Overview and History
Visiting a Chinese pharmacy in the Republic of China is much like being inside a miniature museum of natural science. Tucked away in row after row of tidy drawers are animal, plant, and mineral products, each with a particular purpose. Among the assortment of curiosities are cinnabar and amber, to relax the nerves; peach pits and safflower, to improve blood circulation; bearþs gall to relieve pain and tranquilize; Chinese ephedra (mahuang) to induce perspiration; and ginseng to strengthen cardiac function.
The filling of a prescription ordered by a Chinese doctor is a fascinating process to watch. The pharmacist selects a few particular ingredients from the hundreds on his shelf. These are taken home by the patient, boiled into a ‘soup’, and consumed. Confronted with such a steaming brew, you might ask yourself just what the basis of this ancient medical art is. The theoretical framework of Chinese medicine was established more than two millennia ago. A great deal of ancient medical knowledge is preserved in the pre-Chin (221-207 B.C.) Inner Cannon (Nei Ching), a comprehensive record of Chinese medical theories up to that time. The Han dynasty (206 B.C.-220 A.D.) produced an authoritative and valuable practical guide-even to the present day-to the treatment of illness, the Treatise on Diseases Caused by Cold Factors (Shang Han Lun) by Chang Chung-ching. One of the best-known Chinese medical works is the Materia Medica (Pen Tsþao Kang Mu), compiled in the Ming dynasty (1368-1644 A.D.) by Li Shih-chen.
This encyclopedic work heralded a new era in the world history of pharmacology; it includes descriptions of 1,892 different kinds of medicines. These works have all been translated into several foreign languages, and have exercised a profound influence on East Asian and European countries. The Chinese have a unique system of categorizing illnesses that is widely divergent from its Western counterpart. The philosophy behind Chinese medicine is that man lives between heaven and earth, and comprises a miniature universe in himself. The material of which living things are made is considered to belong to the þyinþ, or female, passive, receding aspect of nature. The life functions of living things, on the other hand, are considered to belong to þyangþ, or masculine, active, advancing aspect. The functions of living beings are described in terms of the following five centers of the body: 1. ‘heart’ or ‘mind’ (hsin); this refers to the ‘command center’ of the body, which manifests itself as consciousness and intelligence; 2. ‘lungs’ or ‘respiratory system’ (fei); this system regulates various intrinsic functions of the body, and maintains cybernetic balance; 3. ‘liver’ (kan); this term includes the limbs and trunk, the mechanism for emotional response to the external environment, and the action of organs; 4. ‘spleen’ (pþi); this organ system regulates the distribution of nutrition throughout the body, and the metabolism, bringing strength and vigor to the physical body; and 5. ‘kidneys’ (shen); this refers to the system for regulating the storage of nutrition and the use of energy; the human life force depends on this system.
This theory is used to describe the system of body functions, and as a whole is referred to as the ‘latent phenomena’ (tsþang hsiang). The passage of the seasons and changes in the weather can have an influence on the human body. Those having the most pronounced effect are wind (feng), cold (han), heat (shu), moisture (shih), dryness (tsao), and internal heat (huo ‘fire’). Excessive or extraordinary changes in the weather harm the body, and are referred to as the ‘six external disease-causing factors’ (liu yin). On the other hand, if mood changes within the individual, such as happiness (hsi), anger (nu), worry (yu), pensiveness (szu), grief (pei), fear(kþung), and surprise (ching) are too extreme, they will also harm good health. These emotions are called the ‘seven emotions’ (chþi chþing). In Chinese medicine, the six external disease-causing factors, interacting with the seven emotions, form the theoretical foundation of disease pathology. These theoretical models, coupled with the ‘theory of latent phenomena,’ are used to analyze the patientþs constitution and his illness, and diagnose the exact nature of his overall physical and psychological loss of balance. Based on this analysis, the doctor can prescribe a method to correct the imbalance. The object of Chinese medicine is the person, not just the illness. In Chinese medical thinking, illness is only one manifestation of an imbalance that exists in the entire person.
