Succinum (Amber)

Use in Chinese Medicine
by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon


Succinum is the Latin term for a substance that is ultimately derived from sap (succus is Latin for sap or juice). The collected material is more commonly referred to as amber, a term derived from an Arabic word anbar, that had been used for another and unrelated substance, which we call ambergris or grey amber (a secretion from whales found in small lumps washed up on the beach). Succinum originates from the resin of ancient and long-extinct trees, including conifers (e.g., pine trees) as well Fabaceae and other genera. To become amber, the resin has resided in the ground for millions of years. Amber is best known from the selection of transparent yellowish pieces (other colors are also available) used in making jewelry and sculptures. In this article, the subject is its medicinal use, focusing on Chinese medical applications.

Before moving on to the subject of Chinese amber, it should be mentioned that throughout the past 5,000 years, most of the amber in the world has come from the Baltic region. There is a famous collection spot along the Baltic Sea called the Amber Coast. In recent years, the majority of the world's amber has come from a more limited portion of the Baltic, the Kaliningrad Oblast, a Russian sea port area between Poland and Lithuania.

Most of the relatively limited information about amber's constituents and properties comes from analysis of the Baltic ambers, commonly referred to as succinite (1-3). This material is from resins produced more than 40 million years ago. Whether from China, the Baltic, or elsewhere, the process of amber formation is essentially the same, but the species of tree yielding the resin may be different.

Amber had long been used as a medicinal agent in Europe and the Middle East. However, this practice virtually ceased several centuries ago. Amber was primarily used to alleviate stomach aches and rheumatic pains.

CONSTITUENTS

Not all amber is derived from pine resin, as other trees also release similar resins, but pines are considered a primary source. Pine resin contains a number of aromatic compounds: the terpenes, such as pinene, carene, sabinene, limonene, etc., which may be lost during the period of aging to become amber. There are also molecules that give the resin its sticky quality, such as those that make up the hardened pine resin product called colophonium (rosin), mainly abietic acid (image above) and pimaric acid.

These compounds found in pine resin are either pure hydrocarbon (pinene is an example of a pure hydrocarbon, containing only carbon and hydrogen), or hydrocarbons with small amounts of oxygen. There is very little of any other element in the resin (some resins may contain sulfur; a small amount of minerals might be present).

When the tree resin resides in the ground for millions of years, it hardens as moisture is lost and as some of the hydrocarbons cross-link (polymerize) to form longer chains. Pine resin has a relatively low cross-linking capability, so the process is slow and limited. The resulting amber is still chemically similar to the original resin, but it contains more of an essentially inert hydrocarbon mass, which is what gives it the hardness and glass-like nature that is appreciated when using amber for decorative items. Amber still contains some of the larger terpene molecules (4). In a single study of Baltic amber reported in 1877, but repeated by most modern authors, it was said to have 3-8% succinate (succinic acid), which is probably a derivative of the original simple terpenes.


Mine Photos: Amber mining in the Kaliningrad Oblast (the Yantarny mine). Amber can be collected by individuals who search the Baltic sea shore, where it is washed up by the waves, and that was the primary method relied upon until the first amber mine was established in 1870 (yielding 10,000 pounds of amber per year). To get the large quantities in demand throughout the world, several acres of waterfront land, where rich deposits of amber have been found, are dug up with heavy equipment. Mine yields increased rapidly: jumping to 450,000 pounds per year in 1875, and then gradually increasing to a million pounds per year just before the onset of World War I, which disrupted the mining and sales. Today, the Kaliningrad annual production is about 440 tons (880 million pounds), with estimated reserves of 350,000 tons.



