How to be sure you’re getting safe Chinese herbs
I’ve read numerous articles recently about the alleged dangers of Chinese herbs. One such article, not focused specifically on Chinese herbalism, can be read here. You know, I get a surge of irritation every time I read one of these articles which quickly dies down to be replaced by an interest in discussing the topic. I want to answer a few of the common questions about Chinese herbs as best as I can - with an eye towards helping people to be sure they’re not hurting themselves more than they are helping themselves by seeing a Chinese herbalist.
1. Be sure your Chinese physician is well trained
I’ve talked in prior articles about finding competent Chinese medicine physicians and/or acupuncturists. In short, find out where your doctor was educated and do the best you can to investigate their training. In general, accredited schools in the US require a basic knowledge of Western physiology, pathology and phytochemistry. We are trained to recognize the basic signs of Western diseases, how to take blood pressure, do CPR and make referrals to Western physicians should we find it to be necessary. In China, doctors receive even more extensive Western training because of the obsession of the TCM sector with thoroughly Westernizing Chinese medicine.
What is FAR more important is that your physician has received top notch supervised training in Chinese herbalism. Let’s be frank. Chinese herbalism has been practiced for THOUSANDS OF YEARS with much documentation of its toxicology (as such), efficacy and implementation. Assuming that people are using the whole plant, assuming they are following the principles of herb combination, assuming you are informing them of Western medications you are taking — Chinese herbalism is absolutely safe.
Please - allow me to repeat myself - when the physician is trained appropriately, Chinese herbalism is absolutely positively without any doubt in the universe SAFE SAFE SAFE SAFE. Ok?
2. Be sure your physician sources pesticide and heavy-metal free herbs, preferably organic
Now, the concerns about the state of Chinese herbs themselves are well founded. China is undergoing an industrial revolution, in case you haven’t heard, and there have been documented cases of Chinese herbs being contaminated with heavy metals, pesticides, herbicides and even Western pharmaceutical drugs. Your should feel free to ask your doctor what distributor he goes through to get his herbs and check up on that distributor. There are many excellent companies that subject their herbs to testing more rigorous than the FDA requires: Spring Wind Herbs and Evergreen herbs both come to mind as reputable companies with great quality materials. Be willing to pay premium prices for the peace of mind that comes from knowing that your herbs come from people who care about people and the land.
3. Follow all of the instructions your herbalist gives to you
Particularly when you are asked to take an herbal formula home to boil yourself, you need to be absolutely clear what you must do to prepare the herbs safely. Some toxic herbs are used and, when boiled and combined with other herbs, their toxic effects are eliminated. Other herbs will lose their effectiveness if cooked improperly. So, if your doctor doesn’t provide you with explicit instructions, ask her for some. These instructions should include not only information about how to prepare the herbs, but also when to consume them, how often, and when to stop taking them. Be sure you understand and don’t worry about feeling “stupid.” We’re not born knowing how to prepare Chinese herbal medicine. :)
You must also listen to your Chinese medicine doctor when they tell you to avoid certain foods and substances while you are taking your formula. Finally, be absolutely sure you have disclosed all Western pharmaceuticals you are taking to your doctor. There are precious few cases of negative interaction among pharmaceuticals and Chinese herbs, but there are a few and your doctor can’t protect you if you don’t give her the information she needs.
4. Be sure to go to follow up appointments
If your doctor doesn’t ask you to come back (bad business sense!) be sure to ask if you need to have a follow up visit. You shouldn’t keep taking a formula for a long period of time without returning to the physician to be re-evaluated. Chinese herbal formulas are highly individualized and conform to your body’s state as it is presenting. As time goes on and your body changes, your prescription will too. Sometimes your acupuncturist may have you on a prescription for a long period of time to treat a constitutional weakness, support your body in a healing process or to ward off flare ups of a particular pathology. Just be sure you know how long you should go between appointments and under what conditions you should stop taking the prescription.
5. With the exception of teas, avoid taking Chinese herbal supplements without a Chinese medicine doctor’s approval
This isn’t going to make me super popular with people who might otherwise advertise on my site. But, personally, I think it’s a mockery of Chinese medicine that people are able to buy full strength herbal formulas in pill or tablet form without a prescription. Some formulas might be alright, because their action is weak enough that any negative effect is minimized. But, then, why take them? They aren’t enjoyable like tea is and they are frequently expensive! Chinese medicine is medicine, not supplementation. You shouldn’t be taking a formula or single herb that a doctor hasn’t asked you to take and you shouldn’t take it for any longer than they recommend.
I think it’s okay to drink teas made of Chinese herbs so long as you don’t go to special lengths to concentrate them. I’ve already talked about how much I love Gou Qi Zi + Ju Hua tea and the only effects I’ve observed from this practice has been positive. I also enjoy ginger, mint and other single herb teas - sometimes in response to particular pathological states and sometimes not. I feel that these low strength efforts fortify me as well as tasting good and providing me with something to warm my belly on cold nights.
6. Be sure to tell your Chinese medicine doctor your experiences while on an herbal formula
Some people are embarassed to tell their doctor that their herbs gave them diarrhea or some other symptom. This effect is not going to make your doctor think they are incompetent or make them think badly of you. Sometimes the formula isn’t quite perfect and needs to be shifted in one direction or another. In fact, your report back to your herbalist will help them to further understand your pathological state! You can feel free to call your doctor if you have a particularly strong reaction - they will be more than happy to help you understand if this is expected or unusual. Don’t stop taking the herbs simply because you have a mildly negative reaction - call your doctor to let her know and follow her advice explicitly.
