Salt-sensitive hypertension and Classical Chinese Medicine, Part 1
Editor intro
This is a Guest Post by 3rd year Classical Chinese Medicine student (and Chinese medicine blogger) Brandon Brown. Brandon is a friend of mine and an excellent student. He approached me with this paper and I immediately knew it would be a fantastic contribution to the site as many folks have asked me for rigorous examinations of the cross-pollination between Western and Chinese science as expressed in medicine. This will be a 3 part series released over the next 3 days, please feel free to leave comments - Brandon is a regular reader of the site. I should note that he has posted references for the entire series on his blog, you can access those references by clicking on this link. -Eric
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Author intro
The following three posts are from a paper I wrote in the Winter of 2008 for Dr. Edward Neal’s Clinical Physical Diagnosis course at NCNM. It is my attempt to apply classical Chinese medical knowledge to a modern disease processes that is pervasive, salt-sensitive hypertension. In looking at all modern diseases, I believe it is extremely beneficial as CCM practitioners to understand the patho-mechanism as presented to us by current research in Western materialism. Because yang (energy) leads and yin (substance) follows, by knowing the yin we can garner important clues that can allow our yang treatments to strike with more clarity, force, and efficacy. I welcome your thoughts and comments. - Brandon
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Salt-sensitive hypertension : Western science and the macrocosmic view
“The highest good is like water, it settles in the lowest place where people do not like to be.”
Dao De Jing
It is estimated that salt-sensitive hypertension (SSH) accounts for over two-thirds of people over 60 who have primary hypertension . Though there are genetic variants to the tolerance of the amount of salt that effects hypertension, dietary sodium is considered the most important environmental influence. This begs the question: why are some people who are hypertensive experience a salt sensitivity and others do not? The answer to this question may lie in the theories of Chinese Medicine and in the fundamental nature of salt, and its relationship to water and the Kidney. I will first give a summary of hypertension in western terms and discuss current research theories. Following this, I will discuss salt: cultural symbology, the natural formation, and specific references in the medical classics. By so doing, I hope to show how an ancient medicine sheds important light on this modern disease, through the connection of the Kidney and the Heart.
Hypertension - a more Western perspective
Primary hypertension is defined as chronically elevated blood pressure where systolic arterial blood pressure consistently exceeds 140 mmHg or greater. To be considered primary, the hypertension must be idiopathic, and not due to secondary factors such as kidney disease or adrenal tumors, for example. Primary hypertension is considered to be a major risk factor for strokes and cardiovascular disease, and is a leading cause of chronic renal failure . Heart disease is the number one killer in the United States, leading to well over half a million deaths per year.
It was observed in a strict rice and low-sodium diet study performed in 1944 that patients with kidney disease and hypertension were able to lower their blood pressure by as many as 100 mmHg in some cases . Current theories of the pathological mechanism of SSH posit abnormalities in renal sodium transport in the nephron structure of the kidneys . The cause for these kidney abnormalities are thought to be caused by both genetic and environmental factors. Because salt generally attracts water through osmosis, increased blood sodium not excreted by the filtering mechanisms in the kidney causes an increase in the water content of the blood, thereby causing the vessels to swell. This increased swelling, is an increase of “total peripheral resistance of the vasculature”, and is thought to create a long-term load on cardiac output ultimately leading to heart failure. Therefore, we can say that the presence of salt in the blood pushes out from the inside. This is contrary to the renin-angiotensin mechanism of the Kidney, which vasoconstrics and thus pushes in from the outside.
Salt in the Macrocosm
“Ye are the salt of the earth; the best of the human race.”
