Zhizi (Gardenia): Clearing Heat and Relieving Vexation, Benefiting the Gallbladder, Cooling Blood, Reducing Swelling and Relieving Pain

Zhizi (Gardenia) is the fruit of the Rubiaceae plant Gardenia jasminoides. Gardenia flowers have a faint, delicate fragrance that refreshes the heart; the plant is a common ornamental landscape shrub.

The fruit of Gardenia is a commonly used Chinese medicinal. It has very low toxicity, so the Ministry of Health listed it among the first batch of medicines that are both food and medicine. The leaves, flowers, and roots of Gardenia can all be used medicinally, with effects similar to the fruit; however, what ordinary TCM pharmacies use most is the fruit.

Modern pharmacological research has found that Gardenia has liver-protective, cholagogic, blood-pressure-lowering, sedative, hemostatic, and anti-swelling effects. In the clinic, Gardenia is commonly used to treat jaundice-type hepatitis, sprains and contusions, hypertension, diabetes, and similar conditions.

Gardenia contains crocin glycoside aglycones; industrially it can be used as a yellow dye. In ancient China, the yellow garments worn by the nobility were dyed with Gardenia. The Hanguan Yi records: "The dyeing garden produces Gardenia and madder, to supply the dyeing of imperial robes."

Traditional TCM, summarizing clinical experience, holds that Gardenia drains fire and relieves vexation, clears heat and drains dampness, cools blood and stops bleeding, resolves toxin and reduces swelling, and relieves pain. It is indicated for vexation from febrile disease, exuberant liver fire, red eyes and headache, jaundice from damp-heat, lin syndromes (dribbling urinary disorder), vomiting blood and epistaxis, mouth and tongue sores, boils and swellings, and sprain swelling and pain.

According to the TCM theory of four qi and five flavors, the medicinal nature of Gardenia is: "bitter in flavor, cold in nature. It enters the Heart, Liver, Lung, Stomach, and Sanjiao meridians."

It is generally believed that because Gardenia is cold in nature, "those with stomach-cold pain or spleen deficiency with loose stools and diarrhea should avoid it." However, I have used Huanglian Jiedu Tang (which contains Gardenia, Scutellaria, Coptis, and Phellodendron) to treat the diarrhea caused by acute gastroenteritis common in summer and autumn; the effect with Gardenia was better than without it, so one cannot make a blanket statement.

The Bencao Xinfu (New Compilation of Materia Medica) also records of Gardenia: "It stops pain in the heart and ribs, drains fire-evil from the upper jiao, drains damp-heat, resolves the five types of jaundice and yellow disease, stops choleraic muscle cramps and red dysentery. Use it to induce vomiting and it will vomit; use it to purge and it will purge."

Ye Jüquan believed that the reason Gardenia can drain heat, relieve vexation, benefit the gallbladder, and reduce jaundice is that it has a good diuretic effect. In the clinic, Gardenia indeed works well for patients with heat constraint and difficult, dribbling urination.

In Zhang Zhongjing's Shanghan Lun and Jingui Yaolüe, Gardenia is a frequently used herb. Zhizi Chi Tang, Zhizi Gancao Chi Tang, Zhizi Shengjiang Chi Tang, Zhizi Houpo Tang, and Zhizi Baipi Tang in the Shanghan Lun, and Zhishi Zhizi Chi Tang in the Jingui Yaolüe, all use Gardenia.

In the Shanghan Lun and Jingui Yaolüe, Gardenia is often paired with Dan Douchi (prepared soybean). Later, Mr. Shi Jinmo also often paired Gardenia with prepared soybean as a herb pair, prescribing the two together.

Shi Jinmo believed that "Gardenia can drain the evil heat of the heart and lungs, causing it to exit through the urine, and is also good at resolving the constrained fire of the Sanjiao and clearing heat to relieve vexation," while prepared soybean can "sweat and open the couli (interstices), diffuse and vent exterior evil, disperse constraint and relieve vexation." Thus, paired together, Gardenia emphasizes "clearing" and prepared soybean emphasizes "resolving"; "the combined method of clearing and resolving, sweating and releasing the muscles, diffusing exterior evil, clearing interior heat, and resolving constraint and vexation is most exquisite."

