Combining Western Herbs and Chinese Medicine

~.

Foreword H

~,

' *"

the basis of symptoms, without reference to an underlying pattern of disharmony. There was some attempt in the 19th century to take some account of the general constitution of a patient, and some attempt to classify herbs in terms of stimulants and relaxants and so on; but into the 21st century, there has been no satisfactory theory for prescribing herbs. By contrast, the theories of Chinese medicine are well established, encompassing most of human experience, spiritual, emotional, and physical. Many Western practitioners will be surprised to learn that there was a comparable theory system in the herbal medicine of the West that started with Hippocrates in the 5th century BC and was codified by Galen in the 2nd century AD. These Western theories are often remarkably similar to those of Chinese medicine: similarities are not only found in the Galenic system, but also in the later Physiomedical system of the 19th century. For example, in this system, as in Chinese medicine, strong patients are prescribed different herbs from weak patients. The present author's love of the history of herbal medicine has led him to trace its beginnings in ancient Greece and show the development of its theory and practice in the West up to the present day. He draws together the common threads of Western and Chinese tradition, and then uses this new framework of herbal theory to organize the data coming from pharmacological and clinical research. This task needed someone trained in science and skilled in both

used widely throughout the world and in many countries of the East herbal treatment from trained and qualified practitioners is readily available. Sadly, this is not always true in the West. This is a pity, for Western herbs are wonderful, and very effective. For people living in the Western world they have a great advantage over herbs from other countries: they grow here in the West. This means that the plants can be studied at first hand: the way they grow; their preferred habitat; the effect of climate on their therapeutic effectiveness. All can be observed through the changes of the seasons, often in the wild within a few miles of where one lives. They can be gathered in the wild or grown in the garden. All this helps to deepen one's understanding of the nature and action of a herb. From my own 25 years of experience of treating children, I can vouch for the fact that Western herbs can be safe and effective for the treatment of a wide range of pediatric disorders. Nor is the effectiveness of Western herbs limited to children- many of the acute and chronic conditions of adult patients respond well to Western herbs, when these are properly prescribed. So why is it that Western herbs are not more used by health practitioners? The answer lies in the recent absence of any satisfactory theory for prescribing them. For at least 200 years, the ancient Western theories of herbal medicine have been neglected, and herbs have been prescribed mainly on ERBAL MEDICINE IS

IX

Foreword

x

Chinese medicine and Western herbs, with a clear mind to put the whole thing together, and the practicality to test the theories in the clinic. It is not surprising that this has taken a long time, and I am delighted that this book has at last seen the light of day, some 20 years after work first began on the project. There have been many interesting books on herbal medicine written in the last few years, but the present book is exceptional, in containing so much new, and clinically useful

;

....".,

material. For the first time, information on how to use the herbs for different Chinese syndromes has been written down by someone who knows what they are talking about, because they have been using the herbs in clinic for many years. But the information does not stop here. There are complete prescriptions, with analysis of their composition and practical notes on their use, which makes this book stand out in a class of its own. -JULIAN SCOTT, MA, PHD, CERT.Ac. (NANJING)

Preface .. ~

was in science research, which involves two complementary activities. One is the careful gathering of data by close and detailed observation of living material. The other is the attempt to perceive underlying natural patterns within the seeming chaos of the mass of data. These natural patterns can then be represented by theoretical principles, so that the data can be organized, under-

• to classify Western herbs in terms of Chinese values for temperature, taste, actions, and organs entered

stood, and applied. When I first started to study Western herbal medicine in 1973, I was unable to fmd a framework of theoretical principles in the herbal texts then commonly available. There did not seem to be any logical system for matching herbs to disorders or for selecting herbs to form a balanced herb combi-

However, the more I investigated contemporary Western texts, the more I realized that the data they contained derived from a tradition of empirical herb use in the West reaching back over 2000 years. Therefore, I decided to include material from some of the more important materia medica of the past. As I researched the traditional Western texts, it became apparent that there had been a framework of theoretical principles in Western herbal medicine comparable to that in

M

, .....l

y ORIGINAL TRAINING

• to apply the Chinese principles of herb combination to Western herbs • to give illustrative combinations for each herb discussed

nation. In contrast, a similar combination of the close observation and the perception of natural patterns that I had found in science attracted me to Chinese acupuncture. It seemed to me that the framework of theoretical principles of Chinese medicine could also be applied to the use of Western herbs. This idea was reinforced when I started to study Chinese herbal medicine. I began to classify Western herbs in terms of Chinese values of properties, organs entered, actions, and the Chinese syndromes that they could be used to treat. Eventually, I decided to write a book with the following

China. I began to compare and contrast the Western theoretical system with that of the Chinese, and to select elements from each to produce a working synthesis. Early in the writing of this book it became obvious that there was a need to give supporting evidence for any Chinese values assigned to Western herbs. At first I drew this evidence from Western and Chinese traditional texts, but increasingly incorporated data from modern pharmacological and clinical research.

four main aims:

Gradually, the central theme of the book became the integration of theoretical principles from Western tradition, Chinese tradition, and modern pharmacology. This led to a

• to summarize the empirical data on herb use from contemporary Western texts Xl

xii

Preface

complete change in the organization of the material and a total rewrite of the text, which in turn resulted in an additional five years of writing and a book four times its original size..

However, I feel that the extra time and effort have been well worth it, and I have been fascinated by the way that the many different threads of my own past experience and interests have come together in this book.

..

Sources Evidence for statements made

• listed the temperatures and tastes for each herb in the combination so that the reader can check the supporting evidence for these values in the Research and Traditional sources sections of the materia medica chapters

Wherever possible in this book, references to source material are given tor statements made, and over 1,500 references have been cited.

• given PRACTICAL NOTES for each combination, describing its clinical use

SINGLE HERBS In the materia medica chapters of this book, references to support statements made concerning individual herbs are mainly given in the Research and Traditional sources sections.

Translations This book could not have been written in its present form without data from extensive translations from German and Chinese sources.

COMBINATIONS

GERMAN TRANSLATIONS

The materia medica chapters of this book describe and discuss over 150 different herb combinations. A few of these derive from practitioners other than myself, and for these the appropriate references are cited. However, most of the combinations in this book derive from my own experience, and it is therefore not possible to cite references to traditional texts. It is for this reason that I have:

For each herb with a materia medica chapter in this book, translations were made from the following texts in the German language whenever there was information available: Dioscorides, Lonicerus, and Tabernaemontanus. (See Source' abbreviations below for full title).

CHINESE TRANSLATIONS

• explained in detail the principles of herb combination in PART 1 of this book

Similarly, each herb chapter in the materia medica incorporates material from translation of the Chinese Herbal Medicine Dictionary (Zhong yao da ci dian), whenever data was available for a particular herb.

• given my reasoning for the construction of each individual combination according to these principles

xiii

Sources

XlV

Source~9bJiviatioris ~.

." ,"

DIOSCORIDESG Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad K6lbl, Munchen, Germany

.:iJ>.-

(1960)

The majoritY of sources-bookS and journal articlesthat are referred to in this book, are specific to a particular materia medica chapter, and occur elsewhere infrequendy or not at all. However, a number of basic texts that are frequendy referred to have been assigned an abbreviation, often the names of their authors or editors. This has been done to save

ELLINGWOOD Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy. 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994)

cluttering the text with long repeating tides. These abbre-

ESCOP MONOGRAPHS

viations are listed below with their associated full reference. Note: The superscript G indicates that the text is in the German language. The superscript CH indicates that the text is in Chinese.

European Scientific Cooperative

on Phytotherapy: Monographs on the medicinal uses of plant drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) EVANS

Evans We. Trease and Evans' Pharmacognosy, 14th

edn. WB Saunders, London, United Kingdom (1996) BENSKY AND GAMBLE Bensky D, G~ble A, Kaptchuck T. Chinese Herbal Medicine Materia Medica. Eastland Press, Seatde, Washington (1986) BHC Bradley PR (ed). British Herbal Compendium, vol I. British Herbal Medicine Association. Bournemouth. United Kingdom (1992) BHP British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) BOTANICAL SAFETY HANDBOOK

McGuffm M, Hobbs C,

Upton R et al. American Herbal Products Association's Botanical Safety Handbook. CRC Press. Boca Raton, Florida (1997)

FELTER AND LLOYD Felter HW and Uoyd JU. King's American Dispensatory, vols.1 and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1983) Fox Fox W. The Working Man's Model Family Botanic Guide to Health, 7th edn. William Fox, Sheffield, United Kingdom (1878) GERARD Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York, New York (1975) GERMAN COMMISSION E MONOGRAPHS

Blumenthal M

(ed). The Complete German Commission E Monographs: BRUNETON Bruneton J. Pharmacognosy: Phytochemistry Medicinal Plants, 2nd edn. Lavoisier, Paris, France (1999) CHANG AND BUT

Chang H-M, But PP-H (eds). Pharma-

cology and Applications of Chinese Materia Medica, vols. 1 and 2. World Scientific Publishing, Singapore (1986) CHINESE HERBAL MEDICINE DICTIONARyCH

Jiangsu

New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai, China (1975)

Therapeutic Guide to Herbal Medicines. American Botanical Council, Austin. Texas (1998) GRIEVE

Grieve M. A Modern Herbal, vols. 1 and 2. Dover

Publications, New York, New York (1971) GRIGGS

Griggs B. Green Pharmacy: The History and

Evolution of Western Herbal Medicine, 2nd edn. Healing Arts, Rochester, Vermont (1997) HILDEGARD VON BINGEN'S

Bingen's Physica. Healing Arts, Rochester, Vermont (1998)

CHRISTOPHER Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976)

KLOSS

CRELLIN AND PHILPOTT Crellin JK, Philpott. J. A Reference Guide to Medicinal Plants. Duke University Press, Durham, North Carolina (1990)

LONICERUS G

Kloss J. Back to Eden, 5th edn. (1939). Reprinted by _

Lifeline Books, Santa Barbara, California (1975) Lonicerus A. Kreuterbuch (1679). Reprinted

by Verlag Konrad Kolbl, MUnchen, Germany (1962) LYLE

CULPEPER Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood, Illinois (1990)

Von Bingen H. Hildegard von

Lyle TJ. Physio-Medical Therapeutics, Materia

Medica and Pharmacy. Originally published Ohio (1897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932)

~.

...

-

Sources MABEY

Mabey R (ed). The Complete New Herbal. Elm

Tree Books, London, United Kingdom (1988) MAILHEBIAU Mailhebiau P. Portraits in Oils. The C.w. Daniel Company, Saffron Walden, Cnited Kingdom (1995) MARTINDALE Reynolds EFJ (ed). Martindale: The Extra Pharmacopoeia, 31st edn. Royal Pharmaceutical Society, London, United Kingdom (1996)

•

MILLS Mills S. The Essential Book of Herbal Medicine. ArkanafPenguin Books, London, United Kingdom (1991) MILLS AND BONE Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal lvledicine. Churchill

xv

PRIEST AND PRIEST Priest AW, Priest LR. Herbal Medication. L.N. Fowler, Romford Essex, United Kingdom (1982) TABERNAEMONTANUSG Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad K6lbl, Munchen, Germany (1993) TIERRA Tierra M. Planetary Herbology. Lotus Press, Twin Lakes, Wisconsin (1988) TISSERAND AND BALACS Tisserand R, Balacs T. Essential Oil Safety: A guide for Health Care Professionals. Churchill Livingstone, Edinburgh, United Kingdom (1995)

Livingstone, Edinburgh, United Kingdom (2000) MOORE Moore M. Medicinal Plants of the Pacific West. Red Crane Books, Santa Fe, New Mexico (1993) PERRY .P~rry LM.~.Medicinal Plants of East and Southeast Asia. The MIT Press, Cambridge, United Kingdom (1980) POlAR AND MACKINNON Pojar J, MacKinnon A. Plants of the Pacific Northwest Coast: Washington, Oregon, British Columbia and Alaska. Lone Pine Publishing, Redmond, Washington (1994)

...

1

WEISS Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers, Beaconsfield, United Kingdom (1988) WICHTL Bisset NG (ed). Herbal Drugs and Phytopharmaceuticals. English edn. Medpharm, Stuttgart, Germany (1994), from 2nd German edn. Wichtl M (ed) (1989) YEUNG Yeung H-C. Handbook of Chinese Herbs and Formulas vol I. Institute of Chinese Medicine, Los Angeles, California (1985)

"i'll

Terminology 1.

1

bi<.i_

L

Mandarin Chinese tones

Chinese names The following conventions have been adopted in this

book: 1. Chinese herb names EXAMPLE:

lower case with tones gul zhI

a

first tone

starts high and is held steady

a a

second tone

starts in midrange and rises

third tone

starts in lower midrange and drops down before rising

a

fourth tone

starts high and drops down sharply

2. Chinese concept names first letter capitalized, (commonly used) no tones EXAMPLE:

Chinese organs and syndromes

Qi

3. Chinese concept names lower case with tones

ENGLISH NAMES

(less commonly used) EXAMPLE:

The English names of Chinese concepts start with a capitalletter, for example, substances such as Blood, organ systems such as Heart, and syndromes such as Deficiency. For ease of indexing, organ syndromes are written with the organ stated before the type of syndrome. For example, the term Heart Deficient Qi is used throughout in this book, rather than Deficient Heart Qi.

yldu'

4. Chinese formula names lower case and italics, no tones EXAMPLE:

5. Chinese book tides EXAMPLE:

6. Chinese authors EXAMPLE:

liu wei dihuangwan only first letter of first word capitalized, no tones

Abbreviations of organ names

Huang di nei jing first letter of both elements capitalized, no tones

Bladder Gallbladder Heart Intestines

Zhang Zhong-jing

xvii

BL GB

HT IN

Terminology

xvm

Kidney Liver Lung Spleen

Stomach Uterus

KI

LR LU SP ST

UT

Intestines In referring to the use of Western herbs, this book generally uses the term Intestines to represent the combined Chinese organ systems of Large Intestines and Small Intestines, without differentiating between the two. However, in the Gentiania and Centaurium chapter, these herbs are referred to as specifically affecting the Small Intestine organ system. Uterus The term Uterus is used in this book to refer to the Chinese concept of the female reproductive system.

NONSTANDARD CHINESE SYNDROMES Some of the organ system syndromes given in this book are not standard Chinese syndromes, that is, they are not generally listed in classical Chinese texts. Examples are: • Heart Qi Irregularity • Heart Stagnant Qi • Intestines Qi Disturbance • Kidney Stagnant Qi • Kidney fear invades the Heart • Lung Stagnant Qi • Uterus Stagnant Qi I have used these terms to represent common patterns that I have observed in the clinic. Heart Qi Irregularity This syndrome represents irregularity of the Qi of the Heart, especially irregular function of the physical heart organ with predominantly physical signs, such as arrhythmia. It thus differs from Heart Spirit Disturbance, which represents disturbance of the Spirit of the Heart and may include symptoms of mental and emotional imbalance. Herbs such as Crataegus and Leonurus can be said to strengthen and stabilize Heart Qi, and thus treat the syndrome of Heart Qi Irregularity. They thus help to reduce excessive fluctuations in cardiac rhythm, blood pressure, or body temperature (see the chapters on these herbs). Heart Stagnant Qi This term refers to Stagnant Qi of the Heart, which may be associated with poor posture and lack of physical exercise, sadness and depression, frustration and difficulties in relationships,' and difficulty in expressing feelings and affection. Physical symptoms may include a sensation of fullness or obstruction in the chest, dull ache in the chest, and poor peripheral circulation. This syndrome

differs from Stagnant Blood of the Heart in that the latter syndrome is characterized by severe chest pain. Herbs such as Rosmarinus can be used to move Stagnant Qi of the Heart and thus to treat associated depression (see the chapter on this herb). Intestines Qi Disturbance This term refers to a disturbance of the rhythm of intestinal function by such factors as irregular eating habits, laxative abuse, or emotions such as Heart anxiety, Kidney fear, or Liver anger. Associated symptoms include abdominal distension, intestinal colic, borborygmus, flatulence, and irregular bowel movements. Herbs such as Lavandula and Lobelia can be used to calm the Intestines by rela.xing intestinal muscle spasms and restoring normal peristalsis (see the chapters on these herbs). Kidney Stagnant Qi In my opinion, one aspect of Kidney energy is ambition and the desire to achieve. If this energy has no suitable outlet or if it is obstructed, the syndrome of Kidney Stagnant Qi can arise with associated symptoms, such as dysmenorrhea or pain in the kidney area: Kidney Stagnant Qi can also be associated with states of chronic fear. Herbs such as Ruta can be used to move Stagnant Qi of the Kidney and thus to treat associated conditions of pain in the urinary and reproductive systems (see the chapter on this herb). Kidney fear invades the Heart In my opinion, excessive Kidney fear, whether expressed or suppressed, can disturb Heart Spirit, resulting in symptoms such as insomnia, nightmares, nervousness, palpitations, and hysteria. Herbs such as Anemone and Ruta can be used to treat these symptoms by reducing Kidney fear (see the chapters on these herbs). Lung Stagnant Qi This syndrome can be associated with poor posture and lack of physical exercise, chronic asthma or bronchitis, and the emotion of grief, whether expressed or suppressed. Herbs such as Lobelia, which can both stimulate breathing and relax bronchial spasms, can be used to move Lung Qi and relieve symptoms such as the sensation of restricted breathing with fullness in the chest (see the chapter on this herb). Uterus Stagnant Qi This term refers to the Stagnation of Qi in the female reproductive system, which may be associated with poor posture and lack of physical exercise, or with emotional constraint-whether associated with suppressed anger, depression, fear, or grief. The syndrome may be linked to conditions such as amenorrhea, dysmenorrhea with dull aching, irregular menstruation, or premenstrual syndrome with distension and soreness of the breasts. Herbs such as Leonurus or Ruta, which can move the Qi of the Uterus, can be used to treat these conditions (see the chapters on these herbs).

Introduction !'

Aims ofthis book I'·

This book has the following aims:

for beginners to perceive any pattern in the mass of data confronting them. It was hard to differentiate between herbs and thus difficult to select the most suitable herb for the specific needs of a particular patient. For example:

• to provide a clear differentiation between the different herbs presented

• Christopher listed both Achillea and Salvia for fever, nasal catarrh, digestive weakness, flatulence, liver disorders, hemorrhages. ulcers, and hair problems!

• to provide a framework of theoretical principles as a basis for herb choice and herb combination

• Grieve listed both Rosmarinus and Salvia for cough, • to initiate an integration in the use of herbs according to Western tradition. Chinese tradition, and modem

digestive weakness. kidney disorders, headache, poor memory, nervous disorders, and hair problems2

research

• the BHP listed both Lavandula and Rosmarinus for

• to give suitable herb combinations to illustrate the use of each main herb presented

headaches, migraines, myalgia, spasms, flatulent dyspepsia. and depression 3

• to emphasize the importance of safety considerations

I have therefore taken every effort in this book to bring out the unique character of each herb that makes it special and different from the others.

in herbal medicine

CLEAR DIFFERENTIATIO~ BETWEEN HERBS \.-'=-

FRAMEWORK OF THEORETICAL

Perhaps the greatest initial difficulty in studying phytotherapy is learning to differentiate between the different

PRINCIPLES

herbs. In the herbal texts that were readily available when I

At the time I began to study phytotherapy, there did not appear to be a system of theoretical principles for matching herbs to disorders within Western herbal medicine itself. The Galenic system had not been used for almost two centuries-

began to study herbal medicine, the frequency of overlapping uses between the: different herbs often made it difficult

xix

._-,,-.,,~

Introduction

xx

most modern herbalists were unaware of its existence-and the theoretical system of Chinese herbal medicine had not yet become known in the West. At that time, there were attempts to explain herb choice in terms of the paradigms of either Physiomedicalism or conventional Western medicine, neither of which was wholly satisfactory. The materia medica available in the early 1970s, such as the texts of Christopher, Grieve, or the BHP, did not include a theoretical system to explain the choice of single herbs or the logic behind herb combinations.l became determined to write a materia medica that did include such a system. Therefore, every herb that has a materia medica chapter in this book is categorized in terms of temperature, taste, actions, and the organ syndromes that it can treat. For each of these herbs, examples of combinations are given to illustrate the principles of herb combining.

INTEGRATION OF WESTERN TRADITION, CHINESE TRADITION, AND MODERN

nations, few consistently explained the logic behind their herb formulations. Some, for example, Christopher, occasionally justified their combinations in empirical terms, simply stating that a particular combination was effective. Others sometimes gave brief theoretical explanations for their combinations. For example, Shook explained his formula for nephritis and diabetes in terms of a mixture of Physiomedical and conventional medical concepts,6 and Weiss sometimes gave very brief explanations of the combinations 7 he listed in terms of conventional medicine. However, I have not seen a text in the English language, published between 1890 and 1990, in which the illustrative combinations are consistently explained in terms of a system of theoretical principles. In this book, six illustrative combinations are generally given for each of the herbs with a materia medica chapter. These combinations illustrate the principles of combination laid out in PART I of this book and show how the' effects of one herb can be enhanced or moderated by the other herbs in a combination.

RESEARCH The original aim of this book was to provide Chinese values for properties and actions for a number of commonly used Western herbs, and to use the principles of herb combination found in Chinese herbal medicine. However, as the book evolved, its central theme became the integration of Western herbal tradition, Chinese herbal tradition, and modern research, bringing together both empirical data and theoretical principles from these three sources. The categories of temperature and taste used in this book most closely follow the Chinese model, but Western herbal and modern pharmacological concepts have been incorporated. The concepts used for the herbal action categories draw equally on the Western and Chinese herbal systems, with further expansion of understanding from pharmacology and clinical research. One of the most fundamental principles in this book is that of restoring balance within the body by creating a matching balance within a herb combination. This principle is common to both the Western and Chinese traditional systems, and can greatly contribute to the safety of herbal practice, as discussed below.

COMBINATIONS TO I~LUSTRATE HERB USE '

..

Many of the 20th century materia medica of Western herbs in the English language did not include illustrative combinations for most of the herbs presented. 2•3•4•s Of those authors who regularly gave illustrative combi-

SAFETY CONSIDERATIONS IN HERBAL MEDICINE Safety considerations are essential to the practice of herbal medicine. Three chapters are devoted to safety issues in PART I of this book. In addition, relevant cautions, contraindications, and toxicological data are listed for each herb that has its own materia medica chapter. The premise of this book is that it is possible both to maximize the safety of herbal medicine and to increase the availability of beneficial herbs to the public. Safety considerations need not stifle the scope of herbal practice. Indeed, both increased safety and increased clinical effectiveness result when practitioners take greater care with the balance of temperature, tastes, and actions within a combination.

Choice ofherbs in the materia medica There is an average of 15 pages for each herb chapter in the materia medica of this book, thus limiting the number of herbs that can be treated in this degree of detail. The selection of 51 main herbs, from the several hundred that have been in common use in the West, reflects my personal background and preferences, as shown in the following three examples.

Introduction

-

...

XXI

NORTH AMERICAN HERBS

PART I

I have included several herbs native to North America, such as Asclepias, Hydrastis, Lobelia, Myrica, Phytolacca, and Zanthoxylum. These herbs represent the important contribution of the Native American people and of the Physiomedical movement to herbal therapy, and I find them to be amongst the most effective herbs available. They are well known in Britain but are still little used in Europe.

deals with the principles of herb combination in both theory and practice, and with considerations of dose and safety.

MEDITERRANEAN AROMATIC HERBS

-

,

I have also included several aromatic herbs native to the Mediterranean region, such as Lavandula, Rosmarinus, Salvia, and Thymus. These herbs from the Lamiaceae family have high essential oil content. Their aromatic constituents can affect both emotional and mental state, which has made these herbs central to the development of aromatherapy. They are little known in China. and Lavandula and Rosmarinus have been much more commonly used in Europe than in the United States. CARDIOACTIVE HERBS I have included several herbs that can be used to treat cardiac disorders such as cardiac weakness, cardiac arrhythmias, and angina pectoris. Examples are Cinchona, Convallaria, Crataegus, Leonurus, and Sarotharnnus. Two of these herbs, Cinchona and Convallaria, are on Schedule Part III of the Herbal Remedies Order 1977 of the UK, and in my opinion are not suitable for over-the-counter sales. However, they can be useful in the treatment of certain heart disorders, providing all appropriate screening, treatment precautions, and monitoring procedures are taken.

Additional herbs In addition to herbs which have their own chapter in the materia medica, the Additional herbs chapter contains a brief description of 66 further herbs that are included in the combinations discussed in this book.

PART I

PART II PART II, the materia medica, is the heart of this book. Readers are advised to study the preliminary chapter Using the materia medica, which explains how the herb chapters are organized and how they can be used to best effect.

DATA ACCESS Cross references

Herb names cross references In this book, herbs are referred to by their botanical names. Readers who wish to refer to herbs by their English, Pharmaceutical, or Mandarin names will find these in the cross references in the Appendix. However, these cross references contain only a single main page reference for each herb. More detailed page references are to be found in the Index under the herb's botanical name.

Herb combfnation cross references About 150 herb combinations are discussed in this book. The CombinationsChinese syndromes cross reference gives the main page reference for each combination, together with its associated Chinese syndromes. Herb combinations for specific disorders can be accessed using the Disorders-combinations cross reference. Index The Index has been specially designed for ease or access to four main types of data: • herbs • herb actions • disorders • Chinese syndromes

Please read the Index introduction for a detailed explanation ofhow to access these four types ofdata.

References

.How this book is organized 1. Christopher

This book has three main divisions: Herbal medicine in theory and practice • PART II Materia medica • Appendices • PART I

JR. School of Natural Healing. BiWorld, Provo. Utail

(1976)

2. Grieve M. A Modem Herbal, vols. 1 and 2. DoYU Publications, New York, New York (1971) 3. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983)

xxu

Introduction

4. Cook WH. The Physio-Medical Dispensatory, Cincinnati (1869). Reprinted by Eclectic Press. Portland, Oregon (1985)

6. Shook E. Advanced Treatise in Herbology. Enos Publishing. Banning.

5. Hohnes P. The Energetics of Western Herbs. Artemis Press. Boulder. Colorado (1989)

7. Weiss RF. Herbal Medicine. English edn. Beaconsfield Publishers,

California (1992) Beaconsfield. United Kingdom (1988)

~-.

i

Table of Contents FOREWORD PREFACE

Xl

SOURCES

xiii

Materia medica Using the materia medica

161

Achillea

165

Althaea

183

PART I:

Anemone

193

Herbal medicine in theory and practice

Angelica

TERMINOLOGY·" INTRODUCTION ...

I~

PART II:

IX

xvn

xix

History

···3

_

205

Arctium

221

Temperature

19

Arctostaphylos

233

Taste

29

Artemisia

243

57

Asclepias

263

Actions glossary

67

Berberis and Hydrastis

273

Principles of herb combination

83

Calendula

299

Practical herb combination

89

Capsella

309

Actions

-

Dose '"

Capsicum··.·

·······97

·

:

319

Safety

121

Clffilcifuga

339

Safety and the organ systems

139

Cinchona

355

Safety in clinical practice

151

Cinnamomum

371

vii

Table of Contents

VUl

387

Taraxacum

399

Thuja

Crataegus

411

Thymus

Echinacea··:·······························.··

42 5

Turnera

771

Euphrasia

439

Valeriana

781

Filipendula

447

Viburnum

795

Gentiana and Centaurium

455

Zanthoxylum

Glycyrrhiza

473

Zingiber

819

Hamamelis

493

Harpagophytum

503

Additional herbs

837

Juniperus

513

Lavandula .,

527

Leonurus

539

Commiphora Convallaria

Lobelia·····.·············

···········

···········.· .. ···

553

Myrica·····················.············· .. ····.··573

725

····

········739 · .. ·····

·· 757

:

805

Appendices GLOSSARY'"

847

HEALING CRISES ... 851 HERB PROPERTIES ...

853

Phytolacca

587

HERB NAMES ... 859

Piscidia

599

CROSS REFERENCES:

Potentilla

607

Family-botanical names

865

Rheum

619

Botanical-family names

869

Rosmarinus

635

English -botanical herb names .. ,

Ruta

651

Pharmaceutical-English herb names

Salvia

667

Botanical-Mandarin herb names

883

Sambucus

687

Mandarin-botanical herb names

885

Sarothamnus

697

Smilax································ Tanacetum

·

707

715

873

Combinations-Chinese syndromes ... Disorders-combinations ... INDEX ...

899

893

877

887

PART I:

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·Herbal Medicine in Theory and Practice

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History • History ofthe materia medica

ancient Greece and Rome, three of the most influential founders ofWestern herbal medicine can be said to be Hippocrates, Dioscorides, and Galen. Hippocrates developed a complete system of holistic therapies. These were based on a framework of medical theory developed from the new philosophies of his time. In addition, he imbued medicine with an ethical code and a deep sense of humanity. He has been said to have given medROM THE TIMES OF

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The first section discusses the development of the theoretical principles of Western medicine and their basis in early Western philosophy. The second section describes the application of these principles to the classification of herbs according to theoretical properties. The third section chronicles the development of materia medica from ancient Greece to the present day.

icine a soul. Dioscorides was the author of the first Western materia medica that was both thorough and practical.! His book was notable for its clear compilation of empirical herbal knowledge and became the most influential materia medica in Western history. The indications that Dioscorides gave for individual herbs have been copied in subsequent herbal texts

Philosophical principles and medical theories Throughout the world, the earliest forms ofherbal medicine were associated with shamanism and magic. The causative factors of disease were believed to be malevolent spirits, whether these were demons or the ghosts of ancestors. It was believed that these evil influences could be driven off by the shaman using a combination of herbs and magic. Shamanistic herbal medicine remains in use today in many cultures, but it is outside the scope of this book. About 2,500 years ago, in both China and the West, philosophers began to explain their observations of the world around them in terms of the logic of natural laws. This led to an understanding of the origins of disease based on the operation of natUral principles, rather than as a result of supernatural intervention.

right into the 20th century. Galen, in addition to his great contributions to anatomy and physiology, was responsible for producing a detailed theoretical system for classifying and using herbs according to properties and actions. The system associated with his name was used in the West for 15 centuries and provided a theoretical structure in herbal medicine similar to that used in the Chinese medicine tradition. The contributions of these and other authors'to the theory and practice of herbal medicine are discussed under three section headings below: '

• Philosophical principles and medical theories • Classification ofherbs by properties and actions

3

4

Combining Western Herbs and Chinese Medicine

In both China and the West, the natural world was explained according to philosophical principles such as: • the existence of a vital force • a duality of complementary polar forces • the operation of a number of'elements' or 'phases of change' In the West, these philosophical concepts began in ancient Greece, and the concepts that developed were incorporated into the theoretical principles of Western herbal medicine.

