The various forms and formulations of herbs
Westerners have grown up with medicine that comes in sanitary, often hermetically sealed packages with enclosures only the scientifically trained can read and understand. Western medicines are sugarcoated, perfectly formed pills and capsules in childproof and tamperproof containers. Sterile drugs are administered via tubes directly into a vein or given as an injection. In comparison, especially if one is unprepared, Chinese herbal medicine appears earthy and primitive. Chinese herbs have been likened to a bird's nest or a sack of sticks and twigs and bark and often come as a surprise when a person goes for their first visit to a Chinese doctor.
Although we in the West have grown used to a more removed presentation when it comes to medicine, the fact is that Western pharmaceuticals developed directly from herbology. The roots of Western pharmacology extend as far back as the Ebers Paprus, Egyptian compilations of medical texts circa 1550 B.C., which contain seven hundred magical formulas and folk remedies. In the first century A.D., the Greek physician Dioscorides wrote the first Western pharmacological treatise, a listing of herbal plants used in classical medicine. Before the early ninth century the doctor and pharmacist were one and the same. The herbalist both prescribed and prepared medical compounds. “When I went to school we had a yearlong course called pharmacognosy, the study of plant life and how it relates to human beings and their health,” said Sheldon Miller, R. Ph. (father of Dr. Glenn E. Miller), who earned his pharmacy degree in 1952. “In those days, many of our medications were from herbs, plants, trees, shrubs and so on. Before I graduated from pharmacy school I apprenticed in a drugstore. We had what they called masquerading jars—five-gallon glass jars in which you weighed out a certain amount of tree bark or roots or whatever you were working on. You would add a dilutant such as alcohol or water. The jars would be turned every twenty-four hours. That was my job, picking them up and turning them over. As far as herbs are concerned, we were one step removed from the actual harvesting process. In those days, you were grinding and mixing and folding and filling.”
Mr. Miller remembers when medicines were one step removed from their plant sources—indeed, it has been only since the late eighteenth century that pharmacology has developed with advances in chemistry and biology that enabled drugs to be standardized. Western pharmacology recognized that a natural substance can contain many ingredients, not all of which are responsible for its medicinal effect. Researchers first isolated the ingredient from a plant source that was thought to have the primary healing property for a given condition. Active ingredients are the constituents within the natural substance responsible for a particular biological effect. Isolating the specific active ingredient(s) responsible for a therapeutic effect has been the focus of Western medicine.
The next step was to determine or standardize how much of the ingredient to prescribe. In the early nineteenth century, chemists began to make exciting progress in isolating active ingredients—aspirin (from the bark of willow trees), morphine (from the seeds of poppy flowers), strychnine (from the poisonous Nux Vomica tree), quinine (from the bark of the cinchona tree), penicillin (from molds on grains) and many others—from their crude plant sources. In the twentieth century, and particularly since World War II, pharmacological researchers developed a vast array of new drugs. Since that time, more drugs have been made by chemical synthesis—many of which are chemical imitations of plant medicines. However, a quarter of modern prescription drugs still come from plant sources.
Two thousand years ago, Chinese medical scholars became aware of active ingredients and actually isolated a number of them from mineral sources. However, they quickly noted the problem of side effects and by the late third century, decided to stay with the use of whole natural substances, which contain ingredients that are meant to interact synergistically and to counteract potential side effects. (See chapter 15 for more on isolated active ingredients, side effects and whole natural herbs.)
The first important figure in Chinese herbology was the divine husbandman Shen Nong, who is believed to have lived around five thousand years ago. Shen Nong is mentioned in dozens of books dating as far back as 607 B.C. He is said to have discovered the medicinal properties of herbs by systematically trying herbs himself, sometimes with toxic or adverse reactions, compelling him to quickly find an antidote.
Around the time of Christ, Chinese scholars of herbology began sorting out the knowledge in herbology that had accumulated up to that point. These works eventually led to the writing and compilation of the book Shen Nong's Herbal Materia Medica. The book has three volumes, containing 365 medicinal substances. More than 60 percent of these 365 medicinal substances are still in use today. Shen Nong's Herbal Materia Medica established the basic theory of herbology. It defined the relationships of herbs in a formula and their roles, such as primary, secondary, assisting or facilitating herbs. It explained that the nature of interactions among different herbs in a formula can be synergetic, counterbalancing or contradicting. There are also magnified toxicities, in which case the combination or interaction is to be avoided. The book described the flavors, Energetic temperatures and toxicity of herbs. In addition, under each herb, the book indicated the natural habitat, growing conditions, harvest time, method of processing and method of how to identify the quality of herbs and recognize the genuine species.
