Combining Western Herbs and Chinese Medicine

Citation preview

~.

Foreword H

~,

' *"

the basis of symptoms, without reference to an underlying pattern of disharmony. There was some attempt in the 19th century to take some account of the general constitution of a patient, and some attempt to classify herbs in terms of stimulants and relaxants and so on; but into the 21st century, there has been no satisfactory theory for prescribing herbs. By contrast, the theories of Chinese medicine are well established, encompassing most of human experience, spiritual, emotional, and physical. Many Western practitioners will be surprised to learn that there was a comparable theory system in the herbal medicine of the West that started with Hippocrates in the 5th century BC and was codified by Galen in the 2nd century AD. These Western theories are often remarkably similar to those of Chinese medicine: similarities are not only found in the Galenic system, but also in the later Physiomedical system of the 19th century. For example, in this system, as in Chinese medicine, strong patients are prescribed different herbs from weak patients. The present author's love of the history of herbal medicine has led him to trace its beginnings in ancient Greece and show the development of its theory and practice in the West up to the present day. He draws together the common threads of Western and Chinese tradition, and then uses this new framework of herbal theory to organize the data coming from pharmacological and clinical research. This task needed someone trained in science and skilled in both

used widely throughout the world and in many countries of the East herbal treatment from trained and qualified practitioners is readily available. Sadly, this is not always true in the West. This is a pity, for Western herbs are wonderful, and very effective. For people living in the Western world they have a great advantage over herbs from other countries: they grow here in the West. This means that the plants can be studied at first hand: the way they grow; their preferred habitat; the effect of climate on their therapeutic effectiveness. All can be observed through the changes of the seasons, often in the wild within a few miles of where one lives. They can be gathered in the wild or grown in the garden. All this helps to deepen one's understanding of the nature and action of a herb. From my own 25 years of experience of treating children, I can vouch for the fact that Western herbs can be safe and effective for the treatment of a wide range of pediatric disorders. Nor is the effectiveness of Western herbs limited to children- many of the acute and chronic conditions of adult patients respond well to Western herbs, when these are properly prescribed. So why is it that Western herbs are not more used by health practitioners? The answer lies in the recent absence of any satisfactory theory for prescribing them. For at least 200 years, the ancient Western theories of herbal medicine have been neglected, and herbs have been prescribed mainly on ERBAL MEDICINE IS

IX

Foreword

x

Chinese medicine and Western herbs, with a clear mind to put the whole thing together, and the practicality to test the theories in the clinic. It is not surprising that this has taken a long time, and I am delighted that this book has at last seen the light of day, some 20 years after work first began on the project. There have been many interesting books on herbal medicine written in the last few years, but the present book is exceptional, in containing so much new, and clinically useful

;

....".,

material. For the first time, information on how to use the herbs for different Chinese syndromes has been written down by someone who knows what they are talking about, because they have been using the herbs in clinic for many years. But the information does not stop here. There are complete prescriptions, with analysis of their composition and practical notes on their use, which makes this book stand out in a class of its own. -JULIAN SCOTT, MA, PHD, CERT.Ac. (NANJING)

Preface .. ~

was in science research, which involves two complementary activities. One is the careful gathering of data by close and detailed observation of living material. The other is the attempt to perceive underlying natural patterns within the seeming chaos of the mass of data. These natural patterns can then be represented by theoretical principles, so that the data can be organized, under-

• to classify Western herbs in terms of Chinese values for temperature, taste, actions, and organs entered

stood, and applied. When I first started to study Western herbal medicine in 1973, I was unable to fmd a framework of theoretical principles in the herbal texts then commonly available. There did not seem to be any logical system for matching herbs to disorders or for selecting herbs to form a balanced herb combi-

However, the more I investigated contemporary Western texts, the more I realized that the data they contained derived from a tradition of empirical herb use in the West reaching back over 2000 years. Therefore, I decided to include material from some of the more important materia medica of the past. As I researched the traditional Western texts, it became apparent that there had been a framework of theoretical principles in Western herbal medicine comparable to that in

M

, .....l

y ORIGINAL TRAINING

• to apply the Chinese principles of herb combination to Western herbs • to give illustrative combinations for each herb discussed

nation. In contrast, a similar combination of the close observation and the perception of natural patterns that I had found in science attracted me to Chinese acupuncture. It seemed to me that the framework of theoretical principles of Chinese medicine could also be applied to the use of Western herbs. This idea was reinforced when I started to study Chinese herbal medicine. I began to classify Western herbs in terms of Chinese values of properties, organs entered, actions, and the Chinese syndromes that they could be used to treat. Eventually, I decided to write a book with the following

China. I began to compare and contrast the Western theoretical system with that of the Chinese, and to select elements from each to produce a working synthesis. Early in the writing of this book it became obvious that there was a need to give supporting evidence for any Chinese values assigned to Western herbs. At first I drew this evidence from Western and Chinese traditional texts, but increasingly incorporated data from modern pharmacological and clinical research.

four main aims:

Gradually, the central theme of the book became the integration of theoretical principles from Western tradition, Chinese tradition, and modern pharmacology. This led to a

• to summarize the empirical data on herb use from contemporary Western texts Xl

xii

Preface

complete change in the organization of the material and a total rewrite of the text, which in turn resulted in an additional five years of writing and a book four times its original size..

However, I feel that the extra time and effort have been well worth it, and I have been fascinated by the way that the many different threads of my own past experience and interests have come together in this book.

..

Sources Evidence for statements made

• listed the temperatures and tastes for each herb in the combination so that the reader can check the supporting evidence for these values in the Research and Traditional sources sections of the materia medica chapters

Wherever possible in this book, references to source material are given tor statements made, and over 1,500 references have been cited.

• given PRACTICAL NOTES for each combination, describing its clinical use

SINGLE HERBS In the materia medica chapters of this book, references to support statements made concerning individual herbs are mainly given in the Research and Traditional sources sections.

Translations This book could not have been written in its present form without data from extensive translations from German and Chinese sources.

COMBINATIONS

GERMAN TRANSLATIONS

The materia medica chapters of this book describe and discuss over 150 different herb combinations. A few of these derive from practitioners other than myself, and for these the appropriate references are cited. However, most of the combinations in this book derive from my own experience, and it is therefore not possible to cite references to traditional texts. It is for this reason that I have:

For each herb with a materia medica chapter in this book, translations were made from the following texts in the German language whenever there was information available: Dioscorides, Lonicerus, and Tabernaemontanus. (See Source' abbreviations below for full title).

CHINESE TRANSLATIONS

• explained in detail the principles of herb combination in PART 1 of this book

Similarly, each herb chapter in the materia medica incorporates material from translation of the Chinese Herbal Medicine Dictionary (Zhong yao da ci dian), whenever data was available for a particular herb.

• given my reasoning for the construction of each individual combination according to these principles

xiii

Sources

XlV

Source~9bJiviatioris ~.

." ,"

DIOSCORIDESG Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad K6lbl, Munchen, Germany

.:iJ>.-

(1960)

The majoritY of sources-bookS and journal articlesthat are referred to in this book, are specific to a particular materia medica chapter, and occur elsewhere infrequendy or not at all. However, a number of basic texts that are frequendy referred to have been assigned an abbreviation, often the names of their authors or editors. This has been done to save

ELLINGWOOD Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy. 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994)

cluttering the text with long repeating tides. These abbre-

ESCOP MONOGRAPHS

viations are listed below with their associated full reference. Note: The superscript G indicates that the text is in the German language. The superscript CH indicates that the text is in Chinese.

European Scientific Cooperative

on Phytotherapy: Monographs on the medicinal uses of plant drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) EVANS

Evans We. Trease and Evans' Pharmacognosy, 14th

edn. WB Saunders, London, United Kingdom (1996) BENSKY AND GAMBLE Bensky D, G~ble A, Kaptchuck T. Chinese Herbal Medicine Materia Medica. Eastland Press, Seatde, Washington (1986) BHC Bradley PR (ed). British Herbal Compendium, vol I. British Herbal Medicine Association. Bournemouth. United Kingdom (1992) BHP British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) BOTANICAL SAFETY HANDBOOK

McGuffm M, Hobbs C,

Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press. Boca Raton, Florida (1997)

FELTER AND LLOYD Felter HW and Uoyd JU. King's American Dispensatory, vols.1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) Fox Fox W. The Working Man's Model Family Botanic Guide to Health, 7th edn. William Fox, Sheffield, United Kingdom (1878) GERARD Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) GERMAN COMMISSION E MONOGRAPHS

Blumenthal M

(ed). The Complete German Commission E Monographs: BRUNETON Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) CHANG AND BUT

Chang H-M, But PP-H (eds). Pharma-

cology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986) CHINESE HERBAL MEDICINE DICTIONARyCH

Jiangsu

New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975)

Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin. Texas (1998) GRIEVE

Grieve M. A Modern Herbal, vols. 1 and 2. Dover

Publications, New York, New York (1971) GRIGGS

Griggs B. Green Pharmacy: The History and

Evolution of Western Herbal Medicine, 2nd edn. Healing Arts, Rochester, Vermont (1997) HILDEGARD VON BINGEN'S

Bingen's Physica. Healing Arts, Rochester, Vermont (1998)

CHRISTOPHER Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)

KLOSS

CRELLIN AND PHILPOTT Crellin JK, Philpott. J. A Reference Guide to Medicinal Plants. Duke University Press, Durham, North Carolina (1990)

LONICERUS G

Kloss J. Back to Eden, 5th edn. (1939). Reprinted by _

Lifeline Books, Santa Barbara, California (1975) Lonicerus A. Kreuterbuch (1679). Reprinted

by Verlag Konrad Kolbl, MUnchen, Germany (1962) LYLE

CULPEPER Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990)

Von Bingen H. Hildegard von

Lyle TJ. Physio-Medical Therapeutics, Materia

Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932)

~.

...

-

Sources MABEY

Mabey R (ed). The Complete New Herbal. Elm

Tree Books, London, United Kingdom (1988) MAILHEBIAU Mailhebiau P. Portraits in Oils. The C.w. Daniel Company, Saffron Walden, Cnited Kingdom (1995) MARTINDALE Reynolds EFJ (ed). Martindale: The Extra Pharmacopoeia, 31st edn. Royal Pharmaceutical Society, London, United Kingdom (1996)

•

MILLS Mills S. The Essential Book of Herbal Medicine. ArkanafPenguin Books, London, United Kingdom (1991) MILLS AND BONE Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal lvledicine. Churchill

xv

PRIEST AND PRIEST Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Romford Essex, United Kingdom (1982) TABERNAEMONTANUSG Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad K6lbl, Munchen, Germany (1993) TIERRA Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, Wisconsin (1988) TISSERAND AND BALACS Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995)

Livingstone, Edinburgh, United Kingdom (2000) MOORE Moore M. Medicinal Plants of the Pacific West. Red Crane Books, Santa Fe, New Mexico (1993) PERRY .P~rry LM.~.Medicinal Plants of East and Southeast Asia. The MIT Press, Cambridge, United Kingdom (1980) POlAR AND MACKINNON Pojar J, MacKinnon A. Plants of the Pacific Northwest Coast: Washington, Oregon, British Columbia and Alaska. Lone Pine Publishing, Redmond, Washington (1994)

...

1

WEISS Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988) WICHTL Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (1989) YEUNG Yeung H-C. Handbook of Chinese Herbs and Formulas vol I. Institute of Chinese Medicine, Los Angeles, California (1985)

"i'll

Terminology 1.

1

bieri5

bitter

LR, GB, Sp' ST, LU

UT,IN

Calendula

bitter

ST,IN LR, GB,IN

Rubus

bitter, sour

Sarothamnus

bitter

HT, Kl, BL

Chelidonium

bitter, 51. acrid

Serenoa

sweet, sl. sour

KI, BL, SP

Chrysanthemum

sweet, 51. bitter

LU,LR

Cimicifuga

acrid, 51. bitter, 51. sweet

KI, LR, UT

Cinchona

bitter

HT, SP

Urtica

acrid

LU,BL

Viburnum

51. bitter, 51. sour

UT

Vinca

sour

BL,UT

bitter, 51. acrid

LR,UT

sweet

BL

sweet

Sp,ST

',---'

Vitex Zea Ziziphus

"'f

Curcuma (rhizome) acrid, bitter

LR, GB, HT

Echinacea

acrid, bitter, 51. sweet

LU, BL

Equisetum

51. bitter, 51. sweet

BL

Temperature '--"~-.'~

·····~-':::.~_C'.7·--""·:.---~

Herb :··-:~=:-:":::;::Taste·:~--~:::::,,:::=~·.:.-::· Organs .::.:~-7:: :::~~:C::-:.:

23

COLD HERBS

The following herbs are classified as cold in this book:

bitter, acrid

lU

Filipendula

sour, bitter

ST. IN, Bl

Harpagophytum

bitter

Sp'ST

Hydrastis

bitter

S~

Iris

bitter

lR, GB,IN

Mahonia

bitter

lR, GB, Sp' ST, lU

Matricaria

sl. bitter, sl. aromatic

ST,IN, HT

Nepeta

aromatic, acrid

lU,lN, HT

Ophiopogon

sweet, sl. bitter

HT,lU, ST

Phytolacca

acrid

lU

Plantago

sour, sl. bitter

lU,lN

Polygonum

sour, sl. bitter

lU,lN

Rhamnus

bitter

IN,ST,lR

Rumex

bitter, sl. sour

LR,IN

Salvia mil.

bitter

HT,lR, UT

Sambucus

acrid, sl. bitter

LU

Sanguisorba

sour, bitter

IN, UT

• antipyretic

clear Excess Heat

Scrophularia

sl. bitter

lU

clear Damp Heat, Heat Toxin

sl. bitter

lR, KI, Bl

• strong antimicrobial

Smilax Tanacetum

bitter

lR

• anti-inflammatory

clear Damp Heat, Excess Heat

Valeriana

bitter, sweet

HT, lR, ST, IN

• sedative

Viola ado.

sour, sweet, bitter

LU,Bl

sink Heart Spirit Disturbance or Liver Hyperactive Yang

Viola tri.

sour, sweet, bitter

LU,Bl

Euphorbia

IN,lU,lR,GB,Bl,UT

Cool herbs are those that can have a moderate cooling effect on the body and are specific for treating warm disorders. Cool herbs can be especially associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):

• antimicrobial

clear Damp Heat

• anti-inflammatory • cooling alt~rative

clear Damp Heat or Deficiency Heat clear Damp Heat or Heat Toxin

• cooling anticatarrhal

clear Phlegm and Heat

• cooling diaphoretic

clear Wmd Heat

• tranquilizer

calm Heart Spirit Disturbance or Liver Hyperactive Yang

Each of the cool herbs listed in the table has its characteristic range of actions and uses. For example, both Matricaria and Sambucus are cool herbs with anti-inflammatory and" anticatarrhal action, but the specific target area of Matricaria is the gastrointestinal system, whilst that of Sambucus is the sinuses. Both Althaea and Arctostaphylos can be used as cool anti-inflammatory herbs for the urinary system, but Althaea has demulcent action, whilst Arctostaphylos is more strongly antimicrobial.

Anemone

bitter

HT,KI

Asclepias

bitter

LU

Baptisia

bitter

LU

Humulus

bitter

HT,lR,lN

Piscidia

bitter

HT,lR

Pulsatilla

bitter

IN, ST, LR

Cold herbs are those that can have a strong cooling effect on the body and are specific for treating hot disorders. Cold herbs can be especially assoCiated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):

Cold herbs may have antimicrobial, anti-inflammatory, and alterative actions, like the cool herbs, but they can have a stronger cooling and sedating effect on the body. Caution Cold herbs should be used with caution or they may depress metabolism and reduce the ability of the body to heal itself. Combinations with only cold herbs are rare, and these herbs are usually combined with some warm herbs to moderate their potential ill "effects.

Variable temperature Variable herb temperature is a concept that can help to resolve some of the apparent contradictions regarding herb temperature, can broaden and deepen understanding of the mechanism of herb action, and can contribute to both greater flexibility and greater precision in herb combining. The majority of herbs have one main temperature effect, for example, Asclepias is cold, Cinnamomum bark is hot, and Agrimonia is neutral. However, some herbs can have a range of potential temperature effects, just as they can have a range of potential actions. Which of the potential temperature effects manifests in a specific situation depends on the condition of the patient and on the temperatures of the other herbs in the

24

Combining Western Herbs and Chinese Medicine

combination. These herbs are referred to in this book as

• one active constituent may have variable-temperature

variable-temperature herbs.

effects • different active constituents may have different temperature effects

Example Achillea millefolium is classified in this book as a warm-cool variable-temperature herb, that is, it can have a range of potential temperature effects that include warm, neutral, and cool.

Warm

Achillea can act as a warming diaphoretic if the patient has a cool condition, such as influenza with chills associated with Wind Cold, especially if Achillea is combined with warming diaphoretics, such as Zingiber.

One active constituent may have variable-tempera~e effects For example, Gentiana is classified as a variabletemperature herb with a temperature range of neutral-cool. The bitter secoiridoids in Gentiana may be responsible for both potential temperature effects of this herb: the neutral, bitter digestive tonic action and the cool anti-inflammatory action. Which of these two potential secoiridoid actions manifest itself will depend on the syndromes of the patient.

Neutral Achillea can act as a neutral bitter tonic if the patient has a neutral condition, such as weak digestion without signs of either heat or cold associated with Spleen Deficient Qi, especially if Achillea is combined with neutral, bitter digestive tonics, such as Marrubium.

Cool Achillea can act as a cooling diaphoretic if the patient has a warm condition, such as influenza with fever associated with Wmd Heat, especially if Achillea is combined with cooling diaphoretics, such as Sambucus.

DETERMINANTS OF TEMPERATURE

If a combination contains variable-temperature herbs, their effective temperature will be determined by the state of the patient and by the other herbs in the combination. For example, as shown below, in the combination Achillea: influenza + sore throat, the overall temperature of the combination is cool. This is because the variable-temperature herbs, Achillea and Mentha, can both have a cooling effect in the context of a Wind Heat condition, especially when they are combined with a cooling herb, such as Sambucus. -- .-. -

Herb

,-:-~ .. ~J:,:"",""-f.:.;10;~';'~~ ~':."I'!~''''f~:·;.'?'(·-~ t;;I:·~~:-

.. Daily.. dose,:". rerrifjernture .. -... '- .

. - '.",.,. ,-'"

Achillea Mentha pip. Sambucus

.

-

6g 3g 3g

.

-,'

...~

".""".'

warm-cool warm-cool cool

.;

---- .!~'.-

•

--7-~.~ "~;'c'-

Taste '

"-

acrid, bitter acrid. aromatic acrid, 51. bitter

MECHANISM OF

Different active constituents may have different temperature effects In the case of Achillea, it may be that the sesquiterpene lactones are responsible for the cooling antiinflammatory action and that monoterpenoids, such as camphor, are responsible for the warming diaphoretic action.

VARIABLE TEMPERATURE AND HOMEOSTASIS In addition to their ability to treat conditions involving mixed signs of heat and cold, some variable-temperature herbs can have a normalizing effect specifically on body temperature. If the patient'$ body temperature is pathologically low or high, these herbs can have a warming or cooling effect, respectively, and help to normalize body temperature. Thus, they can be said to assist in the body's homeostasis. For example, Lobelia has been found to be effective both in cases of extreme coldness and in high fever. Whether this homeostatic effect is due to the alkaloid constituent lobeline, or whether different constituents are responsible for separate warming and cooling effects is not known. Salvia officinalis is another herb that can be used to alter body temperature. It can be used as a warming herb for headaches or muscle aches associated with sensations of cold, and it can be used as a cooling herb for menopausal hot flashes. Salvia has a complex biochemistry, and the mechanism of its warming and cooling effects is not yet known.

VARIABLE-TEMPERATURE HERBS

VARIABLE TEMPERATURE The phenomenon of variable. t~mperature must have its basis in the biochemistry ofplant.a~,tive constituents. However, there is insufficient data .at present to go beyond speculation. Two of the factors that may contribute to variable temperature are:

The table below shows herbs that have been classified in this book as having variable temperature. Each of the herbs marked with an asterisk"" has a separate chapter in the materia medica of this book in which the reasoning behind the variable-temperature status is discussed in the Traditional sources section.

Temperature

Warm-cool Achillea*

acrid. bitter

LU. SP,HT. UT

Artemisia abs. *

bitter. aromatic.

LR.SP,UT

Artemisia vul. *

aromatic. bitter

LR. SP, UT

Hyssopus

acrid. aromatic

LU,HT

Lobelia *

acrid

LU, IN. HT. UT

Mentha pip.

acrid. aromatic

LU, ST, IN, LR

Ruta*

bitter. aromatic

KI. LR. HT. UT

Salvia off. *

aromatic, acrid

LU. HT, LR, UT

Thuja*

acrid. aromatic. bitter

LU, HT. BL, UT

Thymus*

aromatic

LU, BL. HT. UT

Centaurium*

bitter

SP, ST. 51, LR, GB

Euphrasia*

acrid. sour. bitter

LU

Gentiana*

bitter

SP, ST. 51. LR, GB

Neutral-cool

sweet

ST, IN, LU, KI. HT

Hamamelis*

sour. sl. bitter

SP, IN

Populus

bitter, sour

Sp, ST, IN. LR. BL

Potentilla*

sour. bitter

IN

Rheum*

bitter. sour

IN.ST, LR. HT

Taraxacum*

bitter

KI, BL. LR. GB, ST. IN

Glycyrrhiza*

Cool-cold

25

in lower doses, Rheum can act as a bitter digestive tonic to treat weak digestion and poor appetite associated with Spleen Deficient Qi. In this situation, it can have a moderate cooling action, if any. At higher doses, Rheum can have a strong cooling effect, for example, for a patient with severe gastritis associated with Stomach and Liver Heat.

Differences of opinion on herb temperature No perfect system for the classification of herbs by temperature has been devised. There have been differences of opinion on the temperature classification of specific herbs not only in different countries and in different centuries, but also between different authorities in the same time and place. This range of opinion can be found in both Western and Chinese herbal medicine.

