Clinical Experience with Angong Niuhuang Pill in Treating Two Intractable, Difficult Cases

Angong Niuhuang Wan (Peaceful Palace Bovine Bezoar Pill) is one of the "Three Treasures" of TCM warm-disease medicine (the other two being Zixue San and Zhibao Dan). Angong Niuhuang Wan was developed on the basis of Wanshi Niuhuang Qingxin Wan.

Wanshi Niuhuang Qingxin Wan is a formula by Wan Quan (art name Mizhai; from Luotian, Huanggang, Hubei), a famous physician of the Ming dynasty. It was originally a formula for treating high fever and convulsions, coma and delirium, vexation and restlessness, and wind-stroke with orifices blocked, caused by pediatric pox and measles.

The original prescription of Wanshi Niuhuang Qingxin Wan: Niuhuang (Bovine bezoar) 2.5 fen, Zhusha (Cinnabar) 1.5 qian, Huanglian (Coptis) 5 qian, Huangqin (Scutellaria) 3 qian, Zhizi (Gardenia) 3 qian, Yujin (Curcuma) 2 qian.

Angong Niuhuang Wan, on this basis, further adds Xijiao (rhinoceros horn, now replaced by water buffalo horn), Shexiang (musk), Bingpian (borneol), Zhenzhu (pearl), etc., and is coated with gold leaf.

Converting each herb in the Angong Niuhuang Wan prescription into modern dosages gives: Niuhuang, Yujin, Xijiao, Huanglian, Zhusha, Zhizi, Xionghuang (realgar), and Huangqin, 30 g each; Bingpian and Shexiang, 7.5 g each; Zhenzhu 15 g; and gold leaf, an appropriate amount.

All the herbs used in this formula are cold in nature. Its effects of cooling blood and calming fright, settling wind and anchoring the spirit, are the crown of TCM formulas. Modern pharmacological research shows that this formula can significantly improve cerebral circulation.

Angong Niuhuang Wan is an extremely costly patent medicine; a single pill sells for nearly 1,000 yuan. Therefore, under normal circumstances doctors rarely prescribe it. At present it is mostly used for emergency rescue after stroke, or for treating sequelae of cardiovascular and cerebrovascular diseases. Its derivative preparations, Qingkailing injection and Xingnaojing injection, are widely used clinically.

Angong Niuhuang Wan is called one of the "Three Treasures for Emergencies" because of its power to raise the dying. It is generally given only when the heat has entered the pericardium and the patient presents with a rigid tongue, cold limbs, coma, and delirium.

But in fact this formula has excellent effects in clearing heat and resolving toxin, dissipating phlegm, and awakening the spirit. Clinically, doctors often use it for all kinds of difficult, complicated diseases. This year I used Angong Niuhuang Wan to treat two very intractable cases, both with rapid effect.

The first was my son's habitual nosebleed. My father, myself, and my son—three generations—all had habitual nosebleeds. When the weather turned hot, the air dried out, or the heating was turned on at home, nosebleeds came very easily, sometimes several times a day. And the bleeding often would not stop; each nosebleed took more than ten minutes to stop.

I originally did not know that Angong Niuhuang Wan could treat this kind of habitual nosebleed. A former colleague of mine also had a problem of uncontrollable nosebleeds; the frequency and volume of bleeding were frightening.

Later she accidentally learned from an acquaintance that Angong Niuhuang Wan could treat habitual nosebleed, so she took two pills. According to her, after taking it she shivered for quite a while and felt utterly chilled all over; after stopping the medicine she recovered on her own, and has never had a nosebleed since.

This spring, my son again had uncontrollable nosebleeds. I had tried many methods before, all with only temporary effect and no cure, so this time I decided to use Angong Niuhuang Wan. I gave him one pill, taken all at once, and his previous habitual nosebleeds were nearly eradicated.

For a long time after taking it he had no nosebleeds, until about a month ago, when he had two more nosebleeds after strenuous exercise and very hot weather. I gave him one more Angong Niuhuang pill, and the nosebleeds have not recurred.

In previous years at this season he would have several nosebleeds every day. I myself used to be like that; my uncontrollable nosebleeds only resolved on their own after I turned thirty. My father was the same.

The second patient was a woman with intractable, unexplained headache. She had had headaches for more than ten years, worsening with each menstrual period. She felt heaviness in the head, as though weighed down by a heavy object, was very drowsy, and had great difficulty getting out of bed.

The patient lives in Beijing, where seeking medical care is very convenient. Over more than ten years she consulted every famous doctor she could find, with no effect. Over time, the condition gradually developed into depression. Western medical brain examinations showed no abnormalities. Because of this illness, she studied TCM on her own and tried moxibustion and cupping, but the results were poor. She had worn herself out and felt that life was no longer worth living.

I once used a family-secret formula for treating brain disorders, handed down by my teacher, to treat this patient, and it worked for a while. But later the condition recurred.

With no other option, I decided to try Angong Niuhuang Wan. After taking only one pill, all of the patient's symptoms disappeared completely. Neither I nor the previous doctors had ever achieved this result with her.

In addition, recently when I treated an elderly patient with cancer fever and ascites, while using Wuling San I also gave Angong Niuhuang Wan. After taking it, the patient's nighttime restlessness and difficulty falling asleep were rapidly resolved.

Last year, when I treated a patient with tumor metastasis to the brain, I also used Angong Niuhuang Wan. Otherwise I have had few opportunities to use it, because the medicine is simply too expensive and most patients cannot afford it.

In older formula books, there is a caution that Angong Niuhuang Wan should not be used lightly when the patient does not present with coma. But in the two difficult cases I treated, neither patient had coma or delirium, and after taking the medicine there was no sign of pathogenic heat sinking inward. So this contraindication is open to question.

However, Xionghuang (realgar) and Zhusha (cinnabar) in Angong Niuhuang Wan are toxic, gold leaf is a heavy metal and also toxic, and the remaining herbs are all too bitter-cold. Therefore, this medicine can only be used for a short time to treat disease; once the patient's symptoms are relieved, it should not be used repeatedly.

The above experience is purely accidental and does not yet constitute a systematic line of thinking. I write it down without presumption, for the reference of readers.