New Uses of Epimedium

by Bob Flaws<, Dipl. Ac. & C.H., FNAAOM

As Joanne Ehret has demonstrated with her translation on Plastrum Testudinis (Gui Ban) from the Zhong Yao Da Ci Dian (Great Dictionary of Chinese Medicinals) in the last issue (April 2000) of Blue Poppy’s On-line Chinese Medical Journal, the information in Bensky & Gamble’s Chinese Herbal Medicine: Materia Medica on any given medicinal is only a fraction of the information on that medicinal in the Chinese medical literature. For instance, each month, the Zhong Yi Za Zhi (Journal of Chinese Medicine) publishes a series of articles on the new or non-standard uses of a particular Chinese medicinal. In the December 1999 issue (#12), this section of the Zhong Yi Za Zhi was devoted to new or non-standard uses of Herba Epimedii (Yin Yang Huo or Xian Ling Pi).  To help continue evidencing the kinds of materials currently only available in Chinese and, therefore, the clinical importance of Western practitioners of Chinese medicine learning to read modern medical Chinese, below is a precis of some of that information.

Liver cirrhosis ascites

In any article titled, "Thre Heavy Use of Epimedium in the Treatment of Liver Cirrhosis Ascites," written by Shen Xiu-yun, Shen says that, according to Chinese medical (patho)physiology, liver cirrhosis ascites is due to spleen-kidney dual vacuity. In this case, kidney vacuity does not transform (water fluids), while spleen vacuity does not move or transport (water fluids). This then results in water dampness being retained and accumulating. In addition, if liver qi becomes depressed and binds, then the liver loses its control over orderly reaching. Hence the qi and blood become static and stagnant and blood does not abide in the channels. Rather, fluids and humors seep out (of the channels) and produce water in the abdomen. Shen then quotes Zhang Zhong-jing, author of the Jin Gui Yao Lue (Essentials of the Golden Cabinet), "If blood [flow] is inhibited, it becomes water." Therefore, treatment of this condition should bank and supplement the spleen and kidneys at the same time as dispelling stasis and disinhibiting water, and Shen says that this approach can achieve speedy effects.

Based on this approach, the author of this article uses a heavy dose of Herba Epimedii combined with medicinals which disinhibit water and disperse swelling. Epimedium’s nature and flavor are acrid and warm. However, it is warm but not drying. It enters the liver and kidney channels, and its has the functions of supplementing the kidneys and invigorating yang. Therefore, the author uses this medicinal in order to supplement the kidneys so that they will transform the qi to move water. This then also assists the spleen’s movement and transformation of water dampness. In clinical practice, Epimedium is commonly (or standardly) used at a dosage of 9-15g. However, for the treatment of liver cirrhosis ascites, Shen says it can be used at 20-30g. In that case, it should be combined with Radix Codonopsitis Pilosulae (Dang Shen), Rhizoma Atractylodis Macrocephalae (Bai Zhu), Radix Astragali Membranacei (Huang Qi), and Sclerotium Poriae Cocos (Fu Ling) to fortify the spleen, boost the qi, and transform dampness and with Rhizoma Curcumae Zedoariae (E Zhu), Radix Salviae Miltiorrhizae (Dan Shen), Hirudo Seu Whitmania (Shui Zhi), Rhizoma Alismatis (Ze Xie), Semen Plantaginis (Che Qian Zi), and Pericarpium Arecae Catechu (Da Fu Pi) to quicken the blood and dispel stasis, disinhibit water and disperse swelling. These should then be assisted by Radix Bupleuri (Chai Hu) to course the liver and rectify the qi. When al these medicinals are used together, they can speedily disperse and eliminate qi stagnation and blood stasis combined with water fluid retention and accumulation.

