| The Many Faces of Herbal Medicine |
| Written by Administrator | |
| Sunday, 15 February 2009 | |
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ELIXIRS, WINES, PILLS AND PORRIDGES The Many Faces of Chinese Herbal Medicine by, Henry McCann, DAOM
As Chinese medicine matures in the United States and other western countries, and as comprehensive training in Chinese herbal medicine becomes more widely available to acupuncture and Oriental medicine providers, these other less commonly understood forms of herbal medicines are growing in understanding and popularity. This article will introduce the many faces of Chinese herbal medicine that up until now have received less press and attention in the west. Hopefully this will demonstrate to practitioners and patients alike that there is a tremendous wealth of material in Chinese herbal sciences that is as yet still untapped. The most commonly used forms of Chinese herbal medicines are decoctions (tang ji), pills (wan ji), and modern pill-like formats such as capsules (jiao nang ji). In particular, the decoction format is the most commonly prescribed type of herbal medicine in Chinese hospitals today, and the form that is mostly taught as the standard of care in American colleges of Oriental medicine. A decoction is a water extraction of herbs usually made at home by the patient. After a formula is prescribed by the physician, the patient takes the raw herbs and boils them for a period of time, after which the herbs are strained out and the resulting liquid consumed. A decoction is a highly potent and convenient way of taking the large dosages of herbs that are often needed to treat acute or serious conditions. Generally, decoctions are thought to be easily absorbed by the body and fast acting because of this easy absorbability. Decoctions are traditionally customized for the specific needs of each patient; they can be modified easily and are thus capable of being adapted to constantly changing clinical presentations. On the negative side, decoctions can have very strong and, to some patients, unpleasant tastes. Some people find the taste so objectionable that they simply cannot drink them. Decoctions also require a significant time in preparation so that many Americans, with busy lives and barely enough time to cook even food, find themselves unable to make the commitment necessary to prepare them at home. One new solution to the problem of cooking time is modern herbal pharmacies that can pre-decoct and then vacuum pack decoctions. This technology is widely used in Chinese hospitals and some of the larger Chinese herbal pharmacies in the West now offer this service. Vacuum packed decoctions allows patients to go home with ready made individualized decoctions packed in single dose sized packets similar to drink pouches. Thus, patients enjoy all the therapeutic benefits of traditional decoctions without any of the inconvenience of preparing them. In both Asia and the West, today decoctions can be made with granular herbal extracts (chong fu ji). A granular extract starts in a pharmaceutical company where single herbs or even complete formulas are decocted, and then concentrated and dessicated. The result is a fine powder of usually a 5:1 or higher concentration that can later be reconstituted by simply stirring in hot water. Physicians prescribe granular extracts just as they would decoctions, the difference being that there is no cooking requirement. Patients simply take the appropriate dose of granular extract powder, add to hot water, and drink as they would any other decoction. Granular extracts have the same aforementioned benefits and drawbacks of traditional decoctions. Unlike traditional decoctions however, granular herbs are highly convenient in that they require no cooking, and are compact and portable. Formulas can also be made into pills or capsules as already mentioned. Pills are very convenient to take and have little or no unpleasant taste associated with them. Thus, not surprisingly, patients are sometimes most compliant when taking pills. Despite their ease of administration, pills cannot be customized as easily as a decoction can, and thus are best given for uncomplicated conditions or for long-term administration when patients will simply not cook decoctions. Pills are also milder than decoctions. Aside from traditional decoctions, tablet, capsules and granular extract powders, there are an incredible variety of other herbal preparations in Chinese medicine. While Asian patients in Asia commonly use these other preparations, they are less known and, therefore, underutilized by western patients. Following are other herbal preparations with some representative formulas. Please note however, that these formulas are provided as examples and should only be taken under the guidance of a license Oriental medicine provider. Medicinal wines are mentioned in classic texts of Chinese medicine dating back to the Yellow Emperor’s Inner Classic (Huang Di Nei Jing Su Wen, Su Wen for short). The 24th chapter of the Su Wen says, “When a person is in frequent shock, blocking up the passages of the master and reticular channels, diseases mostly causes numbness of muscles which should be treated by massage and medicated wines.” There are some recipes in the Su Wen as well, although they are less than palatable for a modern patient. For example, the 40th chapter of the Su Wen reads, “Drum distension should be treated by medicated wine of chicken feces; one dose will produce results, the second dose will cure the disease.” Medicinal wines are made by soaking herbs in grain alcohol (which acts as both a solvent and preservative for the herbs) for a period of time of anywhere from a few weeks to several months. When ready, the resulting liquor is taken small amounts at a time. Like decoctions, the