Zi Gen Mu Li Tang - 紫根牡蠣湯 - Arnebia/Lithospermum and Oyster Shell Decoction

Source: New Book on Syphilis and Leprosy (1787)

Category: Formulas that Treat Abscesses and Sores

Pattern: Chronic and deep "Bayberry Sore Toxins" (楊梅瘡毒, Yang Mei Chuang Du)

Key Symptoms: Chronic deep red sores which overlap roughly with the sores of secondary syphilis. At present used for the treatment of breast cancer, chronic stubborn skin lesions, mastitis, enlarged lymph nodes of the neck, appendicitis, impetigo, systemic lymph carcinoma and red itching disorders of unknown origin and haemorrhoids.

Ingredients

Dang Gui

9-12g

Pinyin: Dang Gui Chinese: 當歸 Pharmaceutical: Radix Angelicae sinensis Taxonomy: Angelica sinensis English: Chinese Angelica Root / Tang-Kuei / Dong Quai Root
Tastes: Sweet, Pungent, Warm Meridians Entered: Heart and Liver
Actions & Indications: Tonifies the Blood and regulates the menses Blood Deficiency, especially when affecting the Heart and Liver with pale, ashen complexion, lusterless nails, tinnitus, blurred vision and palpitations Blood Deficiency associated irregular menstruation, amenorrhea and dysmenorrhea Invigorates and harmonizes the Blood and disperses Cold (stops pain due to Blood Stasis) Blood Stasis causing abdominal pain and carbuncles and pain due to Blood Stasis from traumatic injury, especially when accompanied by Deficiency Cold Postpartum menstruation Pregnancy (use with caution) Blood Deficiency with chronic Wind-Damp-Bi Moistens the Intestines and unblocks the bowels Dry Intestines due to Blood Deficiency Reduces swelling, expels pus, generates flesh and alleviates pain Sores and abscess (Chuang Yung), internally and topically Stops coughing and treats dyspnea Used adjunctively for coughing Tonifies the Blood while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 6-12g in decoction. Cautions: It is contraindicated in cases of Damp-Heat stagnating in the Middle, Lung Heat with Phlegm Fire, and Yin deficiency with effulgent Yang because it is warm and sweet in properties. In addition, it should be used with caution in cases of loose stool because it can moisten intestines to smooth stool. Many sources recommend using caution, avoiding or only taking under guidance of a TCM physician during pregnancy as it can cause uterine contractions. However, there are no studies supporting this and the only scientific literature seems to suggest that Z-Ligustilide has anti-spasmodic activities that alleviate dysmenorrhoea by inhibiting uterine contractions (Du et al., 2006; Dietz et al., 2016). Caution is also advised in breast cancer patients due to its oestrogen stimulating activity. This based upon Lau et al (2005) who found it may stimulate breast cancer growth in vitro, however Yue et al, (2019) demonstrated that it is not that stimulatory in breast cancer both in vitro and in vivo through a series of tests, although they suggested it should still be used with caution in estrogen receptor-positive breast cancer. Conversely, a large population study in Taiwan by Wu et al (2014) found it reduced the subsequent risk of endometrial cancer in breast cancer survivors taking tamoxifen, especially in those of reproductive age.

Bai Shao

6-9g

Zi Cao

6-9g

Da Huang

1-3g

Pinyin: Da Huang Chinese: 大黄 Pharmaceutical: Radix et Rhizoma Rhei Taxonomy: Rheum palmatum English: Chinese Rhubarb Root
Tastes: Bitter, cold Meridians Entered: Large Intestine, Spleen, Stomach, Liver and Heart
Actions & Indications: Drains Heat and purges accumulations Intestinal Heat Excess, with high fever, profuse sweating, thirst, constipation, abdominal distention and pain, delirium, a yellow tongue coat and a full pulse Yang-Ming Fu Stage Qi Level Heat in the Intestines Drains Fire Fire from Excess with intense fever, sore throat, and painful eyes and constipation Fire toxin sores due to Xue Level Heat, especially with constipation Clears Heat, transforms Dampness and promotes urination Damp-Heat with oedema, jaundice, painful urinary dysfunction and acute, hot dysenteric disorders Drains Heat from the Blood Bloody stool either from hemorrhoids or Heat in the Intestines Chaotic movement of hot Blood with hemoptysis or epistaxis with constipation It can be powdered and administered orally for bleeding in the upper digestive tract Invigorates the Blood and dispels Blood Stasis Blood Stasis with amenorrhea, fixed abdominal masses or fixed pain Blood Stasis due to traumatic injury Intestinal abscess Clears Heat and reduces Fire toxicity Topically or internally for burns or skin lesions (Chuang Yung) due to Heat Clears Heat and eliminates Phlegm Chronic Accumulation of Phlegm-Heat with cough, dyspnea, mania, disorientation and other symptoms of Phlegm Misting the Heart
Standard Dosage: 10-15g in decoction. Excessive decoction will reduce the purgative action. Therefore it should be added at end to achieve this purpose and over-decocted to eliminate this action. Cautions: It should be used with caution in case of spleen and stomach deficiency for its bitter and cold property which is easily to damage stomach qi. It is contraindicated to women during pregnancy, menstruation or lactation for it has actions of activating blood and resolving stasis, and can make the purged substances follow lactating out.