WESTERN HERBAL MEDICINE For example, the temperature values given for Artemisia absinthium (wormwood) in different Western texts range from very hot to hot in the first degree:

Three main groups of variable-temperature herbs are discussed in this book: • warm-cool • neutral-cool • cool-cold Warm-cool These herbs can have either a warming or cooling effect, depending on the patient's condition. They may also have a neutral-temperature effect when they are used to treat conditions without signs of either heat or cold. In this case, they do not change the temperature balance of ,. ',~.

the patient. The example of Achill~a is given above. Neutral-cool These herbs can have either a neutral-temperature effect or a cooling effect depending on the patient's condition. For example, Glycyrrhiza can have a cooling antiinflammatory action if the patient has a hot condition, such as gastritis associated with Stomach Heat. However, if the patient has a neutral condition, such as exhaustion without signs of heat or cold associated with Kidney Deficient Qi, Glycyrrhiza can have a neutral-temperature effect. Cool-cold These herbs can have either a moderately cooling or strongly cooling effect, depending on the patient's condition and the dose in which they are used. For example.

.. - ~-,'--. :":(.

--;··~~~;~;)~·r:;r"f.r;"-;.~'_

Author

Assigned temperature

von Bingen 3

very hot

Gerard'

hot in the second degree

Tabernaemontanus S

hot in the first degree

CHINESE HERBAL MEDICINE Students reading a basic text on Chinese herbal medicine that is published in the West may see only one temperature listed for a specific herb. What they may not know is that such Western texts are brief summaries of much more detailed texts in the Chinese language, which may give not merely a consensus of opinion on the temperature of each herb. but a range of opinion from different classical texts. For example. for Angelica pubescens (du hu6), the range of opinion on its temperature from the Chinese sources summarized in the Chinese Herbal Medicine Dictionarl includes warm, slightly warm. neutral. and slightly cool.

EXPLANATION The differences of opinion on the temperature classification of a herb may be due to one or more of the following fucto~:

~

26

Combining Western Herbs and Chinese Medicine

• different traditions of use • a single herb contains both warming and cooling constituents • chemical differences in different samples of the same herb • differences in human populations Different traditions of use Different temperature values for the same herb may arise even when there are no appreciable chemical differences between different populations of the same species. The different values are simply due to different traditions of use for the same herb. For example, in the Western tradition, Commiphora has been used as a warming carminative for weak digestion with signs of cold. In the Chinese tradition, this herb (mb y1lO) has been used as a neutral-temperature herb for epigastric and abdominal pain. A single herb contains both warming and coo14lg constituents Some herbs contain some constituents with potentially cooling effect and other constituents with potentially warming effect. For example, some varieties of Achillea millefolium contain both potentially warming camphor and potentially cooling sesquiterpene lactones, and thus can have a variable-temperature effect. This may be one of the reasons why in the past Achillea has been classified in the West sometimes as slightly hot and sometimes as cold in the first degree (see the Achillea chapter). Chemical differences in different samples of the same herb These chemical differences may arise from a number of factors, including: • genetic differences in populations of the same species • different methods of cultivation • different methods of preparation

Genetic differences in populations ofthe same species In some cases, chemical differences between different herb populations of the same species may account for the difference of opinion on the temperature of the same herb. For example, Valeriana officinalis has been considered cooling by some herbal practitioners in Europe and warming by some practitioners in the USA. This difference of opinion may be linked to known chemical differences between the different geographical populations of this herb, associated with variations in chromosome number (see the Valeriana chapter).

grown with artificial light in a greenhouse and harvested before maturity. The first Salvia sample may tend to be more warming (see the Salvia chapter).

Different methods of preparation Use of the fresh or dried herb, variation in the time and temperature of storage, and differences in the method of preparation can make significant chemical differences between samples of the same species. For example, both fresh ZingIber (shengjiang) and dried Zingiber (gan jiang) can be classified as hot in Chinese medicine, but the dried herb is considered more warming to the Interior. There are real chemical differences between fresh and dried ginger that underlie this difference in temperature effects (see the Zingiber chapter). As another example, the temperature of Panax ginseng can vary considerably with the country of origin and the method of processing. Ginseng cured in rock candy-white ginseng (bcii shenF--can be used to treat Qi and rm Deficiency and can be classified as cooling. Ginseng cured by steaming-red ginseng (h6ng shen}-can be used to treat Qi and Yang Deficiency and can be classified as warming.

Caution Failure to make these temperature distinctions between different preparations of the same herb can result in adverse effects for the patient. Differences in human populations The perceived temperature effect of a herb may vary with differences in the physiology and pathology of human populations that result from differences in genetics, climate, and life-style. For example, until relatively recently, the bulk of the population in China lived in the countryside, did much physical work, lived in unheated housing, ate small amounts of home-grown food with little meat, and had relatively little medication. Such rural populations tend to have more syndromes of Deficiency and Cold. In contrast, the bulk of the population in some Western countries is urban, does very little physical exercise, lives on junk food with potentially harmful additives, and takes prolonged multiple medication. Such urban populations tend to have more syndromes of Stagnation, Deficiency Heat, and Retained Pathogen. The temperature effect of herbs on the body is likely to be different in these two populations. For example, in the urban population Panax ginseng is more likely to produce adverse effects involving Heat.

Different methods of cultivation There may he important chemical differences in samples of a single herb species due to differences in methods of cUltivation and time of harvesting. For example, a sample of Salvia officinalis grown in its natural habitat in a warm, dry climate and harvested at maturity will have a greater amount of monoterpenoids and a different chemical spectrum than a sample of the same species

References 1. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. -Eastland Press, Seattle, Washington (1986)

~'"

-

-

Temperature 2. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood. Illinois (1990) 3. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester. Vermont (1998) 4. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publi-

'_L

,

r I

27

cations, New York, New York (1975) 5. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl,Munchen. Germany (1993) 6. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (1975)

...

Taste Taste as a herbal property This refers to a theoretical system for classifying herbs according to the type of effect they have on the body. Herbs can then be selected according to the taste property to correct specific types of imbalance. For example, according to Chinese herbal theory, sweet herbs often have tonic action so that they are often selected to treat Deficiency patterns.

Concepts oftaste

...

This chapter introduces a new approach to the theory of taste, drawing on concepts from Chinese medicine, Western herbal tradition, and modern biochemistry. This movement towards an integrated approach can increase theoretical understanding and widen the clinical application of the taste concept in herbal therapy. It can also help to resolve some of

The importance of experience It is very valuable for practitioners of herbal medicine to taste and take the herbs that they use. In this way, they can compare and contrast the theoretical taste properties of each herb used with its tastes in the mouth and with its effects on their own bodies. For each herb with an individual materia medica chapter in this book, its tastes in the mouth and its taste properties are discussed separately in the section on Traditional

the apparent contradictions between the Chinese and \Vestern concepts of taste.

TASTE IN THE MOUTH AND TASTE AS A PROPERTY There are two overlapping concepts of taste: taste in the mouth and taste as a herbal property. Over the centuries, the different tastes that substances have in the mouth have been associated with different herbal effects.

sources.

Taste in the mouth

The classification of herbs in terms of taste can facilitate herb choice in two main ways:

IMPORTANCE OF THE TASTE PROPERTY

This relates to taste as a sensation-to

what the herb actually tastes like in the mouth and on the tongue. This subjective experience has a foundation in physiology and biochemistry. There may be individual variations in the quality and intensity of the taste experience, and there may be cultural differences relating to differences in linguis-

• by providing a simple overview of herbal groups • by acting as a sophisticated method for the mutual balancing of herbs in a combination

tic concepts or patterns ofnutrition. However, there is a general consensus of experience and most people experience quinine as bitter, honey as sweet, cayenne as acrid, and ,", lemons as sour.

29

Overview Dividing herbs according to their taste properties gives the practitioner about five herb groups to choose from when assessing a situation. This is a more manageable number of groups for getting a preliminary overview than

-,

Combining Western Herbs and Chinese Medicine

30

the 20 to 30 action categories, and it is not as restrictive as would be the two choices offered by the Yin-Yang division. For a more detailed classification, each taste can be subdivided into action categories, as discussed in the individual taste sections below. Balance At the basic level of herb combination, herbs can be selected according to their action categories to match the patients syndromes. In addition to this, at a more sophisticated level of herb combination, taste properties can be used . to optimize the balance between the herbs in the combination. This is discussed in the Balancing the tastes section in this chapter, which contains a table of the 20 main taste combinations that can be used in the clinic. It is also discussed in the Taste section of the Principles of herb combination chapter.

CHINESE AND WESTERN CONCEPTS OF TASTE

sidered to be a taste, but in this book, I have used it as such (see discussion in the Aromatic section), I have not included the salty taste property of Chinese medicine since I fmd this taste to be rare in the Western herbs that I use in clinical practice. I have included the astringent property with the sour taste property since there is such a close overlap between the two. Finally, the Chinese category of bland is not used as a taste property in this book.

CHANGING CONCEPTS OF TASTE Concepts of taste property are currently in the process of change and expansion due to input from three different sources: Chinese herbal tradition, Western herbal tradition, and modern biochemistry. Each of these three systems can make valuable contributions to the understanding of taste, and each has its limitations or blind spots. It is important to keep an open mind in order to see beyond the limitations of each system if a useful integration is to be achieved in the future.

This section very briefly introduces the Chinese and Western concepts of taste and the taste classification used in this book. These are discussed in greater detail in the sections on the individual tastes. Chinese herbal tradition In Chinese medicine, there are two main taste classifications; one is associated with Chinese herbal tradition, and the other is associated with Five Element theory. In both classifications, there are five main taste properties: bitter, sweet, acrid, sour, and salty. However, the effects associated with each of the five tastes are not necessarily identical in the herbal and the Five Element models. For example, in the herbal model, bitter is often associated with clearing Heat and Damp, whereas in the Five Element model, it is associated with tonifying the Heart. Also, in the herbal model, the additional properties of aromatic, astringent, and bland are often used together with the five tastes. Western herbal tradition In the West, the Galenic system described each herb in terms of its temperature (whether warming or cooling) and moisture (whether drying or moistening), and the body parts on which the herb acts. However, in this system, there was less emphasis on the taste property than in Chinese herbal medicine. More recently in Western herbal medicine, individual taste sensations have been associated with specific herbal effects, for example, bitter with the digestive tonic action and aromatic with the . , . '. carminative action. ........ . . ,:

",

This book The five taste properties used in this book are bitter, sweet, sour, acrid, and aromatic. I am aware that in Chinese medicine, the aromatic property is not strictly con-

Chinese herbal tradition The Chinese herbal system of taste properties gives a framework of clear, simple concepts for classifying herbs and matching them to syndromes. Perhaps most importantly, it contributes a system of matching herbs with each other according to taste to produce a balanced combination. The limitation of the Chinese system is that it has remained relatively static for a long time, without further evolution of its concepts. As in the history of the Galenic system in the West, respect for the authority of tradition may have reduced rigorous critical investigation and discussion, and slowed the evolution of ideas. Western practitioners are reevaluating the concepts of traditional Western phytotherapy in the light of the theories of Chinese medicine. Perhaps it is time for Chinese practitioners to reevaluate the concepts of taste in view of ideas from Western herbal tradition and from modern biochemistry. This would be especially valuable in the case of the aromatic, bitter, and sweet properties. Western herbal tradition In the West, from the time of Galen to Culpeper, concepts of taste were not as clearly developed or as well organized as in China. However, Western herbal therapy has more recently made major contributions in this area with respect to understanding and utilization of the bitter and aromatic concepts. This is discussed in the individual sections on these tastes. Biochemistry and taste On the one hand, the concepts of taste from Chinese and Western herbal tradition can contribute to the application of phytopharmacology to clinical

r."

Taste practice. On the other hand, concepts and detailed information from phytochemistry and phytopharmacology can help to give breadth and depth to the understanding of taste. Contribution of taste to biochemistry There is a vast number of individual active herb constituents. 'Whilst these can be organized into major chemical groups, such as phenols and steroids, there is as yet no clear and simple system in phytopharmacology to match individual constituents, or even major chemical groups, to the syndromes of the patient. The structured framework of the taste concept can be used to give some organization to the apparent chaos of the biochemical data. To the degree that active constituents can be classified in terms of taste, they can be linked to herb actions and thus to the treatment of specific syndromes. For example, if a constituent is bitter, it may have one or more of the potential actions associated with this taste, for example,

it may function as a digestive tonic. Contribution of biochemistry to taste Research on active constituents and their pharmacological effects have demonstrated new practical uses for phytochemicals with a specific taste. For example, some chemicals with the sweet taste have been shown to have immunoregulatory effect. In addition, each t:tste can be subdivided into groups according to its chemical type and pharmacological effect. For example, sweet phytochemicals can be divided into the

following groups:

r-

• nutrient carbohydrates • demulcent mucopolysaccharides • immunopolysaccharides • adaptogenic triterpenoid saponins The contribution of new practical uses and a system of subdivision of the taste types can lead to a more profound understanding of taste and a wider clinical application of each taste group.

Bitter The bitter taste sensation follows stimulation of the bitter taste receptors on the tongue. Substances differ in the intensity of the bitter sensation they evoke and are sometimes given bitterness values. For example, the most abundant bitter secoiridoid in Gentiana root is gentiopicroside with a bitterness value of about 12,000. However, the most important bitter component in Gentiana root is amarogentin, which, although only present in tiny amounts, nonetheless has a bitterness value of 58,000,000 (see the Gentiana chapter).

31 CHINESE HERBAL TRADITION According to the Five Element theory, the bitter taste tonifies the Heart. However, most of the herbs classified as bitter in modern Chinese materia medica are not listed as tonifying the Heart, and in the herbal tradition, bitter is more associated with reducing Excess conditions. For e.xampIe, it can be associated with the following actions: l • drains Damp • clears Heat • drains downward • purges stools • clears Lung Phlegm Drains Damp In some circumstances, the bitter property can be associated with draining Damp regardless of whether the Damp is associated with Heat or Cold. 2 It should be noted that not all herbs that drain Damp and promote urination are classified as bitter; some are sweet, like Zea (yu mi xu), or sweet and bland, like Poria (m ling). Clears Heat In some circumstances, the bitter property can be associated with clearing Heat from the organ systems, whether Heat from Stomach or Heart, or Damp Heat from Liver or Bladder. Many herbs that are listed as clearing Wind Heat, Summer Heat, Heat, Heat in the Blood, Damp Heat. or Heat Toxin are classified as bitter. For example, Coptis (huang Han) can cool the Blood, clear Heat Toxin, clear Heat in the Heart or Stomach, and clear Damp Heat in the Intestines. However, not all herbs that clear Heat do have the bitter property. Gypsum (shi gao) is sweet and acrid, Lophatherum (dan zhli ye) is sweet and bland, and Calcitum . (han shui shi) is acrid and salty. Drains downward In some circumstances, the bitter property can be associated with the tendency to move Qi downwards as in the following actions: • redirects Lung Qi to treat cough, for example, Prunus armeniaca (xlng ren) • redirects Intestines Qi to treat constipation, for example, Rheum (cia huang) • drains Heart Heat out through the unne, for example, Akebia (mil tong) Purges stools Whilst most herbs listed as bitter are not purgatives. most herbs in the laxative, purgative, and cathartic categories of Chinese medicine are classified as bitter. Most of these bitter herbs that move stool are cold or cool and are especially appropriate for constipation due to Heat, for example, Rheum, Cassia (fan xie ye), and Aloe (1ti hul).

Combining Westet:n Herbs and Chinese Medicine

32

Clears Lung Phlegm In some circumstances, the bitter property can be associated with dissolving Phlegm and relieving cough. Prunus armeniaca is an example of a warm, bitter antitussive, and Euphorbia (ze qI) is an example of a cool, bitter, and acrid expectorant. Bitter herbs that clear Phlegm are often also acrid (see the Acrid section in this chapter).

Summary of Chinese tradition Whilst the Five Element theory proposes a tonic action for the bitter taste, the herbal tradition emphasizes its reducing: downward-moving, and drying effects. \NESTERN HERBAL TRADITION In the last century of Western herbal tradition, the bitter taste has been associated with the following actions: • bitter digestive tonic • bitter general tonic • bitter cholagogue and hepatic Bitter digestive tonic In the Western tradition, bitter herbs have been used to treat the lack of appetite and digestive weakness.3.4·5.6 More recendy, it has been suggested that bitter herbs may help to treat malabsorption, gastrointestinal infection, and food allergies (see the Biochemical perspective section below). Bitter general tonic The general tonic effect of the bitter herbs may largely depend on their digestive tonic action. In terms of Chinese medicine, it can be said that some bitter constituents can tonify and move the Qi of the Spleen, Stomach, and Intestines, and thus indirectly help to tonify Qi and Blood. In the Western tradition, bitter herbs have been used to treat exhaustion, anemia, weight loss, and associated muscular weakness and mus~ular atrophy.3.4.5.6 It has recendy been suggested that bitter herbs may help to strengthen the immune system.7 Bitter cholagogue and hepatic Bitter herbs have a tradition of use in the West to strengthen the secretion and flow of bile, and to treat disorders of the liver and gallbladder.3.4. 5.6. 7 Expressing this Western use in terms of Chinese medicine, it can be said that some bitter herbs can tonify and move the Qi of the Liver and Gallbladder. ,Other actions of bitter herbs The main emphasis in the use of bitterherbs in the,West has been on ~eir general tonic, digestive tonic, cholagogue, and hepatic actions. However, herbs with the bitter taste are found in other Western action groups, especially the following:

• antimicrobial, antipyretic, and anti-inflammatory • cardiotonic • tranquilizer These are discussed in the section Combining the Western and Chinese perspectives below. BIOCHEMICAL PERSPECTIVE Bitter herbs, or more precisely, bitter constituents, can be said to have three main levels of activity: • general bitter effects • effects shared by members of a particular chemical group • effects specific to an individual chemical General bitter effects All substances that stimulate the bitter taste receptors at the back of the tongue may set off a cascade of events in the gastrointestinal and hepatobiliary systems. These may include stimulation of appetite, flow of saliva, flow of digestive secretions from the stomach, intestines, and pancreas, and stimulation of the secretion and flow of bile (see the Research section in the chapters on Artemisia and Gentiana). Increase in bile flow may then have a laxative effect. This subject has been reviewed by Mills and Bone/ who noted that reduced gastric secretion can lead to abnormal bowel flora, malabsorption of nutrients, and an increased tendency to enteric infection. By increasing gastric secretion, bitter herbs may thus help to treat these conditions. In addition, reduced gastric secretion may lead to the inadequate breakdown of polypeptides. This may result in an increase in potential antigens and an increase in allergic responses related to foods. By increasing gastric secretion, bitter herbs may therefore help in the prevention and treatment of food allergies. It was also suggested that bitter herbs may assist in the normalization of blood sugar levels and the stimulation of the immune function. Effects shared by members of a particular chemical group In addition to the general bitter effect, each substance may then have additional effects characteristic of the chemical group to which it belongs. For example, the quinoline alkaloid group, to which quinine and quinidine belong, can have antimalarial and cardioregulatory effects. Many different chemical groups can produce the bitter taste sensation. For example, each of the following groups contains some substances with the bitter taste: monoterpenoids, sesquiterpenoids; sesquiterpene lactones, diterpenoids, triterpenoids, iridoids, flavonoids, and alkaloids. This great variety of chemical types may explain why bitter herbs can have such a wide range of actions.

-,...

Taste Effects specific to an individual chemical Each bitter substance may have effects that are specific to its unique individual structure. For example, within the quinoline alkaloid group, quinidine is a stronger antimalarial than quinine and has more risk of cardiotoxicity (see the Cinchona chapter).

lvlultiple effects of a single bitter chemical It is interesting that some bitter chemicals can have most of the actions that have been associated with bitter herbs above. For example, the alkaloid berberine, present in Berberis and Hydrastis, has been reported to have choloretic, hepatic, antimicrobial, anti-inflammatory, cardiotonic, and respiratory effects. It would be interesting to determine if a specific chemical structure can be associated with this range of actions and if this structure can also stimulate the bitter taste receptors.

33

General tonic exhaustion anemia weight loss muscular weakness muscular atrophy weak immune system Digestive tonic lack of appetite digestive weakness malabsorption gastrointestinal infection food allergies

Hepatobillary tonic

COMBINING WESTERN AND CHINESE PERSPECTIVES The Western emphasis on tonification and the Chinese herbal emphasis on reducing and cooling seem to be irreconcilable opposites, but they can be regarded as just the two

depression epigastric and abdominal distension nausea intolerance of fatty foods reCOliery from habitual overeating recovery from substance abuse recovery from prolonged medication gallstones constipation

Antimicrobial infections such as: recurring respiratory infections acute bacillary dysentery urogenital infections boils AntI-Inflammatory inflammatory disorders such as: gastritis colitis cystitis arthr,itis Antipyretic disorders with fever such as: acute influenza acute tonsillitis mononucleosis malaria some chronic fatigue syndromes

ends ofa spectrum ofbitter actions. -·-tonifies Qi.~.:~b~esQi ... clears H~at

.

';,'--

T~e

~

..

':--.''; ~-..,~"':":~--'-~

action of moving Qi acts as the bridge between tonifying

Qi and clearing Heat. Stagnant Qi can be associated with Deficient Qi, as in exhaustion and depression, or it can be associated with accumulation of Heat and Damp, as in recurring diarrhea with sensations of heat. In more complex conditions, Stagnant Qi can occur with patterns of both Deficiency and Heat, as in some cases of weak digestion with chronic gastrointestinal inflammation. Bitter herbs, depending on their temperature, can be used in all of these situations. Six potential bitter actions The table below shows six of the main potential actions of bitter herbs, together with some of their associated uses. These six actions can be divided into two groups as follows:

• tonic actions:

general, digestive, and hepatobiliary tonic

• cooling actions: r:'

antimicrobial, antiinflammatory, and antipyretic

The tonic actions are associated with tonifying Qi and moving Qi, and the cooling actions are associated with clearing Heat and moving Qi.

