An introduction to Chinese herbs
by Subhuti Dharmananda, Ph.D., Institute for Traditional Medicine, Portland, Oregon
The herbal tradition of China is valued scientifically, as well as being a fascinating
and popular tradition. Scientists working in China and Japan during the past four
decades have demonstrated that the herb materials contain active components that
can explain many of their claimed actions. Modern drugs have been developed from
the herbs, such as treatments for asthma and hay fever from Chinese ephedra, hepatitis
remedies from schizandra fruits and licorice roots, and a number of anticancer
agents from trees and shrubs. Several popular formulations produced in China,
called "patent medicines," are relied upon daily by millions of Chinese
(in China and abroad), such as the Bupleurum Sedative Pills and Women's Precious
Pills that invigorate the energy, nourish the blood, calm tension, and regulate
menstruation, and Yin Chiao Jie Du Pian, which is a reliable treatment for the
early stages of common cold, sore throat, and influenza.
More than three hundred herbs that are commonly used today have a history of use
that goes back at least 2,000 years. Over that time, a vast amount of experience
has been gained that has gone towards perfecting their clinical applications.
According to Chinese clinical studies, these herbs, and others that have been
added to the list of useful items over the centuries, can greatly increase the
effectiveness of modern drug treatments, reduce their side-effects, and sometimes
replace them completely.
In China, the two most common methods of applying herb therapies are to make a
decoction (a strong tea that must be simmered for about an hour or more) and to
make large honey-bound pills. Both of these forms meet with considerable resistance
in Western countries. The teas are deemed too time-consuming, smelly, and awful-tasting
to justify their use, and the honey pills (boluses) are sticky, difficult to chew,
and bad tasting. Thus, modern forms that are more acceptable have been developed
for most applications.
The two popular forms to replace the standard Chinese preparations are extract
powders (or granules) and smooth, easy-to-swallow tablets or capsules. The extracts
are made by producing a large batch of tea and then removing the water and producing
a powder or tiny pellets; the resulting material is swallowed down with some water
or mixed with hot water to make a tea. Tablets and capsules contain either powdered
herbs or dried extracts or a combination of the two. Despite the convenience,
one must take a substantial quantity of these prepared forms (compared to the
amount of drugs one takes). For example, doses of the dried extracts range from
1-2 teaspoons each time, two to three times per day, and the tablets or capsules
range from about 3-8 units each time, two to three times per day.
The herb materials used in all these preparations are gathered from wild supplies
or cultivated, usually in China (some come from India, the Mid-East, or elsewhere).
There are an estimated 6,000 species in use, including nearly 1,000 materials
derived from animal sources and over 100 minerals, all of them categorized under
the general heading "herbs." Herbs are processed in various ways, such
as cleaning, soaking, slicing, and drying, according to the methods that have
been reported to be most useful. These materials are then combined in a formulation;
the ingredients and amounts of each item depend on the nature of the condition
to be treated.
In some cases, a practitioner of Chinese medicine will design a specific formulation
for an individual patient, which might be changed frequently over a course of
treatment. In other cases, one or more formulas already prepared for ingestion
without modification are selected for use. The outcome is monitored, and the determination
of whether to continue the current formula, change to another, or discontinue
use is made on the basis of actual versus desired outcomes and the obvious or
subtle effects of using the herbs.
As a general rule, acute ailments (those that arise suddenly and are to be treated
right away) are treated for a period of 1-30 days. If an outbreak of influenza
or eruption of herpes virus is caught early enough, a one or two day treatment
will prevent further development of the disease. In the case of acute active hepatitis
causing jaundice, a treatment of 15-30 days may be necessary. For chronic diseases
(those that have persisted for several months or years), the treatment time is
often dependent on the dosage used and the ability of the individual to undertake
all necessary steps to overcome the disease (perhaps changing diet, lowering stress,
and increasing exercise). When a high-dosage therapy is applied, most chronic
ailments can come under control (and some are cured) by a treatment of about three
months duration. If the daily dosage is lowered (because of inability to take
the higher doses), the treatment time increases-perhaps to 6-12 months. Examples
of chronic ailments are autoimmune disorders and degenerative diseases associated
with aging. In some cases, herbs are taken daily, for an indefinite period, just
as some drugs are taken daily. This is typically the situation when there are
genetic disorders or permanent damage that cannot be entirely reversed, problems
of aging, and ailments that have been left for too long without effective treatment.
The main reason that more Westerners are turning to Chinese herbs rather than
local herbs is because of the vast scope of experience in using the Chinese materials.
