to Nourish Blood, Bone, and Joints
Deer antler is a common ingredient in Chinese tonic preparations. It may be surprising, especially to the practitioner of Chinese medicine, to learn that New Zealand is the world's largest producer of deer antler, followed closely by Australia and Canada (both increasing rapidly), and that Korea is probably the world's largest user of antlers, with an apparently insatiable appetite for antlers of all species. China is also a major producer and consumer of deer antler products and appears to have the longest history of medicinal use of deer antler as well as production via deer farming.
The story of deer antler can be traced back to the first Chinese Materia Medica, Shennong Bencao Jing (ca. 100 A.D.), where it is described briefly (1). There is also reference to earlier use of deer antler in an archeological find (a set of silk scrolls named Wushier Bingfang, from a tomb dated 168 B.C.). However, use of antler appears to have been infrequent until the animals were raised on "deer farms" starting in the mid-16th Century in China (Ming Dynasty period). This is a time when several other cultivation and animal husbandry projects were established in support of medicine. Soon after, Wu Kun included a formula in his book Yi Fang Kao (Study of Prescriptions, 1584) that has inspired much work with the combination of deer antler and tortoise shell, two bone-like materials rich in gelatins. His formula is Gui Lu Erxian Jiao (gui = tortoise, lu = deer, erxian = two immortals; jiao = gelatin). The formula is made as a firm gelatin, using the following recipe (proportioned to the amount being made):
|Deer antler (lujiao)||5,000 g|
|Tortoise plastron (guiban)||2,000 g|
|Lycium fruit (goujizi)||1,500 g|
|Ginseng (renshen)||500 g|
This formula is said to replenish yin and essence, tonify qi, and strengthen yang. It is used for deficiency of kidney yin and yang, deficiency of blood and essence in the penetrating and conception vessels, with symptoms of weakness of the lower back and legs, impotence, blurred vision, etc. (2). The penetrating vessel, (chongmai), one of the extra meridians, is referred to as the "sea of blood." The conception vessel (renmai), while sometimes associated with reproduction, is related to generation more broadly, including generation of blood. Tortoise shell and deer antler are said to nourish the marrow.
More importantly for the future of Chinese herb prescribing with deer antler, Zhang Jingyue described two important tonic formulas in pill form (presented in the book Jingyue Quanshu, 1624), one to emphasize tonification of kidney yang (said to nourish the right kidney), called Yougui Wan, and one to emphasize nourishing kidney yin (said to nourish the left kidney), called Zuogui Wan. Though prepared originally as pills (= wan), they were later commonly used as decoctions for replenishing the kidney (you = right; zuo = left; gui = replenish).
|Yougui Wan||Zuogui Wan|
Deer antler gelatin (lujiaojiao)
Cinnamon bark (rougui)
Deer antler gelatin (lujiaojiao)
Tortoise shell gelatin (guibanjiao)
The first three ingredients belong to the yin nourishing portion of Rehmannia Six Formula (Liuwei Dihuang Wan), where rehmannia and cornus nourish the liver and kidney yin and dioscorea nourishes the spleen and kidney yin. Further, both formulas contain lycium fruit and cuscuta. In the modern texts, lycium fruit is known as a yin and blood tonic, while cuscuta is known as a yang tonic and astringent, but cuscuta is also considered somewhat yin nourishing. Cuscuta is commonly paired with lycium fruit to nourish the kidney and liver and benefit vision. Also, both formulas contain deer antler gelatin derived from boiling the antler (described further below). Chinese doctors regard the whole antler as primarily a revitalizing yang tonic with some yin nourishing qualities, while the gelatin is considered to be a milder yang tonic, with greater emphasis on nourishing yin, in a manner similar to tortoise shell (which lacks yang tonic properties). Both tang-kuei (in Yougui Wan) and achyranthes (in Zuogui Wan) are used to nourish the blood and invigorate blood circulation. But, whereas Zuogui Wan incorporates the cooling tortoise shell gelatin, Yougui Wan has the yang-benefiting eucommia and two herbs to warm the kidney yang: cinnamon bark and aconite. These are the same herbs used in Rehmannia Eight Formula (Bawei Dihuang Wan), along with rehmannia, cornus, and dioscorea. So, both of Zhang Jingyue's formulas nourish the kidney yin and essence, and both nourish yang, but Yougui Wan also warms the kidney and invigorates yang. To further emphasize yang tonification, deer antler may be used in place of the gelatin in Yougui Wan.
