Herbal Medicine
Navigate this sectionIntroduction to Chinese Herbs
Chinese herbal medicine has a profound history that forms the backbone of an outcome-driven healthcare system. Spanning from the early Han Dynasty to the late Han Dynasty, this ancient practice witnessed significant advancements, refinement, and expansion. During this period, clinical experience led to the refinement of medical theories, pulse diagnosis, acupuncture techniques, and herbal prescriptions. Classical texts emerged, providing a systematic framework for Chinese medicine and guiding practitioners for generations to come.
One of the most influential texts, the Huangdi Neijing (Yellow Emperor’s Inner Canon), compiled around the 2nd century BCE, synthesized medical knowledge and theories of the time. Divided into the Suwen (Plain Questions) and the Lingshu (Spiritual Pivot), this treatise covered human physiology, diagnosis, treatment principles, and acupuncture techniques comprehensively.
Daoist philosophy played a significant role in shaping Chinese medicine during the Daoist Hundred Schools of Thought era. The harmony of Yin and Yang, the flow of vital energy, and the interconnectedness of humans with nature became foundational principles in Chinese medical theory. Daoist scholars and alchemists explored various substances, including herbs, minerals, and other natural materials, seeking longevity and immortality. This exploration led to the discovery and utilization of numerous herbs that are now essential components of Chinese herbal medicine.
Classical texts such as the Shanghan Lun (Treatise on Cold Damage Disorders) and Shennong Bencao Jing (Divine Farmer’s Materia Medica) further contributed to the advancement and codification of Chinese medicine. The Shanghan Lun focused on the diagnosis and treatment of complex diseases, prescribing formulas and considering acupuncture points for specific conditions. The Shennong Bencao Jing cataloged a wide range of herbs and their therapeutic properties, serving as a fundamental reference for herbal medicine.
Modern Chinese herbal medicine draws upon this rich tradition. With over 500 medical materials and thousands of formulas dating back thousands of years, practitioners combine single herbs to create multi-herb formulas for mass production or custom prescriptions. This pharmacological system requires in-depth knowledge of single herbs and the ability to create formulas that direct the chief agents to specific areas of the body. While mainstream pharmacology tends to isolate and synthesize specific chemical constituents for patenting, traditional Chinese herbs continue to provide inspiration for pharmaceutical development.
It’s worth noting that traditional medicine, including herbal medicines, acupuncture, and other local therapies, is widely used worldwide. According to the World Health Organization Global Centre for Traditional Medicine, approximately 88% of countries incorporate traditional medicine into their healthcare systems. While the US healthcare system primarily relies on synthetic medications, the medical properties of herbs have still contributed to the development of various drugs through the isolation and synthesis of specific chemical constituents.
Blending modern pharmacological underpinnings with medicinal herbs, Chinese Medical Herbology & Pharmacology provides single herb information while Chinese Herbal Formulas and Applications provides information to a range of healthcare practitioners. These texts include herb monographs; photographs, chemical structure diagrams, toxicology, cautions and contraindications, herb-drug interactions, formulas, and evidence-based research.
*The information on these pages is for educational purposes only. The information is not intended to prevent, diagnose, treat, or cure.
Herbal Medicine Regulations
Herbal Medicine Regulations and Policies
Dietary Supplement Health and Education Act of 1994
US Food and Drug Administration. Dietary Supplement Health and Education Act of 1994. US Food and Drug Administration; Silver Spring, MD, USA: 1994. Public Law 103–417.
NOTES
- Preparations dispensed are dietary supplements.
- Always use disclaimer that the dietary supplementis not intended to diagnose, treat, cure, or prevent any disease.
- Ingredients fall under federal jurisdiction.
Current Good Manufacturing Practice
In Manufacturing, Packaging, Labeling, or Holding Operations for Dietary Supplements: Final Rule. http://www.gpo.gov/fdsys/pkg/FR-2007-06-25/html/07-3039.htm
NOTE – Acupuncturists and Herbalists are subject to discretionary enforcement since they are not exempt from the rules. Enforcement Discretion means that the FDA will exercise its regulatory authority only if practitioners have adequate professional training and dispense supplement products on the basis of one-on-one consultations, and the supplements dispensed have no known or suspected safety concerns.