The main indication when Gardenia and prepared soybean are used together is "deficiency vexation." The simplest pattern treated by Zhizi Chi Tang is: "vexation and heat in the body, inability to sleep; in severe cases, anguished distress in the heart, restless sitting and lying, indescribable; or fullness and oppression in the chest and epigastrium; or epigastric pain; an empty, gnawing discomfort as if hungry but not hungry; sweating only on the head; a red tongue with yellow coating; a rapid pulse."

These symptoms are commonly seen in colds and in the later stages of warm and febrile diseases; because constrained heat has not been cleared, patients often have chest oppression, vexation and restlessness, insomnia, and profuse sweating (especially head sweating). They are also often seen in children after external contraction, with bodily heat and agitation, clouded spirit and refusal to eat. Therefore Zhizi Chi Tang is also a commonly used pediatric formula; I often use it to treat persistent high fever, clouded spirit and vexation, and incessant crying in children.

In addition, this small formula can also treat menopausal syndrome presenting with the above symptoms.

Zhizi Gancao Chi Tang, on the basis of the above, additionally presents symptoms of "scant qi" and "shortness of breath," and adds Gancao to boost qi.

Zhizi Shengjiang Chi Tang, on the basis of Zhizi Chi Tang, adds one herb, Shengjiang (Fresh Ginger), to treat the Zhizi Chi Tang pattern accompanied by vomiting.

From these three prescriptions we can see that, in treating disease, TCM adds or removes herbs according to the principle: "if the pattern is present, use the herb." Changing one herb changes the main indication.

Zhizi Houpo Tang uses three herbs—Gardenia, Houpo (Magnolia bark), and Zhishi (Immature Bitter Orange)—and treats "vexation with abdominal fullness, restless lying and rising." The main distinction in medication between Zhizi Chi Tang and Zhizi Houpo Tang is that one treats "chest fullness" and the other "abdominal fullness": chest fullness means constrained heat in the upper jiao, abdominal fullness means constrained heat in the lower jiao.

In the past, the "palpation" (qie) in TCM's inspection, listening-smelling, inquiry, and palpation actually included both "pulse palpation" (taking the pulse) and "abdominal palpation" (abdominal examination). Japanese kampo physicians in particular attached great importance to abdominal diagnosis; Japanese kampo doctors have specialized monographs on abdominal examination, such as Fujin Kikan Kiran and Fujin Kikan Kiran Yoku.

Zhizi Chi Tang and Zhizi Houpo Tang are clinically used precisely as a pair distinguished by abdominal signs. Unfortunately, because China has long emphasized the separation of men and women, this abdominal examination, much valued as early as the Han dynasty, has steadily declined.

In Zhizi Houpo Tang, apart from Gardenia, the other two herbs constitute half of a Da Chengqi Tang. Da Chengqi Tang is the classic formula for treating Yangming abdominal-excess syndrome; here, the strongly purgative Mangxiao (Mirabilite) and Dahuang (Rhubarb) in Da Chengqi Tang have been replaced by Gardenia, indicating that the Yangming abdominal-excess syndrome is in the process of forming but has not yet formed, so Rhubarb and Mirabilite are not yet needed to purge. Only Gardenia is used to clear interior heat, so that interior heat exits through the urine and is resolved.

This is a method of expelling evil without injuring the righteous. From this one can see how meticulous Zhang Zhongjing's pattern differentiation and how cautious his medication were.

Zhishi Zhizi Chi Tang is formulated with three herbs: Gardenia, Zhishi, and prepared soybean. This formula may actually also add Houpo. From the above, we then understand that Zhishi Zhizi Chi Tang treats deficiency-vexation with fullness and discomfort in both chest and abdomen: prepared soybean can both diffuse the couli and harmonize the stomach, while Zhishi promotes intestinal peristalsis and resolves Yangming abdominal signs.

Thus Zhishi Zhizi Chi Tang treats deficiency-vexation with fullness and discomfort in the upper and middle jiao. This symptom is commonly seen in patients newly recovered from serious illness, weak and with righteous qi not yet restored, who are again contracted by exterior evil, leading to chest fullness and vexation, anguished distress in the heart, and restless sitting and lying. If the patient has not had a bowel movement for a long time and dry stool has formed, Dahuang may be added to the above formula.