MEDICINAL USES IN CHINA

Succinum is classified in China as being sweet in taste (though, in fact, it has barely any taste, being only slightly bitter and sweet; it has no fragrance), and neutral in nature. It is useless in decoction because so little material is extracted in boiling water (there is some extraction into alcoholic media). Mainly, Chinese amber is ground to powder and swallowed down with water or, more commonly, with a decoction of herbs that make up a formula with the succinum. It is also combined into pills made with powder or extract of the other ingredients. Typical dosing for succinum is 1.5-3.0 grams for one day. Because the powder is very fine, to avoid getting it stuck in the throat or inhaled, it is common to stir the powder into the warm decoction and swallow it down; being soaked in the liquid, the powder won't cause any problems.

In the Materia Medica (5), succinum is listed among the "settling" or "heavy" sedatives, which are mainly mineral materials; in fact, amber is organic and quite light weight. There is an ancient saying in China that "when the tiger dies, its soul enters the earth and transforms into stone," referring to the droplets of amber. So the material is called tiger's soul: hupo (the po is the bodily soul; there are also spirit souls, called hun, that can roam about, but the po goes into the ground). Another sedative used by the Chinese is called fu-shen (spirit of poria), which is a segment of pine root with a solid fungus, poria (also called hoelen), that grows on it. In terms of sedative effects, fu-shen and amber are attributed similar properties. The properties of amber are also shared with other, chemically unrelated, fossil materials such as dragon bone and dragon teeth (mainly fossilized remains of mastodons and other large animals from the ice age period; they are mainly composed of calcium carbonate and other mineral components).