Which of these actions manifests in a particular situation will depend on the state ofthe patient, on the other herbs in the combination, and on the temperature ofthe bitter herbs. Use of bitters for hepatobiliary stagnation In Chinese medicine, the syndrome of Stagnation of Liver Qi can have many manifestations and ramifications. These include depression, nausea, indigestion with epigastric and abdominal distension or discomfort, gallstones,.constipation, intolerance of fatty foods, and recovery from substance abuse or prolonged multimedication. By moving Liver Qi, bitter herbs can therefore assist in the treatment of a wide range of conditions. (See the Research sections in the Berberis and Gentiana chapters for hepatobiliary effects of bitter active constituents.) Western use of bitter herbs to treat hot conditions It is interesting to note Culpeper's use of the bitter herb Berberis to cleanse the body of 'choleric humors' (associated with anger), to clear heat from the liver and .from the blood, and to treat jaundice, itching skin disorders, boils, and fever. 8 Also, Lonicerus wrote that Berberis is good for headache if it is a result of heat and acidity from gallbladder disease. 9 In Chinese medicine terms, this would be equivalent to clearing Heat or Damp Heat from the Liver-Gallbladder, clearing the resulting Blood Heat or Damp Heat from the skin, and reducing Liver Hyperactive Yang associated with Liver-Gallbladder Qi Stagnation.

Combining Western Herbs and Chinese Medicine

34

Antimicrobial. antipyretic. and anti-inflammatory actions

strong downward effect on it, and they are cool or cold in

In Chinese herbal tradition. the main emphasis for the bitter herbs is on clearing Heat and Damp. In terms of Western herbal medicine. this translates into the antimicrobial. antiinflammatory. and antipyretic actions. It is not stated in Western tradition that bitter herbs are specific for infections, inflammations, and fever. However, bitter herbs have been used just as much for these disorders as they have been used for general debility, atonic digestion, and hepatobiliary weakness. (See the Research sections in the Berberis and Gentiana chapters for antimicrobial. antipyretic, and antiinflammatory actions of bitter active constituents.)

temperature. Additional actions of bitter herbs Two further actions associated in the Chinese herbal tradition with the downward~moving aspect of the bitter taste have been noted above: purgative and antitussive actions.

Purgative In China, the bitter taste is also associated with .the purgative action, that is. to direct Intestines Qi downward and move the stool. Whilst most of the purgative herbs used in the West have a bitter taste. such as Rhamnus and Rheum, these actions are not generally regarded as specific to the bitter taste.

Alterative action of bitters In my opinion, certain bitter herbs have the capacity to treat recurring fever by their alterative action of clearing toxins from the body or, in Chinese medicine terms, by clearing Retained Pathogens. The three bitter effects of tonifying Qi, moving Qi. and clearing Heat can combine to do the following:

• tonifies Qi

• moves Qi

helps to strengthen the natural ability of the body to clear pathogens from the system and to prevent further infection helps to clear pockets of Stagnation with accumulation of pathogens and toxins that may act as foci for recurring infections

• clears Heat can allow the Qi and Ym to rebuild to speed convalescence This is discussed in the Cinchona chapter in the section

Possible mechanism ofantipyretic effects. Bitters herbs and the Heart There are two very different groups of bitter herbs with effects on the Heart: one group has tonic action, and the other has a calming. reducing, and cooling action.

Tonics The bitter taste is said to tonify the Heart in the Chinese Five Element tradition, and there is a minor tradition in Western herbal therapy that states that the heart can be strengthened by bitter herbs. Some of the cardiotonic herbs used in the West have a bitter taste, such as Cinchona. Convallaria. Leonurus, and Sarothamnus, but other cardiotonic herbs, such as Crataegus, are not appreciably bitter. These cardiotonic bitter herbs can be said to tonify and stabilize Heart Qi, and ijiost of them are more or less neutral in temperature. Tranquilizers Most Western herbs that have a strong tranquilizing action also have the bitter taste, for example, Anemone, Gelsemium, Humulus, Piscidia, and Valeriana. These herbs can be said to calm the Heart Spirit by having a

Antitussive Two other actions associated with the bitter taste in the Chinese herbal tradition are the antitussive action, that is. directing Lung Qi downward, and the expectorant action, that is, clearing Lung Phlegm. In the West, whilst some herbs with antitussive and expectorant action have a bitter taste, such as Marrubium, these actions are not linked specifically to the bitter taste.

DIRECTION OF ENERGY OF BITTER HERBS The effect of a bitter herb on the direction of energy movement depends on its specific actions and the organs it affects. Stomach and Intestines In the Western view, bitter substances can stimulate the bitter taste receptors, thus increas- - • ing gastrointestinal and hepatobiliary secretions. This can be described as a tonic effect that can assist in the normalization of the natural downward movement in the stomach and intestines. This is a different emphasis from the downward movement proposed by the Chinese herbal tradition. which can involve purgative and diuretic actions, with an overall reducing effect on the body. Liver and Gallbladder Stimulation of hepatobiliary function can be said to include dispersal of Liver Stagnant Qi. This movement is not limited to the downward direction since it can have upward, downward. and horizontal components. Some bitter constituents, for example, the bitter constituents of Piscidia, can reduce the disturbed upward movement of Liver Yang, to treat headaches and migraines. Heat clearance In the West, bitter herbs are commonly used as antimicrobials, anti-inflammatories, and antipyretics, and these actions can be related to the action of clearing Heat in Chinese -medicine. However, these Western actions are not necessarily associated with the clearance of Heat by downward movement via the stools and urine, as proposed for the bitter taste in the Chinese herbal tradition.

Taste Heart In the Chinese Five Element tradition, the bitter taste is said to tonify the Heart, but no specific effect on the direction of energy movement is proposed. The same is true of the Western concept of the cardiotonic effect of bitters. However, the bitter herbs with tranquilizing action can be described as having a downward-directing effect on the pathological upward movement of Heart Spirit or Liver Yang.

Summary Bitter herbs, or more specifically bitter constituents, may help to normalize the natural downward movement in the stomach and intestines, and help to spread Liver Qi. They may also have one or more of the following effects, depending on their specific chemical structure: • nondirectional antimicrobial, antipyretic, and antiinflammatory actions • nondirectional cardiotonic action • downward-directing tranquilizing action • downward-directing diuretic or purgative action

TEMPERATURE OF BITTER HERBS In itself, the bitter property tends to be either neutral, as in some of the digestive tonics, cardiotonics, and tranquilizers; or cooling, as in some of the antimicrobials, antipyretics, anti-inflammatories, and sedatives. Warm bitter herbs generally have bitter combined with acrid, for example, Myrica and Sanguinaria. The wide variation in temperature among Western herbs with the bitter taste, from warm to cold, is illustrated by the following examples: Temperature warm

neutral

Examples Myrica for patterns of Deficiency, Stagnation, and Cold, such as exhaustion and depression with sensations of cold Marrubium for patterns of Deficiency and Stagnation, with or without Heat or of Cold, such as a weak cough with sensations of obstruction in the chest

neutral~ool

Gentiana for patterns of Deficiency and Stagnation with some Heat. such as weak digestion with gastroenteritis

cool

Berberis for patterns of Stagnation and Heat with or without some Deficiency, such as cholecystitis with sensations of heat

cold

Asclepias for patterns of Excess Heat. with or without Stagnation, and in the absence of DefIciency. such as acute respiratory infections with fever

CAUTIONS Chinese herbal tradition

It must be clearly understood

35 that in the Chinese herbal tradition, cautions and contraindications for bitter herbs depend on their temperature, rather than on the bitter quality itself.

Cool or cold bitter herbs Chinese contraindications for Cold Deficient patterns of the Spleen and Stomach, especially with diarrhea, are related to the temperature, rather than to the bitter property itself. Cool or cold bitter herbs are contraindicated or to be used with caution for Cold Deficient conditions of the Spleen and Stomach, especially with loose stools or diarrhea. However, sweet cold herbs may be similarly contraindicated for Cold Deficient patterns of the Spleen and Stomach since it is not the taste but the cold temperature that is damaging to the Spleen. Warm 'or hot bitter herbs In contrast to cooling bitter herbs, warming bitter herbs may be indicated for Cold Deficient patterns of the Spleen and Stomach. For example, Evodia (wti zhii yti) is indicated for diarrhea from Cold Deficient Spleen and Kidneys. Warm bitter herbs are generally contraindicated for Heat patterns, especially Deficiency Heat associated with Deficient Ym. Western herbal tradition Some texts contraindicate certain bitter herbs in cases of gastric ulceration or hyperacidity due to the possibility that they may increase the secretion of gastric acid and aggravate these conditions. However there is evidence to suggest that these herbs can reduce rather than increase the potential for gastric irritation (see the Toxicology section in the Gentiana chapter).

Sour In the mouth, the sour taste and the astringent effect can be differentiated as follows:

• sour taste • astringent effect

'sharp: acid taste oflemon juice or vinegar puckering or drying effect on the mouth and tongue

The sour taste is not necessarily accompanied by a puckering effect, nor is the astringent effect necessarily accompanied by a 'sharp' taste.

CHINESE HERBAL TRADITION In the Five Element tradition, the sour taste is said to tonify the Liver. In the Chinese herbal tradition, the concepts of sour (suan) and astringent (se) are very close. Most of the herbs in the astringent action group are classified as sour, although there are exceptions, and the main manifestation of the sour taste is the astringent action.

36

Combining Western Herbs and Chinese Medicine

Astringency is associated with firming and stabilizing the Qi to hold things in their proper place. This includes not only the prevention of leakage of fluids and of organ prolapse, but also the stabilization of the organ functions, including their mental and emotional aspects. By firming and stabilizing the Qi, the astringent action can counteract three related pathologies: • Deficiency of the holding function of Qi • Excessive dispersal of Qi • Qi not holding Spirit firm Deficiency of the holding function of Qi This is Deficiency of a very specific function of Qi-not the warming, moving, or activating aspect-but the special function of holding things firm and stable and in their proper place. If this function of Qi becomes weakened, then there may be leakage of fluids through cell walls, leakage of blood from capillaries, loss of sweat through the pores, leakage of urine or stool through atonic sphincters, and the prolapse of organs. Excessive dispersal of Qi If the condensing and concentrating function of Qi is weak, there may be an excessive, dispersing, outward movement leading to loss of energy from the body and to a diffusive and scattering effect on the Qi. If the Defensive Qi becomes less dense and more diffuse, it is easier for pathogens to enter the body, resulting in chronic or recurring illnesses. If the Qi of the Kidney becomes more diffuse or scattered, mental concentration becomes more difficult, and it may become more difficult to focus the will to get things done. Qi not holding Spirit firm Weakness in the capacity of Qi to hold the Spirit firm and stable may result in the disturbed upward movement of energy in the body, with symptoms such as mental or emotional instability, anxiety, insomnia, and palpitations. Schisandra is an example of a herb that can be used to counteract all three of these pathologies since it can:

• reduce excessive dispersal ofQi to treat excessive sweating and reduce the side effects of dispersing herbs, such as Ephedra

• strengthen the holdingfunction of Qi to treat urinary frequency, diarrhea, and vaginal discharge

• strengthen the holdingfunction ofQi to firm and stabilize Heart Spirit to treat insomnia and palpitations

,WESTERN HERBAL TRADITION . , Sour taste There does not appear to have been a clear concept of the sour taste in the West comparable to that of Chinese medicine. However, Gerard 10 described the juice of

the lemon as 'sharp' and stated that it 'cutteth, divideth, and maketh thin, gross, tough, and slimy humors? Lemon juice has been used in Western folk medicine to cleanse the liver and to treat liver and gallbladder disorders. In Britain, greasy fish and chips are usually drenched with vinegar, and this can be associated with the sour taste assisting the liver to deal with this intake of oily food. 11

Astringent action Lonicerus and Tabernaemontanus used the term 'ziehen zusammen' (to draw together) to describe herbs, such as Achillea, that are used to stop hemorrhages and the leakage of stool, sperm, or vaginal discharge. Christopher described astringents as 'herbs that influence the vital contractility of cell walls, condense the tissues, make them denser and firmer, and arrest discharges.' The emphasis in the West is on what can be called the material aspects of astringency, that is, on preventing the leakage of the fluids and holding the organs in their proper place. Western astringent herbs are therefore used internally to treat disorders, such as diarrhea, bleeding, discharges, urinary incontinence, and organ prolapse, and locally to treat varicose veins, hemorrhoids, wounds, and ulcers. Western herbal therapy does not appear to possess a concept comparable to the Chinese idea of the energetic aspect of astringency in terms of firming the energies of organ systems and stabilizing the mind and emotions.

BIOCHEMICAL PERSPECTIVE Sour taste The sour taste sensation may result from the stimulation of the sour taste receptors by hydrogen ions. Sour-tasting compounds are often carboxylic acids, such as acetic acid (as in vinegar), citric acid (as in lemon juice), and oxalic acid (as in Rumex). Tannin astringents Local astringent effects, and the puckering sensation produced by many astringents on the mouth and tongue, are most commonly associated with tannins (see the Potentilla chapter).

Bioavailability of tannins This topic has recently been reviewed/ and in the present state of knowledge, it appears that intact tannin molecules have poor bioavailability. This is perhaps fortunate since intact hydrolyzable tannins in the blood have been reported to be hepatotoxic. However, the bowel flora breaks down tannins into smaller phenol molecules that can be absorbed through the gut wall into the blood and can have antioxidant effects in the body. Therefore, whilst tannins can have local astringent and antihemorrhagic effects on the mucosa of the mouth, stomach, or intestines, there is currently no evidence to indicate that they can produce these effects at sites remote from the

Taste

37

gut. It is therefore necessary to verify traditional claims for tannin-containing herbs that they can treat disorders such as hemoptysis, menorrhagia, or urinary incontinence. It is possible that the products of tannin breakdown in the gut may contribute to astringent and antihemorrhagic effects at sites remote from the gut, but this has yet to be demonstrated.

Relatively material aspect This refers to the relatively more

Nontannin-containing astringents Substances other than tannins may have local astringent or antihemorrhagic ef-

nins.

fects, as for example in the following herbs:

Relatively energetic aspect This refers to the relatively more

• Calendula

antihemorrhagic and vulnerary actions may be due to resinous constituents

• Capsella

antihemorrhagic action may be due to

• Capsicum • Commiphora

a peptide antihemorrhagic action may be due to the amide capsaicin antihemorrhagic and vulnerary actions may be 9,ue to both resinous and polysaccharide constituents

Equisetum and Hydrastis also have astringent or antihemorrhagic actions, and have not been reported as containing appreciable quantities of tannins. Astringent mechanisms Three possible components of the astringent mechanism can be summarized as follows. 1. Tannins or other chemicals may have local effects on the gut mucosa, following oral administration, or on the surface of the body, following topical application. 2. Substances may be absorbed through the gut wall and travel in the bloodstream to target tissues remote from the gut. 3. Substances may first strengthen the function of the organ systems, resulting in indirect astringent effects. For example, in terms of Chinese medicine, Schisandra may reduce diarrhea by first firming Kidney Qi, or Astragalus may treat diarrhea by first tonifying the Qi and Yang of the Spleen. However, there is as yet no data linking astringency to the systemic effects of plant constituents.

COMBINING WESTERN AND CHINESE PERSPECTIVES The discussion below links elements from Chinese medicine and Western herbal tradition. 1\vo aspects of astringency Sour herbs can be said to manifest two main aspects of astringency, the relatively material and the relatively energetic.

material manifestations of astringency, such as reduction of leakage of fluids and treatment of organ prolapse. In the West, astringent herbs are used to treat these more material aspects. Most Western astringent herbs can be classified as sour, such as Geranium and Vinca, or sour and bitter, such as Polygonurn and Sanguisorba, and most of them contain tan-

energetic manifestations of astringency, that is, stabilizing organ functions, especially their mental and emotional aspects, to treat such disorders as palpitations and dreamdisturbed sleep. Western contribution The contribution of the Western herbal tradition lies not so much in theoretical concepts of astringency, but in the development of the use of a wide range of astringent herbs. For example, Myrica can be used as a warming, anticatarrhal astringent to treat diarrhea with mucus in the stools and sensations of cold. Polygonurn bistorta can be used as a cooling, demulcent, anti-inflammatory astringent to treat diarrhea with intestinal inflammation and sensations of heat. Up to the present, there have been few research studies on the mechanism of astringency, and of these studies, most have focused on the tannins. In the future, research studies may reveal a variety of astringent mechanisms, involving both local and systemic astringent effects. Chinese contribution The specific contribution of Chinese medicine is in regard to the relatively energetic aspects of astringency, especially the use of sour astringent herbs in the treatment of mental and emotional disorders. In terms of Chinese medicine, if the Qi does not perform its function of firming and stabilizing the energies of the organ systems, their normal rhythm and direction of movement may become disturbed, as in the irregular upward movement of Heart Spirit Disturbance. Cardioregu1ators and nervines The Chinese concepts of the energetic aspects of astringency can be applied to the Western action concepts of cardioregulators and nervines. Herbs with these actions can be used to strengthen and stabilize the function of the coronary and nervous systems, respectively. In some of these herbs: the sour astringent property may contnbute to the stabilizing effect

.

Cardioregulator . In terms of Western herbal medicine, a cardioregu1a~r ca:n be defined as a herb that by strengthening the heart can stabilize i~ function and treat conditions such as arrhythmia. labile blood pressure, and fluctuations in energy and. body temperature. In terms of Chinese medi-

38

Combining Western Herbs and Chinese Medicine

cine, a cardioregulator can be said to tonify Heart Qi, and, by doing so, firm and stabilize Heart Qi to treat the syndrome of Heart Qi Irregularity. The two main cardioregulatory herbs listed in this book are Crataegus and Leonurus. Both have a sour taste in the mouth and are ascribed the sour astringent taste property in this book. They can be said to have astringency with respect to the specific function of firming and stabilizing Heart Qi. A cardioregulator can be said to treat problems of the coronary system (Heart Qi Irregularity), rather than the nervous system or the mind and emotions (Heart Spirit Disturbance), and Crataegus is a good example of this. However, in addition to tonifying and stabilizing Heart Qi, Leonurus can also calm Heart Spirit Disturbance. It can thus be used to treat anxiety in addition to cardiac weakness and arrhythmia.

Nervines These can be defined as herbs that tonify and stabilize the nervous system. They can be used to treat depression and emotional instability, especially when these are . associated with physical, emotional, and mental exhaustion. In terms of Chinese medicine, nervines can be said to tonify the Qi or Y'm of the Kidney, and the Qi, Y'm, or Blood of the Heart, and to firm and stabilize Heart Spirit. Some nervine herbs have a sour taste in the mouth and can be assigned the sour astringent taste property, for example, Hypericum and Schisandra. In my opinion, both these herbs can firm and stabilize Kidney Qi. This can reduce the diffusing, dispersing, and disturbing effect of fear on the Kidney itself, and lessen the disturbing effect of fear on the Heart. They can also firm and stabilize Heart Spirit, and can thus be used in combinations for enuresis and dream-disturbed sleep associated with fearfulness and anxiety. DIRECTION OF ENERGY The astringent property can be said to hold things firm, stable, and in their proper place. It can be seen as a passive effect of maintenance, rather than an active effect that moves energy in a particular direction. It can, thus, control excessive outward movement of energy and fluids, but it does not in itself produce an active inward (centripetal) movement of energy. It can also control the excessive disturbed upward movement of energy, but it does not actively direct energy downward.

TEMPERATURE The,~~tionof Qi t? hold things firm and in their proper place is not, in itself, associated with either warming or cooling effects. Most of the astringent herbs that have been classifiedin this book as only sour or slightly sour are neutral in temperature, for example, Capsella and Geranium.

Herbs classified as having both the sour and bitter tastes are also mainly neutral, for example, Agrimonia and Quercus. Some .herbs with both the sour and bitter tastes are listed as neutral-cool or cool, and this may be associated with the anti-inflammatory bitter constituents, as in Filipendula and Hamamelis. Sour astringent herbs that are warming, such as Myrica and Schisandra, are not common, and the warming effect of both these herbs may be due to the acrid constituents.

CAUTIONS Chinese herbal tradition Astringent herbs are contraindicated for Exterior conditions that are not fully cleared since astringents will reduce the outward dispersive movement needed to clear Exterior pathogens through the body surface. This includes skin rashes that are in the process of expressing. In apparent contradiction to this, Schisandra has been used for allergic skin disorders. However, I do not generally use Schisandra in the acute stage of allergic skin disorders associated with Wmd Heat. I use Schisandra in the chronic or remission phase associated with Kidney Deficient Qi. For example, in this book, Schisandra is not included in the combination Arctium: recurring urticaria: acute phase, but it is included in Arctium: recurring urticaria: remission phase. Astringent herbs are also contraindicated in Chinese medicine for Interior Stagnation since they may reduce the dispersing, moving effect required to clear the Stagnation. Warm astringents, such as Schisandra, are especially to be avoided in cases of Interior Stagnation with Heat. Western herbal tradition Astringent herbs are contraindicated when it is necessary to allow toxins to clear from the body via sweat, urine, stools, or discharge. Also, there are specific cautions to be used for astringent herbs with a high tannin content (see the Toxicology section in the Potentilla chapter).

Sweet In the Chinese herbal tradition, the sweet taste is associated with the taste that rice gives in the mouth on chewing; it is not associated with the intensely sweet sensation of sugar, as in the West. This cultural difference explains why some Chinese herbs that are listed as having the sweet property do not taste sweet to Westerners. For example, PanaX ginseng is listed as sweet and slightly bitter in property. However, to most Western people, brought up on massive amounts of sweet foods and candies, the taste in the mouth is primarily bitter, and not all Westerners can detect a sweet taste.

Taste CHINESE HERBAL TRADITION Five Element tradition In this tradition, the sweet taste is said to tonify the Spleen and is linked with Earth. This element can act as the center reference point to which other things are linked and around which they have their movement, giving them stability and balance. The material solidity and weight of the Earth element can be associated with a dampening of excessive movement away from the central position and, therefore with a moderation of extremes. Earth and the sweet taste can also be associated with nourishment, especially of the material aspect of Qi. Herbal tradition In this tradition, the following effects have been associated with the sweet taste property:! • tonic • moistening • antispasmodic ,.; '" • harmonizing of emotions • harmonizing of other herbs • moderation of other herbs

Tonic In Chinese medicine, the sweet taste is associated mainly with the ability to tonify Qi, Blood, ¥m, or Yang. It is especially associated with the nourishing function of Oi. that is, the capacity to increase the solid substance of the body. A good example of a herb with this effect is Ziziphus fruit (da zao). Moistening Closely associated with the nourishing action of the sweet taste is its moistening effect-the ability to tonify Fluids. For example, Pseudostellaria (tai z1 shen) and Ophiopogon (mai men dong) are used for their moistening effect.\2

Antispasmodic Some herbs with the sweet taste can reduce muscle spasms and alleviate pain. This is said to be due to the sweet taste nourishing the rm of the tendons and thus relaxing the muscles. l Glycyrrhiza is such a herb. Angelica sinensis (dang gui) can also relieve pain, and this may result partly from its ability to tonify the Blood. nourish the muscles. and relieve spasms. However, the analgesic effects of this herb may be primarily due to the ability of its acrid constituents to move Blood Stagnation.

