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Therapies

Chinese herbal medicine

What Is It?
How Does It Work?
What You Can Expect
Health Benefits
How To Choose a Practitioner
Cautions
Evidence Based Rating Scale
References


What Is It?

Practiced for over 2,000 years, Chinese herbal medicine is a primary component of Traditional Chinese Medicine (TCM), which also includes acupuncture, dietary principles and massage, as well as therapeutic exercise and movement. (For background on Traditional Chinese Medicine, see this entry in the WholeHealthMD Reference Library).

The main difference between Chinese medicine and Western medicine lies in its view of how to deal with illness. In Western medicine, specific drugs are sought to correct specific disease states and are evaluated for how effective they are for specific conditions. These drugs are subject to safety concerns due to the risk of side effects from chemicals that are "new" to our bodies. Chinese medicine, on the other hand, sees a disease condition as the result (or manifestation) of "imbalances" within the body, or between the body and various environmental factors. (1, 2) The aim of Chinese medicine is not to prescribe an herbal agent to treat a particular manifestation, but rather to help the patient's stressed organ systems operate in a more natural, balanced state.

In Chinese herbal medicine, not everyone with the same disease is given the same herbs. This is because each individual's unique constitution and relationship to the environment is evaluated before an herbal prescription is devised. If you suffer from chronic cough, for example, your ailment would be evaluated in the context of your individual pattern of lung qi (the life force that courses through the body along pathways called Meridians). (1, 2) The relationship of your lungs to pathologic influences (such as viruses and air pollution) would also be taken into account, as well as the way your lungs are nourished by the body's blood, fluids and energy metabolism.

Over the course of history, the Chinese have established more than 20,000 herbal formulas from plants, minerals and animal products. Today some 2,000 are currently in use and subject to active research in the People's Republic of China.

A TCM practitioner seldom prescribes single herbs but instead offers individualized combinations based on time-tested formulas. If you consult with a specially trained herbalist, you will likely receive an individual formula that may be changed or modified as you recover. Otherwise, your practitioner may select a stock formula of mixed herbs from the many Chinese "patent medicines." The patent medicines tend to be designed for specific symptom relief (for everything form sinus problems to athlete's foot). In recent years, herbal medicine companies in the United States have begun importing the herbs and producing products for both Chinese medicine practitioners and the self-care market in forms more acceptable to Westerners.

How Does It Work?

Practitioners of Chinese herbal medicine seek to promote or restore health by diagnosing and treating "disharmonies" between organs or imbalances in your qi. A typical evaluation includes three components:

 The first assesses the balance between yin and yang aspects of body functions. This roughly corresponds to the balance between the stress response system and the repair and recovery system (sympathetic and parasympathetically controlled functions) that we recognize in Western medicine.

 

 The second considers the correspondence of the ailment to the five phase elemental system of living energy in Chinese medicine--wood, fire, earth, metal, and water. It is believed that each internal organ and body system has a characteristic elemental quality that can become imbalanced by physical, mental, or environmental factors.

 

 The third determines the quality of the imbalance in the organ or metabolic system that is ill and whether the problem is one involving blood, fluid, energy function, or the organ's self-repair system.

This is all expressed in an ancient, symbolic method of describing the ailment that incorporates natural terms. In fact, a TCM diagnosis can sound much like a weather report. Colds and flus may be described as "wind-heat invading the lungs," or "wind-cold affecting the stomach." Some kinds of endometriosis may be described as "damp-heat" in the "lower burner." An asthma patient might have "a failure of the kidneys to moisten the lungs."

And just as these symptoms are categorized by their "cosmological" nature, so are herbal medicines. Every Herb is first classified by what are termed the Four Energies (hot, warm, cold, and cool). "Cold" herbs are used for "hot," or "yang," diseases, and "hot" herbs for cool, or "yin" ailments. For example, if you have the flu and are hot with fever, cold or cooling herbs that are known to clear heat and toxins would be prescribed. Or, if you have chronic diarrhea and feel clammy and weak, hot or warming herbs that soothe the digestive tract would be given. However, since most illnesses are a complex mixture of various degrees of heat and cold, absolute "hot" and "cold" patterns are extremes. The goal of the herbal practitioner is to analyze the ratio of heat to cold required for optimal health in a particular individual.

