How Cancer Patients Should Choose Between Renshen, Xiyangshen, Dangshen, and Taizishen

Renshen, Xiyangshen, Dangshen, and Taizishen are four qi-tonifying herbs commonly used in clinic and four healthy-qi-supporting herbs commonly used in oncology. Many tumor patients themselves buy one of these four ginsengs or their extracts as a health supplement. I am often asked by patients which one is best, so I now write this article for a complete introduction.

Though these four are all named “shen,” they are actually not plants of the same family. Only Renshen and Xiyangshen belong to the Araliaceae; Dangshen is a Campanulaceae plant and Taizishen is a Caryophyllaceae plant, so their active constituents differ greatly.

The TCM “eighteen incompatibilities” rhyme includes the line “all shen and x Shao rebel against Lilu.” Traditional TCM holds that the various ginsengs and Veratrum (Lilu) are of opposing properties and cannot be used together. From a modern scientific standpoint, this claim is debatable, but the prejudice has formed and is hard to dispel; patients or relatives with some knowledge of Chinese medicine can easily use it to make trouble for the prescribing doctor. To be cautious and safe, when prescribing, doctors should not put the various ginsengs together with Lilu. Of course, Lilu is an emetic, and few patients nowadays are willing to try TCM emetic methods; those with phlegm stagnation mostly go to hospitals for Western nebulization and suction, so there is little opportunity to use Lilu anyway.

The ℌnineteen mutual antagonisms” rhyme says “Renshen most fears Wulingzhi.” If we prescribe Renshen and Wulingzhi (Trogopterori Faeces) in the same formula, pharmacies will refuse to fill it, because TCM pharmacies still avoid the “eighteen incompatibilities” and ℌnineteen mutual antagonisms.” In practice many TCM doctors use Renshen and Wulingzhi together and consider the effect good; for example, Li Ke often used them this way. Some pharmacies extend the nineteen-antagonism pairing of “Renshen” and “Wulingzhi” to every Chinese medicine named “shen,” which often causes trouble for prescribing doctors.

Renshen is the rhizome of Panax ginseng of the Araliaceae, mainly produced in China's three northeastern provinces and one of the three treasures of the Northeast. Ginseng is also produced in North Korea and South Korea; Korean ginseng is commonly called Gaolishen. Both our Northeast ginseng and Gaolishen are of good quality; I think for routine use the ordinary, moderately priced ginseng in pharmacies is enough, and there is no need to use the most expensive.

What is sold in pharmacies nowadays is mostly cultivated ginseng; wild old mountain ginseng is expensive and unaffordable for ordinary patients. Most of what pharmacies sell is forest-cultivated ginseng from the Northeast; the ginseng used in health supplements is also forest ginseng. The older and larger the forest ginseng, the more expensive and the better its efficacy.

Ginseng products sold in pharmacies are divided into white dried ginseng, red ginseng, and ginseng tails. White dried ginseng is made by washing and sun-drying fresh ginseng; red ginseng is a processed product made by steaming, sun-drying, and oven-drying white dried ginseng. Generally, “renshen” in a TCM prescription means white dried ginseng; if the doctor thinks the patient would do better with the warming-tonifying red ginseng, he will write “hongshen” in the prescription. TCM holds that after white dried ginseng is processed into red ginseng, its warming-tonifying action is stronger. During storage, ginsenosides in white dried ginseng easily leach out; in red ginseng storage ginsenosides are less lost, though some ginsenosides are lost during processing.

Ginseng tails are the root fibers of ginseng and have the same tonifying action, but with weaker force; they are for patients who are weak but not severely weak. In addition, ginseng leaves also enter medicine, with effects similar to ginseng but weaker. Some merchants also sell ginseng flowers.

Ginseng binds with moisture in the air, easily causing loss of ginsenosides, and is also prone to insect infestation, so purchased ginseng must be protected from moisture and insects. Generally, ginseng should be stored in a dry, sealed container, and it is best to place some Xi Xin (Asari Radix) around it; protected by asarum, the chance of insect infestation is reduced.

TCM holds that Renshen is sweet, slightly bitter, and slightly warm; processed red ginseng is purely a warming-tonifying herb. Renshen enters the Spleen, Lung, Heart, and Kidney meridians. It has the actions of greatly supplementing original qi, restoring the pulse and stemming desertion, supplementing spleen qi, generating fluids and nourishing blood, and calming the spirit and benefiting intelligence. The usual dose is 3–9 g; for emergency treatment of massive bleeding it may reach 30–50 g.

Renshen is one of TCM's four great emergency herbs. Folk say “renshen extends life”; it is an herb for emergency when life hangs by a thread. It works well in emergency for massive bleeding and heart failure. Durshen Tang uses only single ginseng, thickly decocted, to rescue what TCM calls “desertion patterns.”

But the problems caused by abusing Renshen are too many to enumerate, and there are reports of deaths from taking it. So the ancients also said: “Renshen killing a man is no crime; Dahuang saving a man is no merit.” Ordinary people like tonics and dislike purgation. Most people who don't know pharmacology abuse Renshen; when excessive warming-tonification kills a patient, no one blames the ginseng, only the severity of the disease. When Dahuang is needed for purgation to save a life, they fear to use it. Chinese patients mostly seem to have this complex, loving to overuse tonics and health supplements.

Renshen should not be used long term. People who long use Renshen or ginsenoside supplements show side effects of excitation, morning diarrhea, rash, insomnia, excessive sweating, nervousness, hypertension, mental euphoria, edema, increased libido, poor appetite, depression, hypotension, amenorrhea, and constipation; medically these are collectively called “ginseng abuse syndrome.” Renshen's side effects resemble corticosteroid poisoning. When a patient overdoses on Renshen and develops high fever and mania, the best antidote is quickly eating raw radish. Those who cannot eat raw radish can stew white radish into a thick broth and drink it as tea.

