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Chinese Herbalism in America

Dr. Michael Tierra L.AC., O.M.D.

During the 19th and early 20th centuries, Traditional Chinese Medicine was being overshadowed by Western scientific medicine. Many were turning to this because they admired the lifestyle of invading Western societies such as the British. Part of the Communist revolution of Mao Tse Tung was a revival by the Communists of Traditional Chinese Medicine as in Mao's words, "a national treasure." Under the influence of materialistic Communist socialism, Traditional Chinese Medicine underwent a divestment from its more obvious earlier spiritual and mystical influences from Taoism and other religious philosophies. As such it has enjoyed increasing favor throughout many Western countries. However, many Western practitioners today feel a need to reinstate the universal, non-sectarian spiritual orientation of Traditional Chinese Medicine.

In America, Traditional Chinese Medicine lead by the widespread acceptance of acupuncture and its being legally licensed in the majority of the states, makes it a truly alternative holistic medical practice and it is increasingly including the practice of Traditional Chinese Herbalism. Recently the NCAA a national commission for the testing and certification of acupuncture and Traditional Chinese Medical Doctors have created a separate test certifying practitioners as Chinese Herbalists. This is good news not only because individuals trained as Chinese herbalists will undoubtedly be allowed to use native herbs and herbs from throughout the world but shows a growing trend leading to the recognition of herbalism as a distinct profession in the United States.

Once upon visit to Thailand, I wanted to discover what Thai herbalism was about. They are justly famous for their unique system of Thai massage but a number of Thai people directed me to a Chinese pharmacy and said that in fact, throughout Asian countries, including Africa, Traditional Chinese Medicine was the most respected because it was the most reliably effective system of natural healing. After decades of practice and study of Western, Native American and Ayurvedic systems of medicine, I feel that with its integrated theoretical, diagnostic and medicinal classification system and over 3000 years of accumulated experience, Traditional Chinese Medicine is indeed the most effective system of healing and a truly worthy alternative to Western scientific allopathy. Planetary Herbology, which is what the orientation of the East West Herb Course, is the integration of herbs from around the world into the system of Traditional Chinese Medicine.

The Traditional Classification of Chinese Herbs

Chinese herbalism classifies herbs according to the Four Energies, the Five Flavors, the Four Directions and their relationship to the 12 Internal Organs. While they are called herbs because the majority of the substances used consist of plants, in fact, to a lesser extent, substances from the animal and mineral kingdoms are also used. Herbs are also described as food-like, mildly toxic and very toxic.

The Four Energies

The Four Energies are cold, cool, warm and hot. Sickness is also classified as cold or hot in nature so that herbs that have the ability to oppose or counterbalance a cold or hot disease. Herbs that have a cold energy are used to treat inflammatory and toxic conditions. Some of these are Lonicera and Forsythia blossoms and gentian root for instances. In western herbalism these might be classified as alterative, blood purifying or detoxifying.

Herbs such as dried ginger or cinnamon bark have a warm energy and counteract cold, hypotonic conditions, promoting digestion and circulation. One characteristic of a cold natured disease is clear or white mucus. A tea of fresh or dried ginger is a simple and effective treatment for this condition.

Warm or cool natured herbs are a lesser degree of cold or hot and are used accordingly. There is actually a fifth or neutral energy and commonly includes whole grains and seeds.

The Five Flavors

The Five Flavors are spicy, sweet, sour, bitter and salty. Herbs may have a complex of more than one flavor. This organoleptic classification of herbs is a way that Chinese herbalism relates to the biochemical action of herbs. The flavors of herbs do not always relate to the actual perceived flavors but are used to indicate the actions of specific herbs.

In most cases, herbs with the same flavor have similar properties, while those of different flavors have different properties. However, some herbs may have similar flavors but different properties or different properties with similar flavors. Because of this both the nature and flavors are jointly taken into consideration.

The Four Directions

Herbs have lifting, lowering, floating and descending properties. These may also be interpreted as upward, downward, outward or inward directions in terms of their ability to influence physiological processes.