Ren Dong Teng

6-9g

Sheng Ma

1-3g

Huang Qi

6-9g

Pinyin: Huang Qi Chinese: 黄芪 Pharmaceutical: Radix Astragali Taxonomy: Astragalus membranaceus English: Astragalus Root / Mongolian Milkvetch Root
Tastes: Sweet, warm Meridians Entered: Lung and Spleen
Actions & Indications: Tonifies Qi and Blood Postpartum fever due to Qi and Blood Deficiency Recovery from severe Blood loss Strengthens the Spleen and raises the Yang Qi of the Spleen and Stomach Spleen Qi Deficiency with anorexia, fatigue and diarrhoea Central Qi Sinking (prolapse) Lung and Spleen Qi Deficiency Qi Failing to contain Blood Qi and Blood Deficiency Fever from Qi Deficiency Tonifies Wei Qi, stabilizes the Exterior and tonifies the Lungs (aids circulation of moisture downward from the face) Wei Qi Deficiency with spontaneous sweating Lung Qi Deficiency with frequent colds or shortness of breath Excessive sweating associated with Qi, Yang or Yin Deficiency Dampness in the head Promotes urination and reduces oedema Spleen Deficiency oedema or superficial oedema with reduced urination (It can be used as a stand-alone herb for this) Promotes the discharge of pus, generates flesh and expels toxins Chronic ulcerations and sores that either have trouble forming pus or have formed pus but are not draining well Generates Body Fluids Wasting and thirsting disorder (消渴 Xiao Ke) Bi Syndrome with numbness of the limbs and paralysis Relieves numbness and pain Numbness and pain due to Deficiency of Qi and Blood Tonifies the Qi while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015)
Standard Dosage: 10-15g in decoction. Large dosages of up to 30g can be used for severe debilitation, Blood deficiency or unhealing sores (e.g. Dang Gui Bu Xue Tang). Cautions: It is contraindicated in cases of exterior excess with excessive pathogen, internal obstruction, yin deficiency with yang hyperactivity, early stage of sores and ulcers of excessive pathogen and no deficiency of heathy qi, because it can tonify qi, raise yang and strengthen superficial.Caution with patients on immunosuppressents due to its immune modulating effects.

Mu Li

6-9g

Pinyin: Mu Li Chinese: 牡蛎 Pharmaceutical: Concha Ostreae English: Oyster Shell
Tastes: Salty, astringent, slightly cold Meridians Entered: Liver and Kidney
Actions & Indications: Heavily settles and calms the Spirit Agitated Heart and Spirit with palpitations with anxiety, restlessness and insomnia Calms the Liver, benefits Yin and anchors Floating Yang Liver Yin Deficiency with Liver Yang Rising or Yin Deficiency with internal Heat with restlessness, irritability, palpitations and spontaneous sweating Prevents leakage of fluids Continuous sweat after febrile disease or in patients with steaming bone disorder Loss of fluids due to Deficiency with night sweats, spontaneous sweating, nocturnal emissions, spermatorrhea or vaginal discharge and uterine bleeding Softens hardness and dissipates nodules Various kinds of lumps particularly neck lumps such as goiter or scrofula Absorbs acidity and alleviates pain (calcined) Excessive Stomach pain with a sour taste in the mouth Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of animal parts which can, with protracted taking, fortify the bones and joints (骨节 Gu Jie), kill evil ghosts (邪鬼 Xie Gui), and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: 15-30g in decoction. Cautions: The high mineral content of this medication may prevent the oral absorption of the fluoroquinolone class of antibiotics. Caution should also be taken due to the possibility of heavy metal absorption from the oysters' environment. If decocting it is advisable to leave the dregs at the bottom as heavy metal particles will naturally sink. It is still probably advisable to avoid for long term use unless the source is known to be clean. Animal products are prohibited from use in the UK under the Medicines Act 1968 ch. 67 which restricts herbalists to the use of plant products only. It is generally substituted with Xuan Shen, Bai Shao and Wu Wei Zi or Tian Ma. If viewed from a western perspective as a source of calcium which may cause sleep disturbances, then supplementation or inclusion of high calcium/magnesium content herbs (e.g. Kun Bu which is also salty and softens nodulation) could be considered, especially if other signs such as oesteoporosis or muscle cramps are present and the risk of side effects from calcium/magnesium supplements are low (stones, calcified arteries, GI issues). However, this assumes a mechanism which does not match many of the traditional patterns for which it is prescribed.

