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Aging & Longevity, All About Herbs, Internal Medicine, Pain, Prevention

San Qi: The Other Ginseng

Skye Sturgeon, DAOM |

Notoginseng is one of several herbs in the Chinese Materia Medica that is revered as Jīn bù huàn 金不換 or ‘Worth more than gold’. That is, the herb is priceless for its intended purpose.

The genus Panax contains approximately 60 species, which are characterized by the presence of saponin glycosides, including ginsenosides. The most commonly used Panax herbs used in Chinese medicine are Panax Ginseng (Rén shēn 人参), Panax quinquefolius (Xī yáng shēn 西洋參), and Panax notoginseng (Sān qī  三七) (Some texts may refer to this herb as Panax Pseudoginseng, although technically, this is another species). The genus name, ‘Panax’ is derived from the Greek meaning ‘all-healing’ and shares the same root as ‘panacea’. Ren shen and Xi yang shen are notable for their ability to benefit the Qi and generate fluids, while San qi is included in the Materia Medica in the category entitled ‘Herbs that Regulate the Blood’ in the section, ‘Herbs That Stop Bleeding’.

san chi notoginseng

Although its use in Chinese herbal medicine likely antedates, the first published description of its medicinal value is attributed to Li Shi-Zhen in the Ben Cao Gang Mu (Compendium of Materia Medica) in 1596. In ancient times, it was referred to as Shān qī (山漆, mountain lacquer) because of its ability to close wounds by causing the edges of wounds to adhere together. Later the name was changed to the more common name, San qi (Three Seven). One theory for the change is that the mature plant has three petioles with seven leaflets each, although some plants have two or four petioles. It is also said to be suitable for harvest after three years and that the most potent plant should be left to mature until seven years after sprouting.   

Like its genus siblings, Panax notoginseng is an understory plant, typically found in forested areas where it grows beneath taller trees, preferring an elevation greater than 4500 feet. Since the plant thrives in a shade environment, it is cultivated using artificial shade, particularly in shade houses. This method is used to control the environment and optimize growth conditions. In the past after harvesting, the soil was so depleted that it had to remain fallow 20 years between plantings, but now with new soil remediation technologies, replanting time has been significantly reduced to about 5 years.  

Notoginseng’s ‘di dao’ (地道 geo-authentic) region is the hilly forested areas of Tianyang district of Guangxi Province and this lends itself to its alternative name, Tián qī (田七, farm seven) (The Wade-Giles transliteration is sometimes found in older references, Tien chi.), which may also refer to its cultivation in a field or farm rather than wild-crafted in the mountains, even though the wild plants are the most valuable.  According to Bensky, the best notoginseng is produced in mountains and farms of Wenshan in Yunnan Province from the spring harvest. 

Traditional Chinese Medicine 

The dried and sliced root is the part of the plant most commonly used, and can be decocted, although it is quite common to administer the herb in powders, capsules, tablets, and teapills.  San qi / Radix notoginseng is sweet, slightly bitter, and warm, and enters the Liver, Stomach, and Large Intestine channels.  Flos notoginseng (Sān qī huā 三七花), the flower, is sweet, cool, calms the Liver and lowers blood pressure. It can assist in helping hypertension and sore throat. Another form of Notoginseng that is sometimes used is 'Cooked’ Notoginseng (Shu San Qi 熟三七). This herb is broken into chunks, cooked in oil, strained, and cooled before powdering. This processing reduces its ability to stop bleeding and transform stasis but enhances its tonifying action. For weak patients with Qi and/or Blood Deficiency, it can prove to be a valuable tailoring herb when developing a formula. 

Radix Notoginseng is widely used because of its’ unique ability to stop bleeding without causing Blood Stasis and can be used to resolve blood clots. Some sources indicate that Notoginseng mildly tonifies the Blood and assists the Spleen in repairing damaged blood vessels and holding the blood in the vessels. Formally, the TCM functions of San qi are: stops bleeding, invigorates the Blood to transform Blood Stasis, reduces swelling, alleviates pain and removes extravasated Blood (blood that has leaked out of blood vessels into surrounding tissues). The styptic qualities of San qi allow its use for internal and external bleeding including vomiting blood, nosebleed, and blood in the urine or stool. For open cuts or wounds, powdered San qi is applied directly into the wound. Notoginseng is the herb of choice for traumatic injuries, and is used for swelling and pain due to falls, fractures, contusions, and sprains. It can also be used for chest and abdominal pain, as well as joint pain caused by Blood Stasis due to trauma. Notably, it has been shown to be an effective adjunct therapy for penetrating wounds such as those caused by sharp objects, stabbing or gun shots, by stopping or reducing bleeding until more professional medical intervention can be availed. In fact, the awareness of biomedicine to the usage of this herb was first encountered during the Vietnam War era when it was discovered that Vietcong soldiers carried a formulation containing notoginseng (the proprietary formulation Yunnan Bai Yao, which is believed to be comprised of 70% San qi) to self-treat for war injuries and bleeding until they were able to get to a field hospital.