FDA Industry Guidance on Complementary and Alternative Medicine Products
Their Regulation by the Food and Drug Administration. Read Full Article
Dietary Supplement and Non-Prescription Drug Act
United States Government Printing Office; Washington, DC, USA: 2006. Public Law 109–462.
Herbal Medicine Resources
Chinese Herbal Compounding and Safety Certificate of Qualification Course
The National Certification Commission for Acupuncture and Oriental Medicine (NCCAOM) offers an online course that provides best compounding and dispensing practices for licensed acupuncturists, herbalists, students, lab technicians, herb pharmacy compounders, and any other office staff who compound herbal formulas in their office or retail dispensaries. Participants receive 10 NCCAOM PDA points and the official NCCAOM CHCS COQ Badge on program completion.
Single Herb Cards
This is a free resource. The front side and the back side can be joined together by printing each file on one side. Students often provide the files to a printer, such as Kinkos, that can also cut the cards.
Common Herb Allergies
Allergen Labeling and Consumer Protection Act 2004
Wheat – fu xiao mai, shen qu
Gluten – e jiao, fu xiao mai, lu jiao jiao, mai ya, shen qu, yi tang
Soy – dan dou chi, e jiao, he shou wu, lu jiao jiao
Tree Nuts – bai guo, hu tao ren, shen qu, xing ren, yu li ren
Others – sesame (zhi ma) and cuttlefish (hai piao xiao)
Herb-Drug Interactions – Chen X.W., Sneed K.B., Pan S.Y., Cao C., Kanwar J.R., Chew H., Zhou F. Herb-drug interactions and mechanistic and clinical considerations. Curr. Drug Metab. 2012;13:640–651. doi: 10.2174/1389200211209050640.
FDA on Botanical Drugs and Supplements – https://www.fda.gov/regulatory-information/search-fda-guidance-documents/complementary-and-alternative-medicine-products-and-their-regulation-food-and-drug-administration
Chinese Herbs & Allergens: Labeling with Caution
By Shellie Rosen, DOM, Lac – Published February 2018, Acupuncture Today
The growing prevalence and awareness of allergen-related side effects from consumable goods begs the question, “Are we labeling potential allergens appropriately?” The Food and Drug Administration (FDA) has required allergen labeling for over a decade. The ingredients the FDA focuses upon are responsible for “90 percent of all food allergies.”1 Chinese herb formulas may contain potential allergens not typically recognizable to consumers and not currently required by the FDA. Practitioners can provide an excellent service to patients by understanding the food allergen labeling law, the ingredients necessary to label, and additional Chinese herbs that are worth discussing (and labeling) with sensitive patients.
The Allergen Labeling Law
The Food Allergen Labeling and Consumer Protection Act (FALCPA) became law in 2004 (Title II of Public Law 108-282). The purpose of FALCPA was to set requirements for supplements or foods that contain a major food allergen, or proteins associated with allergens, to be appropriately labeled for consumers.
Section 403 of the Federal Food, Drug and Cosmetic Act from 1938 requires that food “fabricated from two or more ingredients declare each ingredient by its common or usual name.” FALCPA was needed to assist consumers of food and supplement products further because allergens became both more prevalent and widely known as causes of illness. Consumers required help identifying potential antagonists. Some labels under section 403 were initially not clear enough for those suffering from allergen sensitivities.
What are the Major 8 Allergens?
- Milk
- Egg
- Fish
- Crustacean shellfish
- Tree Nuts
- Wheat
- Peanuts
- Soybeans (or processed with soy)
Chinese medicine practitioners must ensure their prescriptions carry allergen labels for the ‘major eight’ allergens. The agency released a “Final Guidance” October 5, 2005 that breaks down specific areas required for labeling allergens. For example, if a product contains tree nuts or fish, the particular type of nut and fish/shellfish must be labeled. The deadline for dietary supplements to comply with allergen labeling requirements was January 1, 2006. Chinese Herb practitioners serve patients best when they contract with companies that label allergens in compliance with federal regulations.