In Chinese medicine there are well over eight thousand herbs known to have medicinal qualities. Only about five hundred are commonly used. While not all the substances used in Chinese herbal medicine are technically herbs, the use of the word is standard in Chinese medicine. Herbal formulas contain combinations of roots, seeds, grains, flowers, berries, fruit peel, bark, leaves, stems, kernels, wood, shells, nuts, minerals, pollen, resin, seaweed, clay, fossilized bones and occasionally animal parts or proteins.
Western medicine, such as blood pressure medication, is generally intended to target one specific biological function. For example, a drug can lower blood pressure. But if you take too high a dose for you, or if you are exquisitely sensitive, the drug will reduce your blood pressure to below normal. While Western doctors often pinpoint one specific problem and prescribe one drug for that problem, Chinese herbalists rarely prescribe a single herb but rather combine herbs to achieve a regulating function. Many herbs can normalize a biological function—that is, the same herb that is prescribed to lower the blood pressure in hypertensive people can also raise it in hypotensive individuals. That is the wonder of many herbs. In addition, most herbs provide a wide margin of safety, so you do not usually have to worry about overdosing.
Blood sugar regulation is another example of how Western medicine and Chinese medicine approach an imbalance differently. Patients with hypoglycemia (low blood sugar) or hyperglycemia (high blood sugar) are given different medications by Western medicine. However, in Chinese medicine the same group of herbs can effectively normalize blood sugar, raising or lowering it as the need may be.
The basic medicinal properties of herbs are characterized through the theories of Five Flavors, Four Temperatures, Basic Energetic Tendencies and Meridian Affinities.
Five Flavors
The basic Energetic properties used to characterize herbs are Sour, Bitter, Sweet, Acrid and Salty. Bland and Stringent were added to the original list, but the term Five Flavors remains to this day.
Sour: Any property that is contracting, holding or pulling back is considered Sour.
Bitter: Any property that is clearing or drying is considered Bitter.
Sweet: Any property that is tonifying or harmonizing or that soothes urgency is considered Sweet.
Acrid/Pungent: Any property that disperses or promotes movement of Vital Substance is considered Acrid.
Salty: Any property that is softening (of hardness or any mass) or purging is considered Salty.
Bland: Any property that is draining (Dampness) or promotes urination is considered Bland.
Stringent: Any property that is contracting, holding or pulling back yet is stronger than Sour is considered Stringent.
Four Temperatures
The Four Temperatures (different from physical temperature) used to characterize properties of herbs are Cool, Cold, Warm and Hot. Neutral was added to the list later on.
Cool: Any herb that can counteract or decrease Heat disharmony.
Cold: Similar to Cool but stronger or more extreme.
Warm: Any herb that can counteract or decrease Cold disharmony.
Hot: Similar to Warm but stronger or more extreme.
Neutral: Neither Warm nor Cool. Appropriate to be used for disharmonies other than Heat or Cold in nature.
Basic Energetic Tendencies
The Four Basic Tendencies of Energetic movement of herbs are Ascending, Descending, Floating and Sinking.
Ascending: Any herb that is Energetically uplifting, dispersing or expelling, opening up orifices, or inducing vomit.
Descending: Any herb that is Energetically purging, draining, clearing, calming, dissolving or constricting.
Floating: Similar to Ascending but primarily affects upper part of the body.
Sinking: Similar to Descending but primarily affects lower part of the body.
Meridian Affinities
In Western pharmacology, when you take a drug it will most often evenly distribute throughout your body with the exception of areas such as the brain and placenta, where the body has protective barriers that prevent certain substances from reaching brain and fetal tissue. In Chinese medicine each herb is intended to target particular aspects of your body's Energetic system. It does this by entering specific Meridians. This is known as the herb's Meridian Affinity. For example, if a doctor considers your problem to be related to Liver Energy, he or she will prescribe herbs that target your Liver Energetic system. Although the herbs were used to target this Energetic system, they will also go into other Meridians as well. It is very rare for an herb to only go to one single Meridian. The majority of herbs and herbal formulas target multiple Meridians. On the other hand, of ten thousand known medicinal herbs, only two or three go into all fourteen Meridians.
Each one of the herbs in a Chinese formula has multiple active ingredients that result in various effects on the body. When combined, these herbs can potentially produce a nearly infinite number of interactions.
In every formula there are four essential types of herbs. The primary herb acts as the chief therapeutic agent for the main illness or symptoms, and it is usually in the largest dose. The secondary herb or herbs reinforce the therapeutic effect of the primary herb for the main disease or symptom. It can also act as the chief therapeutic agent for the secondary disease or symptoms. The secondary herb or herbs can be one, a group or several groups depending on the complexity of the patient's condition.