Epimedium’s qi-boosting & spirit quieting effects

In an article titled, "Epimedium’s Has Qi-boosting & Spirit-quieting Effects," by Xu Ying-zhang, the author says that, based on his clinical experience, Epimedium not only treats yang wilting (i.e., impotence) and other such conditions due to original yang insufficiency but that it also has qi-boosting and spirit-quieting effects. To substantiate this opinion, Xu says that folk healers commonly use 100-200g of Epimedium decocted with squid and red wine as a treatment for bodily fatigue and lack of strength due to overtaxation. Based on this, the author commonly adds 10-15g of Epimedium to qi-supplementing formulas and thinks that the therapeutics effects are consequently higher. For instance, for those with qi vacuity with easy catching of colds, the author likes to use self-composed Yi Qi Zhu Gan Tang (Boost the Qi & Dispel Flu Decoction). This consists of: Radix Astragali Membranacei (Huang Qi), 15g, Radix Ledebouriellae Divaricatae (Fang Feng), 6g, Rhizoma Atractylodis Macrocephalae (Bai Zhu), 10g, Ramulus Cinnamomi Cassiae (Gui Zhi), 6g, Radix Albus Paeoniae Lactiflorae (Bai Shao), 6g, Radix Glycyrrhizae (Gan Cao), 3g, Herba Epimedii (Yin Yang Huo), 10g, Herba Agrimoniae Pilosae (Xian He Cao), 15-30g, uncooked Rhizoma Zingiberis (Sheng Jiang), 2 slices, and Fructus Zizyphi Jujubae (Da Zao), 3 pieces. Xu says that administering 10-15 ji of this formula can get a good effect.

In terms of Epimedium’s supposed spirit-quieting effects, Xu gives a case history as evidence of this claim. The patient was a 45 year old male who had enduring insomnia for 10 years. He had already been given both Chinese and Western medicines without good effect. The man was emaciated, his facial complexion had scanty luster, and he displayed qi timidity. In addition, he complained of dizziness, emotional tension, weak lower limbs, and impotence. The author gave the man Hei Gui Pi Tang (Black Restore the Spleen Decoction) for half a month. At that time, the man’s complexion was somewhat improved. However, he still had bad insomnia, sleeping only three hours per day. According to the Ben Jing ([Divine Farmer’s] Materia Medica Classic), Epimedium "rules yin wilting and damage due to exhaustion... boosts the qi strength and strengthens the mind (zhi)." Based on this, the author added 15g of Epimedium to the original formula and administered this for seven days. At the end of that time, the man was able to sleep 4-5 hours per night. After continuing this formula for another half month, the man was able to sleep 5-6 hours per night, and his sexual functioning had improved.   

Urolithiasis

In an article titled, "Epimedium in the Treatment of Urinary Tract Calculi," Lan Fa-ming et al. report that, in recent years, they have been using heavy doses of Epimedium as the main medicinal in the treatment of urinary tract stones and, in every case, have gotten good results. As evidence, they too present a case history of a 39 year old woman. The woman had severe, right-sided lumbar distention and pain which felt like she was being cut. This pain radiated to her right lower abdomen and was accompanied by frequent, yellow urination. When she urinated, her stream would stop in the middle. Other signs and symptoms included torpid intake, a pale tongue with white fur, and a moderate (i.e., relaxed or slightly slow) pulse. Ultrasonography revealed a spot in her upper right kidney which was 0.5cm in diameter. Her left kidney revelaed no such abnormality. WBCs in her urine were 0-1, RBCs were 0-4, and calcium oxylate crystals were ++++. Therefore, the woman was diagnosed as suffering from a kidney stone.

Based on all this, the woman’s Chinese medical pattern was categorized as enduring brewing of damp heat which had produced a stone. The formula used was Ba Zheng San (Eight [Ingredients] Correcting Powder) plus Radix Rubrus Paeoniae Lactiflorae (Chi Shao), Herba Lysimachiae Seu Desmodii (Jin Qian Cao), and Endothelium Corneum Gigeriae Galli (Ji Nei Jin). However, after taking 10 ji of this formula, there was no effect. Instead, the woman was given six ji of: Herba Epimedii (Yin Yang Huo), 75g, Herba Lysimachiae Seu Desmodii (Jin Qian Cao), 60g, and Semen Benincase Hispidae (Dong Gua Zi), 20g. This resulted in the patient’s low back pain gradually diminishing and her urination becoming freely and smoothly flowing. After yet another 10 ji of this second formula, the woman’s urine was normal and all her symptoms had disappeared. Ultrasonography also showed both kidneys were normal.