In every province of China, there are large schools of traditional Chinese medicine,
research institutes, and teaching hospitals, where thousands of practitioners
each year gain training in the use of herbs. The written heritage of Chinese medicine
is quite rich. Ancient books are retained, with increasing numbers of commentaries.
New books are written by practitioners who have had several decades of personal
experience or by compilers who scan the vast diverse modern literature and arrange
the results of clinical trials into neat categories.
American practitioners are usually trained at any one of about 45 colleges in
the U.S., with a three- or four-year series of courses that include basic Oriental
medical theory, acupuncture, and herb prescribing. Certification is offered at
the national level and licensing or registration is offered now by most states.
Many doctors from China have come to the U.S. and currently offer professional
services throughout the country, but most often in the larger cities. Continuing
education is provided through numerous symposia offered by the colleges and professional
organizations devoted to Oriental medicine. Often, these meetings focus on the
treatment of specific diseases or training in the use of a specialized acupuncture
technique or valuable herb formula.
Chinese herbs are provided in the U.S. as food supplements, not as drugs. Thus,
they are not strictly regulated by the FDA except for monitoring the cleanliness
of manufacturing facilities (for those materials made in the U.S.; for the imported
items, FDA monitors only the listing of ingredients to help ensure no toxic herbs
are being used). Random testing of crude herb materials and herb products made
in the U.S. indicate that they are free of harmful bacteria and chemical contaminants.
Imported products must be used with some caution, as some of them are problematic,
yet get past the investigators. There are a few patent remedies that are labeled
with only herb ingredients, but also contain several Western drugs. Some patents
from China contain only Western drugs (and say so on the box, in Chinese), but
purchasers may be unaware of this because they are told only that this is an effective
remedy that came from China. Thus, imported Chinese herb products should be taken
solely on the basis of a prescription from a trained health professional.
Adverse responses to Chinese herbs are monitored at the Institute for Traditional
Medicine through its contacts with numerous practitioners around the country and
subscriptions to technical journals published in China and Japan. Negative interactions
with Western drugs have not been noted for any of the common herb materials when
used in the normal dosage range. A few people experience allergic reaction to
individual herbs, a problem that often cannot be predicted in advance since these
are idiosyncratic responses. A more common reaction is a gastro-intestinal response,
which might include constipation or diarrhea, nausea or bloating. Such reactions
may occur if the individual has poor digestive functions, or if the herbal formula
is not quite right for the needs of the individual. Taking the herbs at a different
time in relation to meals may be helpful in resolving some of the gastro-intestinal
reactions. In a few cases, use of Chinese herb formulas may cause dizziness, headache,
agitation, sleepiness, hungry feeling, lowered appetite, sensation of heat or
cold, or other sensory reactions. If such responses persist after about three
days of using the herbs, it may be necessary to change formulas.
Successful treatments based on the application of Chinese herbs are also monitored
at the Institute. However, most American practitioners find themselves too busy
(because of the small number of practitioners in this country) to prepare detailed
reports of their successful cases; thus, it is necessary to rely primarily on
the large-scale clinical trials conducted in China for the purpose of learning
about the success rates. Such clinical reports, published in the Chinese language,
are abstracted and published in English by the Chinese University of Hong Kong.
These reports, and other translated materials, are compiled by the Institute and
sent to practitioners in a variety of formats, including a technical series called
Clinical Tips. Trials supported by the Institute for Traditional Medicine in the
U.S. that have generated successful outcomes include treatment of HIV/AIDS, multiple
sclerosis, and endometriosis.
Following are some examples of common ingredients of Chinese formulas that have
become widely used because of their reliable action, the quick results usually
experienced, and the diversity of therapeutic activities that can be obtained
from each. These reviews serve as examples of what Chinese doctors must know.
It will be noted that the dosage range is often very large, reflecting various
uses and different methods of application.
FIFTEEN COMMONLY-USED CHINESE HERBS
The long tap roots of astragalus are, today, the most commonly used herb material
in China. Astragalus normalizes immune responses (used for immune deficiency,
allergies, and autoimmunity), benefits digestive functions, and treats disorders
of the skin from burns to carbuncles. Astragalus is used as a promoter of the
functions of several other herbs, such as salvia and tang-kuei (mentioned below).
It is used in the treatment of AIDS and hepatitis, for chronic colitis, senility,
and cardiovascular diseases. Cancer patients who take this herb can often avoid
the white blood cell deficiencies (leukopenia) that occur with chemotherapy. The
root is rich in polysaccharides and flavonoids that produce the beneficial effects.
