腹中。同續斷、生地、白膠、杜仲、山萸、北味、人參、黃耆、棗仁。治血崩不止。
Chuān Xiōng
Qì warm. Wèi acrid. Non-toxic. Mainly treats wind strike entering the brain with headache, cold impediment and hypertonicity of the sinews. Emergency metal-inflicted wounds. Women’s childlessness from blood block. Chuān Xiōng’s qì is warm. It is endowed by heaven with the gentle wood qì of springtime. It enters the foot juéyīn liver channel. Its wèi is acrid and non-toxic, the flavor of metal, of the Western lands. It enters the hand tàiyīn lung channel. Its qì and wèi all ascend and are yáng. Wind acts as a yáng evil and injures the upper [burner]. Wind’s qì communicates with the liver. The liver channel and the dū mài meet at the vertex of the head. The result is wind strike. Wind evil enters the brain and there is headache. This [medicinal] masters it. Acrid and warm is able to scatter. Cold injures the blood. The blood is inhibited so there is numbness and impediment. The blood does not nourish the sinews, so there is sinew tension and hypertonicity. The liver stores blood and governs the sinews. Chuān Xiōng enters the liver and is acrid and warm. The blood is quickened and the tendons are unconstrained. Those with impediment are cured and those with hypertonicity recover completely. Emergency metal-inflicted wounds [i.e., cuts]. Metal-inflicted wounds [result in] blood loss. Then the tendons are sometimes slack and sometimes tense. Chuān Xiōng’s wèi is acrid and moistening. Moistening is able to treat tension. Its warm qì is relaxing. Relaxing is able to treat slackness. Women are endowed with a passageway to give birth, which primarily relies on the blood. If there is blood block, there is no passage, thus no childbirth. Chuān Xiōng enters the liver. The liver is the viscera of blood storage, and the channel of hair growth. Its qì is warm, thus blood is quickened; there will naturally be reproduction without end.
Formulations:
Chuān Xiōng together with Bái Sháo [Rx Paeoniae Alba], Guī Shēn [Rx Angelicae Sinensis], and Shēng Dì [Rx Rehmanniae] is called Sì Wù Tāng [Four Substance Decoction]. It treats blood deficiency. Together with Gān Jú [Fl Chrysanthemi], Guī Shēn, Shēng Dì, Bái Sháo, Gān Cǎo [Rx Glycyrrhizae] it treats blood deficiency headache. Together with Guī Shēn, Guì Xīn [Cx Cinnamomi Rasus], Niú Xī [Rx Achyranthis], treats dead fetus in the uterus. Together with Xù Duàn [Rx Dipsaci], Shēng Dì, Bái Jiāo [Resina Liquidambaris], Dù Zhòng [Cx Eucommiae], Shān Yú [Fr Corni], Běi Wèi [Fr Schisandrae], Rén Shēn [Rx Ginseng], Huáng Qí [Rx Astragali], Zǎo Rén [Sm Zizyphi], treats unceasing uterine bleeding.
The second is an excerpt from Běn cǎo bèi yào (Essentials of Materia Medica) by Wāng Áng (1694):
芎藭
補血潤燥，宣，行氣搜風
辛溫升浮。為少陽（膽）引經，入手、足厥陰（心包、肝）氣分，乃血中氣藥。助清陽而開諸郁（丹溪曰：氣升則鬱自降，為通陰陽血氣之使），潤肝燥而補肝虛（肝以瀉為補，所謂辛以散之，辛以補之），上行頭目，下行血海（衝脈），搜風散瘀，止痛調經。
治風濕在頭，血虛頭痛（能引血下行，頭痛必用之。加各引經藥，太陽羌活，陽明白芷，少陽柴胡，太陰蒼朮，少陰細辛，厥陰吳茱萸。丹溪曰：諸經氣鬱，亦能頭痛），腹痛脅痛，氣鬱血鬱，濕瀉血痢，寒痹筋攣，目淚多涕（肝熱），風木為病（諸風掉眩，皆屬肝木）。
Xiōng Qióng
Supplements blood, moistens dryness, diffuses, moves qì and tracks wind.
Acrid and warm, ascends and floats. Serves as shǎoyáng (gallbladder) channel conductor, enters the hand and foot juéyīn (pericardium, liver) qì aspect and is a qì within the blood medicinal.
