BIRMINGHAM CENTRE FOR CHINESE MEDICINE
245 Alcester Road South, Kings Heath, Birmingham B14 6DT
Tel: 0121-441 2757
CHINESE HERBAL MEDICINE: GENERAL INTRODUCTION
CHINESE HERBAL MEDICINE: AN INTRODUCTION
This page provides an explanation of the Chinese herbal medicine tradition. A very brief description is given in our page on 'Chinese Herbs'.
The following account is for those who would like a bit more background and detail.Chinese herbal medicine (CHM) is one discipline within a broad tradition which includes also acupuncture, massage (tuina), dietary therapy, and breathing exercise (qi gong). The tradition has evolved over more than two thousand years, spreading from China to other parts of the Orient, including Japan, Vietnam and Korea. CHM retains a strong presence in health provision in China today. It is practised in hospitals throughout the country for the treatment of a wide range of conditions, alongside western medicine. More recently it has become increasingly popular in the West, in particular in the UK. It developed here rather later than acupuncture, but in the past ten to fifteen years the use of CHM has expanded rapidly.
Naturally, with such a long history many approaches to diagnosis and treatment have evolved. At the same time there is a strong continuity within the tradition, with an unbroken written record going back to the third century BC, and there are core concepts of health and disease which are shared by Chinese medicine practitioners around the world.
These notes briefly explain:
- some of the key underlying concepts of Chinese medicine
- the diagnosis of patterns of disharmony
- the principles that guide treatment with Chinese medicines
- the forms in which Chinese herbal medicine is prescribed
KEY CONCEPTS: YIN-YANG AND QI
In the very broadest terms, good health is a state in which a person has optimum vitality and in which the various functions needed to maintain that vitality are unimpeded. Ill-health is due to a loss of that vitality or to some form of impediment to those functions, or both. Good health furthermore requires a balance, which is represented by the core idea of Yin-Yang--a concept drawn from a school of thought which came to be central to the Chinese medical tradition. The polarity of Yin-Yang represents the mutual dependence of all things. In the context of human life, health and disease, this can be understood in the following way. Any form of life depends on substance and activity. Substance is Yin: it is the stuff our bodies are made of: bones, muscles, internal organs, blood, fluid and so on. Activity is Yang: it is movement or transformation, including the transformation required to repair and build body tissue.
The relationship can be likened to the wax and flame of a candle. The wax is the Yin aspect (substance), the flame is the Yang (activity, transformation, heat). They are mutually dependent. You need wax as fuel for the activity (hence wax is consumed by the flame), while you need a process of transformation in order to create wax. The comparison is not complete, because a candle has a fixed amount of substance. Once the wax is consumed the candle ceases to burn, while human beings continue to take in nourishment in order to keep the flame alive. Still, our life is also limited, the substance is consumed with age and the flame eventually goes out.
Health and longevity depend on a harmony of Yin and Yang. This means creating a balance between substance and activity which will maximise the Qi (hard to translate but close to energy or vitality) available for all life functions, and will ensure that the Qi flows freely, without obstruction. On one side is nourishment, rest and calm (Yin), on the other is activity/movement/transformation (Yang). If the Yin is in excess relative to the Yang (let us say through a life of overeating and under-exercising), there is a slowing down, a stasis: the flame is reduced. If there is an excess of Yang relative to Yin (for example through a chronically over-active lifestyle, with inadequate rest and recovery), the substance is too quickly depleted: the flame burns too fast. Either way the Qi/vitality/ energy will be compromised (diminished or blocked), leading to dysfunction and disease.
Achieving such harmony is not only, and not even primarily, a matter for medicine. Although medicine has been a respected occupation in China, it is not seen as having all the answers. Medicine can help to redress imbalances, to relieve suffering and to fend off disease. Yet the ways in which life is lived are more important, including appropriate diet and exercise, work and rest, emotional states and attitudes of mind. These basic elements of traditional wisdom, discovered anew by modern health education, help to keep the role of the physician in proper perspective.