Because of the rather late introduction of antler in standard traditional Chinese medicine formulations, this ingredient rarely appears in Japanese preparations. The last major influence on Kampo from China was Gong Tingxian (1522-1619) with his book Wanbing Huichun (1587). He did not emphasize kidney tonification strategies. As a result, the Kampo literature doesn't reveal antler-based formulas.
During the Qing Dynasty (1644-1910), the use of ginseng and deer antler became quite popular as a method of therapy, sometimes referred to as warm tonification. The Qing Dynasty medical commentator Xu Dachun (1693-1773) complained about over-reliance on these remedies (3):
Those physicians who prefer to be fashionable use only rapidly supplementing acrid and hot substances, namely ginseng, aconite, dry ginger, red atractylodes, deer antler, and cooked rehmannia. And no matter whether a patient was harmed by cold, heat, or dampness, these physicians go back and forth between these few herbs to compose their prescriptions. Often enough, these herbs are contraindicated in the case of the illness to be treated, and every trial is bound to kill someone. Still, there is not the slightest self-reproach.
Well, this has its origin in the physicians of today who prefer to make lofty speeches to deceive the people. Also, people are pleased if one uses warm and supplementing herbs, and this applies, in particular, to the rich and noble. Those physicians who do not follow these preferences of their patients will not be able to continue their profession for long! Hence, people strive to achieve the best effects, but they cause only unending calamity.
The acrid herbs were dry ginger, aconite, and red atractylodes (which was used at that time as we now use white atractylodes), and all the herbs mentioned were warming, some of them considered hot (though today, all are classified as warm except dry ginger and raw aconite, but not processed aconite). These invigorating tonics were expected to cause people to feel an immediate response to the therapy-a stimulation of their basic energy-compared to the usual tonification approach which might require weeks of regular use of the herbs and a nearly imperceptible daily improvement. Some of these herbs, like ginseng and deer antler, were rare and costly, so the rich sought them out, figuring that they had unique access to important remedies. It is much the same today: many people seek quick fixes and may be drawn to the unusual costly herbs if they can afford them.
Xu argued that reliance on a few popular and quick acting agents tends to be contrary to the most widely accepted methodology, which is to perform differential diagnosis and then prescribe according to need, regardless of the ordinary nature of some herbs or their lack of contemporary popularity. Hence, these warm tonifying agents might be contraindicated in cases of heat syndrome, damp-heat, blood heat, stomach fire, phlegm-heat in the lungs, and yin deficiency leading to excess yang. There was much concern during his time about killing patients with wrong prescriptions. Working in the absence of modern medicine, the remedies were used for people with fatal diseases who would die if not cured, and who might be worsened by some of the therapies (for example, raw aconite could be quite toxic if not cooked properly in making a tea). These specific concerns aside, all of the herbs mentioned were recognized as valuable, so long as they were given according to need.
The use of deer antler continued through the Qing Dynasty at a modest level until the 20th century, when it became the subject of modern research methods. Both the Russians (who had been farming deer antler since the 1840s) and the Chinese started subjecting deer antler to analysis by scientific methods, though those methods were relatively crude. About the same time, patent medicine factories sprung up in China and helped fill the growing demand for tonics made with rare ingredients such as deer antler and ginseng. Chinese patent medicine factories now use more than 1,000 kg of deer antler each year. This increased interest and distribution, in turn, led to rapid build-up in the number and size of deer farms.
Initially, antler was collected from several species of wild deer (animals of the Cervidae family). There are 45 species of deer in the world, divided into 17 genera; not all of them have antlers. Two species of deer have been the common source of domestic deer antler for Chinese medicine: Cervus nippon, the sika deer, and Cervus elaphus, the red deer.