Lifting refers to herbs that stimulate Yang Qi. Lowering or inward means to sedate or penetrate more deeply. Floating means to extend outward to the surface and usually includes diaphoretic properties. Downward means to purge or treat the lower part of the body.

Herbs with a lifting energy are used for diseases associated with a collapse of Qi, prolapse of various internal organs, coldness, depression, low energy and fatigue. These may include warm tonic herbs such as astragalus root but may also include bupleurum and cimicifuga which while having a cool energy are used to raise the Qi. Mint is also used because it has the ability to direct the Qi upwards to the mind and relieve depression.

Herbs with a floating energy have diaphoretic properties and are used for the initial stages of colds, flus, fevers and eruptive skin diseases. Examples of herbs with this property are numerous and include ephedra (ma huang), cinnamon twigs, mint and schizonepeta.

Herbs with a descending energy are used to treat diseases whose symptoms express themselves upward including symptoms of cough, vomiting and asthma. Two examples of herbs in this category include Pinellia and perilla.

Herbs whose energy is downward have the ability to purge or promote circulation in the lower part of the body. Examples are rhubarb root, angelica du huo and achryanthes.

Herbs also have heavy or light qualities. In general, flowers or leaves are light while roots, seeds or fruits are heavy. So that light herbs a commonly used for treating acute, feverish diseases while heavy herbs are used for deeper, more chronic conditions.

Herbs Classified 12 Internal Organs

In more recent Chinese medical history, herbs have been classified as entering or affecting one or more of the 12 Internal Organs. Since the internal organs in Chinese medicine refer not only to the specific organ but to the acupuncture channel or meridian that belongs to that organ, specific herbs are known to have a more or less specific effect on the corresponding organ meridian. Many of the relationships are obvious and correspond with some exceptions to the relationship of the flavors to the Five Elements.

Herbs with a sweet flavor typically belong to the Earth element and therefore enter the Spleen-pancreas and Stomach organ meridians. These commonly have a nutritive and tonifying energy. Those with spicy a spicy flavor belong to the Lungs and large intestine which are part of the Metal element. At least in terms of the lungs, these have the ability to promote diaphoresis and lessen mucus. Herbs with a salty energy belong to the Kidney-adrenals and bladder which belongs to the Water element. These have the effect of lubricating and moistening bodily tissues. Herbs that are sour enter the Liver and Gall Bladder meridians which belong to the Wood element and these aid in inhibiting and regulating bodily secretions. Finally, herbs that are bitter belong to the Fire element which includes the Heart, Pericardium Small Intestines and Triple Warmer. These are detoxifying and help to clear and improve the circulatory passages.

As stated previously, there are exceptions with the relationship of the flavors with their corresponding organs and acupuncture meridians. Because herbs often have complex biochemical properties, they may have more than one flavor and thus affect and enter more than one organ meridian.

A somewhat minor theory based on Five Element correspondence is the use of herbs according to their colors. Thus green herbs enter the Liver, red colored substances enter Heart, yellow colored herbs enter the Spleen, white colored herbs enter the Lungs and Black colored herbs enter the Kidneys. Besides the actual color of the herbs the Chinese will go through the trouble of coloring pills according to the particular organ that is primarily affected.

Toxic and Non-toxic Herbs:

The materia medica clearly indicates when an herb has reputed toxicity and may be indicated as "toxic" or "slightly toxic". Herbs that are toxic have a much more narrow margin of safety according to dosage and are usually taken for a short period of time ranging from one to five days at a time.

Contraindications:

Contraindications are when an herb is able to aggravate a preexisting condition or imbalance. There are the classically contraindicated and incompatible herbs listed below, herbs contraindicated during pregnancy, avoiding the use of drying or warm natured herbs for conditions associated with Yin deficiency or heat, moistening herbs for conditions of dampness, tonifying herbs for conditions of excess, cold natured herbs associated with conditions of coldness.

The place where one may encounter contraindications with herbs is when they are prescribed too heavily according to a specific disease. Nearly all diseases have at least two faces and more often more, based on the Eight Principles. Most diseases can have underlying excess or deficiency, coldness or heat, chronic or acute, yin or yang as part of the complex and require different herbal approaches accordingly.