Harmonizing ofemotions According to Yang, the moderate

stTeet

taste gives it the ability to harmonize the quality of the emotions and reduce stress, and Lilium brownii (bcii he) and Rehrilannia (shu dl huang) can be used to do this.\ (See the discussion'In the Combining the Western and Chinese perspectives section below.) ,

,'~

.,'

.-

Harmonizing of other herbs Some sweet substances can act

39 as a stabilizing central focus for the other herbs in a combination and can bring together and harmonize their different effects. Glycyrrhiza (gan cao) is the most common example of this.

Moderation of other herbs Substances with the sweet taste can moderate the effects of other herbs. For example, Glycyrrhiza can moderate the harsh effects of other herbs, such as the burning sensation of acrid Capsicum on the mucus membranes. Sweet herbs can moderate the speed and intensity of the effects of other herbs, making their effects less rapid and violent and more moderate and longer lasting. 1 For example, the sweet herb Serenoa can be used to moderate the Yang tonic action of Panax ginseng and Turnera. As a result, the body can incorporate this Yang energy ina smooth and steady fashion, rather than in a short burst that may result in imbalance and side effects.

WESTERN HERBAL TRADITION The theory of taste properties was not as well developed in the West as in China. In addition, the sweet taste was not associated directly with elaborate theoretical concepts. The fruits of Ficus carica, the fig, and Ziziphus jujube, the date, are examples of sweet herbs that were used from ancient times in the West. Both of these fruit were used for their nutritive action and as demulcents to treat respiratory disorders. 1J Althaea and Ulmus are examples of sweet herbs that are currently used in the West for their demulcent and nutritive action. 5,14

BIOCHEMICAL PERSPECTIVE Herbs that are classified as sweet in this book generally contain one or more of the following four types of constituent: • nutritive constituents • mucopolysaccharides • immunopolysaccharides • adaptogens Nutritive constituents The nutritive aspect of the sweet tonic action goes beyond simply supplying sweet nutrients in the form of sugars and starches. It also involves strengthening the natural ability of the body to make Qi and Blood and form tissue. This may involve herb constituents, such as minerals and vitamins, that may act as cofactors and facilitate the anabolic processes of the body. For example, Ziziphus fruit contains calcium, phosphorus, and iron, and the vitamins A, Bz, and C. in addition to sugars and starches.

Combining Western Herbs and Chinese Medicine

40

Mucopolysaccharides Demulcent herbs contain abundant mucopolysaccharides that can form a slippery gel and have a soothing and protective effect on inflamed mucus membranes. Althaea. Plantago major, and Viola are examples of herbs with demulcent action based on mucopolysaccharides, and these herbs can be used for conditions involving inflammation, soreness, and dryness of the respiratory mucosa. (See the Althaea chapter.) Immunopolysaccharides Polysaccharides from the following herbs have been reported to have an immunomodulatory effect: Althaea, Angelica, Calendula. Echinacea, Thuja, and Viburnum (see the chapters on these herbs). This can be regarded as a specific aspect of the Qi tonic action, related to the concept of tonifying Defensive Qi. There is some debate as to the effectiveness of the socalled immunopolysaccharides in vivo. However, it may be that these constituents help herbs, such as Echinacea or Thuja, to increase the resistance of the body to infection. Adaptogens This term refers to herbs or herb constituents that can enhance endurance and strengthen the natural ability of the body to adapt to environmental shocks and stresses. This is a specific aspect of the Qi tonic action that enables the body to maintain homeostasis even under adverse conditions. The active constituents that are responsible for the adaptogenic effect are often triterpenoid saponins. These chemicals can have multiple effects on the body and can strengthen the ability of the following systems to adapt to stresses: • Kidney (nervous and endocrine systems) • Heart (cardiovascular system) • Liver (hepatoprotective system) Examples of sweet tonic herbs with adaptogenic action based on triterpenoid saponins are Astragalus (astragalosides), Glycyrrhiza (glycyrrhizin), and Panax ginseng (ginsenosides). COMBINING WESTERN AND CHINESE PERSPECTIVES The discussion below combines elements from Chinese medicine, Western herbal tradition, and biochemistry, and is • organized under the following headings: • tonic • demulcent • stabilization of the emotions ":~" , • moderation of other herbs Tonic The main effect associated with the sweet taste is the tonic action. However, the tonic action of the sweet taste is

different in nature from the tonic action of the bitter or acrid tastes. Unlike the acrid and bitter tastes, the sweet taste is not associated with increasing movement and dispersing Qi Stagnation. The tonic action of the sweet taste is especially associated with strengthening the material aspect of Qi. Sweet tonics aid the formation of Blood, Yin, and Fluids, and some sweet tonics, such as Serenoa and Ziziphus, can be used to assist in weight gain. Some sweet tonics can strengthen the ability to adapt to environmental stresses and the ability to resist infection. However, these herbs are more for maintaining the stability of the homeostatic mechanism and the integrity of the body's defense system. They do not necessarily tonify Yang in the sense of increasing warmth and movement. Many of the herbs in the Yang tonic group that do strengthen these aspects are either not sweet or have taste properties in addition to sweet, such as acrid and bitter. Demulcent In the Chinese tradition, some sweet tonic herbs are said to help to generate Fluids and thus have a moistening effect, for example, Ophiopogon. Such herbs can be used to treat conditions involving dryness, soreness, and inflammation of the mucous membranes. In the Western tradition, demulcent herbs, such as Althaea, are used for similar conditions, but their effect has been explained in terms of supplying mucilage to the body, rather than by increasing the generation or secretion of Fluids. It is possible that some herbs may have both mucilagesupplying and Fluid-generating effects, or that these two effects are part of the same phenomenon. For example, Althaea is listed as a demulcent in the West and Ophiopogon as a Fluid tonic in China, but both herbs can be used to treat dryness and inflammation of the respiratory mucosa with dry cough and thick sputum that is difficult to expectorate. Stabilization of the emotions The sweet taste can be associated with the Earth element. The damp, heavy, static nature of the sweet taste can be utilized to reduce excessive or disturbed movement of energy, and to stabilize, balance, and harmonize the flow of the emotions. For example, the calming nature of Valeriana may be partly due to the heavy nature of its sweet property, which helps to weigh down the disturbed upward movement of Heart Spirit or Liver Yang that can be associated with anxiety or anger, respectively. I often combine Valeriana with the sweet herb Glycyrrhiza to emphasize this function of the sweet taste. ), . As another example, Cra~~egus h,as a cardioregulatory action that enabl~s it to stabilize"fluctuations in Heart Qi resulting in arrhythmia, energy fluctuations, or emotional lability. I consider the cardioregulatory action of Crataegus to be due paitly to its sour property that can firm Heart Qi

Taste and partly to its sweet property that emphasizes stability around a center point by dampening movement toward the extremes. Moderation of other herbs In a similar way, sweet herbs can moderate the extremes of other herbs in a combination and provide a stable central pivot for their actions. For example, if the patient has both anxiety and depression associated with Deficiency, the following combination could be used: Herb

Ratio

Temperature

Taste

Lavandula Passiflora Hypericum Avena Serenoa Rosmarinus Zingiber

1 1 1 1 0.5 0.5 0.5

51. warm neutral neutral neutral neutral warm hot

aromatic, bitter 51. bitter sour, 51. sweet sweet sweet, 51. sour aromatic, bitter, acrid acrid, aromatic

Th~ sweet taste ofAvena, Hypericum, and Serenoa forms the stable central point of this combination. Lavandula and Passiflora have a calming action to treat anxiety, and Rosmarinus and Zingiber have a stimulant action to treat depression. The sweet herbs will moderate movement toward the extremes of anxiety or depression, reducing any tendency to overcorrection by Lavandula and Passiflora on the one hand or Rosmarinus and Zingiber on the other.

DIRECTION OF ENERGY OF SWEET HERBS In terms of the Five Elements, the sweet taste maintains the movement of energy stable around the center, and dampens movement toward the extremes. It can be said to weigh down excessive or disturbed upward movement, and to reduce excessive outward dispersing movement of energy. However, in high doses, some of the sweet adaptogenic herbs, such as Astragalus, Glycyrrhiza, and Panax ginseng can aggravate or produce excessive or disturbed upward movement of Heart Spirit or Liver Yang. For example, in excessive doses and in susceptible persons, Glycyrrhiza can aggravate hypertension. At high doses, the adaptogenic action becomes a Yang tonic effect with increased upward movement, overriding the heavy nature of the sweet property that tends to control this effect.

TEMPERATURE OF SWEET HERBS In itself, the sweet taste can be associated with the neutral temperature and can be used to stabilize fluctuations in the temperature of the body. Some sweet herbs are classified as cool, but these usually also have the bitter taste in its anti-inflammatory aspect, for example, Althaea, Ophiopogon, and Viola. Herbs with the sweet taste that are classified as warm or hot usually also have the acrid taste, for example, Cinnamomum.

41 CAUTIONS General cautions In Chinese medicine, sweet herbs are avoided or used with caution in the following patterns: • Exterior Excess • Interior Stagnation • Damp • Phlegm Manifestations of the last three patterns include sensations of heaviness, feelings of lethargy and depression, mental heaviness and dullness, digestive stagnation, loss of appetite, nausea, bloating, weight gain, and catarrhal conditions. Specific cautions There are specific cautions and contraindications for different types of sweet herbs. For example,

• Astragalus can have warming and drying effect and so should be used with caution in cases ofYin Deficiency with Heat signs

• Ophiopogon is a sweet herb that is moistening and cooling and is therefore inappropriate for patterns of Deficiency with Cold and Damp

• Panax ginseng is a sweet herb with a stimulating and upward movement effect on the energy and is therefore to be avoided in cases of Heart Spirit Disturbance or Liver Hyperactive Yang

Acrid In the mouth and on the tongue, the acrid or pungent taste can be associated with a range of related sensations, including the severe burning of Capsicum, the prickling of Lobelia, and the tingling of Echinacea or Zanthoxylum. The acrid taste is sometimes referred to as pungent or spicy.

CHINESE HERBAL TRADITION According to the Five Element tradition, the acrid taste tonities the Lung. In the Chinese herbal tradition, the characteristic function of the acrid property is moving and dispersing. It can move Stagnation of Qi and Blood and disperse pathological factors associated with the Stagnation, such as Exterior Wmd, Toxin, or Retained Pathogen. The acrid property can promote Fluid metabolism and help to move and disperse accumulation of Damp or Phlegm.

The acrid property is not necessarily warming. Cool, acrid herbs can be used to disperse Heat, and warming, acrid herbs can be used to disperse Cold.

42

Combining Western Herbs and Chinese Medicine

Three well-known acrid categories In the Chinese herbal tradition, the acrid taste is commonly associated with the following three herb categories: • cool, acrid herbs that clear Exterior Wind Heat • warm, acrid herbs that clear Exterior Wind Cold • acrid herbs that warm the Interior Action groups containing acrid herbs Acrid herbs are not just found in the three well-known categories mentioned above, they are also found in other Chinese action categories. A more complete list is as follows: • clear Heat • clear Wind Heat • clear Wind Cold • clear Wind Damp • transform Phlegm and stop cough • open the Orifices • transform Dam~ i ~ . • regulate the Qi • move the Blood • warm the Interior • tonify Yang • external application Clear Heat In Chinese medicine, the acrid taste occurs in action categories where it might not be expected, for example, the action categories of herbs that clear Heat (drain Fire) and clear Heat Toxin. In these cold. acrid herbs, the moving and dispersing functions of the acrid property are important to assist in the complete clearance of Heat from the body to prevent the possibility of some Heat lingering in the body as a Retained Pathogen. The acrid and cooling properties combine to move Stagnation of Qi and disperse the associated accumulation of Heat and Toxin. l For example. in Chinese medicine, Prunella (xia kii dlO) is a cold, acrid herb that can clear Liver Heat with hypertension and headache, and also disperse Phlegm Heat to treat neck lumps and goiter. Houttuynia (yU xing dio) is a cold acrid herb that can clear Heat Toxin and treat swellings and abscesses. and can clear Lung Phlegm Heat to treat lung abscess or cough. Clear Wmd Heat Herbs with this action can be said to assist in the dispersing function of the Lung, move Stagnation in the surface channels, and disperse Wind Heat and Retained Pathogen. The acrid and cooling properties combine to move Stagnation of Qi and disperse the Wind Heat. Some acrid, cooling diaphoretics are also bitter, and the bitter property may assist the acrid in clearing Heat. For example, in Chinese medicine, Arctium seeds (niu bang ZI) can be used for acute urticaria with feverishness and sore throat.

Clear Wmd Cold Herbs with this action are commonly used in acute respiratory or other infections when chills are dominant to fever and there is pain and sensations of cold in the head, neck, or body. The warming and acrid properties combine to disperse Stagnation, Wmd, and Cold from the surface channels, and often increase or regulate sweating. For example, in Chinese medicine, Angelica dahurica (bai zhi) can be used for acute common cold with headache, sinus congestion, and sensations of cold; and fresh Zingiber (sheng jiang) can be used for acute influenza with chills and cough with copious sputum. Clear Wmd Damp The function of the acrid property in these herbs is to move Stagnation of Qi and Blood in the channels of the muscles, tendons, and joints, and to disperse the Wind and Damp associated with the Stagnation. These acrid herbs can thus be used to treat pain or restriction of movement associated with inflammation of the muscles, tendons, and joints. Some are warming, acrid herbs to disperse Wind Damp Cold, for example, Angelica pubescens (dli huo), and others are cooling, acrid herbs to disperse Wmd Damp Heat, for example, Gentiana macrophylla (qin jiao). li'ansform Phlegm and stop cough A specific aspect of the moving and dispersing function of the acrid taste is to dissolve and disperse Phlegm. l One application of this is to treat wheezing and cough. Once again, the acrid property can be used to treat patterns of either Heat or Cold:

• Pinellia (ban xia) has both the warming and acrid properties that can be used to treat cough associated with Lung Phlegm Cold

• Euphorbia helioscopia (ze qi) has both the cooling and acrid properties that can be used to treat cough or wheezing associated with Lung Phlegm Heat Open the orifices Another application of the capacity of the acrid taste to dissolve and disperse Phlegm is its ability to clear so-called insubstantial Phlegm from the channels. This can assist the aromatic property to open the orifices and revive the Spirit. Aromatic and acrid herbs have been used in Chinese medicine to treat severe acute conditions such as febrile delirium or coma from cerebrovascular accidents, for example, Secretio Moschus (she xiang). Some of these herbs have also been used to treat chronic conditions such as dizziness, deafness, mental dullness, poor memory, or disorientation, for example, Acorus (sm chang pu). li'ansform Damp In Chinese medicine, the herbs in the transform Damp group are most commonly associated with the aromatic property; but they are also acrid in taste, and nearly all are warm in temperature. These herbs are used to revive the Spleen, move Stagnation in the Spleen and Stomach, and transform Damp.

{ .. i

Taste The dispersing and moving functions of the acrid taste complement the lightening and penetrating functions of the aromatic property. Together they can counteract the heavy, deadening characteristics of Damp that can be associated with stagnation, accumulation, and obstruction. For example, Atractylodes lancea (cang zhu) is a warm, acrid, aromatic herb that can treat disorders associated with Spleen Damp, for example, loss of appetite, nausea, epigastric distension, and diarrhea. This herb is especially useful to treat Damp patterns because its aromatic property can transform Damp, its bitter taste can drain Damp downwards, and its dispersing acrid taste can assist both of these processes.

I

.~

Regulate the Qi Due to the moving and dispersing function of the acrid taste, many herbs in the regulates the Qi action category have the acrid property. Most of these herbs are acrid and warm. For example, the mature peel of Citrus reticulata (chen pi) can move Stagnation of Spleen and Stomach Qi to treat nausea with epigastric and abdominal distension. Move the Blood Many of the herbs in this action category have the acrid property, which helps them to disperse and move Blood Stagnation. Most of the acrid herbs that move the Blood are warming. An example is Ligusticum (chuan xiong), which can be used for pain in the chest, sides, or lower abdomen. However, some of the acrid herbs that move the Blood are cooling, for example, the tuber of Curcuma longa (yil jIn), which can be used for chest pain associated with Heart Stagnant Blood and Heart Phlegm Heat. Warm the Interior The acrid and warming properties tend to accentuate each other. The acrid property is moving and dispersing, and the warming property is activating and moving, and can loosen Stagnation, especially that due to Cold. The two properties can combine to produce a rapid, stimulating, and dispersing effect. Most herbs that warm the Interior also warm the Middle Burner and are specific for clearing Cold from the Spleen and Stomach. For example, dried Zingiber (gan jiang) can be used to treat vomiting, epigastric pain, or abdominal pain, when these are accompanied by sensations of cold. A few of the herbs that warm the Interior can warm and strengthen the Kidney. For example, Cinnamomum bark (roil gul) is an acrid herb that can be used for weak back, urinary frequency, and impotence with sensations of cold. These herbs may also warm and strengthen the Yang of the Heart. Tonify the Yang Some~f the herbs' iIi the tonifi~~.th~' Yang group are warming and acrid. However, these herbs are usually also sweet, bitter, or salty. In itself, the acrid taste may be quickly and temporarily stimulating, but it usually needs

43 other properties to add the slow tonic component. For example, the slower, heavier, nourishing characteristics of the sweet taste can provide a good balance to the quick, moving, and dispersing aspects of the acrid taste. For example, Eucommia (dil zhong) has both the acrid and sweet properties. The sweet taste tonifies chronic Deficiency of the ~idney and Liver, and strengthens the sinews and bones to treat weakness in the lower back and legs. The moving and dispersing function of the acrid taste assists circulation of Qi and Blood in these areas to complement the sweet tonic function. External application Many of the substances in this category have the acrid property, and some of these substances are acrid and hot, for example, camphor (zhang nilo). This herb is applied topically in sprains and trauma to reduce pain and swelling associated with Blood stasis. WESTERN HERBAL TRADITION The acrid taste has not been developed as a well-defined theoretical concept in the West as it has in China, and there is not such a clear association of specific actions with the acrid taste. The main action associated with the acrid taste in the West is the circulatory stimulant action. However, there is a wide range of Western action categories that contain herbs with the acrid taste. These are discussed in the Combining the Western and Chinese perspectives section below. Circulatory stimulants These can be defined as herbs that can stimulate or tonify heart function, improve circulation, and warm the body. Some, for example, Capsicum, can specifically increase coronary circulation; some, for example, Zanthoxylum, can specifically increase peripheral circulation; and others for example, fresh Zingiber, are specific for warming the surface of the body. BIOCHEMICAL PERSPECTIVE The acrid taste sensation is not associated with a specific type of taste receptor on the tongue. It is a more general effect, following stimulation of sensory nerve fibers in the mouth or tongue. This may be similar to the counterirritant and local analgesic effect of some acrid substances on the skin. As with the bitter taste, the acrid taste is not limited to one type of chemical. Substances with the acrid taste can be found in various groups of plant constituents, for example, monoterpenoids, phenols, amides, and isothiocyanates. However, the bitter taste sensation on the tongue is followed by a specific sequence of physiological events, but no such sequence is yet known for the acrid taste. This may be partly due to the lack of a specific taste receptor for acrid.

44

Combining Western Herbs and Chinese Medicine

As noted previously, the pharmacological effects associated with the sweet taste can be divided into different groups, each group of effects associated with a different type of chemical. For example the adaptogenic tonic function of the sweet taste can be associated mainly with triterpenoid saponins. This detailed differentiation is not yet possible for the acrid taste. Actions of acrid constituents reported by research Some of the Western actions listed in the table below as associated with the acrid taste have been reported for specific acrid constituents. However, in herbs with multiple tastes, it can be very difficult to decide which pharmacological effects can be attributed to each taste. This is especially so when a single constituent possesses more than one taste, for example, camphor can be classified as both acrid and aromatic. Capsicum is thus a useful herb for study since acrid appears to be its only appreciable taste. Both Capsicum and its main pungent constituent, the amide capsaicin, have been reported to have antimicrobial, circulatory stimulant, digestive tonic, adrenal tonic, and topical irritant and analgesic effects (see the Capsicum chapter). Zingiber is a more complex herb to study since it can be hard to separate the acrid and aromatic effects, and because it has a number of different types of pungent constituents. The following effects have been reported for Zingiber's pungent constituents, the gingerols and shogaols: cardiotonic, thermogenic (warming), digestive stimulant, antispasmodic, antiemetic, antidiarrheal, and antitussive (see the Zingiber chapter).

COMBINING WESTERN AND CHINESE PERSPECTIVES The table below shows a range of Western actions that can be associated with the acrid property along with their nearest equivalent Chinese action concept. Understanding the role of the acrid property in these different action groups gives a deeper appreciation of the nature of the acrid concept. Each action is discussed below in terms of the different aspects of the acrid property, of which the most fundamental are moving and dispersing.

• antimicrobial, alterative

clear Heat

• cooling diaphoretic

clear Wind Heat

• warming diaphoretic

clear Wind Cold

• antirheumatic, antiarthritic

clear Wind Damp

• anticatarrhal, expectorant, antitussive

transform Phlegm and stop cough

.. -~

• resuscitant. anticonvulsant

open the Orifices

• carminative

transform Damp, regulate the Qi

• antispasmodic. analgesic

move the Blood

• circulatory stimulant

warm the Interior

• tonic

tonify the Yang

• counterirritant

external application

Antimicrobial and alterative (clear Heat) In Chinese medicine, in some circumstances, the moving and dispersing functions of the acrid property can result in a cooling effect by clearing Heat of various kinds. This can apply to some Western acrid herbs in the following action categories:

LOBELIA antipyretic

clear Excess Interior Heat and Wind Heat

CAPSICUM anti-inflammatory

clear Heat associated with Interior Stagnation

THUJA antimicrobial

clear Damp Heat and Heat Toxin

PHYTOLACCA alterative

clear Damp Heat. Heat Toxin. and Retained Pathogen

Some antimicrobial and alterative acrid herbs are classified as warming, such as Capsicum and Thuja, others as cooling, such as Phytolacca, and others as variable-temperature herbs, such as Lobelia. In each case, it is the moving and dispersing functions of the acrid property that results in the clearance of Heat Diaphoretic (clear Exterior Wmd) Western herbs with the diaphoretic action, that is, inducing or increasing perspiration, can be divided into cooling diaphoretics and warming diaphoretics.