Jesus Christ in Matthew 5:13
The creation story of salt begins with fresh water falling from the sky as rain, and landing on the elevated earth. The nature of water is to always seek the lowest point of any terrain. The rain water falls on the hills at first as drops, which coalesce to form a trickle, which then join to form streams and these eventually join to form massive rivers, which empty into the sea. On this journey, constant erosion takes place as minerals are stripped from the earth and mountains and carried to the ocean. Because of its polar nature, water acts as a solvent to all matter. Place any material in water, and given enough time, transformation will occur. Metal will rust, vegetation will decay, and other liquids will eventually diffuse and become one with the water. The mineral rich streams, which still taste like fresh water to us, empty into the vast oceans that today are heavily salted and totally unpalatable, even though they are only 3.5% salt . The oceans continue to accumulate more and more salts because over millions of years evaporation extracts the water from the ocean, but not the minerals. The minerals are too heavy and earthbound to be steamed up to the heavens. This process is depicted in Figure 1.
Figure 1: The generation of saltwater
Of special interest in Figure 1 is how it reflects the generating cycle of the 5 Phases (五行). That is, Water falls from Heaven onto Earth and Metal, flowing down to Water, where through the energy of Fire, the fresh water is evaporated upwards toward heaven by the process of Wood. What is left behind is a storehouse of salt. Because of this, we would expect to find that places of warmer climate would have oceans with higher salt content. This is in fact the case, as places such as the Mediterranean Sea have a much higher salinity than that of cold water oceans (the Arctic and Northern Pacific, for example).
Salt is very much a dissolved solid from the Metal sphere. It is highly organized and crystalline, and looks almost identical to ice (Figure 2). Salt was the first currency of the civilized world, due to its value as a preserver of meat. As Richard Manning writes in Against the Grain, it was the ability to preserve and store meat which essentially lead to the creation of wealth and signaled the shift from nomadic hunter-gatherer societies to those of sedentary agrarian caste systems. Earlier than 800 A.D., the Yellow Emperor himself is said to have fought the very first war over the precious commodity . In 450 B.C., iron was put to use to boil sea water in huge pots to extract salt, a method that was used for the next 2000 years. By expediting the evaporative process, larger amounts of salt could be garnered more quickly and thus a greater amount of wealth could be amassed. Even in these ancient times salt stored, or preserved, wealth. To this day, the word “salary” comes from the Latin “salarium”, or “to be payed with salt.”
Not surprisingly, then, salt as a symbol of wealth came to symbolize all that is good. It is common practice to throw salt over the shoulder to ward off the devil, sumo wrestlers throw salt in the wrestling ring to purify it before a match, and placing piles of salt in tombs purifies the soul’s journey from earth to heaven, for example. Throughout history and across the world, in almost every culture, salt has been used in religious, medical, and cultural contexts to purify and clean the soul and the body from evil and disease . Ultimately, however, it is argued that salt is a often a cultural metaphor for semen, and the essence of man.
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In the next article in this three part series, Brandon will dive into the microcosm - discussing the mechanisms above as they reflect into the human body. Look for it coming soon.
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Tags: disease, environment, heart, kidney, macrocosm, metal, nature, salt, Science, water, western research, western-scienceRelated 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
On entering into a philosophical morass: Chinese medicine and Western science
Let’s get something straight. I’m very confused about the role of Western scientific research as it is currently practiced in verifying the claims of practitioners of Chinese medicine. Various studies, including the famous “sham acupuncture” study seem to challenge the premise that the theoretical bases of Chinese medicine are an accurate description of reality and our interactions with it. For instance, concerning the study referenced above, if any old needle through the skin will cure migraines - what of channel theory? What of our highly developed ideas about acupuncture techniques? Similar doubt is cast on Chinese herbalism by placebo controlled double blind studies showing no significant improvement in patient outcomes with the administration of various herbal extracts or even, in some cases, whole herbal formulas. What gives? Why spend all this money to learn a highly nuanced medical system if that system can’t stand on its own two feet? (Yes, I know, there are plenty of studies that verify CM’s efficacy, but that’s beside my specific point here).
