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CHINESE HERBALISM



Traditional Chinese Medicine (TCM) is an ancient system of healing that bases diagnosis on an individual's pattern of symptoms rather than looking for a named disease. This approach is very different from that of Western Medicine. Chinese herbalism is one element of TCM, the predominant form of Asian medicine worldwide, which covers a vast range of therapies from acupuncture to herbal remedies. Acupuncture is better known in the West, but herbal medicine is much more important in China, and practitioners of Chinese herbalism can now be found all over the world.

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HISTORY

The Nei Jing (The Yellow Emperor's Classic of Internal Medicine), dating to c. 200 B.C.-A.D. 100, is the earliest known document to set out the principles that underlie Traditional Chinese Medicine to this day. This important text takes the form of dialogues between the Yellow Emperor, considered to be the father of Traditional Chinese Medicine, and his follower, Ji Buo. It emphasizes the ideals of moderation, balance, and harmony, which are central to the ancient Chinese philosophy of Taoism. Compendiums such as the 3-rd century Shen Nong Bencaojing (Classic of Roots and Herbs of Shen Nong) provided some of the earliest written documentation of herbal remedies. The first comprehensive encyclopedia of Chinese herbs, the Bencao Gangmu (Outlines of Roots and Herbs Studies), was compiled by Li Shizhen in the 16th century. Around this time, less scholarly reference works for home use also began to be published.

TCM DIAGNOSIS Pulse-taking has been vital to TCM diagnosis for centuries, and notions of decency formerly limited practitioners' touch to only the wrists of female patients.

Western medicine, introduced to China by 16th-century missionaries, gradually threatened to overtake traditional healing. However, the establishment of the People's Republic in 1949 lead to a revival of herbalism, acupuncture, and other ancient medicinal skills, known collectively as Traditional Chinese Medicine. In China, TCM is now taught at universities and practiced in all hospitals alongside Western methods. Its popularity is growing fast in countries with a large Chinese community, such as the U.S., the U.K., and Australia.

HERBAL REMEDIES Herbal remedies in China are often dispensed in hospitals or street pharmacies. A few animal and mineral substances are included under the general heading of "medicinal herbs."

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KEY PRINCIPLES

The concepts of holism, of yin and yang, and of the five elements are the three most important principles of TCM.

TCM views the body holistically, as an integrated whole, so problems in one area affect the other areas, just as treating specific problems benefits the system as a whole. Running through the body are meridians, a network of channels carrying qi, or "life energy". The organs of the body are nourished by the so-called "vital substances": qi, blood, body fluids, and "Kidney essence"; all govern growth and sexuality, and determine the general constitution of each individual. Yin ("moon" or "overcast") and yang ("sun" or "sunshine") symbolize opposing but complimentary forces in nature. Each continually changes into its converse, just as day turns into night, and one helps define the other; without day, we would not know what night was. When the dynamic of yin and yang in the body is disturbed and either one becomes excessive, disease or emotional problems follow. Factors that may provoke a disturbance include infection, accidents, emotional stress, poor diet, pollution, even the time of year and weather conditions.

Yin and yang can be further divided into:

Interior (yin) / Exterior (yang)
Deficiency (yin) / Excess (yang)
Cold (yin) / Hot (yang)

Together, these categories form the 8 principle patterns of potential disharmony, a diagnostic framework used to categorize symptoms. For example, a slow pulse is a "cold" symptom. The treatment principle is to "scatter the cold," bringing yin and yang into balance.

Another key concept in TCM is that of the 5 elements or 5 phases - fire, earth, metal, water, and wood. The qualities represented by the 5 elements can be described to all things in the universe, including the body's internal organs. The Chinese concept of an organ is broader and less literal than its Western equivalent. Just as one element will support or inhibit the function of another (water dowses fire; fire melts metal), so one organ affects another. The kidneys (water) control the heart (fire); the heart controls the lungs (metal).