In addition to the Four Energies, the herbal practitioner will also consider the phases of diagnosis by using flavor qualities (spicy, sweet, sour, bitter, and salty) when creating a formulation. The Four Movements (to push upward, to push downward, to float, to sink), which describe how herbal agents affect qi flow in the body, are also taken into account. So are the ways herbs can affect fluids through their moistening or drying qualities.

Not surprisingly, several herbs are typically combined in a Chinese herbal formula. A traditional formula usually contains four classes of ingredients, arranged in a special order. The names for these arose in ancient, feudal times. The principal herb in the formulation is called the Emperor. An herb that treats a secondary condition or enhances the action of the first herb is the Minister. An Assistant counteracts any side effects of the first two, and an Envoy harmonizes the other ingredients and carries them to the parts of the body that they are to treat.

Because most formulas in Chinese herbal medicine contain varying amounts of multiple ingredients (unlike Western, single-ingredient drugs that come in standardized doses), demonstrating how Chinese herbal medicine works in modern terms can be challenging. However, some Western clinical studies have confirmed the benefits of Chinese herbal formulas. (See Health Benefits, below.)

What You Can Expect

A practitioner of Chinese herbal medicine may be an acupuncturist, a Doctor of Oriental Medicine (O.M D.) or other health-care practitioner (see How to Choose A Practitioner, below). Whatever practitioner you choose, the basic diagnostic examination you'll receive before any herbs are prescribed is essentially the same. In brief, the examination includes four parts:

 A visual exam. The practitioner will scrutinize your general physique, your facial expression, your complexion, and your tongue. 

 Listening and smelling. Your breathing, other body sounds, and body odors will be checked. 

 Questioning. As with a medical history, many questions will be asked about your symptoms and your health. 

 Palpation. The practitioner will examine your body organs through the abdomen, at qi points along the energy meridians and at the pulse.

Your practitioner may dispense the herbs in the office or give you an herbal prescription to be filled at a Chinese herbal store. Your remedy may be made up in a variety of modern forms: alcohol extracts, tablets or powders to steep in a tea. Traditional forms include a soup or tea that you boil from raw herbs, pills (made with wax, honey or flour paste) and wine with herbs steeped in it. Other Chinese herbal remedies are used on the outside of the body in the form of pastes, poultices, plasters, or in moxibustion (a technique in which a wick made of herbs is burned at a slight distance above the skin).

For most acute problems, you will likely be directed to take the Chinese herbs for only a few days. For chronic conditions, they can be prescribed for weeks or months. Most herbs have milder effects than typical Western drugs, the ingredients in the remedies are generally eliminated by your body in about four hours. While long-term use of some herbs can be safe, others may affect liver function or be hazardous if taken during pregnancy. Most experienced herbalists will want to re-evaluate your condition and change the herbal formula and dosing plan periodically. You should expect to return for adjustments to your herbal prescription at three- to four-week intervals until your illness is resolved.

Health Benefits

As they have for centuries, Chinese herbs continue to be an integral part of Chinese medicine. Contemporary Chinese scientists regularly publish studies on the effectiveness of herbs for various ailments in more than 100 contemporary Chinese journals. However, because randomized, Placebo-controlled studies are unusual in China, many Western practitioners have had a hard time trusting the effectiveness of these ancient treatments. (3)

Even so, the gap between East and West is narrowing. Some Western studies have been conducted on Chinese herbal formulas with promising results. Remedies have been tested for acute conditions such as colds and flu. A meta-analysis of trials performed by the Cochrane Collaboration suggested some remedies may be effective for flu, though they are not ready to be advanced a clinical recommendation. (4) Their review focused on 11 studies including 2,088 patients. Since the studies did not all prescribe the same herbal preparation, no firm recommendations could be drawn as to an individual medication’s efficacy. The included trials were also lacking in rigorous study methodology and size. As Western medicine begins to investigate the remedies from the Far East, evidence will become more readily available regarding the particular herbal concoctions that may benefit the flu. More research is necessary to expound on these initial findings.

Remedies also have been tested for chronic problems such as fibromyalgia (5), irritable bowel syndrome, and various skin conditions.