Cooling diaphoretic In herbs with this action, for example, Nepeta, the dispersing function of the acrid property can be said to assist clearance of Wind Heat. In some cooling diaphoretics, the Heat-clearing function of the bitter property assists the acrid dispersing function to remove Heat from the system. Such acrid and bitter diaphoretic herbs often also have the alterative action of clearing Retained Pathogen from the surface of the body, for example, Achillea. Warming diaphoretic Herbs that have the warming diaphoreticaction often also have the circulatory stimulant

Taste action, for example, fresh Zingiber. Both these actions are associated with the warming, stimulating, moving, and dispersing aspects of the acrid property. In the diaphoretic action, these acrid functions are active more at the surface of the body, and in the circulatory stimulant action, more in the interior. Antirheumatic and antiarthritic (clear Wmd Damp) In herbs with these actions, the moving and dispersing functions of the acrid property can be said to clear Wind and Damp, and associated Stagnation, from the channels of the muscles and joints. In some Western herbs with these actions, for example, Arctium and Phytolacca, the dispersing aspect of the acrid property can have a cooling effect by dispersing Heat. In other Western herbs with these actions, for example, Myrica and Zanthoxylum, the acrid property is combined with a warming, circulatory stimulant effect. Anticatarrhal, expectorant, and antitussive (transform Phlegm and stop cough) In Chinese medicine, the moving and dispersing functions of the acrid property can be associated with the functions of penetrating, dissolving, and dispersing Phlegm. These acrid functions can contribute to the Western anticatarrhal, expectorant, or antitussive actions. Anticatarrhals reduce excessive secretion and accumulation of mucus by the mucous membranes, wherever these may be in the body, but do not necessarily initiate the cough reflex. Expectorants have the more specific function of promoting the coughing up of phlegm, and antitussives can reduce excessive coughing. There is no exact equivalent of the anticatarrhal action in Chinese medicine. It is not the same as the action transforming Damp since the anticatarrhal action does not necessarily depend on stimulating the Spleen, but rather on a local effect on the mucous membranes. However, there may be some overlap between the two actions. In the Western herbal tradition, Sambucus is an example of a cooling acrid anticatarrhal that can be used for sinusitis, and Euphorbia hirta is a cooling acrid expectorant that can be used for bronchitis. Angelica archangelica can act as a warming acrid expectorant for cough with watery sputum or as a warming anticatarrhal for sinusitis. Lobelia is an example of an acrid antitussive herb that can be used for hot or cold conditions. . Resuscitant and anticonvulsant (open the orifices) In Chinese herbal medicine terms, the acrid functions of penetrating, dissolving, and dispersing Phlegm from the channels can complement the functions of the aromatic property of transforming Phlegm, opening the orifices, and reviving the Spirit.

In Western tradition, the acrid herbs Lobelia and Symplocarpus were components of the Antispasmodic tincture beloved of the Physiomedical and Eclectic practitioners. This combination, or Lobelia as a single herb, were given for fainting and for loss of consciousness associated with asphyxia, drowning, concussion, or apoplexy. They were also given for infantile convulsions, epilepsy, and febrile delirium. These acrid herbs can be said to combine the actions of dearing Phlegm and opening the orifices with extinguishing Wind and stopping tremors. Carminative (transform Damp and/or regulate the Qi) Herbs with this action are usually warming and are usually not only aromatic but also acrid. These tWo properties combine to regulate Qi, move Food Stagnation, and, in some cases, transform Damp and Phlegm. The digestive stimulant aspect of the carminative action may be more due to the acrid property, and the smooth muscle relaxant aspect may be more associated with the aromatic property. For example, Elettaria is a warming, acrid, aromatic herb that can be used for loss of appetite, flatulence, and intestinal colic, and can be said to regulate Qi and relax spasms. Angelica archangelica and Juniperus are aromatic and acrid herbs that can regulate Qi and, in addition, transform Damp. They can be used to treat loss of appetite and flatulence with sensations of heaviness in the limbs and body. Antispasmodic and analgesic (move the Blood) Some Western herbs that possess only the acrid taste, such as Capsicum and Lobelia, can be used as antispasmodics and analgesics both when taken internally and when used as external applications. This can be related to the acrid function of moving Qi and Blood and dispersing local areas of Blood stasis. For example, both Capsicum and Lobelia can be used for angina pectoris, postnatal pain, or local trauma. Circulatory stimulant (warm the Interior) In herbs with this action, the stimulating and moving aspects of the acrid property are associated with a strong warmirig effect. Such herbs stimulate the cardiovascular system and warm the body. This group contains the hottest herbs used internally in the West and includes Capsicum, Cinnamomum, Sanguinaria, Zanthoxylum, and Zingiber. It is interesting that Capsicum, the hottest of these herbs, has 1;leen used to equalize the distribution of heat in the body, to reduce fever or to treat certain patterns ofhypertension with sensations of heatin the head and upper body (see the Capsicum chapter). Redistribution or clearance of Heat can be associated with the dispersing function of the acrid property.

46

Combining Western Herbs and Chinese Medicine

The circulatory stimulant category has no exact equivalent in Chinese medicine, the closest category being that of herbs that warm the Interior. However, the· emphasis for most of these herbs is on warming the Spleen and improving digestion, rather than warming the Heart and improving circulation. A few of the herbs in the action category of moving the Blood can be described as circulatory stimulants in terms of Western tradition, for example, Commiphora (mb yao). However, circulatory stimulants have the specific function of strengthening coronary or peripheral circulation and warming the body. Herbs in the category of moving the Blood do not necessarily do this. Rather, they have the function of relieving pain due to Blood Stagnation, wherever it may be in the body and regardless of whether it is associated with Cold or Heat. Tonic (tonify Yang) When combined with the warming property, the acrid property is normally associated only with rapid stimulating, moving, and dispersing effects. Warming acrid herbs that also have a more gradual tonic action usually also have an additional taste. such as sweet or bitter. For example, Cinnamomum is warming, acrid, and sweet. and Turnera is warming, acrid, and bitter. However, Capsicum is a good example of a warming acrid herb that has only the acrid taste property but can have a more long-lasting tonic action in addition to its rapid stimulant effects. Counterirritant (external application) It may be that one aspect of the acrid property is its capacity to irritate the tissue and thereby initiate the natural local healing process. This can stimulate local circulation of Qi and Blood in the tissues and reduce pain and swelling due to blood stasis. Capsicum and Lobelia are examples of acrid counterirritants used in the West as topical applications for sprains and injuries.

DIRECTION OF ENERGY The function of the acrid taste is moving and dispersing and its direction of movement is outward. The acrid property is light and moving, and therefore likely to accentuate the upward movement of other light and moving energies. such as Heart Spirit and Liver Yang. It can counteract the heavy, dulling, downward effect of Damp. Acrid and wiU'lning The outward dispersing movement is accentuated if the acrid herb. is also warming. However. different acrid, warming herbs can vary greatly in their effects, as shown by. the difference between-Ephedra and Capsicum. '..,' '.'". .'0-' .• .

Ephedra This is an example of a warming. acrid herb with such a strong dispersing effect that there is the potential of loss of energy through the body surface and of depletion of

Lung and Kidney Qi. Ephedra can also accentuate irregular .: upward movement of energy and aggravate Heart Spirit Disturbance or Liver Hyperactive Yang, resulting in hypertension with sensations of heat in the upper body.

":c=:

Capsicum This is a powerful warming acrid herb with a very different effect on the movement of energy from Ephedra. Although it can have a strong dispersing effect. Capsicum does not accentuate disturbed upward movement. In fact. it tends to equalize the circulation of Qi and Blood throughout the body, so that it can be used to treat certain forms of hypertension with heat in the head and face.

TEMPERATURE Especially in the West, the acrid taste is often associated with the warming property. Certainly the moving dispersing nature of acrid is more comparable to the nature of the warming property than it is that to the nature of the cooling property. However: acrid resembles bitter in that neither of these tastes is necessarily linked to any particular temperature. Although acrid is perhaps more often associated with the warming property and bitter with the cooling, both tastes can be associated with any of the temperature categories. from hot to cold.

CAUTIONS General cautions The key function of acrid is moving and dispersing. Therefore, herbs with a strong dispersing effect of the type that can result in depletion or disturbance of energy, for example, Ephedra, are contraindicated or to be used with caution in cases with severe Deficiency of Qi or Disturbance of Spirit. However, this does not necessarily apply to acrid herbs that have a strong dispersing effect but are less likely to lead to depletion. For example, Achillea can have an acrid dispersing effect, but this is balanced by both tonic and astringent actions. . Specific cautions The specific indications of an acrid herb will depend on its temperature, its tastes, other than acrid, and its specific actions. For example, a hot acrid herb such as Capsicum would generally be contraindicated for peptic ulcers with Stomach Heat, and a cool acrid herb such as Echinacea should be used with caution for exhaustion with Deficiency and Cold in the Spleen, Stomach, and Intestines.

/.

.·Aromatic

. In the case. of the aromatic property. the sense of taste overlaps with the sense of smell. Aromatic substances are generally partially volatile at room temperature. and any

Taste effect they may have on the body may be partly via stimulation of taste receptors and partly via stimulation of olfactory receptors.

CHINESE HERBAL TRADITION The Five Element taste correspondences did not include aromatic, and in the Chinese herbal tradition, the aromatic property (xiang) was not strictly regarded as a taste.

47 substances can be used either to revive consciousness and treat coma, or to calm febrile delirium and help to reduce spasms and convulsions. Again, most of these aromatic substances also have the acrid property, which may contribute to the capacity to penetrate Phlegm. Some are warming, for example, Liquidambar resin (sii. he :dang), and others are cooling, for example, ox gallstone (nili huang).

Herbs that regulate the Qi Some of the herbs in this categoFunctions of the aromatic property The aromatic property is similar to the acrid in that it has moving and dispersing functions. However, to a greater degree than acrid, the aromatic property is considered to be lightening, penetrating, awakening, and reviving. The aromatic property is especially used when the Spleen fails to digest the food and metabolize Fluids properly, resulting in the accumulation of Damp and Phlegm. The aromatic property can:

• awaken the Spleen to transform Damp • penetrate the turbidity of Damp • lighten the effect of the heaviness of Damp on the body and the mind

• revive the Heart Spirit and open the orifices Actions associated with the aromatic property In Chinese herbal medicine, two groups of herbs are specifically associated with the aromatic property: • aromatic herbs that transform Damp • aromatic substances that open the orifices In addition, there are aromatic herbs in the category of herbs that regulate the Qi.

Aromatic herbs that transform Damp The aromatic property of these herbs awakens the Spleen to transform Damp, penetrates the turbidity of Damp, and lightens the effect of the heaviness of Damp on the digestive system and the body in general. These herbs are used to treat loss of appetite, nausea, vomiting, abdominal distension, and diarrhea when these are associated with indications of Damp, such as lethargy and sensations of heaviness and dullness in head, body, and limbs. The aromatic herbs in this group are also acrid and most of them are warm. fhese three properties combine to move Stagnation and to disperse Damp and Cold, as in, for example, Agastache (hub xiang) and Eupatorium fortunei (pei lcin).

Aromatic substances that open the orifices The aromatic property of these substances is said to penetrate the turbid Phlegm that is clouding and obstructing the sensory orifices and to revive the Heart Spirit. Phlegm can have either a dulling or a disturbing effect on the mind. Therefore, these

ry have the aromatic property and can move Stagnant Qi in the Spleen, Stomach, or Intestines to treat such complaints as belching, nausea, vomiting, and epigastric or abdominal distension and pain. A good example is the mature peel of Citrus reticulata (chen pi). Regulating Qi and transforming Damp are two actions that can have similar effects. The difference between the two is that Qi regulators are specific for intestinal spasms and pain linked to Stagnation of Qi, whilst herbs that transform Damp are specific for abdominal distension and diarrhea with lethargy and sensations of heaviness linked to Damp. The action of regulating the Qi is more connected to the moving, relaxing, and calming aspects of the aromatic property, and the action of transforming Damp is more related to awakening the Spleen and penetrating and lightening Damp. Clarifying terminology Herbs that are aromatic in smell and in property are not always classified as aromatic in the materia medica of Chinese herbs. Rather, an examination of these texts reveals that these herbs are treated as follows: 1. Some herbs are not classified as aromatic in the list of

properties for their materia medica entry, but are included in the chapter relating to aromatic herbs that transform Damp and/or the chapter relating to aromatic substances that open the orifices. For example, Agastache (huQ xiang) and Eupatorium fortunei (pei hin) are included in the Aromatic Herbs that Transform Dampness chapter in Bensky and Gamble, but are both listed only as acrid in the text of Yeung. 2. Some herbs are not classified as aromatic in the list of properties for their materia medica entry and are not included in the two 'aromatic' chapters, but are described as aromatic elsewhere in the text. For example, camphor (zhang nao) is listed only as acrid in Bensky and Gamble, and in Yeung, but is described in both books as an aromatic herb to open the orifices. 3. Some herbs are not classified as aromatic in the list of properties for their materia medica entry and are not included in the two 'aromatic' chapters. In addition, they are not described as aromatic in the text, but nevertheless, they have a strong aroma and have actions that can

Combining Western Herbs and Chinese Medicine

48

be linked to the aromatic property, for example, Angelica dahurica (bai zhI) and Ligusticum (chuan xiong). One recent text by a Chinese author has listed these herbs as aromatic in property.l

WESTERN HERBAL TRADITION Fragrant herbs are found especially in three main Western action categories: • carminatives • tranquilizers • antidepressants Carminatives Culpeper wrote that one of the herb properties that strengthens the stomach and assists digestion is the aromatic property. Carminatives can be defined as aromatic herbs that aid digestion, excite peristalsis, promote the expulsion of gas from tlle gastrointestinal tract, and relieve the pain caused by flatuleilce:These herbs are aromatic because of their relatively high content of volatile oils. Examples are: Elettaria and Pimpinella. Tranquilizers Many of the herbs used in the West to treat insomnia, calm anxiety, and relax nervous and muscular tension are rich in aromatic oils. Many of these herbs are from the family Lamiaceae, for example, Hyssopus, Lavandula, Melissa, Mentha pulegium, Nepeta, Rosmarinus, Salvia, and Thymus. Culpeper recommended Lavandula, for example, for'tremblings and passions of the heart: and Tabernaemontanus listed it for palpitations. Antidepressants Aromatic herbs have a long tradition of use for treating melancholy and lowness of mood. For example, Culpeper described the following herbs for these conditions:

• Melissa

causes the heart to become merry and drives away troublesome cares and thoughts from the mind that arise from melancholy • Rosmarinus can drive melancholy'vapours' from the heart and refresh the spirits and make them lively and active • Salvia can quicken the senses and treat lethargy in those persons who are dull and heavy of spirit

WESTERN AROMATHERAPY

and permeate the body, bringing a wonderful sense of light- .-ening and well-being. The subject feels temporarily raised above the darkness and heaviness of the clouds to where the sun is shining and the atmosphere is clear and peaceful. The tension and cares of daily life seem to fall away, allowing the soul to expand. Lonicerus and Tabernaemontanus used Lavandula, Rosmarinus, and other aromatic herbs as steam inhalations or as steam baths to treat both internal and external ailments. Culpeper described the use of two or three drops of the oil extracted from Lavandula or Rosmarinus to be taken internally or applied to the temples and nostrils. He used these oils for the physical, emotional. and mental conditions for which he recommended these herbs. He warned that these aromatic oils should be used with caution and in small amounts since their nature is very quick, piercing, and subtle. The traditions of using aromatic herbs for emotional and mental disorders. and of us~g concentrated ()~s have existed for a long time in Western herbal medicine. In recent years, aromather~py has developed and expanded these traditions, and the interest in the medical use of aromatherapy has given impetus to the isolation of individual aromatic constituents and to the study of their pharmacological effects.

BIOCHEMICAL PERSPECTIVE Aromatic substances may have their pharmacological effects by stimulating both the olfactory receptors in the nasal membranes and the taste receptors on the tongue. In addition, they may stimulate receptors in interior tissues of the body, following absorption through the nose, mouth, gut, or skin. Whilst there appear to be several different types of olfactory receptors, each sensitive to a different group of odors, there do not appear to be taste receptors that are specific for aromatic substances. However, aromatic compounds can have one or more of the main tastes, especially acrid or bitter. Three levels of the aromatic effect As with bitter compounds, aromatic constituents can be said to have three main levels of activity: • effects shared by aromatic compounds in general • effects shared by members of a particular chemical group _. effects specific to individual chemicals

'F~r ih6us~ds-ofyears;in all Cultures, the inhalation ~f

Effects shared by aromatic compounds in general For example,

fragrances has been used to change mood and state of consciousness. As a subjective experience, the fragrance of an aromatic substance can change the nature of the air itself

those aromatic substances whose scent is generally experienced as fragrant and pleasing generally have the common effect of lifting and lightening a person's mood. This effect

---

Taste may follow stimulation of a variety of types of olfactory receptors and may be mediated by the limbic system.

Effects shared by members of a particular chemical group An aromatic substance may have additional effects that are characteristic of its chemical type. This may be either by stimulation by a specific type of olfactory receptor, following inhalation of a volatile substance, or by chemical reaction within the body, following oral administration. For example, the monoterpenoid ketones, such as camphor and pulegone, may be especially linked to calming or antidepressant effects, whilst the monoterpenoid phenols, such as carvacrol and thymol, may be especially associated with the antimicrobial action. However, whilst there has been considerable speculation suggesting that each of the different groups of monoterpenoids has a different spectrum of characteristic pharmacological effects, it should be pointed out that there is very little research data to support such a clear differentiation. Effects specific to individual chemicals There can be considerable differences in pharmacological effect between monoterpenoids in the same chemical group, for example, within the monoterpenoid ketone group: • fenchone is an antitussive • valerone is a sedative • camphor can be a stimulant

COMBINING WESTERN AND CHINESE PERSPECTIVES Definition of aromatic

An aromatic herb can now be

defined in the following terms: • it is fragrant and has a relatively high essential oil content • it has one or more of the following energetic effects: dispersing, lightening, moving, opening • it has one or more of the following actions: carminative, tranquilizer, antidepressant, resuscitant Carminative There is considerable overlap between the Western concept of carminative and the Chinese concepts of aromatic herbs that transform Damp and herbs that regulate the Qi of the Spleen, Stomach, and Intestines. These concepts all deal with the treatment of digestive disorders, especially those concerned with epigastric or abdominal distension and discomfort.

I I

Carminatives and Damp The Western concept of carminative does not emphasize the clearance of Damp. However, certain aromatic herbs used in the West as carminatives can

49 be used to stimulate the Spleen and to clear Damp and Phlegm from the body. Two good examples are Angelica archangelica and Juniperus. both of which are drying in nature. These herbs can be used not only to treat flatulence and intestinal colic, but also to assist in the treatment of edema, obesity, general catarrhal conditions, and rheumatism associated with Exterior and Interior Damp and Cold.

Normalizing effect of carminatives on the gut In terms of Chinese medicine, the carminative action can be associated with the regulation of the Qi in the Spleen, Stomach, and Intestines. In terms of Western physiology, carminatives can be said to have a normalizing effect on the muscle of the gut. They can both relax intestinal spasms to normalize muscle tone and stimulate the gut to normalize peristalsis. They do not have an antispasmodic effect to the point of flaccidity, nor do they stimulate peristalsis to the point of producing spasms and pain. In fact~ carminatives can be given to counteract the griping caused by purgatives. For example, the essential oil of Cinnamomum cassia has been reported both to increase gastrointestinal secretion and to stimulate digestive action, and also to relieve intestinal spasms (see the Cinnamomum chapter). Carminative and tranquilizer effects Some aromatic herbs and herb constituents can have both an antispasmodic action on the smooth muscle of the gut and a tranquilizing effect on the central nervous system. For example, Lavandula can be used for intestinal colic and anxiety. Also, the aromatic constituents of Cinnamomum can relieve intestinal spasms and have. sedative and anticonvulsant effects. It is not yet possible to separate the mechanisms of these antispasmodic and tranquilizer effects. Tranquilizer Aromatic herbs, such as Lavandula, Mentha pulegium, and Salvia, can be used to treat both anxiety and insomnia as well as headaches and migraine. In terms of Chinese medicine, they can be said to calm Heart Spirit and Liver Yang and thus control disturbed upward movement of theQi. The mechanism of these effects can give an insight into the nature of the aromatic property. It does not control the upward movement by firming the Qi, as do sour herbs, nor by weighing it down by its heavy nature, as do sweet herbs, nor by having a sedative action on consciousness, as do some bitter constituents. Rather, by its calming and lightening nature, the aromatic property can gently relax internal tensions, and by its moving and dispersing nature, the aromatic property can dissipate the pressure of constrained energy that may contribute to the disturbed upward movement.

\

50

Combining Western Herbs and Chinese Nledicine

Antidepressant Aromatic herbs, such as Lavandula, Mentha piperita, Rosmarinus, and Thymus, can be used to treat melancholy and lowness of mood. In terms of Chinese medicine, these herbs can be said to treat depression associated with Stagnation of the Heart, Liver, or Lung Qi. They may also have a tonic effect on the Heart or Spleen that may assist in the treatment of depression associated with Deficiency, but the antidepressant effect of the aromatic property is not so much linked to this tonic effect. Rather, the aromatic property has its effect on depression by lightening heaviness, lifting mood, relaxing constraint, and calming the mental and emotional disturbance that may be associated with depression.