The various formulas formed by pairing Gardenia and prepared soybean are also commonly used for mental disorders. When mental illness presents with the above symptoms, they may also be used at one's discretion.

In addition, when cancer patients have pleural or ascites accompanied by vexation, insomnia, and profuse head sweating, Gardenia and prepared soybean can also be included as a herb pair within a compound formula.

Zhizi Baipi Tang is a commonly used formula for jaundice: Gardenia 15 pieces, Huangbai (Phellodendron) 2 liang (10g), Zhi Gancao (honey-fried Licorice) 1 liang (5g). This formula treats body heat and yellowing, vexation, thirst but not much drinking, uneven sweating, scanty dark urine, yellow coating and rapid pulse.

In modern pharmacological terms, this mainly uses Gardenia's liver-protective and cholagogic effects; from the TCM theoretical perspective, such patients belong to the damp-heat type of jaundice, requiring the damp-heat to be drained out through the urine.

The above formulas mainly use Gardenia's effect of clearing heat and relieving vexation. But each kind of "vexation" has different accompanying signs, so different formulation strategies are needed; this is the hallmark of TCM pattern differentiation and treatment. Leaving aside TCM pattern differentiation and only considering a single herb's modern pharmacological effects, clinical results are hard to satisfy.

There are many other formulas that use Gardenia to clear heat and relieve vexation—for example, Jiawei Xiaoyao Wan, Angong Niuhuang Wan, and Wanshi Niuhuang Qingxin Wan all use this effect of Gardenia; I will not list them one by one here.

Clinically, Gardenia's effect of clearing heat and draining dampness is also commonly used. Besides the Zhizi Baipi Tang above, there is the modern patent medicine Yinzhihuang granules, a commonly used patent medicine for protecting the liver and gallbladder, clearing heat, and reducing jaundice.

I myself often add Gardenia to Yinchen Wuling San to treat jaundice and ascites caused by hepatobiliary disease, with a certain effect, offered for reference.

According to the Shanghan Lun, after taking Gardenia-type formulas, vomiting means recovery—that is, the patient vomits after taking the medicine and then gets well. Patients with acute gastroenteritis or gastroenteric cold may indeed show this "recovery through vomiting" after taking Gardenia-series formulas. However, clinically, patients who vomit after taking Gardenia-series decoctions are rarely seen; over all these years I have not seen a single case, and Professor Hu Xishu said he had also rarely seen vomiting after Gardenia formulas. So this record is not necessarily accurate.

Another major effect of Gardenia is its action of cooling blood and stopping bleeding.

Here I want to mention an elderly patient with hematuria I recently treated. The patient originally had a urinary system stone; after the stone was surgically removed by Western medicine, he continued to have hematuria and painful urination, and various antibiotics were ineffective. With no other way out, he turned to me.

I directly prescribed Xiaoji Yinzi: Shengdi (Raw Rehmannia), Xiaoji (Cephaiophora thistle), Huashi (Talcum), Mutong (Akebia), Puhuang (Typha pollen), Oujie (Lotus node), Dan Zhuye (Lophatherum), Danggui (Angelica), Zhizi (Gardenia), and Gancao (Licorice), 9 g each.

The action of Xiaoji Yinzi is to cool blood and stop bleeding, and to promote urination and free lin. The herbs selected in this formula all have similar effects—cooling blood and stopping bleeding, promoting urination and freeing lin, or activating blood and resolving stasis. Gardenia here has both diuretic and hemostatic effects. When the herbs match the pattern, the patient stopped having hematuria after only two doses.

Besides Xiaoji Yinzi, Shihui San is another famous hemostatic formula containing Gardenia. In addition, Angong Niuhuang Wan, which contains Gardenia, is also quite effective for intractable epistaxis; I have previously written an article specifically introducing this.

Gardenia also reduces swelling and relieves pain. It is an important herb for traumatic swelling and pain; in orthopedic traumatology it is commonly used for bruises and sprains. Grind Gardenia into powder, mix with egg or flour, blend with leek puree, and apply externally to the injured area—it rapidly reduces swelling and pain.