Assists the clear yáng as well as opens depression of various kinds (Dān Xī said: when qì ascends, it follows that depression naturally downbears, thus acting to free yīn, yáng, qì and blood), moistens liver dryness and supplements liver deficiency (the liver uses draining for the purposes of supplementing, what is known as “using acrid to scatter, using acrid to supplement”), ascends to the head and eyes, descends to the sea of blood (chōng mài), tracks wind and scatters stasis, stops pain and regulates menstruation.
Treats wind-dampness in the head, blood deficiency and headache (it can guide blood downwards, so it is a necessity to use for headaches. Add various channel conducting medicinals, such as Qiāng Huó [Rx Notopterygii] for tàiyáng, Bái Zhǐ [Rx Angelicae Dahuricae] for yángmíng, Chái Hú [Rx Bupleuri] for shǎoyáng, Cāng Zhú [Rz Atractylodis] for tàiyīn, Xì Xīn [Hb Asari] for shǎoyīn, Wú Zhū Yú [Fr Evodiae] for juéyīn. Dān Xī said: qì depression in various channels can also cause headaches), abdominal and ribside pain, qì depression and blood stasis, damp diarrhea and bloody dysentery, cold impediment and sinew hypertonicity, teary eyes and excessive mucus (liver heat), diseases of wind-wood (various wind shaking and dizziness, all pertaining to liver wood).
Cautions, Contraindications, Incompatibilities
Chuān Xiōng antagonizes Shān Zhū Yú (Fr Corni) and Huáng Qí (Rx Astragali); counteracts Huá Shí (Talcum) and Huáng Lián (Rz Coptidis), and is incompatible with Lí Lú (Rz et Rx Veratri, who doesn't play well with others in general). Most sources have it contraindicated for yīn deficiency, which makes the above references to its moistening ability somewhat surprising. Wāng Áng does have this to say, though:
然香竄辛散，能走泄真氣，單服久服，令人暴亡（單服則臟有偏勝，久服則過劑生邪，故有此失。若有配合節制，則不至此矣。昂按：芍、地酸寒為陰，芎、歸辛溫為陽，故四物取其相濟以行血藥之滯耳。川芎辛散，豈能生血者乎？…)
However, aroma penetrates and acrid scatters, which can leak and discharge the true qì. If taken by itself for a long time, it can cause one to die suddenly (taking singly results in a viscera having prevalence [over others], long term taking of excessive doses breeds evil, therefore this is a mistake. Áng comments: Bái Sháo and Dì Huáng are sour, cold, and yīn, Chuān Xiōng and Dāng Guī are acrid, warm, and yáng, therefore the four substances help each other with medicinals to move blood stagnation. Chuān Xiōng is acrid and scattering, how can it engender blood?…)
Recent Research
· I’d previously listed a study involving Tiān Má (Rz Gastrodiae) and Chuān Xiōng which found that the pair enhanced serotonin and decreased glutamate expression, with reduction in permeability of the blood brain barrier. (Wang et al., 2015).
· A review and meta-analysis of Chuān Xiōng formulas found they can reduce migraine frequency, severity and duration (Shan et al., 2018).
· Another study suggests Chuān Xiōng can have a neuroprotective effect by increasing proliferation of neuroblasts and reducing neuroinflammation after ischemic strokes (Wang et al, 2020).
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
Shan, C. S., Xu, Q. Q., Shi, Y. H., Wang, Y., He, Z. X., & Zheng, G. Q. (2018). Chuanxiong formulae for migraine: A systematic review and meta-analysis of high-quality randomized controlled trials. Frontiers in Pharmacology, 9, 589. doi: 10.3389/fphar.2018.00589
Wang, 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
Wang, M., Yao, M., Liu, J., Takagi, N., Yang, B., Zhang, M., Xu, L., Ren, J., Fan, X., & Tian, F. (2020). Ligusticum chuanxiong exerts neuroprotection by promoting adult neurogenesis and inhibiting inflammation in the hippocampus of ME cerebral ischemia rats. Journal of ethnopharmacology, 249, 112385. https://doi.org/10.1016/j.jep.2019.112385
Wiktionary. 穹. Retrieved October 22, 2023. https://en.wiktionary.org/wiki/%E7%A9%B9
Wiseman, N., & Brand, E. (2020). Comprehensive Chinese materia medica. Paradigm Publications.
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