I’ve talked in various articles on this site about my basic opinion about the relationship between Western science and Chinese medicine. At my school, NCNM, we talk about these things quite a bit in classes, in the hallways, in subversive meetings around Portland, Oregon. But, to be totally frank, the conversations don’t often delve deeply. This isn’t because we don’t want to go beyond the surface. Sometimes it feels like these concepts are coated with Teflon - the mind so readily slips off. It’s such work just to get through the program, I think most of us just don’t have the mental energy to work through this kind of analysis. Further, most of us weren’t attracted to the medicine because of analytical research indicating that it is effective. To some extent, it’s a gut level reaction. Or you could say that it’s a spiritual attraction - whatever you like.
I find, though, with my dual background in Western philosophy and Western science, I simply can’t let the matter lie. Believe me, I’d rather it be any other way. So, I’m going to attempt to unpack this issue - it’s going to take some time. It’s going to take a lot of reading and a lot of thinking and I’m not even sure what kind of result I can expect. I want to make it abundantly clear that I fully believe that Classical Chinese Medicine *does* stand on its own two feet, that it is deeply rooted in a science that needs no independent verification. I simply want to understand, for myself, what that means. In a sense, for me, this (long) journey will be an intellectual exercise. Perhaps an important one. We’ll see.
In a preliminary way, I can imagine that my exploration is going to have to go over some of the following terrain:
1. What is the nature of Western science as it is currently practiced? Essentially, what assumptions does Western science take for granted and how are they being challenged? My sense is that I’ll have to look pretty deep into the gaping maw of materialism in this part of my journey.
2. How do modern research standards grow out of the above assumptions? How are they independent from them? How have modern research standards evolved and how are they currently evolving?
3. How can the ideas of a non-material essence to the human being come back into acceptance by science? Is that desirable or necessary? What would that mean and what are the philosophical and practical implications?
4. Is there merit to the assertion that the scientific system that grows out of one world view cannot be adequately assessed or criticized by the scientific system that grows out of another? If so - what does this mean for an increasingly globalized world where many different worldviews are forced to interact?
5. What produces the most favorable patient outcomes and how would we measure those outcomes?
I’m going to have to look into a lot of disciplines in which I don’t have much expertise. That’s okay with me. I’ve come to accept that in any endeavor, there’s probably someone who knows more than me. That’s the benefit of this kind of public dialogue - lots of folks can contribute.
I’m interested to hear your thoughts in the comments.
Eric
Tags: Acupuncture, chinese-herb, classical-chinese-medicine, integrative-medicine, philosophy, philosophy of science, Theory, western research, western-scienceRelated posts
Multi-disciplinary herbal study - Huang Qi
Last term at NCNM, the Classical Chinese Medicine students in my class took a course with Paul Kalnins, an anthroposophical researcher and natural medicine superstar, about the pharmacology of natural substances. We were asked to write a paper about a particular herb, bringing together Chinese and Western information about it. I asked my class if anyone would be interested in bringing their paper public, and one brave soul took me up on my offer - Danit Polunsky. Below find the results of her research - lightly modified from the original. It’s been a while since I’ve talked about a single herb, so I thought this would be welcomed. I’ll put my paper up next - on Wu Zhu Yu.
Huang Qi: Astragalus Propinquus - aka: Astragalus membranaceu
Kingdom: Plantae
Division: Magnoliophyta
Class: Magnoliopsida
Order: Fabales
Family: Fabaceae
Subfamily: Faboideae
Genus: Astragalus
Species: A propinquus
Botany:
Huang qi prefers sandy to loamy soil, which is well drained, or even dry. Huang qi likes soil that is neutral & alkaline, in a sunny location; it will not grow in the shade. Huang qi, Astragalus membranaceus, is an herbaceous perennial with a deep straight tapering taproot.
