PERSICA AND CARTHAMUS
Herbs Paired for Treatment of Blood Stasis
Persica (taoren) and carthamus (honghua) appear in numerous modern formulas as a linked pair of herbs used to break up static blood and invigorate circulation. Persica is none other than the inner kernel of the common peach (Prunus persica), known in China as tao (ren = seed). Carthamus is the well-known yellow-red colored, mildly flavored spice called safflower (hong = red; hua = flower). It is remarkable that such common materials play so large a role in Chinese herb prescriptions for serious ailments.
Originally, persica was used without carthamus in ancient formulas, such as those of the Shanghan Lun and Jingui Yaolue (ca. 220 A.D.). Most often, persica was combined with rhubarb to treat stagnation in the lower abdomen that produced a syndrome of cold in the lower body (e.g., cold feet) and heat in the upper body (causing, among other symptoms, severe mental distress), with abdominal pain and possible formation of lumps. Examples of potent blood-vitalizing formulas of those ancient texts are (1, 2):
The combination of persica and carthamus as a treatment for blood stasis was popularized via the Yizong Jinjian (Golden Mirror of Medicine; 1742). That text formally presented Tao Hong Siwu Tang, a derivative of the famous Siwu Tang (Tang-kuei Four Combination) with addition of tao (taoren) and hong (honghua); the formula had been in use for centuries but was now firmly established in a Chinese medicine compilation of significant prescriptions. Siwu Tang was described in the Hejijufang (ca. 1100 A.D.) and the formula with persica and carthamus was first described in Danxi Zhifa Xinyao (Heart and Essence of Danxi's Methods of Treatment; 14th Century) in the chapter on menstrual disorders (3). It was presented there as a treatment for amenorrhea due to dried blood (deficient blood, where the moist yin quality is exhausted). Zhu Danxi was head of the Yin Nourishing School of the Jin-Yuan reform period and was primarily concerned about the problem of damage to the yin (which includes the blood). Tao Hong Siwu Tang nourishes blood and also vitalizes the blood (4). The ingredients are:
The indications for Tao Hong Siwu Tang have since been expanded somewhat. It is now indicated for a wider range of menstrual disorders due to blood deficiency and blood stagnation: irregular cycle length, premenstrual stress, excessive bleeding, and abdominal pain and distention that accompany or just precede menstruation (4). In the modern versions, red peony substitutes for peony (white peony) and raw rehmannia substitutes for cooked rehmannia (5). These substitutions enhance both the blood vitalizing and heat clearing aspects of the formula.
The Japanese herbalist Kagawa Genyetsu (1700-1777), who specialized in gynecology and obstetrics, adjusted the original formulation according to the model of traditional formulas in the Shanghan Lun yielding Zhe Chong Yin (Cinnamon and Persica Combination), a formula still used in Japan (6):
The main adjustment is replacing rehmannia with cinnamon and moutan, which are considered aids to vitalizing blood circulation. Cinnamon (the twig is used) opens the meridians and alleviates pain. The formula has the same indications as Tao Hong Siwu Tang but is also used in Japan for treating inflammatory disorders of the pelvic organs, such as uterine inflammation and peritonitis. Kagawa indicated it additionally for treatment of blood stasis following pregnancy, miscarriage, or spontaneous abortion. Moutan is used here to vitalize blood and clear heat. This formulation is similar to a prescription of the Jingui Yaolue, Guizhi Fuling Wan (Cinnamon and Hoelen Formula), made with cinnamon, peony, moutan, persica, and hoelen. In Japan, Cinnamon and Hoelen Formula is the most frequently used therapy for abdominal blood stasis and its secondary manifestations (e.g., heat disorders, mental distress, abdominal pain).
In a modern dictionary of Chinese medicine (Zhongguo Yixue Dazidian; 1921 by Xie Guan), Tao Hong Siwu Tang is again presented in slightly altered form:
|Red Peony||3 g|
This version is related to a prescription recommended in the same menstrual disease section of Danxi Zhifa Xinyao that had Tao Hong Siwu Tang. In that text, licorice and citrus took the place of cyperus; the formula was recommended for abdominal pain that appeared just as menstruation was about to begin, the same indication as given in the medical dictionary for the revised version with cyperus. The intended application of the original formulation-to regulate suppressed qi and blood-is even better represented by the above version, since cyperus has become established as a qi regulator for lower abdominal stasis. Citrus, also a qi regulator, is usually utilized today for qi stasis in the central region (stomach/spleen zone) rather than the lower region of the abdomen.
Another variant of the above prescription is Shengxue Qingre Fang, recorded in the Wanbing Huichun (Restoration of Health from Myriad Diseases; 1587) as a formula for delayed and difficult menstruation with abdominal pain; compared to the above prescription, it simply included two more ingredients: saussurea and licorice. The formula was described as one that clears heat (qingre), a property that can be attributed to the ingredients peony, raw rehmannia, and moutan. In general, it is understood that prolonged stasis of qi and blood with deficiency of blood engenders heat which rises upward and causes mental agitation and dryness of the skin and hair, with uneven complexion, including pallor (from blood deficiency) and flushes of redness (due to heat in the blood).
