Herbal quality : the Fuzi (aconite) dilemma
As you all know, herbs are my passion. More accurately, formulas are my passion. Formula science is my passion! :) But, I do have a strong affinity for the herbs as plants and study them as such. Further, I have a real desire to get as close as possible to the original way of prescribing the herbs in formulas, where “original” means Han dynasty or thereabouts. If you read the Shang Han Lun, there are very specific instructions for how herbs are prepared and how they should be processed. Many of these instructions appear to be ignored in contemporary times, and I can only imagine that this is having some effect with regards to our herbal effectiveness.
However, even if we prescribe and prepare the herbs exactly as indicated it means nothing if the quality of the herbs is terrible. Recently, in a class at NCNM, a professor allowed us to taste Fuzi from different sources. We had three samples of bulk Fuzi. One was from a popular herb company, the second was from China, specially prepared in the traditional way at the instruction of Heiner Fruehauf. The third was raw Fuzi - unprepared - from China.
We were asked to observe how the herb tasted, its texture, and how it made us feel. The first batch was - depressing. It was brittle, soft, had almost no flavor and absolutely no bodily sensation resulted from tasting it. This is similar to what is found in many clinics. We tasted the second batch a few minutes later, the differences were striking! There was an almost immediate pungency and quite a bit of numbness on the tongue. This numbness continued for quite a while. We have been told by several professors that we want to find this quality in the Fuzi we prescribe to our patients - it indicates that the living potency of the herb is retained.
The best fun happened when we tasted (just a bit) of fresh Fuzi. Oh boy! My THROAT was numb after that one. You could really feel the medicinal quality - it was incredible. The only thing I could think after this little taste test was, “How can we get more of the good stuff and less of the bad stuff?” The consensus seems to be that the best quality Fuzi is not available in the states or really anywhere in the West. Further, the recent earthquake in China apparently did great damage to the areas where much of the high quality Fuzi is produced - creating even greater shortages.
The quality of the initial herb is only part of the problem - processing is the next piece of the puzzle. Fresh Fuzi is often brined, and then treated in various ways. Reports have indicated that industrial chemicals and harsh processes are used in the preparation of lots of commercial Fuzi. At the very least, you can tell that much of what’s available from the major herb companies is wildly over-brined. The brining process reduces the toxicity of the herb - but we have to remember that the “toxicity” of herbs (usually produced by alkaloid content) is a large part of why it is clinically effective! Skilled herbalists know how to exploit the positive nature of the herb while minimizing the potential for harm from the strong compounds contained within. When we overprocess herbs, we don’t do anyone any favors.
How can we, in the contemporary West, make up for these various deficiencies? How can we prescribe herbs in the way they are meant to be prescribed - full of their vital force and particular benefits? How can we know if an herb has been processed appropriately? These questions can easily be added to the ones I’ve had about using local species and other related conversations on Deepest Health. I’m looking forward to hearing what you think about this important issue. Please voice your thoughts and share your research with us in the comments! No registration is necessary.
Eric
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Tags: agriculture, formulas, health, herbs, quality, ScienceRelated posts
Chinese herb substitution and using local species
I thank you all for your patience as I adjust to my workload. The reality of the situation is that I’m going to have to post what I can, when I can. But, with the onset of clinic I find myself coming up with many new thoughts to share - I’ll do my best to get them up in a timely fashion. Look also for the return of the podcast this week. I know you’ve missed me. :)
Anyway, in a fantastic lecture by Dr. Arnaud Versluys this weekend, I was reinspired to consider a very real problem in Chinese herbal medicine. We use herbs that travel long distances, are sometimes beset with chemical and heavy metal toxicity, are sometimes banned by ill-informed government agencies and some of which are becoming rare and, thus, expensive. Given that I am very serious about a rigorously authentic Shang Han Lun
The particular herb that came up in discussion about this issue was Xi Xin - Asarum - Wild Ginger. I love this herb. It’s used in a couple of indispensible formulas, perhaps most importantly in Dang Gui Si Ni Tang. Most herbalists agree that there’s simply no substitute for Xi Xin, but I’ve seen or heard of people try to replace it with Wu Tou, Yu Jin, Sheng Jiang + Mai Men Dong (?!) and other interesting combinations. Most of these same herbalists agree that it’s simply not the same without Xi Xin.