According to Chinese legend, Shen Nung, the Chinese father of agriculture and leader of an ancient clan, took it upon himself to test, one by one, hundreds of different plants to discover their nutritional and medicinal properties. Many of these turned out to be poisonous to humans. Over the millennia, Chinese have used themselves as guinea pigs in this same way to continue testing plants for their properties of inducing cold (han), heat (jeh), warmth (wen), and coolness (liang). They classified the medicinal effects of the plants on the various parts of the body, then tested them to determine their toxicity, what dosages would be lethal, and so forth. For example, the stem of Chinese ephedra is a sudorific; but its roots, to the contrary, can check perspiration. Cassia bark is warming in nature, and is useful in treating colds. Mint is cooling in nature, and is used to relieve the symptoms of illness resulting from heat factors. This accumulation of experience strengthened the Chinese understanding of natural phenomena, and increased the applications of natural principles in Chinese medicine.
The same principles described in the preceding are also applied to assess the patientþs living environment, his life rhythms, the foods he prefers or avoids, his personal relationships, and his language and gestures, as a tool in better understanding his illness, and suggesting improvements in various areas. Once the excesses or imbalances are pinpointed, they can be adjusted, and physical and mental health and balance restored. This attainment of equilibrium in the bodyþs flow of energy is the ultimate guiding principle of Chinese medical treatment. In addition to the prescription of medicines, acupuncture is another frequently used tool of treatment in Chinese medicine. Its history antedates written Chinese language, but acupuncture was not fully developed until after the Han dynasty. Its theoretical base is the adjustment of cþhi, or the flow of life energy. Cþhi flows through the body via the system of ‘main and collateral channels’ (ching luo) of the body. At certain points along these channels, acupuncture needles may be inserted, or Chinese mugwort (ai tsþao) burned in moxibustion, to adjust imbalances in the flow of cþhi, and concentrate the bodyþs self-healing powers in the points where needed.
In 1980, the World Health Organization released a list of 43 types of pathologies which can be effectively treated with acupuncture. The use of acupuncture as anesthesia during surgery or for painless childbirth is no longer þnews.þ Acupuncture is simple to administer, has few side effects, and has broad applications. It has opened up a whole new þhotþ field of scientific and medical research. In the Republic of China on Taiwan, the government has put great efforts into promoting the modernization of Chinese medicine. As a result, there are now people trained in both traditional Chinese and modern Western medical arts who have made commendable contributions to the treatment of hepatitis, high blood pressure, cancer, and other diseases that are so far difficult to treat. In the area of pharmacology, researchers have evaluated effectiveness, analyzed, tested, and formulated concentrated dosages of Chinese pharmaceutical products for commercial sale.
The prescriptions for these drugs are easier to fill, and are much more convenient for the patient than the old boiling method. In the area of basic scienc, modern research is being conducted in the field of pulse diagnosis. The three fingers used in the past to determine illness through feeling of the pulse are now being replaced by pressure reactors. The pressure reactor converts variances in pulse pressure into electromagnetic waves, and registers them on a screen. This data is then analyzed by a computer. Many important new discoveries have been made through unique combinations of traditional and modern science. In the Republic of China, the marriage of modern scientific precision with the art of traditional Chinese medicine is on the threshold of opening up a whole new world of medical diagnosis and treatment.
An Introduction to Chinese Herbal Medicine
What are Chinese herbs? In China, herbs are called herbal medicine, which is made up of roots, bark, flowers, seeds, fruits, leaves, and branches. Herbal medicine has been a part of the written history of Traditional Chinese Medicine for over 4000 years. There are over 3000 different herbs that can be used for medical purposes. Only 300 to 500 of these herbs are commonly used. It is important to use herbs grown in China rather than outside of their native environment. One must use the right herb from the right resource to get the full benefit.
What are herbs used for? Herbal therapy has three main functions: (1) to treat the immediate problem, such as killing bacteria or a virus, (2) to strengthen the body, helping it to recover, and (3) to maintain health.
How are herbs categorized?
- Property: Every herb is said to have the property of being either cool, cold, warm, or hot. Cool and cold herbs treat “hot” symptoms, such as fever, thirst, sore throat or constipation. Warm and hot herbs treat “cold” symptoms, such as cold hands and feet.
- Flavor: There are seven flavors of herbs; pungent, sweet, sour, astringent, bitter, salty, and neutral.
- Channels: Channels (or meridians) run throughout the body, affecting different organs. Each kind of herb affects a particular channel and organ.
