Herbalism, traditional Chinese
Chinese herbalism is one of the major components of traditional Chinese medicine (TCM), or Oriental medicine (OM). In TCM, herbs are often used in conjunction with such other techniques as acupuncture or massage. Chinese herbalism is a holistic medical system, meaning that it looks at treating a patient as a whole person, looking at the mental and spiritual health as well as the physical health, of the individual. Illness is seen as a disharmony or imbalance among these aspects of the individual. Chinese herbalism has been practiced for over 4,000 years.
One of the earliest and certainly the most important Chinese herbal text is the Huang Ti Nei Ching, or Yellow Emperor's Classic of Internal Medicine. It is believed to have been authored by Huang Ti during his reign over China, which started about 2697 B.C. Since that time, herbal practices have been more extensively documented and refined. In modern China, traditional Chinese herbalism is taught alongside conventional Western pharmacology. Chinese herbal remedies have been used in the West only relatively recently, over the past two decades. These remedies are more gentle and natural than conventional medicines. In addition, they have fewer unpleasant side effects. Individuals with chronic disorders in particular are increasingly drawn to the holistic aspect of Chinese herbalism and TCM in general.
Traditional Chinese medicine originated in the region of eastern Asia that today includes China, Tibet, Vietnam, Korea, and Japan. Tribal shamans and holy men who lived as hermits in the mountains of China as early as 3500 B.C. practiced what was called the "Way of Long Life." This regimen included a diet based on herbs and other plants; kung-fu exercises; and special breathing techniques that were thought to improve vitality and life expectancy.
After the Han dynasty, the next great age of Chinese medicine was under the Tang emperors, who ruled from A.D. 608–906. The first Tang emperor established China's first medical school in A.D. 629. Under the Song (A.D.) 960–1279 and Ming (A.D. 1368–1644) dynasties, new medical schools were established, their curricula and qualifying examinations were standardized, and the traditional herbal prescriptions were written down and collected into encyclopedias. One important difference
between the development of medicine in China and in the West is the greater interest in the West in surgical procedures and techniques.
Philosophical background: the cosmic and natural order
In Taoist thought, the Tao, or universal first principle, generated a duality of opposing principles that underlie all the patterns of nature. These principles, yin and yang, are mutually dependent as well as polar opposites. They are basic concepts in traditional Chinese medicine. Yin represents everything that is cold, moist, dim, passive, slow, heavy, and moving downward or inward; while yang represents heat, dryness, brightness, activity, rapidity, lightness, and upward or outward motion. Both forces are equally necessary in nature and in human well-being, and neither force can exist without the other. The dynamic interaction of these two principles is reflected in the cycles of the seasons, the human life cycle, and other natural phenomena. One objective of traditional Chinese medicine is to keep yin and yang in harmonious balance within a person.
In addition to yin and yang, Taoist teachers also believed that the Tao produced a third force, primordial energy or qi (also spelled chi or ki). The interplay between yin, yang, and qi gave rise to the Five Elements of water, metal, earth, wood, and fire. These entities are all reflected in the structure and functioning of the human body.
The human being
Traditional Chinese physicians did not learn about the structures of the human body from dissection because they thought that cutting open a body insulted the person's ancestors. Instead they built up an understanding of the location and functions of the major organs over centuries of observation, and then correlated them with the principles of yin, yang, qi, and the Five Elements. Thus wood is related to the liver (yin) and the gall bladder (yang); fire to the heart (yin) and the small intestine (yang); earth to the spleen (yin) and the stomach (yang); metal to the lungs (yin) and the large intestine (yang); and water to the kidneys (yin) and the bladder (yang). The Chinese also believed that the body contains Five Essential Substances, which include blood, spirit, vital essence (a principle of growth and development produced by the body from qi and blood), fluids (all body fluids other than blood, such as saliva, spinal fluid, sweat, etc.), and qi.
Because it is a safe and inexpensive solution to health problems of all kinds, Chinese herbalism is very popular in China. In recent years, herbalism has been modernized with the introduction of quality control. For example, herbs are subjected to absorption spectrometry to determine levels of heavy metals found in some. Because they are standardized, Chinese herbs are safer for self-treatment. This approach puts the individual, not the physician, in charge of the individual's health; that is a basic goal of Chinese herbalism.
Chinese herbalism offers unique advice regarding what foods can help and what can hinder, and a herbalist can help an individual discover what he is allergic to. In addition, Chinese herbs stimulate the immune system and provide beneficial nutrients, aside from their role in curing illness.
At M.D. Anderson Hospital in Texas, medical research has confirmed that patients undergoing chemotherapy were shown to have an improved degree of immune function when they took the tonic herb astragalus (huang qi). (It is well known that chemotherapy suppresses the immune system.) Research also showed that T-cell and macrophage activity and interferon production were increased in patients using the Chinese herbs ganoderma, lentinus, and polyporus, helping the body fight cancer cells. Agents also found in ganoderma were found to inhibit platelet aggregation and thrombocyte formation, which would be helpful to counter circulation and heart problems.