DIAGNOSING PATTERNS OF DISHARMONY
The Yin-Yang polarity deeply informs the Chinese medicine tradition. It establishes a way of thinking in which component elements, though they can be distinguished, are inseparable parts of a whole. While modern biomedicine is typically concerned with disease categories that can be isolated and identified from laboratory tests, Chinese medicine describes patterns of disharmony. The interest is not only in the symptoms and signs associated with a specific area of dysfunction, but in the relationship of these symptoms to the wider pattern of which they are a part, and which give them diagnostic meaning. In this sense Chinese medicine is concerned with the whole person.
The description of patterns of disharmony does not stand in opposition to conventional diagnosis or objective tests. The importance of these is well understood, and in practice the great majority of patients treated by Chinese medicine practitioners have been diagnosed and/or treated conventionally. Competent practitioners know when it is inappropriate to treat without a prior conventional diagnosis, and will distinguish between Chinese medicine as alternative and as complementary treatment. Chinese medicine can often help where conventional approaches have failed or where a conventional diagnosis is lacking, but it is also frequently used alongside orthodox treatments.
Diagnosis is the identification of a pattern of disharmony displayed by the individual patient, based on four main methods: observing, listening, questioning and palpating. A disharmony may be read in a number of ways. From one perspective it may involve a deficiency or dysfunction in one or more of the Organs, in particular the Spleen, Liver, Heart, Lungs or Kidneys. These are not to be confused with the anatomical organs of biomedicine: they refer rather to spheres of function. For example the 'Chinese' Spleen is concerned with the 'transformation and transportation' of food and drink. It has been likened to the pancreas, but such comparisons obscure much more than they reveal. The key thing is the function, which is the digestion and assimilation of food. A strong Spleen means a strong digestion, which is the basis for good energy, good appetite, normal bowel pattern and freedom from digestive discomfort. If there is a deficiency of the Spleen, this might manifest as tiredness (the energy from food is not being efficiently extracted and transported around the body), loss of appetite (absorption has slowed down), loose stools (food is inadequately digested) and abdominal discomfort or pain (poor functioning leads to stasis).
Most of the 'Chinese' Organs do include the organ suggested by the English term, and the 'Chinese' Lungs, Kidneys, and Heart are indeed associated with respiratory, urinary and circulatory functions. However, it is best not to assume anything about the relationship between the Chinese Organ and the anatomical entity. Hence to say that there is a 'Liver disharmony' or a 'Kidney deficiency' does not mean that there is anything wrong with the liver or kidneys in the conventional sense (though there may be).
Another perspective in diagnosis involves identifying patterns according to the presence of pathogenic factors. Such factors, which are not to be thought of as microbes, are described in terms derived from the natural world, namely Heat, Cold, Dampness, Wind, Dryness, together with varieties of Toxin and disease-causing products of the body described as Blood Stasis and Phlegm. These patterns may have an external origin in climate or environment--for example, a damp house or damp working conditions may lead to a Damp condition affecting the joints, a hot environment may aggravate a Hot condition affecting the skin. However, Dampness or Heat do not refer to causative agents as such. Rather it is the pattern as a whole that is defined as Damp or Hot.
Other forms of diagnosis are also used, for example differentiating the 'level' at which the disease is found, which may be outer or inner, with other distinctions at the inner level. There are agreed criteria for identifying disharmonies at the different levels, and this may in important ways affect the treatment strategy.
Alongside patterns of disharmony, much attention is also given to aetiology (the origins of disease). The origins of disease are broadly categorised as (1) external: these are again described as Heat, Cold, Dampness, Dryness, Wind, but in this case referring to outside forces impinging on the person (2) internal, which relate mainly to the emotional sphere. Seven emotions (joy, anger, worry, pensiveness, sadness, fear and fright) appear in the Chinese medical tradition, and each can take a pathological form, thus becoming a source of disharmony. (3) neither external nor internal: these factors include diet, imbalances of work and rest, and sexual factors (4) other origins including trauma, burns, bites and parasites. Inherited and congenital factors, although not typically included in textbook accounts, are also recognised.
