The Anti-Cancer and Pain-Relieving Actions of the Chinese Herb Maqianzi (Nux Vomica)
Maqianzi is the dried ripe seed of Strychnos nux-vomica (Loganiaceae); it is also called Maqianzi, Maqian, Fanmubie and Niugen.
Maqianzi was first recorded as a medicinal in Li Shizhen's Bencao Gangmu (Compendium of Materia Medica). However, Li Shizhen's understanding of Maqianzi's toxicity was wrong; Li believed Maqianzi was non-toxic, but in fact it is a highly toxic Chinese herb with a very low lethal dose.
The main toxic constituent of Maqianzi is strychnine (brucine is also present); the toxic dose in humans is 0.77-28 g. It is generally held that the toxic dose of Maqianzi is 1.5-3 g, and the lethal toxic dose is 4-12 g or more.
Someone once took the powder of seven stir-fried ripe Maqianzi seeds; within two minutes he had headache, dizziness and inability to stand, and after ten minutes developed rapid breathing, profuse sweating, convulsions and coma, and finally died. Recently there was also a report of a patient who over-dosed on Maqianzi while treating facial paralysis and died.
It is generally held that tea, coffee and opioids can worsen the respiratory depression caused by strychnine poisoning. Therefore, when taking Chinese herbs or patent medicines containing Maqianzi (such as Pingxiao Pian or Pingxiao Jiaonang), one should avoid tea, coffee and opioids. Hence, whenever using Chinese herbs or patent medicines containing Maqianzi, do not combine them with Western painkillers.
Some also hold that Shexiang (musk) and Yuanhu (Corydalis), commonly used TCM painkillers, can worsen strychnine poisoning. But in my experience, as long as the dosage is controlled, using Shexiang and Yuanhu together with Maqianzi gives better swelling-reducing, pain-relieving, anti-cancer and nodule-dispersing effects than using Maqianzi alone.
The toxic substances in Maqianzi are excreted very slowly; long-term use has a cumulative effect. After two consecutive months of taking it, pause for at least 4-5 days before resuming. To be safe, when I have patients take any toxic Chinese herb, I use the method of taking it for five days and resting for two, to avoid the serious effects on the patient's body from cumulative poisoning.
But for patients taking medicines containing Maqianzi, after two or three months I have them stop for a period before resuming.
The toxicity of Maqianzi varies with the degree of processing, so even from the same manufacturer, different batches of Maqianzi-containing products differ in toxicity. Each time, carefully increase gradually from a small dose to a large one.
To be safe, Maqianzi should be used in pills or powders; avoid putting it in decoctions, because pills and powders make the dosage easy to control and serious poisoning events are less likely.
The toxic and therapeutic doses of Maqianzi are very close, so during treatment one often takes it until mild toxic signs appear; it must not be taken in excess. When applied externally, its toxic constituents can be absorbed through the skin, so external use must also be cautious.
After Maqianzi poisoning, common reactions are convulsions, dry mouth, dizziness, headache and gastrointestinal irritation; death is mostly due to exhaustion and asphyxiation from recurrent tonic convulsions.
Patients poisoned by Maqianzi are prone to convulsions and restlessness when stimulated by light and sound, so Maqianzi is best taken at night before bed, and the patient should then sleep in a quiet, dark environment. Some patients taking Maqianzi also develop palpitations, numbness and clumsiness of the limbs, facial stiffness, difficulty swallowing, fear, and epileptiform attacks. In severe poisoning, when convulsions recur five or more times, the patient often dies of lung-qi or heart-qi exhaustion.
After taking Maqianzi or Maqianzi-containing patent medicines, if the above side effects appear, one may have peripheral white-blood-cell count and hemoglobin checked; they are generally above normal. Urinalysis may show urine protein and red and white blood cells.
If a patient shows signs of Maqianzi poisoning, immediately place him in a dark room, keep him quiet, and avoid light, sound and other external stimuli. As soon as possible use central nervous system depressants, such as sodium thiopental or sodium amobarbital 0.3-0.5 g intramuscularly, or diazepam 20-30 mg intravenously. If convulsions are still not controlled, light anesthesia with ether may be used.
Once convulsions are controlled, if poison is thought to remain in the stomach, gastric lavage may be done with 0.1% potassium permanganate. Drink cow's milk or egg white to precipitate the poison and reduce absorption, but absolutely avoid acidic drinks and opioids. Then give the patient an intravenous drip of high-dose vitamin C and glucurolactone to speed liver detoxification and protect the liver. During convulsions, Wugong (centipede) 3 pieces and Quanxie (scorpion) 6 g may be ground into powder and swallowed. Also use Fengmi (honey) 60 g, Lüdou (mung bean) 30 g and Gancao 30 g, decocted and taken frequently.
The reason I introduce Maqianzi's toxicity, the reactions after poisoning, and the antidote methods in such detail before presenting the herb itself is that Maqianzi is a Chinese herb whose toxicity and action are both very strong. To use its benefits, one must first know its harms; only by being familiar with its toxicity can one use this herb in the clinic with greater care, achieving the goal of safe and effective medication.
Maqianzi is excellent at dispersing swelling, relieving pain and fighting cancer. In TCM circles there is a saying that "without Maqianzi there is no good orthopedics." The secret orthopedic formula Qianjin Jiegu Dan, which has circulated among the Guizhou people for more than two hundred years, has miraculous efficacy; its composition is very simple—Maqianzi and Zhiqiao powder in a 1:2 ratio, made into honey pills. Adults take it 3 times daily, 2 g each time, maximum 8 g per day; children take proportionally less.