A 1998 study published in the Journal of the American Medical Association showed that Chinese herbal medicine helped improve the symptoms of irritable bowel syndrome. A group of 116 patients were divided into groups: One group was given an individualized Chinese herbal treatment, one group was given a standard Chinese herbal formulation, and the third group was given a Placebo, or dummy pill. The two groups who received the herbs experienced significant improvement in their symptoms (the individualized group maintained the improvement longer), as compared to the placebo group. (6)

A study published in Lancet found that 31 patients with atopic dermatitis (AD) appeared to be helped by Chinese herbal therapy. (7) Another recent study in the British Journal of Dermatology confirmed efficacy of a Chinese herbal remedy in the treatment of AD in children. A randomized, double-blind, placebo-controlled study of 85 children with long-standing, moderate-to-severe AD who received two daily doses of three capsules of Chinese herbal medicine or placebo found those taking the herbal medicine improved the quality of life and need for topical corticosteroid use. (8)

A review of clinical trials in the British Journal of Clinical Pharmacology found two trials that showed Chinese herbs as a more effective treatment than a placebo for treating eczema. More study is needed in this area, however, because some adverse reactions have been reported to the treatment. (9)

Some Chinese herbs are becoming commonplace in the West for treatment of common ailments. For example, an extract of Ginkgo (Ginkgo biloba) has been found to improve awareness, judgment and social function in people with Alzheimer’s disease and dementia; the sleep-inducing agent Valerian (Valeriana officinalis) is being used to treat insomnia, and Echinacea preparations (from Echinacea purpurea and other Echinacea species) are being used for their immune-boosting properties.

How to Choose a Practitioner

The regulation of TCM varies from state to state in the United States. In many but not all states,  acupuncturists (Doctors of Oriental Medicine) are required to be tested and licensed to do acupuncture and other TCM procedures. In California, Texas, Nevada, and New Mexico, for example, the state exam tests acupuncturists on proper prescribing of Chinese herbs. In other states, however, herbal certification is voluntary. Ask if your acupuncturist has passed the National Certification Commission for Acupuncture and Oriental Medicine herbal exam.

In addition to acupuncturists, many M.D.s and osteopathic doctors (D.O.s), as well as naturopathic physicians (N.D.s) and chiropractors, have studied Chinese herbs and incorporate their use into their practices. Medical personnel with less training may also be able to perform herbal medicine safely if they work according to protocols designed by certified TCM herbal specialists. As you would with any health provider, always check into your Chinese herbal medicine practitioner's credentials and background.

Cautions

If you have a chronic condition or a new acute problem that is seriously disabling you, get a diagnostic evaluation from a conventional primary-care physician before consulting a practitioner of Chinese herbal medicine. 

 Plan on coordinating your care between your primary-care doctor or specialist and your herbalist. If they won’t work together, find individuals that will. 

 Long-term use of some Chinese herbs can affect liver function; consult with your doctor if you have liver problems. 

 Some Chinese herbs can be hazardous if taken during pregnancy. 

 As you would with any health practitioner, if your condition is not improving in a reasonable time, get a second opinion. There are increasing numbers of practitioners familiar with both Western and traditional Chinese medicine, should you need a re-evaluation. 

 Herbal remedies are regulated as "dietary supplements" under current Federal laws. This means that the Food and Drug Administration (FDA) has not evaluated their effectiveness and safety as therapies. Occasionally herbal products have been reported to cause health problems due to contamination with unsuspected pharmaceutical drugs, erroneously chosen herbs, or improper dosing by ill trained practitioners. Be sure to work only with a licensed and certified practitioner to ensure that you get the best care.

Evidence Based Rating Scale 

The Evidence Based Rating Scale is a tool that helps consumers translate the findings of medical research studies with what our clinical advisors have found to be efficacious in their personal practice. This tool is meant to simplify which supplements and therapies demonstrate promise in the treatment of certain conditions. This scale does not take into account any possible interactions with any medication/ condition/ or therapy which you may be currently undertaking. It is therefore advisable to ask your doctor before starting any new treatment regimen.

Condition

Rating

Explanation

 

 

  

 

 

Alzheimer’s disease

 

 

 

 

 

 

 

 

A large study found efficacy of Ginko extract EGb 761 in improving awareness, judgment and social function.

 

 

 

 

 

 

 

 

 

 

 

 


Date Published: 04/19/2005

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