TREATING WITH CHINESE HERBAL MEDICINE
The art of treatment with Chinese herbal medicine is to choose a formula (a combination of herbs) which matches the pattern of disharmony of the individual, and to modify the formula in order to accommodate changes in the course of treatment and, if necessary, revisions in diagnosis. If the condition is diagnosed as a malfunction of one or more of the Organs, then this is addressed by 'supplementing' that function or eliminating blockages which impede it. If the disharmony is due to the predominance of a certain pathogenic factor, the treatment will require eliminating or resolving it in some way so as to restore balance and/or strengthen some aspect of the person's vitality in order to assist in that process.
The Chinese materia medica contains several hundred commonly used ingredients, including roots, stems, flowers, leaves and barks, together with some mineral and animal substances. The choice of an appropriate formula is the choice of a combination of herbs or other medicinals with certain properties. Properties refer, first, to 'taste' or 'flavour': sweet, sour, bitter, pungent, salty or bland. Second, they describe temperature: hot, warm, cool, cold, neutral. This is not a thermometer reading, but a quality which has been identified from its observed physiological effect. Hence ginger is warming, mint is cooling. Third, substances may be described as having an outward or inward movement, for example some pungent substances help to 'sweat out' a disease while sour substances have an inward action by virtue of their astringent properties.
The materia medica is then grouped into broad categories in accordance with physiological action. For example there are medicinals that (a) 'release the exterior'--treat the early stages of disease caused by external agents (b) 'clear Heat' through their cooling and usually bitter properties (c) treat Damp-Heat by clearing Heat while drying Dampness (d) 'warm the interior' (e) 'drain' Dampness through their diuretic action (f) 'transform' Dampness by virtue of their warm and aromatic properties (g) 'transform Phlegm' (h) 'regulate Qi' by treating certain forms of stasis (i) 'invigorate Blood' by counteracting Blood Stasis (j) 'calm the spirit' (j) 'supplement' one or another form of a deficiency. (The significance of such descriptions will become clearer when some clinical cases are discussed)
Chinese medicinals are rarely prescribed as 'simples' or single remedies. They are combined into formulas which will typically contain 10 or more ingredients. The principle is that a balance of ingredients with certain properties is matched to a pattern of disharmony, allowing for great flexibility in addressing the individual characteristics of the patient and changes that occur during the course of treatment.
CHM may be prescribed in a number of ways. The main traditional method is the tea. A combination of loose herbs is prepared for the patient, who makes a tea or decoction (a water extract produced by simmering) and drinks it twice a day. The most commonly used items in the materia medica can now also be obtained in the form of concentrated powders. These are often preferred to teas for reasons of convenience and better compliance, although teas retain definite advantages, notably: (a) the ingredients are cooked together, creating a potential for synergy between the ingredients (as happens in the cooking of a soup or stew) (b) the ingredients can be modified in a number of ways (for example by dry-frying or charring, or frying with honey, vinegar or salt) which changes the property of the raw material, either strengthening or moderating a particular action.
In addition, a wide range of formulas are available in tablet form. These are very convenient but lack the flexibility of individually prepared prescriptions. External preparations are also made, including creams, ointments and washes for skin conditions, and compresses for traumatised tissue.
CONDITIONS SUITABLE FOR TREATMENT WITH CHINESE HERBAL MEDICINE
The possible uses of Chinese herbal medicine are very wide, but the following conditions may be singled out:
- skin
disease, including eczema and psoriasis- respiratory
conditions, including asthma, bronchitis, rhinitis and sinusitis- gastro-intestinal
conditions, in particular irritable bowel syndrome and other 'functional' gastro-intestinal disorders- gynaecological
problems, including pre-menstrual syndrome, dysmenorrhoea, menopausal syndrome, endometriosis, some forms of infertility- urinary
conditions, including chronic cystitis- rheumatological
conditions, including rheumatoid and osteo-arthritis- headaches
- chronic fatigue syndromes
- anxiety and depression
- hepatitis and HIV
(some promising results have been obtained for treatment of Hepatitis C, and supportive treatment may be beneficial in the case of HIV)- supportive treatment for some metabolic disorders, including diabetes and thyroid conditions
- supportive treatment for some cancers