Astragalus may be used by itself, usually as a liquid extract, or in combination
with other herbs in the form of teas, pills, or tablets. Dosage is from 1-60 grams
per day, depending on the application and form. Caution: some individuals may
experience flatulence and abdominal bloating from use of astragalus.
The rhizomes of atractylodes are considered very important to the treatment of
digestive disorders and problems of moisture accumulation. The herb helps move
moisture (and nutrients) from the digestive tract to the blood, reducing problems
of diarrhea, gas, and bloating, and helps move moisture from the body tissues
to the bladder for elimination, alleviating edema. The herb is frequently included
in tonic prescriptions, and the herb is rarely used by itself. Dosage is from
200 milligrams in capsules and tablets to 15 grams per day in the form of decoction.
Caution: persons suffering from a hot and dry condition may experience worsening
of those symptoms if large amounts of atractylodes are used.
The thin roots of bupleurum are one of the most frequently used herbs in the Japanese
practice of Oriental medicine. Doctors in Japan have found it useful in the treatment
of liver diseases, skin ailments, arthritis, menopausal syndrome, withdrawal from
corticosteroid use, nephritis, stress-induced ulcers, and mental disorders. The
roots are rich in saponins that reduce inflammation and regulate hormone levels.
The herb is not used by itself, but rather in formulas with about four to twelve
ingredients, made as teas, pills, or tablets. Dosage ranges from a few hundred
milligrams of powder to about 15 grams in tea per day. Caution: some individuals
may experience dizziness or headaches from use of bupleurum.
Cinnamon (guizhi and rougi)
The twigs (guizhi) and bark (rougi) of this large tropical tree are said to warm
the body, invigorate the circulation, and harmonize the energy of the upper and
lower body. Modern studies demonstrate that cinnamon reduces allergy reactions.
Traditionally, cinnamon twig is used when the peripheral circulation is poor and
cinnamon bark is used when the entire body is cold. If the upper body is warm
and the lower body is cold, then cinnamon will correct the imbalance. Cinnamon
is usually cooked together with other herbs to make a warming tea, or powdered
with other herbs to make a pill or tablet that regulates circulation of blood.
Dosage is 0.3-3 grams of bark and up to 9 grams of twig per day. Caution: large
amounts of cinnamon are irritating to the liver and should not be used by those
with inflammatory liver disorders.
This rhizome (underground stem) is one of the most bitter herbs used in Chinese
medicine. It is rich in alkaloids that inhibit infections and calm nervous agitation;
it is usually combined with other bitter-tasting herbs, such as phellodendron,
scute, and gardenia, to promote these actions. Examples of its many uses include
treatment of skin diseases, intestinal infections, hypertension, and insomnia.
Coptis is a close relative of an extremely bitter and very useful American herb,
goldenseal. Because of its taste, coptis is most often used in the form of pills
or tablets. Typical dosage is from a few hundred milligrams of powder to 3 grams
in decoction per day. Caution: regular use of coptis in large dosage may cause
The fibrous rhizome of this herb is highly spicy and said to benefit digestion,
neutralize poisons in food, ventilate the lungs, and warm the circulation to the
limbs. Today, ginger is commonly used as a spice in cooking; as a medicine it
has been shown helpful in counteracting nausea from various causes including morning
sickness, motion sickness, and food contamination. Many herbalists use ginger
in the treatment of cough (it acts as an expectorant) and common cold. Ginger
is used in making teas and the powder is encapsulated for easy consumption. Typical
dosage is from a few milligrams used as an assistant in herb formulas to about
3 grams per day in making decoctions. Instant tea granules (sugar or honey base)
are available. Caution: persons who suffer from dryness-dry cough, thirst, dry
constipation, etc.-may find that ginger worsens the condition.
The root has long been cherished as a disease-preventive and a life preserver.
It calms the spirit, nourishes the viscera, and helps one gain wisdom. Modern
applications include normalizing blood pressure, regulating blood sugar, resisting
fatigue, increasing oxygen utilization, and enhancing immune functions. Traditionally,
the root is cooked in a double boiler to make a tea, used either alone or with
several other herbs. Today, teas can be made quickly from carefully prepared extracts
in liquid or dry form; ginseng powder is made into tablets or encapsulated, and
ginseng formulas are available in numerous forms for easy consumption. Typical
dosage is 0.5-3.0 grams. Higher doses may be used over the short term for specific
therapeutic actions: in China 30 grams is recommended to treat shock (sudden hypotension).