The sika deer is an East Asian species, ranging from Vietnam to Taiwan in the south and from China to Korea and Japan in the north; there are about 13 different subspecies of this deer. The sika deer mainly lives in open woodlands and is typically a chestnut red to yellowish brown with white spots on the sides and a dark stripe extending from neck to tail. Sika deer have been introduced to New Zealand for deer farming to produce antlers, and have also been introduced into Europe.
The red deer originally ranged from Europe to Asia, and it has been introduced into New Zealand, Australia, Chile, and Argentina for the purpose of deer farming to produce antler. It has a glossy reddish brown color in summer (but in winter turns drab grey-brown). Red deer prefer open, grassy glades in the forest, but frequently use woody cover.
Deer farming has become a huge enterprise outside the Orient. The animal meat is used as food, and the antlers are usually exported to the Orient, though there is a new industry in making antler-based health products for domestic consumption in Canada and other countries. The table on the next page indicates the extent of deer farming (adapted from ref. 4).
Large deer farm in New Zealand.
Sika deer farm in China.
Packaged antler product, showing thick and thin slices of antler.
|Number of Deer Farms and Farmed Deer in the Major Deer Farming Countries; June 1998.|
In China, a survey of deer farming of species used for antler (ca. 1995) revealed (5):
|Species||Number of Provinces||Number of Farms||Number of Animals||Number of Animals Reproduced|
In Korea, the biggest consumer nation for deer antler, data from the end of 1992 indicated that 143,000 deer were held in pens (about 20 deer each), producing about 100 tons of fresh antler, which yields about 30 tons of dried product (6). That same year, about three times as much was imported, mainly from New Zealand, Russia, and China. China later became an antler importer rather than exporter, except for finished medicinal preparations and small supplies sent to oversea Chinese pharmacies.
The primary material collected at the deer farms is called velvet. The term originally arose from the fine hairs on the antler, but is now used specifically to indicate the antler's stage of growth: before it calcifies (ossifies). In nature, antlers will fall off after they have ossified; thus, collecting fallen antler doesn't provide the desired "velvet." The older material is still valued: it is boiled to yield deer antler gelatin (described below) and used for certain applications, such as dispersing swellings.
Deer velvet is removed while the deer is under local anesthetic (which is a new practice in China and is a mandated practice in other countries that developed deer antler farming more recently). The antlers then grow back. Alternatively, if the deer is killed for use as food, the antlers are removed afterward. The cut antlers are bathed in boiling water and air dried, and then further dried in the shade or by low temperature baking. The fine hairs may be removed before additional processing. A typical dried antler from the sika deer weighs about 150 grams.
Traditionally, deer antler is sliced very thinly or ground to powder. It is not commonly boiled in decoctions with herbs because the gelatins easily stick to the herb dregs or cooking pot, and so the loss of valuable material is considered too great. Therefore, the herb powder is usually taken separately.
To make gelatin, ossified antlers (which are less expensive than velvet) are boiled for several hours to release the gelatin (protein components) from the hard matrix. Then, the antler gelatin can be added to an herbal decoction after all the boiling is done and the dregs have been strained. Or, it too can be ground to powder, and consumed directly. After removing the gelatin from the antler, the residual hard antler material is dried and ground up to make lujiaoshuang (degelatinized deer antler), which is mostly used for topical applications (treating boils, eczema, and skin ulcers, serving as an astringent and aid to faster healing). It is also considered of some limited value as a kidney yang tonic if taken at high enough dosage.
Antler pills are a common patent medicine product; the antler is not used alone, but in various formulations. These include liquids in glass vials (ginseng-deer antler, similar to the ginseng-royal jelly product; there is a combination with ginseng, antler, and royal jelly); pills used as sexual tonics (antler combined with epimedium, cynomorium, ginseng, and lycium fruit); and general tonics (complex formulas with herbs for tonifying qi and yang, and nourishing yin and blood).
The thin slices are made by removing the outer, hairy portion of the antler, soaking the antler in hot alcohol to soften it, and then carefully slicing it to produce round wafers. The slices are best suited for soaking in wine to make a "tincture" of antler, sometimes referred to as pantocrin (or pantocrine), based on the Russian designation for the alcohol extract. Very thin slices (virtually clear) can be eaten directly.