The calming effect of succinum is only one of the claimed properties, which include these main areas:
Subduing fright, tranquilizing the mind, and relieving convulsion. Succinum is used in the treatment of palpitation, amnesia, dreaminess, insomnia, epilepsy, etc. According to Jiao Shude (6), it is mainly used to treat epilepsy; this is typically first diagnosed during childhood, so amber is used in pediatric formulas. According to the traditional Chinese viewpoint (which differs markedly from the modern medical interpretation in this regard), epilepsy is caused by children becoming frightened when they see a strange sight or hear a strange sound. An example of a Chinese treatment for epilepsy in babies and young children is the ancient Hupo Zhenjing Wan (Amber Fright-Settling Pill), a formula of 25 ingredients (7), including minerals (pearl, cinnabar, realgar; the latter two are based on heavy metals), animal parts from endangered species (rhino horn, musk), as well as ordinary herbs (mentha, angelica, uncaria, etc.). A smaller version of this formula is called Hupo San (Amber Powder), with 14 ingredients, but including the cinnabar and musk, as well as other substances of concern; several of its ingredients must be swallowed as powder, the others made into tea. A more suitable formula incorporating amber for modern use is Hupo Duomei Wan (Amber Sleep-improving Pill), made with just five ingredients: amber, codonopsis, hoelen, licorice, and antelope horn (an endangered animal species, that can be substituted by their domestic water buffalo horn); this formula is not indicated for epilepsy, however.
Alleviating water retention and relieving stranguria (difficult urination). Succinum is applied to the urinary disorders such as stranguria complicated by hematuria (blood in the urine), particularly when caused by pathogenic heat. Succinum is considered to be like hoelen, with which it is often combined, in promoting urination through its bland nature. A formula for kidney and bladder stones, with blood in the urine, is called Hupo San (Amber Powder; different than the formula by the same name mentioned above), with amber, plantago seed, juncus, and mentha (the three herbs are made as tea, which is then used to swallow down the amber powder). A modern formula, produced in Taiwan (Kaiser Pharmaceuticals) and sold worldwide, is Hupo Huashi Pian (Amber Stone-Transforming Tablets), which is used for kidney and bladder stones with blood in the urine; the formula includes imperata and san-chi (notoginseng; also called tien-chi ginseng) for stopping or preventing bleeding, and diuretic herbs for promoting the passage of stones. Some of the ingredients of the tablet, such as desmodium, lygodium spore, and orthosiphon, are reputed to shrink stones. In a Chinese clinical report (8), a formula called Paishi Decoction was given to 215 patients with renal, urethra, or bladder stones every four hours, resulting in elimination of stones in nearly 60% of the patients. The formula included amber, dianthus, plantago seed, gardenia, lysimachia, gallus (jineijin), rehmannia, achyranthes, lygodium spore, phellodendron, akebia, and licorice. A similar formula (9), called Rongshi Decoction (replacing dianthus, rehmannia, and phellodendron with malva, talc, bamboo leaf, and rhubarb), was given twice daily to 32 patients with stones in the urinary system. This method required an average treatment time of 45 days, but it was claimed that 30 patients had passed their stones. A third formula of similar nature (10), called Hupo Shiwei Decoction, using pyrrosia, talc, lysimachia, and lygodium spore as the main diuretic herbs, and with several blood vitalizing herbs (e.g., red peony, sparganium, zedoaria, and vaccaria) to accompany the amber, was given three times daily to 51 patients having urolithiasis. It was reported that 35 were cured, and that stones were found in the urine of many of the patients, the largest stone passed was 1.6 x 0.8 cm. In the Chinese clinical work, patients were told to drink plenty of water and also to do jumping exercises to try and help move the stones down.
Promoting blood circulation to remove blood stasis. Succinum is used in the treatment of amenorrhea and abdominal mass caused by blood stasis and stagnation of vital energy. Amber is also recommended for lower abdominal pains affecting the genitalia, such as pain of the testes, prostate, uterus, or vulvar region. Amber is included in the 28-ingredient formula Da Tiaojing Wan (Major Menstruation-Regulating Pill) for irregular and painful menstruation (7). A clinical report (11) described a formula for benign prostate swelling, called Bushen Sanjie Decoction, derived from the traditional Rehmannia Eight Formula with addition of tonic herbs, such as codonopsis, astragalus, and asparagus, and blood vitalizing herbs, including amber, pangolin scale, eupolyphaga. It was claimed that following treatment for 6-12 months, 25 of the 30 patients so treated showed some improvement. Recently, amber has been included in some formulas for treatment of heart disease, because of its claimed blood vitalizing effects; for example, it was combined with ginseng and notoginseng in the treatment of angina (12). Yang Yifan (13) also mentions the use for heart disease, saying: "In clinical practice, it is used for patients with heart diseases when the blood is not circulating properly, and at the same time the patient has palpitations and restlessness, such as seen in coronary heart disease." The same formula with amber, ginseng, and notoginseng has been prescribed in cases of chronic liver disease to normalize the blood conditions (14). Jiao Shude (6) mentions that amber "frees the orifices" which is designation for treating conditions such as atherosclerotic blockage of the arteries and blood clots that can cause angina, heart attack, and stroke.
Other internal uses: Amber is used as an ingredient in tonic formulas, often along with pearl powder. A qi and blood tonic formula for lowering blood lipids-Jianyanling-is comprised mainly of amber, astragalus, pearl, rehmannia, ho-shou-wu, polygonatum root, and American ginseng; in addition to lowering lipids, it is used as an anti-aging formulation and a treatment to aid recovery for cancer patients after undergoing standard medical therapies (15, 16). Succinum is used in treating stomach ache, also in formulas with pearl. An example is the formula designated Weibao; the basic formula is comprised of pearl and amber with alisma, indigo (qingdai), mume, bletilla, licorice, san-chi, and rhubarb. To this, various additions would be made according to the presenting signs. In the study report of 100 patients treated with the Weibao formulas for chronic gastritis, about 80% of patients were said to show significant improvement of symptoms when using the herbs for 3-6 months (17).
Topical applications: Astringing ulcers and promoting tissue regeneration. Used externally, it is efficacious in the treatment of ulcers, boils, swellings, etc.

