Yin-natured, Dark Skin Color with a Heavy drinker, Fatty liver, and Insomnia Are Clues of  Zhi Zi Selection.

Finding A Guiding Herb Makes Easier to Find the Most Efficient Formula ⑨ Zhi Zi

Zhi Zi is used for various symptoms caused by hyperactive liver metabolism and increased body temperature

By Hyunchang Cho, L.Ac., Ph.D ([email protected])

1. Pharmacological Hypothesis of Zhi Zi

(1) Zhi Zi promotes liver functions and detoxification, increases bile secretion, and lowers bilirubin levels. It cleanses poisonous alcohol from our bodies. 

(2) Decreased liver detoxification + food toxins leading to more toxins in bloodstream → skin disorder w/redness and rash. 

(3) Zhi Zi lowers increased body temperature due to heat produced from the stressed liver. 

(4) As a result, Zhi Zi seems to treat aversion to heat, localized heat, redness, and heat due to localized inflammation, insomnia w/ frequent awakenings, and such. 

Zhi Zi appears to have liver-related effects. It promotes liver functions and detoxification. In <Pharmacological Interpretation of Oriental Medicine>, Zhi Zi enhances bile secretion and inhibits increasing bilirubin levels in the blood. In <Picture Encyclopedia of Clinically Used Traditional Herbs>, Zhi Zi is said to protect the liver. 

Too much bilirubin in the blood can cause yellowing of the whites in the eyes. Facial complexions tend to turn darker and yellowish if liver functions are weak. This is why Zhi Zi patients tend to have darker skin tones and many pigmented spots on their faces. Therefore, Zhi Zi can be used for various liver disorders, including hangovers from too much drinking, jaundice, etc.

Poor liver detoxification and increased food toxins may lead to more toxins in the bloodstream, resulting in various skin disorders w/ redness and rash. 

Zhi Zi formulas consist of herbs that promote liver functions and herbs that normalize small and large intestinal functions. Herbs promoting liver functions are Zhi Zi, Yin Chen Hao, Huang Bai, Xiang Chi, etc. Herbs that normalize small and large intestinal functions are Da Huang, Mang Xiao, Hou Po, Zhi Shi, Gan Jiang, etc. This means we can speculate that Zhi Zi formulas would include such herbs as the main ingredients. To enhance liver detoxification, liver functions and small and large intestinal functions should be normalized. Food is first absorbed in the small and large intestines and then through the portal veins, eventually reaching the liver. Too many toxins entering the liver will put pressure on the detoxifying capacity of the liver. Herbs like Da Huang, Mang Xiao, Hou Po, Zhi Shi, and Gan Jiang can normalize intestinal functions, reducing the number of food toxins entering the liver and promoting liver detoxification.

In our body, heat production and metabolic activity are most active in skeletal muscles and the liver. This is why most body heat is produced in skeletal muscles and the liver. The liver can produce heat and increase core body temperature through active metabolism. Increased liver metabolism means more body heat. In such cases, Zhi Zi can enhance liver functions, thereby cooling heat produced by the liver and, as a result, body temperature as well.

Zhi Zi is used for various symptoms caused by hyperactive liver metabolism and increased body temperature, such as aversion to heat, localized heat, redness and heat due to acute inflammation, insomnia w/ frequent awakenings, etc.

We assume that Zhi Zi’s insomnia is caused by increased body temperature due to hyperactive liver metabolism. It becomes hard to sustain deep sleep with elevated body temperature throughout the night. Huang Lian and Fu Ling’s insomnia w/ difficulty falling asleep differs from Zhi Zi’s insomnia w/ frequent awakenings. Patients would say things like ‘I usually don’t have problems with falling asleep, but frequently wake up during the night and cannot go back to sleep,’ ‘I frequently wake up at night, or ‘I wish to sleep more, but I tend to wake up early and cannot sleep more.   

Our body temperature needs to go down first to sleep well at night. With Zhi Zi patients, their body temperature remains high, which translates to frequent awakenings during the night and early awakening, as their body temperature rises earlier than other people in the morning.

2. Clinical Signs of Zhi Zi

In Shang Han Lun and Jin Kui Yao Lue, Zhi Zi formulas can be divided into 1)Zhi Zi formulas w/o Xiang Chi and 2)Xiang Chi + Zhi Zi formulas.

With Zhi Zi formulas w/o Xiang Chi, insomnia may be 1) absent, 2) mild, or 3) when severe, it would still appear as frequent awakenings rather than the difficulty to fall asleep. With Xiang Chi + Zhi Zi formulas, difficulty to fall asleep is almost always present and prominent, which is accompanied by chest discomfort (chest fullness) and sometimes Upper Heat and redness of the skin as well. In clinical practice, Xiang Chi + Zhi Zi formulas, with their difficulty falling asleep, chest discomfort, Upper Heat, and redness of the skin, are often hard to distinguish from Huang Lian formulas. I had such difficulties in my early days as well.

As I have come to understand the concept of CAPE and tacit knowledge, the process of distinguishing two herbs (and their formulas) became much easier. Physical symptoms of difficulty to fall asleep, chest discomfort, Upper Heat, and redness of the skin can appear in both Huang Lian and Xiang Chi + Zhi Zi formulas. The difference is that Xiang Chi + Zhi Zi patients are Yin-natured, with the main emotions of sorrow, oppression, and melancholy, and Huang Lian patients are Yang-natured, with the main emotions of anger, engagement, and excitement. You can distinguish these two herbs/formulas with the tacit knowledge of Yin/Yang nature (personality) and main emotions.