Author(s): Mok Tik Lun*, Wong Wing In and Lee Ka Lai
This study explores the traditional Chinese medicine formulation Shenqi Pill, originally described in Shanghan Zhabing Lun, and its application in treating kidney deficiency-related ailments. While the pill includes Fuzi, known for its toxicity, concerns arise regarding its long-term use. Historical texts such as Qianjin Yaofang and Zhuhou Beiji Fang suggest substituting Fuzi with Wuweizi for prolonged administration, citing the latter’s safety and therapeutic benefits. Wuweizi not only addresses labor-induced weakness but also nourishes kidney and liver function, possessing a balanced flavor profile with lower toxicity. This research emphasizes the importance of historical literature in guiding safe herbal practices, advocating for the incorporation of Wuweizi in Shenqi Pill to enhance patient safety while maintaining efficacy in treatment.
The Shenqi Pill, originating from the Eastern Han Dynasty text Shanghan Zhabing Lun, is a traditional Chinese medicine formulation designed to kidney yang deficiency syndrome. Its composition includes the following ingredients: Dihuang, Shanyao, Shanzhuyu, Zexie, Fuling, Mudanhua, Guizhi, and Fuzi.
In contemporary practice, Shenqi Pill has gained significant popularity both in China and abroad, like prescribed for hypertensive patients [1]. Various pharmaceutical companies have developed different forms of this remedy, including pills and granule powders, aimed at enhancing kidney yang and overall vitality. The widespread use of Shenqi Pill highlights its importance in traditional and modern herbal medicine for addressing kidney yang deficiency issues.
In Shanghan Zhabing Lun, the Shenqi Pill is primarily indicated for treating kidney deficiency-related lower back pain, as well as ailments associated with water retention and dampness. The underlying mechanism of these conditions often involves a deficiency of kidney yang, which can lead to symptoms such as fatigue, weakness, and discomfort in the lumbar region.
Due to the chronic nature of deficiency syndromes, the treatment duration can be prolonged. Patients typically need to take the Shenqi Pill for an extended period, often ranging from one month to several months, to achieve significant therapeutic effects. This necessity for long-term use highlights the importance of consistent administration to effectively restore kidney function and alleviate symptoms, making it a vital component of treatment for those suffering from kidney yang deficiency syndrome.
Fuzi possesses a spicy and warming nature, which plays a crucial role in the efficacy of Shenqi Pill. Its properties are particularly effective in warming and tonifying kidney yang, which is essential for addressing conditions related to kidney deficiency. Despite its therapeutic benefits, the inclusion of Fuzi in Shenqi Pill raises concerns due to its potent toxicity. Fuzi is derived from the roots of the Aconitum plant, which contains alkaloids such as aconitine and mesaconitine [2]. These compounds can be toxic, especially with long-term use, and their safety profile has come under scrutiny. Incidents of aconitine poisoning have been reported, particularly with decoctions that include Fuzi, leading to serious side effects. Common symptoms of aconitine toxicity include bradycardia (slow heart rate) and ventricular extrasystoles (premature heartbeats), which can pose significant health risks to patients.
Historical texts such as Qianjin Yaofang and Zhuhou Beiji Fang provide valuable insights into the formulation of Shenqi Pill, particularly regarding the substitution of Fuzi with Wuweizi during long-term use. In both Qianjin Yaofang and Zhuhou Beiji Fang, the phrase “Zhang Zhongjing said” is explicitly mentioned. Although this recommendation does not originate from Shanghan Zhabing Lun, both Qianjin Yaofang and Zhuhou Beiji Fang reference the teachings of Zhang Zhongjing, a revered figure in traditional Chinese medicine.
The works of Zhang Zhongjing have unfortunately suffered from loss and fragmentation over time, making it necessary to rely on other historical texts to fill in the gaps. The high scholarly status of Qianjin Yaofang and Zhuhou Beiji Fang underscores the importance of their content and their relevance to contemporary practices.
By examining these references, it becomes evident that the practice of replacing Fuzi with Wuweizi during prolonged administration of Shenqi Pill is not only supported by historical precedent but also reflects a cautious approach to minimize toxicity while maintaining therapeutic benefits. This adjustment aligns with the evolving understanding of herbal medicine, emphasizing safety and efficacy in patient care.
The decision to substitute Fuzi with Wuweizi in the long-term use of Shenqi Pill is grounded in both safety and therapeutic efficacy. While Fuzi is known for its potent effects, its toxicity makes it unsuitable for prolonged administration. This rationale is straightforward and widely accepted in clinical practice.
In contrast, Wuweizi offers a range of beneficial properties that make it an ideal alternative. As documented in the Shennong Bencao Jing, Wuweizi is recognized for its ability to treat conditions caused by labor-induced weakness and to nourish the body. It is known to replenish qi as well as to enhance men’s vitality by supporting the production of essence and blood.
Furthermore, Wuweizi is characterized by its unique composition of the five basic flavors—sour, bitter, sweet, pungent, and salty— allowing it to provide a balanced approach to treatment. This comprehensive flavor profile enables Wuweizi to tonify the liver and kidneys while maintaining a lower toxicity level compared to Fuzi.
Consequently, the use of Wuweizi not only addresses the safety concerns associated with long-term use of Shenqi Pill but also aligns with the principles of traditional Chinese medicine, promoting holistic health and well-being.
The examination of historical literature significantly contributes to the safe application of herbal remedies such as Shenqi Pill. By analyzing texts like Qianjin Yaofang and Zhuhou Beiji Fang, we gain valuable insights into the rationale for substituting Fuzi with Wuweizi in long-term treatments. This substitution not only mitigates the risks associated with the toxicity of Fuzi but also incorporates the beneficial properties of Wuweizi, promoting overall health while adhering to the principles of traditional Chinese medicine.
Thus, thorough research and historical validation are essential in modern herbal practice, ensuring that patients receive safe and effective treatments tailored to their needs.
