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Arisaema

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Arisaema refers to the Chinese herb tiannanxing obtained fromseveral species of Arisaema (Araceae Family), mainly Arisaema erubescens and A. heterophyllum, which are cultivated for the herb market.   The part used is said to be a rhizome, but is more accurately described as a tuber or corm.  The common western name for this plant is “Jack-in-the-pulpit,” the name derived from the flower’s central spadix (spike, referred to here as “Jack”) within the unique pulpit-shaped flower.  Originally, the Chinese had called the herb “tiger’s paw” (huzhang), because of the digitate leaves (fanning out like a spread hand or paw); the name was later changed to tiannanxing, which refers to the star-like (xing) shape of the leaves; tiannan, meaningsouthern heaven, probably referred to a region where the herb was gathered.

The writers of several Materia Medica appear to have failed to distinguish the processed herb used internally from the more rarely utilized raw herb, and this situation has led to several authors describing arisaema as toxic.  In fact, while the raw material has significant irritant action, the processed herb has low toxicity.   Thus, as an example, British physicians working in China (1) wrote that arisaema is “considered exceedingly poisonous,” while noting that the herb is used for many diseases that are thought to be associated with phlegm.   

If one bites into a piece of the raw arisaema rhizome, it will promptly cause a sharp burning sensation in the mouth, and this has been attributed to substantial amounts of needle-shaped calcium oxalate crystals.  These crystals are a strong irritant, especially to mucosal membranes, as in the mouth.  The crystals are thought to accumulate in some plants as a defense mechanism against foraging animals.   Oxalate, usually bound to calcium, is a substance found in many plants; calcium oxalate is the astringent component of spinach and chard, small berries, and rhubarb stems.  At high enough doses, oxalate is toxic, but it is well-tolerated up to a certain point as indicated by it being found in ordinary foods.  Rather, it is the long oxalate crystals (called raphides), as found in raw arisaema, which lead to its classification as toxic.   Roasting or boiling the tubers breaks down the crystals and yields an edible product rich in starch that has been consumed as food by Native Americans (primarily Arisaema triphyllum, known as the Indian turnip).

The raw herb is used for its irritant effect, being applied topically for skin diseases with infection and swelling (e.g., abscesses); it damages the bacteria and stimulates a healing response.  Calcium oxalate is water soluble and its removal is enhanced by using a basic substance, either alum (aluminum potassium sulfate) or quick lime (calcium oxide).  Alum is mixed with ginger juice in the processing; similarly, quick lime is mixed with licorice.  The same method is used in the treatment of pinellia (banxia), a close botanical relative of arisaema.  The crystals are removed by soaking the tuber for two days at moderate temperature; alternatively, the herb is boiled in the mixture for 2–3 hours. 

Raw arisaema is not exported from China, so herbalists elsewhere utilize only the processed herb that has the calcium oxalate removed.   There is also a specially processed arisaema called dannanxing, where dan refers to bile.  Bile is considered cooling and moistening, while arisaema is deemed warming and very drying, so bile-processed arisaema (which has a dark, nearly black color) has the more extreme properties attributed to arisaema neutralized (the bile-processed material is even classified as somewhat cooling) yet the herb retaining its primary action: resolving phlegm.  Bile products are used to resolve phlegm as well. 

The active components of arisaema remain unknown.  There have been reports of an alkaloid being present (2), but this is questionable as the finding of alkaloids has not been confirmed recently; the alkaloid contents of Arisaema and Pinellia species appear to be very low, so any alkaloids that are present most likely do not contribute significantly to the activity of the herbs.   There are also reports of triterpene glycosides (saponins) in arisaema, and this remains a possible major active component, at least in terms of explaining some of the claimed effects of phlegm accumulation.

Stronger than Pinellia
As is the case with arisaema, several Materia Medica list pinellia as being toxic, but, in fact, processed pinellia (the only one used internally these days) is a relatively mild herb with very low toxicity.  Processed arisaema may be considered a relatively strong herb, though its dosage in formulas is usually about the same as that for pinellia when the two are combined or when they are used in similar prescriptions.  Arisaema’s activity is often described with an emphasis on potency.  Yang Yifan (3) notes that arisaema (italics added) “has a very strong dispersing ability and can intensively dry dampness, dissolve damp-phlegm…and expectorate large amounts of white sputum.”  Chinese-English Manual (4) indicates that arisaema will “deprive dampness and eliminate phlegm.”  Materia Medica (5) notes that arisaema is “extremely drying.”  Jiao Shu De (Jiao 2003) contrasts pinellia and arisaema saying that the former is “static” while the latter is “not static,” referring to the concept that arisaema has a very strong dispersing quality, which pinellia lacks. The Advanced Textbook of Traditional Chinese Medicine (6) points out that pinellia is especially used for settling qi and applied for vomiting and gastric fullness, while arisaema is especially used for eliminating wind and relieving convulsions, thus used to treat stroke, vertigo, and tetanus.   These applications of arisaema are related to it being non-static; it is thought that the herb goes through the jing and luo vessels clearing out obstructions, while pinellia mainly stays within the stomach and intestines to affect these organs.