So Renshen may be used judiciously only when the patient is very weak, or when a cancer patient's blood counts drop sharply during radiotherapy or chemotherapy. Otherwise, cancer patients are not advised to take Renshen or ginseng-extract supplements on their own long term; Renshen should be used under a doctor's guidance.

TCM holds that “excess qi becomes fire”; over-supplementing qi with Renshen produces a yang-overactive and internal-heat constitution, which also tends to promote tumor progression. But not every patient is barred from Renshen; especially weak patients can take Renshen to supplement deficient original qi, with great benefit, and it can inhibit tumor progression. Only patients who are not so weak will get the opposite effect from Renshen.

Renshen can treat qi deficiency tending to desertion with cold limbs and faint weak pulse, spleen deficiency with poor appetite, lung deficiency with cough and wheezing, impotence and uterine cold, qi deficiency with fluid damage and thirst, internal heat and wasting-thirst, qi-blood deficiency, chronic illness and emaciation, heart-qi insufficiency, palpitations and insomnia. In addition, Renshen can be combined with exterior-releasing and purgative herbs for patterns of qi deficiency with external contraction, or internal repletion-heat binding with righteous-qi deficiency. Using Renshen to support the righteous while dispelling pathogen achieves the goal of dispelling pathogen without damaging the righteous. Cancer patients in the late or terminal stage need Renshen.

Modern pharmacology has confirmed that Renshen raises white blood cells, red blood cells, and hemoglobin in the blood of normal or anemic mice, so Renshen can be used for anemia in cancer patients or lowered blood counts from radiotherapy and chemotherapy. If the patient has blood deficiency with sallow complexion and low spirits, grinding Renshen into powder and stirring into the decoction, or decocting it separately and mixing it in, helps restore the blood counts. Renshen also enhances immunity and has anti-tumor effects, which may relate to inhibiting tumor angiogenesis. So for weak tumor patients, using Renshen achieves the dual goals of supplementing qi and blood and fighting the tumor.

Xiyangshen is the root of Panax quinquefolium of the Araliaceae, mainly produced in the United States and Canada and also cultivated in China. Because it was once imported from North America, it is also called Huashenqi. Xiyangshen is sweet, slightly bitter, and cool in nature, entering the Heart, Lung, and Kidney meridians. It supplements qi and nourishes yin, and clears heat and generates fluids. So Xiyangshen suits patients with dual qi and yin deficiency; whenever there is dual qi-yin deficiency with deficiency-heat, vexation and fatigue, cough with phlegm and blood, qi deficiency with fluid damage, dry mouth and throat, or marked internal heat and wasting-thirst, Xiyangshen may be used. It is often brewed as tea, powdered for swallowing, or cut into thin slices to hold in the mouth. Daily dose 0.5–6 g.

Dangshen is the dried root of Codonopsis pilosula, Codonopsis pilosula var. modesta, or Codonopsis tangshen of the Campanulaceae. There is also a “Ming Dangshen,” but that is the dried root of Changium smyrnioides of the Apiaceae, a different herb from the commonly used Dangshen. Ming Dangshen tends to moisten the lung and resolve phlegm, and nourish yin and harmonize the stomach. Dangshen is sweet and neutral, entering the Spleen and Lung meridians. It supplements spleen qi and nourishes blood and fluids. It can be used for spleen-lung qi deficiency, poor appetite and fatigue, cough and deficiency wheezing, qi-blood insufficiency, sallow complexion, dizziness and fatigue, palpitations and shortness of breath, dual qi-fluid damage with shortness of breath and thirst, and internal heat and wasting-thirst. Usual dose 9–30 g, decocted in water.

Taizishen is the dried tuberous root of Pseudostellaria heterophylla of the Caryophyllaceae, sweet, slightly bitter, and neutral, entering the Spleen and Lung meridians. It boosts qi and fortifies the spleen, and generates fluids and moistens the lung. It is used for spleen deficiency with fatigue, poor appetite, post-illness weakness, dual qi and yin insufficiency, spontaneous sweating and thirst, and lung-dryness dry cough. Usual dose 9–30 g, decocted.

These four shen have something in common: all can supplement spleen and lung qi, with Renshen strongest, then Xiyangshen, then Dangshen; Taizishen's force is the weakest. For blood-tonifying effect, Renshen and Xiyangshen are best, Dangshen next, and Taizishen basically has no obvious blood-tonifying effect. So anemic patients should not choose Taizishen but one of the other three. For yin-nourishing and moistening effect, however, Taizishen and Xiyangshen are best.

For pure yin-nourishing and moistening, Taizishen should be considered first, then Xiyangshen. If there is qi-blood deficiency plus internal heat, choose Xiyangshen. Xiyangshen is cool in nature, unlike the warming Renshen (especially red ginseng). Some patients have strong internal heat; using Renshen backfires, causing dry heat, vexation, and thirst, but Xiyangshen both supplements spleen-lung qi and clears deficiency heat.

Renshen should not be taken long term. People with weak constitution who need long-term ginseng-containing Chinese medicine should consider substituting Dangshen for Renshen. The Sheng Mai Yin produced by Tong Ren Tang comes in two versions: Renshen formula and Dangshen formula. Generally, for severe dual qi-yin deficiency, I suggest the Renshen-formula Sheng Mai Yin; for chronic disease requiring long treatment, use the Dangshen formula. Dangshen's side effects are not as marked as Renshen's.