Each flower has five petals; the banner is large and envelopes the rest of the petals in a bud, often relaxing when the flower blooms. The two adjacent petals are the wings, surrounding the two bottom petals with claws one and a half times the length of the limb. The two bottom petals are fused together at the apex, remaining free at the base and forming a boat-like keel. Together the petals are whorled into a bell shape (calyx campanulate), 8 to 9 mm long, forming a tube 3 times longer than the linear subulate lobes. Each flower is hermaphroditic with 10 stamen, 9 fused and 1 free. They are pollinated by bees, moths and butterflies. Huang qi’s flowers turn into legumes that are 10 to 13 mm long, papery and glabrous. The seeds are dark brown, kidney shaped, and 7 to 8 mm long.
The taproot grows 30 to 100 cm long and 0.5 to 2 (rarely 2.5 ) cm in diameter. It is twisted near the crown, wider at the top, and generally stripped of secondary rootlets. The outer surface is light grayish-yellow to yellowish-beige with longitudinal wrinkles irregularly dispersed throughout horizontal lenticel-like patterns. A cross section of the top portion of root reveals 2 to 3 mm thick light yellowish-white outer cortex surrounding light yellow xylem that look like cracks in larger roots. The root has an overall fibrous texture, making it difficult to break, a slightly starchy aroma, and a starchy, mildly sweet slightly acrid, bean-like taste. Many of the Fabaceae host diazotrophs in their root nodules. Diazotrophs take nitrogen gas out of the air and convert it into a form of nitrogen that is usable to the plant, such as ammonia, nitrate, and nitrogen dioxide, in a process called Nitrogen fixation. Nitrogen fixation is important for replenishing the soil nutrients
Traditionally, the roots of 4 to 5 year old plants are collected in the spring or autumn; the autumn harvest is superior to the spring harvest. In the autumn the qi is descending and internalizing in preparation for winter, which is reflected in the qi of the root herb. The spring qi is emerging upward and outward, striving for growth and spreading from the root into the leaves. After gathering, the roots are cleaned and graded according to size. Some roots are dried whole, while others are cut and sliced. Most authorities report increased potency and increased root size from plants in the Shanxi Province and Mongolia in western northeast China. The Huang qi samples from Shanxi province and Mongolia show high astragaloside I and II concentrations in fingerprint analysis tests.2 Comparative chemical analyses of roots of varying age show that the isoflavone and astragloside concentrations, the constituents correlated with activity, decrease as the diameter of the roots increases. Increasing age also correlates to a decrease in concentration of most constituents.
High quality roots are dry, but still supple and resistant to snapping. The outer surface is relatively unwrinkled, with a floury texture and a solid deep yellow core — in contrast to material which is lacking a core or roots in which the core is black or pithy.
Western Perspectives on Huang Qi activity:
Huang Qi is known for three main groups of active constituents. Flavonoids and isoflavanoids, which give the root slice a yellow color, are metabolized on the Shikimate pathway. Flavonoids are generally known for anti-inflammatory and anti-oxidative effects which assist the body’s reaction to allergens, viruses, and carcinogens. It is believed that isofavanoid activity will help restore impaired immune systems. Saponins are common ingredients of Fabaceaea family members. Saponins are triterpenoids, formed through the mevalonic acid pathway. Saponins are common adaptogens, known to enliven blood circulation and resolve phlegm. Huang qi also has long-chain polysaccharides with potential medicinal benefit mediated by white blood cells.
The majority of Western research on Huang qi is focused on its immune stimulation activity and its ability to restore the activity of a suppressed immune system. In an epidemiological study in China, 1000 individuals were administered Huang qi orally or as a nasal spray to test its preventative effects in upper respiratory illnesses. The incidence of common colds decreased on the whole, and the duration of the colds contracted was shortened dramatically.
Huang qi’s remarkable ability to restore the functioning of a suppressed immune system has been labeled within Chinese medicine as fu zheng gu ben, “restore the correct and secure the root.” It is used to enhance non-specific immunity, protect adrenal cortical function during radiation and chemotherapy, and ameliorate bone marrow depression.4 Studies report general immune stimulation that include increased stem cell generation of blood cells and platelets, increased lymphocyte proliferation, increased numbers of antibody producing cells, increased numbers of spleen cells, stimulation of phagocytic activity by macrophages and leukocytes, and increased cytotoxicity by natural killer cells.