The ban on Xi Xin for practitioners is ridiculous to the extreme and I’m not going to discuss that here. What I would like to hear people discuss is how they make substitutions in these cases. When an herb you need isn’t around, what do you do? What herbs have you had to learn to live without? I understand that UK herbalists are quite restricted in what they can prescribe - how have my UK readers dealt with this problem? Even when a governmental agency isn’t busy interfering, we sometimes lose herbs. Consider Xi Jiao, rhino horn. Consider the precarious state of Ren Shen, ginseng.
There are a couple of associated questions that come up when one considers this issue. One is - should we simply learn to work with fewer, simpler herbs? Dr. Versluys is known to say that he thinks he could do a fair job of treating patients with only 10 herbs - a set of cooling herbs in each of five flavors and a corresponding set of warming herbs. If you know formula science and architecture, such artistry is certainly possible. Is this the standard towards which we should strive? It seems far superior to the never ending quest for the “perfect herb for cancer” or memorizing five hundred herbs, over half of which are specialized for particular symptoms.
Taking this a little bit farther, we should consider the wisdom of relying on herb sources that can only be accessed by air shipments from another continent. Given peak oil, given the unstable political nature of our planet, given the environmental crisis we find ourselves in… should we at least consider the possibility that we may need to rely on local sources for our herbs at some point in the future?
My friend said an interesting thing to me today. In the course of discussing this various issue he said, “To be true Classical Chinese herbalists, we should use the herbs we find around us.” I didn’t question him any farther on this issue, but I think he’s right from some perspectives. Learning the Chinese herbs and formula science so deeply that it is second nature allows us to look at all plants, animals and minerals with the eyes of a Classical Chinese herbalist. Then it seems at least possible that we could, if necessary, find other materials that meet the needs of our patients.
I’d be interested to hear your thoughts on this rambling post. Doubtless there are many opinions out there - share them here on Deepest Health by responding in the comments. No registration is necessary and you can even post anonymously if you are respectful.
Thanks for reading,
Eric
Tags: chinese-herb, chinese-herbs, environment, flavors, formulas, herbs, nature, versluysRelated posts
The Art of Palpating the Abdomen for the Purpose of Prescribing Chinese herbal formulas
This is a guest post from recent National College of Natural Medicine (NCNM) graduate, Kumiko Shirai. She is a fine herbalist already and obviously has an expertise in the (almost) lost art of abdominal diagnosis. I have seen this work in action and can attest to its amazing effectiveness! Please enjoy the article. There are more guest articles to come! -Eric
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Japanese abdominal diagnosis, known as fukushin 腹診 is an art form of medical practice that is virtually lost in modern practice of Chinese medicine. There are two major schools and types of abdominal diagnosis, Nanjing and Shanghan Lun schools, which separates into the Japanese schools of acupuncture and the schools of herbalism respectively. There are many modern books written on acupuncture style of abdominal diagnosis, which is also referred to as hara diagnosis, however books written on herbal prescription style of fukushin are difficult to find.
In the studies of Japanese style of herbal prescriptions, kampo, 漢方 which is mostly based on Han Dynasty formulas from the classical texts of the Shanghan Lun and the Jingui Yaolue, one can find many abdominal patterns and findings for almost every formula. It appears, though it is not certain, that Zhang Zhongjing used abdominal palpation as part of his diagnostic tools. And there are many Japanese scholars who have elaborated and perfected their practices of fukushin for the purpose of herbal prescriptions based on Zhang Zhongjing’s classical texts.