formulas for medicinal wines would ideally be individualized for the specific patient, although wines are a convenient way of ingesting medicinals over long periods of time. Furthermore, they are moderate acting, and have the benefits of both the alcohol as well as the medicinals included in the formula. From the Chinese medical perspective, alcohol is bitter, sweet, and acrid. The acrid (spicy) flavor of medicinal substances or foods means that it courses and spreads qi and blood internally, and can be effective at removing stagnation in the channels. The bitter flavor allows the alcohol to penetrate deeply into the body, and the sweet flavor gives alcohol a supplementing or nourishing quality. Additionally, alcohol is thought to be hot in temperature. Thus, even by itself, alcohol penetrates deeply into the channels to remove cold and stagnation, but simultaneously supplements. When herbs that also remove stagnation, eliminate cold and supplement the body are added to alcohol, the resulting medicinal wine is very potent; not surprisingly tonic formulas are thus often made into medicated wines. Overall they are good for the chronically vacuous patient with some aspect of internal cold, qi stagnation and blood stasis. Because of their warm natures, tonic liquors are more appropriate for regular use in winter. There are contraindications to taking medicinal wines however. First, most medicinal wines are not suitable for patients who tend towards significant over-heating. This is true even of formulas that contain herbs that clear heat; they are not absolutely contraindicated but they must be used with caution. Alcohol should only be ingested in moderation, for in excess it becomes toxic to the body. The celebrated Ming dynasty Chinese herbalist Li Shi Zhen (1518–1593 A.C.E.) summarized alcohol with these words, “Spirits and wine are heavenly drinks. If taken in moderation they will promote circulation of qi and blood, dispel cold and depression and be refreshing. But, they will impair vital essence and stomach qi, consume blood unduly, and induce phlegm-fire if taken intemperately. Furthermore, spirits and wine are very hot in nature, and thus toxic.”
Congee (zhou) is a porridge made from variety of grains, most commonly rice, but also from millet, brown rice, Job’s tear barley, or other grains and legumes. In China simple congees are a popular breakfast food to this day. Occasionally, congees are cooked together with Chinese herbs to make a type of medicated diet therapy. Like medicinal wines, medicated congees can be a convenient and effective way of taking herbal medicines. Also like medicinal wines, medicated congees have a long history in Chinese medicine. The earliest extant texts of Chinese medicine were several manuscripts unearthed from 1972 to 1974 at the Ma Wang Dui tomb sites in Hunan, China. These texts, which date back to 186 B.C.E., contain some recipes for medicated congees. The aforementioned Li Shi Zhen included over 60 medicated congee recipes in his encyclopedic herbal medicine reference, the Ben Cao Gang Mu. The basic procedure for making congees is rather simple. Rice (or another staple grain or legume) is boiled for a few hours in a volume of water that is 5 to 8 times the typical cooking amount resulting in a watery and soupy porridge. Alternately some people prefer cooking congee by putting the rice and water in a slow cooker overnight. To make a medicated congee, appropriate herbs for a patient are added to the rice and water during the cooking process. Because congees are made from food staples, they are easily digested and mild acting, with no significant contraindications. Since rice and most other grains are more neutral in terms of temperature and flavor, compared to medicated wines, there is a much wider applicability of congees in treating all sorts of conditions; the porridge will take on the function, flavor and temperature of the herbs that are cooked within.
Medicated extract syrups, sometimes commonly known as elixirs, are rarely seen herbal preparations in the west. Extract syrups are formulas that are decocted and then highly concentrated before being prepared in a sugar or honey base. The whole process of cooking medicated syrups can take several days, with the concentrating process alone taking 10 to 12 hours of continuous cooking. In the Wu Shi Er Bing Fang (Formulas for the Treatment of Fifty Two Disorders), a text found in the already mentioned Ma Wang Dui tomb sites and the earliest existing book of Chinese herbal formulas, there are 30 syrup recipes. Other classic texts of herbal medicine such as the Qian Jin Yao Fang by Sun Si Miao (581-682 A.C.E.), and the Ben Cao Gang Mu by Li Shi Zhen, contain recipes for medicated syrups as well. Medicated syrups commonly are made with tonic herbs and are used to treat patients with chronic disease or weak constitutions. They are generally mild and slow acting, and thus need to be consumed daily for long periods of time (unlike the previously discussed traditional water decoctions which are much faster acting and more appropriate in acute conditions). Like medicinal wines, syrups are traditionally used more in the winter, as the concentrated nature of the syrup mimics the contracting and dense yin nature of winter. Medicated syrups, especially tonic formulas, were an herbal format favored by Chinese nobility. Their recipes abound in the records of treatments given to members of the Qing elite, the last imperial dynasty to rule over China (1644 – 1912 A.C.E.). In particular, the medical records of the Empress Dowager Ci Xi have been academically studied and then published in both Chinese and English. Since Ci Xi suffered from fatigue, poor digestion, and a weak spleen and kidney, there are many tonic syrups created for her that have survived to today.