Given even this, herbs are relatively safe. In fact, in terms of many physiological propensities, they are have amphoteric or regulating properties. It is wise to use herbs carefully, beginning with a lower dosage with periodic evaluations and reconsiderations at least weekly.

Dietary Restrictions

Certain foods tend to be contraindicated with some herbs and formulas. In most cases this means the avoidance of foods that could aggravate a previous imbalance such as raw, cold foods for conditions of Coldness; hot, spicy foods, heavy, sweet foods, richly nutritious animal protein foods for conditions of Excess; greasy and mucilaginous foods for conditions of Dampness; and foods that are heavy and hard to digest for conditions of Food Stagnation and digestive weakness.

In addition, there are certain herbs that are prohibited to be taken simultaneously with various foods. For instance neither Licorice (Gan cao), Coptis (Huang lian), Platycodon (Jie geng) nor Mume (Wu mei) can be taken with pork. Mint cannot be taken with turtle meat nor Poria mushroom with vinegar.

Principles of Formulation

Chinese herbalism is primarily formula based. Herbs represent an energy comprised of complex biochemical constituents which are enhanced and/or altered when they are combined together.

Formulations can be classified as follows:

  1. Mutually Synergistic: This occurs by combining two or more herbs with similar characteristics intended to amplify the original effect. Examples are the combination of angelica sinensis (dang gui) and ligusticum being two herbs that promote blood circulation, rhubarb and sodium sulfate which are two herbs that promote purgation and gypsum and anemarrhena which are two herbs that reduce fevers and inflammation.
  2. Mutual Assistance: If one herb is used as the major herb, the others are subordinately used to bring out the properties of the major herb. Examples are the use of ephedra (mahuang) and pueraria root to induce perspiration and release the surface, rhubarb root and Scutellaria to purge and detoxify.
  3. Mutually Enhancing: This represents the combination of herbs with different properties that mutually enhance each other's action. Examples are the combination of poria cocos and astragalus root for treating edema and deficient Qi, rhubarb root and Coptis for purging and detoxifying.
  4. Mutually Pacifying: It is possible to combine two herbs together, for instance, so that one eliminates the toxicity of the other. An example is the combination of Pinellia and ginger. In fact, the toxicity of Pinellia is commonly pre-treated with ginger to eliminate its toxic properties. Licorice is combined with prepared aconite to counteract its toxicity.
  5. Mutually Antagonistic: By combining certain herbs together, one will cause the other to lose all or part of its therapeutic effect. An example is the use of ginseng and green tea. Classically Chinese herbalism delineates "nineteen antagonisms". An example is the combination of ginseng with radish seeds.
  6. Mutually Incompatible: A small number of herbs when used together can create toxicity or strong side effects.
  7. Herbs That Are Best Used Alone: Some herbs work best when used alone such as deer antler.

Standard Pharmaceutical Principles of Formulation

Principles of organizing an herbal formula are the same in both traditional western pharmacy as well as Chinese. The Chinese, however, organize their formula to reflect ancient political organization of state as follows:

Two examples of these principles are as follows:

Processing Herbs

Many Chinese herbs are standardly processed for use to enhance their therapeutic properties. Some of these include Angelica sinensis and Rehmannia glutinosa which are presoaked in rice wine and dried for use, Pinellia ternata which is fried in fresh ginger juice to detoxify it and Prepared aconite which for which there are several methods of preparation that can be used to neutralize its toxicity.

In addition to this, herbs can be stir fired in honey to make them warmer and more tonifying such as prepared or baked licorice root. They are also commonly calcined or burnt to enhance their astringent properties.

Chinese herbs are each methodically sliced, tied together or cosmetically presented to prevent adulteration as well as to grade their quality. Because of this, one may find several grades of a single herb available in a Traditional pharmacy.

As with many imported herbs and foods, some are fumigated to preserve their color and fresh appearance as well as to prevent insect infestation. To date, I have never witnessed or heard of any adverse reaction to this processing. It must be remembered that Chinese herbs represent a relatively small part of one's dietary input and are taken on a limited basis to achieve a specific therapeutic objective.

