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
Uses of Arisaema
Dao Tan Tang (Expel Phlegm Decoction); includes pinellia, chih-shih, hoelen, citrus
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
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.