VITAL FORCE The most basic concept of traditional Western herbal medicine is that of a vital force or life energy that pervades all matter and sustains all the functions of the body. Healing power of life One manifestation of this vital force is the inherent ability of the body to heal itself. This concept of the vis medicatrix naturae has been attnbuted to Hippocrates of Cos, who lived about 400 Be. Hippocrates is regarded by many as the greatest Western physician of all time and the primary founder ofWestern medicine, although the writings attributed to him may be the work of a school, rather than of a single man. 2 One of the basic teachings of the Hippocratic school was that the physician should assist the body to heal itself and should use minimal treatment, avoiding such intrusive modalities as strong drugs or surgery wherever possible. Vital heat of the body The vital force was often associated with the natural heat of the body. In the 2nd century AD, Galen emphasized that this vital heat should be supported in any treatment and should not be diminished. In the 17th century, Culpeper wrote that 'we live by heat and not by cold:3

In the early 19th century, Thomson stated that 'cold or the lessening of the power of heat is the cause of all disease; that to restore heat to its natural state was the only way that health could be produced.'4 In China, the concept of cold as a main origin of disease was emphasized about the 3rd century AD by Zhang Zhong-Jing in his famous work the Shang han za bing lun.s Vitalism and mechanism During the 19th century, the philosophical basis of the sciences and medicine became increasingly mechanistic. Vitalism and mechanism were seen as irreconcilable opposites and the importance of the concept of a life energy declined in1:he new mechanistic medicine that was developing. In herbal medicine, the principle of a vital force was maintained by the North American Physiomedical practitioners, including Lyle, Thurston, and Cook.

In the last 40 years, the increasing popularity of Chinese medicine in the West, with its basis in Qi theory, has brought renewed interest in and understanding of the concept of life energy, and of the fundamental importance of supporting this force in helping the body to heal itself. Mechanism and vitalism can now be seen not as mutually exclusive concepts but as two different views of the same reality. The mechanistic understanding of biochemistry and the vitalistic understanding of life energy are both useful complementary views of reality. PAIRS OF COMPLEMENTARY OPPOSITES In China, Ym- Yang theory, the concept that all phenomena are the result of two opposing forces, may have originated about 4,000 years ago in the Shang dynasty.6 However, the first record of the application of this theory to medicine appears in the Huang di nei jing, of which some parts may have been written about 200 BC.7 The concept of a polarization of reality may have existed in the West for millennia. The principle of complementary opposing principles, such as fire and water, are basic to many cultures. Aristotle may have been one of the first to incorporate it into a new logical philosophy, just as Hippocrates was one of the first to assimilate this very ancient concept into the new medical corpus, about 400 BC. Concept of balance Both the Chinese and Western models of health and disease were based on the concept of balance, whether between two opposites, such as heat and cold, or between a greater number of principles, such as the four humors (see below). Disease was regarded as an imbalance, and herbal or other treatments were aimed at assisting the natural tendency of the body to restore its inherent balance. According to Hippocrates, health depended on a proper balance of heat and cold, and dryness and moisture. If a person had a disorder involving heat and dryness, this would be balanced with food or herbs that were cooling and moistening. This concept of polar opposites was later used by Galen asthe basis for his systematic classification of herbs according to the herbs' properties. His system of grading herbs according to degrees of heat ar:d cold and dryness and moisture remained in use until the 18th century.3 In the early 19th century in North America, the Physiomedical movement of naturopathic herbal therapy developed from the work of Thomson. Its early phase included a duality of treatment principles: stimulate and relax, which can be regarded as a crude analogy to Yin-Yang theory. Later Physiomedical authors developed a more sophisticated understanding, and in 1890 Cook wrote:

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History 'Regularity in periods of alternate labor and rest is characteristic of all vital action...the earliest departure of the tissues from under the full control of the vital force will be in the lack of ability either to relax or to contract some of the tissues as readily as in the healthy state... ' 8

In the late 19th and early 20th century, Western physiologists described the body as a system in oscillating balance with values maintained within narrow limits. This concept was later termed homeostasis, and pathologically large fluctuations in the balance were described in terms of hyperfunction or hypofunction. In modem herbal therapy, treatments aim at strengthening the natural homeostatic mechanism of the body in order to correct any hyper- or hypofunction. This can be regarded as the principles of Hippocrates or of Cook put into modern terminology.

THE ELEMENTS

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In Chinese medicine, according to the theory of the Five Elements, all natural phenomena can be described in terms of transformations between the phases of Fire, Earth, Metal, Water, and Wood. This theory may have had its origins as early as 500 BC,9 but it was first systematized by Zou Yen about the 4th century BC. Medical application of the Five Element correspondences system, linking each phase to associated organs, tissues, and emotions, are given in the Huang di nei jing, possibly written about 200 BC. However, according to Jia De-dao,lo it was not until the Song dynasty (960-1279 AD) that Five Element relationships were commonly used to explain disease processes. In ancient Greece, Empedocles, ",no lived about 450 BC, proposed that everything is composed of the four elements of fire, air, water, and earth, combined in differing proportions. According to Empedodes, these four dynamic principles underlie the transformations observed in both man and nature. The first record of the medical applications of the Greek Four Element theory is found in the writings of Hippocrates in the 5th century BC. Hippocrates linked the four elements to the four seasons and to the four humors of the body (see below). He taught that the four humors vary in strength according to the season, for example, phlegm increases in a man in the winter. because phlegm is the coldest constituent of the body and most closely akin to winter. Each season therefore has its characteristic diseases. I ~ It seems more than coincidence that the very similar theories of Four Elements and Five Elements should arise within about one century of each other in Greece and China, respectively. According to Unschuld," a philosophical impulse may have spread from an unknown source somewhere

5

between Greece and China, and may then have been modified according to the different intellectual environments of the two cultures.

Primary qualities In addition to the theory of the Four Elements-fire, air, water, and earth-both Aristotle and Hippocrates also used the concept of the four primary qualities: hot, cold, dry, and moist. I 2.13 These can be regarded as two pairs of complementary opposites: • hot and cold • dry and moist

Each element was said to incorporate a pair of primary qualities, one relating to temperature and the other relating to humidity. Fire was said to be hot and dry, air to be hot and moist. earth to be cold and dry, and water to be cold and moist. 11 In the medical system of the Hippocratic school, each element, \Yith its associated pair of primary qualities, was assigned a corresponding humor and temperament. This system of element correspondences resembles that of the Five Elements in Chinese medicine, as described in the Huang di nei jingo Elements fire air earth water

Primary qualities

Humor -'c'-Temperament·

hot and dry hot and moist cold and dry cold and moist

yellow bile blood black bile phlegm

choleric sanguine melancholic phlegmatic

The Four Humors In the Hippocratic system, it was believed that the human body was composed of four 'humors' or vital fluids: yellow bile, blood, black bile, and phlegm. Each of the Four Humors was linked to one of the Four Elements and to a pair of primary qualities, as shown in the table. Disease was thought to result from disturbance in the humoral balance. The humors were considered as partly material and partly energetic, similar to the concept of the Substances of Chinese medicine: Qi, Blood, Jing, Spirit, and Fluids. Forerunners of the modem concepts of Qi, Blood, Jing, Spirit, and Fluids can be found in the Huang di nei jing and may date back to the 2nd century BC. I ' The Four Temperaments Each of the four humors was associated with a temperament. Yellow bile was associated with the choleric temperament, blood with the sanguine temperament, black bile with the melancholic temperament, and phlegm with the phlegmatic temperament. The temperament described a person's physical constitution and psychological type. When in balance, each temperament was associated with specific positive qualities, but

6

Combining Western Herbs and Chinese Medicine

when in excess, each temperament was associated with characteristic negative qualities. For example, when in balance, the choleric temperament confers the positive qualities of warmth, activity, and courage, but when in excess, the choleric temperament results in the negative qualities of anger and irritability. The temperament assigned to a particular individual depended on the relative proportions of the four humors in the body-yellow bile, blood, black bile, and phlegm-and on the relative proportions of the primary qualities-heat, cold, dryness, and moisture. For example, in a person of the phlegmatic temperament, the dominant humor would be phlegm, and the dominant qualities would be cold and moist. This has important implications for the maintenance of health or the origin of disease. For example, if a person of the phlegmatic temperament were to consume too much food with the cold and moist qualities, the humor phlegm would become excessive. In the words of Culpeper, the person would become sleepy, dull, slow, heavy, and forgetful, with dreams of floods and water, much spitting and nasal discharge, and a slow and deep pulse. 3 The principle of treatment in such a case would be to reduce the excess of coldness and moisture by providing climate, foods, or herbs that were of the opposite qualities of hot and dry..

Importance oftemperature and humidity in the treatment In the medical system of ancient Greece and Rome, correcting imbalances of humors and temperaments involved correcting imbalances between heat and cold, as well as dryness and moisture. It was for this reason that, in the 2nd century AD, Galen classified herbs so carefully in terms of their degree of temperature, and humidity. This is discussed below in the section Classification ofherbs byproperties and actions. Importance ofhumors and temperaments in the treatment Occasionally, up to the 17th century, Western texts described the therapeutic effect of herbs in terms of correcting humoral imbalances. For example, both Gerard l5 and Culpeper wrote that Berberis could cleanse the body of choleric humors. However, I have not seen any traditional Western text that systematically listed the humors or temperaments associated with each herb. Western herbal texts from the 16th and 17th centuries continued to describe the disorders treated by herbs in terms of pathologies of heat and cold, and moisture and dryness. However, the.texts increasingly described disorders in terms of organ system imbalances rather than imbalances of humors or temperaments. For example, they used terms such as 'excessive moisture in the liver' and 'excessive cold in the stomach:

Similarly, traditional Chinese herbal texts did not generally describe herbs in terms of the Five Elements. Rather, the texts described the herbs in terms of syndromes of Substances, organ systems, and other pathologies, including Heat and Cold.

Classification ofherbs by properties and actions The theoretical approach to herb choice, in any medical paradigm, is based on assigning theoretical property values to each herb. Herbs with the appropriate property values can then be matched to specific syndromes. The evolution of Western herb classification according to temperature, humidity, and action is discussed below. Taste, as a theoretical concept, was of lesser importance in the West than in China. TEMPERATURE The polarity of fire and water was fundamental to ancient Greek philosophy, and in medicine, Hippocrates taught that health depended on a proper balance of heat and cold. Dioscorides was aware of this and sometimes described the general temperature effect of herbs.\ For example, he described Commiphora as warming. However, he did not consistently give herb temperatures in his materia medica, nor did he divide temperature into a number of grades. The systematic classification of herbs according to temperature was done by Galen of Pergamon (130-200 AD), and his model of nine degrees of temperature was influential for over 1,500 years. Galen's temperature classification Galen classified herbs according to nine temperature categories: temperate, hot in the first to the fourth degree, and cold in the first to the fourth degree. During its IS-century reign, the Galenic system went through various modifications. The description of Galenic categories given below comes from A Key to Galen's Method of Physic, written in 1651. This is included in Culpeper's Complete Herbal and English Physician Enlarged 3 and the herb examples given for each temperature category in this chapter are from A Catalogue of Simples in the New Dispensatory in that book.

Temperate These herbs correspond to the neutral category of the Chinese system (see the Temperature chapter) in that they do not have ~arming or cooling effect on the patient, and do not affect the temperature properties of other herbs in a combination to make them either hotter or colder. Temperate herbs were used in diseases lacking pathological man-

History ifestations of either heat or cold. An example is Ziziphus fruit (date).

Hot in the first degree These are herbs that just correspond to the natural heat of the body itself. They do not result in alteration to the body heat unless the body is slightly pathologically cool, in which case they help to restore the natural heat of the body. An example is Petroselinum root (parsley).

Hot in the second degree These herbs are slightly hotter than the natural temperature of the body. They were used to restore balance by their own force and strength when nature alone was unable to do so. An example is the aerial parts of Rosmarinus.

Hot in the third degree These were described as herbs sufficiently heating to inflame and cause fever if inappropriately prescribed. An example is Zingiber root.

Hot in the fourth degree These were described as herbs with the highest degree of heat, capable of causing blistering if topically applied. An example is Allium sativum (garlic).

Cold in the first degree These herbs are the least cold of the four cold categories and the least potentially damaging to the natural heat of the body. They were used to treat conditions that had only a slight degree of pathological heat, especially in children or people with weak. stomachs who it was believed were easily harmed by cold medicines. An example is Arctium leaves.

Cold in the second degree Culpeper listed the use of this category for those with a hot liver and a strong stomach. An example is Taraxacum herb.

Cold in the third degree

Culpeper did not clearly differentiate between herbs cold in the second and third degrees, that is, herbs cold in the third degree simply seem more cooling than those in the second degree in that they are used to treat hotter conditions. He described their use for the 'unbridled heat of choler' in persons with liver heat and a strong stomach. An example is Polygonum bistorta root.

7

and later writers, such as Tabernaemontanus 1i and Culpeper. For example, she classified wormwood as very hot, whilst Dioscorides listed it as warming and T~bernaemontanus listed it as warm in the fIrst degree. Galenic system during the 16th-19th centuries Whilst Culpeper used Galen's temperature system in the section A Catalogue of Simples in the New Dispensatory in his book, he did not consistently use it in the individual entries of his materia medica and often used looser terms such as warming or cooling. More systematic authors, such as Tabernaemontanus and Gerard, consistently used Galen's nine-category system. Since their texts were used as standards into the 18th century, herbal practitioners would have been familiar with Galen's system up t9 that time, even if they did not use it in its full rigor. Use of the Galenic temperature classifIcation system appears to have declined in the West during the 19th century, and no other system of classification of herbs by temperature seems to have replaced it in general use. Physiomedical and Eclectic texts There is considerable overlap between the Physiomedical and Eclectic movements, and both were derived in part from the work of Samuel Thomson (see below). The Physiomedical movement was characterized by belief in a vital force and in the restoration of health by balancing stimulation and relaxation of the body and tissues. The Eclectics were generally medical doctors who specialized in botanic medicine. In their fmal flowering in the late 19th and early 20th centuries, the Eclectic physicians made enormous advances in the detailed knowledge of individual herbs, often incorporating the new biochemical knowledge of the time. They also ma~e advances in botanical pharmacy, that is, in the extraction and processing of botanical preparations. (See Pharmacy and Pharmacognosy by lloyd in Ellingwood's text. IS) It should be noted that neither of these two groups of North American practitioners used a systematic temperature classification.

Physiomedical texts In Physiomedical theory, the fundaCold in the fourth degree Herbs in this category were used 'to stupify the senses' and used, for example, in cases of violent pain. An example is the aerial parts of Hyoscyamus niger (henbane).

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Hildegard von Bingen Not all practitioners used Galen's system. For example, Hildegard von Bingen 16 used a less structured classification, including the categories of very hot, hot, slightly hot, neither hot nor cold, cold, and very cold, which is closer to the Chinese system than to that of Galen. She tended to classify herbs as hotter than earlier writers of the Graeco-Roman era, such as Dioscorides and Galen,

mental principle of treatment was to support the natural heat of the body. Warming herbs played a greater role in treatment than cooling herbs. However, herbs that warm the body were not usually described as warming herbs but as 'stimulating' herbs. Similarly, herbs that cool were not usually described as c;oling herbs but as 'relaxing' herbs. For example, Lyle described Capsicum, Myrica, Zanthoxylum, and Zingiber not as hot herbs but as stimulant herbs, and he described Asclepias not as a cold herb but as a relaxant herb. 19

Eclectic texts Like the Physiomedicalists, the Eclectic authors Felter, lloyd, and Ellingwood did not usually describe herbs

Combining Western Herbs and Chinese Medicine

8

as warming or cooling. However, the Eclectics had a more sophisticated understanding of the multiple actions of individual herbs than the Physiomedicalists, and they considered the division of herbs into stimulants and relaxants less important. For example, the Eclectics described Capsicum as stimulant, but did not specifically classify Asclepias as relaxant. Modem texts Neither the herbal of Grieve of 1931 20 nor the BHP of 198Yl described herbs in terms of warming or cooling, and the division of herbs into stimulants and relaxants, in the Physiomedical sense, is rarely used in these texts. Later works, with a bias towards pharmacology rather than practical instructions for herb use, such as the BHC of 1992~ and the ESCOP monographs of 1996,23 do not describe herbs in terms of temperature. However, Tierra's Planetary Herbology of 1988 24 classified herbs in terms of temperature, using the Chinese temperature grades of hot, warm, slightly warm, neutral, cool. and cold. The temperature values assigned to individual herbs follow the temperature values given in Chinese texts where these are available. I have adopted the same six Chinese temperature divisions. However, in assigning temperature values for herbs discussed in this current text, I have weighed traditional Western and traditional Chinese sources, pharmacological and clinical research, and my own personal experience (see the Temperature chapter).

HUMIDITY In the medical system of Hippocrates, the concept of humidity was of fundamental importance. The four humors and their associated temperaments were each composed of a pair of primary qualities, one relating to temperature and the other relating to humidity. For example, the melancholy temperament, associated with the humor black bile, was based on the pairing of the qualities of cold and dryness. An excess of black bile would involve an excess of cold and dryness, and could be corrected by the use of herbs that were hot and moist in quality. Correcting imbalances of humors and temperaments, therefore, involved correcting an imbalance between dryness and. m()isture as well as an imbalance between heat and cold; accordingly, foods and herbs were classified according to their humidity ~ well as their temperature. It was understoodth~t' foods and herbs~oUld'change their properties deperidirig ~n their o~i~, d~gree of 'fr~~hness, and mode of preparation~For example, in the Sth century BC, Hippocrates classified barley as cold and moistening or cold and drying, depending ~ri the way in which it was prepared. II

In the 2nd century AD, Galen classified herbs according to their degree of humidity as well as their degree of temperature. In his classification, he used the categories of dry in the first, second, third, or fourth degree, and moist in the first, second, -third, or fourth degree. Whilst the classification of herbs as dry or moist remained important in the West into the 18th century, the classification of herbs into specific degrees of humidity never seem to have been regarded as important as degrees of temperature. Hildegard von Bingen generally described herbs as simply drying or moistening. Although he listed herbs according to degrees of moisture in the section A Catalogue ofSimples in the New Dispensatory, Culpeper usually omitted some of the Galenic degrees of moisture. In addition, the individual entries in his materia medica section usually simply stated whether the herb is drying or moistening. Gerard and Tabernaemontanus often classified herbs in terms of degrees of moisture, but they did so less consistently than they classified them in terms of degrees of temperature. Later authors have rarely gone beyond occasional general statements that a herb is drying or moistening. Similarly, in Chinese tradition, herbs are not divided into different grades with respect to humidity. They may, however, be described in general terms as drying or moistening.

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TASTE Dioscorides sometimes described the taste of herbs in his materia medica. For example, he described the berries of Juniperus as sweet and slightly bitter, and Commiphora resin as pungent. However, taste does not appear to have been developed as a theoretical concept in the West as it was in China (see the Taste chapter). It is only recently in the West that the taste and olfactory sensations have been associated with specific therapeutic effects, for example the bitter digestive tonic and aromatic carminative actions.

ACTIONS Since Graeco-Roman times, herbs have been classified in terms of their actions, that is, the type of therapeutic effects they have on the body. Empirical and theoretical actions The names given to actions can be roughly divided into two types: the relatively empirical and the relatively theoretical.

Empirical actions These action names simply state the desired therapeutic effect without implying the mechanism by which it is to be achieved. For example, if the patient has inadequate urination, then the required therapeutic effect isto promote urination.

History

9

Theoretical actions These action names imply a theoretical mechanism by which the effect is ac.llleved. The theoretical cephalicals pectorals cordials stomachicals hepatics splenicals nephriticals hystericals arthriticals

action mechanism is linked to the theories of etiology and pathology used by the particular medical paradigm. For example, in the Physiomedical paradigm, arthritis was often associated with accumulations of toxins in the blood. It was therefore appropriate to use a herb with the alterative action in order to clear the body of toxins and thus relieve the arthritis.

The terms 'cephalics,' 'pectorals: 'cordials,' and 'stomachics' were used in herbal medicine into the 1970s,25 and the term 'hepatics' is still in use as an action category.

Dioscorides In his materia medica, Dioscorides often described a herb in terms of its actions. The names used by Dioscorides for these therapeutic effects reflect his own nature, which was empirical rather than theoretical. The

Actions and specific organ syndromes. In both China and

words representing an action are very close to words for the associated disorder. For example, if the patient has a wound and is bleeding, the appropriate actions are to stop the bleeding and heal the wound. There is no implication of the theoretical mechanism by which the action is effected. Other therapeutic effects mentioned by Dioscorides include promote urination, induce menstruation, and increase lactation. Galen The action categories of Galen are described by Culpeper in Section III of A Key to Galen's Method ofPhysic.3 Some of these, such as 'medicines provoking urine: are like those of Dioscorides in that they simply refer to a therapeutic effect and do not imply a theoretical mechanism via which the effect is attained. Other action categories used by Galen are closely related to theoretical concepts, and their empirical use is not always clear. For example, theoretically, 'emollient' medicines were considered to soften that which is hard, to moisten that 3

which is dry, and 'to warm that which is congealed by cold: However, the exact empirical effect of the emollient action was not clear in Culpeper's account. This was due to his dis-

agreements with other authors over the theoretical definition of this action.

Actions and organs Galen was not merely a theoretician, he was a man of complex nature and many accomplishments..

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He was one of the fathers of modern anatomy and physiology, whose knowledge of anatomy came from his own dissections and whose contributions to physiology came from his own experiments. It is not surprising, therefore, that many of

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his action categories related to specific organ systems and

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parts of the body. In section II of his chapter A Key to Galen's Method of

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Physic, Culpeper described the following types of medicine that have their action on specific parts of the body:

head lungs heart stomach liver spleen kidney and bladder uterus joints

the West, actions were often linked not only to a specific organ system, but also to a specific organ system syndrome. In China, the first texts giving systematic association between actions and specific organ syndromes were those of Zhang Yuan-Su in the 12th century AD. For example; Zhang Yuan-Su wrote that Coptis (huang lian) drains Heart Fire, and Ligusticum (chuan xiong) disperses the Liver. 26 In the Galenic system described by Culpeper, actions were sometimes associated with specific organ syndromes. For example, Berberis was given to clear liver heat, Chelidonium was given to open obstructions of the liver and gallbladder, and Rosmarinus was given to clear melancholy vapors from the heart. However, individual herbs were not consistently associated with specific organ syndromes in 16th and 17th century Western materia medica. Physiomedical action categories Certain empirical actions, such as diaphoretic, diuretic, and purgative, seem to be basic to all medical systems. However, individual empirical actions were often subdivided into different types, according to their theoretical mechanisms within the particular medical paradigm. The Physiomedical authors subdivided herbal action categories according to their theory of the need to balance stimulation and relaxation. For example, Lyle described Zingiber as a stimulating diaphoretic, Asclepias as a relaxing diaphoretic, Juniperus as a stimulating diuretic, and Eupatorium purpureum as a relaxing diuretic. Eclectic action categories The later Eclectics tended to differ from the Physiomedicalists in that they were generally less influenced by the theory of relaxation and stimulation. and more influenced by recent advances in medical science. The action categories used by the Eclectics reflect their convergence with what is now called 'conventional medicine.' For example, the Eclectic doctor Ellingwood used the categories of sedatives, hypnotics, narcotics, anesthetics, ane.

Combining Western Herbs and Chinese Medicine

10

analgesics in common with the more orthodox doctors of :Us day. However, the Eclectics continued to use action categories associated with holistic practice, such as tonics and alteratives. The tonics were used to strengthen the circulatory and digestive systems, and to help the body to heal itself. The alteratives were used to cleanse the body of the toxins that were seen as the root of many disorders.

Skin

irritants caustics emmolients demulcents protectives

Stomach, liver, and digestive system

emetics antiemetics digestives hepatics astringents carminatives sialagogues antisialogogues apositics dentifrices

_4nticatarrhal action The Eclectics also emphasized the .l1l1portance of the anticatarrhal action. This was linked to :ne theory that oversecretion by the mucous membranes =auld lead to the obstruction of the ducts of the body by =atarrh (phlegm). This catarrhal obstruction could then lead -r:J dysfunction of the respiratory, digestive, hepatobiliary, u:-inary, or reproductive system. They used anticatarrhal =l~bs, such as Hydrastis and Myrica, to strengthen and tone :ne mucous membranes in order to normalize mucus secre::Ion and thus clear catarrhal states.

Antimicrobial

antizymotics deodorants parasiticides antihelmintics

Nutrition and the blood

restoratives alteratives

Miscellaneous

antidotes antagonists hemostatics styptics

~liingwoo'd's

action categories In 1919, the Eclectic practi::lOner Ellingwood listed the following main action categories, .;.argely according to organ systems:

-ervous system

sedatives' depressants excitants stimulants analeptics

::::cretory systems

cathartics diuretics renal sedatives diluents antilithics diaphoretics antihidrotics vesical tonics vesical sedatives

-"".mrt and circulatory system

~nroductive

system

~sDiratory system

cardiacs vasomotors antipyretics aphrodisiacs anaphrodisiacs emmenagogues uterine tonics uterine sedatives oxytocics abortifacients galaetagogues antigalaetagogues acting on respiratory muscles acting on lung tissue acting on mucus membranes

The list is fascinating since it reflects the state of development of herbal medicine at that time, its underlying philosophy, and its theoretical base. It can be seen from the list that many of the action categories in modern Western herbal medicine were already in place by the beginning of the 20th century. (The reader is referred to Ellingwood's text for definitions of the action categories listed.) Terms borrowed from conventional medicine Many of the Western herbal action categories that have been added later in the 20th century have been adopted from conventional medicine. Examples are: antiallergic, antianginal, antiatheromatic, antihypertensive, anti-inflammatory, antimigraine, antioxidant, and hepatoprotective. Some of these terms, for example, 'anti-inflammatory' and 'antihypertensive,' refer to an empirical general effect without specifying the theoretical mechanisms by which they are produced, in terms of the paradigm of biochemistry.

Actions in terms of biochemical mechanism However, conventional medicine often classifies medicines first according to general action group, and then according to the specific biochemical mechanism by which the action is achieved. For example, the term antihypertensive refers to the general action group of medicines used to reduce blood pressure, which can then be subdivided into such categories as:

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History • angiotensin-converting enzyme inlubitors • angiotensin receptor antagonists • beta-blockers • calcium channel blockers • potassium-sparing diuretics • thiazide diuretics • loop diuretics • selective alpha-l adrenergic blockers • antiadrenergic agents

11

inventory from Babylon, the capital city of ancient Mesapotarnia, listed 200 similar substances in the first millennium BC. 28 The early herbals of ancient Greece may have included much material from earlier Egyptian and Mesopotamian records, but only fragments of the latter have survived. This discussion of the historical development of materia medica therefore starts in ancient Greece. ANCIENT GREECE

Application to herbal medicine This system of subdividing actions according to a proposed biochemical mechanism can be applied to the individual active constituents of Western herbs in cases in which the biochemical mechanism of action is known. However, some herbs have more than one active constituent contributing to each action, each with their own biochemical me~hanism. In such cases, it is necessary to evaluate the relative contributions of the different action mechanisms. For example, two different types of chemicals contribute to the antispasmodic action of Thymus vulgaris: • the monoterpenoid phenols thymol and carvacrol • the flavonoids thymonin and cirsilineol The biochemical mechanism of action of the flavonoids may be due to inhibition of calcium ion flow, but the mechanism for the monoterpenoid phenols is not yet known (see the Thymus chapter). As more becomes known of the pharmacology of active constituents, the subdivision of herbal actions according to biochemical mechanism will become more widespread. This can be a positive step forward, providing that preoccupation with mechanistic detail does not replace the holistic approach.

History of materia medica The first great civiliz~tions developed about 3000 BC in the fertile river basins of the Nile, Tigris-Euphrates, Indus, and Huang-Ho. Information on herbs, and the herbs themselves, may have been exchanged in gradual stages via early trade routes. There may have been an exchange between Egypt and Mesopotamia, Mesopotamia and India, and possibly even between India and China. For example. the Ebers Papyrus. written in Egypt about 1500 BC referred to over 500 different substances-:-induding minerals. plants. and animal products-and co~tilils 876 formulations made from these substances. 27 Perhaps due to cultural exchange via the early trade routes, a pharmacy

In addition to his enormous output in virtually every field of knowledge, Aristotle founded a botanic garden in Athens, and wrote a text on plants. Fragments of his book have been found but are too incomplete to gain a detailed picture of this work. Aristotle's botanic garden was inherited by his disciple Theophrastus of Eresos (370-c. 285 BC) who developed the study of plant morphology to a level which w:as not substantially raised until the development of the lenses and the microscope nearly 2,000 years later. 29 His accurate and detailed observation and his insight made a great contribution to the development of scientific botany and facilitated accurate naming and description of medical herbs by later authors. The earliest Greek text on medicinal plants and their effects on the body may have been the Rhizotomikon written in the 4th century BC by Diodes of Caryatos, a disciple of Aristotle. 30 In the 1st century BC, an illustrated herbal was produced by Crataeus, the physician of King Mithridates of Pontus, but only fragments of the text have survived. 3O ANCIENT ROME Dioscorides The most famous text on herbal medicine surviving from the ancient Graeco-Roman world was the De Materia Medica of Pedanius Dioscorides in the 1st century AD. Dioscorides was a doctor traveling with the Roman armies of Emperor Nero. He brought together the existing information on medical substances and described each one in a clear, accurate, and practical manner. Dioscorides' excellent work remained the standard text until the great expansion of herbal knowledge in the 16th century. Even then, his work was regarded as authoritative and was continually quoted by later herbalists. For example, Dioscorides described the berries of Juniperus as slightly warming, astringent, sweet, and slightly bitter. and noted their use to treat stomach pain. bloating and gripes, chest diseases and cough. decreased urination, cramps, and uterine pains. About 1,500 years later. Culpeper used this description almost word for word. Even more remarkable. all of the indications of Dioscorides for

12

Combining Western Herbs and Chinese Medicine

Juniperus were repeated by the American herbalist Jethro Kloss in his text of 1939. 31 Whether American herbal practitioners know it or not, the entries for some herbs in standard American texts, such as those by Kloss and Christopher, have a basis in the material set down in the 1st century AD by Dioscorides, the founding father of Western phytotherapy. It is interesting that the first book in China with systematic descriptions of individual herbs was also written about the 1st century AD. This was the Shen nong ben cao jing, (Classic ofthe Materia Medica), written by unknown authors. Both this book and the materia medica of Dioscorides described herbs in practical terms, rather than in terms of magic. Also, both books were empirical rather than theoreti.:al. Neither book consistently classified herbs in terms of theoretical properties and linked these to therapeutic effects. This theoretical systematization began in China about 600 AD with the Yao xing ben cao (Materia Medica of Medicinal Properties), and in the West in the 2nd century AD with the work of Galen. Pliny Another Roman author who was much quoted by 16th and 17th century herbalists was Pliny the Elder (23-79 AD). His Historia Naturalis was compiled in the 1st century AD from the work of many Greek and Roman authors. This Lext perpetuated many earlier errors, and Pliny himself may .nave had no direct experience as a physician. However, his work was a great storehouse of information, and as Stearn ?oints out, it 'was of great importance in the medieval and Renaissance period as the major surviving work of Latin a..,tiquity. Many Greek concepts and plant names came to the notice of lQth century herbalists through the Latin of ":J.. )'9 _llilY· -

Pliny sometimes listed the medical uses of plants. For ~ple, Tabernaemontanus wrote that, according to Pliny,

::;entiana lutea is a good stomach remedy taken with water -v.rhen there is a fever or taken with wine when there is no :Ever. Also, Culpeper wrote that, according to Pliny, Salvia ?rocureth women's courses, and stays them from coming :lawn too fast.' However, the contribution of Pliny was more D botany; especially to botanical terminology; than to herbal :nedicine. ::'alen of Pergamon Galen has been described as 'the most .::illuential man and one of the most prolific writers in med..::al history.'32 In the 2nd century AD,he made extraordinary =::mtributions to the knowledge of anatomy and physiology, ~d wrote on the circulation of the blood, pulse diagnosis, ...nd the physiology of the brain and nervous system. In addition to his undeniable talent for observation and ==periment, Galen had a perhaps overly strong theoretical :.ent. He systematized the theories of Hippocrates -and

Aristotle, and used his very structured system to produce a very detailed classification of herbs according to theoretical properties (see the discussion on Temperature above). The application of his system profoundly influenced later materia medica. The great gift of Galen to Western herbal medicine was to provide a classification of herbs according to theoretical principles, comparable to those employed in Chinese herbal medicine (see above). Unfortunately, Galen produced a theoretical framework for herbal medicine that was perhaps overly complex and rigid, and he had a tendency to force the facts to fit this framework. If there had been an immediate successor to Galen with a more critical and flexible approach, the history of medicine and of phytotherapy may have taken a very different course.32 This was not the case, and Galen's death in 200 AD was followed by the decline of Roman civilization, culminating in the sacking of Rome by the Vandals in 455 AD. According to one author, 'in all history there is no full stop more emphatic than the death of Galen. For fifteen centuries after his death, Galen's doctrines carried almost the authority of scripture.'32 Throughout the Middle Ages in Christian Europe, from the fall of Rome to the Renaissance in the 15th century, there were no great innovations or expansions in the theory of herbal medicine.