Pills, tablets and extracts taken over a longer period are unprocessed. Furthermore, not all Chinese herbs are fumigated and increasingly, there are Western Chinese importers who are making unfumigated Chinese herbs commercially available. The problem is that the consumer should be aware that cosmetically fumigated Chinese herbs will present a better appearance which does not attest to any therapeutic superiority.

Dosage and Preparation of Herbs

As previously stated, the range of safe dosage for the majority of Chinese herbs is wide while those that are classified as toxic have a much lower range of dosage requirements and preparation.

Metric weights are given throughout this book to conform to Western standards. However, Chinese herbal dosage is customarily given according to their own standard or weights and measures as follows:

Decoctions and Teas

The most common form of Chinese preparation is in decoction and teas. Traditionally these are prepared in a clay pot. They can also be prepared in glass, unchipped enamel or high quality stainless steel without interfering with their properties. They should not be prepared in iron, copper, aluminum or any type of metal that can alter the chemistry of the herbs.

The herbs should be soaked for 30 to 60 minutes in 4 cups of water before exposing them to heat. They are then quickly brought to a boil and simmered until the fluid is reduced by half. This is then strained and the original liquor is set aside for use. The same dose of herbs can be similarly cooked to make two or three further decoctions. The usual dose is one cup twice a day.

Herbs with volatile oils, usually diaphoretics, are usually prepared in less water and cooked for only 5 or 10 minutes. Tonics are simmered in more water for a longer period of time, usually 45 - 60 minutes.

Certain herbs should receive individual extractive consideration based on their constituents. Minerals and shells such as gypsum, oyster and abalone shell, turtle shell, dragon bone are boiled for 15 minutes before the others. Aromatic herbs such as mint, cardamon, Citrus peel, saussurea and others are added for the last 5 to 10 minutes in order to prevent the volatilization of their active constituents. This also applies to some purgative herbs such as rhubarb and senna leaf.

Herbs that are particularly precious should be decocted separately. This may include high grade ginseng and deer antler. This can be taken separately or added to the decoction.

Certain herbs and substances are unsuitable for decoction. These include amber and pseudoginseng. These are finely powdered and infused in warm boiled water or added to the decoction.

Some herbs such as donkey-hide gelatin and malt sugar are dissolved in boiling water or in the finished decoction.

One cup or dose is taken twice a day or as much as three times a day or every four hours for more acute diseases. Tonics are taken before meals, herbs that are bitter and might adversely effect digestion is given after (though not immediately after) meals. Anthelmintics and purgatives should be taken on an empty stomach. Sedatives and tranquilizers should be taken a half hour before bed-time. Anti-malarial herbs should be taken prior to the attack.

In most cases herbs are taken warm. For inflammatory or Heat diseases, they can be taken cool. For Yin Deficiency with Heat signs, the herbs should be taken cool while Yang Deficiency with Cold signs, the herbs are taken in warm decoction.

Pills should be taken with warm boiled water. Liquid alcoholic extracts are either 5 to 1 tinctures or a 1 10 1 extract. The tinctures are taken in prescribed 10 to 60 drop doses while the extract is taken in single to ten drop dosage because of its greater concentration. If one desires to nearly eliminate the alcohol, the prescribed alcoholic extract can be placed in a cup of boiling water, this will leave no more than 2% of the alcohol in solution.

Dried extracts are fast becoming the most popular and convenient form to take Chinese herbs. These are presently manufactured by a handful of companies based mostly in either Taiwan, Hong Kong or Mainland China. They are usually 5 to 1 in potency and the average adult dose is one half to one teaspoon twice daily. Children can take less according to age. These can be taken in hot water or placed in gelatin capsules as desired.

Classical Herbal Formulas

Herbal formulas represent the backbone of Traditional Chinese herbalism. Many of them date back well over 2000 years and have had the benefit of scrutiny and revision of some of the greatest Chinese herbalists down through the ages. Many of these are available in various forms, teas, patented commercial pills, liquid and dried extracts. For the beginning student of Chinese herbalism it is a good principle to emphasize the use of traditional formulas and then branch out to learn basic methods to modify them according to the individual and finally to extract the most salient principle of various formulas to create combinations appropriate for each individual.

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