What You Should Label
Label any ingredient that derives from a potential allergen, since labeling products is a public safety concern, especially in the case of potential allergens. FALCPA wants consumers to have access to clear language that avoids ambiguity. Labels are not compliant when they do not state the source product of the allergen. Listing “whey” isn’t adequate; the label must also say “milk.”
A product that derives from a potential allergen must label that allergen source. Perhaps there is a belief that a particular processing method may mitigate the potential threat of an allergic response. In this case, opinions shall not interfere with patient rights. For example, some individuals may be allergic to shrimp, but tolerate glucosamine made from shrimp. Perhaps because glucosamine derives from shrimp shells, not shrimp flesh where the protein that initiates an allergic response resides.
Although allergic reactions have not been problematic with shell-derived glucosamine, it is sourced from shellfish and must label as such.
Patient’s and their doctors have the right to know what products are in their prescription. If you have done research on a particular processing method and you believe potential antagonists transform enough to render the allergen source inactive, then offer your patient the information and allow them to decide with their doctor if the risk is worth it. The Chinese herbal compendium offers creative ways around potential allergens, why take a chance?
If you want to get an idea of what a safety recall by the FDA looks like, check out their website. Notice how many products you find recalled for “Undeclared” ingredients related to potential allergens.
Chinese Herbal Medicine Pharmacology System
Chinese herbal medicine pharmacology is an intricate system that categorizes herbs based on their properties and actions within the body. Each herb possesses distinct characteristics, including temperature, taste, direction, and specific effects on the body. Before we evaluate those properties, lets look at an example by comparing the practice of Western herbology to that of Chinese herbal medicine.
The system of Chinese herbal medicine differs from Western herbology in several ways. Western herbology matches a symptom to an herb, such as turmeric for inflammation. Chinese medicine does not treat symptoms. It treats patterns of imbalance. To treat those patterns, it must take direct aim based on the properties of the herbs.
In Chinese herbal medicine, two parts of the turmeric plant are used as medicine: the root and the tuber. These are separate medicines because the root and the tuber have different properties and are used in different ways. While both flavors are considered pungent and bitter, the root (Ezhu) is considered warm, works in the liver and spleen systems, and often used as an anti-tumor. The tuber (Yu Yin) is considered cold, works in the liver, heart, and lungs systems, and often used as an anti-depressant. These differences can be evaluated through their phytochemical and pharmacological differences, which are codified into properties of temperature, taste, direction, and action.
Temperature
Herbs are classified as either “hot” (re), “warm” (wen), “cool” (liang), or “cold” (han). This classification refers to the thermal nature of the herb and its effect on the body. For example, hot or warm herbs are used to dispel coldness and promote circulation, while cool or cold herbs are employed to clear heat and cool down the body.
Taste
Herbs are categorized into five tastes: “bitter” (ku), “sweet” (gan), “sour” (suan), “spicy” (xin), and “salty” (xian). Each taste corresponds to specific actions in the body. For instance, bitter herbs often have a draining effect, promoting elimination and drying dampness, while sweet herbs are nourishing and tonifying, helping to strengthen and harmonize bodily functions.
Direction
This property indicates the herb’s affinity for certain body regions or organs. For example, some herbs have an upward or ascending direction, which means they promote the circulation of energy (qi) and fluids towards the upper body, benefiting the head and the respiratory system. Conversely, downward, or descending herbs assist in moving energy and fluids downward, benefiting the digestive system or relieving symptoms like coughing or nausea.
Actions
Herbs can have various actions in the body, such as dispersing, harmonizing, tonifying, or purging. These actions describe the specific therapeutic effects an herb has on the body. For instance, dispersing herbs help to move energy and alleviate stagnation, while tonifying herbs nourish and strengthen deficient conditions.