. i¥o'"

-..:..:.

MIDDLE AGES During the Middle Ages, the shock and uncertainty following the fall of Rome and the destabilization of Western civilization may have contributed to the closed mind-set that inhibited questioning and critical investigation. The desire to preserve the doctrines of the past led to a stifling of innovation in the present. In the Christian world, to question the words of Aristotle was tantamount to questioning the authority of the Church and was strongly discouraged. The three main groups who kept herbal medicine alive in the West in the Middle Ages were the physicians of the Islamic world, the healers in the Christian monasteries, and the uneducated herbal practitioners. Islamic physicians The years following the fall of Rome up to about 1000 AD have been called the Dark Ages, and they were a nadir for the development of philosophy, science, and medicine iIi Christian Europe. However, these years saw the birth and flowering of Islamic culture. and the preservation . of Graeco-Roman science and medicine within the Islamic countries.)y·~e_.9th century. the works of Hippocrates, DioscoIides~_aIidGalen had been translated into Arabic.

Rhazes Islamic medicine was at first inspired by the teachings of the Hippocratic school, which emphasized preven-

History tion and minimally intrusive treatment. This was reflected in the writings of the Persian physician Ar-Rhazi (869-925 AD) who became known as Rhazes in the West. He wrote that 'where a cure can be obtained by diet, use no drugs, and 30 avoid complex remedies where simple ones will suffice:

Avicenna One of the most celebrated Moslem physicians was the Persian Ibn Sina (980-1037), known in the West as Avicenna. His book, the Canon of Medicine,33 was a magnificent compilation of Graeco-Roman and Islamic medicine, and became a standard text, not only in the Islamic world, but later in Christian Europe as well. Avicenna was perhaps more influenced by Galen than by Hippocrates, and like Galen, he had a tendency to favor elaborate theoretical systems. The writings of Avicenna gave such an impression of completeness and authority that, combined with his championing of Aristotle and Galen, they were readily accepted:in medieval Europe. This had the unfortunate result of ~inforcing the dogmatic adherence to the Galenic system within the Christian countries.

Islamic materia medica and pharmacy The Islamic physicians greatly enlarged the range of herbs used by the Greeks and Romans. They added many medicinal plants from North Africa, Arabia, and Persia, and herbs and spices brought via the trade routes from India and the Far East. They may have introduced the carminative spices Eugenia (cloves) and Myristica (nutmeg), and the purgative use of Cassia (senna) and Rheum (rhubarb). The materia medica of Ibn Baitar (died 1248) listed more than 2000 substances. About 1750 were plants, the others were animal products and minerals..l-I This expansion of the materia medica was a true contribution by the Arabian doctors. However, Islamic pharmacists began to produce increasingly complex herb combinations containing expensive and exotic ingredients and involving elaborate preparation. This highly profitable practice was continued by European apothecaries from the 12th century onwards, and such herbal treatment rapidly became beyond the reach of all but the rich (see the section on Culpeper below). Christian monasteries During the Dark Ages in Christian Europe, the monasteries were one of the few places where learning was preserved and where ordinary people could receive medical treatment. One of the duties of monastic life, laid down by Benedict of Nursia in the 6th century, was caring for the sick. Some of the monks and nuns were encouraged to study herbs and the'preparation of medicines; and to become familiar with the works of Hippocrates, Dioscorides, and Galen.30 In the 12th century, a Benedictine abbess of the Rhine-

13

land wrote one of the most important herbals of the Middle Ages. This was Hildegard von Bingen, and her main medical text is known today as Physica. 16 Her book is clearly written and contains a wealth of practical experience. Whilst she described herbs as hot or cold and moist or dry, she did not use the elaborate nine-grade classifications of Galen for degrees of heat or moisture. However, she sometimes described herbs in terms of treating imbalance of the humors or temperaments, especially of phlegm and melancholy. Uneducated herbalists So far this discussion has focused on the written tradition of Western herbal medicine. Whilst the materia medica of Dioscorides was based on empirical knowledge, the medicine practiced by followers of Galen emphasized prescribing herbs according to theoretical principles. This found its extreme manifestation in the Arabian elaborations of the Galenic system with their complex multiherb prescriptions. In the Middle Ages, most people were poor and could not read, so that Galenic medicine was beyond their reach. Unless treated in the monasteries by educated monks or nuns, the only herbal medicine available to the majority was that supplied by uneducated persons, whose knowledge of herbs came from oral tradition and personal experience. These empirical practitioners kept alive a detailed and practical knowledge of the use of single herbs, also known as 'simples: This folk knowledge may often have been recorded in writing by more literate colleagues and formed an important source for both medieval and Renaissance materia medlca. RENAISSANCE The Renaissance is the term applied to the period irl the 14th-16th centuries when there was a rebirth of the irlvestigative spirit and a questioning of religious and other dogmas in Christian Europe. As with the 5th century Be irl ancient Greece, there was an increase in intellectual activity and an advancement of science and invention, in addition to new developments in art and literature. This renewed interest irl detailed observation, objective description, and experimentation gave new life to the study of herbal medicine. In Germany, new herbals were written by Otto Brunfels (1530), Hieronymus Bock (1539), and Leonhard Fuchs (1543). What distinguished these works from those of earlier herbalists was the very detailed description of each plant and the more accurate illustrations (see Publishers Note in Gerard. 15 ) In the second half of the 15th century, some of the most famous books on herbal medicirle were published. In 1583, the Flemish author Rembert Dodoens published his second

Combining Western Herbs and Chinese Medicine

14

and larger herbal, and in 1588, Jakob Dieter of Bergzabern, under the name of Tabernaemontanus, compiled one of the greatest materia medica of all time. In England, the most popular herbal was that of John Gerard published in 1597. The text of Gerard's herbal was based on a translation into English of Dodoens herbal of 1583, and most of the illustrations were from Jakob Dieter's herbal of 1588. 17 Tabernaemontanus Jakob Dieter was a doctor and pharmacist, and a student of Hieronymus Bock. Dieter wrote what has been claimed to be the most comprehensive Western herbal: the 1,660 pages of the 1731 edition of this book, revised by Hieronymus Bauhinus, contain more than 3,000 herb studies and about 2,500 illustrations. I, This wonderful book contains very thorough descriptions of the plants, with a discussion of their many names in different languages and extraordinary detail of their practical use. It classifies the temperature and humidity of each her~ a~co_r
17

TH

AND 18

TH

CENTURIES

During these centuries in Germany, the most influential herbal text appears to have been that of Tabernaemontanus, whilst in Britain, the most popular materia medica were the Gerard-Johnson herbal of 1633 and Culpeper's herbal of 1652. However, during the 18th century in Europe, advances in the study of herbs came not so much from new materia medica, but from the advances in plant taxonomy that culminated in the system of Carl Linnaeus. In North America, the 17th and 18th centuries saw an increased use of Native American herbs by the settlers. In this time. there were the beginnings of the integration of the use of indigenous herbs and European herbs that can be seen in the North American materia medica of the later 19th century. Gerard In 1633, the Gerard herbal was revised and enlarged by Thomas Johnson. He was a more rigorous scholar than Gerard who corrected Gerard's errors and added material from his own botanical observations and from European herbals published after 1597. The Gerard-Johnson herbal described about 800 plants more than the original Gerard text, bringing the tqtal to about 2,850 plants. Like the materia medica by Tabernaemontanus, the Gerard-Johnson herbal classified herb: te!Dperature and moisture according to Galen'ssystem,:an,~,~s~~et.iInesthe herbal described the effect of the herb in t~rin.s correcting the balance of the humors and temperaments.~stnot as thorough as the work of Tabernaemontanus,the herbal is

of

nevertheless a most useful book and remained for many years the most detailed materia medica in the English language. Culpeper Nicholas Culpeper can be said to have made five great contributions to herbal medicine. Firstly, he wrote an excellent materia medica in which the properties and uses of the individual herbs were so clearly and vividly described that his book is still one of the most clinically useful texts available. Secondly, in 1651, Culpeper wrote a clear description of Galen's principles of herb prescription (A Key to Galen's Method of Physic), which appears to be the only adequate description of Galen's work on herbal medicine currently available in English. Thirdly, Culpeper is famous for simplifying and demystifying the medicine of the day. This included the translating of Latin into English. Latin had been used as a means to keep medical knowledge in the hands of the privileged few, and away from the populace. As a result of Culpeper's efforts, simple remedies could be understood and used by the ordinary people. Fourthly, Culpeper objected to the expensive and complicated herbal formulations of the day. He wanted to teach people to use herbs that grew in England and were inexpensive and readily available. He believed that English herbs '-'.' were best fitted for English bodies, and he did not include -, v. expensive foreign herbs in his materia medica. Cinnamon, cloves, nutmeg, and even pepper and ginger did not have ~~ individual entries in the materia medica section of Culpeper's book. Fifthly, through his interest in astrology, Culpeper linked each herb to a specific planet. This can sometimes be useful since it can give an understanding of the direction of energy of the herb. For example, a herb governed by the sun, such as Rosmarinus, is likely to have a warming and outward- ~ " dispersing or centrifugal energy. This is comparable to the descriptions of herbs in terms of direction of energy found in Chinese medicine. '-

Culpeper as a source for modern herbal texts Culpeper was strongly influenced by Dioscorides, to whom he often ref- _ ered. The brevity, clarity, and practicality of Dioscorides probably appealed strongly to Culpeper. Often, the wording of the herb uses in Culpeper's materia medica suggests that _ these were taken with very little alteration from Dioscorides'

text. . '. In his turn, Culpeper has had an enormous influence on __ m~y, modern herbal· texts. A Modern Herbal, written by Mary' Grieve in 1931, refers extensively to Culpeper. The classic American herbal text School of Natural Healing pub- __ lished in 1976 by John Christopher,zs included many herb

History indications that seem to have been directly lifted from Culpeper. For example, Culpeper wrote that Juniperus berries 'strengthen the brain exceedingly, help the memory, and fortify the sight by strengthening the optic nerves.' Christopher wrote that this herb 'is a strengthener of the brain, memory and optic nerve.' Many modern herbal texts in the English language, whether British or American, contain material from Culpeper's herbal, and much of this material derives from the materia medica of Dioscorides. Both practitioners and their patients owe a debt to these dedicated physicians. Linnaeus Correct plant identification is absolutely essential to safe and effective herbal medicine. This requires detailed and accurate plant description and a consistent system of plant naming. It is not always possible to be sure of the identity of plants referred to in the Graeco-Roman texts. For example, what Galen called Oxycantha appears to have been Berberis, whilst what Dioscorides called Oxycantha may have been Crataegus. Even in 16th and 17th century texts such as those by Tabernaemontanus and Gerard and Johnson, nomenclature can sometimes be confusing and identity uncertain. For example, the Gerard-Johnson herbal refered to Berberis as Spina acida or Oxycantha. The Swedish naturalist Carl Linnaeus (1707-1778) is the man associated with the introduction of a consistent system of nomenclature and identification for plants and animals. His works Species Plantarum (1753) and Genera Plantarum (1754) have been accepted by international agreement as the starting point for botanical nomenclature. Botanical names published before 1753 are termed 'pre-Linnaean' and are not recognized unless they were adopted by Linnaeus in 1753 or r later, or adopted by subsequent authors. ' North America The early settlers in North America, from the 17th century onwards, may have brought with them both oral and written herbal traditions from their countries of origin. Thus they may have had access both to European folk medicine and, via writers like Culpeper, to herbal knowledge from Graeco-Roman physicians, such as Dioscorides. They may also have brought with them European herbs in the form of seeds or ~ttings, but on arrival in America, they would come into contact with the herbs of the New World and with the herbal knowledge of the Native Americans. An early benefit of Native American herb knowledge was the use of spruce beer as a cure for scurvy, first recorded in 1652. Spruce beer was used by Captain Cook to prevent and cure scurvy in his long sea voyages in the late 18th cen-

T

r

tury.36 The early pioneers may have been living in conditions similar to those of the Native Americans themselves and

15

were too distant from towns to benefit from conventional medical assistance. As a result, they probably used a combination of European and Native American herbal medicine. However, the first American herbal, written by Samuel Stearns in 1772, rarely quoted Native American sources directly and revealed the author's ignorance of the ways in which the plants were used by the indigenous peoples. 30 It was not until the early 19th century that indigenous American herbs started to be popularized and Native American herbal knowledge to be generally acknowledged in print.

19 TH

CENTURY

The 19th century in North America was the time of the development of the Physiomedical and Eclectic movements of American herbal therapy. These movements integrated the use of both indigenous and European herbs. Thomson During the 19th century in North America, much conventional medicine consisted in giving massive doses of calomel (mercurous chloride) and draining the patient of huge amounts of blood. These crude and dangerous procedures assisted the growth of herbal medicine since this offered a less harmful and more effective alternative. Samuel Thomson (1769-1843) popularized the use of a system of naturopathic and herbal procedures, which appear to integrate the methods of Hippocrates with the practices of the Native Americans. However, whilst Thomson acknowledged and revered Hippocrates, he did not acknowledge the Native Americans as the source of much of his materia medica and methodology.30 More than a third of the 65 herbs listed by Lloyd as the main herbs used by Thomson are native to North America. 37 These include such famous American herbs as Hamamelis, Hydrastis, Lobelia, Myrica. and Zanthoxylum. The two herbs most frequently used by Thomson were Capsicum and Lobelia-the Yang and Y"m of his systemCapsicum to stimulate and Lobelia to relax. Thomson believed that all diseases are caused by cold and used: Capsicum to support the natural warmth of the body; he used a combination of Capsicum and Lobelia to manage fever. Thomson also emphasized the importance of clearing: the body of all obstructions and of all accumulated toxins. This was done by using diaphoretics and steam baths to produce sweating, and by the use of emetic and purgative herbs. Lyle The work of Thomson and his contemporaries provided the inspiration and the foundation for both the Physiomedical and Eclectic movements. In 1897, Lyle prod.uced the work Physio-Medical Therapeutics, Materia: Medica, and Pharmacy, which described the principles c£ Physiomedical treatment. It also provided an. extensive:

16

Combining Western Herbs and Chinese Medicine

materia medica in which herbs were not only described in terms of their uses but also in terms of the Physiomedical explanation of their effects on the body. For example, Myrica is described as a 'positive, diffusive, stimulating, astringent alterative and tonic... In hot infusion it gradually arouses the circulation and favors an outward flow of blood: Lyle's terminology was used by Priest and Priest in their book on Physiomedical herbal medicine written in 1982. 38 For example, they describe Myrica as 'positive diffusive stimulant-arouses circulation: In 1898, the revised edition of King's American Dispensatory was produced by Felter and Lloyd. 39 Felter and Lloyd

In my opinion, this is the greatest work on herbal medicine in the history of North America, ranking with the text of Tabernaemontanus as one of the greatest materia medica of all time. The 2,200 pages of this work integrate knowledge from five main sources. There is data derived from the mate. .ria medica of Dioscorides, from European folk medicine, from Native American tradition, from the extensive empirical testing of the herbs by the Eclectic practitiQners, and from the biochemical research of the times. A surprising amount of phytochemical and pharmacological knowledge existed in the late 19th century and was utilized by the Eclectics. For example. Stenhouse extracted the alkaloid sparteine from Sarothamnus in 1853,39 and in 1898, Felter and Lloyd described the use of sparteine to treat cardiac disorders such as cardiac weakness, arrhythmia, and cardiac edema.

20

TH

CENTURY

The Eclectic movement continued into the 20th century with the publication of such excellent materia medica as that of Ellingwood in 1919. However, following the Flexner report of 1910, the Physiomedical and Eclectic colleges were gradually driven out of business, and by 1938, they had all 30 closed. The Physiomedical and Eclectic movements greatly declined, and medicine became increasingly dominated by the new pharmaceuticals.

on Physiomedical principles and almost half the herbs taught were American. However, the American influence was not the only one on the British herbalists, and it is significant that the coat of arms of the NIMH is supported on one side by an ancient Egyptian physician and by a Native American herbalist on the other. In addition to the blending of the traditions of the Old and the New World, the Institute began to incorporate the concepts of modern Western medicine and phytopharmacology that were gaining ground in the late 19th century. All three of these influences on British phytotherapy are reflected in the BHP of 1983. British Herbal Pharmacopoeia This book was a milestone in the development of herbal medicine in Britain and was originally published in three sections between 1971 and 1974. The therapeutic sections of this work were compiled by Fletcher Hyde and can be said to represent the distilled wisdom of the senior practitioners of the NIMH. The BHP was the first scientific materia medica for trained practitioners published in Britain, superceding Grieve's text A Modern Herbal, originally published in 1931. The latter work is a useful source of information, and its historical data on individual herbs can be fascinating. However, it was written as much for the general public as for the trained practitioner, and by 1970, its biochemical information was out of date. Christopher's text Following the first installment of the BHP in 1971 in Britain, a materia medica of a very different kind was published in the United States, in 1976. This was School of Natural Healing by John Christopher, which was a text of North American naturopathic herbal medicine in the tradition of Thomson and Jethro Kloss. The BHP and Christopher's text both share the background of the Physiomedical tradition and the use of herbs indigenous to North America. However, the BHP illustrated the beginning of the trend in European phytotherapy to include increasing amounts of scientific data at the expense

The National Institute of Medical Herbalists From about 1840 onward, knowledge of American herbs and the teachings of the Physiomedicalists and Eclectics was spread in

of data on traditional use. For example, the entry for Lavandula in the BHP contained more than twice as much data on scientific aspects as on traditional therapeutics. Christopher was not interested in research data. He was a clinician and teacher who provided an invaluable wealth of

England by American lecturers such as Coffm and Beach.

practical information on the use of individual herbs. His

This knowledge was absorbed by the British herbal practitioners, who incorporated it into their practice and training.

materia medica is one of ~e very few that illustrate the actions and uses of each herb by giving a variety of combinations that include that herb. The combinations are given with practical notes on their use. Some of them are from earlier practitioners, such as Coffm. Lyle, Shook, and Nowell, but most of them may derive from Christopher himself.

In 1864, they founded the National AssoCiation of Medical Herbalists, which later became the National Institute of Medical Herbalists, the NIMH. As Mills has pointed out,4O up to the late 1970s, training for British herbalists was baSed

i

History

.~

Later texts

In the last 25 years, it can be said that there have

been three main influences on phytotherapy in the West: traditional Western herbal medicine, traditional Chinese herbal medicine, and phytopharmacological research. Some texts have concentrated on a description of the active constituents of medical plants,2z.41 or on pharmacological and clinical research. 4. 23 Others have begun to describe herbs in terms of both western and Chinese traditional medical theory.H.42 The challenge for materia medica of the immediate future ,:.1

is to utilize the positive contributions of all three paradigms.

'-'

This can broaden and deepen understanding of the individual herbs, so that they can be used more effectively and for a wider range of applications.

17

18. Ellingwood F. American Materia Medica, Therapeutics and Pharmacognosy. Hth edn. (l919). Reprinted by Eclectic Medical Publications. Sandy, Oregon (1994) 19. Lyle TJ. Physio-~!edical Therapeutics, ~!ateria Medica and Pharmacy. Originally published in Ohio (l897). Reprinted by the National Association of Medical Herbalists of Great Britain, London, United Kingdom (1932) 20. Grieve M. A Modern Herbal. vols. 1 and 2. Dover Publications, New York. New York (1971) 21. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 22. Bradley PR (ed). British Herbal Compendium, vol. 1. British Herbal Medicine Association, Bournemouth, United Kingdom (1992) 23. European Scientific Cooperative on Phytotherapy: Monographs on the Medicinal Uses of Plant Drugs. European Scientific Cooperative on Phytotherapy, Exeter, United Kingdom (1997) 24. Tierra M. Planetary Herbology. Lotus Press. Twin Lakes, Wisconsin (1988)

References 1. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad'K6lbl. Miinchen, Germany (1960) 2. jouanna j, Hippocrates. john Hopkins University Press, Baltimore, Maryland (1999) ,.0;1<'

3. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Reprinted by Meyerbooks. Glenwood, Illinois (1990) 4. Mills S, Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone. Edinburgh. United Kingdom

.~

(2000) 5. Mitchell M. Feng Yeo Wiseman N (eds). Shang Han Lun: On Cold Damage. Paradigm Publications, Brookline. Massachusetts (1999) 6. Porkert M. The Theoretical Foundations of Chinese Medicine. MIT Press. Cambridge. Massachusetts (1974) 7. Unschuld PU. Medicine in China: A History of Ideas. University of California Press, Berkeley. California (1985) 8. Cook WH. The Science and Practice of Medicine. Cincinnati (1893) 9. Needham j. Science and Civilization in China. vol. 2. Cambridge University Press. Cambridge, United Kingdom (1956) 10. Kaptchuk TJ. The Web That Has No Weaver. Congdon and Wedd. New York. New York (1983)

Ii.

jones WHS (trans!). Hippocrates vol. IV. Harvard University Press, Cambridge, Massachusetts (1998)

12. Waterfield R (trans!).Aristode: Physics. Oxford University Press, New York. New York (1999) 13. Tobyn G. Culpeper's Medicine. Element Books. Rockport, Massachusetts (1997)

27. Ackerknecht EH. Therapeutics: from the Primitives to the Twentieth Century. Hafner Press, New York. New York (1973) 28. Sigerest HE. Man and Medicine. WW Norton, New York, New. New York (1932) 29. Stearn WT. Botanical Latin, 4th edn.. Timber Press, Pordand, Oregon (1992) 30. Griggs B. Green Pharmacy: The History and Evolution of Western Herbal Medicine, 2nd edn. Healing Arts, Rochester, Vermont (1997) 31. Kloss T. Back to Eden, 5th edn. (1939). Reprinted by Lifeline Books. Santa Barbara, California (1975) 32. Wingate P. The Penguin Medical Encyclopedia. Penguin Books Ltd, Middlesex, United Kingdom (1976) 33. Bakhtiar L. The Canon of Medicine (al-Qanun fi'l-tibb): Avicenna. Kazi Publications Inc. Chicago, Illinois (1999) 34. Garrison FH. History of Medicine. WB Saunders. Philadelphia, Pennsylvania (1913.1968) 35. Blunt W. The Compleat Naturalist A Life of Linnaeus. William Collins. London, United Kingdom (1971) 36. Price AG (ed). The Explorations of Captain James Cook in the Pacific. Dover Publications. New York. New York (1971) 37. Lloyd JU. The Life and Medical Discoveries of Samuel Thomson. Lloy
ro.

39. Felter H¥i, Lloyd King's American DispenS
15. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas johnson. Dover Publica-

40. Mills S. The Essential Book of Herbal Medicine. ArkanaIPenguin Books. London, United Kingdom (1991)

16. Von Bingen H. Hildegard von Bingen's Physiea. Healing Arts, Rochester. Vermont (1998) 17. Tabernaemontanus JT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl. Miinchen. Germany (1993)

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26. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Easdand Press, Seattle, Washington (1986)

14. Veith I (transl). The Yellow Emperor's Oassie of Internal Medicine. University of California Press. Berkeley, California (1972)

tions. New York, New York (1975)

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25. Christopher JR. S<:hool of Natural Healing. BiWorld, Provo. Utah (1976)

41. Bisset NG (ed).lkrbal Drugs and Phytopharmaceuticals. English edn. Medpharm, stuttgart, Germany (1994). from 2nd German edn. Wichti M (ed) (1989) 42. Holmes P. The Energetics of Western Herbs. Artemis Press. Boulder; Colorado (1989)

Temperature O

principles of Western and Chinese traditional medicine is the concept of the bal-

NE OF THE FUNDAMENTAL

ance of heat and cold. The etiology and pathology of disease can be discussed in terms of the imbalance of heat and cold within the body, and sYndromes can be classified in terms of degrees of heat and cold. If herbs are also classified in terms of heat and cold, then herbs can be chosen to match disorders in order to correct the temperature balance of the body and restore

Terminology In this book, the terms 'heat' and 'cold' begin with a lowercase letter unless they specifically refer to a Chinese syndrome or concept, in which case, they begin with an uppercase letter: 'Heat'and 'Cold:

Temperature classification ofherbs

health.

For over 2,000 years, herbs have been divided into different temperature categories in both China and the West. In Chinese medicine, herbs are commonly divided into the five

Temperature classification of syndromes

temperature categories hot, warm, neutral, cool, and cold. l The additional category of slightly warm is also sometimes used.

In the terminology of traditional herbal medicine, the word 'temperature' refers to the degree of heat or cold manifested by the syndrome. It does not necessarily refer to body temperature, although this factor may be included. If the condition is classified as warm or hot, this general-

Various temperature classification systems have been used in the West, the most famous being that of Galen. He divided herbs into nine temperature categories: temperate; hot in the first, second, third, and fourth degree; and cold in the first, second, third, and fourth degree (see History chapter).

ly refers to systemic or local subjective sensations of heat, raised body temperature, or local areas hot to the touch, and often redness. This condition may be associated with hyper-

This book classifies herbs as hot, warm, neutral, cool, or cold, and sometimes uses the category of slightly warm for herbs intermediate between warm and neutral. The concept

function. If the condition is classified as cool or cold, this generally refers to systemic or local subjective sensations of cold, low-

of variable temperature is also introduced to describe herbs that can have more than one temperature effect, as discussed later in this chapter.

ered body temperature, or local areas cool to the touch, and often pillor. This condition may be associated with hypo-

function.

19

Combining Western Herbs and Chinese Medicine

20

Matching herbs to syndromes

cold. Culpeper summarized the Western tradition when he

As Galen pointed out, the temperature properties of herbs do not refer to the herbs themselves but to their effect on the human body.2 Herbs are classified by temperature in order to treat syndromes of specific degrees of heat and cold. A simple system for matching herbs and syndromes is shown in the table.

'{ beseech you to take notice of this, that seeing our bodies are nourished by heat, and we live by heat, no cold medicines are friendly to the body ... children, and such people whose stomachs are weak, are easily hurt by cold medicines:!

Herb

Syndrome hot warm neutral cool cold

cold cool neutral warm hot

These correspondences seem obvious, but failure to match correctly the temperatures of herbs and syndromes is one of the most common causes of adverse effects in herbal medicine. For example, if the practitioner incorrectly diagnoses the patient's syndrome as cold when it is cool and prescribes hot herbs instead of warm ones, the treatment may produce a syndrome of heat. Alternatively, the practitioner may correctly diagnose the patient's syndrome as cool and give warm herbs, but omit to tell the patient to stop taking the warm herbs as soon as there are no longer symptoms of cold. Continued use of the warm herbs may again re~ult in overcorrection and in symptoms of heat. It is therefore most important to have a thorough understanding of the principles of balancing heat and :old.

\'\TESTERN PRINCIPLES OF BALANCING HEAT AND COLD Traditional Western systems for the temperature classiiication of herbs rest on the following four principles of tem?erature balancing: • support the vital force • support the natural power of the body to heal itself • support the heat of the body • give only the minimum treatment to restore the temperatur~ b~ance ,

.

wrote:

Give only the minimum treatment to restore the temperature balance It was considered most important to use only herbs of a temperature just sufficient to correct the temperature imbalance of the body. This was considered especially important when using cold medicines. For example, if the patient had a slightly warm condition, they would require only herbs that are cold in the first degree in terms of Galen's classification system (see the History chapter). If the practitioner were to use herbs that are cold in the second and third degree, this might damage the vital force, the heat of the body, and the natural ability of the body to heal itself. This might result in the production of a syndrome of cold more serious than the original mlld heat condition.

!!!"J

Examples for the main temperature categories /

The categories of hot, warm, slightly warm, neutral, cool, and cold are discussed in this section, and examples of the herbs in each of these categories are given. The examples used are herbs that are discussed in either the individual materia medica chapters or the Additional herbs chapter of this book. Each of the individual materia medica chapters of this book gives the reasoning for assigning the specific temperature value for the title herb in the Limitations and Traditional sources sections of the chapter.

.j

HOT HERBS The following herbs are classified as hot in this book:

Capsicum

acrid

HT. SP, ST. IN, LU

Cinnamomum (bark)

acrid, sweet. aromatic

Sp' ST, IN, LU, HT, KI, UT

.

These principles are discussed hi the History chapter; the ~:ond two are also briefly reviewed here. .

.

:"l,'"

."{

2,npport the heat of the body Western medical tradition :~eved that warmth was the essential characteristic of life, ..:.td that in the human body, heat must predominate over

Zanthoxylum acrid. aromatic, (bark) 'it..;·:': _7'"''''''''0 bitter

HT, Sp,ST,IN

zanthoxylum (berries)

acrid, aromatic. bitter

HT, Sp, ST, IN

Zingiber (dried)

acrid, aromatic

LU, Sp, ST, IN, HT, UT

Zingiber (fresh)

acrid, aromatic

LU, Sp,ST, IN, UT

._l

Temperature Hot herbs are those that can have a strong warming effect on the body and are specifically used to treat cold disorders. Hot herbs can be especially associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):

21

Herb . Rosmarinus

aromatic. bitter.

A.Qel-t.t'i·'

Sanguinaria,

,bitter. acrid ~"···"'iJw"'·tc. vc..-..().O.. C'O' .... o/r: Schisandra sour

LU, HT, LR HT, KI, LU. LR

-uC)w~c\ac...

• metabolic stimulant • circulatory stimulant • warming diaphoretic • warming antirheumatic • counterirritant

tonify Yang of Kidney, Heart, or Spleen warm and move Qi and Blood clear Wmd Cold Damp clear Wmd Cold Damp, warm and move Qi and Blood topical irritant

Not all hot herbs have all these actions to the same degree. Also, each hot herb in the table above has its characteristic range of actions and uses. For example, a specific use of Capsicum is as a metabolic stimulant to tonify Heart Yang, and a specific use of Cinnamomum bark is to tonify Kidney Yang. Zanthoxylum is a circulatory stimulant that is specific for moving Qi and Blood to the extremities, and a specific use of fresh Zingiber is as a warming diaphoretic to clear Wind Cold. Caution Hot herbs should be used with caution since their excessive, prolonged, or inappropriate use may change a pathology of cold into a pathology of heat. Combinations with only hot herbs are rare. These herbs are usually combined with warm, neutral, variable-temperature, or even cool herbs, for a more gentle and gradual correction of the temperature imbalance. This will avoid adverse effects due to temperature overcorrection and the resulting oscillations between pathologies of cold and heat.