Since this fossil resin has ingredients in common with those of the original resin, a look at other Chinese pine materials that contain the resin may shed light on the actions of amber. Aside from fu-shen (mentioned previously), there are two of them still used today (5):

Colophonium (pine resin; rosin; originally called songzhi = pine teeth, and now called songxiang = pine fragrance) is said to be sweet and warm, and having the properties of drying dampness and dispelling wind and wind-damp (e.g., treats rheumatism). It is mainly used topically.

Pine Nodes (songjie = pine node) is described as bitter and warm, having the properties of dispelling wind, drying dampness, and strengthening tendons and muscles. It is often used for "rheumatism."

Further, if one examines other resins, such as "dragon's blood" (xuejie), used in Chinese medicine, they are typically recommended for vitalizing blood and alleviating pain, and applied topically to heal wounds.
REFERENCES
FAO Report: Non-wood forest products from conifers: resin. http://www.fao.org/documents/show_cdr.asp?url_file=/docrep/X0453E/X0453e10.htm
Kaliningrad Guide: Environment, Natural Resources, and Related Manufacturing (chapter 7). http://www.informest.it/progetti/kaliningrad/ENG/DOC/guida/7.PDF
Munro J, Amber forever, Saudi Aramco World, 1981; 32(6). http://www.saudiaramcoworld.com/issue/198106/amber.forever.htm
Matuszewska A and John A, Some possibilities of thin layer chromatographic analysis of the molecular phase of Baltic amber and other natural resins, ACTA Chromatographica 2004; 14: 82-91. http://www.us.edu.pl/uniwersytet/jednostki/wydzialy/chemia/acta/ac14/zrodla/07_AC14.pdf
Hsu HY, et al., Oriental Materia Medica: A Concise Guide, 1986 Oriental Healing Arts Institute, Long Beach, CA.
Mitchell C, et al. (translators), Ten Lectures on the Use of Medicinals from the Personal Experience of Jiao Shude, 2003 Paradigm Publications, Brookline, MA.
Huang Bingshan and Wang Yuxia, Thousand Formulas and Thousand Herbs of Traditional Chinese Medicine, vol. 2, 1993 Heilongjiang Education Press, Harbin.
Wang Xinji, Treatment of 215 cases of urolithiasis with Paishi Tang, Hunan Journal of Traditional Chinese Medicine 1987; (2): 8-9.
Jiang Xianming, Treatment of 32 cases of urolithiasis with Rongshi Tang, Hunan Journal of Traditional Chinese Medicine 1987; (2): 10.
Su Zongze, et al., Treatment of 51 cases of urolithiasis with Hupo Shiwei Tang, Pharmacology and Clinical Applications of Chinese Materia Medica 1987; 3(1): 54-56.
Pan Liqun and Huang Shugang, Treatment of 30 cases of prostatic hypertrophy with Bushen Sanjie Tang, Jiangsu Journal of Traditional Chinese Medicine 1987; 8(11): 507-509.
Yuan Jinqi, et al., 116 cases of coronary angina pectoris treated with powder composed of ginseng, notoginseng, and succinum, Journal Traditional Chinese Medicine 1997;17(1): 14-17.
Yang Yifan, Chinese Herbal Medicines Comparisons and Characteristics, 2002 Churchill Livingstone, London.
Yuan Weiqi, Prelminary studies on improvement of serum protein abnormalities of patients with chronic hepatic disease treated with ginseng, notoginseng, and amber powder, Journal of Traditional Chinese Medicine 1990; 31(12): 732.
Qian Zengnian, et al. Anti-aging actions of Jianyanling, Chinese Traditional and Herbal Drugs 1988; 19(7): 307-312.
Lu, Decheng; et al. (1994). Effects of Jianyanling on serum lipids, apolipoprotein, and lipoprotein. Chinese Journal of Integrated Traditional and Western Medicine, 14(3): 142-44.
Yuan Weiqi, Preliminary studies on improvement of serum protein abnormalities of patients with chronic hepatic disease treated with ginseng, notoginseng, and amber powder, Journal of Traditional Chinese Medicine 1990; 31(12): 732.