The use of carthamus during menstruation (as opposed to its use during the days just prior to initiation of menstrual bleeding) has been somewhat controversial; in particular, large doses are thought to increase menstrual bleeding. According to Yang Yifang (7):
If a small dosage is applied, carthamus can regulate the blood circulation; if a large dose is applied, it can break up the congealed blood and stop pain. It can be used for treating syndromes of blood stagnation, such as seen in uterine fibroids, endometriosis, amenorrhea, dysmenorrhea, irregular menstruation, and infertility. Because it can move the blood strongly, it may cause bleeding or make it heaver, so the dosage and treatment course should be controlled carefully. During menstruation, this herb should be used in a smaller dosage or stopped for 3 days to avoid heavy menstrual bleeding.
The concern about causing heavy menstrual bleeding gives recognition to the problem that women in China often have anemia (or border on the condition), perhaps because of low iron in the diet. It is said in traditional Chinese medicine proverbs that women always tend towards blood deficiency. Therefore, great care is taken to avoid increased blood loss during menstruation, including lowering the dose of herbs that promote increased blood flow or halting herb therapy during menstruation (when it might otherwise be needed to treat cramping pain). On the other hand, for cases of delayed menstruation, scanty menses, and amenorrhea, carthamus is given to encourage menstrual bleeding.
Carthamus has gained a reputation in modern China as an ideal herb for regulating the menstrual cycle. A popular patent preparation based on use of carthamus for this purpose is Tong Jing Wan (Menstruation Regulating Pill). According to its label, the formula includes Toa Hong Siwu Tang (minus rehmannia), with lindera, corydalis, cyperus, typha, salvia, and san-chi. Similarly, a modern instant granule preparation called Yue Yue Shu Granule features carthamus for promoting easy menstruation when taken before starting the menstrual period (see illustration, next page). Both formulations include tang-kuei and corydalis for alleviating spasm and pain. When using such formulas at the time of menstrual bleeding, the patient's prior history of menstrual bleeding should be considered. For example, women with uterine fibroids that cause excessive bleeding may have to be particularly careful about using carthamus during menstruation.
A famous quote about carthamus and its properties is attributed to Zhu Danxi: "If a lot is used, it cracks stasis, and if a small amount is used, it nourishes blood." The differing dosage-relative properties of carthamus are described in greater detail by Philippe Sionneau, in his book Dui Yao (8): "At a weak dosage of 1-2 grams per prescription, it stimulates the engenderment (production) and transformation of blood. At a moderate dose of 3-5 grams, it harmonizes the blood. At its usual dosage of 6-10 grams, it quickens the blood. At a high dosage of 10-15 grams, it breaks the blood." As to the combination of persica and carthamus, Sionneau elaborates (for the usual dosage range of 6-10 grams):
|Action on blood||breaks blood stasis; dispels stasis more strongly than carthamus||quickens the blood, opens the channels, dispels stasis and stops pain; moves the blood more strongly than persica|
|Site of action||tends to dispel stasis in the lower part of the body, in the abdomen, and in the organs||tends to dispel stasis in the upper part of the body and in the channels|
|Nourishing||nourishes the blood only very slightly||promotes blood production|
When combined: "they complement and reinforce each other. Together they effectively quicken the blood and dispel stasis, engender blood and stop pain." They are used together for cardiac and chest pain due to heart blood stasis; amenorrhea, dysmenorrhea, and menstrual irregularities; fixed, stabbing, and severe pain aggravated by pressure; and traumatic injuries with pain and swelling.
Wang Qingren, the Chinese physician famous for producing modern blood vitalizing prescriptions, used persica and carthamus in virtually all his prescriptions that have been retained in modern practice, including Xuefu Zhuyu Tang, Gexia Zhuyu Tang, Shengtong Zhuyu Tang, Tongqiao Huoxue Tang, and Buyang Huanwu Tang. While other blood vitalizing ingredients would vary from formula to formula (he relied mainly on red peony, tang-kuei, cnidium, achyranthes, and corydalis), this pair of herbs remained consistent (see table below, which is laid out to display common ingredients for vitalizing blood). Interestingly, his formula for pain in the lower abdomen, Shaofu Zhuyu Tang, was one of his blood-vitalizing prescriptions that did not contain persica and carthamus, contrary to the common practice of using these herbs for that application.
|Xuefu Zhuyu||Gexia Zhuyu||Shengtong Zhuyu||Buyang Huanwu||Tongqiao Huoxue|
|Red peony||Red peony||Red Peony||Red Peony|
|Bupleurum, Chih-ko, Platycodon, Raw Rehmannia, Licorice||Lindera, Cyperus, Chih-ko, Licorice, Moutan, Corydalis||Chin-chiu, Chiang-huo, Myrrh, Cyperus||Astragalus||Allium, Musk, Jujube|
In modern preparations of these formulas, achyranthes (niuxi) is often replaced by cyathula (chuanniuxi); also, salvia, which was not widely used at the time Wang Qingren wrote his formulas, is now frequently added. Salvia is said to vitalize blood and nourish blood; with red peony, it cools blood and strongly invigorates circulation.