Herbal remedies are used to rebalance these forces within the body. Herbs are classified under the 5 elements according to taste, each of which denotes a medicinal action: sweet, sour, bitter, pungent, and salty. The opposing yin/yang qualities of hot and cold are linked with the action of specific herbs. Baical skullcap (huang quin), for example is a bitter, "cold" herb, used to lower fever. Each herb is said to work in specific organs and related meridians, and with "tendencies of action"; floating and sinking, ascending and descending. An herb with an "upward" action would be used to treat a "sinking" disorders, such as diarrhea.

THE THEORY OF CHINESE MEDICINE While Western health care practitioners start with a symptom, then look for a specific cause, Traditional Chinese Medicine regards the symptom as a part of a "pattern of disharmony." Yin/Yang and the 5 elements theory are used both to classify the pattern and to determine an effective herbal cure.

YIN & YANG Yang organs are thought to "channel" energy - acute pain, spasms, and headaches indicate excess yang. Yin organs "hold" energy - dull aches and pains, chilliness, and fatigue are signs of excess yin. Most people show a mixture of yin/yang symptoms; the skill of a practitioner lies in discerning the pattern and prescribing the correct remedy. Yin and Yang are traditionally represented as broken and solid lines in symbols known as trigams.

THE FIVE ELEMENTS Each element has a yin organ and a yang organ, plus specific tastes, emotions, and seasons of the year. Qualities belonging to the same element are said to support one another. So, to treat a liver disorder, a yin organ with the element wood, a Chinese practitioner might use sour-tasting herbs, since sour is associated with wood.

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EVIDENCE & RESEARCH

Extensive clinical trials of various herbs and formulas have been carried out in China. Most persuasive for Westerners, however, has been the recent success of Chinese herbs in treating eczema, described in the British Journal of Dermatology in 1992, Dr. David Atheron and Dr. Mary Sheehan, consultants in dermatology at the Hospital for Sick Children, London, undertook a study of 47 children with severe atopic eczema. Dr. Ding Ho and another Chinese herbalist, Dr. Guang Xu, devised the standardized herbal formulas prescribed. Most of the children's eczema showed a 60 percent improvement within 4 weeks, with no side effects (despite concerns that certain herbs could cause liver damage). Interestingly, some children who did not respond to the standardized remedy proved to be responsive when their formulas were individually adjusted.

A further trial with adult atopic dermatitis at the Royal Free Hospital, London, published in The Lancet in 1992, support these findings.

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CONVENTIONAL MEDICAL OPINION

While interest has been sparked by studies such as those described above, the focus of conventional medicine on the physiological causes and symptoms of illness makes it difficult for conventional practitioners to understand concepts such as Yin, Yang, and Qi. Drug companies are seeking to exploit some Chinese herbs, but many health care providers are concerned about the possible side effects of certain remedies.

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CONSULTING A PRACTITIONER Taking The Pulse: TCM identifies 3 different pulse points on each wrist. The locations are related to meridian pathways, said to channel the life energy known as qi through the body.

CONSULTING A PRACTITIONER

The initial consultation may take as long as an hour. Your health is assessed by means of the "Four Examinations" of TCM:

• LOOKING: The practitioner observes all the visible evidence of your state of health, particularly your tongue, the tone of your skin and hair, and the way your move.



• ASKING: The practitioner asks about your family history, habits, body functions, and any symptoms of poor health.



• LISTENING & SMELLING: The sound of your voice and breathing is noted, as is any distinctive body odor.



• PULSE TAKING & TOUCHING: The pulse is checked for quality, rhythm, and strength. Areas of discomfort or pain are examined by touch.

STANDARD TESTS When you first consult a TCM practitioner, you are assessed according to 4 diagnostic methods, 2 of which are illustrated to the left. THE TONGUE reveals vital clues about your pattern of symptoms. TOUCH detects hard and tender areas, keys to yin/yang balance.

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USING CHINESE HERBS

In TCM, herbs are rarely prescribed singly, but are generally taken as a formula. A standard prescription may have 10 to 15 herbs with a history of treating a particular pattern of disharmony. Each herb in the formula has a different role, and each is classified according to its taste and temperature. Practitioners often adapt a basic formula, adding other herbs to suit a patient's age, constitution, and pattern of disharmony.