Medicated Teas (Cha Ji) Medicated teas are powdered herbal medicines, often in conjunction with ordinary tea leaves (Camellia sinensis) but sometimes not, that are then steeped in boiled water to make tea. This is different from traditional herbal decoctions in that medicated teas are prepared by infusion, that is, they are simply steeped in boiled water rather than cooked for a period of time in the boiling water. These preparations are usually pleasant tasting and mild acting, and thus more commonly used for treating simple disease conditions or for preventing disease and maintaining health. Since they are not decocted, medicated teas require only a very short time to prepare and are thus very user friendly. Because of their mild acting nature, they are suitable for long-term administration in old and young patients alike. One downside of this method of administration is that since the dosage of herbs is so small, medicated teas are not nearly as potent a method of taking herbs as decoctions, pills, granular extracts, or other formats discussed above.
Precious Pills (Dan Ji) Precious pills, known as Dan in Chinese, are a specific variety of pills. Usually, they are larger in size and contain either expensive or rare ingredients, or are used to treat emergency conditions. As such, instead of being taken regularly, they are used on an as-needed emergent basis. Often Dan are prepared as large single pills that are either to be swallowed or chewed. The pills are sometimes coated with precious minerals or metals and then sealed in wax for preservation. Two examples of this type of formula are An Gong Niu Huang Wan and Su He Xiang Wan. An Gong Niu Huang Wan contains many rare ingredients including cow gallstones (Calculus bovis), deer musk (Moschus), cinnabar, and realgar, and is coated in gold foil. It is traditionally used to treat febrile disease that leads to unconsciousness or delirium, such as severe fevers or encephalitis B. Su He Xiang Wan contains similar rare ingredients, such as cinnabar, deer musk, aloeswood, and styrax; this formula is used traditionally in the treatment of sudden loss of consciousness with extreme pain in the chest, such as in acute myocardial infarction. However, since formulas such as these contain potentially toxic ingredients, they are usually prohibited in the United States even though their use continues in Asia. Herb injection is perhaps one of the most innovative modern uses of herbs, and, as the name suggests, it is an integration of Chinese herbal medicine with acupuncture therapy (the word zhen means “needle” or “acupuncture”). In injection therapy, herbs are prepared in sterile solution for intravenous, intramuscular or subcutaneous injection. Often, injections are done at acupuncture points to take advantage of the functions of both the herbs and point. This is a particularly fast acting and potent way of delivering herbs, and an area of much exploration and research in China. Even though this method is commonplace in Asia, it is rarely seen in the United States; only a very few states, such as Florida and New Mexico, permit point injection by Oriental medicine providers.
Chinese medicine bases treatment on both disease diagnosis (bian bing) and pattern diagnosis (bian zheng), however, in modern professional Chinese medicine, pattern diagnosis is considered to be paramount in determining proper treatment. There is an adage in Chinese that says, “different disease, same treatment; same disease, different treatment.” (tong bin yi zhi, yi bing tong zhi) In other words, patients with different diseases may get the same treatment if the underlying pattern of disharmony of the internal organs and channels, the cause, is the same. Likewise, patients with all the same disease or complaint may get completely different treatments if their pattern or cause is different. When assessing patients, doctors of Chinese medicine (also known as Oriental medicine) use the four diagnoses of asking, looking, smelling and touching. Each of these techniques leads the physician to a detailed understanding of a patient’s unique complaints and their causes. The doctor can then go on to prescribe an appropriate combination of herbs, and in what format they should be taken. Thus, to determine which format of herbs is good for an individual patient, they should first consult a professional Oriental medicine provider for an evaluation of their specific needs. Even simple herbal products for general health and wellbeing should be taken after consultation with a professional herbalist. Chinese herbal medicine is regulated in only a few states in the United States. Luckily however, there is a national board that certifies Chinese herbal medicine providers, the National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM). The NCCAOM offers certification in several domains, and most states recognize their certifications as a basis for determining licensure eiligibility for Oriental medicine providers. In order to be sure your herbalist is properly trained, they should be NCCAOM certified in either Chinese Herbology (designated a Diplomate in Chinese Herbology, or Dipl. C.H.), or in Oriental Medicine (designated a Diplomate in Oriental Medicine, or Dipl. O.M.) If they are you can be sure they are competent herbal medicine providers who are also aware of herb safety issues. Chinese herbal medicine has much to offer beyond the most commonly seen decoctions and tablets. As American consumers of Chinese medicine become more savvy and aware of treatment options, they will reap the benefits of a medical system that has served a significant portion of the world’s population for a majority of world history. For more information on herbs, please contact the author or a local licensed Oriental medicine provider.
Henry McCann, DAOM, LAc, is a doctor of acupuncture and Oriental medicine with a private practice in Madison, NJ. Dr. McCann teaches Chinese herbal medicine at the Pacific College of Oriental Medicine (NYC), and is the head lecturer for the Cork Institute of Post-graduate Acupuncture (Ireland). He completed his advanced training at the Oregon College of Oriental Medicine and studied Chinese medical gynecology at the Chengdu University of Traditional Chinese Medicine (China). |
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| Last Updated ( Sunday, 15 February 2009 ) |