Uses of Arisaema
There are four major uses of arisaema: to expel large amounts of phlegm, to clear phlegm mist of the heart orifices, to remove phlegm-obstruction of the meridians (especially luo vessels), and to dry accumulation of phlegm-damp in the arms or throughout the body.   For removing excess phlegm, arisaema is often accompanied by pinellia, chih-shih (zhishi), hoelen (fuling), and citrus (chenpi); for clearing orifices, it is often accompanied by herbs in the same plant family (Araceae), namely typhonium (baifuzi) and acorus (shichangpu), as well as by certain unrelated materials, especially gastrodia (tianma), polygala (yuanzhi), earthworm (dilong), and silkworm (baijiangcan).   Arisaema, like gastrodia and earthworm, is said to “eliminate wind” as well as to clear phlegm, explaining their applications for treating convulsions, strokes, and other “wind-phlegm” disorders.  Some sample formulas with arisaema are:

Dao Tan Tang (Expel Phlegm Decoction); includes pinellia, chih-shih, hoelen, citrus
Qing Qi Hua Tan Wan (Cleanse Qi and Resolve Phlegm Pill); includes pinellia, chih-shih, hoelen, citrus
Di Tan Tang (Phlegm Eliminating Decoction); includes: pinellia chih-shih, hoelen, citrus, acorus
Er Zhu Tang (Two Processed Decoction); includes pinellia, hoelen, citrus
Cang Zhu Dao Tang (Red Atractylodes Phlegm Expelling Decoction; includes pinellia, hoelen, citrus
Yu Zhen San (Powder for Calming Convulsion); includes: typhonium, gastrodia
Xiao Huo Luo Dan (Minor Pill for Opening Luo Vessels); includes: earthworm
Zheng Rong Tang (Appearance Normalizing Decoction): includes typhonium, silkworm, pinellia
Shen Bai San (Miraculous White Powder); includes typhonium, gastrodia
Shen Xian Jie Yu Dan (Immortal’s Speech Recovering Pill); includes typhonium, acorus, polygala, gastrodia

In modern practice, arisaema is included in formulas for post-stroke syndrome when there is evident phlegm accumulation and for cases of Alzheimer’s disease; other applications include advanced (severe) arthritis, carpal-tunnel syndrome (especially in persons who are overweight), headaches (when phlegm obstruction is deemed one of the contributing factors), and bronchitis with sputum production.

Because of its reputation of having a very drying quality, arisaema is generally contraindicated in cases of yin deficiency, though the bile-treated arisaema can be used instead.  Arisaema is contraindicated during pregnancy, because some ancient texts suggest that it has abortifacient activity. 

Dosage in Formulas and Sample Formulas
The usual dosage of arisaema in decoction, according to various Materia Medica, is given as either 3-6 grams per day (7, 8); 3-10 grams per day (6), or 5-10 grams per day (9), the higher dosing being found in texts describing more recent instances of use of this herb.  It is unusual for Chinese doctors to prescribe higher doses than these, with 9–10 grams the amount commonly used for serious diseases.  For this herb, 15 grams is the maximum prescribed, and only rarely, such as when used in treatment of obese patients.   Arisaema is commonly included in pill prescriptions, and the dose of the herb (powdered and incorporated into pills, capsules, or tablets) taken in one day is about 1 gram.

An example of treatment for post-stroke patient relayed in the book Treatment with Knotty Diseases (10) is as follows:

The decoction is given with 6 grams powdered scorpion, which is swallowed down with the decoction liquid.  Sinapis (baijiezi, the mustard seed) is utilized like arisaema for dispelling large amounts of phlegm. 

Another example is from Clinic of Traditional Chinese Medicine (11), which presents a formula for treatment of depression associated with phlegm stagnancy, a modification of Er Chen Tang:

Cyperus (xiangfu) is one of the central Chinese herbs for treating depression (12).  The trio of acorus, polygala, and curcuma, found in this and the previous example, is used to clear phlegm obstructing the orifices of the heart, thus improving brain function; arisaema intensifies that effect.  A third example is treatment of obstructive emphysema (13), when characterized by phlegm-heat:

Because the therapy was for a heat syndrome, bile-treated arisaema was chosen; the seed of trichosanthes (gualouren) was used as a cooling herb for resolving phlegm; gypsum (shigao) and scute (huangqin) are included for clearing heat from the lungs.