If you follow these simple rules you will be safe - and that’s that.
Eric
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Tags: chinese-herb, chinese-herbs, chinese-medicine, professional-development, safetyRelated posts
Chinese herb of the week: The qualities and uses of Ma Huang
I hope you’ll excuse me for getting this out a little later than I had hoped - the weekend was jam packed!
Ma Huang - Ephedra - 麻黄
Ma Huang is one of the most famous herbs in the Chinese Materia Medica - and with good reason. In a world where medicine is mostly unable to deal with the most common illnesses that people encounter, colds and flus, an herb that can handily address these symptoms has a right to be respected. Unfortunately, some of the popularity of this herb exists for more nefarious reasons. Ephedra has been implicated in a number of exertion related deaths, particularly in young football players and people seeking to lose weight.
Unfortunately, many people are unable or unwilling to learn the whole story. These deaths did not come from the controlled use of appropriate doses of the whole herb under the supervision of an appropriately trained Chinese medicine physician. In many cases, the herb is broken down to isolate the desired alkaloids (for example, L-ephedrine) and often mixed with other stimulating compounds to increase the metabolism of the imbiber. It is not used using the principles of formula science - and thus is dangerous. When Ma Huang is used in its natural or minimally prepared form, prescribed by a physician within a carefully constructed formula appropriate to the patient’s condition and constitution - it is absolutely safe and, even, quite beneficial.
Read more
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Increasing safety of Chinese medicine without killing its soul
Every morning I read through the Chinese medicine news available on the Internet. It always makes me happy to be blogging about what I blog about. Today I ran across this article for a second time discussing the continuing efforts of Chinese researchers to modernize TCM.
The main point in the article, along with most articles like it, is that TCM must modernize in order to be viable in the 21st century. Surely not the first time in Chinese medicine’s history that this argument has been made. Modernization is supposed to progress on two fronts. First, modernization means safety through tighter regulation of herbal products and tougher licensing standards for practitioners. Second, modernization means adopting rigorous materialist worldview based testing of treatments with the eventual goal of reshaping the medicine as a whole to come into line with that materialist worldview.
Regarding modernizing for safety: I can respect this, as I’ve discussed already. If this means that practitioners and patients will be less likely to get herbs tainted with pesticides, herbicides and heavy metals - I’m all for it. Of course, companies have already risen up to take care of this problem and they are growing in popularity every day. Scrupulous practitioners will seek out clean sources for their herbs. This may be a case where the market is going to be a better regulator than any governmental body could be.
With regards to licensing standards - they should definitely exist. Everyone seeking to practice as a Chinese medicine physician should be expected to have a certain amount of theoretical and clinical education as well as basic training in rescue medicine and doctor-patient relationships. That being said, the exact composition of that educational mix should be left to a governing body composed of experienced Chinese medicine docs! The method currently used in Oregon and many other US states seems to work fine - in our program at NCNM we learn basic Western medicine principles so we can effectively communicate with other physicians, we learn rescue medicine, we learn doctor-patient relationship, we learn TCM and then we learn the real medicine - Classical Chinese Medicine. Our program is fully accredited and we will be eligible for licensure upon graduation. It seems to work out ok.
The latter part of modernization is what I’m not so sure about. Chinese medicine is not based on a materialist worldview. It is not based on either/or logic, for the most part. Chinese medicine seeks to honor the complexity of the human being, the humans’ environment, the herbs. Rather, Chinese medicine RECOGNIZES the complexity of the human being, environment and herbs and does not shy away from it. It’s true that a treatment that works in one individual will not necessarily work the same way in another, and for Western medicine this is a serious problem. One major goal in that system is replicability. It seems for that system if you’re not capable of exactly replicating something, you must be misunderstanding something. For instance, the effect could be due to “placebo effect” or you could just be failing to understand some component of the system and thus not setting up the experiment properly. Thus, by this theory, if you do more research you will understand it better and, thus, be able to replicate the effect you are seeking.
This philosophy has become so ubiquitous that most people don’t even seek to challenge it in any substantive way.
But this way of seeing things is not the basis for Chinese medicine. It doesn’t mean that the ancient Chinese thought that things could never be replicated. The four gates treatment of acupuncture, for instance, has a similar and powerful effect on nearly everyone it is used on. Ma Huang will make almost everyone sweat when in the right formula at the right time. A red tongue almost always indicates heat in the body. These principles are just as fixed, just as replicable as any in Western medicine. But that’s not the basis of the medicine. The basis of the medicine is interaction, is interplay, is changeability, is a great balancing act. That’s why it needs skilled, deeply educated practitioners that aren’t busy trying to isolate compounds from Yang tonifying herbs to act as a competitor for Viagra. It needs practitioners who spend their time reading the classics, refining their diagnostic and treatment techniques, dwelling on the qualities of nature and working on their own self-cultivation.
Changing the way herbs are processed, making sure that doctors are trained, holding ourselves to high standards of cleanliness and propriety - all of these things are boons of modernization and I welcome them with open arms. But we simply must not allow the incessant drumbeat of scientific materialism to tell us how our medicine must dance. We can exist side by side, treating what we treat best. A world in which Classical Chinese Medicine and Western medicine both seek to serve patients and not ideological or political masters would be a beautiful world indeed.
Eric Grey
Tags: Acupuncture, Blogging, chinese-medicine, licensing, medical-safety, safety, traditional-chinese-medicineRelated posts
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