SymplocarPus . O:u,~ • ~O"",,,,",,,, Turnera )a~"""

HT. LR, Sp' ST, IN

acrid

LU,LR

bitter. aromatic, acrid

KI,Sp,IN

Warm herbs are those that can have a moderate warming effect on the body and that are specifically used to treat cool disorders. Warm herbs can be especially associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):

• warming tonic • carminative • warming antispasmodic • warming expectorant

tonify Qi and Yang move Qi of Spleen and Intestines move Qi and relax spasms clear Lung Phlegm Cold

In addition, some warm herbs can act as metabolic stimulants, circulatory stimulants, or warming antirheumatics, but generally to a lesser degree than hot herbs. Each of the warm herbs listed in the table has a characteristic range of actions and uses. For example, Turnera is specific as a warming tonic for Qi and Yang of the Kidney, whilst Elettaria relaxes spasms and is specific as a carminative to move the Qi of the Spleen and Intestines. A specific use of Angelica archangelica is as a warming expectorant, whilst A. sinensis is more often used as a warming tonic for Qi and Blood.

WARM HERBS The following herbs are classified as warm in this book: Herb

Taste

Organs

bitter, acrid. aromatic

LU. Sp' ST,IN. HT

sweet., aromatic. bitter

HT, LR, SPoUT

Cinnamomum twigs

acrid, sweet, aromatic

HT, LU, BL

Citrus aur.

acrid, aromatic, bitter

LU. Sp'ST,IN

Angelica arc. Angelica sin.

Qtll<'''',

',io -

C'\

r'.-<.'o<:,c-,:f.. .

SLIGHTLY WARM HERBS The following herbs are classified as slightly warm in this book: Herb

Taste

Organs

sweet

Sp,LU

sour, sweet

HT

aromatic. 51. acrid

ST, IN, KI. LR

aromatic. 51. sour, 51. acrid

KI, BL. SP, IN. LU. LR

Lavandula A~fo;.ttl1~

aromatic, bitter, 51. acrid

HT, LR, IN

Panax gin.

sweet, 51. bitter

KI, HT, SP, LU

Petroselinum

aromatic, 51. acrid

KI, BL,IN

Astragalus

As~m20

Crataegus

Foeniculum \\1\\(''''0

Juniperus .z{,.,....'~-lO

Commiphora

bitter, acrid

HT. ST, IN. LU. UT

clettaria

aromatic, acrid

ST,IN

Ephedra

acrid, sl, bitter

LU,HT

Eupatorium per.

bitter, acrid, aromatic

LU

~en~ha pul.

aromatic

HT,IN, UT

Mynca

acrid, sour, bitter

ST, IN, LR, GB, HT, LU

'Tt;.<;;;;,.ft.(..

G.Qd.a"ff'~"'l '0

tupo.~I'-'t> c~b

-01:°/';<"'1

,

b~' . . ~t~l(l)-~·~_,t., .'~')\~~ii:'C

(n,·~~(

Sc0 oc<

Trigonella \~\'u~('i'

bitter, 51. sweet, - 51. acrid

SP,IN. LU

Combining Western Herbs and Chinese Medicine

22

Slightly warm herbs are used to treat disorders that are intermediate between neutral and cool. which have only a few mild manifestations of cold. Herbs that are classified as slightly warm may have warming tonic, carminative, warming antispasmodic, or warming expectorant actions. like the warm herbs, but with a milder warming effect. For example, Lavandula is a less warming and less stimulant antidepressant than Rosmarinus. and Juniperus is a less warming and less stimulant expectorant than Sanguinaria.

NEUTRAL HERBS The following herbs are classified as neutral in this book:

Neutral herbs are those that do not affect the temperature of the body or of the herbs with which they are combined. They are especially used to treat neutral-temperature conditions or mi..'Ced conditions of heat and cold. Combinations used to treat mixed conditions may include warm, neutral, and cool herbs. The neutral herbs form a stable 'center' in a combination, reducing the likelihood of temperature oscillations by the body. Neutral herbs can be associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions): • astringent

stabilize and bind

• anticatarrhal

no exact Chinese equivalent

• antispasmodic

move Qi and relax spasms

• emmenagogue

no exact Chinese equivalent

• diuretic

drain Damp

• neutral tonic

tonify Qi and Blood, rather than

Agrimonia

sour, 51. bitter

LU, IN. BL, UT

Agropyron

sour, 51. sweet

BL

Avena

sweet

Sp,HT, KI

Ballota

bitter, sour

ST

Capsella

sour

ST, IN, BL, UT

Caulophyllum

bitter

UT

Chamaelirium

bitter, sour

UT

Convallaria

bitter, 51. sweet

HT, KI, BL

Galium

sour, 51. bitter

KI, BL

Geranium

sour

ST,IN, UT

Glechoma

sour, bitter

LU

Hydrangea

bitter, sour

BL

Hypericum

sour, 51. sweet

HT, KI, LR

Leonurus

sour, 51. bitter

HT. UT

Lycium

sweet

LR, KI

Marrubium

bitter

LU,SP

Mitchella

51. sour

UT

Molasses

sweet, 51. bitter

SP

Panax qui.

sweet, 51. bitter

LU, ST, KI

Ae5culus

bitter, sour

SP

Parietaria

bitter

KI, BL

Althaea

sweet, 51. bitter

LU, ST, IN, BL

Passiflora

51. bitter

HT, LR

Arctium (root)

51. acrid, 51. bitter

LU, IN, KI, BL

Prunus

bitter, aromatic

LU, HT

Arctium (seeds)

acrid, 51. bitter

LU, IN, KI, BL KI, BL

YangorYm Each of the neutral herbs listed in the table has its characteristic range of actions and uses. For example, both Agrimonia and Mitchella are neutral-temperature astringents, but Agrimonia is a more general-purpose astringent, whilst Mitchella is specific for the female reproductive system. Both Convallaria and Sarothamnus are neutral herbs with cardiac tonic, antiarrhythmic, and cardiac diuretic actions. Sarothamnus differs from Convallaria in being specific for cardiac weakness with hypotension.

COOL HERBS The following herbs are classified as cool in this book: Herb

_>:-Taste

-,; 'Organs

Pseudostellaria

sweet, 51. bitter

Sp,LU, HT

Arctostaphylos

bitter, sour

Quercus

sour, bitter

IN

Bert:>eri5

bitter

LR, GB, Sp' ST, LU

UT,IN

Calendula

bitter

ST,IN LR, GB,IN

Rubus

bitter, sour

Sarothamnus

bitter

HT, Kl, BL

Chelidonium

bitter, 51. acrid

Serenoa

sweet, sl. sour

KI, BL, SP

Chrysanthemum

sweet, 51. bitter

LU,LR

Cimicifuga

acrid, 51. bitter, 51. sweet

KI, LR, UT

Cinchona

bitter

HT, SP

Urtica

acrid

LU,BL

Viburnum

51. bitter, 51. sour

UT

Vinca

sour

BL,UT

bitter, 51. acrid

LR,UT

sweet

BL

sweet

Sp,ST

',---'

Vitex Zea Ziziphus

"'f

Curcuma (rhizome) acrid, bitter

LR, GB, HT

Echinacea

acrid, bitter, 51. sweet

LU, BL

Equisetum

51. bitter, 51. sweet

BL

Temperature '--"~-.'~

·····~-':::.~_C'.7·--""·:.---~

Herb :··-:~=:-:":::;::Taste·:~--~:::::,,:::=~·.:.-::· Organs .::.:~-7:: :::~~:C::-:.:

23

COLD HERBS

The following herbs are classified as cold in this book:

bitter, acrid

lU

Filipendula

sour, bitter

ST. IN, Bl

Harpagophytum

bitter

Sp'ST

Hydrastis

bitter

S~

Iris

bitter

lR, GB,IN

Mahonia

bitter

lR, GB, Sp' ST, lU

Matricaria

sl. bitter, sl. aromatic

ST,IN, HT

Nepeta

aromatic, acrid

lU,lN, HT

Ophiopogon

sweet, sl. bitter

HT,lU, ST

Phytolacca

acrid

lU

Plantago

sour, sl. bitter

lU,lN

Polygonum

sour, sl. bitter

lU,lN

Rhamnus

bitter

IN,ST,lR

Rumex

bitter, sl. sour

LR,IN

Salvia mil.

bitter

HT,lR, UT

Sambucus

acrid, sl. bitter

LU

Sanguisorba

sour, bitter

IN, UT

• antipyretic

clear Excess Heat

Scrophularia

sl. bitter

lU

clear Damp Heat, Heat Toxin

sl. bitter

lR, KI, Bl

• strong antimicrobial

Smilax Tanacetum

bitter

lR

• anti-inflammatory

clear Damp Heat, Excess Heat

Valeriana

bitter, sweet

HT, lR, ST, IN

• sedative

Viola ado.

sour, sweet, bitter

LU,Bl

sink Heart Spirit Disturbance or Liver Hyperactive Yang

Viola tri.

sour, sweet, bitter

LU,Bl

Euphorbia

IN,lU,lR,GB,Bl,UT

Cool herbs are those that can have a moderate cooling effect on the body and are specific for treating warm disorders. Cool herbs can be especially associated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):

• antimicrobial

clear Damp Heat

• anti-inflammatory • cooling alt~rative

clear Damp Heat or Deficiency Heat clear Damp Heat or Heat Toxin

• cooling anticatarrhal

clear Phlegm and Heat

• cooling diaphoretic

clear Wmd Heat

• tranquilizer

calm Heart Spirit Disturbance or Liver Hyperactive Yang

Each of the cool herbs listed in the table has its characteristic range of actions and uses. For example, both Matricaria and Sambucus are cool herbs with anti-inflammatory and" anticatarrhal action, but the specific target area of Matricaria is the gastrointestinal system, whilst that of Sambucus is the sinuses. Both Althaea and Arctostaphylos can be used as cool anti-inflammatory herbs for the urinary system, but Althaea has demulcent action, whilst Arctostaphylos is more strongly antimicrobial.

Anemone

bitter

HT,KI

Asclepias

bitter

LU

Baptisia

bitter

LU

Humulus

bitter

HT,lR,lN

Piscidia

bitter

HT,lR

Pulsatilla

bitter

IN, ST, LR

Cold herbs are those that can have a strong cooling effect on the body and are specific for treating hot disorders. Cold herbs can be especially assoCiated with the following Western actions (shown in italics and then followed by the corresponding Chinese actions):

Cold herbs may have antimicrobial, anti-inflammatory, and alterative actions, like the cool herbs, but they can have a stronger cooling and sedating effect on the body. Caution Cold herbs should be used with caution or they may depress metabolism and reduce the ability of the body to heal itself. Combinations with only cold herbs are rare, and these herbs are usually combined with some warm herbs to moderate their potential ill "effects.

Variable temperature Variable herb temperature is a concept that can help to resolve some of the apparent contradictions regarding herb temperature, can broaden and deepen understanding of the mechanism of herb action, and can contribute to both greater flexibility and greater precision in herb combining. The majority of herbs have one main temperature effect, for example, Asclepias is cold, Cinnamomum bark is hot, and Agrimonia is neutral. However, some herbs can have a range of potential temperature effects, just as they can have a range of potential actions. Which of the potential temperature effects manifests in a specific situation depends on the condition of the patient and on the temperatures of the other herbs in the

24

Combining Western Herbs and Chinese Medicine

combination. These herbs are referred to in this book as

• one active constituent may have variable-temperature

variable-temperature herbs.

effects • different active constituents may have different temperature effects

Example Achillea millefolium is classified in this book as a warm-cool variable-temperature herb, that is, it can have a range of potential temperature effects that include warm, neutral, and cool.

Warm

Achillea can act as a warming diaphoretic if the patient has a cool condition, such as influenza with chills associated with Wind Cold, especially if Achillea is combined with warming diaphoretics, such as Zingiber.

One active constituent may have variable-tempera~e effects For example, Gentiana is classified as a variabletemperature herb with a temperature range of neutral-cool. The bitter secoiridoids in Gentiana may be responsible for both potential temperature effects of this herb: the neutral, bitter digestive tonic action and the cool anti-inflammatory action. Which of these two potential secoiridoid actions manifest itself will depend on the syndromes of the patient.

Neutral Achillea can act as a neutral bitter tonic if the patient has a neutral condition, such as weak digestion without signs of either heat or cold associated with Spleen Deficient Qi, especially if Achillea is combined with neutral, bitter digestive tonics, such as Marrubium.

Cool Achillea can act as a cooling diaphoretic if the patient has a warm condition, such as influenza with fever associated with Wmd Heat, especially if Achillea is combined with cooling diaphoretics, such as Sambucus.

DETERMINANTS OF TEMPERATURE

If a combination contains variable-temperature herbs, their effective temperature will be determined by the state of the patient and by the other herbs in the combination. For example, as shown below, in the combination Achillea: influenza + sore throat, the overall temperature of the combination is cool. This is because the variable-temperature herbs, Achillea and Mentha, can both have a cooling effect in the context of a Wind Heat condition, especially when they are combined with a cooling herb, such as Sambucus. -- .-. -

Herb

,-:-~ .. ~J:,:"",""-f.:.;10;~';'~~ ~':."I'!~''''f~:·;.'?'(·-~ t;;I:·~~:-

.. Daily.. dose,:". rerrifjernture .. -... '- .

. - '.",.,. ,-'"

Achillea Mentha pip. Sambucus

.

-

6g 3g 3g

.

-,'

...~

".""".'

warm-cool warm-cool cool

.;

---- .!~'.-

•

--7-~.~ "~;'c'-

Taste '

"-

acrid, bitter acrid. aromatic acrid, 51. bitter

MECHANISM OF

Different active constituents may have different temperature effects In the case of Achillea, it may be that the sesquiterpene lactones are responsible for the cooling antiinflammatory action and that monoterpenoids, such as camphor, are responsible for the warming diaphoretic action.

VARIABLE TEMPERATURE AND HOMEOSTASIS In addition to their ability to treat conditions involving mixed signs of heat and cold, some variable-temperature herbs can have a normalizing effect specifically on body temperature. If the patient'$ body temperature is pathologically low or high, these herbs can have a warming or cooling effect, respectively, and help to normalize body temperature. Thus, they can be said to assist in the body's homeostasis. For example, Lobelia has been found to be effective both in cases of extreme coldness and in high fever. Whether this homeostatic effect is due to the alkaloid constituent lobeline, or whether different constituents are responsible for separate warming and cooling effects is not known. Salvia officinalis is another herb that can be used to alter body temperature. It can be used as a warming herb for headaches or muscle aches associated with sensations of cold, and it can be used as a cooling herb for menopausal hot flashes. Salvia has a complex biochemistry, and the mechanism of its warming and cooling effects is not yet known.

VARIABLE-TEMPERATURE HERBS

VARIABLE TEMPERATURE The phenomenon of variable. t~mperature must have its basis in the biochemistry ofplant.a~,tive constituents. However, there is insufficient data .at present to go beyond speculation. Two of the factors that may contribute to variable temperature are:

The table below shows herbs that have been classified in this book as having variable temperature. Each of the herbs marked with an asterisk"" has a separate chapter in the materia medica of this book in which the reasoning behind the variable-temperature status is discussed in the Traditional sources section.

Temperature

Warm-cool Achillea*

acrid. bitter

LU. SP,HT. UT

Artemisia abs. *

bitter. aromatic.

LR.SP,UT

Artemisia vul. *

aromatic. bitter

LR. SP, UT

Hyssopus

acrid. aromatic

LU,HT

Lobelia *

acrid

LU, IN. HT. UT

Mentha pip.

acrid. aromatic

LU, ST, IN, LR

Ruta*

bitter. aromatic

KI. LR. HT. UT

Salvia off. *

aromatic, acrid

LU. HT, LR, UT

Thuja*

acrid. aromatic. bitter

LU, HT. BL, UT

Thymus*

aromatic

LU, BL. HT. UT

Centaurium*

bitter

SP, ST. 51, LR, GB

Euphrasia*

acrid. sour. bitter

LU

Gentiana*

bitter

SP, ST. 51. LR, GB

Neutral-cool

sweet

ST, IN, LU, KI. HT

Hamamelis*

sour. sl. bitter

SP, IN

Populus

bitter, sour

Sp, ST, IN. LR. BL

Potentilla*

sour. bitter

IN

Rheum*

bitter. sour

IN.ST, LR. HT

Taraxacum*

bitter

KI, BL. LR. GB, ST. IN

Glycyrrhiza*

Cool-cold

25

in lower doses, Rheum can act as a bitter digestive tonic to treat weak digestion and poor appetite associated with Spleen Deficient Qi. In this situation, it can have a moderate cooling action, if any. At higher doses, Rheum can have a strong cooling effect, for example, for a patient with severe gastritis associated with Stomach and Liver Heat.

Differences of opinion on herb temperature No perfect system for the classification of herbs by temperature has been devised. There have been differences of opinion on the temperature classification of specific herbs not only in different countries and in different centuries, but also between different authorities in the same time and place. This range of opinion can be found in both Western and Chinese herbal medicine.

WESTERN HERBAL MEDICINE For example, the temperature values given for Artemisia absinthium (wormwood) in different Western texts range from very hot to hot in the first degree:

Three main groups of variable-temperature herbs are discussed in this book: • warm-cool • neutral-cool • cool-cold Warm-cool These herbs can have either a warming or cooling effect, depending on the patient's condition. They may also have a neutral-temperature effect when they are used to treat conditions without signs of either heat or cold. In this case, they do not change the temperature balance of ,. ',~.

the patient. The example of Achill~a is given above. Neutral-cool These herbs can have either a neutral-temperature effect or a cooling effect depending on the patient's condition. For example, Glycyrrhiza can have a cooling antiinflammatory action if the patient has a hot condition, such as gastritis associated with Stomach Heat. However, if the patient has a neutral condition, such as exhaustion without signs of heat or cold associated with Kidney Deficient Qi, Glycyrrhiza can have a neutral-temperature effect. Cool-cold These herbs can have either a moderately cooling or strongly cooling effect, depending on the patient's condition and the dose in which they are used. For example.

.. - ~-,'--. :":(.

--;··~~~;~;)~·r:;r"f.r;"-;.~'_

Author

Assigned temperature

von Bingen 3

very hot

Gerard'

hot in the second degree

Tabernaemontanus S

hot in the first degree

CHINESE HERBAL MEDICINE Students reading a basic text on Chinese herbal medicine that is published in the West may see only one temperature listed for a specific herb. What they may not know is that such Western texts are brief summaries of much more detailed texts in the Chinese language, which may give not merely a consensus of opinion on the temperature of each herb. but a range of opinion from different classical texts. For example. for Angelica pubescens (du hu6), the range of opinion on its temperature from the Chinese sources summarized in the Chinese Herbal Medicine Dictionarl includes warm, slightly warm. neutral. and slightly cool.

EXPLANATION The differences of opinion on the temperature classification of a herb may be due to one or more of the following fucto~:

~

26

Combining Western Herbs and Chinese Medicine

• different traditions of use • a single herb contains both warming and cooling constituents • chemical differences in different samples of the same herb • differences in human populations Different traditions of use Different temperature values for the same herb may arise even when there are no appreciable chemical differences between different populations of the same species. The different values are simply due to different traditions of use for the same herb. For example, in the Western tradition, Commiphora has been used as a warming carminative for weak digestion with signs of cold. In the Chinese tradition, this herb (mb y1lO) has been used as a neutral-temperature herb for epigastric and abdominal pain. A single herb contains both warming and coo14lg constituents Some herbs contain some constituents with potentially cooling effect and other constituents with potentially warming effect. For example, some varieties of Achillea millefolium contain both potentially warming camphor and potentially cooling sesquiterpene lactones, and thus can have a variable-temperature effect. This may be one of the reasons why in the past Achillea has been classified in the West sometimes as slightly hot and sometimes as cold in the first degree (see the Achillea chapter). Chemical differences in different samples of the same herb These chemical differences may arise from a number of factors, including: • genetic differences in populations of the same species • different methods of cultivation • different methods of preparation

Genetic differences in populations ofthe same species In some cases, chemical differences between different herb populations of the same species may account for the difference of opinion on the temperature of the same herb. For example, Valeriana officinalis has been considered cooling by some herbal practitioners in Europe and warming by some practitioners in the USA. This difference of opinion may be linked to known chemical differences between the different geographical populations of this herb, associated with variations in chromosome number (see the Valeriana chapter).

grown with artificial light in a greenhouse and harvested before maturity. The first Salvia sample may tend to be more warming (see the Salvia chapter).

Different methods of preparation Use of the fresh or dried herb, variation in the time and temperature of storage, and differences in the method of preparation can make significant chemical differences between samples of the same species. For example, both fresh ZingIber (shengjiang) and dried Zingiber (gan jiang) can be classified as hot in Chinese medicine, but the dried herb is considered more warming to the Interior. There are real chemical differences between fresh and dried ginger that underlie this difference in temperature effects (see the Zingiber chapter). As another example, the temperature of Panax ginseng can vary considerably with the country of origin and the method of processing. Ginseng cured in rock candy-white ginseng (bcii shenF--can be used to treat Qi and rm Deficiency and can be classified as cooling. Ginseng cured by steaming-red ginseng (h6ng shen}-can be used to treat Qi and Yang Deficiency and can be classified as warming.

Caution Failure to make these temperature distinctions between different preparations of the same herb can result in adverse effects for the patient. Differences in human populations The perceived temperature effect of a herb may vary with differences in the physiology and pathology of human populations that result from differences in genetics, climate, and life-style. For example, until relatively recently, the bulk of the population in China lived in the countryside, did much physical work, lived in unheated housing, ate small amounts of home-grown food with little meat, and had relatively little medication. Such rural populations tend to have more syndromes of Deficiency and Cold. In contrast, the bulk of the population in some Western countries is urban, does very little physical exercise, lives on junk food with potentially harmful additives, and takes prolonged multiple medication. Such urban populations tend to have more syndromes of Stagnation, Deficiency Heat, and Retained Pathogen. The temperature effect of herbs on the body is likely to be different in these two populations. For example, in the urban population Panax ginseng is more likely to produce adverse effects involving Heat.

Different methods of cultivation There may he important chemical differences in samples of a single herb species due to differences in methods of cUltivation and time of harvesting. For example, a sample of Salvia officinalis grown in its natural habitat in a warm, dry climate and harvested at maturity will have a greater amount of monoterpenoids and a different chemical spectrum than a sample of the same species

References 1. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. -Eastland Press, Seattle, Washington (1986)

~'"

-

-

Temperature 2. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks. Glenwood. Illinois (1990) 3. Von Bingen H. Hildegard von Bingen's Physica. Healing Arts, Rochester. Vermont (1998) 4. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publi-

'_L

,

r I

27

cations, New York, New York (1975) 5. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad Kolbl,Munchen. Germany (1993) 6. Jiangsu New Medicine Institute. Chinese Herbal Medicine Dictionary (Zhong yao da ci dian) Science and Technology Press, Shanghai. China (1975)

...

Taste Taste as a herbal property This refers to a theoretical system for classifying herbs according to the type of effect they have on the body. Herbs can then be selected according to the taste property to correct specific types of imbalance. For example, according to Chinese herbal theory, sweet herbs often have tonic action so that they are often selected to treat Deficiency patterns.

Concepts oftaste

...

This chapter introduces a new approach to the theory of taste, drawing on concepts from Chinese medicine, Western herbal tradition, and modern biochemistry. This movement towards an integrated approach can increase theoretical understanding and widen the clinical application of the taste concept in herbal therapy. It can also help to resolve some of

The importance of experience It is very valuable for practitioners of herbal medicine to taste and take the herbs that they use. In this way, they can compare and contrast the theoretical taste properties of each herb used with its tastes in the mouth and with its effects on their own bodies. For each herb with an individual materia medica chapter in this book, its tastes in the mouth and its taste properties are discussed separately in the section on Traditional

the apparent contradictions between the Chinese and \Vestern concepts of taste.

TASTE IN THE MOUTH AND TASTE AS A PROPERTY There are two overlapping concepts of taste: taste in the mouth and taste as a herbal property. Over the centuries, the different tastes that substances have in the mouth have been associated with different herbal effects.

sources.

Taste in the mouth

The classification of herbs in terms of taste can facilitate herb choice in two main ways:

IMPORTANCE OF THE TASTE PROPERTY

This relates to taste as a sensation-to

what the herb actually tastes like in the mouth and on the tongue. This subjective experience has a foundation in physiology and biochemistry. There may be individual variations in the quality and intensity of the taste experience, and there may be cultural differences relating to differences in linguis-

• by providing a simple overview of herbal groups • by acting as a sophisticated method for the mutual balancing of herbs in a combination

tic concepts or patterns ofnutrition. However, there is a general consensus of experience and most people experience quinine as bitter, honey as sweet, cayenne as acrid, and ,", lemons as sour.

29

Overview Dividing herbs according to their taste properties gives the practitioner about five herb groups to choose from when assessing a situation. This is a more manageable number of groups for getting a preliminary overview than

-,

Combining Western Herbs and Chinese Medicine

30

the 20 to 30 action categories, and it is not as restrictive as would be the two choices offered by the Yin-Yang division. For a more detailed classification, each taste can be subdivided into action categories, as discussed in the individual taste sections below. Balance At the basic level of herb combination, herbs can be selected according to their action categories to match the patients syndromes. In addition to this, at a more sophisticated level of herb combination, taste properties can be used . to optimize the balance between the herbs in the combination. This is discussed in the Balancing the tastes section in this chapter, which contains a table of the 20 main taste combinations that can be used in the clinic. It is also discussed in the Taste section of the Principles of herb combination chapter.

CHINESE AND WESTERN CONCEPTS OF TASTE

sidered to be a taste, but in this book, I have used it as such (see discussion in the Aromatic section), I have not included the salty taste property of Chinese medicine since I fmd this taste to be rare in the Western herbs that I use in clinical practice. I have included the astringent property with the sour taste property since there is such a close overlap between the two. Finally, the Chinese category of bland is not used as a taste property in this book.

CHANGING CONCEPTS OF TASTE Concepts of taste property are currently in the process of change and expansion due to input from three different sources: Chinese herbal tradition, Western herbal tradition, and modern biochemistry. Each of these three systems can make valuable contributions to the understanding of taste, and each has its limitations or blind spots. It is important to keep an open mind in order to see beyond the limitations of each system if a useful integration is to be achieved in the future.

This section very briefly introduces the Chinese and Western concepts of taste and the taste classification used in this book. These are discussed in greater detail in the sections on the individual tastes. Chinese herbal tradition In Chinese medicine, there are two main taste classifications; one is associated with Chinese herbal tradition, and the other is associated with Five Element theory. In both classifications, there are five main taste properties: bitter, sweet, acrid, sour, and salty. However, the effects associated with each of the five tastes are not necessarily identical in the herbal and the Five Element models. For example, in the herbal model, bitter is often associated with clearing Heat and Damp, whereas in the Five Element model, it is associated with tonifying the Heart. Also, in the herbal model, the additional properties of aromatic, astringent, and bland are often used together with the five tastes. Western herbal tradition In the West, the Galenic system described each herb in terms of its temperature (whether warming or cooling) and moisture (whether drying or moistening), and the body parts on which the herb acts. However, in this system, there was less emphasis on the taste property than in Chinese herbal medicine. More recently in Western herbal medicine, individual taste sensations have been associated with specific herbal effects, for example, bitter with the digestive tonic action and aromatic with the . , . '. carminative action. ........ . . ,:

",

This book The five taste properties used in this book are bitter, sweet, sour, acrid, and aromatic. I am aware that in Chinese medicine, the aromatic property is not strictly con-

Chinese herbal tradition The Chinese herbal system of taste properties gives a framework of clear, simple concepts for classifying herbs and matching them to syndromes. Perhaps most importantly, it contributes a system of matching herbs with each other according to taste to produce a balanced combination. The limitation of the Chinese system is that it has remained relatively static for a long time, without further evolution of its concepts. As in the history of the Galenic system in the West, respect for the authority of tradition may have reduced rigorous critical investigation and discussion, and slowed the evolution of ideas. Western practitioners are reevaluating the concepts of traditional Western phytotherapy in the light of the theories of Chinese medicine. Perhaps it is time for Chinese practitioners to reevaluate the concepts of taste in view of ideas from Western herbal tradition and from modern biochemistry. This would be especially valuable in the case of the aromatic, bitter, and sweet properties. Western herbal tradition In the West, from the time of Galen to Culpeper, concepts of taste were not as clearly developed or as well organized as in China. However, Western herbal therapy has more recently made major contributions in this area with respect to understanding and utilization of the bitter and aromatic concepts. This is discussed in the individual sections on these tastes. Biochemistry and taste On the one hand, the concepts of taste from Chinese and Western herbal tradition can contribute to the application of phytopharmacology to clinical

r."

Taste practice. On the other hand, concepts and detailed information from phytochemistry and phytopharmacology can help to give breadth and depth to the understanding of taste. Contribution of taste to biochemistry There is a vast number of individual active herb constituents. 'Whilst these can be organized into major chemical groups, such as phenols and steroids, there is as yet no clear and simple system in phytopharmacology to match individual constituents, or even major chemical groups, to the syndromes of the patient. The structured framework of the taste concept can be used to give some organization to the apparent chaos of the biochemical data. To the degree that active constituents can be classified in terms of taste, they can be linked to herb actions and thus to the treatment of specific syndromes. For example, if a constituent is bitter, it may have one or more of the potential actions associated with this taste, for example,

it may function as a digestive tonic. Contribution of biochemistry to taste Research on active constituents and their pharmacological effects have demonstrated new practical uses for phytochemicals with a specific taste. For example, some chemicals with the sweet taste have been shown to have immunoregulatory effect. In addition, each t:tste can be subdivided into groups according to its chemical type and pharmacological effect. For example, sweet phytochemicals can be divided into the

following groups:

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• nutrient carbohydrates • demulcent mucopolysaccharides • immunopolysaccharides • adaptogenic triterpenoid saponins The contribution of new practical uses and a system of subdivision of the taste types can lead to a more profound understanding of taste and a wider clinical application of each taste group.

Bitter The bitter taste sensation follows stimulation of the bitter taste receptors on the tongue. Substances differ in the intensity of the bitter sensation they evoke and are sometimes given bitterness values. For example, the most abundant bitter secoiridoid in Gentiana root is gentiopicroside with a bitterness value of about 12,000. However, the most important bitter component in Gentiana root is amarogentin, which, although only present in tiny amounts, nonetheless has a bitterness value of 58,000,000 (see the Gentiana chapter).