Antler is a simple extension of bone, so it has a calcium-phosphate matrix of hydroxyapatite, Ca10(PO4)6(OH)2, integrated with smaller amounts of calcium carbonate (CaCO3); its composition is similar to that of human bones. Thus, one of the therapeutic roles of taking deer antler is as a source of calcium to help prevent or treat osteoporosis, which is consistent with the traditional bone strengthening action of deer antler. An analysis of the ossified antler showed that 73% is hydroxyapatite and related mineral compounds, while 27% is organic materials (7). If consumed as a powder (rather than a decoction), a person taking 3 grams of deer antler (see dosage section, below) will get about 800 mg of calcium. Hydroxyapatite is considered one of the most efficiently absorbed forms of calcium available. In velvet, the hydroxyapatite is about 50% (8), so the calcium in 3 grams is about 600 mg.
Deer antler also has a substantial amount of gelatinous components, ones that have become widely publicized in recent years, though from other source materials: glucosamine sulfate, chondroitin sulfate (which is a polymer of glucosamine), and collagen. These compounds have been shown to benefit the joints in cases of osteoarthritis by providing substrate materials useful for regenerating the body's connective tissues (collagens) found in joints and sinews. In addition, they may have some anti-inflammatory action, useful for arthritis and tendonitis. These actions of the gelatin portion support the traditional concept that antler benefits joints and ligaments. In a 3-gram dose of ossified deer antler powder, one will obtain about 750 mg of these substances, which is low compared to therapeutic amounts taken as supplements for osteoarthritis (about 1,500 mg/day); 3 grams of velvet antler will provide the desired 1,500 mg. If deer antler gelatin is consumed, there is an even higher proportion of these ingredients, though some of the components may be transformed during the prolonged boiling into less active forms, so the dosage of gelatin to use is higher than for antler velvet.
Recently, the traditional use of antler to nourish the bone marrow and blood has been validated by studies in which the active components responsible were identified: monoacetyldiglycerides (9, 10). These are small molecules that stimulate the marrow stem cells that produce blood cells (see illustration, next page; 11). Inhibition of hematopoiesis (blood cell production) occurs with several cancer drugs and with radiation therapy; some disease processes, such as myelodysplastic syndrome (MDS), involve progressive decline in stem cell activity with undetermined causes. If further research confirms the therapeutic importance of the monoacetyldiglycerides, they can be synthesized in large quantity. In the meantime, deer antler is the main therapeutic source for them (the amount present in antler has not been quantified).
Stem cells leading to various blood lines. The basic marrow stem cell differentiates during early fetal development into two types of stem cells, the lymphoid (which produces lymphocytes) and the myeloid (which produces all the other blood cells). Platelets (thrombocytes) are not true blood cells, but are cytoplasmic fragments of the megakaryocytes. T-cells are lymphoid cells that differentiate via action of the thymus gland. All the cell lines except erythrocytes (red blood cells) and megakaryocytes are involved with immune responses. Thus, deer antler, when used to stimulate the stem cells in patients with bone marrow depression, may improve immune responses, as indicated by laboratory animal studies.
Deer antler also has essential fatty acids, making up about 2.5% of the velvet antler (not enough to be clinically active) and insulin-dependent growth factor (for which it is not known whether there is any clinical effect). Other organic compounds have been detected, but in miniscule amounts.
The velvet antler in powdered form is typically used in dosages of 1-3 grams/day. Less than 3 grams may be a low dosage for promoting bone marrow function; the dosage levels traditionally indicated may reflect the rarity and expense of the antler (which is now partly alleviated by the increase in deer farming, but velvet is still relatively costly). The 3-gram dosage is probably essential for hematopoietic effect and for benefiting joints and tendons. Antler gelatin, because it is obtained from older antler material, is relatively inexpensive, is milder, and is used in larger quantities, 6-9 grams. Degelatinized antler is consumed in dosages of 6-9 grams, or more.