The concept and significance of the abdomen are different in Japan from what exists in Western cultures. It was not too long ago that Japanese people commonly said, “I am going to go see a doctor to get my abdomen examined.” In Japanese culture, the abdomen or hara is central. Alternatively, the nervous system and mind seem to be central in Western cultures. But, when we think about it, the Japanese idea makes a lot of sense. The abdomen is physically a central part of the body, containing many of the vital organs. Japanese people also believe that hara is the seat of the soul, where self-consciousness is anchored. On the other hand, from pathological sense, the abdomen is where people hold emotional stress, affecting their digestive problems as well as other physical discomforts. For this reason, in Japanese medicine, the hara becomes a pivotal part of the body during the examination, diagnosis, and treatment.
In fukushin, abdominal patterns are named after herbal formulas such as “Xiao Chaihu Tang pattern” or “sho” in Japanese, which already gives a diagnosis and a treatment plan. On the other hand, in the Nanjing school of abdominal diagnosis, abdominal patterns are named after theoretical diagnostic concepts such as “Liver qi overacting on Spleen”. The difference between Nanjing style of theoretical approach versus Shanghang Lun style of clinical approach is interesting in that it shifted the clinical practice of kampo in Japanese medical history. One of the most influential Japanese scholars, Todo Yoshimasu (1702-1773), emphasized mastering clinical skills rather than understanding theories. He claimed that “proof is always more convincing than logic,” accentuating the importance of the practice of palpation, and to treat what is obvious by carefully examining the abdomen. For this reason, Todo inspired many practitioners to practice palpation during the examination. However, Japanese scholars did not ignore fundamental theories of Chinese medicine completely, and fukushin is still very much based on theory as well.
In order to give an herbal formula based on abdominal diagnosis, one must understand the architecture of the formulas first. There are eight therapeutic methods in the study of herbal prescriptions, however, it is important to break up each method into further smaller groups, understanding the function of the pivotal herb or herbs in each formula. The key herb in a formula may not always be the emperor of the formula, though often times it is. For example, in the purging method, there can be different causes for accumulation in the middle burner hence requiring different approaches and treatment plans. While Dahuang (in Da Chengqi Tang) treats fullness caused by middle burner accumulation due to qi stagnation causing heat, Mangxiao (in Tiaowei Chengqi Tang) treats accumulation of the middle burner due to dryness of the intestines, and Taoren and Mudanpi (in Dahuang Mudanpi Tang) treat fullness by breaking up blood stasis, hence moving both qi and blood. As a consequence, these three formulas, which share a common category of method, will have different abdominal patterns and imply different treatment plans.
In closing, I want to emphasize that examining a person’s center is not only theoretically appropriate but also clinically helpful in the process of assessment, diagnosis and finally planning a treatment. Hence, Chinese medicine practitioners, are encouraged to cherish the art form of practicing this medicine by observing and touching each patient and interpreting such information as holographic representation of the body.
Tags: abdominal diagnosis, asian medicine, clinic, Diagnosis, formulas, japanese medicine, patterns, schools, shang-han-lun, study, TheoryRelated posts
Chinese medicine and cancer : Introduction
One of the things I would like to do as a physician is help people who have various types of cancer. I realize that even this statement will be regarded by some as problematic. Some say that Chinese medicine doesn’t recognize “cancer” as such and that Chinese medicine physicians shouldn’t “specialize” in treating any particular condition. I recognize the points in that argument. However, my partner and I feel a great affinity towards people who have had their lives touched by what Western medicine calls “cancer” in all its variations. It is an affliction that creates great hardship in the lives of many, regardless of what we call it.
I will write a series of posts detailing what I learn as I investigate the range of syndromes that we commonly call cancer. I will be looking at it from different angles. I am fortunate in that I have a variety of approaches to directly observe. Apart from what I will be able to observe in clinic and learn directly from professors, I will be doing literature searches and conversing with my many colleagues flung across the world via the Internet. I hope this series will be helpful for many types of people including my peers and other people who are seeking information about herbs, acupuncture and cancer. I am particularly interested in starting conversation around this issue, so I will try to end every post with a question - please leave your answers (however tentative) in the comments.