Persica is mainly used to treat blood stasis, a syndrome thought to involve blood that has congealed and become inactive; this occurs in the lower abdomen most frequently, but in the abdominal organs generally, as a result of inhibited circulation of qi and blood. In the Lingshu it was explained: "When food and drink cannot be regulated, and joy and anger are not timely, this condition causes the ferrying of liquids to overflow to the insides. These liquids then descend and detain in the marshes [reproductive organs] making the blood paths to be obstructed." Aside from irregular eating and lack of emotional stability, blood stasis may occur also from surgeries, abdominal injuries, childbirth, and as the result of prolonged deficiency of blood that leads to blood dryness and stasis. The short-term therapy is to break up the stasis, usually using persica along with rhubarb and other blood vitalizing agents.
Carthamus is mainly used to invigorate blood circulation; it can also nourish blood when used in small doses; like persica, it can break up static blood, but only at high doses. It is commonly used today to improve cardiovascular circulation and to treat and prevent local blood clotting, as occurs with angina pectoris. In China, a well-known therapy for coronary heart disease with angina is Guanxin Erhao (Coronary Heart No. 2): carthamus, salvia, red peony, cnidium, and rosewood. Carthamus is also used to regulate the menstrual cycle, given without persica when there is little blood stasis. It is primarily indicated when inhibited circulation of qi and blood lead to irregular menstruation, premenstrual syndrome, and pain at the onset of menstruation.
Used together, persica and carthamus strongly overcome blood stasis syndromes, breaking up existing static blood and invigorating the circulation of blood generally. Blood nourishing herbs, such as tang-kuei and peony, may be included for long-term therapy to help nourish the liver and, thereby, prevent future stagnation that arises from disorders of the liver qi affecting circulation of blood.
Yue Yue Shu (literally: month to month comfort, meaning menstrual comfort) Granules, a popular prescription for menstrual cramping and pain, with carthamus (Flos Carthami) as a key ingredient. It is produced by the Henan Wanxi Pharmaceutical Factory. The formulation includes salvia and corydalis and is claimed to regulate female hormones and inhibit synthesis and release of prostaglandin F2α, a substance that is associated with heightened pain sensitivity. Yue Yue Shu can be used to treat irregular menstruation but it is primarily indicated for dysmenorrhea. It is based on the traditional Danggui San, which is comprised of carthamus, corydalis, tang-kuei, and myrrh, and also indicated for dysmenorrhea.
To the ancient Chinese herbalists, the bright red color of mature carthamus flower petals was symbolic of an herb that treats disorders of the blood. The color constituents-a relatively small number of complex flavonoids-are among the main active ingredients of carthamus. India has been the principal provider of safflower, using the seed for food oil and the flower for dye. Now, China is becoming a large producer, using the flower for medicine and the extracts for colorants.
The Safflower Pigment Institute was founded in Tianjin, China in 2002. The company produces natural safflower pigment (red and yellow). The main products are carthamin and safflor yellow (of which there are three subtypes: A, B, and C). Carthamin (also known as carthamus red), was first identified in 1930, and makes up about 0.4% (range: 0.3-0.6%) of the flower petals; it is a red oil-soluble component. When first produced by the plant, the base compound (called precarthamin) is yellow, but as the flower matures, the compound oxidizes to the characteristic deep red color. Safflor yellow is a yellow water-soluble complex that is the main color component of the flower petals, making up about 30% (range: 26-36%) of the content.
Early safflower bloom in yellow
Mature safflower bloom in red
Interior view showing development of petal colors
Carthamin, the red color of carthamus flower.
Pharmacology studies show that the colorful flavonoids of carthamus flower reduce platelet aggregation, reduce blood pressure, act as mild uterine stimulants, and have analgesic effects. Because of their effects on promoting uterine contraction along with the reduction of platelet aggregation, carthamus flower is contraindicated for use during pregnancy and is to be used cautiously during menstrual bleeding. Because of the larger amounts of safflower yellow in the petals and its water solubility (making it more available in standard hot water extracts), this component is probably responsible for most of the therapeutic actions claimed for carthamus flower.
Compared to carthamus, little is known of the active constituents or pharmacology of persica. The use of carthamus compounds as colorants for foods has propelled forward both the chemical and pharmacological study of this member of the famous herbal pair.