31 CHINESE HERBAL TRADITION According to the Five Element theory, the bitter taste tonifies the Heart. However, most of the herbs classified as bitter in modern Chinese materia medica are not listed as tonifying the Heart, and in the herbal tradition, bitter is more associated with reducing Excess conditions. For e.xampIe, it can be associated with the following actions: l • drains Damp • clears Heat • drains downward • purges stools • clears Lung Phlegm Drains Damp In some circumstances, the bitter property can be associated with draining Damp regardless of whether the Damp is associated with Heat or Cold. 2 It should be noted that not all herbs that drain Damp and promote urination are classified as bitter; some are sweet, like Zea (yu mi xu), or sweet and bland, like Poria (m ling). Clears Heat In some circumstances, the bitter property can be associated with clearing Heat from the organ systems, whether Heat from Stomach or Heart, or Damp Heat from Liver or Bladder. Many herbs that are listed as clearing Wind Heat, Summer Heat, Heat, Heat in the Blood, Damp Heat. or Heat Toxin are classified as bitter. For example, Coptis (huang Han) can cool the Blood, clear Heat Toxin, clear Heat in the Heart or Stomach, and clear Damp Heat in the Intestines. However, not all herbs that clear Heat do have the bitter property. Gypsum (shi gao) is sweet and acrid, Lophatherum (dan zhli ye) is sweet and bland, and Calcitum . (han shui shi) is acrid and salty. Drains downward In some circumstances, the bitter property can be associated with the tendency to move Qi downwards as in the following actions: • redirects Lung Qi to treat cough, for example, Prunus armeniaca (xlng ren) • redirects Intestines Qi to treat constipation, for example, Rheum (cia huang) • drains Heart Heat out through the unne, for example, Akebia (mil tong) Purges stools Whilst most herbs listed as bitter are not purgatives. most herbs in the laxative, purgative, and cathartic categories of Chinese medicine are classified as bitter. Most of these bitter herbs that move stool are cold or cool and are especially appropriate for constipation due to Heat, for example, Rheum, Cassia (fan xie ye), and Aloe (1ti hul).

Combining Westet:n Herbs and Chinese Medicine

32

Clears Lung Phlegm In some circumstances, the bitter property can be associated with dissolving Phlegm and relieving cough. Prunus armeniaca is an example of a warm, bitter antitussive, and Euphorbia (ze qI) is an example of a cool, bitter, and acrid expectorant. Bitter herbs that clear Phlegm are often also acrid (see the Acrid section in this chapter).

Summary of Chinese tradition Whilst the Five Element theory proposes a tonic action for the bitter taste, the herbal tradition emphasizes its reducing: downward-moving, and drying effects. \NESTERN HERBAL TRADITION In the last century of Western herbal tradition, the bitter taste has been associated with the following actions: • bitter digestive tonic • bitter general tonic • bitter cholagogue and hepatic Bitter digestive tonic In the Western tradition, bitter herbs have been used to treat the lack of appetite and digestive weakness.3.4·5.6 More recendy, it has been suggested that bitter herbs may help to treat malabsorption, gastrointestinal infection, and food allergies (see the Biochemical perspective section below). Bitter general tonic The general tonic effect of the bitter herbs may largely depend on their digestive tonic action. In terms of Chinese medicine, it can be said that some bitter constituents can tonify and move the Qi of the Spleen, Stomach, and Intestines, and thus indirectly help to tonify Qi and Blood. In the Western tradition, bitter herbs have been used to treat exhaustion, anemia, weight loss, and associated muscular weakness and mus~ular atrophy.3.4.5.6 It has recendy been suggested that bitter herbs may help to strengthen the immune system.7 Bitter cholagogue and hepatic Bitter herbs have a tradition of use in the West to strengthen the secretion and flow of bile, and to treat disorders of the liver and gallbladder.3.4. 5.6. 7 Expressing this Western use in terms of Chinese medicine, it can be said that some bitter herbs can tonify and move the Qi of the Liver and Gallbladder. ,Other actions of bitter herbs The main emphasis in the use of bitterherbs in the,West has been on ~eir general tonic, digestive tonic, cholagogue, and hepatic actions. However, herbs with the bitter taste are found in other Western action groups, especially the following:

• antimicrobial, antipyretic, and anti-inflammatory • cardiotonic • tranquilizer These are discussed in the section Combining the Western and Chinese perspectives below. BIOCHEMICAL PERSPECTIVE Bitter herbs, or more precisely, bitter constituents, can be said to have three main levels of activity: • general bitter effects • effects shared by members of a particular chemical group • effects specific to an individual chemical General bitter effects All substances that stimulate the bitter taste receptors at the back of the tongue may set off a cascade of events in the gastrointestinal and hepatobiliary systems. These may include stimulation of appetite, flow of saliva, flow of digestive secretions from the stomach, intestines, and pancreas, and stimulation of the secretion and flow of bile (see the Research section in the chapters on Artemisia and Gentiana). Increase in bile flow may then have a laxative effect. This subject has been reviewed by Mills and Bone/ who noted that reduced gastric secretion can lead to abnormal bowel flora, malabsorption of nutrients, and an increased tendency to enteric infection. By increasing gastric secretion, bitter herbs may thus help to treat these conditions. In addition, reduced gastric secretion may lead to the inadequate breakdown of polypeptides. This may result in an increase in potential antigens and an increase in allergic responses related to foods. By increasing gastric secretion, bitter herbs may therefore help in the prevention and treatment of food allergies. It was also suggested that bitter herbs may assist in the normalization of blood sugar levels and the stimulation of the immune function. Effects shared by members of a particular chemical group In addition to the general bitter effect, each substance may then have additional effects characteristic of the chemical group to which it belongs. For example, the quinoline alkaloid group, to which quinine and quinidine belong, can have antimalarial and cardioregulatory effects. Many different chemical groups can produce the bitter taste sensation. For example, each of the following groups contains some substances with the bitter taste: monoterpenoids, sesquiterpenoids; sesquiterpene lactones, diterpenoids, triterpenoids, iridoids, flavonoids, and alkaloids. This great variety of chemical types may explain why bitter herbs can have such a wide range of actions.

-,...

Taste Effects specific to an individual chemical Each bitter substance may have effects that are specific to its unique individual structure. For example, within the quinoline alkaloid group, quinidine is a stronger antimalarial than quinine and has more risk of cardiotoxicity (see the Cinchona chapter).

lvlultiple effects of a single bitter chemical It is interesting that some bitter chemicals can have most of the actions that have been associated with bitter herbs above. For example, the alkaloid berberine, present in Berberis and Hydrastis, has been reported to have choloretic, hepatic, antimicrobial, anti-inflammatory, cardiotonic, and respiratory effects. It would be interesting to determine if a specific chemical structure can be associated with this range of actions and if this structure can also stimulate the bitter taste receptors.

33

General tonic exhaustion anemia weight loss muscular weakness muscular atrophy weak immune system Digestive tonic lack of appetite digestive weakness malabsorption gastrointestinal infection food allergies

Hepatobillary tonic

COMBINING WESTERN AND CHINESE PERSPECTIVES The Western emphasis on tonification and the Chinese herbal emphasis on reducing and cooling seem to be irreconcilable opposites, but they can be regarded as just the two

depression epigastric and abdominal distension nausea intolerance of fatty foods reCOliery from habitual overeating recovery from substance abuse recovery from prolonged medication gallstones constipation

Antimicrobial infections such as: recurring respiratory infections acute bacillary dysentery urogenital infections boils AntI-Inflammatory inflammatory disorders such as: gastritis colitis cystitis arthr,itis Antipyretic disorders with fever such as: acute influenza acute tonsillitis mononucleosis malaria some chronic fatigue syndromes

ends ofa spectrum ofbitter actions. -·-tonifies Qi.~.:~b~esQi ... clears H~at

.

';,'--

T~e

~

..

':--.''; ~-..,~"':":~--'-~

action of moving Qi acts as the bridge between tonifying

Qi and clearing Heat. Stagnant Qi can be associated with Deficient Qi, as in exhaustion and depression, or it can be associated with accumulation of Heat and Damp, as in recurring diarrhea with sensations of heat. In more complex conditions, Stagnant Qi can occur with patterns of both Deficiency and Heat, as in some cases of weak digestion with chronic gastrointestinal inflammation. Bitter herbs, depending on their temperature, can be used in all of these situations. Six potential bitter actions The table below shows six of the main potential actions of bitter herbs, together with some of their associated uses. These six actions can be divided into two groups as follows:

• tonic actions:

general, digestive, and hepatobiliary tonic

• cooling actions: r:'

antimicrobial, antiinflammatory, and antipyretic

The tonic actions are associated with tonifying Qi and moving Qi, and the cooling actions are associated with clearing Heat and moving Qi.

Which of these actions manifests in a particular situation will depend on the state ofthe patient, on the other herbs in the combination, and on the temperature ofthe bitter herbs. Use of bitters for hepatobiliary stagnation In Chinese medicine, the syndrome of Stagnation of Liver Qi can have many manifestations and ramifications. These include depression, nausea, indigestion with epigastric and abdominal distension or discomfort, gallstones,.constipation, intolerance of fatty foods, and recovery from substance abuse or prolonged multimedication. By moving Liver Qi, bitter herbs can therefore assist in the treatment of a wide range of conditions. (See the Research sections in the Berberis and Gentiana chapters for hepatobiliary effects of bitter active constituents.) Western use of bitter herbs to treat hot conditions It is interesting to note Culpeper's use of the bitter herb Berberis to cleanse the body of 'choleric humors' (associated with anger), to clear heat from the liver and .from the blood, and to treat jaundice, itching skin disorders, boils, and fever. 8 Also, Lonicerus wrote that Berberis is good for headache if it is a result of heat and acidity from gallbladder disease. 9 In Chinese medicine terms, this would be equivalent to clearing Heat or Damp Heat from the Liver-Gallbladder, clearing the resulting Blood Heat or Damp Heat from the skin, and reducing Liver Hyperactive Yang associated with Liver-Gallbladder Qi Stagnation.

Combining Western Herbs and Chinese Medicine

34

Antimicrobial. antipyretic. and anti-inflammatory actions

strong downward effect on it, and they are cool or cold in

In Chinese herbal tradition. the main emphasis for the bitter herbs is on clearing Heat and Damp. In terms of Western herbal medicine. this translates into the antimicrobial. antiinflammatory. and antipyretic actions. It is not stated in Western tradition that bitter herbs are specific for infections, inflammations, and fever. However, bitter herbs have been used just as much for these disorders as they have been used for general debility, atonic digestion, and hepatobiliary weakness. (See the Research sections in the Berberis and Gentiana chapters for antimicrobial. antipyretic, and antiinflammatory actions of bitter active constituents.)

temperature. Additional actions of bitter herbs Two further actions associated in the Chinese herbal tradition with the downward~moving aspect of the bitter taste have been noted above: purgative and antitussive actions.

Purgative In China, the bitter taste is also associated with .the purgative action, that is. to direct Intestines Qi downward and move the stool. Whilst most of the purgative herbs used in the West have a bitter taste. such as Rhamnus and Rheum, these actions are not generally regarded as specific to the bitter taste.

Alterative action of bitters In my opinion, certain bitter herbs have the capacity to treat recurring fever by their alterative action of clearing toxins from the body or, in Chinese medicine terms, by clearing Retained Pathogens. The three bitter effects of tonifying Qi, moving Qi. and clearing Heat can combine to do the following:

• tonifies Qi

• moves Qi

helps to strengthen the natural ability of the body to clear pathogens from the system and to prevent further infection helps to clear pockets of Stagnation with accumulation of pathogens and toxins that may act as foci for recurring infections

• clears Heat can allow the Qi and Ym to rebuild to speed convalescence This is discussed in the Cinchona chapter in the section

Possible mechanism ofantipyretic effects. Bitters herbs and the Heart There are two very different groups of bitter herbs with effects on the Heart: one group has tonic action, and the other has a calming. reducing, and cooling action.

Tonics The bitter taste is said to tonify the Heart in the Chinese Five Element tradition, and there is a minor tradition in Western herbal therapy that states that the heart can be strengthened by bitter herbs. Some of the cardiotonic herbs used in the West have a bitter taste, such as Cinchona. Convallaria. Leonurus, and Sarothamnus, but other cardiotonic herbs, such as Crataegus, are not appreciably bitter. These cardiotonic bitter herbs can be said to tonify and stabilize Heart Qi, and ijiost of them are more or less neutral in temperature. Tranquilizers Most Western herbs that have a strong tranquilizing action also have the bitter taste, for example, Anemone, Gelsemium, Humulus, Piscidia, and Valeriana. These herbs can be said to calm the Heart Spirit by having a

Antitussive Two other actions associated with the bitter taste in the Chinese herbal tradition are the antitussive action, that is. directing Lung Qi downward, and the expectorant action, that is, clearing Lung Phlegm. In the West, whilst some herbs with antitussive and expectorant action have a bitter taste, such as Marrubium, these actions are not linked specifically to the bitter taste.

DIRECTION OF ENERGY OF BITTER HERBS The effect of a bitter herb on the direction of energy movement depends on its specific actions and the organs it affects. Stomach and Intestines In the Western view, bitter substances can stimulate the bitter taste receptors, thus increas- - • ing gastrointestinal and hepatobiliary secretions. This can be described as a tonic effect that can assist in the normalization of the natural downward movement in the stomach and intestines. This is a different emphasis from the downward movement proposed by the Chinese herbal tradition. which can involve purgative and diuretic actions, with an overall reducing effect on the body. Liver and Gallbladder Stimulation of hepatobiliary function can be said to include dispersal of Liver Stagnant Qi. This movement is not limited to the downward direction since it can have upward, downward. and horizontal components. Some bitter constituents, for example, the bitter constituents of Piscidia, can reduce the disturbed upward movement of Liver Yang, to treat headaches and migraines. Heat clearance In the West, bitter herbs are commonly used as antimicrobials, anti-inflammatories, and antipyretics, and these actions can be related to the action of clearing Heat in Chinese -medicine. However, these Western actions are not necessarily associated with the clearance of Heat by downward movement via the stools and urine, as proposed for the bitter taste in the Chinese herbal tradition.

Taste Heart In the Chinese Five Element tradition, the bitter taste is said to tonify the Heart, but no specific effect on the direction of energy movement is proposed. The same is true of the Western concept of the cardiotonic effect of bitters. However, the bitter herbs with tranquilizing action can be described as having a downward-directing effect on the pathological upward movement of Heart Spirit or Liver Yang.

Summary Bitter herbs, or more specifically bitter constituents, may help to normalize the natural downward movement in the stomach and intestines, and help to spread Liver Qi. They may also have one or more of the following effects, depending on their specific chemical structure: • nondirectional antimicrobial, antipyretic, and antiinflammatory actions • nondirectional cardiotonic action • downward-directing tranquilizing action • downward-directing diuretic or purgative action

TEMPERATURE OF BITTER HERBS In itself, the bitter property tends to be either neutral, as in some of the digestive tonics, cardiotonics, and tranquilizers; or cooling, as in some of the antimicrobials, antipyretics, anti-inflammatories, and sedatives. Warm bitter herbs generally have bitter combined with acrid, for example, Myrica and Sanguinaria. The wide variation in temperature among Western herbs with the bitter taste, from warm to cold, is illustrated by the following examples: Temperature warm

neutral

Examples Myrica for patterns of Deficiency, Stagnation, and Cold, such as exhaustion and depression with sensations of cold Marrubium for patterns of Deficiency and Stagnation, with or without Heat or of Cold, such as a weak cough with sensations of obstruction in the chest

neutral~ool

Gentiana for patterns of Deficiency and Stagnation with some Heat. such as weak digestion with gastroenteritis

cool

Berberis for patterns of Stagnation and Heat with or without some Deficiency, such as cholecystitis with sensations of heat

cold

Asclepias for patterns of Excess Heat. with or without Stagnation, and in the absence of DefIciency. such as acute respiratory infections with fever

CAUTIONS Chinese herbal tradition

It must be clearly understood

35 that in the Chinese herbal tradition, cautions and contraindications for bitter herbs depend on their temperature, rather than on the bitter quality itself.

Cool or cold bitter herbs Chinese contraindications for Cold Deficient patterns of the Spleen and Stomach, especially with diarrhea, are related to the temperature, rather than to the bitter property itself. Cool or cold bitter herbs are contraindicated or to be used with caution for Cold Deficient conditions of the Spleen and Stomach, especially with loose stools or diarrhea. However, sweet cold herbs may be similarly contraindicated for Cold Deficient patterns of the Spleen and Stomach since it is not the taste but the cold temperature that is damaging to the Spleen. Warm 'or hot bitter herbs In contrast to cooling bitter herbs, warming bitter herbs may be indicated for Cold Deficient patterns of the Spleen and Stomach. For example, Evodia (wti zhii yti) is indicated for diarrhea from Cold Deficient Spleen and Kidneys. Warm bitter herbs are generally contraindicated for Heat patterns, especially Deficiency Heat associated with Deficient Ym. Western herbal tradition Some texts contraindicate certain bitter herbs in cases of gastric ulceration or hyperacidity due to the possibility that they may increase the secretion of gastric acid and aggravate these conditions. However there is evidence to suggest that these herbs can reduce rather than increase the potential for gastric irritation (see the Toxicology section in the Gentiana chapter).

Sour In the mouth, the sour taste and the astringent effect can be differentiated as follows:

• sour taste • astringent effect

'sharp: acid taste oflemon juice or vinegar puckering or drying effect on the mouth and tongue

The sour taste is not necessarily accompanied by a puckering effect, nor is the astringent effect necessarily accompanied by a 'sharp' taste.

CHINESE HERBAL TRADITION In the Five Element tradition, the sour taste is said to tonify the Liver. In the Chinese herbal tradition, the concepts of sour (suan) and astringent (se) are very close. Most of the herbs in the astringent action group are classified as sour, although there are exceptions, and the main manifestation of the sour taste is the astringent action.

36

Combining Western Herbs and Chinese Medicine

Astringency is associated with firming and stabilizing the Qi to hold things in their proper place. This includes not only the prevention of leakage of fluids and of organ prolapse, but also the stabilization of the organ functions, including their mental and emotional aspects. By firming and stabilizing the Qi, the astringent action can counteract three related pathologies: • Deficiency of the holding function of Qi • Excessive dispersal of Qi • Qi not holding Spirit firm Deficiency of the holding function of Qi This is Deficiency of a very specific function of Qi-not the warming, moving, or activating aspect-but the special function of holding things firm and stable and in their proper place. If this function of Qi becomes weakened, then there may be leakage of fluids through cell walls, leakage of blood from capillaries, loss of sweat through the pores, leakage of urine or stool through atonic sphincters, and the prolapse of organs. Excessive dispersal of Qi If the condensing and concentrating function of Qi is weak, there may be an excessive, dispersing, outward movement leading to loss of energy from the body and to a diffusive and scattering effect on the Qi. If the Defensive Qi becomes less dense and more diffuse, it is easier for pathogens to enter the body, resulting in chronic or recurring illnesses. If the Qi of the Kidney becomes more diffuse or scattered, mental concentration becomes more difficult, and it may become more difficult to focus the will to get things done. Qi not holding Spirit firm Weakness in the capacity of Qi to hold the Spirit firm and stable may result in the disturbed upward movement of energy in the body, with symptoms such as mental or emotional instability, anxiety, insomnia, and palpitations. Schisandra is an example of a herb that can be used to counteract all three of these pathologies since it can:

• reduce excessive dispersal ofQi to treat excessive sweating and reduce the side effects of dispersing herbs, such as Ephedra

• strengthen the holdingfunction of Qi to treat urinary frequency, diarrhea, and vaginal discharge

• strengthen the holdingfunction ofQi to firm and stabilize Heart Spirit to treat insomnia and palpitations

,WESTERN HERBAL TRADITION . , Sour taste There does not appear to have been a clear concept of the sour taste in the West comparable to that of Chinese medicine. However, Gerard 10 described the juice of

the lemon as 'sharp' and stated that it 'cutteth, divideth, and maketh thin, gross, tough, and slimy humors? Lemon juice has been used in Western folk medicine to cleanse the liver and to treat liver and gallbladder disorders. In Britain, greasy fish and chips are usually drenched with vinegar, and this can be associated with the sour taste assisting the liver to deal with this intake of oily food. 11

Astringent action Lonicerus and Tabernaemontanus used the term 'ziehen zusammen' (to draw together) to describe herbs, such as Achillea, that are used to stop hemorrhages and the leakage of stool, sperm, or vaginal discharge. Christopher described astringents as 'herbs that influence the vital contractility of cell walls, condense the tissues, make them denser and firmer, and arrest discharges.' The emphasis in the West is on what can be called the material aspects of astringency, that is, on preventing the leakage of the fluids and holding the organs in their proper place. Western astringent herbs are therefore used internally to treat disorders, such as diarrhea, bleeding, discharges, urinary incontinence, and organ prolapse, and locally to treat varicose veins, hemorrhoids, wounds, and ulcers. Western herbal therapy does not appear to possess a concept comparable to the Chinese idea of the energetic aspect of astringency in terms of firming the energies of organ systems and stabilizing the mind and emotions.

BIOCHEMICAL PERSPECTIVE Sour taste The sour taste sensation may result from the stimulation of the sour taste receptors by hydrogen ions. Sour-tasting compounds are often carboxylic acids, such as acetic acid (as in vinegar), citric acid (as in lemon juice), and oxalic acid (as in Rumex). Tannin astringents Local astringent effects, and the puckering sensation produced by many astringents on the mouth and tongue, are most commonly associated with tannins (see the Potentilla chapter).

Bioavailability of tannins This topic has recently been reviewed/ and in the present state of knowledge, it appears that intact tannin molecules have poor bioavailability. This is perhaps fortunate since intact hydrolyzable tannins in the blood have been reported to be hepatotoxic. However, the bowel flora breaks down tannins into smaller phenol molecules that can be absorbed through the gut wall into the blood and can have antioxidant effects in the body. Therefore, whilst tannins can have local astringent and antihemorrhagic effects on the mucosa of the mouth, stomach, or intestines, there is currently no evidence to indicate that they can produce these effects at sites remote from the

Taste

37

gut. It is therefore necessary to verify traditional claims for tannin-containing herbs that they can treat disorders such as hemoptysis, menorrhagia, or urinary incontinence. It is possible that the products of tannin breakdown in the gut may contribute to astringent and antihemorrhagic effects at sites remote from the gut, but this has yet to be demonstrated.

Relatively material aspect This refers to the relatively more

Nontannin-containing astringents Substances other than tannins may have local astringent or antihemorrhagic ef-

nins.

fects, as for example in the following herbs:

Relatively energetic aspect This refers to the relatively more

• Calendula

antihemorrhagic and vulnerary actions may be due to resinous constituents

• Capsella

antihemorrhagic action may be due to

• Capsicum • Commiphora

a peptide antihemorrhagic action may be due to the amide capsaicin antihemorrhagic and vulnerary actions may be 9,ue to both resinous and polysaccharide constituents

Equisetum and Hydrastis also have astringent or antihemorrhagic actions, and have not been reported as containing appreciable quantities of tannins. Astringent mechanisms Three possible components of the astringent mechanism can be summarized as follows. 1. Tannins or other chemicals may have local effects on the gut mucosa, following oral administration, or on the surface of the body, following topical application. 2. Substances may be absorbed through the gut wall and travel in the bloodstream to target tissues remote from the gut. 3. Substances may first strengthen the function of the organ systems, resulting in indirect astringent effects. For example, in terms of Chinese medicine, Schisandra may reduce diarrhea by first firming Kidney Qi, or Astragalus may treat diarrhea by first tonifying the Qi and Yang of the Spleen. However, there is as yet no data linking astringency to the systemic effects of plant constituents.

COMBINING WESTERN AND CHINESE PERSPECTIVES The discussion below links elements from Chinese medicine and Western herbal tradition. 1\vo aspects of astringency Sour herbs can be said to manifest two main aspects of astringency, the relatively material and the relatively energetic.

material manifestations of astringency, such as reduction of leakage of fluids and treatment of organ prolapse. In the West, astringent herbs are used to treat these more material aspects. Most Western astringent herbs can be classified as sour, such as Geranium and Vinca, or sour and bitter, such as Polygonurn and Sanguisorba, and most of them contain tan-

energetic manifestations of astringency, that is, stabilizing organ functions, especially their mental and emotional aspects, to treat such disorders as palpitations and dreamdisturbed sleep. Western contribution The contribution of the Western herbal tradition lies not so much in theoretical concepts of astringency, but in the development of the use of a wide range of astringent herbs. For example, Myrica can be used as a warming, anticatarrhal astringent to treat diarrhea with mucus in the stools and sensations of cold. Polygonurn bistorta can be used as a cooling, demulcent, anti-inflammatory astringent to treat diarrhea with intestinal inflammation and sensations of heat. Up to the present, there have been few research studies on the mechanism of astringency, and of these studies, most have focused on the tannins. In the future, research studies may reveal a variety of astringent mechanisms, involving both local and systemic astringent effects. Chinese contribution The specific contribution of Chinese medicine is in regard to the relatively energetic aspects of astringency, especially the use of sour astringent herbs in the treatment of mental and emotional disorders. In terms of Chinese medicine, if the Qi does not perform its function of firming and stabilizing the energies of the organ systems, their normal rhythm and direction of movement may become disturbed, as in the irregular upward movement of Heart Spirit Disturbance. Cardioregu1ators and nervines The Chinese concepts of the energetic aspects of astringency can be applied to the Western action concepts of cardioregulators and nervines. Herbs with these actions can be used to strengthen and stabilize the function of the coronary and nervous systems, respectively. In some of these herbs: the sour astringent property may contnbute to the stabilizing effect

.

Cardioregulator . In terms of Western herbal medicine, a cardioregu1a~r ca:n be defined as a herb that by strengthening the heart can stabilize i~ function and treat conditions such as arrhythmia. labile blood pressure, and fluctuations in energy and. body temperature. In terms of Chinese medi-

38

Combining Western Herbs and Chinese Medicine

cine, a cardioregulator can be said to tonify Heart Qi, and, by doing so, firm and stabilize Heart Qi to treat the syndrome of Heart Qi Irregularity. The two main cardioregulatory herbs listed in this book are Crataegus and Leonurus. Both have a sour taste in the mouth and are ascribed the sour astringent taste property in this book. They can be said to have astringency with respect to the specific function of firming and stabilizing Heart Qi. A cardioregulator can be said to treat problems of the coronary system (Heart Qi Irregularity), rather than the nervous system or the mind and emotions (Heart Spirit Disturbance), and Crataegus is a good example of this. However, in addition to tonifying and stabilizing Heart Qi, Leonurus can also calm Heart Spirit Disturbance. It can thus be used to treat anxiety in addition to cardiac weakness and arrhythmia.

Nervines These can be defined as herbs that tonify and stabilize the nervous system. They can be used to treat depression and emotional instability, especially when these are . associated with physical, emotional, and mental exhaustion. In terms of Chinese medicine, nervines can be said to tonify the Qi or Y'm of the Kidney, and the Qi, Y'm, or Blood of the Heart, and to firm and stabilize Heart Spirit. Some nervine herbs have a sour taste in the mouth and can be assigned the sour astringent taste property, for example, Hypericum and Schisandra. In my opinion, both these herbs can firm and stabilize Kidney Qi. This can reduce the diffusing, dispersing, and disturbing effect of fear on the Kidney itself, and lessen the disturbing effect of fear on the Heart. They can also firm and stabilize Heart Spirit, and can thus be used in combinations for enuresis and dream-disturbed sleep associated with fearfulness and anxiety. DIRECTION OF ENERGY The astringent property can be said to hold things firm, stable, and in their proper place. It can be seen as a passive effect of maintenance, rather than an active effect that moves energy in a particular direction. It can, thus, control excessive outward movement of energy and fluids, but it does not in itself produce an active inward (centripetal) movement of energy. It can also control the excessive disturbed upward movement of energy, but it does not actively direct energy downward.

TEMPERATURE The,~~tionof Qi t? hold things firm and in their proper place is not, in itself, associated with either warming or cooling effects. Most of the astringent herbs that have been classifiedin this book as only sour or slightly sour are neutral in temperature, for example, Capsella and Geranium.

Herbs classified as having both the sour and bitter tastes are also mainly neutral, for example, Agrimonia and Quercus. Some .herbs with both the sour and bitter tastes are listed as neutral-cool or cool, and this may be associated with the anti-inflammatory bitter constituents, as in Filipendula and Hamamelis. Sour astringent herbs that are warming, such as Myrica and Schisandra, are not common, and the warming effect of both these herbs may be due to the acrid constituents.

CAUTIONS Chinese herbal tradition Astringent herbs are contraindicated for Exterior conditions that are not fully cleared since astringents will reduce the outward dispersive movement needed to clear Exterior pathogens through the body surface. This includes skin rashes that are in the process of expressing. In apparent contradiction to this, Schisandra has been used for allergic skin disorders. However, I do not generally use Schisandra in the acute stage of allergic skin disorders associated with Wmd Heat. I use Schisandra in the chronic or remission phase associated with Kidney Deficient Qi. For example, in this book, Schisandra is not included in the combination Arctium: recurring urticaria: acute phase, but it is included in Arctium: recurring urticaria: remission phase. Astringent herbs are also contraindicated in Chinese medicine for Interior Stagnation since they may reduce the dispersing, moving effect required to clear the Stagnation. Warm astringents, such as Schisandra, are especially to be avoided in cases of Interior Stagnation with Heat. Western herbal tradition Astringent herbs are contraindicated when it is necessary to allow toxins to clear from the body via sweat, urine, stools, or discharge. Also, there are specific cautions to be used for astringent herbs with a high tannin content (see the Toxicology section in the Potentilla chapter).

Sweet In the Chinese herbal tradition, the sweet taste is associated with the taste that rice gives in the mouth on chewing; it is not associated with the intensely sweet sensation of sugar, as in the West. This cultural difference explains why some Chinese herbs that are listed as having the sweet property do not taste sweet to Westerners. For example, PanaX ginseng is listed as sweet and slightly bitter in property. However, to most Western people, brought up on massive amounts of sweet foods and candies, the taste in the mouth is primarily bitter, and not all Westerners can detect a sweet taste.

Taste CHINESE HERBAL TRADITION Five Element tradition In this tradition, the sweet taste is said to tonify the Spleen and is linked with Earth. This element can act as the center reference point to which other things are linked and around which they have their movement, giving them stability and balance. The material solidity and weight of the Earth element can be associated with a dampening of excessive movement away from the central position and, therefore with a moderation of extremes. Earth and the sweet taste can also be associated with nourishment, especially of the material aspect of Qi. Herbal tradition In this tradition, the following effects have been associated with the sweet taste property:! • tonic • moistening • antispasmodic ,.; '" • harmonizing of emotions • harmonizing of other herbs • moderation of other herbs

Tonic In Chinese medicine, the sweet taste is associated mainly with the ability to tonify Qi, Blood, ¥m, or Yang. It is especially associated with the nourishing function of Oi. that is, the capacity to increase the solid substance of the body. A good example of a herb with this effect is Ziziphus fruit (da zao). Moistening Closely associated with the nourishing action of the sweet taste is its moistening effect-the ability to tonify Fluids. For example, Pseudostellaria (tai z1 shen) and Ophiopogon (mai men dong) are used for their moistening effect.\2

Antispasmodic Some herbs with the sweet taste can reduce muscle spasms and alleviate pain. This is said to be due to the sweet taste nourishing the rm of the tendons and thus relaxing the muscles. l Glycyrrhiza is such a herb. Angelica sinensis (dang gui) can also relieve pain, and this may result partly from its ability to tonify the Blood. nourish the muscles. and relieve spasms. However, the analgesic effects of this herb may be primarily due to the ability of its acrid constituents to move Blood Stagnation.