In the body, Astragalus increases the activities of Th-1 cytokines and decreases Th-2 cytokines. Th1 cytokines protect against intracellular pathogens like viruses and some bacteria, and are implicated in organ transplant rejection and miscarriage. By inhibiting the production of Th 2 cykotones, Huang qi inhibits the defense against extracellular pathogens, but may exacerbate allergies and asthma.5
In China, Huang Qi is used widely in treating cancer, both as a primary treatment and as an adjunct to chemical and radiation therapies. Most frequently Huang qi is combined with Chuan Xiong (lingusticum wallichii). In a number of randomized prospective clinical studies of cancer patients using a combination of Huang qi and Chuan Xiong, it was found that breast cancer patients given a combination of these herbs as an adjunct to irradiation treatments showed a decrease in deaths from 1 in 2, to 1 in 10. The exact formulas and ratios are not recorded, and in practice may vary due to individual constitution. In another study of patients with advanced non-small-cell lung cancer, the effectiveness of conventional chemotherapy was compared to the effectiveness of chemotherapy in conjunction with the Huang qi and Chuan Xiong formula. Patients with squamous carcinoma showed a significant increase in survival time averaging 204 to 465 days; patients with adenocarcinoma showed a less significant increase in survival from 192 to 324 days6.
Huang qi’s antioxidant activity has been studied in its benefit to the cardiovascular system and has shown improvement in clinical parameters associated with angina, congestive heart failure, and acute myocardial infarct. A number of isoflavonoids have been identified with free radical scavenging activity, and Huang qi’s polysaccharides also report prevention of free radical damage.
A Classical Chinese Medicine Perspective:
Huang Qi’s recorded use dates back to the first century AD in the Shennong Bencao Jing, the Divine Husbandman’s Classic of Materia Medica, in which Huang qi is classified as a “superior herb.” The superior herbs are “rulers…they control the maintenance of life and correspond to heaven. They do not have a markedly medicinal effectiveness. Taking [Huang qi] in large amounts or over a long period of time is not harmful to man. If one wishes to take the material weight from the body, to supplement the influences [circulating in the body], and to prolong the years of life without aging” these herbs should be used.1 Crude Huang qi extract tested on rats and mice confirm Huang qi’s safety - no toxic reactions or mutagenic effects occurred.
According to the Ben Cao Bei Yao, Essentials of Materia Medica “When used in harmonizing preparations, it tonifies and supplements; in sweating preparations it relieves the surface; in cooling preparations, it drains pathogenic heat; in moistening preparations, it nourishes the yin and blood.”