THE CHINESE HERBAL PRACTITIONER The TCM practitioner has a choice of nearly 6,000 herbs, a few mineral and animal components, and hundreds of different formulas, which all figure in the traditional Chinese pharmacopia.

Remedies are usually taken as herbal teas, prepared in daily doses, but herbs may also be prescribed as pills, powders, pastes, ointments, creams and lotions.

PRECAUTIONS

Always consult a licensed practitioner who is fully qualified to prescribe herbal remedies.

Seek medical advice before taking herbs if you are pregnant, or if you ever had hepatitis or other liver diseases.

Also see Western Herbalism.

Eczema treatments are formulated as pills, powders, decoctions, ointments, and washes. An herbal remedy to treat eczema might include the ingredients shown here (Di Huang, Bamboo leaf, Bai Xian, Pi, Huang Bai, Jin Yin Hua, Mu Dan Pi). Practitioners of TCM often start with a fixed formula, adding or deleting herbs according to the symptoms and the individual.

TREATING ECZEMA USING TCM

In TCM, eczema is believed to indicate an imbalance resulting from excess "heat" (yang). In order to restore harmony, the practitioner would prescribe treatment with "cooling" (yin) herbs - such as dittany (bai xian pi), bamboo leaf, and white barley - in the form of pills, powders, and a decoction of dried plants. Dry, flaky eczema is specifically categorized as an excess of "wind heat" (wind, cold, fire, dampness, dryness, and summer heat being the "six pernicious influences" - environmental factors that play upon disease). Ointment for home treatment would also be prescribed. For weeping eczema (indicating "damp heat"), an herbal compress would be applied.

APPLYING COMPRESSES Cotton gauze strips are soaked in an herbal decoction and applied to the skin to treat itchy, weepy eczema.

HOW LONG DOES A TREATMENT LAST? - The initial consultation lasts about an hour and subsequent sessions 30 minutes.

HOW MANY SESSIONS WILL I NEED? - Some conditions, especially chronic (long-standing) complaints, may require several months of treatment, with consultations every 4-6 weeks. Others may respond favorably after one session. Practitioners also recommend regular checkups.

WILL REMEDIES TASTE UNPLEASANT? - Chinese herbal teas can be notoriously unpalatable to Western tastes.

WILL THERE BE ANY AFTER-EFFECTS? - Allergic reactions may occur in rare cases. If you have nausea, diarrhea, or flulike symptoms after taking an herbal remedy, call your practitioner immediately.

TCM - A PATIENT'S EXPERIENCE

Anya, 48, suffered from migraines and had recently had surgery, chemotherapy, and radiation therapy for breast cancer: "The cancer had gone, and I wanted to clear my system of chemicals. Arthritis was a side effect of treatment that even physiotherapy didn't help. The Chinese practitioner worked bit by bit, adjusting the herbs each week. It's not instant relief - the first thing I noticed was that headaches were less frequent. Three months ago I felt 80 percent better. Now, a year later, it's 99.9 percent. She gives me a week's supply of herbs - 20 to 30 ingredients - and she's very strict about how I take them. The taste isn't too bad, a bit bitter or sour but no worse than some cough medicine. When I drink it I really feel something is happening. Now that the arthritis is relieved, she's working on my immune system so I can fight infection better."

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SELF HELP

Herbal teas, pills, ointments, and tinctures that use Chinese "tonic" herbs, such as ginseng, for minor conditions like fatigue, can be purchased over the counter from reputable suppliers, pharmacies, and health food stores. They may be less effective than those prescribed by a practitioner who will make an individualized diagnosis.

CREAMS & OINTMENTS Creams and ointments that contain a ready-made blend of herbs may be effective for minor skin problems. For persistent conditions, however, always consult a health care provider.

HERBAL TEAS Herbal teas containing standard formulas of herbs are available for a wide range of conditions. Adjusting the amounts of heating and cooling foods in your diet may also help.

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