The third type, the assistant herb, reinforces the primary or secondary herbs and counteracts or reduces the toxicity and side effects of these herbs. The assistant herb can be used to buffer any harsh qualities of the primary or secondary herbs if these herbs are too strong for a particular patient.
The fourth herb, the facilitator, may not have any direct therapeutic effect but facilitates the actions of other herbs. The facilitator herb increases the digestibility of all the herbs and increases the synergistic effect of the formula. The facilitator herb also helps deliver the therapeutic properties of the other herbs to the site of the disease. A good example is a patient suffering from attention deficit disorder; the facilitator herb can act upon the blood brain barrier to allow the delivery of the therapeutic properties of herbs to the brain. The cardinal principle of designing an herbal formula is to maximize the positive synergistic medicinal effects while minimizing the undesirable actions and interactions.
When herbs are combined there are many factors to take into consideration. The practitioner must consider that when one factor changes, many other changes may also occur in the body. Sometimes there are very complex interactions. For example, when you drive to work, you have to consider a lot of factors. Your goal is to get to work within a certain time. Sometimes by taking a longer route you can actually get there faster. The distance is not the only factor that you take into consideration. There are traffic conditions, weather and so on.
Herbs are selected based upon your specific Chinese diagnosis. For example, if you have Yin deficiency, an herb that nourishes Yin Energy will be part of your formula. If you have Yang deficiency, an herb that strengthens Yang Energy will be part of your formula. If you have Yang excess, an herb that is Cooling in its Energetic nature will be part of your formula. If you have excess Yin, an herb that is Warming in its Energetic nature will be part of your formula. These are only a few examples.
The art of herb combining is referred to as herbal formulation. All of the elements must work toward a common goal. If you look at one or two herbs individually, you may not recognize how they would help a certain condition, but when looked at in combination their purpose becomes clear. It is possible to create an herbal formula that generates new properties that cannot be derived from individual herbs. In herbal formulation, one plus one plus one does not necessarily equal three. For example, there is a classic formula used to treat anxiety disorder that contains only three herbs: wheat barley, date and licorice. Individually, none of these three herbs can reduce anxiety, but when combined they are very effective. That is the synergy of herbs.
The principal treatment strategies or methods in herbal therapy, referred to as the Eight Strategies/Methods, are: Clearing, Dissolving, Harmonizing, Inducing Vomiting, Purging, Sweating/Releasing Exterior, Tonifying and Warming. Draining and Moving were added to the list later.
Clearing: The herbal treatment strategy to eliminate Heat or Toxin.
Any herb that has this type of effect is considered a Clearing Heat
or Clearing Toxin herb.
Dissolving: The herbal treatment strategy to disperse certain stagnations, soften hardness or masses, or assist digestion of old, undigested foods. It is usually used for abnormally accumulated Qi, Blood, Phlegm, Fluid and foods that cannot be eliminated through Clearing or Purging. Any herb that has this type of effect is considered a Dissolver.
Harmonizing: The herbal treatment strategy to regulate or balance certain relationships or disharmony. It is usually used in the situations where neither simply eliminating nor strengthening is appropriate. Any herb that has this type of effect is considered a Harmonizer.
Inducing Vomiting: The herbal treatment strategy to induce vomiting. It is usually used for helping the body to expel Toxin or abnormally accumulated Foods, Phlegm or Mucus. Any herb that has this type of effect is considered an Emetic (a substance taken to induce vomiting).
Purging: The herbal treatment strategy to clean Stomach and Intestines or induce diarrhea. It is usually used to eliminate stagnations that settled in the digestive tracts such as abnormally accumulated foods, fecal matter, Blood, Phlegm and Fluid. Any herb that has this type of effect is considered a Purgative.
Sweating/Releasing Exterior: The herbal treatment strategy to create or induce perspiration. It is usually used for early stages of imbalances caused by External Causes. Any herb that has this type of effect is considered an Exterior Releaser.
Tonifying: The herbal treatment strategy to strengthen or support Vital Substance. It is usually used for conditions of deficiency. Any herb that has this type of effect is considered a Tonifier or Tonic.
Warming: The herbal treatment strategy to counteract Cold disharmonies or certain stagnations. Any herb that has this type of effect is considered a Yang Warmer or Yang tonic.
Draining: The herbal treatment strategy to promote urination. It is usually used for edema (abnormal Fluid accumulation) or certain types of Dampness. Any herb that has this type of effect is considered a Diuretic.