Wang Haogu, an herbalist of the Jin-Yuan reform period, maintains that “Huang qi replenishes the defensive and, therefore, is a medicinal for the exterior. It boosts the spleen and stomach and, therefore, is medicinal for the center. Since it is able to treat cold damage with the cubit pulse not arriving, it supplements the kidney origin and, hence, is medicinal for the internal.” Through this explanation, Huang qi is seen as a broadly useful tonic ingredient to include in prescriptions.10
Huang qi’s sweet flavor and slightly warm nature tonifies the Spleen, Lung, and Zheng qi. It aids in replenishing the blood, uplifting yang, securing the exterior and reinforcing wei qi. It promotes growth of new tissue, urination, and suppuration. It circulates qi, reducing edema, and it drains yin fire. 8
Huang qi strongly tonifies the yuan qi. It restores both of the Spleen’s major functions; transformation and transportaion of yang qi drawn from the food into circulation via the Spleen’s other function of building new blood. When qi is strong it can more effectively impel the circulation of blood, which in turn helps resolve disease. Strengthening qi to move blood indirectly eliminates blood stasis without injuring zheng qi, as applied in the Bu Yang Huan We Tang: Tonify Yang to Restore the Five Decoction. The chief herb is Huang qi at 120 g, while the supporting herbs are dosed at 3 to 6 g to give the blood an extra, gentle push. 11 It is also often used to assist in recovery after severe blood loss and to promote healing. It is especially helpful from its Lung affiliation in enhancing eliminative functions of skin, especially promoting healing or elimination of non-healing or non-festering chronic sores or ulcerations. 8
The five best know formulas utilizing Huang qi are
|
Formula name |
Uses
|
Astragalus |
|
Buzhong Yiqi Tang |
Spleen/stomach deficiency with symptoms of fever, spontaneous sweating, shortness of breath, fatigue, organ prolapse. |
20 g |
|
Yiqi Congming Tang |
Qi deficiency and failing of yang to rise with symptoms of impairment of vision or hearing. |
15 g |
|
Guipi Tang |
Qi and blood deficiency with symptoms of anxiety, palpitation, insomnia, night sweating, fatigue, bleeding. |
30 g |
|
Shiquan Dabu Tang |
Qi, blood and yang deficiency with symptoms of fatigue, asthmatic breathing, bleeding |
15 g |
|
Yupingfeng San |
Qi deficiency with symptoms of spontaneous sweating and susceptibility to wind invasion. |
30 g |
|
Danggui Buxue Tang |
Generates blood in severely deficient patient, usually after excessive uterine bleeding |
30g 83% |
Resources:
1. Upton, Roy. Astragalus Root.American Herbal Pharmacopoeia and Therapeutic Compendium August 1999.
2. Wagner, Hildebert; Bauer, Rudolf; Peigen, Xiao; Jianming, Chen; Michler, Hans. Radix Astragali Chinese Drug Monographs and Analysis. Vol. 1, No. 8 1997
3. Chang HM, But PH. Pharmacology and Applications of Chinese Materia Medica vol. 2. Singapore World Sci.
4. Lau, BH; Ong, PY; Tosk, JM. Macrophage chemiluminescence modulated by Chinese medicinal herbs Astragalus membranaceus and Lingustrum lucidum. 1989.
5. Phaneuf, Holly. Herbs Demystified. Herbs Demystified, Marlow and Company, 2005.
6. Marazzoni, P; Bombardelli, E. Astragalus membranaceus (Fisch) Bunge. Scientific documentation 30 Mar 1994.
7. Wang, D; Shen, W; Tian, Y; Sun, Z; Yuan, S; Jiang, C. the effects of the three components isolated from Astragalus mongholicus Bunge on scavenging Free Radical. Zhongguo Yaolixue Tongbao. 1994.
8. Bensky, Dan; Gamble, Andrew. Chinese Herbal Medicine Materia Medica revised edition. Eastland Press, Seattle.1993.
9. Zhang, WD; Zhang, C; Liu, RH; Li, HL; Zhang, JT; Mao, C; Moran, S; Chen, CL. Preclinical pharmacokinetics and tissue distribution of a natural cardioprotective agent astragaloside IV in rats and dogs doi:10.1016/j.lfs.2006.02.032
10. Dharmananda, Subhuti PhD. ASTRAGALUS, Practical Aspects of Administering the Herb. Institute for Traditional Medicine, Portland, Oregon http://www.itmonline.org/arts/astragalus.htm
11. Bensky, Dan; Barlet, Randall; Formulas and Strategies. Eastland Press, Seattle 1990.
Tags: Character, chinese-herb, chinese-herbs, chinese-medicine-research, guest-post, herbs, huang qi, pharmacology, western-scienceRelated posts
Why should Chinese medicine students learn Western science?
I don’t have the answer to that question. But, I’ll do my best. To be honest, studying Western science can be pretty interesting. As an intellectual exercise, nothing beats having to go from learning to read and translate passages of the Shang Han Lun to attempting to comprehend the importance of Th1 and Th2 responses in the body. It’s… rigorous, to be sure. As the second part of my “term in review” series, I’d like to briefly discuss my Immunology class (Fall term 2007) with Dr. Heather Zwickey.