Aromatic and acrid The antidepressant effect of the aromatic property is different from that of the acrid. Acrid is more Yang, dynamic, stimulating, and especially more moving. It can stimulat~ the Heart to increase the driving force to move Blood through the vessels and penetrate stasis of the Qi and Blood. A good example of an acrid antidepressant is provided by Capsicum. Aromatic is more Ym, relaxing, calming' and especially, more lightening. Lavandula is a good example of an aromatic herb that can relieve depression by its lightening, relaxing, and gently dispersing effects. Normalizing the effect ofaromatics on the mind and emotions Just as aromatic herbs can have a combination of relaxant and stimulant effects on the gut, thus, normalizing its function, so they can have a combination of relaxant and stimulant effects on the central nervous system and the emotions. In fact, it is in the nature of the aromatic property to have this dual effect. The calming and relaxing nature of the aromatic property can help to treat emotional disturbance, and its lightening and dispersing nature can help to treat depression, especially when the depression is associated with either Stagnation or Disturbance of energy. Resuscitant The use of aromatic herbs as resuscitants is not common in the West, and most Western resuscitant herbs have the acrid property, for example, Lobelia and Capsicum. However, the use of aromatic herbs in the treatment of chronic emotional and mental imbalance is one of the great contributions of Western herbal medicine. In contrast, in Chinese medicine, aromatic substances are used as resuscitants to treat acute conditions of dulling of consciousness, such as apoplectic coma, or are used for acute conditions of disturbance of consciousness, such as febrile delirium or convulsions. There does not appear to be a strong Chinese tradition of using the aromatic property to treat chronic mental and emotional imbalance. Acorus (shi chang pu) is an aromatic herb that can be

\

-_ .. _-~==-.\

used for chronic forgetfulness, mental dullness, or disorientation associated with Phlegm obstructing the sensory orifices and dulling the Spirit. However, its capacity to penetrate Phlegm may be as much due to its acrid taste as to its aromatic property.

DIRECTION OF ENERGY As discussed above, both the acrid and aromatic properties have a moving, dispersing nature and an outward effect on the direction of energy movement. However, acrid is more strongly dynamic in moving Qi and Blood through the vessels and in penetrating Blood stasis or obstruction by Phlegm. Strong acrid herbs, such as Ephedra, can cause excessive outward movement so that energy is lost through the body surface, or it can cause disturbed upward movement. Aromatic herbs have a gentler moving and dispersing effect, and a more relaxing and calming effect. As a result, they can be used to reduce disturbed upward movement. They are characterized by their lighte~ing effect on the body so that they can form a natural counter to treat heaviness of mood and the effects of excessive Damp.

TEMPERATURE Aromatic herbs are mainly warm in temperature, and many of these are also acrid. The few Western aromatic herbs that are cool, such as Matricaria or Nepeta, are also to some degree bitter, and the bitter constituents may contribute to the cooling property. A number of herbs with the aromatic property are listed as variable-temperature herbs in this book and classified as warm-cool, for example, Mentha piperita. This herb is used in both Chinese and Western tradition as a cooling diaphoretic to clear Wind Heat, and this effect is associated with its acrid property. In addition, it has been used in the West since the time of Dioscoridesl 3 as a warming carminative for cold conditions of the stomach, and this effect is associated with its aromatic property. This use has continued, especially in the Spanish-speaking world, for example, in South America 14 and the Philippines. 15

::

CAUTIONS In Chinese medicine, aromatic substances that open the orifices are considered to be scattering in nature and have the potential of draining the source Qi 12. In my opinion, this does not apply to aromatic herbs used in the West as carminatives, tranquilizers, or antidepressants, such as Lavandula, Mentha, Rosmarinus, Salvia, or Thymus.

'-.l

Taste If aromatic herbs are also acrid and warming, they should be avoided in cases of Excess or Deficiency Heat unless the aromatic herbs are combined with other properties. Aromatic herbs that are warming and drying, such as Angelica archangelica, should be avoided in cases of Yin Deficiency and Dryness unless they are moderated by moistening herbs, such as Althaea or Glycyrrhiza.

51 'Effectof.taste;,cont.'·'" ......----.-- ..--------...-----.----~.::=_..::_=.:. Aromatic • lightening effect counteracts heaviness of mood or the dulling, heavy, downward effect of Damp • dispersing, relaxing, and calming effect clears constraint and stagnation, and reduces disturbed upward movement.

TEMPERATURE

Comparison summary In this summary, the following features of the taste properties are compared in table format • direction of energy • temperature • contraindications

A particular taste is not necessarily linked to a particular temperature. This is especially true of the bitter and acrid tastes. Although many bitter herbs are cooling and many acrid herbs are warming, both these taste properties can be associated with temperatures ranging from hot to cold. It depends on the individual herb. For example, Evodia (wti zhii yIi) is a hot herb with the bitter taste, and Prunella (xia kii cao) is a cold herb with the acrid taste.

DIRECTION OF ENERGY The effect of the different taste properties on the direction of energy movement is summarized in the table below. It can be seen that some tastes may have a variety of different effects. Which effect manifests in a particular situation depends on the state of the patient and on the specific chemical structure of the constituent(s) responsible for the taste.

,',

.;....

, ::.(3doses'perday)'" a single herb"I} teaspoons and cups

1 heaped tsp herb per cup water

3 heaped tsp herb per 3 cups water

grams and milliliters

3 g herb per 150 ml water

9 g herb per 450 ml water

ounces and pints

0.1 oz herb per 5 fl. oz water

0.3 oz herb per pint water

DOSE The philosophy of dose has been discussed above, and this book generally follows the higher dose approach.

j

Dose for infusions of more than one herb Infusions are generally made from one, two, three. or at the most four herbs, since infusions are generally used for relatively simple acute or chronic situations. When a herb is used as a single herb, its dose is generally larger than when it is used in combination with other herbs. This is because. in a combination, its actions are assisted by the actions of the other herbs. For example, when I use Achillea as a single herb in an infusion, I use an individual dose of about 3 g. When using Achillea in combination with other herbs. I use less; thus, an individual dose of the combination Achillea: influenza + sore throat contains 2 g of Achillea. in addition to 1 g of Mentha and 1 g of Sambucus. Dose. for decoctions , The two main approaches to the. ...... strength of a decoction are the same as those for an infusion: "

• 1 teaspoon of dried herbs per cup of water 6 • 1 oz of dried herbs per pint of water

l3

";'.~::~ ;i~ . . . t-;.~ :.\.

'_~f

-~"

.-

=

Dose However, the difference is not as extreme as it might at first appear. The 1 oz ofherbs per pint ofwater does not necessarily represent a daily dose. Rather, it may represent the amount of herbs to be taken during 2-3 days. For some of his decoctions, Christopher recommended a dose of 3 tablespoons per day, not 3 cups per day. Also, the figure of 1 oz (approximately 30 g) often refers not to a single herb but to the combined weight of all the herbs in the decoction. Most of my decoctions contain 4-8 herbs. The individual dose of each average dose herb in a combination is about one teaspoon (approximately 2 g). At three individual doses per day the daily dose of each herb is 6 g. If there are 5 herbs in the decoction, each at 6 g per day, then the total quantity of herbs in a daily dose is 30 g.

Note:

Christopher recommended 1.5 pints of water for a decoction, as opposed to his recommendation of 1 pint for an infusion. This was to allow for loss due to evaporation of 0.5 pints since he generally simmered or boiled decoctions for 20-60 minutes.

Average, higher, and lower dose herbs Herbs differ in their strength, so that their doses may be very different. Whilst the daily dose of an average dose herb is about 9 g of dried material, the daily dose of the higher dose herb Taraxacum leaf is 12-30 g, and the maximum daily dose of the lower dose herb Convallaria is 0.45 g.

ADVANTAGES OF INFUSIONS AND DECOCTIONS Cheapness and accessibility Throughout history, infusions or decoctions of fresh or dried herbs have made herbal medicine available to ordinary people who could not afford the expensive herbal preparations provided for the rich. This also applies today when there is a danger in some Western countries that therapeutic doses of herbal preparations, for example, tinctures, are priced beyond the reach of a large proportion of the population. Not only are dried herbs generally the cheapest form of herbal medicine, but those with access to the countryside can gather fresh herbs, and those with a garden, a city plot. or even a window box, can grow them.

: .... -

Link to the natural world Some modern sedentary societies are becoming increasingly out of touch with the world of nature. The use of dried and especially fresh herbs is an excellent way to begin to reconnect with the energy of the natural world that can be such an imp~rtant part of the process of healing. To walk in the woods and fields. to get to know the plants, and to gather them and to use them can bring a sense of peace and fulfillment that is not normally found in a bottle of pills or tincture.

105 Therapeutic value of water Infusions and decoctions are the dispensing forms that combine the therapeutic effects of herbs with the therapeutic effects of water. Water in itself can be cleansing and healing to the system, and the combined cleansing effect of herbs and water can be utilized in the treatment of conditions involving accumulation of toxins and waste materials in the body. Infusions or decoctions are therefore especially appropriate for diaphoretic, diuretic, laxative, and alterative herb combinations. Extraction profile Infusions and decoctions are appropriate to extract active constituents that are water soluble, for example, tannins and polysaccharides. They are therefore appropriate to use for astringent herbs containing tannin, such as Potentilla, for herbs containing demulcent mucopolysaccharides, such as Althaea, and for herbs containing nutritive polysaccharides, such as Chondrus. Whilst decoctions are inappropriate for herbs in which the key acti,ve constituents are aromatic oils, infusions can be an excellent medium for these herbs since the heat of infusions releases some of the aromatic oils from the plant material, allowing these aromatic compounds to be both ingested and inhaled. For example, the wonderful smell of Mentha pulegium infusion can be relaxing even without drinking the tea. Such infusions effectively combine herbal medicine and aromatherapy. Treatment of patterns of Cold The warmth of a hot infusion or decoction can be an important element in the treatment of Cold Deficient or Stagnant conditions of the Spleen, Lungs, or Heart. The warmth of the water combines with the warmth of the carminatives, diaphoretics, or circulatory, stimulants respectively, to treat these patterns. The warmth can have a diffusive, relaxing, and comforting effect on the mind and body. Treatment of patterns of Dryness Infusions or decoctions of herbs containing demulcent mucopolysaccharides, such as Althaea and Viola, are an excellent way to combine the moistening and rehydrating effects of water with the soothing, demulcent. anti-inflammatoryaction of mucopolysaccharides. These can be used to treat patterns of Deficient Ym and Dryness, whether of the respiratory, digestive, or urinary systems.

DISADVANTAGES OF INFUSIONS AND DECOCTIONS Taste If the herbs are unpleasant in taste, some patients may prefer a different dispensing form since there is a relatively large volume of liquid to ingest with infusions or

Combining Western Herbs and Chinese Medicine

106

decoctions (see the subsection on Taste in the section on Factors affecting dose above). However, many patients become accustomed to the bitter taste of decoctions and have good compliance. Convenience Infusions, and especially decoctions, a~e a relatively inconvenient form. If the patients are exhausted, lazy. impatient, or forgetful, or if they have an extremely busy life, they may prefer a more convenient form such as tinctures or capsules. However, the discipline and the routine of making and taking decoctions can be an important first step in learning to care for self and in stabilizing a chaotic lifestyle. Extraction profile Water is a poor solvent for some types of constituents, such as resins. Herbs that have a high proportion of resinous constituents, such as Commiphora or Grindelia, are generally extracted with 90% alcohol.

Infusions These are especially unsuitable for compounds with low solubility in water since the plant material only has a short exposure to water and there is no simmering.

Decoctions To maximize extraction of constituents with low water solubility, the plant material can be presoaked for at least 30 minutes in cold water, and preferably overnight. The mix is then simmered for at least 30 minutes to maximize extraction. and in some cases. can be simmered for an hour or more. Preservation Dried herbs lose their quality more quickly than some other dose forms. tinctures for example, and are also more susceptible to fungal and insect invasion. Dried herbs should be discarded if they do not have their characteristic smell and taste, or if they are looking 'old and graY:

Tinctures and llquid extracts I have experimented with various strengths of tinctures and with various types of liquid extracts, but the bulk of my own experience has been with 1:5 tinctures. Therefore, the different types of tinctures and extracts are briefly compared below, but the emphasis of this book is on 1:5 tinctures. COMPARISON OF TINCTURES AND EXTRACTS Three groups of preparations are compared below: • 1:5 tinctures • 1:2 liquid extracts • 1:1 liquid extracts

1:5 Tmctures Tinctures are made by the process known as '-:-= maceration, that is, by soaking the herb material in a mixture _ ' of water and another solvent, usually ethyl alcohol (ethanol), but sometimes vinegar or glycerol. The term 'tincture' in this book refers to water/ethanol tinctures unless otherwise stated. Tinctures can be of various strengths, ranging from 1:10 to 1:3.The ratio refers to the quantity of herb to the quantity of solvent. Therefore the higher the second figure of the ratio. the weaker the tincture. For example. 5 ml of a 1:5 tincture was made with 1 g of dried herb. whilst 5 ml of a 1:10 tincture was made with 0.5 g of dried herb. Tinctures weaker than 1:5, for example, 1:10 tinctures, can be inconvenient since the patient has to take a greater volume of ethanol tincture. Theoretically, 1:4 and 1:3 tinctures would be more convenient to use than 1:5 since the patient could take a lesser volume of ethanol tincture, providing that these higher concentration tinctures genuinely extracted proportionally more active constituents than a 1:5

_'1 ~'_'

i

--"'

-1

'P' 'l

tincture. 1:2 liquid extracts Preparations that are more concentrated than 1:3, that is, 1:2 and 1:1, are called liquid extracts (fluid extracts). Whilst tinctures are usually made by so~g (maceration), extracts are made by percolation. 1:2 extracts are the highest concentration that can be prepared by cold percolation without using concentration by heat or by vacuum. 2 Theoretically. 1:2 extracts should be 2.5 times stronger than 1:5 tinctures, but I have not yet seen independent research data that demonstrates that 1:2 extracts genuinely contain 2.5 times as much of a range of different active

-..

f"

ingredients than 1:5 tinctures. 1:1 liquid extracts These were traditionally made by the process of reserved percolation. but are now usually made by reconstituting soft or powdered concentrates. In either case, procedures involving vacuum or heat are involved. Equivalents Theoretically, a 1:1 extract should contain five times the quantity of active ingredients than a 1:5 tincture. However. research has shown that the heating and vacuum techniques involved in making 1:1 extracts can cause the loss of active constituents. IS For example, vacuum concentration of Matricaria extract caused the loss of up to half of the aromatic oil content. 19 For herbs with active constituents that may be lost in heating or vacuum procedures, such as aromatic oils or phenols, 1:2 extracts, or'even 1:5 tinctures. may be equal to or even preferable to 1:1 extracts. I do not use 1:1 liquid extracts for aromatic herbs such as __ Lavender, Rosmarinus, Salvia, or Thymus. I have smelled

Dose and tasted various 1:1 extracts, and I have yet to find one that smells and tastes of the full range of aromatic constituents as strongly as a good quality 1:5 tincture. In myopinion, if I cannot smell and taste the characteristic aromatic constituents with which I am familiar, either they are not there or they are denatured.

107 from the catalogue of East West Herbs,23 except that of Panax, which is from their data on the bottle label. Since ethanol can act as a preservative, the usual minimum strength of ethanol is 25%. Below this percentage. there may be microbial growth.

OTHER SOLVENTS ETHANOL AS A SOLVENT Wine has been used since antiquity, both as a medicine and

Two of the main alternative solvents to ethanol are glycerol and vinegar.

as a solvent.

Glycerol

Western tradition In the twelfth century. Hildegard von Bingen20 used cooking in wine as one of her main methods of preparing herbal medicines and recommended wine by itself as a warming tonic for a variety of disorders. Chinese tradition Wine itself is regarded as tonifying. with the ability to move Stagnant Qi and Blood. Tinctures (jiii.) were made by soaking herbs in wine. and to this day. tonic wines are popular in Chinese culture. as they were in the West in my grandmother's generation. In America, in the past, herbal medicines were sometimes made with moonshine whisky as the solvent. I Percentage of ethanol The water and ethanol mixture can extract a wide range of chemicals, but what constitutes the optimum percentage of ethanol is a matter of dispute.19.21.22 The optimum percentage of ethanol varies depending on the type of active constituent. Some manufacturers use 25% ethanol for the majority of their tinctures. This strength may be optimal to extract water-soluble constituents, such as mucopolysaccharides, tannins, and some of the glycosides. For example••the bark of Viburnum prunifolium contains viburnin, a bitter glycoside. According to one research report, an extract of Viburnum bark using 30% ethanol was reported to be five times more spasmolytic than an extract using 60% ethanol.:!:! % ethanol

Active constituents

25%

mucopolysaccharides tannins glycosides

Althaea Quercus Viburnum pru.

45%

aromatic oils alkaloids

Rosmarinus Cinchona

60%

alkaloids steroidal saponins

Lobelia Panax gin.

90%

resins'

Commiphora

1-

Other glycosides, aromatic oils, alkaloids, and many saponins may be more efficiently extracted at higher percentages, between 45-60%. Resins are. usually extracted with 90% ethanol. The ethanol percentages in the table above are

This compound has the following advantages:

• it is a better solvent than ethanol for water-soluble chemicals, such as mucopolysaccharides • it can be used by those who prefer not to take ethanol in any form • it is sweeter in taste than ethanol and therefore more palatable to some • it may be milder and more soothing to the digestive system than ethanol However, glycerol has the following disadvantages: • it is not as effective a preservative as ethanol • it is not as effective a solvent for many active constituents as ethanol • it may be less warming and moving than ethanol, and more likely to aggravate Damp conditions because of . its sweeter property and heavier nature Vmegar Like wine. vinegar has been used for centuries both as a medicine in itself and as a medium for herbal preparations. Hildegard von Bingen recommended a small amount of vinegar to cleanse the body and help digestion. and she used vinegar as an extracting medium in a variety of her herbal preparations. Apple cider vinegar is often preferred in modern vinegar extracts. Vinegar is especially used for extracting alkaloids, for example, the alkaloids of Lobelia and Sanguinaria. However, vinegar is not as effective a solvent as ethanol for other active constituents.

DOSE OF 1:5 TINCTURES OF A SINGLE HERB This depends on which of the following three dose groups the herb belongs to (data is from the BHP):

average

about 1-4 ml, three times per day

Agrimonia

higher

about 5-15 mi. three times per day

Agropyron

lower

about 0.5-1 ml, three times per day

Convallaria

108 . .

Combining Western Herbs and Chinese Medicine

PROBLEMS WITH 1:5

WHAT IS THE MINIMUM DOSE?

MULTIHERB TINCTURES

BHP minimum dose The basic premise from which this problem arises is that of the BHP minimum dose. However, it may be that the BHP figures were referring to single herb. prescriptions, rather than multiherb combinations. In a combination, lesser amounts of a particular herb can be used since its actions are supported by the actions of the other herbs. The example of Achillea is given in the subsection Dose for infusions ofmore than one herb above.

The individual dose of 1:5 tincture recommended by the BHP for the average nontoxic herb is 1-4 mI. Many practitioners use an average of 5 mI of 1:5 tincture as the standard individual dose of a herb combination. This means that if five herbs are combined, there is 1 mI of each herb in a 5-mI individual dose of the combination. Each herb is ,then at the lower end of the range recommended by the BHP as an individual dose. If there are more than five herbs in the combination, then there is less than 1 mI of each herb in a 5-mI individual dose of the combination. Each individual herb is then below the minimum BHP dose and may have no therapeutic effect. Lower dose herbs This problem does not apply to the use of 1:5 tinctures of lower dose herbs, since the minimum individual dose of theSe herbs is about 0.3-0.5 mI. Even if there were 10 such herbs in a combination, resulting in 0.5 mI as the quantity of each herb in an individual dose of the combination, this would still be at or above the minimum individual dose for each herb. Higher dose herbs However, the problem is acute for the higher dose herbs, since the individual dose of just one of these herbs can be greater than the figure of 5 mI for an individual dose of a combination. For example, the individual dose of 1:5 tincture for Agropyron is 5-15 mI. Such herbs might therefore be better taken as decoctions or infusions. Otherwise, if 5 such herbs were together in a combination, each with an individual dose of 5-15 ml, the individual dose of the total combination would be 25-75 ml of tincture. If the solvent for the 1:5 tincture were 45% ethanol, 75 ml of the tincture, three times per day, would be ~quivalent to more than one bottle of wine. Average dose herbs Mills and Bone are concerned that, when using 1:5 tinctures for multiherb combinations, the quantities of the individual herbs may be below therapeutic leve1. 2 If the individual dose of the total combination were kept at 5 ml, then it is only possible to have between 1-5 herbs in a combination, if BHP minimum doses for average dose herbs are to be observed. Mills and Bone recommend 1:2 liquid extracts to overcome this problem. The only way·to increase the number of herbs in a combination, when using 1:5 tincture, is to raise the individual dose of the herb combination above 5 mL However, above the dose of 10.ml of tincture, three times per day, the quantity of alcohol the patient would have to consume would be very high, especially if the percentage of alcohol in the tincture is greater than 25%.

Mills and Bone minimum dose These authors are at the high end of the higher dose approach discussed earlier in this chapter, and many practitioners would not agree with their high figures for minimum dose. For 1:5 tinctures, they tend to recommend higher doses than the BHP. For example, the BHP gives 0.5-1 ml as the individual dose of 1:5 tincture of Harpagophytum, whereas Mills and Bone give it as 5-10 ml. In the case of Harpagophytum, they base this higher dose on data from clinical trials (see the Harpagophytum chapter). However, such clinical data on minimum dose is not available for the majority of herbs. Need for further research More systematic research on the minimum and maximum doses for commonly used herbs is essential for the development of herbal medicine. In addition, a range of independent studies on the comparative extraction profIles of 1:1 and 1:2 liquid extracts, and 1:5 tinctures is important to determine the comparative efficiency of extraction for these methods with respect to different types of active constituents.