Moving: The herbal treatment strategy to promote or invigorate the movement of Qi, Blood, Fluid and foods. It is usually used for stagnation. Any herb that has this type of effect is considered a R Mover.
Chinese herbalists have two basic styles. Classical herbalists begin by identifying a classic formulation that best approximates the patient's needs. The herbalist modifies the formula to fit the patient's unique condition. Creative herbalists, such as master herbalist Henry Han, O.M.D., use only the core ingredients from classic formulas and modify them accordingly. In situations when classic formulas do not come close enough to meeting the patient's needs, the creative herbalist will design a formulation from scratch. In time, the creative herbalist compiles an inventory of innovative, unique formulas. The creative herbalist's style allows him or her to be sensitive to newly emergent illnesses that often do not fit with classic formulas and to create highly effective formulas. Dr. Han's creativity in designing formulas has resulted in his reputation for treating difficult illnesses.
There are some fifty thousand herbal formulas that have survived the test of time, although only about five hundred are commonly used, classic formulas. Throughout history, an enormous number of herbal formulas have come and gone. How a particular herbal formula withstands the test of time is in many ways similar to a process of natural selection. If an herbal formula does not adequately address a health problem, it will fall out of use after a while. It is a testament to their effectiveness that many reliable classical herbal formulas were created hundreds of years ago.
Herbal formulas are brewed into a tea called a decoction to extract the medicinal qualities. The best cooking pots are ceramic or glass. Stainless steel is acceptable. Do not use cast iron, aluminum or copper pots as they will transfer these metals into your herbs as well as alter the therapeutic qualities of the herbs you are brewing.
Use bottled or filtered water rather than tap water, which is treated with chemicals and fluoride. The preferred filtering method is reverse osmosis, a method in which water is forced through a semipermeable membrane that separates contaminants from the water.
Begin by soaking your herbs in enough water to cover them by about one-fourth to one-half inch for a minimum of fifteen minutes, a maximum of overnight (eight hours). Soaking herbs too long will cause them to ferment and rot.
Bring the herbs in the same water they have been soaking in to a rolling boil. Turn down the heat to a low simmer and cook, covered, for twenty to thirty minutes. Your herbalist will advise you of the variations in cooking time depending on your formula.
Strain the herbs and reserve the liquid.
Pour fresh water over the herbs to cover them by about one-fourth to one-half inch. Repeat the cooking process.
Strain the herbs again and combine the two batches of liquid. This will be your tea for one day, divided into two or three equal portions depending on your herbalist's instructions. Warm tea over low heat or drink at room temperature.
For certain conditions, your herbalist will prescribe herbs that require longer or shorter cooking times. These herbs will be packaged separately and will come with special cooking instructions.
It is best to drink your herbal tea one hour before eating on a relatively empty stomach so that your body can best absorb the herbs. Most people find Chinese tea a bitter medicine to swallow but feel the healing benefits are worth putting up with the unpleasant taste. If the tea is a little hard to digest, you may drink it one hour after eating, or add a few slices of fresh ginger to the herbs while cooking. If the tea upsets your stomach, tell your herbalist. He or she can adjust your formula to eliminate these or other side effects.
Dried herbs are primarily imported to the United States from mainland China. About 30 percent of the herbs we receive in the United States are cultivated; the rest are grown wild. There are people in China known as herb collectors who make a living collecting herbs in the wild. Each region of China is known for producing certain indigenous herbs. Indigenous, wild-grown herbs are often of superior quality to herbs that are cultivated—even if they are cultivated in their indigenous area. These wild herbs, in general, have a higher concentration of active ingredients and are less likely to be exposed to environmental contamination. Organically cultivated herbs have become available in recent years.
A preliminary visual inspection is done by experts, who inspect raw herbs to make sure they are the correct species and also for freshness and quality. Moldy or otherwise undesirable herbs are discarded. A quality herbal supplier puts herbs through a finely tuned scientific test process to ensure the presence and desired amount of active ingredients. A variety of factors influence the quality of herbs. For example, if herbs are not properly harvested or the climate or soil conditions have been significantly altered, quality can suffer. Improper drying or cleaning methods can also influence quality. Herbs should also be tested for herbicides, pesticides, heavy-metal contaminants or any other harmful substance. Poor-quality and tainted herbs are discarded. Herbs are then put through a preliminary process where they are thoroughly cleaned under running water for a period of time and then sun-dried. The next step is to cut or crush the herbs into smaller pieces in order to maximize surface area. This allows for the optimal extraction of active ingredients when the herbs are eventually combined into a formula and brewed into a decoction.