Harmonizing ofemotions According to Yang, the moderate

stTeet

taste gives it the ability to harmonize the quality of the emotions and reduce stress, and Lilium brownii (bcii he) and Rehrilannia (shu dl huang) can be used to do this.\ (See the discussion'In the Combining the Western and Chinese perspectives section below.) ,

,'~

.,'

.-

Harmonizing of other herbs Some sweet substances can act

39 as a stabilizing central focus for the other herbs in a combination and can bring together and harmonize their different effects. Glycyrrhiza (gan cao) is the most common example of this.

Moderation of other herbs Substances with the sweet taste can moderate the effects of other herbs. For example, Glycyrrhiza can moderate the harsh effects of other herbs, such as the burning sensation of acrid Capsicum on the mucus membranes. Sweet herbs can moderate the speed and intensity of the effects of other herbs, making their effects less rapid and violent and more moderate and longer lasting. 1 For example, the sweet herb Serenoa can be used to moderate the Yang tonic action of Panax ginseng and Turnera. As a result, the body can incorporate this Yang energy ina smooth and steady fashion, rather than in a short burst that may result in imbalance and side effects.

WESTERN HERBAL TRADITION The theory of taste properties was not as well developed in the West as in China. In addition, the sweet taste was not associated directly with elaborate theoretical concepts. The fruits of Ficus carica, the fig, and Ziziphus jujube, the date, are examples of sweet herbs that were used from ancient times in the West. Both of these fruit were used for their nutritive action and as demulcents to treat respiratory disorders. 1J Althaea and Ulmus are examples of sweet herbs that are currently used in the West for their demulcent and nutritive action. 5,14

BIOCHEMICAL PERSPECTIVE Herbs that are classified as sweet in this book generally contain one or more of the following four types of constituent: • nutritive constituents • mucopolysaccharides • immunopolysaccharides • adaptogens Nutritive constituents The nutritive aspect of the sweet tonic action goes beyond simply supplying sweet nutrients in the form of sugars and starches. It also involves strengthening the natural ability of the body to make Qi and Blood and form tissue. This may involve herb constituents, such as minerals and vitamins, that may act as cofactors and facilitate the anabolic processes of the body. For example, Ziziphus fruit contains calcium, phosphorus, and iron, and the vitamins A, Bz, and C. in addition to sugars and starches.

Combining Western Herbs and Chinese Medicine

40

Mucopolysaccharides Demulcent herbs contain abundant mucopolysaccharides that can form a slippery gel and have a soothing and protective effect on inflamed mucus membranes. Althaea. Plantago major, and Viola are examples of herbs with demulcent action based on mucopolysaccharides, and these herbs can be used for conditions involving inflammation, soreness, and dryness of the respiratory mucosa. (See the Althaea chapter.) Immunopolysaccharides Polysaccharides from the following herbs have been reported to have an immunomodulatory effect: Althaea, Angelica, Calendula. Echinacea, Thuja, and Viburnum (see the chapters on these herbs). This can be regarded as a specific aspect of the Qi tonic action, related to the concept of tonifying Defensive Qi. There is some debate as to the effectiveness of the socalled immunopolysaccharides in vivo. However, it may be that these constituents help herbs, such as Echinacea or Thuja, to increase the resistance of the body to infection. Adaptogens This term refers to herbs or herb constituents that can enhance endurance and strengthen the natural ability of the body to adapt to environmental shocks and stresses. This is a specific aspect of the Qi tonic action that enables the body to maintain homeostasis even under adverse conditions. The active constituents that are responsible for the adaptogenic effect are often triterpenoid saponins. These chemicals can have multiple effects on the body and can strengthen the ability of the following systems to adapt to stresses: • Kidney (nervous and endocrine systems) • Heart (cardiovascular system) • Liver (hepatoprotective system) Examples of sweet tonic herbs with adaptogenic action based on triterpenoid saponins are Astragalus (astragalosides), Glycyrrhiza (glycyrrhizin), and Panax ginseng (ginsenosides). COMBINING WESTERN AND CHINESE PERSPECTIVES The discussion below combines elements from Chinese medicine, Western herbal tradition, and biochemistry, and is • organized under the following headings: • tonic • demulcent • stabilization of the emotions ":~" , • moderation of other herbs Tonic The main effect associated with the sweet taste is the tonic action. However, the tonic action of the sweet taste is

different in nature from the tonic action of the bitter or acrid tastes. Unlike the acrid and bitter tastes, the sweet taste is not associated with increasing movement and dispersing Qi Stagnation. The tonic action of the sweet taste is especially associated with strengthening the material aspect of Qi. Sweet tonics aid the formation of Blood, Yin, and Fluids, and some sweet tonics, such as Serenoa and Ziziphus, can be used to assist in weight gain. Some sweet tonics can strengthen the ability to adapt to environmental stresses and the ability to resist infection. However, these herbs are more for maintaining the stability of the homeostatic mechanism and the integrity of the body's defense system. They do not necessarily tonify Yang in the sense of increasing warmth and movement. Many of the herbs in the Yang tonic group that do strengthen these aspects are either not sweet or have taste properties in addition to sweet, such as acrid and bitter. Demulcent In the Chinese tradition, some sweet tonic herbs are said to help to generate Fluids and thus have a moistening effect, for example, Ophiopogon. Such herbs can be used to treat conditions involving dryness, soreness, and inflammation of the mucous membranes. In the Western tradition, demulcent herbs, such as Althaea, are used for similar conditions, but their effect has been explained in terms of supplying mucilage to the body, rather than by increasing the generation or secretion of Fluids. It is possible that some herbs may have both mucilagesupplying and Fluid-generating effects, or that these two effects are part of the same phenomenon. For example, Althaea is listed as a demulcent in the West and Ophiopogon as a Fluid tonic in China, but both herbs can be used to treat dryness and inflammation of the respiratory mucosa with dry cough and thick sputum that is difficult to expectorate. Stabilization of the emotions The sweet taste can be associated with the Earth element. The damp, heavy, static nature of the sweet taste can be utilized to reduce excessive or disturbed movement of energy, and to stabilize, balance, and harmonize the flow of the emotions. For example, the calming nature of Valeriana may be partly due to the heavy nature of its sweet property, which helps to weigh down the disturbed upward movement of Heart Spirit or Liver Yang that can be associated with anxiety or anger, respectively. I often combine Valeriana with the sweet herb Glycyrrhiza to emphasize this function of the sweet taste. ), . As another example, Cra~~egus h,as a cardioregulatory action that enabl~s it to stabilize"fluctuations in Heart Qi resulting in arrhythmia, energy fluctuations, or emotional lability. I consider the cardioregulatory action of Crataegus to be due paitly to its sour property that can firm Heart Qi

Taste and partly to its sweet property that emphasizes stability around a center point by dampening movement toward the extremes. Moderation of other herbs In a similar way, sweet herbs can moderate the extremes of other herbs in a combination and provide a stable central pivot for their actions. For example, if the patient has both anxiety and depression associated with Deficiency, the following combination could be used: Herb

Ratio

Temperature

Taste

Lavandula Passiflora Hypericum Avena Serenoa Rosmarinus Zingiber

1 1 1 1 0.5 0.5 0.5

51. warm neutral neutral neutral neutral warm hot

aromatic, bitter 51. bitter sour, 51. sweet sweet sweet, 51. sour aromatic, bitter, acrid acrid, aromatic

Th~ sweet taste ofAvena, Hypericum, and Serenoa forms the stable central point of this combination. Lavandula and Passiflora have a calming action to treat anxiety, and Rosmarinus and Zingiber have a stimulant action to treat depression. The sweet herbs will moderate movement toward the extremes of anxiety or depression, reducing any tendency to overcorrection by Lavandula and Passiflora on the one hand or Rosmarinus and Zingiber on the other.

DIRECTION OF ENERGY OF SWEET HERBS In terms of the Five Elements, the sweet taste maintains the movement of energy stable around the center, and dampens movement toward the extremes. It can be said to weigh down excessive or disturbed upward movement, and to reduce excessive outward dispersing movement of energy. However, in high doses, some of the sweet adaptogenic herbs, such as Astragalus, Glycyrrhiza, and Panax ginseng can aggravate or produce excessive or disturbed upward movement of Heart Spirit or Liver Yang. For example, in excessive doses and in susceptible persons, Glycyrrhiza can aggravate hypertension. At high doses, the adaptogenic action becomes a Yang tonic effect with increased upward movement, overriding the heavy nature of the sweet property that tends to control this effect.

TEMPERATURE OF SWEET HERBS In itself, the sweet taste can be associated with the neutral temperature and can be used to stabilize fluctuations in the temperature of the body. Some sweet herbs are classified as cool, but these usually also have the bitter taste in its anti-inflammatory aspect, for example, Althaea, Ophiopogon, and Viola. Herbs with the sweet taste that are classified as warm or hot usually also have the acrid taste, for example, Cinnamomum.

41 CAUTIONS General cautions In Chinese medicine, sweet herbs are avoided or used with caution in the following patterns: • Exterior Excess • Interior Stagnation • Damp • Phlegm Manifestations of the last three patterns include sensations of heaviness, feelings of lethargy and depression, mental heaviness and dullness, digestive stagnation, loss of appetite, nausea, bloating, weight gain, and catarrhal conditions. Specific cautions There are specific cautions and contraindications for different types of sweet herbs. For example,

• Astragalus can have warming and drying effect and so should be used with caution in cases ofYin Deficiency with Heat signs

• Ophiopogon is a sweet herb that is moistening and cooling and is therefore inappropriate for patterns of Deficiency with Cold and Damp

• Panax ginseng is a sweet herb with a stimulating and upward movement effect on the energy and is therefore to be avoided in cases of Heart Spirit Disturbance or Liver Hyperactive Yang

Acrid In the mouth and on the tongue, the acrid or pungent taste can be associated with a range of related sensations, including the severe burning of Capsicum, the prickling of Lobelia, and the tingling of Echinacea or Zanthoxylum. The acrid taste is sometimes referred to as pungent or spicy.

CHINESE HERBAL TRADITION According to the Five Element tradition, the acrid taste tonities the Lung. In the Chinese herbal tradition, the characteristic function of the acrid property is moving and dispersing. It can move Stagnation of Qi and Blood and disperse pathological factors associated with the Stagnation, such as Exterior Wmd, Toxin, or Retained Pathogen. The acrid property can promote Fluid metabolism and help to move and disperse accumulation of Damp or Phlegm.

The acrid property is not necessarily warming. Cool, acrid herbs can be used to disperse Heat, and warming, acrid herbs can be used to disperse Cold.

42

Combining Western Herbs and Chinese Medicine

Three well-known acrid categories In the Chinese herbal tradition, the acrid taste is commonly associated with the following three herb categories: • cool, acrid herbs that clear Exterior Wind Heat • warm, acrid herbs that clear Exterior Wind Cold • acrid herbs that warm the Interior Action groups containing acrid herbs Acrid herbs are not just found in the three well-known categories mentioned above, they are also found in other Chinese action categories. A more complete list is as follows: • clear Heat • clear Wind Heat • clear Wind Cold • clear Wind Damp • transform Phlegm and stop cough • open the Orifices • transform Dam~ i ~ . • regulate the Qi • move the Blood • warm the Interior • tonify Yang • external application Clear Heat In Chinese medicine, the acrid taste occurs in action categories where it might not be expected, for example, the action categories of herbs that clear Heat (drain Fire) and clear Heat Toxin. In these cold. acrid herbs, the moving and dispersing functions of the acrid property are important to assist in the complete clearance of Heat from the body to prevent the possibility of some Heat lingering in the body as a Retained Pathogen. The acrid and cooling properties combine to move Stagnation of Qi and disperse the associated accumulation of Heat and Toxin. l For example. in Chinese medicine, Prunella (xia kii dlO) is a cold, acrid herb that can clear Liver Heat with hypertension and headache, and also disperse Phlegm Heat to treat neck lumps and goiter. Houttuynia (yU xing dio) is a cold acrid herb that can clear Heat Toxin and treat swellings and abscesses. and can clear Lung Phlegm Heat to treat lung abscess or cough. Clear Wmd Heat Herbs with this action can be said to assist in the dispersing function of the Lung, move Stagnation in the surface channels, and disperse Wind Heat and Retained Pathogen. The acrid and cooling properties combine to move Stagnation of Qi and disperse the Wind Heat. Some acrid, cooling diaphoretics are also bitter, and the bitter property may assist the acrid in clearing Heat. For example, in Chinese medicine, Arctium seeds (niu bang ZI) can be used for acute urticaria with feverishness and sore throat.

Clear Wmd Cold Herbs with this action are commonly used in acute respiratory or other infections when chills are dominant to fever and there is pain and sensations of cold in the head, neck, or body. The warming and acrid properties combine to disperse Stagnation, Wmd, and Cold from the surface channels, and often increase or regulate sweating. For example, in Chinese medicine, Angelica dahurica (bai zhi) can be used for acute common cold with headache, sinus congestion, and sensations of cold; and fresh Zingiber (sheng jiang) can be used for acute influenza with chills and cough with copious sputum. Clear Wmd Damp The function of the acrid property in these herbs is to move Stagnation of Qi and Blood in the channels of the muscles, tendons, and joints, and to disperse the Wind and Damp associated with the Stagnation. These acrid herbs can thus be used to treat pain or restriction of movement associated with inflammation of the muscles, tendons, and joints. Some are warming, acrid herbs to disperse Wind Damp Cold, for example, Angelica pubescens (dli huo), and others are cooling, acrid herbs to disperse Wmd Damp Heat, for example, Gentiana macrophylla (qin jiao). li'ansform Phlegm and stop cough A specific aspect of the moving and dispersing function of the acrid taste is to dissolve and disperse Phlegm. l One application of this is to treat wheezing and cough. Once again, the acrid property can be used to treat patterns of either Heat or Cold:

• Pinellia (ban xia) has both the warming and acrid properties that can be used to treat cough associated with Lung Phlegm Cold

• Euphorbia helioscopia (ze qi) has both the cooling and acrid properties that can be used to treat cough or wheezing associated with Lung Phlegm Heat Open the orifices Another application of the capacity of the acrid taste to dissolve and disperse Phlegm is its ability to clear so-called insubstantial Phlegm from the channels. This can assist the aromatic property to open the orifices and revive the Spirit. Aromatic and acrid herbs have been used in Chinese medicine to treat severe acute conditions such as febrile delirium or coma from cerebrovascular accidents, for example, Secretio Moschus (she xiang). Some of these herbs have also been used to treat chronic conditions such as dizziness, deafness, mental dullness, poor memory, or disorientation, for example, Acorus (sm chang pu). li'ansform Damp In Chinese medicine, the herbs in the transform Damp group are most commonly associated with the aromatic property; but they are also acrid in taste, and nearly all are warm in temperature. These herbs are used to revive the Spleen, move Stagnation in the Spleen and Stomach, and transform Damp.

{ .. i

Taste The dispersing and moving functions of the acrid taste complement the lightening and penetrating functions of the aromatic property. Together they can counteract the heavy, deadening characteristics of Damp that can be associated with stagnation, accumulation, and obstruction. For example, Atractylodes lancea (cang zhu) is a warm, acrid, aromatic herb that can treat disorders associated with Spleen Damp, for example, loss of appetite, nausea, epigastric distension, and diarrhea. This herb is especially useful to treat Damp patterns because its aromatic property can transform Damp, its bitter taste can drain Damp downwards, and its dispersing acrid taste can assist both of these processes.

I

.~

Regulate the Qi Due to the moving and dispersing function of the acrid taste, many herbs in the regulates the Qi action category have the acrid property. Most of these herbs are acrid and warm. For example, the mature peel of Citrus reticulata (chen pi) can move Stagnation of Spleen and Stomach Qi to treat nausea with epigastric and abdominal distension. Move the Blood Many of the herbs in this action category have the acrid property, which helps them to disperse and move Blood Stagnation. Most of the acrid herbs that move the Blood are warming. An example is Ligusticum (chuan xiong), which can be used for pain in the chest, sides, or lower abdomen. However, some of the acrid herbs that move the Blood are cooling, for example, the tuber of Curcuma longa (yil jIn), which can be used for chest pain associated with Heart Stagnant Blood and Heart Phlegm Heat. Warm the Interior The acrid and warming properties tend to accentuate each other. The acrid property is moving and dispersing, and the warming property is activating and moving, and can loosen Stagnation, especially that due to Cold. The two properties can combine to produce a rapid, stimulating, and dispersing effect. Most herbs that warm the Interior also warm the Middle Burner and are specific for clearing Cold from the Spleen and Stomach. For example, dried Zingiber (gan jiang) can be used to treat vomiting, epigastric pain, or abdominal pain, when these are accompanied by sensations of cold. A few of the herbs that warm the Interior can warm and strengthen the Kidney. For example, Cinnamomum bark (roil gul) is an acrid herb that can be used for weak back, urinary frequency, and impotence with sensations of cold. These herbs may also warm and strengthen the Yang of the Heart. Tonify the Yang Some~f the herbs' iIi the tonifi~~.th~' Yang group are warming and acrid. However, these herbs are usually also sweet, bitter, or salty. In itself, the acrid taste may be quickly and temporarily stimulating, but it usually needs

43 other properties to add the slow tonic component. For example, the slower, heavier, nourishing characteristics of the sweet taste can provide a good balance to the quick, moving, and dispersing aspects of the acrid taste. For example, Eucommia (dil zhong) has both the acrid and sweet properties. The sweet taste tonifies chronic Deficiency of the ~idney and Liver, and strengthens the sinews and bones to treat weakness in the lower back and legs. The moving and dispersing function of the acrid taste assists circulation of Qi and Blood in these areas to complement the sweet tonic function. External application Many of the substances in this category have the acrid property, and some of these substances are acrid and hot, for example, camphor (zhang nilo). This herb is applied topically in sprains and trauma to reduce pain and swelling associated with Blood stasis. WESTERN HERBAL TRADITION The acrid taste has not been developed as a well-defined theoretical concept in the West as it has in China, and there is not such a clear association of specific actions with the acrid taste. The main action associated with the acrid taste in the West is the circulatory stimulant action. However, there is a wide range of Western action categories that contain herbs with the acrid taste. These are discussed in the Combining the Western and Chinese perspectives section below. Circulatory stimulants These can be defined as herbs that can stimulate or tonify heart function, improve circulation, and warm the body. Some, for example, Capsicum, can specifically increase coronary circulation; some, for example, Zanthoxylum, can specifically increase peripheral circulation; and others for example, fresh Zingiber, are specific for warming the surface of the body. BIOCHEMICAL PERSPECTIVE The acrid taste sensation is not associated with a specific type of taste receptor on the tongue. It is a more general effect, following stimulation of sensory nerve fibers in the mouth or tongue. This may be similar to the counterirritant and local analgesic effect of some acrid substances on the skin. As with the bitter taste, the acrid taste is not limited to one type of chemical. Substances with the acrid taste can be found in various groups of plant constituents, for example, monoterpenoids, phenols, amides, and isothiocyanates. However, the bitter taste sensation on the tongue is followed by a specific sequence of physiological events, but no such sequence is yet known for the acrid taste. This may be partly due to the lack of a specific taste receptor for acrid.

44

Combining Western Herbs and Chinese Medicine

As noted previously, the pharmacological effects associated with the sweet taste can be divided into different groups, each group of effects associated with a different type of chemical. For example the adaptogenic tonic function of the sweet taste can be associated mainly with triterpenoid saponins. This detailed differentiation is not yet possible for the acrid taste. Actions of acrid constituents reported by research Some of the Western actions listed in the table below as associated with the acrid taste have been reported for specific acrid constituents. However, in herbs with multiple tastes, it can be very difficult to decide which pharmacological effects can be attributed to each taste. This is especially so when a single constituent possesses more than one taste, for example, camphor can be classified as both acrid and aromatic. Capsicum is thus a useful herb for study since acrid appears to be its only appreciable taste. Both Capsicum and its main pungent constituent, the amide capsaicin, have been reported to have antimicrobial, circulatory stimulant, digestive tonic, adrenal tonic, and topical irritant and analgesic effects (see the Capsicum chapter). Zingiber is a more complex herb to study since it can be hard to separate the acrid and aromatic effects, and because it has a number of different types of pungent constituents. The following effects have been reported for Zingiber's pungent constituents, the gingerols and shogaols: cardiotonic, thermogenic (warming), digestive stimulant, antispasmodic, antiemetic, antidiarrheal, and antitussive (see the Zingiber chapter).

COMBINING WESTERN AND CHINESE PERSPECTIVES The table below shows a range of Western actions that can be associated with the acrid property along with their nearest equivalent Chinese action concept. Understanding the role of the acrid property in these different action groups gives a deeper appreciation of the nature of the acrid concept. Each action is discussed below in terms of the different aspects of the acrid property, of which the most fundamental are moving and dispersing.

• antimicrobial, alterative

clear Heat

• cooling diaphoretic

clear Wind Heat

• warming diaphoretic

clear Wind Cold

• antirheumatic, antiarthritic

clear Wind Damp

• anticatarrhal, expectorant, antitussive

transform Phlegm and stop cough

.. -~

• resuscitant. anticonvulsant

open the Orifices

• carminative

transform Damp, regulate the Qi

• antispasmodic. analgesic

move the Blood

• circulatory stimulant

warm the Interior

• tonic

tonify the Yang

• counterirritant

external application

Antimicrobial and alterative (clear Heat) In Chinese medicine, in some circumstances, the moving and dispersing functions of the acrid property can result in a cooling effect by clearing Heat of various kinds. This can apply to some Western acrid herbs in the following action categories:

LOBELIA antipyretic

clear Excess Interior Heat and Wind Heat

CAPSICUM anti-inflammatory

clear Heat associated with Interior Stagnation

THUJA antimicrobial

clear Damp Heat and Heat Toxin

PHYTOLACCA alterative

clear Damp Heat. Heat Toxin. and Retained Pathogen

Some antimicrobial and alterative acrid herbs are classified as warming, such as Capsicum and Thuja, others as cooling, such as Phytolacca, and others as variable-temperature herbs, such as Lobelia. In each case, it is the moving and dispersing functions of the acrid property that results in the clearance of Heat Diaphoretic (clear Exterior Wmd) Western herbs with the diaphoretic action, that is, inducing or increasing perspiration, can be divided into cooling diaphoretics and warming diaphoretics.

Cooling diaphoretic In herbs with this action, for example, Nepeta, the dispersing function of the acrid property can be said to assist clearance of Wind Heat. In some cooling diaphoretics, the Heat-clearing function of the bitter property assists the acrid dispersing function to remove Heat from the system. Such acrid and bitter diaphoretic herbs often also have the alterative action of clearing Retained Pathogen from the surface of the body, for example, Achillea. Warming diaphoretic Herbs that have the warming diaphoreticaction often also have the circulatory stimulant

Taste action, for example, fresh Zingiber. Both these actions are associated with the warming, stimulating, moving, and dispersing aspects of the acrid property. In the diaphoretic action, these acrid functions are active more at the surface of the body, and in the circulatory stimulant action, more in the interior. Antirheumatic and antiarthritic (clear Wmd Damp) In herbs with these actions, the moving and dispersing functions of the acrid property can be said to clear Wind and Damp, and associated Stagnation, from the channels of the muscles and joints. In some Western herbs with these actions, for example, Arctium and Phytolacca, the dispersing aspect of the acrid property can have a cooling effect by dispersing Heat. In other Western herbs with these actions, for example, Myrica and Zanthoxylum, the acrid property is combined with a warming, circulatory stimulant effect. Anticatarrhal, expectorant, and antitussive (transform Phlegm and stop cough) In Chinese medicine, the moving and dispersing functions of the acrid property can be associated with the functions of penetrating, dissolving, and dispersing Phlegm. These acrid functions can contribute to the Western anticatarrhal, expectorant, or antitussive actions. Anticatarrhals reduce excessive secretion and accumulation of mucus by the mucous membranes, wherever these may be in the body, but do not necessarily initiate the cough reflex. Expectorants have the more specific function of promoting the coughing up of phlegm, and antitussives can reduce excessive coughing. There is no exact equivalent of the anticatarrhal action in Chinese medicine. It is not the same as the action transforming Damp since the anticatarrhal action does not necessarily depend on stimulating the Spleen, but rather on a local effect on the mucous membranes. However, there may be some overlap between the two actions. In the Western herbal tradition, Sambucus is an example of a cooling acrid anticatarrhal that can be used for sinusitis, and Euphorbia hirta is a cooling acrid expectorant that can be used for bronchitis. Angelica archangelica can act as a warming acrid expectorant for cough with watery sputum or as a warming anticatarrhal for sinusitis. Lobelia is an example of an acrid antitussive herb that can be used for hot or cold conditions. . Resuscitant and anticonvulsant (open the orifices) In Chinese herbal medicine terms, the acrid functions of penetrating, dissolving, and dispersing Phlegm from the channels can complement the functions of the aromatic property of transforming Phlegm, opening the orifices, and reviving the Spirit.

In Western tradition, the acrid herbs Lobelia and Symplocarpus were components of the Antispasmodic tincture beloved of the Physiomedical and Eclectic practitioners. This combination, or Lobelia as a single herb, were given for fainting and for loss of consciousness associated with asphyxia, drowning, concussion, or apoplexy. They were also given for infantile convulsions, epilepsy, and febrile delirium. These acrid herbs can be said to combine the actions of dearing Phlegm and opening the orifices with extinguishing Wind and stopping tremors. Carminative (transform Damp and/or regulate the Qi) Herbs with this action are usually warming and are usually not only aromatic but also acrid. These tWo properties combine to regulate Qi, move Food Stagnation, and, in some cases, transform Damp and Phlegm. The digestive stimulant aspect of the carminative action may be more due to the acrid property, and the smooth muscle relaxant aspect may be more associated with the aromatic property. For example, Elettaria is a warming, acrid, aromatic herb that can be used for loss of appetite, flatulence, and intestinal colic, and can be said to regulate Qi and relax spasms. Angelica archangelica and Juniperus are aromatic and acrid herbs that can regulate Qi and, in addition, transform Damp. They can be used to treat loss of appetite and flatulence with sensations of heaviness in the limbs and body. Antispasmodic and analgesic (move the Blood) Some Western herbs that possess only the acrid taste, such as Capsicum and Lobelia, can be used as antispasmodics and analgesics both when taken internally and when used as external applications. This can be related to the acrid function of moving Qi and Blood and dispersing local areas of Blood stasis. For example, both Capsicum and Lobelia can be used for angina pectoris, postnatal pain, or local trauma. Circulatory stimulant (warm the Interior) In herbs with this action, the stimulating and moving aspects of the acrid property are associated with a strong warmirig effect. Such herbs stimulate the cardiovascular system and warm the body. This group contains the hottest herbs used internally in the West and includes Capsicum, Cinnamomum, Sanguinaria, Zanthoxylum, and Zingiber. It is interesting that Capsicum, the hottest of these herbs, has 1;leen used to equalize the distribution of heat in the body, to reduce fever or to treat certain patterns ofhypertension with sensations of heatin the head and upper body (see the Capsicum chapter). Redistribution or clearance of Heat can be associated with the dispersing function of the acrid property.

46

Combining Western Herbs and Chinese Medicine

The circulatory stimulant category has no exact equivalent in Chinese medicine, the closest category being that of herbs that warm the Interior. However, the· emphasis for most of these herbs is on warming the Spleen and improving digestion, rather than warming the Heart and improving circulation. A few of the herbs in the action category of moving the Blood can be described as circulatory stimulants in terms of Western tradition, for example, Commiphora (mb yao). However, circulatory stimulants have the specific function of strengthening coronary or peripheral circulation and warming the body. Herbs in the category of moving the Blood do not necessarily do this. Rather, they have the function of relieving pain due to Blood Stagnation, wherever it may be in the body and regardless of whether it is associated with Cold or Heat. Tonic (tonify Yang) When combined with the warming property, the acrid property is normally associated only with rapid stimulating, moving, and dispersing effects. Warming acrid herbs that also have a more gradual tonic action usually also have an additional taste. such as sweet or bitter. For example, Cinnamomum is warming, acrid, and sweet. and Turnera is warming, acrid, and bitter. However, Capsicum is a good example of a warming acrid herb that has only the acrid taste property but can have a more long-lasting tonic action in addition to its rapid stimulant effects. Counterirritant (external application) It may be that one aspect of the acrid property is its capacity to irritate the tissue and thereby initiate the natural local healing process. This can stimulate local circulation of Qi and Blood in the tissues and reduce pain and swelling due to blood stasis. Capsicum and Lobelia are examples of acrid counterirritants used in the West as topical applications for sprains and injuries.

DIRECTION OF ENERGY The function of the acrid taste is moving and dispersing and its direction of movement is outward. The acrid property is light and moving, and therefore likely to accentuate the upward movement of other light and moving energies. such as Heart Spirit and Liver Yang. It can counteract the heavy, dulling, downward effect of Damp. Acrid and wiU'lning The outward dispersing movement is accentuated if the acrid herb. is also warming. However. different acrid, warming herbs can vary greatly in their effects, as shown by. the difference between-Ephedra and Capsicum. '..,' '.'". .'0-' .• .

Ephedra This is an example of a warming. acrid herb with such a strong dispersing effect that there is the potential of loss of energy through the body surface and of depletion of

Lung and Kidney Qi. Ephedra can also accentuate irregular .: upward movement of energy and aggravate Heart Spirit Disturbance or Liver Hyperactive Yang, resulting in hypertension with sensations of heat in the upper body.

":c=:

Capsicum This is a powerful warming acrid herb with a very different effect on the movement of energy from Ephedra. Although it can have a strong dispersing effect. Capsicum does not accentuate disturbed upward movement. In fact. it tends to equalize the circulation of Qi and Blood throughout the body, so that it can be used to treat certain forms of hypertension with heat in the head and face.

TEMPERATURE Especially in the West, the acrid taste is often associated with the warming property. Certainly the moving dispersing nature of acrid is more comparable to the nature of the warming property than it is that to the nature of the cooling property. However: acrid resembles bitter in that neither of these tastes is necessarily linked to any particular temperature. Although acrid is perhaps more often associated with the warming property and bitter with the cooling, both tastes can be associated with any of the temperature categories. from hot to cold.

CAUTIONS General cautions The key function of acrid is moving and dispersing. Therefore, herbs with a strong dispersing effect of the type that can result in depletion or disturbance of energy, for example, Ephedra, are contraindicated or to be used with caution in cases with severe Deficiency of Qi or Disturbance of Spirit. However, this does not necessarily apply to acrid herbs that have a strong dispersing effect but are less likely to lead to depletion. For example, Achillea can have an acrid dispersing effect, but this is balanced by both tonic and astringent actions. . Specific cautions The specific indications of an acrid herb will depend on its temperature, its tastes, other than acrid, and its specific actions. For example, a hot acrid herb such as Capsicum would generally be contraindicated for peptic ulcers with Stomach Heat, and a cool acrid herb such as Echinacea should be used with caution for exhaustion with Deficiency and Cold in the Spleen, Stomach, and Intestines.

/.

.·Aromatic

. In the case. of the aromatic property. the sense of taste overlaps with the sense of smell. Aromatic substances are generally partially volatile at room temperature. and any

Taste effect they may have on the body may be partly via stimulation of taste receptors and partly via stimulation of olfactory receptors.