Maqianzi is not only widely used in orthopedics for setting bones and healing injuries; it also has strong anti-tumor and cancer-pain-relieving actions, with good efficacy against liver cancer, gastric cancer and bone-metastasis cancer. Research has found that the brucine contained in Maqianzi has a marked inhibitory effect on liver cancer, multiple myeloma, breast cancer, and the solid-tumor sarcoma S180.
Traditional TCM holds that Maqianzi is bitter and warm in nature, highly toxic, and enters the liver and spleen channels. Its main actions are to unblock the collaterals and stop pain, and to disperse nodules and reduce swelling. Its common applications are threefold:
First, treating traumatic injuries and fracture pain and swelling. Maqianzi is good at moving and at relieving pain, and is an essential herb for healing injuries and pain in orthopedics. Classic orthopedic formulas such as Jiufen San (from Jijiu Yingxiao Liangfang) and Bali Fen (from Yizong Jinjian) all use Maqianzi. In treating fracture pain and swelling, Maqianzi is often combined with Ruxiang, Moyao, Honghua, Xuejie, Mahuang and Gusubu.
Second, treating stubborn wind-damp impediment, numbness and paralysis. Maqianzi is good at searching out wind-damp between the sinews and bones, opening the channels and connecting vessels, reaching through to the joints, and has strong pain-relieving power; it is a commonly used herb for stubborn wind-damp impediment pain, spasmodic pain, numbness and paralysis. The Republic-of-China physician Zhang Xichun held that Maqianzi's power to "open the channels and reach through to the joints far surpasses that of other herbs." Maqianzi may be used alone or combined with Mahuang, Ruxiang, Wugong, Quanxie and Jiangcan.
Third, treating welling-abscesses, sores and toxin, and swollen painful throat. Maqianzi has the action of dispersing nodules and reducing swelling, and because of its great toxicity it can attack toxin and relieve pain, so it is often used for welling-abscesses, malignant sores, erysipelas and swollen painful throat. It may be used externally or internally.
Raw Maqianzi is a controlled substance in the People's Republic of China, on the same toxicity level as arsenic, so it cannot be lightly taken internally, and external use must also be cautious. The Maqianzi used internally in the clinic is the various processed forms.
The most common processing method is sand-frying: take clean sand and heat it in a wok over a strong fire, add the Maqianzi, and stir-fry until dark brown, with the surface swollen, the interior reddish-brown and small bubbles forming; then remove, brush off the hairs on the Maqianzi, cool, and use for powdering or crushing. There is also an oil-processing method: mainly heat beef tallow or sesame oil, deep-fry the Maqianzi in the boiling oil, then remove, brush off the hairs, air-dry, and use for powdering or crushing.
After sand-scalding or oil-frying, Maqianzi becomes scorched and bristly, with a crisp texture, making it easy to dehair and powder. After heating, the contents of strychnine and brucine in Maqianzi both decrease, which reduces its toxicity. The toxicity of strychnine and brucine in raw Maqianzi is respectively 10 times and 15.3 times that of their processed nitrogen-oxide compounds, so the toxicity of processed Maqianzi is greatly reduced, while its clinical efficacy is not reduced.
Countless famous TCM formulas through the dynasties contain Maqianzi. I append below a selection of those related to tumors:
Longma Zilai Dan (from Wang Qingren's Yilin Gaicuo): Maqianzi eight liang, Dilong (earthworm) eight pieces (cleaned of earth, baked dry and ground into powder), sesame oil one jin. Boil the sesame oil in a wok, add the Maqianzi and fry; when the Maqianzi begins to make slight crackling sounds, cut one in half and check that the interior is purplish-red; then grind into a fine powder, mix in the earthworm powder, and form with flour paste into pills as small as mung beans. Take 3-4 fen per dose, washed down with salt water. For a child aged five or six, take 2 fen, washed down with brown-sugar water. If not made into pills, the powder may also be taken. Each night first take one dose of Huangqi Chifeng Tang (Sheng Huangqi 2 liang, Chishao 1 qian, Fangfeng 1 qian, decocted in water; halve for children), and at bedtime take one dose of the pills. After taking for a month, no need for the decoction; take only the pills, and over time the disease is cured. After curing, continue the pills for another one or two years to guarantee rooting out the disease. Wang Qingren's formula was originally for treating epilepsy; I have read case records of Longma Zilai Dan treating brain tumors, with good results.
Huaji Dan and Kangliu Jian (from Gao Sanmin, "Treatment of 20 Cases of Liver Cancer with Chinese Medicine," Shaanxi Journal of Traditional Chinese Medicine, 2000, 21(3):104). The author Gao Sanmin treated 20 cases of liver cancer with Naosha, Maqianzi, Ganqi, Huangqi, Ezhu, Zhuling, Banxia and Tubiechong; the total effective rate (relief of clinical symptoms) reached 95%.
Pingxiao Pian (or Jiaonang), a commonly used modern anti-cancer patent medicine. Its main ingredients are Yujin, Maqianzi powder, Xianhecao, Wulingzhi, Baifan, Xiaoshi, Ganqi (processed), and Zhiqiao (bran-fried). Its actions are to activate blood and resolve stasis, reduce swelling and disperse nodules, and resolve toxin and relieve pain; it is suitable for a variety of malignant tumors.
In addition, I previously wrote an article introducing a folk secret formula for cancer pain that uses Maqianzi, and appended a modified version I developed on that basis; see my article A Secret Formula for Cancer Pain Shared by a Patient's Family Member.
A few days after this article was published, a patient's daughter prepared the medicine according to my modified formula; after taking it just once, the patient's cancer pain was stopped.
Maqianzi is very widely used in oncology. Mastering Maqianzi's actions and toxicity, and its common compatibility rules, and using it rationally, are basic skills that TCM physicians treating tumors should command.