For certain raw herbs, traditional treatment methods are required to maximize the therapeutic effect while minimizing toxicity. One example is Ban Xia (Pinella), which cannot be used in its raw form due to its strong toxicity. It is
first soaked and then cooked in ginger juice to neutralize its toxicity. Each herb is treated individually with established practices developed over thousands of years. Each dehydrated herb is priced based upon its traditional cost of production, grade of quality, availability and weight. As in Western pharmacies, many herbal apothecaries may add a filling fee for the dispensing of the herbs. The overall cost of a package of dehydrated herbs (one day's dose) ranges from $3 to $15 depending on the type and quantity of herbs your formula contains.
In ancient times, herbs were ground into powder and mixed with honey, as a preservative, and formed into pills. A person had to eat quite a few of these “pills” since the herb powders were not concentrated. Today, dried herbs are processed into patent formulas. The process occurs in a clean room to guard against environmental contamination. Dried herbs are brewed into a decoction in softened and purified water free of heavy metals. The decoction is put through various drying and concentrating processes to create an extract, which can then be compressed into tablets or put into capsules or other dosage forms.
The patent formulas that have already been combined and put into tablet or capsule form obviously cannot be altered or customized. However, loose freeze-dried granules and tinctures (liquid herbs) made up of one single herb can be customized by combining these patent herbs to arrive at a formula that is more suitable for a particular patient. In order to fully customize a formula, each of the herbal ingredients must be available in individual form so that the herbalist can pick exactly the right herbs and combine them in precisely the correct ratios.
The use of patent formulas has several benefits. First is convenience. Patent formulations available as tablets, capsules and tinctures can be obtained without a written formulation. There are a good number of classic patent formulas that can easily be found at most Chinese apothecaries, herbal stores or online herbal stores. Second, if the user makes a mistake in determining the selection of patent formula, it usually will not lead to any significant harmful consequences. Third, although patent formulas are meant for minor illnesses—sim-ilar to the intended use of Western over-the-counter drugs—if someone is suffering from a more serious illness and cannot obtain a customized dried herbal formula, patent formulas can be used in the interim.
It is labor-intensive to customize herbal formulations. An herbalist is required to select all the necessary herbs and relative ratios. He or she must communicate this list to the herbal pharmacist. The herbal pharmacist requires time to accurately fill each formula. The cost of maintaining custom herbs in inventory and filling customized formulas can be two to three times as great as the cost of the herbs themselves. For these reasons, patent formulas are quite a bit less expensive than customized herbal formulas. A patent formula can run between 50¢ and $3 per day.
Patent herbs come from China, Taiwan, Hong Kong and Korea and are even made in the United States. Making patent formulas is considered an art in China, where herbs are selected, harvested and processed into extracts through strictly guarded traditional Chinese medical standards to ensure the quality. Two years ago, the Chinese government mandated that all herbal manufacturers meet Good Manufacturing Practices (GMP) standards.
The Western constitution differs from the Asian constitution. Westerners eat a high-calorie, high-carbohydrate, red-meat-heavy diet, which is Warming, compared to the low-sugar, rice-and-vegetable-based diet of the East, which is Cooling. Lifestyle is another major factor that influences constitution. The pace of life and stress level in the West are notably higher than in the East. Influenced by Chinese medicine, Chinese culture places a great deal of emphasis on moderation and discipline. Westerners have a strong tendency to do things all the way in work and play.
These differences account for the Chinese constitution being Cooler (Yang deficiency or Yin excess), with the Western constitution being Warmer (Yin deficiency or Yang excess). In addition, the Energetic systems of these two constitutions are somewhat different. In China, the most common deficiency seen is the Spleen Yang deficiency. In the United States Kidney Yin deficiency along with Liver Energy stagnation are more prevalent.
Formulas created for the Asian population may not be optimal for the opposite Western constitution, or a higher dosage may be required. For these reasons, Dr. Han is continually researching and creating formulas that are optimal for the Western constitution. You can purchase these formulas—traditional patent formulas as well as formulas containing both Chinese herbs and Western nutraceuticals—online at ancientherbsmodernmedicine.com. (Nutraceuticals are natural substances that, when taken in specific doses, have positive therapeutic effects.)
Self-treating relatively mild or benign conditions and symptoms with patent herbal formulas can be safe and effective. In potentially life-threatening situations or when one is seriously ill, however, herbal formulas must be prescribed by a trained and experienced herbalist. To maximize the benefits of your treatment, your herbalist and Western physician should collaborate and communicate throughout the course of your treatment. If you are taking Western drugs, always tell your herbalist what medications you are taking. Likewise, always tell your Western M.D. if you are taking Chinese herbs. References on pages 423–430 will help you find a Chinese herbalist to treat you on an individual basis.