- Actions: Herbs perform different actions in the body. These are known as lifting, floating, lowering, and sinking.
Why is it necessary to process herbs? Herbs are processed before use. There are several reasons for this. First, processing reduces any possible side-effects by detoxifying the herbs, removing any poisons. Another reason for processing herbs is for easier storage. Processing also filters out impurities such as dirt and sand, and can tone down a strong taste or smell. Finally, processing an herb can strengthen its function.
What are the differences between patent and prescribed herbs? Patent herbs are premixed herb combinations, similar to over-the-counter-drugs. The patient’s symptoms must fit the patent herb’s narrow indications. Prescribed herbs are mixed by an herbalist and tailored to the patient’s symptoms and diagnoses.
What does a Chinese herbalist do? Contrary to popular belief, Chinese herbalists do not normally grow or process herbs. The herbalist writes a prescription tailored to the patient’s individual needs, then mixes it using herbs processed by pharmaceutical companies in China and Taiwan. Only G.M.P. standard herbs are used. G.M.P. stands for Good Manufacture Practice, the highest standard for pharmaceuticals. In China, Chinese herbalists are graduates of Chinese Traditional Medical School, with the same privileges as western physicians.
How are herbs mixed? Herbs are seldom used singly. Most often, they are used in combinations of 10 to 15 herbs. There are three ways to beneficially combine herbs. Mutual Reinforcement involves combining two very similar herbs to create a strong effect. Mutual Assistance is the method of using one herb to help another work better. Mutual Restraint relies upon one herb reducing or eliminating side effects of another herb in the combination.
Two other types of combinations show why one should be experienced and knowledgeable about herbs before attempting to combine them. Mutual Inhibition occurs when one herb reduces another’s effectiveness. Incompatibility occurs when the combination of certain herbs produces side effects or becomes poisonous.
What are some precautions of taking herbs? Herbs, like anything you put in your body, should be taken with a certain amount of caution. Some herbs are too strong for pregnant women and may cause miscarriage. Certain foods can have adverse effects on the herbal therapy. While taking herbs, one should avoid food that is raw (fruit is okay, but vegetables should be cooked), greasy, strong tasting or smelling, difficult to digest (such as beef), or irritating to the digestive system (like spicy foods). For consultation with a certified Chinese herbalist, please call (607)275-9700.
How are herbs taken? Herbal medicine is traditionally taken in tea form. Tea absorbs into the system quickly, and is the most commonly used method. However, if the smell or taste of the tea is unpleasant, capsules or tablets are recommended. Tea should always be warm, and capsules or tablets should be swallowed with warm water. Generally, it is best to take herbs on an empty stomach. You should consult an herbalist for specific instructions on taking herbs, but here are some basic guidelines. Tonic herbs, to promote health, are best taken before meals. Purgative herbs, to cleanse the system, are best taken on an empty stomach. Herbs that either irritate the stomach or are taken to protect the stomach should be taken after eating. Herbs for insomnia and other sleeping disorders should be taken at bedtime.
For what reasons should herbs be taken? As stated before, the three functions of herbal medicine are treatment, recovery, and health maintenance. Generally speaking, herbs can be taken for many kinds of illness. Also, many kinds of western drugs have an herbal alternative. Because it is natural therapy, most herbs do not cause side effects. Those side effects that do occur can be easily counteracted with other herbs. Herbal medicine is simply gentler and safer than chemical medicine. For these reasons, people turn to herbal therapy for a number of indications.
- To treat a chronic illness – Many people with chronic illness take a number of different drugs. Those who are looking for a natural alternative for those drugs switch to herbal therapy. According to current practice in China, and classical Chinese medical teachings, there are many herbal remedies for pain syndromes, gastrointestinal disorders, neurological disorders, stress related syndromes, respiratory disorders, heart problems, sexual dysfunction, allergies and immune system deficiencies, as well as alternatives for antibiotics and anti-inflammatory drugs.
- To reduce side effects – Herbs can be taken to reduce the side effects of other medication. Antibiotics weaken the immune system. Herbal therapy can strengthen the system. Also, during chemotherapy, the white blood cell count drops, causing fatigue, lack of energy and appetite. Herbal therapy has proven quite successful in relieving the side effects of chemotherapy.