What is cancer? Basic Western and Chinese perspectives
From a Western perspective, the most basic way to describe cancer is simply as a disease process in which body cells begin to grow out of control. In general, this happens because of DNA in a cell that becomes damaged and is either (a) repaired, or (b) mitigated by controlled death of the damaged cell. This can happen for many reasons. Further, cancers in various parts of the body grow at different rates, in response to different environmental triggers. This, of course, results in the variable survival rates, symptoms and other features of different cancers. You can have cancer in virtually every part of the body. Causes range from inherited damage to DNA to inhaled toxins to accumulation of toxic by-products in the body and countless other factors. Western medicine has begun to understand cancer fairly well, but the fact is that there is still a ton of work to do. There are a huge number of foundations and government agencies working on finding “cures” for various types of cancer. If you want to learn more about Western perspectives on cancer, or to find resources in that realm - a great starting point is the American Cancer Society. You might also want to check out the National Cancer Institute.
In Chinese medicine, cancer is most often described as either a phlegm or a blood stasis accumulation (or both). Ultimately, cancer is not talked about as such - instead there is a description of masses or tumors. In this way, treatment generally progresses in a manner very similar to other masses and tumors. It is interesting that early on in Chinese medical history, a fairly nuanced way of classifying tumors emerged, based on the color, size, location, painfulness and other features of the mass and its local effects.
As with any other disease, we should start with the basics when we are looking at cancer. Using the essential Ba Gan (Eight Pillar) differentiation can help us get a handle on the disease process we are confronting. Is the imbalance of a Yin or Yang nature? Is it primarily hot or cold? Does it seem to be external (as in a cold) or internal? Is it deficiency or excess? While I’ve heard many simplistic answers to these questions when discussing cancer, I think the truth is probably more complicated. While masses are undeniably Yin in nature, a festering tumor or one in metastasis clearly has Yang qualities. While many cancers have the cold and cooling quality we would expect from a Yin-like disease, others burn brightly and cause great heat both superficially and internally. Regarding the internal or external nature, I think it goes without saying that all cancers are internal - regardless of whether we want to think of them of having been ultimately caused by a penetrating external pathogen. Cancers, too, may have deficient and excess qualities. I’ve obviously answered no questions here, but I’m starting to clarify for myself the deep complexity in a disease with such far reaching effects.
What are the standard approaches to treatment of cancer? Western and Chinese perspectives
Many of us know that the standard treatment options for cancer in the Western medical model are surgery, chemotherapy and radiation. Some folks choose all three of these options, some only one or two. Some people have reported that Western medical doctors (especially at forward-thinking cancer specific research centers) are doing more recommendation of dietary and lifestyle adjustment as a way to manage both the disease and the side effects of the strong Western treatments. This points out the deepest problem with Western medical treatment of cancer - the side effects. Surgery itself has its own recovery process which can be quite difficult for some - particularly those who are quite weak, elderly, or fighting some other disharmony in their body. Radiation and chemotherapy both use agents that are quite toxic for the body. The side effects are many, including the very visible loss of body hair, thinning of the skin surface and often debilitating loss of appetite, nausea and fatigue. Some people consider these to be necessary evils, since these treatments can be quite effective in eradicating some cancers. Still, many people yearn for alternatives - regardless of whether their particular cancer is effectively treated by these methods. Avoiding side effects, improving quality of life and increasing the effectiveness of Western treatments top the list of desired outcomes when people seek Chinese medicine and other natural therapies when treating their cancer.
Chinese medicine uses the basic set of powerful and versatile tools to treat all disease. A full treatment protocol from a Chinese medicine physician will include a Chinese herbal formula, an acupuncture prescription (perhaps involving cupping, needling, moxibustion or a combination of these and other manual therapies) and may also include lifestyle counseling, dietary advice and prescribed Qigong or Taiji movements appropriate for the presenting condition. For phlegm and blood stasis accumulations, the standard treatments will involve both resolving/dissolving the masses directly, promoting general movement throughout the Qi and Blood flow of the body and supplementing any deficiencies that might be accompanying the condition. The dietary advice will be specific for the person, but will probably advise against refined foods, fatty foods and very cold foods - as is the case for most serious conditions. Obviously, a variety of approaches exist - which is what I hope to investigate and communicate as this series progresses.