In the book Bi Syndromes (14), the syndrome of accumulation of phlegm and blood stasis is described.  This condition is exemplified by chronic arthritis with swelling and deformity of the joints, with limitation of extension and flexion.  A sample formulation is modified Tao Hong Yin:

The combination of sinapis, silkworm, and arisaema in this formula, and also in the formula for treating post-stroke syndrome, scours out phlegm-mist in the orifices and meridians while quieting internal wind.

In a recent translation of Dan Xi Xin Fa (15), a chapter on arm pain is presented; the pain is attributed to dampness in the upper burner “running wildly” in the channels and connecting vessels (that is, the jing and luo).  Left arm pain is said to be due mainly to wind-dampness, while right arm pain is more often due to phlegm-dampness.  The basic treatment described by Zhu Danxi in this chapter for eliminating this dampness is Er Chen Tang; the simple formula is to be modified with additional herbs; arisaema is considered particularly important for the right arm pain.  Among the modern applications of this approach are frozen shoulder, lymphedema (16), tennis elbow, and carpal tunnel syndrome.   A tablet designed for these uses (17) was derived from Er Zhu Tang, a formula of the “arm pain” category of the book Wanbing Huichun (published 1587), from which many formulas were absorbed into Japanese practice of Chinese medicine, called Kampo (18).   Arisaema 10 and Er Zhu Tang (referring to the two “zhu,” baizhu and cangzhu, in the formula) also has the damp-removing herbs mentioned previously—arisaema, pinellia, hoelen, and citrus—as well as another component, namely aromatic qi regulating and dispersing herbs: chih-ko (zhike), cyperus (xiangfu), and chiang-huo (qianghuo), to help move the stagnation in the arms. 

References

1. Smith FP and Stuart GA, Chinese Medicinal Herbs, 1973 Georgetown Press, San Francisco, CA.
2. Chang HM and But PPH, Pharmacology and Applications of Chinese Materia Medica, 1987 World Scientific, Singapore.
3. Yang Yifan, Chinese Herbal Medicines: Comparisons and Characteristics, 2002 Churchill-Livingstone, London.
4. Ou Ming (chief editor), Chinese-English Manual of Common Used Herbs in Traditional Chinese Medicine, 1989 Joint Publishing Company, Hong Kong.
5. Bensky D and Gamble A, Chinese Herbal Medicine Materia Medica, 1993 Eastland Press, Seattle, WA.
6. Huang Yarong, compiler, Advanced Textbook on Traditional Chinese Medicine and Pharmacology, volume 2, 1996 New World Press, Beijing.
7. Hsu HY, et.al., Oriental Materia Medica, 1986 Oriental Healing Arts Institute, Irvine, CA.
8. Jiao SD, Ten Lectures on the Use of Medicinals, 2003 Paradigm Publications, Brookline, MA.
9. Huang Bingshan and Wang Yuxia (chief compilers), Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine, 1993 Heilongjiang Education Press, Harbin.
10. Shao Nianfang, The Treatment of Knotty Diseases with Chinese Acupuncture and Chinese Herbal Medicine, 1990 Shandong Science and Technology Press, Jinan.
11. Zhang Enquin, Clinic of Traditional Chinese Medicine, 1990 Publishing House of Shanghai College of Traditional Chinese Medicine, Shanghai.
12. Dharmananda S (2005), Cyperus: Primary Qi Regulating Herb Of Chinese Medicine, START Manuscripts, ITM, Portland, OR.
13. Hou Jinglun and Geng Xiu’e (chief editors), Traditional Chinese Treatment for Senile Diseases, 1997 Academy Press, Beijing.
14. Vangermeersch L and Sun PL, Bi Syndromes, 1994 SATAS, Brussels, Belgium.
15. Yang Shouzhong, translator, The Heart and Essence of Zhu Danxi’s Methods of Treatment, 1993 Blue Poppy Press, Boulder, CO.
16. Dharmananda S, Chinese Herbs for Lymphedema: Exploring the Principles of Treating Phlegm-Damp Accumulation, 2000 START Manuscripts, ITM, Portland, OR.
17. Dharmananda S, A Bag of Pearls, 2004 Institute for Traditional Medicine, Portland, OR.
18. Dharmananda S (2001), Kampo Medicine: The Practice of Chinese Herbal Medicine in Japan, START Manuscripts, ITM, Portland, OR.

July  2010