- To assist Western medication – Herbal medicine can strengthen the effects of Western medication. For example, if a patient is taking medication for his high blood pressure, but it is not producing the desired effects, his doctor may increase the dosage. A heavy dosage can produce unwanted side effects. The patient can, instead, take an herbal supplement that will produce the desired decrease in blood pressure without the side effects.
- For prevention – Herbs are often taken as a method of prevention. For a person suffering from frequent headaches, taking herbs to prevent the headache from ever starting is a much better option than taking a pain reliever after the fact. Herbs are also used to prevent the flu, menstrual cramps and pre-menstrual syndrome, among other things.
- For health maintenance- Herbal therapy can also be used for general health maintenance. Tonic herbs are used to increase energy and to slow the aging process. They are also used for enhancing sexual energy and for cosmetic purposes.
- Herbs are also used to treat minor symptoms that are not severe enough for heavy chemical drugs, symptoms that cannot be diagnosed by Western medicine, and symptoms and illness that are not easy to treat, such as mononucleosis and immune system deficiencies.
Chinese herbal stews can range in complexity from simple Chicken and San Chi Ginseng steamed in the double boiler to the elaborate preparations found in Chinese herbal restaurants and in the homes of the wealthy. Here are some of my favorite recipes.
CHICKEN SOUP WITH ASTRAGALUS, GINSENG, CORDYCEPS, AND DATES
- 1-2 Tbl organic cold-pressed sesame oil
- 3-4 slices fresh ginger root
- 1 medium brown onion, sliced
- 1-2 cups chopped root vegetables of your choice (carrot, turnip, rutabaga, daikon)
- 2-3 skinless hormone-free chicken legs. Other pieces if you like.
- 1 Tbl dark miso paste
- 1 tsp white pepper (more or less to taste)
- 2-3 oz. Astragalus Root (Huang Qi)
- 1 oz. Chinese Red Ginseng Root (Ren Shen)
- 1 oz. American Ginseng Root (Xi Yang Shen)
- 5-6 pieces Cordyceps fungus (Dong Chong Xia Cao)
- 3 pieces Dioscorea Yam Root (Shan Yao)
- 1-2 pieces aged Tangerine Peel (Chen Pi)
- 3-4 pieces Chinese Red Date (Da Zao)
- 2-3 Indian Green Cardomon pods or Chinese Cardomon (Sha Ren)
- 3-4 pieces Poria Fungus (Fu Ling)
Fry the sliced brown onion and thinly sliced ginger root in the sesame oil. When slightly browned, add as much chicken as you like. Vegetarians may substitute tofu or tempeh at this stage. Saute 5 minutes longer and then add the root vegetables and herbs with enough water to reach 2-3 inches above the ingredients. Bring to a boil and reduce to medium-low. Cook for 45 minutes to 1 hour in a heavy pot with a tight lid. 10 minutes before finishing, add the miso paste (after mixing it in a little water) and the pepper and let it simmer to perfection. Salt can be added if the miso is not salty enough. Those on a low-fat diet can reduce the oil to 1 teaspoon, but generally fat is not the issue for those eating this soup.
This is an excellent soup for recouping energy after surgery or prolonged illness. Chicken is a warm blood tonic food which when combined with these herbs raises, the Qi and warms and tonifies the blood which is important as our bodies become very cold during surgery. The cordyceps fungus replenishes the “essence” (jing) which is depleted by surgery, and the ginger, tangerine peel, and cardomon harmonize the digestion and help to relieve the nausea that often occurs post-surgically. The herbs used here are warm so be careful with this recipe if you are recovering from an illness and you still feel heat in your body.
LAMB AND LEEKS WITH DAIKONS
- 1/2 to 1 lb. lean lamb pieces with the bone. Lamb leg bones can be purchased at mideastern markets.