Geriatric asthma

In an article titled, "Epimedium’s Good Effects in the Treatment of Geriatric Asthma," Zhang Xue-hua says that Epimedium can be used as a main medicinal in the treatment of geriatric chronic coughing and asthma. Zhang says that Epimedium’s nature and flavor are sweet and warm and that it has the functions of warming the kidneys and assisting or strengthening yang. When used to treat geriatric coughing and asthma, this medicinal should be combined with Fructus Lycii Chinensis (Gou Qi Zi), Semen Plantaginis (Che Qian Zi), Fructus Arctii Lappae (Niu Bang Zi), Radix Asteris Tatarici (Zi Wan), Radix Platycodi Grandiflori (Jie Geng), Semen Pruni Armeniacae (Xing Ren), Herba Asari Cum Radice (Xi Xin), and Radix Scutellariae Baicalensis (Huang Qin). If there is qi and blood vacuity, add Radix Astragali Membranacei (Huang Qi) and cooked Radix Rehmanniae (Shu Di). If phlegm is profuse, add Semen Sinapis Albae (Bai Jie Zi) and Semen Trichosanthis Kirlowii (Gua Lou Ren). If there is ductal and abdominal fullness and distention and torpid intake, add Semen Raphani Sativi (Lai Fu Zi). If coughing is slight in severity but has lasted for days and days, is accompanied by shortness of breath and panting, and other treatments have failed to achieve an effect, the author typically sees a marked decrease in coughing and panting after administering 3-5 ji of the above formula, with consolidation of the therapeutic effect after administering approximately 10 ji.

Many years of clinical experience has convinced the author that Epimedium is definitely a good medicinal for the treatment of geriatric coughing and asthma based on the fact that, geriatric coughing and asthma are primarily categorized as kidney not grasping or absorbing the qi due to kidney origin insufficiency. Therefore, in Chinese medicine, geriatric coughing and asthma are often called "kidney cough" and "kidney panting." According to Zhang, besides warming the kidneys and assisting yang, Epimedium also has the functions of scattering evils (in the lungs) and stopping coughing. Dr. Zhang says that modern scientific research has shown that Epimedium has anti-tussive and phlegm-dispelling as well as antibiotic effects. 

Azoospermia

In an article titled, "Epimedium in the Treatment of Azoospermia," Zhou Feng-nan says that the single flavor Epimedium can treat both azoospermia and dead sperm. By single flavor, Zhou means using Epimedium all by itself. As evidence of this assertion, Zhou says he treated 23 men between the ages of 22-46 years old with this method. Twelve of these men had azoospermia and 10 had dead sperm. The formula consisted of 30 grams of Epimedium soaked in alcohol for one night and then stir-fried in ginger juice till yellow. This was cooked with one sheep kidney in 500ml of water and 10ml of rice vinegar to which a small amount of table salt was added. After cooking over a slow fire for 50 minutes, this stew made up a one day’s dose which was eaten in two divided portions, morning and evening. Thirty-nine ji equaled one course of treatment.

Zhou then presents a typical case to show the kind of improvement this protocol has achieved. The man was 31 years old and had been married for four years without impregnating his wife. Gynecological examination had shown his wife to be normal. The man, on the other hand, had low back chill, numbness, soreness, and pain, lack of strength in both lower extremities, nocturnal polyuria with long, clear urine, and a deep, fine pulse which was forceless in the cubit positions. The man’s sperm was examined and he was diagnosed as suffeing from azoospermia. After one course of treatment, the man’s sperm count was 79 X10⁹/L. Morphology was 82% normal, motility was 70%, and the degree of motility was II-III. After two more courses of treatment, his sperm count was 130 x 10⁹/L, morphology was 90% normal, motility was 85%, and the degree of motility was III.

According to Zhou, azoospermia is mainly due to long-term kidney yang vacuity and debility. Because kidney water is cold and chill, warm transformation has no source and phlegm dampness is engendered internally. In addition, the spleen and stomach suffer detriment, so transformation and engenderment also have no source. Hence the body is not able to transform and engender the sperm or the sperm die. Therefore, treatment should warm cold, fortify the spleen, and transform dampness, supplement the kidneys and fill the essence. According to Zhou, Epimedium’s flavor (and nature) are acrid and warm, and it enters the two channels of the liver and kidneys where it warms the channels and scatters cold, supplements the kidneys and fills the essence. Zhou ends his discussion by quoting Li Shi-zhen from his Ben Cao Gang Mu (Detailed Outline of the Materia Medica):

Epimedium’s flavor is sweet and its qi is aromatic. Its nature is warm; it is not cold. It is able to boost the essence qi. It is a medicinal which reaches the hand and foot yang ming, the triple burner, and the lifegate. It is appropriate for all true yang insufficiencies.