Caution: excessive consumption of ginseng can lead to nervousness and may produce
hormonal imbalance in women.
This herb is a large fungus that grows on pine roots. It is used to alleviate
irritation of the gastro-intestinal system and, like atractylodes, it helps transport
moisture out of the digestive system into the blood stream and from the various
body tissues to the bladder. When bits of the pine root are included in the herb
material it is called fushen; the combination of the fungus and pine produces
a mild sedative action. This herb, because it is quite mild, is mostly used in
making decoctions or dried decoctions, with a dosage equivalent of about 10-15
grams per day. The herb is non-toxic and rarely causes any adverse effects.
The roots have an extremely sweet taste (but are also bitter) and are said to
neutralize toxins, relieve inflammation, and enhance digestion. In Europe, a drug
has been made from licorice extract that heals gastric ulcers. Licorice is used
by Chinese doctors in the treatment of hepatitis, sore throat, muscle spasms,
and, when baked with honey, for treatment hyperthyroidism and heart valve diseases.
Traditionally, licorice is thought to enhance the effectiveness of herb formulas
and is used to moderate the flavor of herb teas; as a result, it is found in about
one-third of all Chinese herb prescriptions. Licorice powder is encapsulated for
easy consumption or mixed with other herbs and tableted. Dosage is from very small
amounts (a few hundred milligrams) to 15 grams per day in decoction used to treat
viral hepatitis. Caution: excessive consumption of licorice over an extended period
to time can cause sodium/potassium imbalance with symptoms of tachycardia and/or
The stem-like leaves when taken in a dose of several grams stimulate perspiration,
open the breathing passages, and invigorate the central nervous system energy.
It has been shown that most of these effects are due to two alkaloid components,
ephedrine and pseudoephedrine, both of them having been made into modern drugs
(for asthma and sinus congestion, respectively). In addition, the stimulating
action of ma-huang has led to its use as a metabolic enhancer (burns calories
more quickly) for those who are trying to lose weight. Ma-huang also has anti-inflammatory
actions useful in treating some cases of arthralgia and myalgia. Ma-huang can
be made into a tea, or used in extract form; powdered ma-huang is rarely used.
Dosage range is 1-9 grams/day, usually in two or three divided doses. Caution:
the stimulant effect of ma-huang can cause insomnia and agitation; persons with
very high blood pressure may find this symptom worsened by use of ma-huang.
Peony (baishao and chihshao)
The root of this common flower is used to regulate the blood. It relaxes the blood
vessels, reduces platelet sticking, nourishes the blood, and promotes circulation
to the skin and extremities. The root of both wild and cultivated peonies are
used. The wild peony yields "red peony" (chihshao) a fibrous root that
is especially used for stimulating blood circulation. The cultivated peony yields
"white peony" (baishao) a dense root that nourishes the blood. Peony
is often combined with tang-kuei, licorice, or other herbs mentioned here to enhance
or control their effects. The dosage range is from 0.5-15 grams per day. Peony
rarely causes any adverse reactions.
The root of this herb is a dark, moist herb that is extensively used to nourish
the blood and the hormonal system. It is frequently used in the treatment of problems
of aging, because of its ability to restore the levels of several declining hormones.
There are two forms of the herb that are currently used: one, designated shengdihuang
or raw rehmannia, is given to reduce inflammation and is included in many formulas
for autoimmune disorders; the other is designated shoudihuang or cooked rehmannia,
and is used as a nourishing tonic. Often, the two forms are combined together
in equal proportions to address inflammatory problems that are related to the
lack of adequate levels of regulating hormones. The herb is mainly used in making
decoctions or dried decoctions, with a dosage of 10-30 grams per day. Caution:
persons with weak digestion and tendency to experience loose stool or diarrhea
may find that this herb, especially cooked rehmannia, worsens those symptoms.
This large root was one of the first herbs that the Western world imported from
China. It serves as a very reliable laxative, and also has other benefits: enhancing
appetite when taken before meals in small amounts, promoting blood circulation
and relieving pain in cases of injury or inflammation, and inhibiting intestinal
infections. Rhubarb also reduces autoimmune reactions. The impact of rhubarb is
influenced by how it is prepared; if it is cooked for a long period of time, the
laxative actions are reduced but other actions are retained. Typical dosage is
0.5-3 grams per day. Caution: rhubarb, alone or in formulas, should not be used
by those with irritable bowel conditions, as it may cause cramping and diarrhea.