- 3-4 large leeks, sliced
- 3-4 slices fresh ginger root
- 3-4 crushed garlic cloves
- 1 cup sliced Daikon radish root
- 1 Tbl barley miso paste
- 1 tsp black pepper
- 2 tsp organic cold-pressed sesame oil
- 1 oz. Chinese Angelica Root (Tang Kwei)
- 1 oz Rehmannia Root (Shu Di Huang)
- 1-2 oz. Polygoni Multiflore Root (He Shou Wu)
- 2 pieces Dioscorea Yam Root (Shan Yao)
- 2-3 pieces Peony Alba Root (Bai Shao)
- 2-3 pieces Poria Fungus (Fu Ling)
- 1 2″ x 1″ Saigon Cinnamon Bark (Rou Gui)
- 1-2 pieces aged Tangerine Peel (Chen Pi)
- 1 oz. Astragalus Root (Huang Qi)
- 2-3 oz. Chinese Barley Job’s Tears (Yi Yi Ren)
Saute the ginger and garlic in the oil until brown and fragrant. Add the cleaned leek slices (slice them in half and soak for a minute in warm water to remove all the dirt) and lamb and saute a little more. After 5 minutes add the daikon, herbs, bones (if separated), and enough water to cover the ingredients and then some. Bring to a boil and then cook on medium-low for about an hour. As the Job’s Tears tend to absorb water you may have to add more during the course of cooking. Near the end add slightly diluted miso paste and black pepper. The miso paste is optional. It is a traditional Japanese ingredient, but I love the mellow flavor it imparts to all soups. A little red wine or Chinese rice wine could be added at this point also. Serve with a little soy sauce if more salt is needed.
This is a slightly sweet warming soup, excellent for building blood in the winter time. Lean lamb is very rich, and the “blood tonic” herbs in this recipe can, combined with the lamb, produce “dampness in the middle jiao,” so this recipe includes daikon radish, a vegetable known for its damp transforming qualities. In addition the recipe calls for Job’s Tears and Pore, two damp draining herbs.
VEGETARIAN LATE SUMMER / AUTUMN TOFU AND PEAR SOUP
This is an excellent soup for Santa Ana season when people’s lungs and skin are attacked by hot dry wind from the desert. It features foods and herbs that are cooling and moistening. The cold nature of the tofu is balanced by the inclusion of a little ginger root. This recipe lubricates the lungs, clears heat, gently expels wind through the skin, and strengthens the spleen and lungs. It can also be used for a dry cough in the aftermath of a common cold. For increased tonification chicken may be substituted for the tofu, which will, however, make it less cooling.
- 1 lb hard or soft tofu
- 2 Asian or Bosc pears, sliced
- 2 slices fresh ginger root
- 1 small onion, sliced
- 1 dash Chinese five spice powder
- Soy sauce and white pepper to taste
- 1 oz Pueraria Root (Ge Gen)
- 1 oz Fritillariae Bulb (Chuan Bei Mu)
- 1/2 oz Lotus Seed (Lian Zi)
- 1 oz Lily Bulb (Bai He)
- 1/2 oz Polygonati Rhizome (Yu Zhu)
- 2 pieces Dioscorea Root (Shao Yao)
- 1 oz Glehniae Root (Bei Sha Shen)
- 1/2 oz dried Longan Fruit (Long Yan Rou)
Saute the ginger, onions, and tofu in a little sesame oil. If using hard tofu, cut it into strips; if using soft tofu, just mash it up a bit. After the onions are a little brown, add five or six cups of water with the sliced pears and the herbs. Bring to a boil and simmer for 45 minutes. Add a dash of five spice powder near the end. Serve with soy sauce and pepper to taste.
A word of caution – while all the herbs listed in these recipes are perfectly safe kitchen herbs, as with all herbs there are contraindications and cautions. One should not overdo tonic herbs or rich tonic food as this can lead to excessive heat and digestive congestion. If one is yin deficient and suffering from “deficiency heat” or a very weak digestion, some of the tonic herbs can cause additional heat or congestion. Lastly, if you are sick and still carrying a pathogen you should be careful in your choice of herbs. Please consult a local herbalist who practices dietary medicine if you are in doubt. The recipes given here are only meant to promote wellness in otherwise healthy individuals.
You will notice when cooking with herbs that some of the roots, like Ginseng, appear quite edible after cooking and others, like Astragalus appear too stringy and fibrous to eat. You are right! Just eat the ones that look good. Bon Appetit!
Eyton Shalom is an acupuncturist practicing at Park Blvd Health Center in University Heights, San Diego, CA. He can be reached at (619) 296-7591.