Gan Cao

1-3g

Pinyin: Gan Cao Chinese: 甘草 Pharmaceutical: Radix Glycyrrhizae Taxonomy: Glycyrrhiza uralensis seu glabra seu inflata English: Liquorice Root
Tastes: Sweet, slightly cold Meridians Entered: Heart, Lung and Spleen (and all 12 meridians)
Actions & Indications: Tonifies the Spleen and augments Qi Spleen Qi Deficiency with shortness of breath, lassitude and loose stools Qi and Blood Deficiency with an irregular pulse and/or palpitations Heart Qi Deficiency or Heart Yang Deficiency Moistens the Lungs, resolves Phlegm and stops coughing Lung Heat or Cold Productive or non-productive coughing Moderates spasms and alleviates pain Painful muscle spasms of the abdomen and legs Clears Heat and relieves Fire Toxicity Raw for Toxic Heat with sore throat or carbuncles and sores (Chuang Yung) Antidote for many toxic substances (internal and topical) Poisoning Bites (after washing the wound, chew Gan Cao and apply a thick layer on the bite wound, changing whenever it dries out; Bao Xiang-Ao, 1846, New Compilation of Proven Formulas) Moderates and harmonizes the harsh properties of other herbs and guides the herbs to all twelve channels Often added in small doses to harmonise formulas Tonifies the Qi while suppressing Parasites Gu Sydnrome (Fruehauf, 1998) Chronic inflammatory disease (Fruehauf, 2015) Aids fasting Mentioned in the Shen Nong Ben Cao Jing as part of the superior class of herbs which can, with protracted taking, make the body light and prolong life. This may suggest it was part of supplementing the diet when engaging in an "avoiding grain" (Bigu 辟穀) fasting regime to cultivate life (Yangsheng 養生).
Standard Dosage: Typically 1.5-9g in decoction. Large doses can be up 30g. Cautions: It is contraindicated for combining with Hai Zao, Da Ji, Gan Sui and Yuan Hua because of "eighteen antagonisms". It is also contraindicated in cases of dampness obstruction in middle energizer and edema because it can help dampness obstruct qi, and it is prohibited from long-term usage in large dosage (more than 20g/day) and should be avoided or used with extreme caution in patients with high blood pressure because it may raise aldosterone levels in the blood causing retention of sodium. The NHS recommends avoiding during pregnancy.

Subsitutions:
In the UK Mu Li must be substituted with Xuan Shen and Wu Wei Zi. Zi Cao is also prohibited from internal use due to potential Pyrrolizidine Alkaloids and must be substituted. Pu Gong Ying could be a suitable substitute as it can treat sores and is often used in cancer formulas but Lian Qiao, Jin Yin Hua or Zi Hua Di Ding could also be considered.

Preparation: Decoction.

Actions: Clears Heat, resolves Toxicity, dissipates swellings and dispels noxious sores.

Research Links:

American Dragon

TCMWiki

Journal of Chinese Medicine

National Resource Centre for Chinese Materia Medica, China

TCM-ID Integrated Database, East China Normal University

TCM-ID Information Database, National University of Singapore

Pubmed

Science Direct

Google Scholar

Bai Du (Chinese)

A+ Medical Encyclopedia (Chinese)

Reference Notes: (click to display)

These pages are intended to assist clinicians and are not intended for self-diagnosis or treatment for which a qualified professional should be consulted.

Herb Formulas Notebook

紫 根 牡 蠣 湯  Zi Gen Mu Li Tang

Arnebia/Lithospermum and Oyster Shell Decoction