The many dimensions of the human being and their relationship to cancer
Yesterday, a patient remarked to me how disregarded she felt in the conventional Western medical world as she struggled with serious illness. She felt as though the patient had no interest in her as a person and saw her primarily as a carrier of some “target” to be measured and attacked by the physician. This most certainly impacted her healing process. She remarked how different naturopathic and Chinese medicine practitioners feel to her - she believes they/we see her as a complete person. Most of all, she feels like we treat her as a person at all. With a disease like cancer that is still one of the top 3 causes of death in most industrialized nations, I feel that it is easy for physicians to become detached. This may be a form of self-preservation. To become deeply connected with a patient and then have them die is certainly a difficult occurence. However, I believe as a physician of any modality you have a responsibility to learn how to take care of yourself in such a way that you are able to handle the diverse pressures involved.
Like any disharmony, cancer impacts people on as many levels as they have. Cancer certainly has profound physical effects, any Western treatments they are using have their own physical impacts as well. Cancer also impacts people emotionally. This is true of course in the sense that people are having to reckon with their mortality and the range of issues that comes along with that reckoning. But, from a Chinese perspective, the blockages that come about because of the actual existence of the mass and its Qi and Blood disturbing effects will almost surely be detrimental to the emotional balance of the human being. There are also social and spiritual effects on the person. All of these need to be addressed by the physician and patient in concert if true healing is to take place.
Hope, quality of life and survival
A frequently terminal disease like cancer brings up so many questions, it boggles the mind. There’s nothing simple about it. For instance, should survival be pushed for at any cost? That certainly seems to be the mindset of many people in the medical profession and beyond. What about quality of life? What is included in quality of life? If a person cannot feed themselves or use the bathroom by themselves, but can still engage in lively conversation and interact with loved ones - do they have a decent quality of life? While our focus must always be on promoting balance and well-being regardless of a patient’s disease state, we need to be thinking about these questions if only for ourselves. How do we provide a sense of hope and groundedness when the prognosis seems dire? On a more base level, what responsibilities do we have legally and socially when it comes to treating or not treating patients based on the severity of their condition? These are all questions we should be ruminating and discussing with eachother as a community. I’m sure you have ideas of your own, or perhaps have more questions.
A question for the readers: In your work with people who have cancer (or, if you are not a practitioner, in your personal experience with people with cancer) what are the most important things to keep in mind as you interact with the person? How can you create a healing atmosphere for people who are facing a disease that is often (often erroneously) considered to be a death sentence? Go ahead and share your thoughts in the comments. Don’t worry - thinking out loud isn’t penalized here. :)
Thanks for reading.
Eric
Tags: Cancer, compassion, cure, death, disease, patient care, quality of life, western-scienceRelated posts
Eric Grey intern shifts at Pettygrove Classical Chinese Medicine clinic
Just a quick plug before I leave for a leadership retreat. Starting July 3, I will be providing acupuncture and Chinese herbal medicine services at Pettygrove clinic in Portland, OR. The address is 2232 NW Pettygrove., Portland, OR 97210. We provide top rate care, including the services of the city’s best Chinese herbal pharmacy. You can call 503-552-1552 to set an appointment and to find out more about prices. If you need to reach me personally, you can call the same number and ask for extension 5639.
My shifts are as follows:
Under supervising physician Dr. Qin (renown acupuncture specialist) during the first part of the summer on Monday from 12-4. That shift will be supervised by Dr. Arnaud Versluys, internationally known Shang Han Lun style herbalist, during the latter part of the summer at the same time. Under supervising physician Dr. Kou on the cancer-care specialty shift I will be working Monday from 4-8pm. Finally, on Thursdays from 12-4pm I will be honored to work with David Berkshire, a five element acupuncture specialist. I would be happy to see you on any of these shifts. Please contact me by phone or email if you have any questions.
Last but not least, I will be posting Twitter updates to the blog over the weekend - you can read those in the sidebar of the blog in the column closest to the content. Check out the link if you want to learn more about Twitter.
Eric
Tags: classical-chinese-medicine, clinic, eric grey, pettygrove, Portland
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