FLEXIBLE PRESCRIBING One solution to the problem of using 1:5 tincture for multiherb combinations is that of flexible prescribing. My standard individual dose for a total herb combination using 1:5 tinctures is 5 ml. The average number of herbs in my combinations is about six. which gives about 0.83 ml as the individual dose for each herb in the combination. However, various methods can be used to increase this dose when required. For example: • increase the individual dose of the combination from 5 ml (l teaspoon) to 7.5 ml (1.5 teaspoons). which raises the quantity of each herb in an individual dose of the combination from about 0.83 ml to 1.25 ml • increase the ratio of a particular herb in the combination from equal ratio with the other herbs to double, which raises the quantity of that herb in a individual dose of the combination from 0.83 ml to 1.66 ml*

-. ..

Dose • increase both the combination dose to 7.5 ml and the proportion of a particular herb to double, which raises the quantity of that herb in a individual dose of the combination to 2.5 ml • prescribe a particular herb separately from the combination, so that individual doses of up to 7.5 ml of that herb can be given, if appropriate (as with Valeriana in the Clinical examples section below)

'-"

-

*This means that the dose each of the other herbs is now less than 0.83 ml, unless two of the other herbs are only present in 0.5 ratio. In the example below, Astragalus is used at double ratio, whilst Glycyrrhiza and Zingiber are used at half ratio.

Astragalus Echinacea Achillea Cinchona Glycyrrhiza Zingiber

....,....,,-

~-

2 '1 1 1

0.5 0.5

ADVANTAGES OF TINCTURES AND LIQUID EXTRACTS Convenience Tinctures and fluid extracts can be very convenient. There is no preparation for the patient, they can easily be carried with the patient wherever they go, and, because of the relatively small volumes required, compared to infusions and decoctions, they can be easy to use for children and infants. Taste Because of the lesser volume, unpleasant tasting herbs can more easily be taken in tincture form than as decoctions. Preservation Providing they are kept in brown glass bottles out of direct sunlight in a cool place, tinctures in 25% ethanol or higher will usually keep for years. Dried herbs are more likely to lose their effectiveness in a shorter time or become invaded by fungi or insects. Extraction profile Tinctures or liquid extracts with 4560% ethanol are suitable for extracting chemicals, such as aromatic oils, alkaloids, and saponins, and tinctures of 90% ethanol are effective for extracting resins and oleoresins. Treatment of Cold. Damp. Deficiency; and Stagnation In itself, ethanol can be said to be warming, drying, tonifying, and moving. In terms of Chinese medicine, it can therefore be a favorable medium for treating Cold, Damp, Deficient, or Stagnant patterns. This does not mean that ethanol tinctures

109 are inappropriate for the treatment of patterns of Heat, Dryness, or Excess since suitable cool moist herbs can override the nature of the ethanol, especially if the tincture is taken with plenty of water.

DISADVANTAGES OF TINCTURES AND LIQUID EXTRACTS Ethanol Some patients prefer not to take ethanol, whether for religious reasons, because they had an alcohol addiction, or because they do not like the taste of ethanol. They may fmd glycerol extracts acceptable, but these are not suitable for herbs containing resins or aromatic oils. At least some of the ethanol can be evaporated from a tincture by putting an individual dose of the tincture in a cup and then fllling about three-quarters of the cup with boiling water. This method is not so suitable for herbs containing volatile oils, since these will tend to evaporate with the ethanol. Very few children have taste problems with the small amounts of alcohol present in children's doses of 1:5 tincture, providing the tinctures are taken in the appropriate dose for their age, diluted with water, and mixed with fruit juice, milk, or food. Extraction profile Tinctures are not as effective as decoctions in extracting water-soluble chemicals, such as tannins and mucopolysaccharides. Diaphoretic treatments Hot infusions or decoctions are best for diaphoresis, for example, to treat acute influenza and fever. Tinctures are not as effective even if they are taken with large amounts of hot water. ' Alterative treatments Since ethanol is inherently warming and drying, tinctures are not as appropriate for alterative treatments, although they can be used. For these treatments, infusions or decoctions are best since the water and herbs combine in their cleansing effects.

Powders The term 'powders' in this context refers to powdered dried herbs rather than to powdered concentrated extracts.

ADVANTAGES OF POWDERS Flexibility Powders, like infusions, decoctions, tinctures, and liquid extracts, have the advantage of flexibility. Powders of individual herbs can be mixed to make tailor-made combinations for individual patients. This is not generally done

110

Combining Western Herbs and Chinese Medicine

with pills and capsules since the practitioner would have to make up separate batches of pills or capsules for each patient

Pills, capsules, and concentrates

visit.

PILLS AND CAPSULES

Convenience Powders and tinctures are convenient in that the patient only has to mix them in water. The amount and temperature of the water depends on the patient's condition.

Pills and capsules are convenient and do not have problems with taste. However, they have the huge disadvantage of being fixed in composition, so that they cannot be matched to the specific needs of an individual patient. This means that they cannot replace the more flexible dose forms, such as infusions, decoctions, and tinctures. It is theoretically possible to mix powders to make capsules that are specific for the needs of a patient at a particular time. However, it is so time-consuming as to be impractical. There are certain combinations that are so well balanced that they can be used as a useful preliminary or as an adjunct to more specific herbal treatment. A good example is Christopher's lower bowel tonic (now called Dr. Christopher's ......,.""" Fen-L-Bee), which is available in capsules. However, even this excellent formula is not appropriate for everyone and may need modification or to be replaced with more individually tailored combinations.

For example, if it is necessary to produce diaphoresis, the powder can be taken with a greater amount of hot water. If a sedative effect is required, the powder can be taken with a lesser amount of cold water. Slow release Powders can have the advantage of slow release of active constituents, which can be advantageous for the treatment of colon problems since constituents, such as tannins, are still being released when the powder reaches the colon. Extraction profile A possible advantage of powders is that all the constituents reach the digestive system, rather than only those that are soluble in water or alcohol. In contrast, decoctions, for example, are poor at extracting resins. Therefore, a lesser amount of resins will reach the digestive system if herbs are taken in the form of decoctions, than if herbs are taken in the form of powder. However, it is not

known how efficiently the digestive system extracts the various types of active constituents from the powder that reaches the gut.

DISADVANTAGES OF POWDERS Digestive disorders

In terms of Chinese medicine, many

patients have Deficient Spleen patterns. In my opinion, powders, pills, and capsules may be difficult for them to digest and absorb, particularly if they are already taking medication or nutritional supplements in this form, since this will place an additional load on the weak Spleen. Infusions, decoctions, and tinctures extract the active ingredients, which then enter the body in solution. With powders, the body has to do the extraction, and if the Spleen is weak, this process may be inefficient and may put further stress on the weak Spleen. Powders can be taken with warm water, but unless they actually dissolve, the problem remains. Aromatic constituents Powders may not be the best form in which to take herbs with aromatic constituents. Such herbsare better taken as infu.sions, when the oils are released by the heat of the infusion, or as ethanol tinctures, which are the most efficient common means of extracting volatile constituents and making them available to the body.

CONCENTRATES The use of concentrates has already been briefly mentioned under the heading of 1:1 liquid extracts. Whether the concentrates are given as liquids or in solid form, their disadvantage is that active constituents may be lost or denatured during the heating or vacuum processes. Concentrates may therefore be especially unsuitable for herbs containing volatile or heat-labile active constituents. If the concentrates are made into tablets, there is further chance of denaturing of active constituents during the stages of this process. In addition, the number of additives and adulterants are likely to increase.

Advantages and disadvantages ofthe different dose forms The advantages and disadvantages of the different dose forms that are discussed in the text above, are summarized _ in the following table:

Infusions and decocllons • cheapness and accessibility

taste

• link to the natural.world.

lack of convenience

• therapeutic value of water

unsuitable for water-insoluble constituents, such as resins

• infusions suitable for . volatile constituents '

preservation

Dose

111 For example, all of the following items can be said to have a dried herb equivalent of 1 g:

• decoctions suitable for water-soluble constituents, such as polysaccharides and tannins

• 1 ml of 1:1 liquid extract • 2 ml of 1:2 liquid extract • 5 ml of 1:5 tincture • 10 ml of 1:10 tincture

• treatment of patterns of Cold • treatment of patterns of Dryness • diaphoretic treatments • alterative treatments Tinctures and liquid extracts

l~

__

• convenience

unsuitable for patients who h~ problems with alcohol

• taste

less suitable for water-soluble ccr.s:itue~ts, such as polysaccharides and tannins

• preservation

less suitable for diaphoretic treatments

• suitable for ethanol-soluble constituents, such as essential oils, alkaloids, resins, and saponins

less suitable for alterative treatments

• treatment of patterns of Cold and Damp, Deficiency, and Stagnation

limitations on the number of herbs in a combination

• convenience

unsuitable for patients with digestive disorders

• slow release of active constituents

less suitable for volatile cor.stituents

Pills and capsules lack of flexibility: it is not possible to match them to the specific needs of the individual patent

• slow release of active constituents

WEIGHT OF ACTIVE CONSTITUENTS PER UNIT OF PRODUCT

Powders

• convenience

However. the phrase dried herb equivalent can be misleading. The four items above are equivalent in that they all derive from 1 g of dried herb starting material. However, they are not necessarily equivalent in terms of the amounts and relative proportions of the active constituents that they contain. This is due to the fact that extraction efficiency for the different types of active constituents is not equal between the different extraction methods and the different ratio strengths, as reported by research studies.18.19.21.22

digestive disorders; less suitable for volatile ccr,stituents

Equivalence of dose

A more informative method of comparing the different dose forms would be to state the amount (in milligrams) of each of the main active constituents contained in one gram or one milliliter of the dose form. This kind of data is rarely available at present, but may become increasingly available in the future, since it is a useful way to compare the different dose forms. However, this approach is not without difficulties, as described below.

Extraction before or after ingestion Dose forms can be divided into two groups according to when the active constituents are extracted from the raw plant material: • extraction occurs before the dose form is taken into the body • extraction occurs after the dose form is taken into the body

Extraction before ingestion In dose forms such as infusions, In the absence of research data, it is difficult to compare doses between the different dose forms. Three alternative approaches to this comparison are: • dried herb equivalent • weight of active constituents per unit of product • therapeutic efficiency

DRIED HERB EQUIVALENT Mills and Bone have suggested the use of the concept of

1 i

dried herb equivalent in order to make dose comparisons. The dried herb equivalent derives from the product ratio, which expresses the weight of original dried herb material to the weight or volume of finished product.

decoctions, tinctures, fluid extracts, and solid concentrates, the active constituents are mainly extracted from the raw plant material before ingestion. The extract is swallowed and the residue of the original solid raw material is discarded. It is possible to compare these dose forms by assaying the weights of active constituents per unit of extracted product.

Extraction after ingestion In dose forms such as cut fresh herbs, powdered dried herbs taken in water, or powdered dried herbs taken in capsules, the extraction process takes place in the digestive system, after the raw herb material has been ingested. It is not possible to compare these dose forms, either with each other or with dose forms where· extraction takes place prior to ingestion, since there is no standardized method for assaying extraction efficiency after ingestion.

.•

-:;;;;,;;-

112

Combining Western Herbs and Chinese Medicine

Multiple active constituents A few herbs may have one main active constituent, such as capsaicin in the case of Capsicum. However, most herbs have multiple active constituents, and the effectiveness of the herb may depends on the balance between a number of different active constituents which may complement and moderate each other's effects. If the relative levels of the different main active constituents extracted vary between the different dose forms, the therapeutic effectiveness of these dose forms may also vary. Inactivated constituents If a particular extraction process makes a constituent less absorbable or pharmacologically less active, it is not possible to get accurate data on the weight of active constituents that are actually available per unit of product. THERAPEUTIC EFFICIENCY Compari~on in terms of the weight of active constituents per unit of product can be useful for dose forms in which the active constituents are mainly extracted from the plant material before ingestion. However, perhaps the only way in which it is possible to compare these dose forms with dose forms in which the active constituents are mainly extracted from the plant material after ingestion, is in terms of therapeutic efficiency, that is, in terms of reduction of specific signs and symptoms.

It would be useful in the future for research studies to compare the relative therapeutic efficiency of the different types of dose forms to determine which are most suitable for different types of patients and different disorders.

Timing of the dose STANDARD PROCEDURE For chronic conditions, I usually advise patients to take their herbs as a daily routine, usually three times per day, and preferably at set times. For optimum absorption, this can be on a more-or-Iess empty stomach, 1 hour before meals or between meals. For acute conditions, herbs may need to be taken much more frequently, and at any time. BITTERS AS APERITIFS ••~i;:-~:~'.;;·":~;:;-:·- • .... _:_lo-~ ..

'.'

_~.'~~._;~'.':".'

Vitex

Zingiber

T Herbs marked with this symbol are contraindicated in pregnancy and/or lactation, or have cautions on their use during these times.

Combining Western Herbs and Chinese Medicine

146

Juniperus A research study using an ethanolic extract of the berries reported abortifacient activity in rats.

28

Zingiber The Commission E monograph on this herb stated that Zingiber should not be used for morning sickness. However, the editor of the English translation of the Commission E monographs pointed out that a review of the research literature could not justify this caution. In fact, research data indicates. that Zingiber may be of value in reducing vomiting during pregnancy (see Zingiber chapter).

Herbs to prevent miscarriage Some of the herbs in the table, such as Chamaelirium and Lobelia, have a tradition of use during pregnancy to strengthen the uterus or to prevent miscarriage.~9 They are only included in the table since, in my opinion, any herb with a regulatory effect on uterine contractions should be used with caution during pregnancy and should only be prescribed by experienced and qualified practitioners of phytotherapy.

Importance of the dose Some of these herbs in the table may be appropriate for use in pregnancy, providing their specific dose recommendations are followed. For example, it may be prudent to avoid high doses of Glycyrrhiza during pregnancy, especially if there is a history of high blood pressure, but according to Mills and Bone, doses of up to 3 g per day are likely to be safe.

Importance of syndrome Some of these herbs may be appropriate for use in pregnancy, providing that their use is avoided for patients who have specific syndromes that may be aggravated by the particular herb. For example, I have not seen any adverse reports on the use of Capsicum in pregnancy. It may be appropriate to use this herb in pregnancy except for patients with syndromes of Interior Heat. Lactation There is very little research data on the effect of herbs on the infant, when these are taken through the mother's milk. The herbs marked with a T in the table above are contraindicated or to be used with caution during lactation because of theoretical concern over the possibility of active constituents passing into the breast milk. For example, the ESCOP monograph on Rheum did not recommend the use of this herb during lactation. However, two studies have reported that the active constituent rhein does not have a laxative effect on infants when taken by nursing mothers. 30• 31 It was found that the amount of rhein transmitted to the infant was 0.3% of the rhein intake of the mother, which the authors pointed out is far below the oral rhein dose necessary for inducing a laxative effect. 3l

ing types of herbs should be used with caution during menstruation:

_cooling herbs especially for patients with Cold in the Uterus

_ downward-draining herbs especially for patients with Deficient Qi and Yang

_herbs that move the Blood especially for patients with heavy menstrual flow However, if the menstrual flow is absent or less than normal, it may be appropriate to use herbs that move Stagnant Blood in the Uterus throughout the whole cycle, including menstruation itself, until the flow is at a satisfactory level for the patient. The Chinese concept of moving Stagnant Blood in the Uterus has some degree of overlap with the Western herbal concept of stimulant emmenagogue, which refers to herbs with the potential of stimulating uterine contractions. In my opinion, herbs of this type are generally best avoided during menstruation itself if the flow is heavy, and should be used with caution if the flow is normal. Herbs of this type listed in the table above include: - Artemisia absinthium - Artemisia abrotanum - Caulophyllum - Cimicifuga - Commiphora - Hydrastis - Juniperus - Lobelia - Mentha pulegium - Petroselinum - Ruta -Salvia - Sarothamnus - Thuja

Pregnancy According to Chinese medicine, some herbs that invigorate the Blood and clear Blood Stagnation are contraindicated or to be used with caution during pregnan- _ cy, for example: - Commiphora (mb yao) - Curcuma longa tuber (yiI jin) - Leonurus heterophyllus (yl mil ci'iO)

WESTERN DATA: CARCINOMA CHINESE MEDICINE Menstruation

According to Chinese medicine, the follow-

Concern about the possibility that herbs may aggravate or induce carcinoma is largely of recent origin, and was not a-

Safety and the organ systems major consideration of traditional Western or Chinese medicine. This section therefore concentrates on evidence from recent pharmacological and clinical research. Inhibition or stimulation of cancer cells? below, there is evidence that:

As discussed

• some herbs may inhibit breast or uterine carcinoma • some herbs may aggravate or promote the growth of breast or uterine carcinoma • some herbs may either inhibit or promote carcinoma, depending on the methodology of the experiment, including the type ofliving material used, and the dose of the herb material For some herbs, there is evidence that some constituents may inhibit and other constituents may promote carcinoma. Relevance of research studies Promotion of carcinoma in cell cultures or animal studies using overdose levels of isolated constituents does not necessarily mean that infusions, decoctions, and tinctures of the dried herb are carcinogenic when used in the therapeutic dose range. Angelica sinensis One mouse study reported that a polysaccharide from A. sinensis had strong antitumor activity.32 A study using an in vitro culture system reported antiestrogenic activity for A. sinensis. B A third study reported that A. sinensis significantly stimulated the growth of MCF-7 cells, a human breast cancer cell line. This stimulation was independent of estrogenic activity.34 Cimicifuga racemosa Isolated fukinolic acid (2-E-caffeoylfukiic acid) was reported to have estrogenic activity as shown by increased proliferation of an estrogen dependent MCF-7 cell system. 3; However, a more recent study using the MCF-7 cell system reported that an isopropanol extract of Cimicifuga significantly inhibited estrogen-induced proliferation of MCF-7 cells. In addition, the proliferationinhibiting effect of tamoxifen was enhanced by the Cimicifuga extract. According to the authors, the data suggested a nonestrogenic or estrogen-antagonistic effect on human breast cancer cells. 36 An in vivo mouse study reported that a Cimicifuga extract does not stimulate breast cancer cells that are estrogenreceptor positive. The authors concluded that Cimicifuga might be a safe remedy for the treatment of menopausal symptoms in women with a history of breast cancer in which hormone-replacement therapy is contraindicated. 37 (See also the discussion in the Cimicifuga chapter). Glycyrrhiza An in vivo animal study reported that the isolated Glycyrrhiza constituents glabrene and isoliquiritigenin

147

both had a biphasic effect on the growth of breast tumor cells. Both showed an estrogen receptor-dependent growthpromoting effect at lower concentrations (l On~l-l O!lM), and an estrogen receptor-independent antiproliferative effect at higher concentrations (> 15f.l.M).38 However, a study using MCF-7 human breast cancer cells reported that Glycyrrhiza did not significantly stimulate the growth of these cells. 34 Also, a study on estradiolinduced carcinogenesis in mice suggested that Glycyrrhiza may be a promising preventative agent for endometrial cancers (see the Glycyrrhiza chapter). Panax ginseng One study reported that P. ginseng significantly stimulated the growth of MCF-7 human breast cancer cells. This stimulation was independent of estrogenic activity.34 However, an earlier study using MCF-7 cells reported that ginsenoside Rh2 significantly inhibited the cell growth in a concentration-dependent manner. 39 Also, an animal study reported that P. ginseng preparations inhibited the growth of both mammary and uterine tumors. 40 Panax quinquefolium A series of in vitro stL>j'.'

Further specialist diagnosis

·i~:;,~~~~$*1~~~te.t,~~

If the patient has symptoms that may represent a potentially serious condition and the patient has not yet been seen by a conventional medical specialist. this should be done

Full medical history

before commencing herbal treatment.

During the first patient visit. it is important to take a full medical history. including details of all prescribed and selfprescribed conventional medicines. herbs. and food supplements. At the start of each subsequent patient visit. the practitioner should determine if there have been any changes in the substances taken by the patient, including changes in dose. If this is done, should there be any negative reactions. it

Situations in which herbal treatment is inappropriate There may be laws in a particular country or state that restrict herbal treatment of certain conditions, at least by practitioners who are not medical doctors. However,. on 1.", -

151

~,.;.

Combining Western Herbs and Chinese Medicine

152

therapeutic as opposed to legal grounds, whilst specific disorders may be contraindicated for individual herbs, it is not easy to list disorders that are contraindicated for herbs in

general. The decision whether or not to use herbs is generally decided on a case-by-case basis by the individual practitioner, often depending on the level of their training and eXperience.

This topic is discussed in the chapter Practical herb combination. The Taste and Actions chapters contain tables showinghow potential side effects may be avoided by the use of moderating herbs.

.Cautions and contraindications for 'specific herbs and specific pa~ients

EXAMPLES Pregnancy Some practitioners avoid the use of herbs in general during pregnancy. Other practitioners use herbs during this time to treat disorders of pregnancy, but avoid or minimize the use of herbs for conditions that are not pregnancy-related. These practitioners use appropriate precautions and avoid herbs for which pregnancy is a specific contraindication (see the discussion and table in the Safety and the organ systems chapter). Liver damage Similarly, some practitioners avoid the use of herbs for weak patients who have liver damage. However, other practitioners consider that certain types of herbs, such as the hepatoprotectives, can be specifically helpful in assisting in the improvement of liver function for some patients of this type. This is discussed in the Prevention of adverse reactions section below. Patients on multiple medication A patient who is exhausted and depressed from prolonged or severe illness and already has to take many conventional medications may not have the energy or interest to take further medications of any kind. In such cases, it is often preferable to wait until there is a reduction in the number of drugs before prescribing herbal medicine. Patients undergoing changes in medication If the patient is on multiple medication and is in the proc.ess of changing drug doses, or changing from one group of conventional drugs to another, it is prudent to let some time elapse before commencing herbal therapy. This gives time for the following effects to resolve themselves: • adverse reactions to the change in drug dose • withdrawal effects from the first group of drugs • initial adverse reactions to the second group of drugs

Once the herb combination has been screened in terms of actions, temperature, and taste, the next step in the screening process is to determine whether any of the herbs in the provisional combination have cautions or contraindications, especially in the context of the patient's specific syndromes.