The deep red roots of this Chinese sage plant have become an important herb during
the past two decades even though it was used for centuries before that. It is
applied in almost all cases where the body tissues have been damaged by disease
or injury; thus, it is given for post-stroke syndrome, traumatic injury, chronic
inflammation and/or infection, and degenerative diseases. It is best known for
its ability to promote circulation in the capillary beds-the so-called microcirculation
system. In addition, salvia lowers blood pressure, helps reduce cholesterol, and
enhances function of the liver. It may be consumed alone or with other herbs,
in wines, teas, pills, or tablets; dosage is 1-20 grams per day. Salvia rarely
causes any adverse reactions.
The root has been long respected as a blood-nourishing agent. It has its highest
rate of use among women because tang-kuei will help to regulate uterine blood
flow and contraction, but when employed in complex formulas it can be used by
both men and women to nourish the blood, moisten the intestines, improve the circulation,
calm tension, and relieve pain. Tang-kuei is frequently said to have estrogenic
effects, but this is not a valid claim. The recommended dosage for tang-kuei is
0.5-9 grams per day. Tang-kuei may be made as a tea or cooked with chicken to
make soup (the taste is quite strong), but it is often used today as a powder,
encapsulated or made into tablets, alone or with other herbs. Caution: some individuals
find that tang-kuei causes nausea or loose stool.
EXAMPLES OF HERB COMBINING TO MAKE AN EFFECTIVE TREATMENT
An ancient formula prescribed for the initial stage of an infectious disease is
Cinnamon Combination. It includes cinnamon, peony, licorice, and ginger. It is
said that the cinnamon (twig) and peony coordinate the circulation at the surface
of the body (where disease is believed to enter) and relaxes tense muscles. Ginger
and licorice improve the digestive functions and improve the body's healing energy.
An ancient formula used to treat chronic illness is Ginseng and Tang-kuei Ten
Combination. It includes astragalus, ginseng, atractylodes, hoelen, licorice,
cinnamon, tang-kuei, peony, and rehmannia. Astragalus, ginseng, atractylodes,
hoelen, and licorice promote digestive functions, increase the energy, nourish
the internal organs, and enhance weakened immune responses. Cinnamon (bark) warms
up the weakened metabolism. Tang-kuei, peony, and rehmannia nourish the blood.
Another ancient formula, used for a variety of diseases and function disorders,
is Minor Bupleurum Combination. It includes bupleurum, ginseng, ginger, hoelen,
and licorice. Bupleurum harmonizes the circulation between the internal organs
and the body surface, it alleviates stress in the chest and abdomen, and it reduces
inflammation. As indicated above, ginseng, ginger, hoelen, and licorice benefit
the digestive processes and increase energy.
All of these formulas are widely used today, often by making some slight modifications
to address the particular needs of the individual or the characteristics of the
disease. For example, Cinnamon Combination (with appropriate modifications) has
been used in Chinese clinical trials for treatment of frostbite, pernicious vomiting
of pregnancy, and appendicitis. Ginseng and Tang-kuei Ten Combination has been
applied to treatment of side-effects of cancer therapy and for prevention of cancer
recurrence after successful treatment. Minor Bupleurum Combination is one of the
formulas frequently given in cases of chronic hepatitis B infection, and it is
also used for inflammation of the stomach and pancreas.
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Message from Ron Teeguarden
Chinese drug therapy
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Chinese medicinals and side effects
Chinese Medicine Overview
The origins of Chinese medicine
History of Chinese medicine
What is the difference?
Introduction to Chinese herbs
Modern and Chinese medicine
Philosophy of herbs
My view of Chinese medicine
Learning about herbs
Is it safe?
Prevention of herb-drug interaction
Taoism and Chinese traditional medicine
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The characters and functions of Chinese medicine
The duty of Oriental and Western medicine
Questions about Chinese traditional medicine
Understanding Chinese medicine
Yin and Yang
Five element theory
Foundations of chemistry of ancient China
Preparation of herbs
The Processing of Chinese Herbs for Medicinal
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Ginseng and Astragalus combination
How to take Chinese herbs?
The principles of formula writing
The prescriptions of Chinese herbs medicine
The eight principles
What does the treatment involve?
Toxicity and interactions issues in Chinese herbal
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Yoga and Oriental medicine
Deal with insurance companies
Visiting herbal doctors
Becoming a herbalist
Books to read
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