Typical Tongue & Pulse

Although patient presentations vary, the tongue is usually pale or purple, possibly with purple or dark spots, or distended and dark sublingual veins. The pulse can be possibly wiry, choppy, or hollow.

Biomedicine Considerations

Panax notoginseng contains saponin ginsenosides Rb1, Rb2, Rb3, Re, Rd, Rg, Rg2, Rg3, Rh1, and F2, and notoginsenosides , R2, R3, R4, R6 as major constituents. The Rb1, Rd and Rg1 content of  notoginseng has been found to be higher than that of Panax ginseng and Panax quinquefolius. According to the Chinese Pharmacopeia, the acceptable minimum level of the totaled amounts of ginsenosides Rg3 and Rb1 plus notoginsenoside R1 must exceed 5%/wt. These saponins are known for their bioactivity and as such they have been the subject of extensive biomedicine research (examples in the References section). In addition, notoginseng provides a rich source of amino acids, fatty acids, esters, polysaccharides, and flavonoids. 

Notoginseng has several very important functional attributes, including antihypertensive, antithrombotic, anti-atherosclerotic, neuroprotective actions, as well as having anti-inflammatory, antioxidant, and anti-aging effects. In particular, recent clinical trials on treatment with extracts from notoginseng, either alone or in combination with conventional drugs as novel treatment strategies exhibited positive effects in cardiovascular diseases, especially coronary artery disease (atherosclerosis), the coagulation system, angiogenesis (the repair and creation of new blood vessels), myocardial ischemia, and angina. 

Panax notoginseng saponins can regulate signaling pathways associated with inflammation by inhibiting the synthesis of nitric oxide (NO) and IL-2 (an interleukin) expression in dose-dependent manners. The components of San qi exhibited an immunosuppressive effect and promoted the apoptosis (programmed cell death) of damaged or injured cells. 

Notoginseng saponins have also demonstrated positive effects on lipid metabolism and glucose production for both hypoglycemia and hyperglycemia and on absorption of glucose by cells, in addition to reducing some of the inflammatory processes associated with diabetes.

Cautions, Contraindications, and Interferences

  • Contraindicated for those with no Blood Stasis.  
  • Contraindicated for those with Blood Deficiency.  
  • Contraindicated for those with hemoptysis or epistaxis due to Blood Heat. (Combine with cooling herbs) 
  • Use with caution during pregnancy.  
  •  Use caution with Yin Deficiency. (Combine with herbs that nourish the Yin.)  

Medications changed by the liver (Cytochrome P450 1A2 (CYP1A2) substrates) interact with Panax Notoginseng. Check the information accompanying the pharmaceutical drug. (Here is a link to a developing list of Chinese herbs that may have drug interactions, found at Sacred Lotus.com. The American Herbal Products Association offers among its ‘Resources’, The Botanical Safety Handbook. This >1000-page book is available as a book or as an on-line subscription that indicates the safety of each listed species and the potential for drug interactions.  

Use with caution for patients taking anticoagulants such as heparin, warfarin (Coumadin) and enoxaparin (Lovenox) or antiplatelet drugs such as aspirin, dipyridamole (Persantine) and clopidogrel (Plavix) as concurrent use may have an additive or synergistic effect. For more in-depth information on pharmaceutical drugs and Chinese herbs, See in the reference section: Sperber, Chapter 6, Section 8 (Platelet Inhibitors) and Section 9 (Anti-coagulants). 

There are many herbs and dietary supplements that may interfere with clotting mechanisms for a variety of reasons. For a partial list of such interferences, see: https://www.webmd.com/dvt/supplements-that-thin-blood-what-you-need-to-know.

San Qi products available from Mayway Herbs

Administration and Dosage

  • Decoction: 2-10g
  • Honey Pills and Powdered Herbs:1-3g up to 3 times/day 
  • Extract Powder: 3g, 3x/day
  • Severe bleeding: 3-6g up to 3 times/day 
  • Capsules: 2 capsules daily 
  • Teapills: 8 pills 3X/day. Administer half an hour before or one hour after eating. In acute cases, dosage may be increased to 8-12 pills every 2-4 hours, then reduced to a maintenance dose as the formula takes effect. May be used short to medium-term for a few weeks to a month. Once the acute symptoms of this condition are resolved, this formula should be discontinued or combined with an appropriate constitutional formula if administered over longer periods.

In Conclusion

Although Panax Notoginseng may not be as well-known as its close relatives within the genus, San qi is an extremely valuable herb to have on hand. San qi’s hemostatic ability to stop bleeding without stagnation and its wide applications for assisting to treat many commonly encountered conditions in today’s world, including first aid, make it an essential addition to the TCM practitioner’s clinic.

References

About the Author

Skye Sturgeon, DAOM is the Quality Assurance Manager and Special Consultant for Mayway, USA. Skye was the former Chair of Acupuncture & East Asian Medicine and core faculty member at Bastyr University, core faculty member and Faculty Council Chair at the American College of Traditional Chinese Medicine, and President and Senior Professor of the Acupuncture & Integrative Medicine College, Berkeley. Before making Chinese medicine his career choice, Skye held various positions in the Natural Foods Industry for 12 years and prior to that was a clinical biochemist and toxicologist.

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