CHINESE HERBAL TRADITION The Five Element taste correspondences did not include aromatic, and in the Chinese herbal tradition, the aromatic property (xiang) was not strictly regarded as a taste.

47 substances can be used either to revive consciousness and treat coma, or to calm febrile delirium and help to reduce spasms and convulsions. Again, most of these aromatic substances also have the acrid property, which may contribute to the capacity to penetrate Phlegm. Some are warming, for example, Liquidambar resin (sii. he :dang), and others are cooling, for example, ox gallstone (nili huang).

Herbs that regulate the Qi Some of the herbs in this categoFunctions of the aromatic property The aromatic property is similar to the acrid in that it has moving and dispersing functions. However, to a greater degree than acrid, the aromatic property is considered to be lightening, penetrating, awakening, and reviving. The aromatic property is especially used when the Spleen fails to digest the food and metabolize Fluids properly, resulting in the accumulation of Damp and Phlegm. The aromatic property can:

• awaken the Spleen to transform Damp • penetrate the turbidity of Damp • lighten the effect of the heaviness of Damp on the body and the mind

• revive the Heart Spirit and open the orifices Actions associated with the aromatic property In Chinese herbal medicine, two groups of herbs are specifically associated with the aromatic property: • aromatic herbs that transform Damp • aromatic substances that open the orifices In addition, there are aromatic herbs in the category of herbs that regulate the Qi.

Aromatic herbs that transform Damp The aromatic property of these herbs awakens the Spleen to transform Damp, penetrates the turbidity of Damp, and lightens the effect of the heaviness of Damp on the digestive system and the body in general. These herbs are used to treat loss of appetite, nausea, vomiting, abdominal distension, and diarrhea when these are associated with indications of Damp, such as lethargy and sensations of heaviness and dullness in head, body, and limbs. The aromatic herbs in this group are also acrid and most of them are warm. fhese three properties combine to move Stagnation and to disperse Damp and Cold, as in, for example, Agastache (hub xiang) and Eupatorium fortunei (pei lcin).

Aromatic substances that open the orifices The aromatic property of these substances is said to penetrate the turbid Phlegm that is clouding and obstructing the sensory orifices and to revive the Heart Spirit. Phlegm can have either a dulling or a disturbing effect on the mind. Therefore, these

ry have the aromatic property and can move Stagnant Qi in the Spleen, Stomach, or Intestines to treat such complaints as belching, nausea, vomiting, and epigastric or abdominal distension and pain. A good example is the mature peel of Citrus reticulata (chen pi). Regulating Qi and transforming Damp are two actions that can have similar effects. The difference between the two is that Qi regulators are specific for intestinal spasms and pain linked to Stagnation of Qi, whilst herbs that transform Damp are specific for abdominal distension and diarrhea with lethargy and sensations of heaviness linked to Damp. The action of regulating the Qi is more connected to the moving, relaxing, and calming aspects of the aromatic property, and the action of transforming Damp is more related to awakening the Spleen and penetrating and lightening Damp. Clarifying terminology Herbs that are aromatic in smell and in property are not always classified as aromatic in the materia medica of Chinese herbs. Rather, an examination of these texts reveals that these herbs are treated as follows: 1. Some herbs are not classified as aromatic in the list of

properties for their materia medica entry, but are included in the chapter relating to aromatic herbs that transform Damp and/or the chapter relating to aromatic substances that open the orifices. For example, Agastache (huQ xiang) and Eupatorium fortunei (pei hin) are included in the Aromatic Herbs that Transform Dampness chapter in Bensky and Gamble, but are both listed only as acrid in the text of Yeung. 2. Some herbs are not classified as aromatic in the list of properties for their materia medica entry and are not included in the two 'aromatic' chapters, but are described as aromatic elsewhere in the text. For example, camphor (zhang nao) is listed only as acrid in Bensky and Gamble, and in Yeung, but is described in both books as an aromatic herb to open the orifices. 3. Some herbs are not classified as aromatic in the list of properties for their materia medica entry and are not included in the two 'aromatic' chapters. In addition, they are not described as aromatic in the text, but nevertheless, they have a strong aroma and have actions that can

Combining Western Herbs and Chinese Medicine

48

be linked to the aromatic property, for example, Angelica dahurica (bai zhI) and Ligusticum (chuan xiong). One recent text by a Chinese author has listed these herbs as aromatic in property.l

WESTERN HERBAL TRADITION Fragrant herbs are found especially in three main Western action categories: • carminatives • tranquilizers • antidepressants Carminatives Culpeper wrote that one of the herb properties that strengthens the stomach and assists digestion is the aromatic property. Carminatives can be defined as aromatic herbs that aid digestion, excite peristalsis, promote the expulsion of gas from tlle gastrointestinal tract, and relieve the pain caused by flatuleilce:These herbs are aromatic because of their relatively high content of volatile oils. Examples are: Elettaria and Pimpinella. Tranquilizers Many of the herbs used in the West to treat insomnia, calm anxiety, and relax nervous and muscular tension are rich in aromatic oils. Many of these herbs are from the family Lamiaceae, for example, Hyssopus, Lavandula, Melissa, Mentha pulegium, Nepeta, Rosmarinus, Salvia, and Thymus. Culpeper recommended Lavandula, for example, for'tremblings and passions of the heart: and Tabernaemontanus listed it for palpitations. Antidepressants Aromatic herbs have a long tradition of use for treating melancholy and lowness of mood. For example, Culpeper described the following herbs for these conditions:

• Melissa

causes the heart to become merry and drives away troublesome cares and thoughts from the mind that arise from melancholy • Rosmarinus can drive melancholy'vapours' from the heart and refresh the spirits and make them lively and active • Salvia can quicken the senses and treat lethargy in those persons who are dull and heavy of spirit

WESTERN AROMATHERAPY

and permeate the body, bringing a wonderful sense of light- .-ening and well-being. The subject feels temporarily raised above the darkness and heaviness of the clouds to where the sun is shining and the atmosphere is clear and peaceful. The tension and cares of daily life seem to fall away, allowing the soul to expand. Lonicerus and Tabernaemontanus used Lavandula, Rosmarinus, and other aromatic herbs as steam inhalations or as steam baths to treat both internal and external ailments. Culpeper described the use of two or three drops of the oil extracted from Lavandula or Rosmarinus to be taken internally or applied to the temples and nostrils. He used these oils for the physical, emotional. and mental conditions for which he recommended these herbs. He warned that these aromatic oils should be used with caution and in small amounts since their nature is very quick, piercing, and subtle. The traditions of using aromatic herbs for emotional and mental disorders. and of us~g concentrated ()~s have existed for a long time in Western herbal medicine. In recent years, aromather~py has developed and expanded these traditions, and the interest in the medical use of aromatherapy has given impetus to the isolation of individual aromatic constituents and to the study of their pharmacological effects.

BIOCHEMICAL PERSPECTIVE Aromatic substances may have their pharmacological effects by stimulating both the olfactory receptors in the nasal membranes and the taste receptors on the tongue. In addition, they may stimulate receptors in interior tissues of the body, following absorption through the nose, mouth, gut, or skin. Whilst there appear to be several different types of olfactory receptors, each sensitive to a different group of odors, there do not appear to be taste receptors that are specific for aromatic substances. However, aromatic compounds can have one or more of the main tastes, especially acrid or bitter. Three levels of the aromatic effect As with bitter compounds, aromatic constituents can be said to have three main levels of activity: • effects shared by aromatic compounds in general • effects shared by members of a particular chemical group _. effects specific to individual chemicals

'F~r ih6us~ds-ofyears;in all Cultures, the inhalation ~f

Effects shared by aromatic compounds in general For example,

fragrances has been used to change mood and state of consciousness. As a subjective experience, the fragrance of an aromatic substance can change the nature of the air itself

those aromatic substances whose scent is generally experienced as fragrant and pleasing generally have the common effect of lifting and lightening a person's mood. This effect

---

Taste may follow stimulation of a variety of types of olfactory receptors and may be mediated by the limbic system.

Effects shared by members of a particular chemical group An aromatic substance may have additional effects that are characteristic of its chemical type. This may be either by stimulation by a specific type of olfactory receptor, following inhalation of a volatile substance, or by chemical reaction within the body, following oral administration. For example, the monoterpenoid ketones, such as camphor and pulegone, may be especially linked to calming or antidepressant effects, whilst the monoterpenoid phenols, such as carvacrol and thymol, may be especially associated with the antimicrobial action. However, whilst there has been considerable speculation suggesting that each of the different groups of monoterpenoids has a different spectrum of characteristic pharmacological effects, it should be pointed out that there is very little research data to support such a clear differentiation. Effects specific to individual chemicals There can be considerable differences in pharmacological effect between monoterpenoids in the same chemical group, for example, within the monoterpenoid ketone group: • fenchone is an antitussive • valerone is a sedative • camphor can be a stimulant

COMBINING WESTERN AND CHINESE PERSPECTIVES Definition of aromatic

An aromatic herb can now be

defined in the following terms: • it is fragrant and has a relatively high essential oil content • it has one or more of the following energetic effects: dispersing, lightening, moving, opening • it has one or more of the following actions: carminative, tranquilizer, antidepressant, resuscitant Carminative There is considerable overlap between the Western concept of carminative and the Chinese concepts of aromatic herbs that transform Damp and herbs that regulate the Qi of the Spleen, Stomach, and Intestines. These concepts all deal with the treatment of digestive disorders, especially those concerned with epigastric or abdominal distension and discomfort.

I I

Carminatives and Damp The Western concept of carminative does not emphasize the clearance of Damp. However, certain aromatic herbs used in the West as carminatives can

49 be used to stimulate the Spleen and to clear Damp and Phlegm from the body. Two good examples are Angelica archangelica and Juniperus. both of which are drying in nature. These herbs can be used not only to treat flatulence and intestinal colic, but also to assist in the treatment of edema, obesity, general catarrhal conditions, and rheumatism associated with Exterior and Interior Damp and Cold.

Normalizing effect of carminatives on the gut In terms of Chinese medicine, the carminative action can be associated with the regulation of the Qi in the Spleen, Stomach, and Intestines. In terms of Western physiology, carminatives can be said to have a normalizing effect on the muscle of the gut. They can both relax intestinal spasms to normalize muscle tone and stimulate the gut to normalize peristalsis. They do not have an antispasmodic effect to the point of flaccidity, nor do they stimulate peristalsis to the point of producing spasms and pain. In fact~ carminatives can be given to counteract the griping caused by purgatives. For example, the essential oil of Cinnamomum cassia has been reported both to increase gastrointestinal secretion and to stimulate digestive action, and also to relieve intestinal spasms (see the Cinnamomum chapter). Carminative and tranquilizer effects Some aromatic herbs and herb constituents can have both an antispasmodic action on the smooth muscle of the gut and a tranquilizing effect on the central nervous system. For example, Lavandula can be used for intestinal colic and anxiety. Also, the aromatic constituents of Cinnamomum can relieve intestinal spasms and have. sedative and anticonvulsant effects. It is not yet possible to separate the mechanisms of these antispasmodic and tranquilizer effects. Tranquilizer Aromatic herbs, such as Lavandula, Mentha pulegium, and Salvia, can be used to treat both anxiety and insomnia as well as headaches and migraine. In terms of Chinese medicine, they can be said to calm Heart Spirit and Liver Yang and thus control disturbed upward movement of theQi. The mechanism of these effects can give an insight into the nature of the aromatic property. It does not control the upward movement by firming the Qi, as do sour herbs, nor by weighing it down by its heavy nature, as do sweet herbs, nor by having a sedative action on consciousness, as do some bitter constituents. Rather, by its calming and lightening nature, the aromatic property can gently relax internal tensions, and by its moving and dispersing nature, the aromatic property can dissipate the pressure of constrained energy that may contribute to the disturbed upward movement.

\

50

Combining Western Herbs and Chinese Nledicine

Antidepressant Aromatic herbs, such as Lavandula, Mentha piperita, Rosmarinus, and Thymus, can be used to treat melancholy and lowness of mood. In terms of Chinese medicine, these herbs can be said to treat depression associated with Stagnation of the Heart, Liver, or Lung Qi. They may also have a tonic effect on the Heart or Spleen that may assist in the treatment of depression associated with Deficiency, but the antidepressant effect of the aromatic property is not so much linked to this tonic effect. Rather, the aromatic property has its effect on depression by lightening heaviness, lifting mood, relaxing constraint, and calming the mental and emotional disturbance that may be associated with depression.

Aromatic and acrid The antidepressant effect of the aromatic property is different from that of the acrid. Acrid is more Yang, dynamic, stimulating, and especially more moving. It can stimulat~ the Heart to increase the driving force to move Blood through the vessels and penetrate stasis of the Qi and Blood. A good example of an acrid antidepressant is provided by Capsicum. Aromatic is more Ym, relaxing, calming' and especially, more lightening. Lavandula is a good example of an aromatic herb that can relieve depression by its lightening, relaxing, and gently dispersing effects. Normalizing the effect ofaromatics on the mind and emotions Just as aromatic herbs can have a combination of relaxant and stimulant effects on the gut, thus, normalizing its function, so they can have a combination of relaxant and stimulant effects on the central nervous system and the emotions. In fact, it is in the nature of the aromatic property to have this dual effect. The calming and relaxing nature of the aromatic property can help to treat emotional disturbance, and its lightening and dispersing nature can help to treat depression, especially when the depression is associated with either Stagnation or Disturbance of energy. Resuscitant The use of aromatic herbs as resuscitants is not common in the West, and most Western resuscitant herbs have the acrid property, for example, Lobelia and Capsicum. However, the use of aromatic herbs in the treatment of chronic emotional and mental imbalance is one of the great contributions of Western herbal medicine. In contrast, in Chinese medicine, aromatic substances are used as resuscitants to treat acute conditions of dulling of consciousness, such as apoplectic coma, or are used for acute conditions of disturbance of consciousness, such as febrile delirium or convulsions. There does not appear to be a strong Chinese tradition of using the aromatic property to treat chronic mental and emotional imbalance. Acorus (shi chang pu) is an aromatic herb that can be

\

-_ .. _-~==-.\

used for chronic forgetfulness, mental dullness, or disorientation associated with Phlegm obstructing the sensory orifices and dulling the Spirit. However, its capacity to penetrate Phlegm may be as much due to its acrid taste as to its aromatic property.

DIRECTION OF ENERGY As discussed above, both the acrid and aromatic properties have a moving, dispersing nature and an outward effect on the direction of energy movement. However, acrid is more strongly dynamic in moving Qi and Blood through the vessels and in penetrating Blood stasis or obstruction by Phlegm. Strong acrid herbs, such as Ephedra, can cause excessive outward movement so that energy is lost through the body surface, or it can cause disturbed upward movement. Aromatic herbs have a gentler moving and dispersing effect, and a more relaxing and calming effect. As a result, they can be used to reduce disturbed upward movement. They are characterized by their lighte~ing effect on the body so that they can form a natural counter to treat heaviness of mood and the effects of excessive Damp.

TEMPERATURE Aromatic herbs are mainly warm in temperature, and many of these are also acrid. The few Western aromatic herbs that are cool, such as Matricaria or Nepeta, are also to some degree bitter, and the bitter constituents may contribute to the cooling property. A number of herbs with the aromatic property are listed as variable-temperature herbs in this book and classified as warm-cool, for example, Mentha piperita. This herb is used in both Chinese and Western tradition as a cooling diaphoretic to clear Wind Heat, and this effect is associated with its acrid property. In addition, it has been used in the West since the time of Dioscoridesl 3 as a warming carminative for cold conditions of the stomach, and this effect is associated with its aromatic property. This use has continued, especially in the Spanish-speaking world, for example, in South America 14 and the Philippines. 15

::

CAUTIONS In Chinese medicine, aromatic substances that open the orifices are considered to be scattering in nature and have the potential of draining the source Qi 12. In my opinion, this does not apply to aromatic herbs used in the West as carminatives, tranquilizers, or antidepressants, such as Lavandula, Mentha, Rosmarinus, Salvia, or Thymus.

'-.l

Taste If aromatic herbs are also acrid and warming, they should be avoided in cases of Excess or Deficiency Heat unless the aromatic herbs are combined with other properties. Aromatic herbs that are warming and drying, such as Angelica archangelica, should be avoided in cases of Yin Deficiency and Dryness unless they are moderated by moistening herbs, such as Althaea or Glycyrrhiza.

51 'Effectof.taste;,cont.'·'" ......----.-- ..--------...-----.----~.::=_..::_=.:. Aromatic • lightening effect counteracts heaviness of mood or the dulling, heavy, downward effect of Damp • dispersing, relaxing, and calming effect clears constraint and stagnation, and reduces disturbed upward movement.

TEMPERATURE

Comparison summary In this summary, the following features of the taste properties are compared in table format • direction of energy • temperature • contraindications

A particular taste is not necessarily linked to a particular temperature. This is especially true of the bitter and acrid tastes. Although many bitter herbs are cooling and many acrid herbs are warming, both these taste properties can be associated with temperatures ranging from hot to cold. It depends on the individual herb. For example, Evodia (wti zhii yIi) is a hot herb with the bitter taste, and Prunella (xia kii cao) is a cold herb with the acrid taste.

DIRECTION OF ENERGY The effect of the different taste properties on the direction of energy movement is summarized in the table below. It can be seen that some tastes may have a variety of different effects. Which effect manifests in a particular situation depends on the state of the patient and on the specific chemical structure of the constituent(s) responsible for the taste.

,',

.;....

, ::.<:~-~:~=,._~~

Bitter • range from hot to cold • mainly neutral or cooling - neutral, as in some of the digestive tonics, cardiotonics, and tranquilizers

- cooling, as in some of the antimicrobials, antipyretics, anti-inflammatories, and sedatives

Effect of taste on the direction of energy movement"

Sour/astringent

Bitter • nondirectional antimicrobial, antipyretic, and antiinflammatory action • nondirectional cardiotonic action • spreads Liver Qi • normalizes the natural downward movement in the stomach and intestines • downward-directing tranquilizing action • downward-directing diuretic or purgative action

Sourjastrlngent .........-

• warm bitter herbs generally also have the acrid taste

• holds things firm, stable, and in their proper place, thus, controlling excessive outward or upward movement of energy and fluids

Sweet • maintains the movement of energy stable around the central point of balance and dampens movement toward the extremes

• mainly neutral • if the herb has both sour and bitter tastes, then it is mainly neutral or cooling • if the herb has both sour and acrid tastes, then it is mainly warming Sweet • mainly neutral • if the herb has both sweet and bitter tastes, then it is mainly neutral or cooling • if the herb has both sweet and acrid tastes, then it is mainly warming Acrid • ranges from hot to cold • most are warming, some are variable-temperature (warm-cool), and some are cooling Aromatic

• weighs down excessive or disturbed upward movement

• mainly warm in temperature and these are usually aromatic and acrid

• reduces excessive outward dispersing movement of energy

• the few that are cool are aromatic and bitter

Acrid

.

• increases movement of Qi and Blood through the vessels • disperses energy outward • accentuates upward movement of other light and moving energies, such as Heart Spirit and liver Yang • counteracts the heavy, dulling, downward effect of Damp

CAUTIONS It is important to remember that cautions or contraindications for a particular taste may depend more on the temperature of a particular herb with that taste, than on the taste property itself.

52

Combining Western Herbs and Chinese Medicine In some cases the contraindications for one taste can be overcome by utilizing the moderating effects of another taste property; this topic is dealt with in the next section.

Bitter • warm or hot bitter herbs are generally contraindicated for Heat patterns • cool or cold bitter herbs are generally contraindicated for Cold Deficient patterns of the Spleen and Stomach, especially with diarrhea • some texts contraindicate certain bitter herbs for gastric ulceration or hyperacidity since they may increase the gastric acid secretion, but see the discussion in the Toxicology section of the Gentiana chapter

Sour/astringent • Exterior conditions that are not fully cleared, including skin rashes that are in the process of expressing • during a treatment to clear toxins from the body via sweat, urine, stools, or discharge • Interior Stagnation, including Stagnation with Damp, and, in the case of warm astringents, Interior Stagnation with Heat • long-term use of herbs with high tannin content; see the Toxicology section in the Potentilla chapter

Sweet • Exterior Excess • Interior Stagnation • Damp • Phlegm • therefore, to be used with caution in cases of sensations of heaviness, feelings of lethargy and depression, mental heaviness and dullness, digestive stagnation, loss of appetite, nausea, bloating, weight gain, and catarrhal conditions

Acrid • herbs with a strong dispersing effect, of the type that can result in depletion or disturbance of energy, such as Ephedra, are contraindicated in cases with severe Deficiency of Qi or Disturbance of Spirit

Aromatic • aromatic substances that open the orifices are considered to be scattering in nature and have the potential to drain the source Qi • aromatic herbs that are also acrid and warming should be used with caution in cases of Excess or Deficiency Heat • aromatic herbs that are warming and drying should be used with caution in cases of Yin Deficiency and Dryness

TASTE + COMBINATION

+ sour/astringent (support)

Balancing the tastes Each taste has its specific range of uses and its specific disadvantages. Tastes can be combined so that one taste can support the beneficial effects of another to maximize the clinical effectiveness or moderate the potential adverse effects of another to minimize side effects. As an example of support, the warming and moving aspects of the acrid taste can support the digestive tonic aspect of the bitter taste. As an example of moderation, the aromatic function to revive the Spleen and transform Damp can moderate the potential adverse effect of sweet tonics to produce Stagnation and Damp. Optimizing the balance of the taste properties can be an important part of creating effective herb combinations. An example of taste balancing is given in the Taste section in the chapter Principles ofherb combination. In balancing the tastes, it is possible either to pick one herb with both the required tastes or to pick two herbs, each with one of the required tastes. For example, if bitter and acrid are required to stimulate digestion, either Rosmarinus can be selected, which has both tastes, or bitter Gentiana can be combined with a suitable amount of acrid Capsicum.

:-,

'I 1 ,-,.,1

f:"l

. I

-~ """""

._~

Note The term support is used here in a general sense to indicate the strengthening of the effect of one action by another. Support could be by the specific processes of either complementarity or emphasis, but this differentiation is not made in this section. Complementarity and emphasis are described in the Principles ofherb combination chapter. ~-.

BALANCING TASTES TABLE For each taste, shown in upper case in a gray bar in the left-hand column, a description of its support or moderation by each of the other four tastes is given with a herb example. The Taste aspect column lists which specific aspect of the main taste is being supported or moderated. For example, for the bitter taste, this column shows whether it is the digestive tonic, tranquilizer, and cardiotonic, hepatobiliary, or purgative aspect that is under discussion.

TASTE ASPECT

DESCRIPTION

HERB EXAMPLES

bitter digestive tonic

the sour/astringent property can enhance the digestive tonic aspect of bitter by maintaining the Integrity of the gut wall

bitter Gentiana combines with sour astringent Agrimonia to treat weak digestion with malabsorption