By understanding these properties, Chinese medicine practitioners select and combine herbs to create customized formulas that address a person’s specific pattern of disharmony. This holistic approach considers the individual’s overall constitution, symptoms, and the dynamic interplay of various herbs to restore balance and promote health.
Videos
For more on herb classification based on properties, see https://www.youtube.com/watch?v=9rLreD3UWNU
For a Beginner’s Guide to Chinese Medicine, see https://www.youtube.com/watch?v=dpOv9gr8MP8&t=178s
Single Herbs
Herbal medicines are not limited to the Chinese herbal medicine system. There are an eclectic variety of herbs that can be adopted into the system by understanding key properties.
The refinement and expansion of Chinese medicine involved continuous observation, experimentation, and integration of diverse perspectives due to the interaction between Chinese medicine and local medicine traditions in other countries. This cultural fusion and exchange of medicinal knowledge not only enriched both Chinese and local medicine but also laid the foundation for cross-cultural cooperation that continue to influence medical practices today.
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This is a free resource. The front side and the back side can be joined together by printing each file on one side. Students often provide the files to a printer, such as Kinkos, that can also cut the cards.
Multi-Herb Formulas
Chinese herbal formulas are an integral part of Chinese medicine and have been used for centuries to promote health and treat various ailments, known as patterns. The formulas consist of a combination of herbs carefully selected and combined to achieve specific therapeutic effects. Herbal formulas are crafted blend of substances designed to function synergistically. This synergy applies to herb pairs and herb combinations consisting of up to over a dozen substances. The blends serve many purposes. Herbal pairs can serve to balance or enhance to strengthen the effects, counterbalance an undesirable property, or harmonize herbs in the formula.
Additionally, specific therapeutic strategies and methods underlie the formulation and application of herbal combinations. One of the fundamental principles in formulating Chinese herbs is the concept of herb pairs. Another fundamental principle in formulating herbs is to enhance a targeted area and or affect.
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Herb Pairs
Herb pairs in Chinese herbal formulas refer to the strategic combination of two herbs that work synergistically to enhance their therapeutic effects. These pairs are designed to balance each other’s properties, increase potency, and minimize potential side effects. For example, one herb may target a specific symptom or organ, while the other herb can harmonize or enhance its action.
Herb Formula Assembly
When assembling a Chinese herbal formula, several factors are taken into consideration. One consideration is herbal pairs and herbal supports. To enhance a targeted area or affect, herbs are assembled strategically under 4 categories. The categories are chief, deputy, assistant, and envoy.
Chief. The chief herb(s) is the main ingredient in the formula that is directed toward the principal pattern of pathology. The chief herb(s) is indispensable as it has the greatest effect for treating the pattern.
Deputy. The deputy herb(s) aids the chief herb in treating the principal pattern or pathology and serves as the main ingredient to treat any coexisting patterns or comorbidities.
Assistant. The assistant herb(s) reinforces the effect of both the chief and deputy herbs, and directly influences a less important aspect of the target pattern or comorbidities. The assistant herbs also moderate or eliminate potential harsh nature of other ingredients to reduce toxicity or side effects of other herbs in the formula.
Envoy. The envoy herb(s) guide the actions of the chief ingredients to specific target areas within the body and focuses the action of the formula on a certain channel or area of the body. The envoy also harmonizes and integrates the actions of the other ingredients in the formula.
Additionally, the directions in which the herbs are combined in a formula are crucial. The order and proportion of each herb are carefully determined to maximize their synergy and minimize potential interactions or side effects. The precise assembly of these herbs aims to create a harmonious and effective blend that addresses the underlying imbalances causing the symptoms.
By combining herbs strategically, Chinese herbal formulas offer a holistic approach to healing, aiming to restore balance and promote well-being in the body. These formulas are tailored to individual needs and have been widely used to treat a broad range of health conditions in TCM.