Chinese Herbal Medicine: The Methods Used in TCM

Because herbal medicine is the most dominant TCM intervention worldwide, we will examine it in some depth. It is important to note that although we have attempted wherever possible to provide dosages, indications, contraindications, and cautions in Part II, it is essential, before using TCM or any other herbals, for patients to review the research and work with a certified TCM clinician. TCM herbals are very potent.

In purchasing any herbals, including TCM, it is imperative to identify a quality manufacturer, preferably one in or subject to U.S. regulatory oversight. Underscoring this point is a study reported in late 1998 in the New England Journal of Medicine. For the development of a computer database of Asian patent medicines, the California Department of Health Services, Food and Drug Branch, studied 260 such preparations collected from California retail herbal stores. Using gas chromatography, mass spectrometry, and atomic absorption methods, the department found that at least 83 of the 260, or 32 percent, contained undeclared pharmaceuticals or heavy metals, while 23 of the 260 had more than one contaminant. Although the majority of the products were tested as accurately labeled and safe, the large percentage of contaminated herbals requires the utmost caution.

About 85 percent of Chinese herbs are derived from plants, about 12 percent are from animals, and about 3 percent come from minerals. TCM herbal materials are generally processed in much the same way as Western herbal medicines. The active part of the plant is separated from the rest of the plant and is cleaned, freed of toxins, dried, and prepared for use. These herbs are then employed in the following forms:

• Crude herbs are boiled to make herbal decoctions or strong teas. This is the preferred method of administering herbs among native Chinese practitioners.
  
  
• Dried decoctions. For convenience, herbal teas can also be made from dried powder. These powders are imported to America from Taiwan, and are also manufactured in the United States by Taiwanese companies.
  
  
• Patent medicines. Herbs are often combined in complex formulas, known as patent medicines. Patent medicine pills are relatively inexpensive, and are convenient. Some also contain Western drugs. However, there is no American quality control over imported products.
  
  
• American pills and extracts. Several American companies now make Chinese herbal formulas. Most notably, the Sun Ten Laboratories in Irvine, California produce herbal supplements to the same standards found among pharmaceutical manufacturers. They tend to be more expensive, but are more uniform in quality, are accurately labeled, and do not contain Western drugs. However, little clinical research has been done on these preparations.

TCM herbs are not prescribed on the basis of their chemistry, as we would understand it in the West. Instead, they are used to introduce certain influences into the body, in order to balance and harmonize the patient's vital energy. This energy is considered to be the primary healing force in TCM.

Chinese herbs are also prescribed on the basis of the Five Elements. Each of the elemental qualities is associated with a characteristic flavor. Wood, for example, is associated with a sour taste. Furthermore, medicinal herbs are also said to have the four natures of hot, cold, warm, and cool. Additionally, a fifth characteristic is identified as bland, which mediates between the others. California acupuncturist Al Stone, in his well- documented acupuncture site on the Internet, has offered an insightful example of how herbs are prescribed. In the case of an arthritis patient whose symptoms are aggravated by damp weather, the TCM interpretation would be that there has been an invasion of cold and damp into the acupuncture meridians and they are lodged in the joints. An herb used to treat this condition might be one that grows in a cold, damp climate, such as sea vine bark. Although this treatment might sound nonrational by the standards of Western medicine, it can, like a great many TCM herbal treatments, be quite effective.

TCM herbs seem to be particularly effective when used in combinations, or formulas. A formula often consists of the principal herb, or King herb; the associate, or Minister; the adjuvant, or Assistant; and the guiding herb, or Messenger. A King herb focuses on the main symptoms and dominates the formula. A Minister herb strengthens the effect of the King herb. An Assistant herb has a variety of different actions, including the treatment of less important symptoms, and the reduction of the toxicity or irritating properties of the King herb. A Messenger herb coordinates the effects of the other herbs, and delivers the herbs to a particular site in the body.

Clearly, Chinese herbal medicine operates on an entirely different principle from the reductionist approach of Western biomedicine, including Western herbalism. Modern Western medicine generally seeks to find a single active agent to address a specific complaint, whereas TCM herbal preparations employ a combination of medicinal substances with complementary qualities. With combinations of herbs, the overall impact of the formula is less drastic, and is intended primarily to harmonize the function of the organs and the qi.

There are 5,767 TCM herbs, but only about 235 are commonly used. In Japan, the national health insurance system recognizes 148 TCM formulas and 118 herbs.

Following are some of the TCM herbs that are commonly used in the United States today.

• Ginseng (Panax ginseng, ren shen). Ginseng root is highly valued as an adaptogen, which helps the body adapt to change, and thus prevent stress-related illness.
  