Taste TASTE + COMBINATION

TASTE ASPECT

DESCRIPTlON

53 HERB EXAMPLES , '.'-'."':"=::-:::!

•

~~~4'!':

BITTER, CaNT. bitter tranquilizer

the sour/astringent property can support the tranquilizer aspect of bitter by firming the energy of the Heart to stabilize the emotions

bitter Passiflora combines with sour astringent Schisandra to treat difficulty in concentration with fearful anxiety

bitter cardiotonic

the sweet property can support the cardiotonic aspect of bitter by nourishing the Heart

bitter Convallaria combines with sweet Glycyrrhiza to treat exhaustion from cardiac weakness

bitter tranquilizer

the heaviness of the sweet property can support the tranquilizer aspect of bitter by weighing down irregular upward movement of energy

bitter Valeriana combines with sweet Glycyrrhiza to treat anxiety, restlessness, and headache

bitter digestive tonic

the sweet property can reduce gastric irritation from excessive secretion of gastric acid resulting from gastric stimulation by bitter herbs

bitter Cinchona combines with sweet demulcent Althaea to reduce the possibility of gastric irritation

bitter digestive tonic

the acrid property can support the digestive tonic aspect of bitter by warming and moving the Qi of the Spleen, Stomach, and Intestines

bitter Gentiana combines with acrid Capsicum to treat weak digestion with sensation of cold in the epigastrium

bitter hepatobiliary anti-inflammatory

the warming acrid properties can moderate potential adverse effects of the cooling bitter properties on the Spleen

cooling bitter Berberis combines with warming acrid Zingiber to reduce the possibility of impaired digestion and absorption

bitter tranquilizer

the aromatic property can complement the tranquilizer aspect of bitter by its lightening, dispersing, relaxing, and calming functions

bitter Anemone combines with aromatic Mentha pulegium to treat anxiety and headache with feelings of desperation

bitter purgative

the relaxing function of the aromatic property can moderate the potential purgative aspect of bitter to produce intestinal spasms

bitter Rheum can be combined with aromatic Foeniculum to reduce the possibility of intestinal colic

reduce leakage of fluids

the cooling and bitter properties can support the sour astringent property in cases of leakage associated with Heat

neutral astringent Quercus can be combined with cool bitter Hydrastis to treat diarrhea with sensations of buming on defecation

stabilize emotions

the sweet property can nourish the Heart and weigh down disturbed upward movement of energy to support the stabilization of emotions by sour

sour Hypericum combines with sweet Avena to treat nervous exhaustion with emotional lability

reduce leakage of fluids

the demulcent sweet property can moderate the potentially irritating effect of tannin-containing astringents on the gut wall

sour Potentilla combines with sweet demulcent Althaea to treat diarrhea with colitis

(support)

reduce leakage of fluids

the warming and acrid properties can support the sour astringent property in cases of leakage associated with Cold

sour Geranium combines with acrid Myrica to treat diarrhea with sensations of cold in the abdomen

+ aromatic

stabilize emotions

the calming and relaxing functions of the aromatic property can support the sour astringent function to firm and stabilize the Heart Spirit

sour Hypericum combines with aromatic Mentha pulegium to treat daytime anxiety and enuresis with nocturnal terrors

+ sour/astringent (support)

+ sweet (support)

(moderate)

+ acrid (support)

(moderate)

+ aromatic (support)

(moderate)

SOUR. + bitter (support)

+ sweet (support)

(moderate)

+ acrid

--

I

r

(support)

54

Combining Western Herbs and Chinese Medicine

TASTE + COMBINATION

TASTE ASPECT

DESCRIPTION

HERB EXAMPLES

sweet nutrient tonic

the digestive tonic aspect of bitter can supPOrt the uptake and utilization of the sweet tonic, thus enhancing the tonification of Qi and Blood

sweet nutrient molasses combines with bitter Gentiana to treat poor appetite with weight loss and anemia

sweet demulcent

the anti-inflammatory and antimicrobial aspects of bitter can complement the sweet demulcent action

sweet demulcent Althaea combines with bitter Arctostaphylos to treat cystitis with infection and burning sensation on urination

sweet demulcent

the wound healing and hemostatic effects of astringency can complement the sweet demulcent anti-inflammatory effect

sweet demulcent Althaea combines with sour Capsella to treat peptic ulceration with bleeding

sweet adaptogenic

the warming, moving, acrid effects complement the sweet adaptogenic effects to treat hypofunction while maintaining homeostasis

sweet Panax ginseng combines with acrid Cinnamomum bark to treat reduced stamina with sensations of cold

sweet immunoregulator

the dispersing acrid function of clearing Retained Pathogens complements the immuneregulatory aspect of sweet to strengthen Defensive Qi

sweet Echinacea combines with acrid Achillea to treat recurring respiratory conditions with fever

sweet nutrient tonic

the moving nature of acrid can moderate the tendency of sweet to produce digestive stagnation

sweet Serenoa combines with acrid Capsicum to treat debility with poor appetite, lethargy, abdominal sensations of fullness and cold

sweet nutrient tonic

the aromatic function to revive the Spleen and transform Damp can moderate the tendency of sweet to produce fat and mucus

sweet Ziziphus fruit combines with aromatic Citrus to treat debility in persons with tendency to weight gain and chronic sinusitis

acrid diaphoretic

the cooling and bitter properties can help the dispersing nature of acrid to clear Wind Heat from the body surface

acrid Sambucus combines with bitter Achillea to treat influenza with fever

(support)

acrid circulatory stimulant

the sour function of tonifying the liver can support the acrid function of moving Stagnation and dispersing Damp and Phlegm

acrid Zanthoxylum combines with sour Myrica to treat sluggish liver function with lethargy and sensations of heavi· ness and cold

(moderate)

acrid diaphoretic

the sour astringent property to hold fluids and energy in the body can moderate the excessive loss of energy by the dispersing function of acrid

acrid Ephedra combines with astringent Schisandra to reduce possible excessive sweating and weakening of Defensive Qi

acrid metabolic stimulant

the steadying, slowing aspects of the sweet property can convert the rapid, stimulant effect of acrid to a more moderate and sus· talned tonic action

acrid Cinnamomum bark combines with sweet Serenoa to treat exhaustion with emaciation and sensations of cold

acrid stimulant antidepressant

the gentle dispersing, calming, and relaxing nature of the aromatic property can moderate the rapid, stimulant, acrid antidepressant effect

acrid and stimulant Rosmarinus combines with more aromatic and calming Lavandula to treat depression with nervous tension

SWEET

+ bitter (support)

(support)

+ sour (support)

+ acrid (support)

(moderate)

+ aromatic (moderate)

ACRID

+ bitter (support)

+ sour

+ sweet (moderate)

+ aromatic (moderate)

_t:.-,

Taste TASTE + COMBINATION

55

TASTE ASPECT

DESCRIPTION

HERB EXAMPLES

aromatic carminative

bitter stimulates secretion of gastrointestinal enzymes and bile to complement the aromatic stimulation of appetite and peristalsis

aromatic Mentha piperita combines with bitter Gentiana to treat weak digestion with loss of appetite. abdominal distension and flatulence

aromatic antidepressant

the sour astringent function of firming and stabilizing the emotions complements and moderates the moving. lightening, and antidepressant functions of the aromatic property

sour astringent Schisandra combines with aromatic Lavandula to treat emotional lability with depression and emotional constraint

aromatic tranquilizer

the tonic aspect of sweet can nourish the Heart and Liver. thus helping to calm the Spirit and Yang, and complement the relaxing aspect of aromatic

aromatic Lavandula combines with sweet Ziziphus to treat nervous headache associated with Deficient Qi and Blood

aromatic anticatarrtlal

acrid can penetrate and move the Phlegm and complement the aromatic function of transforming Damp and Phlegm

aromatic Thymus combines with acrid Thuja to treat catarrhal obstruction of the respiratory and urogenital system

AROMATIC

+ bitter (support)

+ sour (moderate)

+ sweet (support)

+ acrid (support)

References .....

1. Yang Yi-fan. Chinese Herbal Medicines. Churchill Livingstone, Edinburgh, United Kingdom (2002)

9. Lonicerus A. Kreuterbuch (1679). Reprinted by Verlag Konrad K6lbl, Munchen, Germany (1962)

2. Yeung H-C. Handbook of Chinese Herbs and Formul~s, vol. 1. Institute of Chinese Medicine, Los Angeles, California (1985)

10. Gerard J. The Herbal or General History of Plants: The Complete 1633 Edition as Revised and Enlarged by Thomas Johnson. Dover Publications, New York. New York (1975)

3. Felter HW, lloyd JU. King's American Dispensatory, vols. I and 2, 18th edn. (1898). Reprinted by Eclectic Medical Publications. Sandy. Oregon (1983) 4. Ellingwood F. American Materia Medica. Therapeutics and Pharmacognosy, 11th edn. (1919). Reprinted by Eclectic Medical Publications, Sandy, Oregon (1994) 5. Christopher JR. School of Natural Healing. BiWorld, Provo, Utah (1976) 6. Weiss RF. Herbal Medicine, English edn. Beaconsfield Publishers. Beaconsfield, United Kingdom (1988) 7. Mills S. Bone K. Principles and Practice of Phytotherapy: Modern Herbal Medicine. Churchill Livingstone, Edinburgh, United Kingdom (2000) 8. Culpeper N. Culpeper's Complete Herbal and English Physician Enlarged. Meyerbooks, Glenwood. Illinois (1990)

11. Tabernaemontanus IT. Krauterbuch (1731). Reprinted by Verlag Konrad K6lbl, Miinchen, Germany (1993) 12. Bensky D, Gamble A. Chinese Herbal Medicine Materia Medica. Eastland Press, Seart!.e, Washington (1986) 13. Grieve M. A Mod= Herbal, vols. 1 and 2. Dover Publications. New York, New York (1971) 14. British Herbal Pharmacopoeia. British Herbal Medicine Association. West Yorks, United Kingdom (1983) 15. Dioscorides P. Kreutterbuch (1610). Reprinted by Verlag Konrad K61bl. Munchen, Germany (1960) 16. Bejar E et al (eds). Herbs of Southern Ecuador. LH PreSS, Spring Valley, California (2001) 17. Pardo de Tavera TH. Plantas Medicinales de Philipinas. Ayala Foundation, Makati City. Phillipines (2000)

.-~.

Actions· herb can be defined as the types of therapeutic effects it has on the body. This is in contrast to the uses or indications of a herb, which refer to the disorders it can be used to treat. An indication refers to a practical result, whilst an action refers to the process by which that

T

to tonify the intestines and move the stool, and a herb with a tonic laxative action can be chosen, such as Turnera • constipation with dryness principles of treatment are to moisten the intestines and move the stool, and a herb with a moistening laxative action can be chosen, such as Linum (flaxseeds) • constipation with excessive heat principles of treatment are to clear the heat and move the stool, and a herb with a cooling purgative action can be chosen, such as Rheum

HE ACTIONS OF A

result is achieved.

Action concept

,

1-

Actions can be regarded as the bridge between theory and practice. They link the theoretical concepts of etiology, pathology, syndrome classification, principles of treatment, and principles of herb choice with the practical end resultthe treatment of a particular disorder.

ACTIONS REFLECT THE MEDICAL PARADIGM

EXAMPLE If a patient has constipation, for example, the simplest approach would be to bypass the action concept and pick any herb that has constipation as one of its indications. However, the problem with this simplistic approach is that constipation, like most other disorders, may have a variety of etiologies and pathologies and may be associated with various different syndromes. In the theory of traditional Western phytotherapy, for example, constipation may be associated with weakness, dryness, or excessive heat in the intestines and in the body as a whole. The principles of treatment and the herb action . chosen will depend on the specific syndrome as follows:

i

• constipation with weakness principles of treatment are

57

The names of some action categories simply refer to a practical therapeutic effect without implying the mechanism by which this effect is achieved and without linking the action to the theoretical concepts of the medical paradigm. For example, the word 'diuretic' simply refers to the therapeutic effect of increasing urination. However, the names of many action categories reflect the underlying philosophy and theoretical principles of the medical paradigm to which they belong. Often, general categories, such as diuretic, diaphoretic, and tonie, are divided into more specific subcategories. In each of these, the action name is preceded by a qualifying word that implies the action mechanism and links the action concept to the theories of the specific paradigm. Thi~ is shown in the following examples, in which the qualifyIDg word has been put in italics:

Combining Western Herbs and Chinese Medicine

58

• in conventional medicine, the general category of diuretics is divided into such categories as osmotic diuretics or thiazide diuretics, according to the proposed physiological or biochemical mechanism • in Western Physiomedical tradition, the general category of diaphoretics is divided into stimulating diaphoretics and relaxing diaphoretics, according to the Physiomedical theory of stimulation and relaxation • in Chinese herbal tradition, the general category of tonics is divided into Qi tonics, Blood tonics, Yin tonics, and Yang tonics, according to Chinese theories of Qi and Blood and Yin and Yang ACTIONS, PROPERTIES, AND ORGAN SYNDROMES Actions and properties In the herbal traditions, some action categories have names that do not include reference to either temperature or taste, as in the action names 'purgative' or 'drain Damp: However, other action categories have names that link the concepts of action, temperature, and taste, as in the term 'warming acrid herbs that release the Exterior:

from the liver or the Chinese action concept of tonifying Spleen Qi. The evolution of action concepts that refer to organ systems or specific organ syndromes is briefly discussed in the History chapter.

Classification ofherbs by action Herbs can be organized into groups according to their action. The table below shows some of the main action groups from Western herbal medicine, together with their approximate Chinese action equivalent. However, there is never a complete equivalence between the action categories of different paradigms. For example, there is no exact Chinese equivalent of the Western anticatarrhal action category, and there is no exact Western equivalent of the Chinese transform Damp action category. The equivalents shown in the table are only approximations, and the reader is· referred to the Action glossary chapter for a more detailed discussion of Western and Chinese equiva-

Actions and organ syndromes In the herbal traditions, some action categories refer to therapeutic effects on a particular organ system, for example, the action categories of circulatory stimulant and digestive tonic. Other action categories refer to the treatment of a specific organ syndrome, for example, the old Western action concept of clearing heat

Diaphoretic

.

lents. How the modern herbal action categories evolved in the West, from the time of Dioscorides in the 1st century AD to the present day, is discussed in the History chapter. ACTIONS AS A CRITERION OF HERB CHOICE Herbs are described and classified by their actions so that the appropriate herbs can be selected to treat a specific

clear the surface disperse Wind Cold disperse Wind Heat

Zingiber (fresh) Sambucus

Antirheumatic, antiarthritic

disperse Wind Damp

Angelica archangelica

Antipyretic, etc.

clear Heat clear Heat clear Damp Heat and Heat Toxins clear Heat and Damp Heat clear Damp Heat and Heat Toxins

Asclepias Baptisia Filipendula Taraxacum (root)

laxative, purgative

drain Downwards

Rheum

Diuretic

drain Damp

Parietaria

Carminative

transform Damp or regulate Qi

warming diaphoretic cooling diaphoretic

antipyretic antimicrobial anti-inflammatory alterative

transform Damp regulate the Qi of the Stomach and Intestines

Expectorant, etc. expectorant antitussive anticatarrhal

transform Phlegm and stop cough transform Phlegm stop cough no exact Chinese equivalent

Juniperus Citrus aurimtium

Euphorbia hirta Prunus serotina Hydrastis

-" Actions

59

Antispasmodic antiasthmatic

regulate Q; regulate Lung Qi

Ephedra

Analgesic antianginal

move the Blood move Heart Blood and relieve pain

Crataegus

Emmenagogue tonic emmenagogue hormonal emmenagogue stimulant/antispasmodic emmenagogue

tonity and regulate the Uterus* tonify the Uterus regulate Uver Qi move Uterus Qi and Blood

Chamaelirium Vitex Leonurus

Circulatory stimulant

warm the Interior

Capsicum

Tonic general tonic

tonitying herbs tonify Qi tonify Blood tonify Yin and Auids tonify Yang • tonify Spleen and Stomach Qi tonify Heart Qi

Glycyrrhiza molasses Althaea Turnera Gentiana Convallaria

Astringent antidiarrheal antihemorrhagic

stabilize and bind, stop bleeding stabilize and bind stop bleeding

Geranium Vinca

Nervlneand sedative nervine tranquilizer, sedative

calm the Spirit nourish the Spirit settle and calm the Spirit

Avena Valeriana

Anticonvulsant, etc. antispasmodic, anticonvulsant antimigraine agent

extinguish Wind and stop tremors extinguish Wind and stops tremors calm Uver Yang

Lobelia Tanacetum

Resuscitant, anticonvulsant

(aromatic substances that) open the orifices

Acorus

Antihelmlntic

expel parasites

Artemisia absinthium

Topical

external use

Calendula

moistening and demulcent tonic antidepressant, aphrodisiac digestive tonic cardiotonic

* The action category of herbs that tonify and regulate the Uterus is not standard to Chinese convention and has only been inserted in the table to give a Chinese approximation to the corresponding Western action.

condition. However, actions are not the sole criterion of herb choice. The chapter Principles of herb combination describes how herbs are combined according to considerations of action, temperature, taste, and organ syndromes.

Working with actions The following basic concepts are fundamental to working with herb actions in the clinic: • range of potential actions • normalizing actions • action groups . • primary and secondary actions

RANGE OF POTENTIAL ACTIONS Usually, herbs do not have just one action. Rather, they have a range of potential actions. For example, Achillea can

have nine or more different actions, among them the antipyretic, anticatarrhal, alterative, bitter digestive tonic, and diaphoretic actions (see the discussion in the Achillea chapter). Which of these actions manifest in a particular situation may depend on the patient's condition. For example, the antipyretic action is absent or minimal unless there is a fever.

NORMALIZING ACTIONS Some individual herbs can have two actions that are apparently opposite in their effects. For example, Lobelia can have a stimulant or relaxant action on the smooth muscles of the bronchi, intestines, or uterus, depending on the initial state of the patient (see the detailed discussion in the Lobelia chapter). Rather than descnbe such herbs as either stimulant or relaxant, it might be more accurate to descnbe them as having a normalizing or regulatory action. Other examples are Crataegus, which can normalize either hyper- or hypo-

-

Combining Western Herbs and Chinese Medicine

60

.

/~I

:r:~~t,

tension, and Lavandula, which can have either a calming or an antidepressant action. depending on the patient's state.

ACTION GROUPS

the herb or herbs with that action can be used in higher __ ~ o.,£'';;;: doses than herbs with secondary actions. For example, in the combinations discussed in this book, nerbs with the desired primary actions are often used at t\-vice the dose of herbs with secondary actions, assuming that the herbs are of equal potency (see the section Factors affecting dose in the Dose

.-_.~-

VYhen a herb has more than one action. some of these actions may work together in groups to meet the needs of the situation. For example. Achillea can be used to treat recurring fever, in which case the diaphoretic action can work together with the antipyretic and alterative actions. The diaphoretic action increases sweating and can clear Wmd Heat from the Exterior, the antipyretic action can help to clear Excess or Deficiency Heat from the Interior, and the alterative action can clear Retained Pathogen from the body to prevent recurrence of febrile episodes. (These action groups are discussed in greater detail in the Achillea chapter.)

chapter).

Action contraindications There are situations in which specific herb actions are contraindicated or need to be applied with caution. Whether or not an action is contraindicated in a particular situation depends not only on the action itself, but also on the specific characteristics of the individual herb. These characteristics include the strength of the action for the particular herb, and the properties of temperature and taste.

PRiMARY AND SECONDARY ACTIONS Four factors determine which actions are of primary and which of secondary importance in any given situation: • the herb itself • the context of a specific patient's condition • the context of a specific herb combination • the dose The herb itself If a herb has multiple actions, some of these are usually regarded as more important than others. In the case of Achillea, for example, the diaphoretic action is generally regarded as of primary importance and the bitter digestive tonic action is regarded as secondary. Therefore, Achillea is more commonly used to treat respiratory infections with fever and chills than it is to treat digestive weakness. The context of a specific patient's condition The state of the patient's health plays an important role in determining which actions of a particular herb are dominant. For example, if Achillea is used in a case in which digestive weakness is severe and feverishness only mild, the bitter digestive tonic action is likely to be of primary importance and the diaphoretic action of secondary importance. The context of a specific herb combination VVhich actions are dominant for a particular herb depends upon the herbs with which it is combined. For example, the bitter digestive tonic action of Achillea is generally regarded as secondary. However, if Achillea is combined with other herbs for which

this action is prim;u-y, such as~i#}}~e~~~~thi~;~~d Gentiana, the bitter digestive tonic action. of. Achillea can - fi' . - ' , ' become of primary importance. Dose

If an action is required to be of primary importance,

STRENGTH An action may not be contraindicated in itself, but only when it is particularly strong. For example, Iris has mild purgative action and is appropriate for constipation in weak patients, whilst Cassia fruit (senna) has much stronger purgative action, and may in some circumstances be contraindicated for weak patients.

TEMPERATURE If a specific action category is required in a particular case, it is important to match the temperature value of a herb with this action to the temperature requirements of the patient. For example, tonics are generally appropriate to treat conditions of Deficiency, but a warming tonic is generally contraindicated for hot patterns, such as Deficient Yin with Deficiency Heat. This situation requires a cooling tonic. However, a warming tonic may, in certain cases, be used in a mixed temperature situation, if it is used in relatively small amounts, and its warming effects are balanced and moderated by the other herbs in the combination (see

Temperature chapter). TASTE If a specific action category has been selected. it may be necessary to match the taste value of a herb with this action to the requirements of the patient and to the taste balance requirements of the herb combination. For example, a sweet tonic may be contraindicated in a case of digestive weakness and general debility if this occurs

.. '

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,..."lI~"

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Actions

61

the potential adverse effects of another herb to minimize side effects.

with obesity, lethargy, and abdominal distension from Spleen Qi Deficiency with Qi Stagnation, Damp, and Phlegm. In this situation, a tonic herb with acrid, aromatic, and bitter taste properties would be more appropriate. However, a sweet tonic may be appropriate in some cases of this kind, if it is used in relatively small amounts, and if its potential for aggravating Qi Stagnation and accumulation of Damp and Phlegm is balanced and moderated by the other herbs in the combination (see Taste chapter).

Support For example, the circulatory stimulant action can support the diaphoretic action, resulting in increased perspiration. Either a herb with both these actions, such as Zingiber, can be chosen, or a herb with diaphoretic action, such as Achillea, can be combined with a herb with circulatory stimulant action, such as Capsicum.

Note The term 'support' is used here in a general sense to indicate the strengthening of the effect of one action by another herb. Support could be by the specific processes of either complementarity or emphasis, but this differentiation is not made in this section. Complementarity and emphasis are described in the chapter on Principles of herb combina-

MINIMIZING POTENTIAL SIDE EFFECTS In many cases, the potential side effects of a particular action can be avoided or reduced by the moderating effect of another action. For each action listed in the Balancing actions table below, an example is given of a second action that can moderate the side effects of the first action. This information can be great value in the clinic.

tion. Moderation For example, the antispasmodic action can moderate the tendency of the purgative action to produce intestinal spasms as a side effect. For example, Rheum can be combined with Foeniculum so that the purgative action of Rheum is moderated by the antispasmodic action of Foeniculum.

Balancing actions in a herb combination Some actions usefully complement each other's effects, whilst other actions work in opposition. In designing a balanced herb combination, actions can be combined so that one action can support the beneficial effects of another action to maximize their clinical effectiveness or moderate

BALANCING ACTIONS TABLE For each action shown in the left-hand column, a description of its support or moderation by additional actions is given with a herb example.

~

Action

Additional actions .. .

Description...'..

Herb example

anticatarrhal

assists in the clearance of toxins by reducing excessive accumulation of mucus

Hydrastis

circulatory stimulant

assists in the clearance of toxins by increasing circulation and clearing obstructions

Myrica

detoxicant

reduces adverse effects of accumulated toxins released by alteratives

Glycyrrhiza

demulcent

soothes inflammation due to accumulated toxins released by alteratives

Viola

'

Alterative (support)

.....

~-

(moderate)

Analgesic (support)

(moderate)

.....................................•.•................................................................ antispasmodic

reduces muscle spasms that are contributing to the pain or resulting from it

Viburnum

tranquilizer

calms nervous tension that is aggravating pain or resulting from it

Anemone

nervine tonic

treats the mental and physical exhaustion associated with chronic pain

Avena

circulatory stimulant

moderates the potential depressing effect of a sedative analgesic action on metabolism

Rosmarinus

62

1,

Combining Western Herbs and Chinese Medicine

Antiarthritic (support)

(moderate)

Anticatarrhal (support)

(moderate)

Antidepressant (support)

(moderate)

Antihypertensive (support)

(moderate)

diaphoretic

treats the effects of exposure to wind and damp, eliminates toxins from the body in the sweat

Zingiber

cirCUlatory stimulant

increases circulation and clears obstruction, stimulates clearance of toxins

Zanthoxylum

anti-inflammatory, analgesic, antipyretic

relieves pain and swelling, treats acute febrile episodes

Populus

alterative

clears toxins from the joints and assists in the detoxification of the liver, reducing inflammation

Taraxacum

tonic

treats the anemia resulting from gastric irritation by antiinflammatory drugs

Gentiana

detoxicant

assists in the detoxification, reducing inflammation from toxins released by antiarthritics

. Glycyrrhiza

............................................................................................................................................................................................................. stimulates local circulation, reduces local inflammation, reduces mucus accumulation

Capsicum

circUlatory stimulant

stimulates circulation, thereby stimulating clearance of toxins and obstructing phlegm

Zanthoxylum

carminative

stimulates the digestion, reduces the formation of phlegm

Angelica arc.

alterative

clears toxins and pathogens that are causing excessive mucus secretion

Thuja

demulcent

moderates the tendency of some anticatarrhals to dry the mucus membranes

Polygonum

. ',' counterirritant

...•...............•..•..•...............................•.............................................. circulatory stimulant

supports the antidepressant effect by stimulating the heart and circulation

Capsicum

tonic

makes the stimulant antidepressant effect more gradual, stable, and sustained

Serenoa

tranquilizer

moderates potential for overstimulation

Passiflora

........................•....•.•..•.•......•............................................................ antiatheromatic, antilipidemic

assists in the treatment of hypertension due to hyperlipidemia and atheroma

Commiphora

tranquilizer, sedative

assists in the treatment of hypertension associated with nervous tension

Valeriana

antispasmodic, anticonvulsant

assists in the treatment of hypertension associated with muscular spasms or apoplexy

Lobelia

antimigraine

treats the hypertension associated with headaches or migraines

Lavandula

nervine

treats the hypertension associated with physical and' nervous debility

Viscum

cardioregulator' ,. , .

normalizes blood pressure, reducing the possibility of hypotension or blood pressure oscillations

Crataegus

circulatory stimulant

normalizes blood pressure, reducing the possibility of hypotension from sedative antihypertensives

Capsicum

Actions

63

Anti-inflammatory (support)

(moderate)

antiallergic

assists in the treatment of inflammatory disorders with an allergic component

Ephedra

antimicrobial

assists in the treatment of inflammatory disorders with infection

Arctostaphylos

astringent

assists in the healing of inflamed mucosa. reduces discharge or bleeding from the inflammation

Hamamelis

demulcent

moistens and soothes dry, inflamed mucosa

Althaea

analgesic

assists in the treatment of pain associated with inflammatory disorders

Salix

tonic

assists in the treatment of inflammation associated with systemic weakness

Glycyrrhiza

warming carminative

moderates potential weakening effects on digestive system of anti-inflammatory herbs with cooling effect

Zingiber

......•............................... •............. .................................................. ~~

Antispasmodic (support)

(moderate)

tranquilizer. sedative

treats spasms associated with nervous tension or fear

Anemone

nervine tonic

treats mental and physical exhaustion due to chronic pain

Avena

circulatory stimulant

moderates potential depressing effect on metabolism of antispasmodic herbs with sedative action

Rosmarinus

........................................................................................................ Antitussive (support)

(moderate)

Astringent (support)

(moderate)

expectorant

facilitates the expectoration to relieve nonproductive cough with sticky mucus

Marrubium

anticatarrhal

reduces the excessive secretion and accumulation of mucus

Thymus

demulcent

moistens and soothes inflamed mucosa, thereby facilitating expectoration

Viola

antispasmodic

reduces excessive bronchial spasms that may inhibit expectoration

tranquilizer

calming effect supports an antitussive action. especially in nervous coughs

Prunus

circulatory stimulant

moderates the dulling of consciousness from sedative antitussives

Zingiber

carminative

moderates digestive stagnation and increased mucus due to moistening demulcent antitussives

Pimpinella

. Lobelia

......................................................................................................... . Achillea

tonic

normalizes cell permeability and increases muscle tone to reduce leakage and prolapse

anti-inflammatory

reduces discharge by reducing inflammation

Hydrastis

anticatarrhal

reduces discharge by reducing excessive mucus secretion

Myrica

antimicrobial alterative

reduces discharge and treats diarrhea by destroying microorganisms and clearing toxins

Berberis

demulcent

reduces potential irritant effect of tannin astringents

Althaea

Combining Western Herbs and Chinese Medicine

64

Bitter digestive (support)

(moderate)

Carminative (support)

(moderate)

circulatory stimulant

stimulates and speeds digestion. especially if there is Stagnation of Qi from Cold

Capsicum

astringent

can normalize gut permeability to complement stimulation of the digestion by bitters

Agrimonia

demulcent

moderates any potential irritant effect from stimulation of gastric acid secretion by bitters

Althaea

......••.•...•.....................•...............•••......•.............•............................. cirCUlatory stimulant

supports a stimulant effect on digestion and peristalsis. reduces Stagnation of Qi from Cold

Capsicum

bitter digestive

supports the stimulation of the appetite and peristalsis

Rosmarinus

antispasmodic

supports a relaxing effect on gut spasms

Lobelia

moistening sweet tonic

moderates any potential drying effect from anticatarrhal or diuretic carminatives

Glycyrrhiza

....•...........•.•................................... ..........................................• Circulatory stimulant (support)

cardiotonic

provides a gradual and sustained energy increase to complement the stimulation of the circulation

Cinchona

(moderate)

demulcent

counteracts the tendency of some acrid circulatory stimulants to irritate the gastric mucosa

Glycyrrhiza

Demulcent

• • • • • • • • • • • • " . " . " . " . " •• " . " . " •• " .""" fit" " """"""

analgesic anti-inflammatory

complements the anti-inflammatory action of demulcents

Filipendula

(moderate)

carminative

counteracts the digestive stagnation and increased mucus from sweet, moistening demulcents

Citrus

(support)

(moderate)

Diuretic (support)

(moderate)

.

a""" """"."" """ " " """. """,,"" """"""""""""""""""""."""""""""" •• "

(support)

Diaphoretic

~

'""""""""""""""""""" """""""""""" " " """""""."""" , "" "" """" "

..

.

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circulatory stimulant

stimulates peripheral circulation, supports diaphoresis and the clearance of toxins

Capsicum

anticatarrhal

reduces excessive secretion and accumulation of mucus in respiratory infections

Sambucus

antipyretic

reduces fever and lowers the body temperature

Nepeta

alterative

eliminates toxins from the body in the sweat

Achillea

tonic

strengthens the immune system to clear lingering pathogens and to resist further infection

Echinacea

astringent

moderates excessive sweating to avoid weakening the body

Salvia off.

••.••...•.•.••......•.•.•••.•...•.•..................................................................... circulatory stimulant

can stimulate the urinary sy&tem, clear obstruction, and accentuate the diuretic effect

Zingiber

tonic

can tonify the urinary system and strengthen the diuretic effect

Panax gin.

mineral supplement

moderates the effect of mineral loss as a result of diuresis

Taraxacum

Actions

65

Emmenagogue (support)

(moderate)

bioavailability enhancer

can act as a 'carrier' or 'messenger' and enhance the bioavailability of other herbs

Zingiber

circulatory stimulant

can support the use of emmenagogues for conditions with sensations of abdominal cold

Capsicum

tonic

assists in the treatment of reproductive weakness associated with atrophy or hypofunction

Serenoa

stimulant

assists in the treatment of lack of sexual interest associated with depression

Tumera

antispasmodic

assists in the treatment of uterine spasms

Viburnum

tranquilizer

assists in the,treatment of gynecological disorders associated with nervous tension

Saivia off.

astringent

moderates potential excessive bleeding from stimulant emmenagogues

Vinca

.............................. r

_

..

Expectorant (support)

(moderate)

circulatory stimulant

stimulates bronchial circulation and supports the movement ' and clearance of mucus

Sanguinaria

anticatarmal

reduces the excessive secretion and accumulation of mucus

Thuja

demulcent

moistens and soothes inflamed mucosa, thereby facilitating expectoration

Glycyrrhiza

antispasmodic

reduces excessive bronchial spasms that may inhibit expectoration

Lobelia

antiemetic

moderates potential nausea from stimulant expectorants, such as Lobelia

Zingiber

............................................................................................................................................................................................................ Hepatic and cholagogue

circulatory stimulant

improves the circulation in the liver, enhancing clearance of toxins

Capsicum

antioxidant

can contribute to both hepatoprotective and antilipidemic effects

Artemisia, spp.

antispasmodic

assists in the treatment of spasms and pain of the biliary system

Chelidonium

anti-inflammatory alterative

treats hepatobiliary inflammatory conditions associated with accumulation of toxins

Berberis

detoxicant

can assist in the protection against toxins released by the action of alterative hepatics

Glycyrrhiza

(support)

(moderate)

Purgative (support)

(moderate)

........•............................................................................................... cholagogue

increases the secretion of bile, which has a laxative action

Iris

circulatory stimulant

supports the stimulant action of purgatives on atonic bowel

capsicum

tranquilizer

reduces nervous tension that may be contributing to intestinal spasms and obstruction

Valeriana

carminative

moderates potential intestinal colic due to p'urgatives

Foeniculum

demulcent

moderates potential irritation of the intestinal mucosa due to purgatives

Glycyrrhiza

--~--K~L

Combining Western Herbs and Chinese Medicine

66

Sweet tonic (support)

(moderate)

Tranqulllzer (support)

(moderate)

bitter digestive tonic

assists in the absorption of sweet tonics by stimulating the digestive and hepatic function -

Gentiana

circulatory stimulant

stimulates digestion and speeds the assimilation and delivery of nutrients to the cells

Capsicum

carminative

reduces digestive stagnation and sensations of heaviness due to the sweet tonics

Elettaria

............................................................................................................................................................................. nervine

strengthens and stabilizes the nervous system to complement the tranquilizer effect

Avena

cardioregulator

strengthens and stabilizes the cardiovascular system to complement the tranquilizer effect

Crataegus

antidepressant

complements the tranquilizer effect for patients with both depression and anxiety

Thymus

circulatory stimulant

moderates any potential dulling of consciousness from stronger tranquilizers

Rosmarinus

-

Actions glossary Western herbal a.ction ca~egories .discussed in this glossary, the followmg details are given

OR EACH OF THE

P

where appropriate: • synonyms (within parentheses) • defmition and uses • herb examples • types (subcategories) • Chinese equivalent • differentiation from other categories

necessarily strengthen the adaptive capacity. Adaptogens are a subdivision of tonics with the specific quality of strengthening the ability to adapt to stress. Alteratives (blood purifiers and depurants) These are herbs that can clear toxins fro.m the body by increasing the processes of elimination and detoxification. They are used for disorders involving the accumulation of toxins, for example, acute sepsis, arthritis, recurring infections, skin disorders, and the sequelae of chemo- or radiotherapy. They can also be used to assist in detoxification programs for alcohol, drugs, or prolonged medication. For example,

Adaptogens See also Tonics. These are herbs that can enhance the ability of the body to adapt to chemical, physical, emotional, or mental stress. These herbs can enhance the strength and speed of performance under stress, and enhance the speed at which the body returns to normal function after stress. Examples include Astragalus, Eleutherococcus, Panax ginseng, Schisandra, and Withania.

• Achillea

can assist in the clearance of toxins through the skin by diaphoresis

• Phytolacca

can assist in the clearance of toxins from the lymph system

• Taraxacum

can assist in the clearance of toxins via its diuretic and laxative actions

Chinese equivalent There is no exact equivalent to the al-

Chinese equivalent The adaptogenic action can be said to

terative action in Chinese medicine. Perhaps the nearest equivalent action categories are clear Retained Heat, clear Damp Heat, and clear Heat Toxins. It should be noted that the concept of toxins as a main cause of disease, involving cleansing as a major treatment principle, is stronger in Western herbal tradition than in Chinese medicine.

be a subdivision of the Qi tonic action. One of the most important functions of Qi is the capacity for a rapid and appropriate adaptation to environmental stimuli, with rapid subsequent return to the balance between Ym and Yang.

Adaptogens, stimulants, and tonics Stimulants rapidly in-

Analeptics See also Stimulants. Once known as restoratives or resuscitants, these are sub-

crease the activity of the body, but their long-term use may result in depletion or destabilization. Tonics gradually and cumulatively increase the strength of the body but do not

stances that can restore consciousness following fainting or

,

67

Combining Western Herbs and Chinese Medicine

68

coma. In conventional medicine, analeptics that stimulate the central nervous system have been used to counteract the effect oflarge doses of narcotics. In the Western herbal tradition, Lobelia has a tradition of use as a resuscitant to treat the loss of consciousness from fainting, apoplexy, or concussion. It was used either as a single herb or in combinations such as the Antispasmodic tincture (see the Lobelia chapter).

Chinese equivalent The action category of aromatic substances that open the orifices is used to clear Phlegm from the sensory orifices and revive Heart Spirit, and to treat such disorders as apoplectic coma and febrile delirium. Analgesics (anodynes) These are substances that reduce the conscious perception of pain. Three main types are: • anti-inflammatory analgesics • narcotic analgesics • tranquilizing analgesics

Anti-inflammatory analgesics These can relieve pain by reducing inflammation, generally without dulling consciousness. They may also have an antipyretic action. One group used in conventional medicine is the nonsteroidal anti-inflammatories (NSAIDs), which includes the salicylates. Filipendula. Populus. Salix, and Viola are examples of herbs with the anti-inflammatory analgesic action; they contain compounds that can be converted in the body to salicylic acid.

Narcotic analgesics The narcotic analgesics reduce pain but may also produce dullness or drowsiness. One group used for severe pain in conventional medicine is the opiates. such as codeine and morphine. None of the herbs discussed in this book have a narcotic analgesic action.

Tranquilizing analgesics Some substances can assist in the treatment of pain because of their tranquilizing or sedative action, especially when the pain is linked to muscle spasms associated with nervous tension. Tranquilizers calm without necessarily dulling consciousness. Sedatives calm and may also have a dulling effect on consciousness, but not so severe a dulling effect as narcotic analgesics. Piscidia and Valeriana are examples of herbs that can have antispasmodic and analgesic effects in addition to their tranquilizing"action. At high doses. these herbs may have some sedatiVe'effects.' Analgesics and anesthetics ArialgesicS relieve pam;Without necessarily'removing all sensation or'dulling consCiousness. Anesthetics abolish sensation in a specific area (local anesthetics) or in the whole body (general anesthetics).

Chinese equivalent Herbs with the analgesic action can be found in the move the Blood action category. especially when the pain is associated with Blood stasis from trauma or internal causes. Analgesics are also found in the regulate Qi category. but in this case, pain is linked to Qi Stagnation. which may be associated with muscle spasms. such as intestinal colic. Anodynes

See Analgesics.

Antacids See also Antiulcer agents. In conventional medicine. antacids are substances that are used to treat peptic ulceration by neutralizing the hydrochloric acid in the gastric secretions. In Western herbal tradition, the term antacid has been used rather vaguely, to include antiulcer herbs for which a gastric acid neutralization mechanism has not been demonstrated or which ind