The book Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude (12) provides these insights:
Lurong (velvet deer antler): Warm in nature and sweet and salty in flavor, lurong supplements kidney yang, strengthens sinew and bone, boosts sinew and marrow, and nourishes the blood. It is used for patterns of vacuity detriment, such a kidney deficiency and cold limbs, soreness of the limbs, dizzy head and blurred vision, seminal emission, and impotence.
Lujiao (ossified deer antler): Salty in flavor and warm in nature, lujiao supplements kidney yang and boosts essence and blood. It is similar in action to, and can substitute for, lurong, but it is less effective.
Lujiaojiao (deer antler gelatin): Sweet in flavor and warm in nature, lujiaojiao warms and supplements the kidney, supplements yang within yin, frees the blood of the thoroughfare vessel (chongmai), engenders essence and blood, and stanches flooding (excessive uterine bleeding)….It is mostly used for flooding and spotting, vaginal discharge, deficiency bleeding, and yin type flat-abscess (lumps that are not red, swollen, hot, or painful).
Comparisons: Lurong is commonly used as a drastic liver-kidney supplementing medicinal. It has greater supplementing power than lujiao. Lujiao, by contrast, has a moderate liver-kidney supplementing effect, but it quickens the blood, dissipates stasis, and disperses swelling and toxin with greater strength than lurong….Used processed or as a glue (lujiaojiao), it tends to warm and supplement the liver and kidney, enrich and nourish essence-blood. Lujiaojiao is similar in action to lurong, but being slower to supplement, it must be taken over a long period of time to be effective. Lujiaoshuang, which is the dregs left after making lujiaojiao, is less warming and supplementing than either lujiao or lujiaojiao. Lujiaoshuang is used for spleen-stomach deficiency cold, low food intake, and sloppy stool, and it is also used as a substitute for lujiao and lujiaojiao, in which case the dosage must be increased.
The problem of "flooding" and spotting was described by Liu Yiren in his book Heart Transmission of Medicine (ca. 1850; 13):
The disease of flooding and leaking is due to detriment of the chong (penetrating) and ren (conception) vessels. The chongmai is the sea of blood of the twelve channels, and the renmai is the original qi of engenderment and nourishment. If these two vessels suffer detriment, the blood will consequently move frenetically. At its onset, this disease is categorized as repletion heat, requiring clearing heat. Later on, it is characterized as deficiency heat, requiring nourishing the blood and clearing heat. If it endures for many days, it is categorized as deficiency cold, requiring warming the channels and supplementing the blood.
Although antler wasn't commonly used during Liu Yiren's time, it would today be a primary choice for treating the deficiency cold syndrome that he described. Since bleeding is part of the syndrome, antler gelatin would be utilized, probably with tortoise shell.
The Advanced Textbook of Traditional Chinese Medicine and Pharmacology (14) notes the main uses for deer antler (lurong):
a) Chronic diseases marked by general lassitude and spiritlessness, lumbago, and cold limbs, polyuria with clear urine, impotence, spermatorrhea, and leukorrhagia with clear discharge, for which it is often used with cooked rehmannia, eucommia, and cistanche.
b) Infantile maldevelopment marked by weakness of the muscles and bones, incomplete closure of the fontanel, and retarded speech and movement, for which it is often combined with cooked rehmannia and cornus [it is sometimes added to Rehmannia Six Formula, which has these ingredients, and which was designed for promoting healthy growth of children who displayed slow development].
c) Chronic diseases with blood deficiency and liver and kidney deficiency, for which it is often used with ginseng, astragalus, cooked rehmannia, and tang-kuei.
d) Deficiency of the extra meridians (e.g., chongmai) with incessant uterine bleeding, for which it is often prescribed with gelatin, sepia bone, tang-kuei, and tortoise shell.
The effects of lujiao, lujiaojiao, and lujiaoshuang derived from the antlers are basically the same: warming and nourishing kidney yang. But, lujiao also activates blood circulation and relieves swelling, lujiaojiao is more effective for nourishing blood and checking bleeding, and lujiaoshuang possesses an astringent effect [e.g., for incontinence of urine, uterine bleeding, and leukorrhea].