  
• Tang kuei (Angelica sinensis). Tang kuei is considered an excellent herb for women, but in complex formulas can be used by men to nourish the blood, improve circulation, calm nervous tension, and relieve pain.
  
  
• Ma huang (Ephedra sinensis). Ma huang is used as a stimulant; it opens the breathing passages, relieves lung congestion, and enhances weight loss. Its alkaloid components, ephedrine and pseudoephedrine, have both been made into modern drugs.
  
  
• Licorice (Glycyrrhiza uralensis; gan cao). This root is used to neutralize toxins, relieve inflammation, enhance digestion, and to treat hepatitis, sore throat, muscle spasm, and other ailments. It is present in about one-third of all Chinese herbal prescriptions, and is thought to enhance the effectiveness of many herbal formulas. Excessive consumption over an extended period can cause a sodium-potassium imbalance, with symptoms of fluid retention or rapid heartbeat.
  
  
• Ginger (Zingiber officinale; sheng jiang). Spicy ginger root is beneficial to digestion, neutralizes toxins in foods, increases circulation to the limbs, clears the lungs, and soothes nausea.
  
  
• Cinnamon (Cinnamomum cassia; kuei pi). Cinnamon is used to warm the body, invigorate circulation, and harmonize upper and lower body energy. In large quantities, it can irritate the liver, and should not be used by people with inflammatory liver disease.
  
  
• Coptis (Coptis chinensis; huang lian). Rich in alkaloids, it combats infection and calms the nerves. One of its active ingredients, berberine, has broad antimicrobial activity. Coptis is closely related to the bitter American herb goldenseal.
  
  
• Peony (Paeonia albiflora; pai shao). Peony root is used to regulate the blood. It regulates blood vessels, reduces platelet stickiness, and helps promote circulation. Peony is also often used to help balance the female hormonal system.
  
  
• Bupleurum (Bupleurum chinense). One of the most frequently used herbs in Japanese herbal medicine, it has been used in Japan for treating liver disease, skin ailments, arthritis, menopausal symptoms, corticosteroid withdrawal, ulcers, and mental disorders.
  
  
• Astragalus (Astragalus membranaceus; huang ch'i). Probably the most commonly used herb today in China, it normalizes immune functions and has applications in immune deficiencies, autoimmune disease, and allergies. It is also beneficial to digestion, and to the skin, and is included in many formulas to promote the function of other herbs. Also it has been used in the treatment of AIDS and hepatitis.
  
  
• Salvia (Salvia miltiorrhiza; dan shen). Salvia is used in coronary artery disease, and in other cases where there has been damage to body tissues, including after a stroke or a traumatic injury. It is also used for chronic inflammation, infection, and degenerative diseases. Additionally, it promotes circulation in the capillary beds, reduces blood pressure and cholesterol, and helps liver function.

Many modern pharmaceuticals have been derived from TCM herbs. GBE, an extract of Ginkgo biloba, is used to treat cerebral insufficiency. Tanshinone IIA, isolated from salvia, is a coronary vasodilator. Sodium ferulate, derived from tang kuei, is an antiplatelet agent. Quercitin, derived from a variety of herbs, has anti-ischemic effects. Antiepilepsirine, derived from Piper nigrum, is a potent anticonvulsant. Huperzine A, from Huperzia serrata, is used to treat myasthenia gravis and senile dementia. What was considered alternative is now conventional! This, of course, indicates that these herbs do, indeed, have potent qualities and play a vital role in the future of integrative medicine.

For acute ailments, Chinese herbs might need to be taken for only one or two days, but for chronic problems, they can be taken for many months, or even years. It is unusual in the West to use herbs for such a long period of time, since they tend to be thought of as short-term treatments, like drugs. However, because herbs have milder effects than the drugs that are manufactured from them, long-term use usually doesn't cause side effects. In fact, the ingredients of these herbs are generally eliminated from the system in about four hours.

Also, the potentially toxic qualities of herbs are usually balanced by other herbs. In addition, toxic herbs are usually refined, to eliminate their harmful effects. Contaminants may be present in some TCM formulas in the form of Western drugs, perhaps toxic metals, and fecal matter. Generally, crude Chinese herbs are as safe as those used in Western herbal medicine. Even so, pregnant women and nursing mothers should be cautious about Chinese herbs, and people taking other medicines should be alert for drug interactions. For utmost safety, anyone taking TCM herbs should discuss this use with his or her physician.

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From THE BEST ALTERNATIVE MEDICINE: WHAT WORKS? WHAT DOES NOT? by Dr. Kenneth R. Pelletier.
Copyright © 2000 by Dr. Kenneth R. Pelletier, Inc.
Reprinted by permission of Simon & Schuster, Inc., New York, New York.

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Unless otherwise indicated, Dr. Kenneth R. Pelletier. All Rights Reserved.
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