Midcycle bleeding

In an article titled, "The Single Flavor Epimedium in the Treatment of Ovulatory Bleeding," Zhang Hui-ling reports on her treatment of 12 cases of midcycle bleeding with the single ingredient Epimedium with fully satisfactory results in every one of these 12 cases. According to Zhang, most ovulatory or midcycle bleeding is categorized in Chinese medicine as being due to spleen-kidney yang vacuity. Therefore, because this medicinal has the functions of warming the kidneys and assisting yang, it can be used to treat this condition. In this case, Zhang prescribes 10-15g of Epimedium boiled in water for 10 minutes beginning on day 9 of the cycle. One course of treatment lasted one week, with treatment being stopped after day 15. Typically, one course of this treatment was effective.

As an example of her approach, Zhang describes a 34 year old female who was first examined on Mar. 10, 1995. This woman had a small amount of vaginal bleeding each month from days 10-13. The color of this blood was dark brown, and there were no accompanying sensations of discomfort. The woman’s tongue was dark and pale with thin, white fur, while her pulse was deep and weak in both cubit positions. Based on these signs and symptoms, the patient’s Chinese medical pattern was categorized as spleen-kidney yang vacuity. After using the above protocol, there had been no recurrence on follow-up after three years.

Perimenopausal syndrome

In an article titled, "Epimedium in the Treatment of Climacteric Syndrome," Hu Wei-yong says that, because Epimedium is sweet and warm, it assists or strengthens yang without damaging yin. Therefore, it can be used when there is yang vacuity at the same time as there is yin vacuity. Because of this characteristic, Hu has used Epimedium for many years in the treatment of perimenopausal syndrome. As an example of his use of this medicinal, he gives the following case history.

The woman was 53 years old when she was examined on Aug. 17, 1997. Her menses had ceased two years previously. For the last year she had experienced recurrent dizziness, heart palpitations, and insomnia. Emotionally, the patient had difficulty controlling herself and she was easily angered. When her condition was severe, she could not lie down quietly and was not able to sleep at night. This had resulted in her not being able to go to work normally. She had already been prescribed Xiao Yao San (Rambling Powder) and Huang Liang E Jiao Tang (Coptis & Donkey Skin Glue Decoction). This had remitted all her symptoms, but, when she stopped taking these, all the above symptoms came back. The patient’s tongue tended towards red with thin fur, and her pulse was fine and somewhat rapid. Her bilateral respiratory sounds were normal, ECG was normal, and her blood pressure was 140/90mmHg.

Based on the above signs and symptoms, the woman’s Chinese medical pattern was categorized as liver-kidney yin vacuity with loss of regulation of yin and yang. The formula she was given consisted of: Herba Epimedii (Yin Yang Huo), 12g, Rhizoma Anemarrhenae Aspheloidis (Zhi Mu), 10g, Cortex Phellodendri (Huang Bai), 10g, Radix Salviae Miltiorrhizae (Dan Shen), 10g, uncooked Concha Ostreae (Mu Li) and Os Draconis (Long Gu), 15g each, uncooked Radix Rehmanniae (Sheng Di), 15g, and Radix Bupleuri (Chai Hu), 6g. One ji was administered per day. After half a month, all the woman’s symptoms had disappeared, her blood pressure had dropped to 118/82mmHg, and she was already able to return to work. On numerous follow-ups, none of the patient’s symptoms had recurred. Dr. Hu notes that, based on modern scientific research, Epimedium dilates the blood vessels, lower blood pressure, lowers blood sugar, and regulates hormonal secretion.

Conclusion

As the above abstracts suggest, the information on Chinese medicinals in such standard beginner’s textbooks as Bensky & Gamble is only the modern consensus opinion. While this consensus opinion should rightly form the foundation for professional standards of care, it is not necessarily categorically complete. Although I have been practicing Chinese gynecology for 20 years, I have never thought to use Epimedium specifically for the treatment of midcycle bleeding. Having read Zhang Hui-ling’s report, I fully intend to try this medicinal in any cases of ovulatory bleeding in women over 40 years of age who commonly do exhibit symptoms of spleen-kidney dual vacuity at the same time as an element of yin vacuity. Further, Xu Ying-zhang’s and Hu Wei-yong’s article both help explain why Epimedium is such an important ingredient in perimenopausal complaints. It is exactly as a source of such new ideas and inspirations that I find reading modern medical Chinese so important to my clinical practice.

For more information on learning to read modern medical Chinese and on how to subscribe to Chinese medical journals from the People’s Republic of China, see Bob Flaws’s Teach Yourself to Read Modern Medical Chinese available from Blue Poppy Press.