In addition, grind Gardenia and Dahuang in a 2:1 ratio into fine powder, mix with Vaseline into an ointment, spread on a dressing, and apply to the affected area; this treats various无名肿毒 of the yang type (lesions that are red, swollen, hot, and painful). This method can also treat mumps and orchitis.

Dōmoto Junshin summarized the main indications of Gardenia as "severe vexation caused by congestion or inflammatory processes, also treating jaundice and bleeding."

The Bencao Gangmu (Compendium of Materia Medica) also records that Gardenia can be used to treat rosacea and various blood-heat-type skin diseases, which seems also related to Gardenia's blood-cooling and swelling-reducing effects.

Zhu Buxian made a specialized study of Gardenia's pain-relieving effect, writing an article titled "On the Analgesia of Gardenia, Past and Present," which lists effective formulas and cases from famous physicians past and present using Gardenia to treat various pains.

Zhu Buxian believed that Zhizi Ganjiang Tang can be used to treat stomach pain; Liu Hejian also often used equal parts of Gardenia and Gaoliangjiang (Lesser Galangal) to make pills or powders for various abdominal pain that persists after dysentery. The famous modern physician Cheng Menxue was skilled at using this formula for abdominal pain.

The Sushuan Liangfang (Su and Shen's Effective Prescriptions) also records "Cangcu San" (Emergency Powder), used for various cold-hernia abdominal pain, lower abdominal qi, bladder qi, and spleen-kidney pains with spasms and unbearable cramping, sweating and reversal cold. Cangcu San is made of two herbs—Gardenia 49 pieces and Pao Fuzi (processed Aconite) 1 piece—ground together into coarse powder. Each time use 3 qian, one cup of water and half a cup of wine, decoct together to seven-tenths of a cup, and take with a small amount of salt; it is said to have good pain-relieving effect. I have not tried it.

Other physicians have found that using Jianghuang (Curcuma longa) together with Gardenia works well for pain from liver-gallbladder constraint due to cholecystitis and gallstones.

Zhao Rongsheng liked to use Gardenia for women's dysmenorrhea; when treating dysmenorrhea he often used large doses of 30–50 g, reportedly with good effect. For dysmenorrhea due to cold congealing and blood stasis, Zhao often combined Gardenia with Ginger and Guizhi (Cinnamon Twig) or Rougui (Cinnamon bark), with marked effect.

Zhao once treated a dysmenorrhea patient with a chocolate ovarian cyst (5 × 5 × 5 cm), using Shaofu Zhuyu Tang plus 40 g of Gardenia for 50 consecutive doses; the patient recovered and also became pregnant and gave birth to a baby girl.

Zhu Liangchun was skilled at using Gardenia as the principal herb to treat pancreatitis. Modern pharmacological research confirms that Gardenia is indeed effective for pancreatitis: it can raise the body's disease-resistance during an attack, reduce the degree of pancreatic inflammation, and stabilize the acinar-cell membrane during pancreatitis.

References:

1. Liu Duzhou, Newly Compiled Categorized Formulas of the Shanghan Lun
2. Hu Xishu, Hu Xishu's Lectures on the Shanghan Lun
3. Chen Ming, Zhang Yinsheng, Selected Proven Cases of Famous Physicians on Cold Damage
4. Ye Jüquan, Ye Jüquan's Medical Talks on Formula Patterns and Herb Patterns
5. Zhonghua Bencao (Chinese Materia Medica), Editorial Committee of the State Administration of TCM
6. Zhongyao Da Cidian (Great Dictionary of Chinese Materia Medica), compiled by Nanjing University of TCM
7. Lü Jingshan, Shi Jinmo's Herb Pairs
8. Li Shizhen, Compendium of Materia Medica
9. Zhu Liangchun, Collection of Zhu Liangchun's Medication Experience
10. Zhu Buxian, "On the Analgesia of Gardenia, Past and Present," Zhejiang Journal of TCM, 1981(6):16
11. Zhan Wentao, Changjiang Medical Talks
12. Zhang Tingmo, Clinical Chinese Materia Medica
13. Chang Zhangfu, 500 Commonly Backup Chinese Herbs for Clinical Use
14. Dōmoto Junshin, Kōkan Igaku (Imperial Han Medicine)
15. Yoshimasu Tōdō, Yakuchō (Evidence of Drugs)