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
Book review: Clinical Handbook of Internal Medicine (Vol 1)
I have been using the first two volumes of Maclean’s Clinical Handbook of Internal Medicine for a couple of years, now. I find them to be the most useful basic TCM pathology texts available and want to share, briefly, my reasons.
General Information
This text is part of a series that, apparently, will include more volumes in the future. The first volume, pictured at left, covers the Lung, Kidney, Liver and Heart organ systems. The second volume, with blue lettering but a similar cover, looks solely at the Spleen and Stomach. I’ll focus on the first volume for this review, but the majority of what I say applies to both of them.
The authors, in their introduction, explain that their aim was to develop a workable clinical manual of Traditional Chinese Medicine (TCM) that “at least [begins] to take our cultural and social differences into account.” They seem to feel that because Chinese medicine was created and developed in a particular social and geographic location, it will be significantly different when practiced in other locations with differing social and natural environments. The book, then, is a clinical manual intended to make the basic information of TCM more accessible and relevant to Western readers.
The book is created primarily with herbalists in mind, thus the formula suggestions are extensive while the acupuncture suggestions are more sparse. The book is organized by organ system and then by basic TCM symptom picture - for instance the Lung section starts with external diseases (cold and warm) then moves into coughing, wheezing, etc… The Chinese names for the symptom pictures are provided, along with characters. This is helpful since people learn them using different English translations depending on where they study and I found it much easier to simply work with the Chinese. They provide Chinese for herbs, formulas, patents and acupuncture points - though the points have only pinyin, no characters. The general organization of the book is intuitive and the overall quality of the text is reasonable for the price.
Looking Deeper
Let’s investigate a single section. Consider Gan Mao - the “common cold” or external invasion. The book begins with a concise and readable description of the disease in general, providing some historical background and discussion of the severity of the illnesses in question. This moves on to a page on etiology and a fine mindmap of the most common causes. Following this is the section on specific causative factors and their treatment. Fortunately, they begin the discussion in this chapter with Wind Cold. Shang Han Lun fans will be snickering, now. ;) But, not for long - as the first prescription suggested is Jing Fang Bai Du San. Thus begins my basic problem with the text - which is predictable given my trepidation about non-classical formulas.
That being said, the layout of the various treatment options (with confounding symptoms, etc) is clear and descriptive enough without being confusing. Several formula suggestions are followed by standard acupuncture protocols (LI4, GB20, BL12, BL13, GV14) and modifications based on presenting symptoms. The section is completed by other advise to the physician such as, “Acupuncture treatment can be applied 2-3 times in severe cases,” and a list of biomedical (Western) conditions that might fit this picture. In general, all of the sections flow in this way. Some have more extensive descriptions or finer distinctions between symptom patterns, but the basic flow is similar.
My assessment
Positive: I have looked at quite a few books trying to find one that would helpfully and concisely explain syndrome differentiation from a TCM perspective - in good English. I found it in these texts. It could be helpful as a clinical manual, I suppose, but I found it more helpful in my TCM studies as a way to understand the way that your average TCM doctor treats any particular condition. Its breadth, completeness and pleasing layout, as well as inclusion of Chinese characters and pinyin puts it heads above anything else I’ve found. It’s also fantastic as a way to quickly see the basic TCM treatment protocol for a given disease with points AND formulas included.
Negative: The authors seem allergic to Classical formulas. Gui Zhi Tang and Ma Huang Tang are not even mentioned in the Wind-cold section. Um…? I suppose this has to do with the oft repeated refrain that “Westerners are too deficient for such strong formulas.” I must be a strange Westerner, indeed. My daughter, too. Oh, and the rest of my family. Oh, and a big chunk of the patients I’ve seen treated in clinic. Ok, ok - sorry. My point is this - I think it’s a dramatic oversight to leave out Classical formulas. I understand if you want to include others, perhaps put a caveat on the “too strong” formulas - but… honestly?
There are some holes in the texts - I understand future volumes may address this. For instance - no women’s diseases as far as I can see. Also, the organization according to “diseases” (gan mao, yi jing, etc…) sometimes made it difficult to find a formula or point protocol for some simple set of symptoms that doesn’t necessarily fit into one of those categories. That’s not so much a problem of the book, but a problem of that system of categorization. All things being equal, I think this is a relatively minor problem.
Should you buy it?
If you’re interested in having a basic, clear manual for understanding TCM syndrome differentiation and the way that a large majority of TCM physicians treat patients - these books are indispensible. I sold all of my other TCM texts - all my Maciocia included. There is enough theory in here to do the job, and in combination with all the treatment advice it’s just a fantastic resource.
Click here to buy the Clinical Handbook of Internal Medicine Volume 1 from Amazon.com
Thanks for reading,
Eric
Tags: book-review, books, ccm, external invasion, formulas, internal medicine, tcmRelated posts
5 Chinese Medicine texts you shouldn’t live without [Video]
I’ve been figuring out how to take Deepest Health to the next level. It seems important to start diversifying media. Text is great, but the power of the Internet doesn’t stop there. I’m going to begin experimenting with audio and video content to see how best to integrate them into Deepest Health. I’m planning a Podcast series, tentatively on Fridays, that will probably be me rambling about some of what I learned in the given week. I will also be adding interviews with professionals and students when I am able to get them. I will also do Video when possible, particularly when that medium will add something special to the given content.
In the video below, I’m mostly just getting used to the medium. I tried to provide some value for you folks, though, by talking about the five books that are practically glued to me right now. :) You’ll notice product links in the video, I hope they’re not too annoying. I’m also unsure whether RSS/Email subscription readers will be able to see the video - you may have to come to the site to see it. I encourage you to do so! Please give me feedback about this new format. Don’t worry, text will continue. Depending on the situation, I may offer transcripts to folks who request them because they aren’t capable of using the audio or video content. Contact me for more details.
Note: Brief reviews of the following texts are included in this video:
2. Arnaud Versluys’ and Heiner Fruehauf’s formulas text
(Link for the above text points to the NCNM bookstore - you may have to contact them by phone or email to order the book.)
3. Bensky’s Formulas and Strategies
4. Mitchell/Wiseman’s Shang Han Lun translation
5. Deadman’s Manual of Acupuncture
(Links for the last three texts are within the video itself.)
Enjoy!
Tags: Acupuncture, Blogging, book-review, books, chinese-herbs, formulas, video
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