The study of Dui Yao, herbal pairs, is an essential aspect of understanding how the function of herbs that are very different from each other can be used together so that they compliment and support each other. This short translation from the Clinical Handbook of Commonly Used Chinese Medicine Prescriptions (臨床常用中藥方劑手冊) published in Taiwan gives us a glimpse into the use of the ultimate fire and ice combination.
**************************
Zhì fù zî (Aconiti Radix lateralis preparata) is a very hot herb that returns the yang; huáng lián (Coptidis Rhizoma) is a totally cold herb that clears heat. Zhì fù zî (Aconiti Radix lateralis preparata) is acrid and hot, it supports the yang and treats cold from deficiency; huáng lián (Coptidis Rhizoma) is bitter and cold, it drains heart fire to lead out excess heat. Together they function to support the yang and drain heat.
Wang Gao-Xu （王高旭) says “huáng lián (Coptidis Rhizoma) paired with zhì fù zî (Aconiti Radix lateralis preparata) can quickly blend water and fire together.” Clinically, this combination is often used to treat conditions where excess and deficiency are seen together, for knotted heat under the heart due to tangled up mixes of cold and heat, focal distention causing pain in the abdomen, difficult diarrhea, or nausea and heart vexation, when simultaneous yang deficiency and instability is seen with signs such as profuse sweating, aversion to cold, cold limbs and a weak pulse.
As in the Correct Transmission of Medicine (醫學正傳， yi xue zheng chuan) Lian Fu Liu Yi Tang (Coptis-Aconite 6-1 Decoction); uses these two flavors specifically to treat stomach and abdominal pain. Fù zî xiè xïn täng (Accessory Root Decoction to Drain the Epigastrium) from the Shang Han Lun uses this paired herbal combination to treat hardness in the epigastrium and recurrent aversion to cold with sweating. Also in the Classic is stated, “In accord with this presentation, when there is pathogenic heat and the true yang is insufficient—treating the pathogen and not paying attention to the zheng qi will lead to a condition of extreme aversion to cold. Or, if the yang is tonified without considering the heat, then the fullness and focal distention will be increased. This prescription, which uses cold and hot, both drains and tonifies and their mutual interaction treats the problem. In fact, while these herbs are completely opposite in nature and function, in certain situations it is not possible to not to use them together to achieve your therapeutic objective.
In clinic, to come up with the appropriate ratio between these medicinals, the practitioner must prescribe according to the severity or mildness of the cold or heat, and consider the relative mix of excess and deficiency in the patient’s presentation. In those where excessive heat is more severe, a larger amount of huáng lián (Coptidis Rhizoma) should be used; in those patients where cold from deficiency is more pronounced, a larger amount of zhì fù zî (Aconiti Radix lateralis preparata) should be employed.
Do you have some clinical experience using this particular combination? Leave a comment with your experience!
Hi Michael-
I recently used this combination in clinic. Here is the case as I posted it on the CHA forum:
An 84 year old male presented with a return of abdominal pain that he had had several years before but had successfully treated with acupuncture. He had epigastric glomus, acid regurgitation, periumbilical pain that was diffuse, but could wake him at night. He said that he had been diagnosed previously with a “leaky ileocecal valve,” but by his pulse I was concerned that, besides the glomus, he had possibly started forming an abscess. His pulse was slippery and weak in the left cun, and slippery and big in the guan bilaterally. I used fuzi 30g, dahuang 6g, huanglian 3g, huangqin 3g, baijiangcao 15g, yiyiren 30g in granules. His pain was 80% gone after one week and gone after a few more days of herbs.
Best
-Steve
Great case Steve. And an excellent example of not getting stuck on the western diagnosis, but holding true the chart and compass of Chinese medicine!
the case is indeed good and it is also a instance of a combination of hot herbs and cold herbs!