CAUTIONS AND CONTRAINDICATIONS DATA In this book, data on cautions, contraindications, and herb-drug interactions is given for each herb in the materia medica chapters. There is additional information in the Safety and the Safety and the organ systems chapters on herbs that have cautions or contraindications: • during pregnancy and lactation • for specific Chinese syndromes • due to the possibility of adverse herb-drug interactions

Informed patient choice If the practitioner is considering using a herb that may have side effects for a specific patient, the patient should be clearly informed of the benefitrisk ratio so that they can make an informed choice. The patient also should be informed of the nature of any potential side effects so that they can report them to the practitioner as soon as possible, should they occur. The patient can be asked to reduce the dose or to stop taking the herbs if side effects are experienced, as appropriate (see Side effects acceptable to the patient in the section Management of adverse reactions below).

Balancing herb combinations

Prevention ofadverse reactions

To ensure that a herb combination is effective and safe, it should be properly balanced in terms of: herbal actions, temperature, taste, and the principles of herb interaction.

The possibility of adverse reactions can be minimized by ensuring that the following factors are appropriate to the specific needs of the patient

Safety in Clinical Practice • dose level • dose form • timing of the dose • duration of the prescription • breaks in the treatment • alternation between prescriptions • use of moderating herbs

153

the herb for a short-term only. If long-term treatment is necessary, then the possibility of cumulative side effects can be reduced by either: • having regular breaks in the herb treatment • alternating between two herbs with a similar effect

BREAKS IN THE TREATMENT' -DOSE LEVEL As discussed in the Dose chapter, the following com- monsense guidelines can be followed: • use the least dose required to get the desired therapeutic effect • in chronic cases, start at the minimum therapeutic dose and then raise the dose as appropriate • use the herbs for the minimum time at the standard dose before reducing the dose, if appropriate • increase the dose only if the symptoms return • vary the dose to meet the changing requirements of the patient Data on the dose range of individual herbs is given in the materia medica chapters.

-DOSE FORM The dose form used should be appropriate to the partic~ ular patient. For example, tinctures are unsuitable for an alcoholic patient, and powders may be unsuitable for a patient with weak digestion. Infusions or decoctions would _be the preferred forms for such patients (see the table in the section Advantages and disadvantages of the different dose forms in the Dose chapter).

TIMING OF THE DOSE Appropriate timing of the dose can reduce the possibili:y -of negative reactions. For example, if the patient takes a tonic prescription containing Rosmarinus and Turnera just before ~. bed, they may experience restlessness. and insomnia. If the patient takes the combination earlier in the day and never 'ater than 5 PM, it is possible to get the full beneficial effect _ Nithout the negative reaction (see the section Timing of the dose in the Dose chapter). ~DURATION OF THE PRESCRIPTION

The length of time for which a particular herb or herb :ombination is prescribed can be varied to minimize side ~ effects, as discussed in the Dose chapter. Even when a herb 'las potential side effects, these can often be avoided by using

When a herb or herb combination is taken long-term, it may be possible to minimize potential side effects by having regular breaks in the treatment. This is discussed in the section Duration ofthe prescription in the Dose chapter. .

ALTERNATION BETWEEN PRESCRIPTIONS Another method of minimizing potential side effects during long-term treatment is to alternate between herbs or herb combinations. This is discussed in the section Duration ofthe prescription in the Dose chapter.

USE OF MODERATING HERBS Moderating herbs can be included in a combination to minimize potential ~ide effects by balancing the temperature, tastes, and actions of the other herbs in the combination. The Taste and Actions chapters contain tables for balancing tastes and actions, respectively, by using moderating herbs. A specific example of the use of moderating herbs is given under the heading Use of additional herbs to treat side effects in the section Management ofadverse reactions below.

EXAMPLE OF PREVENTIVE MEASURES: PATIENTS WITH LIVER DISORDERS Herbs should be either be avoided or used with especial caution for patients with preexisting liver damage or liver carcinoma, or who are currently taking potentially hepatotoxic conventional medication. If the type or dose of the hepatotoxic drugs is in the process of being changed, herbal therapy is contraindicated until the drug regime is stabilized. Liver tests An initial liver function test may be advisable as a baseline before commencing herbal therapy. Further liver tests can then be used to monitor positive or negative changes due to the herbs or due to herb-drug interactions. The herbal practitioner may wish to work in close association with the patient's general medical practitioner or medical specialist. Dose level If the liver function is impaired, it is advisable for the initial dose of herbal medicine to be very small. For

_._--

-~

.-.-

----.~-'-

. _-'...... '_'0 _

.,.~._,¥t£if!+:,

.:_'C,

~.::~ i .

This is a generally safe herb. A rare instance of yarrow allergic contact dermatitis has been reported, which is thought to be due to the guaianolide peroxide. a-peroxy-achifolide. 37

._------176

Combining Western Herbs and Chinese Medicine

Tisserand and Balacs38 suggested caution in the oral uSe of the essential oil of the camphor chemotype of Achillea. However, since the essential oil constitutes only 0.2-1 % of the dried herb, the camphor content may be unlikely to cause adverse effects in the infusion or tincture.

Goods Act Regulations of Australia. Achillea is not currently--:#.~ listed by the FDA (USA) as a prohibited substance, as subject~...,.._ to an import alert, or as a substance with a warning on its.;::... use.

Traditional sources

Dose Temperature

Tincture Both the BHP and the BHC recommended 2-4 ml of 1:5 tincture, three times per day.

Variations of opinIon The Chinese Herbal Medicine Dictionary classified Achillea millefolium as cold, but this

Can start at the standard dose.

Duration Generally suitable for long-term use, but large quantities of strong Achillea infusion are generally for acute conditions andJor short-term use only.

Cautions These cautions apply to the infusion and the tincture. The use of the oil is outside the scope of this book. Western contraindications The BHC mentioned a rare hypersensitivity to Achillea or to other members of the Compositae. Wichtl described this allergy as itching, inflammation, and formation of vesicles on the skin, in which case the intake of Achillea should be stopped. I have not yet seen this reaction. Chinese contraindications No contraindications were given in the Chinese Herbal Medicine Dictionary. Although I have not seen this reported elsewhere, I have found that strong infusions of Achi)lea can have a drying effect in a few people in some situations, for example, in individuals with sinusitis ac~ompanied by Lung D"eficient Y'm with Dryness. Pregnancy and lactation Side effects Overdose

No adverse reports.

Not reported. No adverse reports.

Interactions

No adverse reports.

herb does not seem to have had a strong tradition of use in Chinese medicine. In Germany, Hildegard von Bingen39 in the 12th century listed Achillea as slightly hot and dry. Tabernaemontanus listed it as drying and astringent and described it as having a temperate warmth with a cooling effect. 40 In England, Gerard41 classified Achillea as'meanely cold: Culpeper42 classified it as cold in the first degree and also considered it to be drying and binding. The variable temperature of Achillea Tabernaemontanus may have been the first to notice the variable temperature of Achillea when he described it as having a temperate warmth with a cooling effect. In this book, Achillea is classified as warm-cool, because, in my experience, it can be used for influenza and acute sinus conditions associated with either

Wind Heat or Wind Cold. Temperature and the needs of the body Whether Achillea has a cooling, neutral, or even warming temperature effect may depend on the needs of the body. If there is a hot condition, this may evoke a cooling effect; if there is a neutral condition, neither a cooling nor warming effect may be evoked; whilst if there is a cool condition, this may evoke a warming effect. According to Dr. Cole of Seattle,43 when there is raised temperature, Achillea has a diaphoretic effect, but when there is no abnormal temperature, it has only a diuretic action. Achillea can have cooling antipyretic and antiinflammatory actions, but according to Mills, +I it does not have this cooling effect in nonfebrile states and may even help to increase the body temperature if it is low.

Regulatory status

Temperature and biochemistry These different potential effects may be linked to different constituents. For example,

Please read the Regulatory status section in the chapter on Safety. .

the chamazulenes and prochamazulenes may be involved in a cooling effect and camphor may be involved in either cooling or warming effects, depending on the situation.

Achillea (yarrow) is on the UK General Sale List, and it is not included in Part 4 of Schedule 4 of the Therapeutic

~+:

PROPERTIES

Dried herb Both the BHP and the BHC recommended 2-4 g of dried herb, three times per day.

Initial dose

...

Temperature and chromosome number The differences of

.....,.

Achillea opinion on the temperature of Achillea may also be linked to the differences in chemical composition of the different subspecies. For example, in hexaploids, potentially warming camphor can be 18% of the essential oil fraction, and cooling sesquiterpenes are found in relatively lesser amounts. Tetraploids have higher levels of sesquiterpenes and camphor is not listed as a main ingredient.3 Therefore, if hexaploid material were used, the physician might conclude that Achillea was slightly warming, whilst if they had used tetraploid material, they might conclude it was slightly cooling.

177

Spleen

dyspepsia loss of appetite bitter tonic bitter aromatic for loss of appetite

Christopher SHC Weiss 46 Wichtl

Heart

thrombotic conditions with hypertension hypertension

SHP SHC

There is no information given in the Chinese Herbal Medical Dictionary for the meridians entered by A. millefolium (yang shi cao).

Taste

Taste in the mouth Yarrow is described in Wichtl as some-

I

~....

-

what bitter and faintly aromatic. I find fresh yarrow to be strongly bitter, definitely acrid, and somewhat aromatic. I find that the intensity of the taste of yarrow is greater in plants from warm climates or alpine meadows with sunny exposure, and less in plants grown in places with little sun and heat, such as Seattle, USA. The acrid taste may be due to the essential oils, and according to the BHC, the bitter taste is due to the sesquiterpene lactones and the alkaloids. The Chinese Herbal Medicine Dictionary classified Achillea millefolium as bitter and acrid in taste property, but that listing may be based on Western use, rather than Chinese tradition.

Taste properties Achillea millefolium, as used in the West, can be classified as acrid in the sense of clearing Exterior Wind from the surface of the body. Tabernaemontanus said that it was the bitter taste that gives yarrow a temperate warmth with a cooling effect. This is a fascinating statement because it implies the multiple functions of the bitter taste property. The pharmacology section of the A. millefolium entry in the Chinese Herbal Medicine Dictionary stated that the bitter taste of this herb can tonify the stomach. This statement may be following Western concepts of the physiological effect of the bitter taste.

ORGANS In terms of Chinese medicine, Achillea, as used in the West, can be associated mainly with disorders of the followingorgans:

Lung

colds hemoptysis respiratory catarrh colds and fever

Fox KlOSS

45

Christopher SHp32

ACTIONS Evidence from traditional sources for the following actions of Achillea is discussed below: • diaphoretic and antipyretic • anticatarrhal • alterative • bitter digestive tonic • circulatory stimulant • antihypertensive and antithrombotic • astringent and antihemorrhagic • emmenagogue • diuretic • antidiabetic Diaphoretic and antipyretic Hildegard von Bingen recommended Achillea for fever, and Tabernaemontanus gave a combination of yarrow and sage for malaria. The Eclectic doctor William Fox, writing in 1878, listed Achillea as a diaphoretic and said that there is not a single herb that has done so much good. He said th~t for a cold, take a strong tea of yarrow and have a hot brick wrapped up in a vinegar cloth applied to the feet, to produce sweat and to remove the cold.47 In 1898, Felter and Lloyd48 mentione.d that the isolated component achilleine, from Achillea, had been used in Southern Europe as a substitute for quinine in the treatment of intermittent fever. Ellingwood listed Achillea for fever, and both Kloss and Christopher recommended Achillea for colds, influenza, fever, and eruptive diseases, such as measles, chicken pox, and smallpox. The BHP listed Achillea as a diaphoretic and antipyretic for fever and the common cold. Anticatarrhal Ellingwood recommended Achillea for oversecretion by the mucous membranes due to atony or inflammation. Felter and Lloyd listed Achillea for leukorrhea with profuse discharge due to atonic or inflamed vaginal mucous membranes, and both Kloss and Christopher listed it for mucous discharges from the bladder. Christopher rec-

178

Combining Western Herbs and Chinese Medicine

ommended Achillea for influenza, respiratory catarrh, and congestive headache. I have found that a hot infusion of Achillea can relieve influenza with sinus congestion and sinus headache, associated with the pattern of Wind Cold Damp invasion.

ascribe this action to Achillea based on a combination of the anticatarrhal, antihypertensive, and antithrombotic actions, which were listed above, and an antilipidemic effect, which 3l has been reported by recent research.

Alterative Both Kloss and Christopher listed Achillea as an alterative herb, and according to Christopher. it can purify the blood of waste material. Both Weiss and Wichtllisted Achillea as a bitter herb that can stimulate secretion of bile, and Christopher stated that it can regulate liver function. However, its most powerful alterative action may be through the skin rather than the liver. Ellingwood stated that, in intermittent or bilious fever, Achillea can cause profuse sweating, which can discolor the bedclothes. Christopher also emphasized the use of copious hot infusions of Achillea to discharge impurities through the skin. I use it for conditions of recurring low-grade fever or for skin disorders or rheumatism when these disorders are associated with retention of toxins at the surface of the body, in the skin, muscles, or joints.

Wounds and ulcers Dioscorides prescribed pounded yarrow to put on a fresh wound to clear it from heat and in.fJ.ammation and to congeal the blood. Lonicerussl gave Achillea wine for both internal and external wounds and injuries. Hildegard von Bingen recommended Achillea for clearing putrid matter from ulcers and wounds, and Culpeper listed Achillea for inflamed wounds, moist ulcers, leukorrhea, and gonorrhea. It seems that the drying astringent, antihemorrhagic, and vulnerary actions of Achillea are assisted in this by its anti-inflammatory, antimicrobial, and

Bitter digestive tonic Tabernaemontanus prescribed a decoction of yarrow in wine for lack of appetite. He recommended that the patient drink a mug of the warm decoction every morning on an empty stomach. Lyle49 described Achillea as a tonic for the appetite, digestive organs, and the general system. He recommended it in cold infusions as a tonic in convalescence from fever, from nervous prostration, and in phthisis (pulmonary tuberculosis) and night sweats. Felter and Lloyd recommended Achillea for gastric and intestinal atony and for flatulence and spasms. Wichtllisted it as a bitter aromatic for loss of appetite and to stimulate the secretion of bile. He also listed it for gastrointestinal inflammation, diarrhea, flatulence, and colic. The German Commission E monograph listed Achillea for loss of appetite. 50 Circulatory stimulant Lyle stated that Achillea in hot infusions can arouse capillary circulation, and Christopher stated that it can equalize the circulation. Mills noted that this herb can be used as a diffusive vasostimulant, and, according to Mabey, Achillea encourages blood flow to the skin, dilating the peripheral arteries and helping to lower blood pressure. Antihypertensive and antithrombotic The BHP gave the specific indications for Achillea as thrombotic conditions with hypertension, whether the thromboses are cerebral or coronary in origin. Mabey listed Achillea for hypertension and for blood clots. and Mills noted its use for lowering moderately high blood pressure. The antiatheromatic action of Achillea is not mentioned in the traditional texts. However, it seems reasonable to

Astringent and antihemorrhagic

alterative actions. Diarrhea and dysentery Dioscorides recommended yarrow decoction for dysentery. Tabernaemontanus gave a combination of yarrow and plantain as an enema for dysentery and listed yarrow powder in red wine for cramps due to dysen-

tery or diarrhea. Culpeper also recommended this herb for bloody dysentery, menorrhagia, and urinary incontinence. However, Felter and Lloyd stated that it can be used for various types of hemorrhage when the bleeding is small in amount. They listed Achillea for hemorrhoids with bloody or mucoid discharges. Kloss recommended it for diarrhea and dysentery and especially for diarrhea in infants. Hemoptysis Tabernaemontanus prescribed yarrow with tormentil (that is, Potentilla erecta) for hemoptysis associat-

ed with pulmonary tuberculosis. Emmenagogue Menorrhagia and leukorrhea Dioscorides said that yarrow . can be made into a suppository with wool and put in the vagina to reduce excessive menstrual flow. Tabernaemontanus recommended yarrow decoction in wine for heavy menstrual flow and prescribed suppositories made from fresh yarrow

for leukorrhea. Culpeper listed Achillea as drying and binding and recommended it for menorrhagia and leukorrhea. Ellingwood listed Achillea for leukorrhea with profuse discharge from enfeebled mucus membranes. Amenorrhea and infertility Felter and Lloyd listed Achillea for atonic amenorrhea. Christopher, BHP, and Mabey all listed Achillea for amenorrhea. In my opinion, this herb can be included in prescriptions for amenorrhea or infertility when there is Deficient Qi and Blood, and a possibility of obstruction of the channels of the Uterus by Phlegm.

Achillea Diuretic Whether Achillea acts as a urinary astringent or as a diuretic may depend on the needs of the patient.

Achillea to reduce urination Culpeper listed this herb for urinary incontinence, and Christopher recommended it for enureSIS,

Achillea to increase urination Tabernaemontanus listed fresh yarrow juice and wine vinegar for urinary retention. Elingwood listed it for deficient renal action, Bright's disease, and edema, and Felter and Lloyd listed it for stranguary and urinary suppression. The BHP listed Achillea as a diuretic and urinary antiseptic. The tannins may be involved in the urinary astringent action, and the essential oils may be involved in the diuretic action. The asparagin listed by Mills as a possible diuretic component of Achillea is not mentioned by the BHC or by Wichtl as a component.

Hematuria Tabernaemontanus listed various Achillea combinations for blood in the urine. Urinary stones Tabernaemontanus also prescribed various Achillea combinations for difficult urination with gravel or stones in the urinary tract. Antidiabetic In an ethrlobotanical survey in Israel, A. fragrantissima was found to be used for treatment of diabetes. 52

COMPARISON OF WESTERN AND CHINESE USE OF ACHILLEA A. millefolium is a major herb in the Western tradition, but a minor one in Chinese medicine. The two traditions are compared under the following headings: • diaphoretic and antipyretic • anticatarrhal and alterative • general tonic and bitter digestive tonic • circulatory stimulant and antihypertensive • astringent and antihemorrhagic • emmenagogue Diaphoretic and antipyretic Achillea is one of the most commonly used herbs in the West for common colds, influenza, and fever. It is not an important herb for these disorders in China, although one text cited in the Chinese Herbal Medical Dictionary listed A. millefolium to clear Wmd and to promotes sweating. Anticatarrhal and alterative Achillea is an important herb in the West to treat catarrhal states of the respiratory system,

179

especially when associated with Wind invasion. This use is not listed in the Chinese Herbal Medical Dictionary. The alterative use of Achillea is more important in,China, and yang shi dio is said to clear Heat and Toxin and treat ulcers and boils. General tonic and bitter digestive tonic The use of Achillea as a tonic is far more common in the West than in China. However, one text cited in the Chinese Herbal Medical Dictionary listed Achillea as a tonic, and another text listed it for Deficient Ym 'steaming bone syndrome: Circulatory stimulant and antihypertensive Although the Chinese Herbal Medical Dictionary listed Achillea as harmonizing the Blood, for example, for traumatic injuries, this herb is not commonly used in China for circulatory disorders. Astringent and antihemorrhagic In the West, Achillea is frequently used as an astringent or antihemorrhagic for a wide range of disorders, including nosebleeds, bleeding hemorrhoids, diarrhea, leukorrhea, and menorrhagia. Achillea is listed as an astringent in the Chinese Herbal Medical Dictionary, for example for bleeding hemorrhoids, but it does not appear to be frequently used. Emmenagogue Achillea is not used as a primary emmenagogue in recent Western tradition, but is commonly used as a secondary herb to treat a variety of womens' disorders. Yang sm dio is listed as a herb for irregular menstruation, but is not often seen in Chinese formulas for gynecological disorders. NATIVE AMERICAN USE OF ACHILLEA Achillea has been widely used by the Native Americans, and it is interesting to classify some of these uses in terms of Chinese actions and to speculate on their basis in phytochemistry.

Native American use and Chinese actions In the table below, the data on·Native American use comes from Plants of the Pacific Northwest Coast by Pojar and MacKinnon:53 Native American use and phytochemistry

As part of ongoing studies on the herbal remedies of the Micmac and Malecite Indians, the sterols and triterpenes of Achillea were investigated. ~-sitosterol was identified as the major sterol and a-amyrin as the major triterpene of this plant. The authors suggested that the effectiveness of Achillea may be partly due to the presence of these compounds, since many sterols and triterpenes exhibit a wide range of pharmacological effects.54

180

Combining Western Herbs and Chinese Medicine NATIVE AMERICAN USE

19. Kasaj D. Krenn L. Prinz S.et al. Z Naturforsch 56(7-8):521-525 (2001}::::•.• -

-chi~;s~':~citk;~":::'~~;:"~;~6f '~'~;'="'Tri6e(i)~~":::: clears Exterior Wind

colds

Klallam

clears Heat

colds and coughs measles

NU~hah-nulth

Squamish

---;-:;~~

..•~

20. Pailer M, Kurnp WG.Arch. Pharm 293:646-654 (1960)

21. Steinegger E. Hansel R. T13 (1988) [cited in Bradley PR (ed). British:~

~:~~~::~.e~~:i':'?::: ~:~

"'-,~_-', "-'~l -: "~.'.~,'-""j:;:'.:'--~'L!-:::';~";:.:~~~';_

Herb,

...

:~

Retained Pathogen + Bladder Damp Heat

',' .},~a~i?.:·Tempercltur~);Tast~:,:::

Arctostaphylos Hydrastis Polygonum Plantago Ian. (leaves) Equisetum Capsella

1 1 1 1 ,1 1

cool cool cool cool cool neutral

bitter, sour bitter sour, bitter sour, sl. bitter sl. bitter, sl. sweet sour

GENERAL

This combination is'forBia:clder Damp Heat with bleeding due to Heat. The overall temperature is cool to treat hot or warm conditions. The dominant tastes are bitter to clear Heat and Damp Heat. and sour to reduce bleeding by astringency.

Temperature Taste ..

Juniperus 1 Arctostaphylos 1 Thymus 1 Thuja 1 Echinacea 1 Hydrastis 1 Zingiber 0.5

51. warm cool warm-cool warm-cool cool cool hot

aromatic, sl. acrid, 51. sour sour, bitter aromatic acrid, aromatic, bitter acrid, bitter, sl. sweet bitter acrid, aromatic

This combination is the same as Juniperus: cystitis

+

recurring respiratory infection and is discussed under that heading.

Arctostaphylos

237

from the following six-herb combination, which is a modification of Christopher's vaginal bolus formula.

5. Prostatitis + infection

Damp Heat in Lower Burner

Ratio

Herb Herb

Ratio Temperature Taste

Thuja

1

warm-