An ingredient of ginseng was found to promote adrenal function, which would give the herb properties of enhancing many hormone functions in the body.
Chinese herbal treatment differs from Western herbalism in several respects. In Chinese practice, several different herbs may be used, according to each plant's effect on the individual's Qi and the Five Elements. There are many formulas used within traditional Chinese medicine to treat certain common imbalance patterns. These formulas can be modified to fit specific individuals more closely.
A traditional Chinese herbal formula typically contains four classes of ingredients, arranged in a hierarchical order: a chief (the principal ingredient, chosen for the patient's specific illness); a deputy (to reinforce the chief's action or treat a coexisting condition); an assistant (to counteract side effects of the first two ingredients); and an envoy (to harmonize all the other ingredients and convey them to the parts of the body that they are to treat).
Methods of diagnosis
A Chinese herbalist will not prescribe a particular herb on the strength of symptoms only, but will take into consideration the physical condition, emotional health, and mental state of the patient. He or she may look at the condition of the patient's hair, skin, and tongue, as well as the appearance of the eyes, lips, and general complexion. The practitioner then listens to the sounds the body makes when breathing. He or she may smell the breath, body odor, or sputum in diagnosis.
TCM practitioners take an extensive medical history of a patient. He or she may ask about dietary habits, lifestyle, and sleep patterns. The patient will be questioned about chief medical complaints, as well as on his or her particular emotional state and sexual practices.
Chinese herbalists employ touch as a diagnostic tool. They may palpate the body or use light massage to assess the patient's physical health. Another chief component of Chinese medical diagnosis is pulse diagnosis, or sphygmology. This is a very refined art that takes practitioners years to master. Some practitioners can detect 12 different pulse points that correspond to the 12 major organs in Chinese medicine. There are over 30 pulse qualities that practitioners are able to detect on each point. The strength, speed, quality, and rhythm of the pulse, to name a few, will be determined before a diagnosis is given.
Chinese herbs may be used alone or in combination. Relatively few are used alone for medicinal purposes. Practitioners believe that illness can be effectively treated by combining herbs based on their various characteristics and the patient's overall health. Every herb has four basic healing properties: nature, taste, affinity, and effect.
An herb's nature is described according to its yin or yang characteristics. Yang, or warming, herbs treat cold deficiencies. They are frequently used in the treatment of the upper respiratory tract, skin, or extremities. Yin, or cooling, herbs, treat conditions of excessive heat. They are most often used to treat internal conditions and problems with organs. Herbs can also be neutral in nature.
An herb's taste does not refer to its flavor, but to its effect on qi, blood, fluids, and phlegm. Sour herbs have a concentrating action. They are prescribed to treat bodily excess conditions, such as diarrhea, and concentrate qi. Bitter herbs have an eliminating or moving downward action. They are used to treat coughs, constipation, and heart problems. Sweet or bland herbs have a harmonizing action. They are used as restorative herbs and to treat pain. Spicy herbs have a stimulating action. They are prescribed to improve blood and qi circulation. Salty herbs have a softening action. They are used to treat constipation and other digestion problems.
An herb's affinity describes its action on a specific bodily organ. (Note that Chinese medicine does not have the anatomical correlation for organ names. They correspond more closely to the organ's function.) Sour herbs have an affinity for the Liver and Gallbladder. Bitter herbs act on the Heart and Small Intestine. Sweet and bland herbs affect the Stomach and Spleen. Spicy herbs have an affinity for the Lungs and Large Intestine, whereas salty herbs act on the Kidneys and Bladder.
Chinese herbs are lastly classified according to their specific actions, which are divided into four effects. Herbs that dispel are used to treat an accumulation, sluggishness, or spasm by relaxing or redistributing. Herbs with an astringent action are used to consolidate or restrain a condition characterized by discharge or excessive elimination. Herbs that purge treat an obstruction or "poison" by encouraging elimination and detoxification. Tonifying herbs nourish, support, and calm where there is a deficiency.
Treatment of diabetes
The incidence of diabetes has increased quite dramatically in recent years, especially in the United States, where in general people take less exercise, and food is taken in greater quantity with a general reduction in quality. This increase has led to a scramble to find new solutions to the problem, and many researchers have focused their interest on Chinese herbal remedies. In the search for more effective and more convenient treatments, the alkaloid berberine has come under close scrutiny for its many uses, among them the treatment of diabetes. In trials, rats given a mixture of berberine and alloxan showed less likelihood of incurring a rise in blood sugar. Patients suffering from type II diabetes who were given between 300 and 600 mg of berberine daily for between one and three months showed a reduction in blood sugar levels, when the drug was taken in conjunction with a controlled diet.
Treatment of AIDS and cancer
Independent researchers are investigating indications that Chinese herbalism can reduce the toxicity of chemotherapy and other medications, in addition to stimulating immune responses.