As part of our Classical Chinese Medicine curriculum at NCNM, we learn a variety of Western subjects. We learn anatomy, physiology and biochemistry first. We move on to learn some Western pathology, Western oriented CPD (clinical physical diagnosis) and most recently, immunology. We will also learn pharmacology, microbiology and a Western approach to public health. Our professors attempt, with varying degrees of success, to integrate these subjects with the insights we are collecting in the Chinese medicine oriented majority of the curriculum. Their efforts are greatly appreciated, but the fact of the matter is that we are still doing a lot of memorizing and seeking to understand information within the materialist scientific framework. Why should we learn about this stuff as students of Classical Chinese Medicine?
First, maybe I should answer the question, “Why shouldn’t we?” Well, first - It’s outside the LAc (licensed acupuncturist) scope of practice for the most part. We’re not able to make, or even confirm or question, Western diagnoses. So while we can receive information that a person has been diagnosed with fibromyalgia, we are not supposed to suggest that fibromyalgia might or might not be an appropriate classification for a patient’s symptoms. Further, very difficult (if not impossible) to make particularly good predictions about Chinese medicine diagnoses based on a Western disease name. Thus, for the average Chinese medicine school graduate, Western medical information isn’t going to be particularly helpful in Chinese medicine diagnosis and treatment. So, why? Why do we have to learn this?
Despite my well-documented resistance to accepting these courses as a valid part of Chinese medicine education, I can think of a few benefits:
1. The ability to recognize emergency situations that would be better handled by the facilities and expertise of Western urgent care and emergency room physicians.
2. The ability to understand potentially life threatening herbal interactions with medications and patient conditions.
3. The opportunity to make attempts at finding correspondences between Western and Chinese concepts, thus potentially building bridges between these disciplines. Without having some basis in the Western sciences, moving toward this kind of understanding is impossible.
4. The ability to carry on basic conversations with Western practitioners about a patient’s symptoms, disease categorization, lab results and pharmaceutical intervention. This could increase the possibility for cross referrals, as people tend to trust people who “speak their language.”
Despite these potential benefits, I think that this part of the education should be kept to a bare minimum. If particular students are very interested in the Western medicine aspect of things, there are plenty of educational opportunities for them outside of our Chinese medicine schools. In our case at NCNM, interested students are fortunate to have the ND (Naturopathic) students and faculty in the same institution. This is helpful because NDs are required to be far more conversant in contemporary Western medical science.
All of this aside, Immunology with Dr. Zwickey was a great experience. As a researcher, teacher, natural medicine enthusiast and medical philosopher she is a dynamo, make no mistake. Dr. Zwickey is the director of the Helfgott Research Institute, an incredible resource for the natural medicine community and recipient of grant monies from a variety of prestigious sources. She infects (no pun intended) everyone around her with a love for research, for the general spirit of open inquiry. She is able to break very complicated biochemical processes down into simple language that anyone can understand. She’s also one of the kindest and most genuine people I have ever met. Because of these and other admirable personal characteristics of Dr. Z, the course was engaging and tricked me into spending countless hours trying to understand the particulars of immunological reactions and interactions.
I am interested to hear from you, kind readers, about any insights you have obtained in Chinese medicine by deeply studying Western medical science. Do you feel that studying Western medicine has greatly enriched you as a scholar and/or practitioner of Chinese medicine? Please let us know in the comments.
Eric
PS: Because I am doing a somewhat “lighter” version of my January commitment in the Year of Sagely Living until school starts, I will not do a real update until a few more days have gone by. More frequent updates will occur after January 7, as I discussed before. Thanks!
Tags: Character, curriculum, education, heather zwickey, helfgott research institute, immunology, Learning, ncnm, studying, western-science
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