Treatment of diarrhea associated with cholera
A team of researchers in Japan has found that some traditional Chinese herbal formulations inhibit the toxin produced by Vibrio cholerae, the microorganism that causes cholera. These preparations appear to be helpful when given in addition to oral rehydration treatment for diarrhea associated with cholera.
Treatment of atopic dermatitis
Some physicians have found Chinese herbal remedies useful in relieving the symptoms of atopic dermatitis, a chronic disorder of the skin that is difficult to treat. Herbal remedies have the advantage of relieving the itching and inflammation associated with atopic dermatitis without the long-term toxic side effects of conventional medications.
Those who are unfamiliar with Chinese herbs and their uses should consult a practitioner before starting any treatment. Once a remedy is prescribed, it may be purchased at Oriental markets or health food stores. Most Chinese remedies prepared for Western markets are standardized and sold in ready-to-use formulations, with instructions for dosage. A Chinese herbalist may prescribe herbs to be made into tea or taken as capsules.
It is best to avoid Chinese herbs that are not sold in a standardized form. Herbs can vary considerably in potency, depending on the time and place of their harvesting. In addition, cases have been reported in Europe as well as the United States of dried Chinese herbs contaminated by sewage or other forms of pollution.
When treating a patient, the herbalist will aim to gently "nudge" the system into shape, rather than producing any immediate reaction. A return to health, therefore, may take time, and it is important that the patient realize the principles underlying the treatment. Some practitioners estimate that treatment will take a month for every year that a chronic condition has existed. The advantage of the slow pace is that if there is a bad reaction to any herb, which is rare, it will be mild because the treatment itself is gentle.
As with most naturopathic therapies, Chinese herbal remedies work best when taken in conjunction with a healthy lifestyle and program of exercise.
Some Chinese herbs are incompatible with certain prescription drugs or foods. Others should not be taken during pregnancy. Because of possible interactions, persons who are interested in taking traditional Chinese herbal remedies should not try to diagnose or treat themselves with these preparations.
Recent studies indicate that some herbs used in Chinese medicines may cause liver damage. Women appear to be more susceptible to such reactions than men. Damage to the liver may range from minor problems involving higher levels of certain enzymes called transaminases, to chronic hepatitis, cirrhosis, and acute liver failure requiring transplantation. Because of these risks, persons considering Chinese herbal treatments should consult a medical doctor before going to the herbalist. It is essential for patients to inform their doctors about all medications or preparations they are taking, including alternative and over-the-counter remedies as well as prescription drugs.
Research & general acceptance
At present, there is renewed interest in the West in traditional Chinese medicine and Chinese herbalism. Of the 700 herbal remedies used by traditional Chinese practitioners, over 100 have been tested and found effective by the standards of Western science. Several United States agencies, including the National Institutes of Health, the Office of Alternative Medicine, and the Food and Drug Administration are currently investigating Chinese herbal medicine as well as acupuncture and Tui na massage. In general, however, Western studies of Chinese medicine focus on the effects of traditional treatments and the reasons for those effects, thus attempting to fit traditional Chinese medicine within the Western framework of precise physical measurements and scientific hypotheses.
Training & certification
Practitioners of Oriental medicine can obtain certification in Chinese herbalism through the National Commission for the Certification of Acupuncture and Oriental Medicine, (NCCAOM). Some states have adopted the NCCAOM examination as all or part of their criteria for licensing. In California, the standards are higher, and these qualifications are not accepted. The licensing titles given by states vary, but herbalists are required to be a doctor of Oriental medicine (OMD or DOMO). In 1990, the U.S. Secretary of Education recognized the National Accreditation Commission for Schools and Colleges of Acupuncture and Oriental Medicine as an accrediting agency.
Molony, David. The American Association of Oriental Medicine's Complete Guide to Chinese Herbal Medicine. New York: Berkeley Publishing Group, 1998.
Oi, H., D. Matsuura, M. Miyake, et al. "Identification in Traditional Herbal Medications and Confirmation by Synthesis of Factors That Inhibit Cholera Toxin-Induced Fluid Accumulation." Proceedings of the National Academy of Sciences of the USA 99 (March 5, 2002): 3042-3046.
Stedman, C. "Herbal Hepatotoxicity." Seminars in Liver Disease 22 (2002):195-206.
Vender, R. B. "Alternative Treatments for Atopic Dermatitis: A Selected Review." Skin Therapy Letter 7 (February 2002): 1-5.
National Center for Complementary and Alternative Medicine <http://nccam.nih.gov/nccam/>.
The California Association of Acupuncture and Oriental Medicine <http://www.CAAOM.ORG/medicine/overview.htm>
For help with herbs and a list of practitioners http://www.craneherb.com/.
Institute of Chinese Materia Medica, China Academy of Traditional Chinese Medicine. Beijing, 100700.
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