Chapter One. The theory and concepts of Chinese herbal medicine
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1. What are the four flavors of Chinese herbs? What are their applications in clinical practice?
In clinical practice, hot or warm herbs are used to warm the body and to treat Cold syndromes. For example, Gan Jiang ( Zingiberis rhizoma) is able to warm the Middle Jiao and treat abdominal cramp and diarrhea; Dang Gui ( Angelicae sinensis radix) can warm the Blood and alleviate pain due to Cold in the Blood. A cold or cool herb is used to clear Heat and to treat Heat syndromes. For instance, Shi Gao ( Gypsum) can clear Heat in the Lung and Stomach and therefore it can reduce fever, wheezing and thirst; Sheng Di Huang ( Rehmanniae radix) can reduce Heart-Fire in order to treat restlessness and insomnia. A neutral herb can be used when the syndrome is not characterized by Heat or Cold. For instance, Fu Ling ( Poria) can promote urination and reduce edema. A neutral herb can also be used in either a Cold or Heat syndrome in combination with other hot or cold herbs. For instance, Fu Ling ( Poria) can be used with Fu Zi ( Aconiti radix lateralis preparata)* to warm the Kidney-Yang and reduce edema; it can also be used with Xiao Ji ( Cirsii herba) to treat painful urinary dysfunction due to Heat in the Bladder. These are the basic applications of the four flavors.
The four flavors are amongst the primary properties of herbs but, in fact, the number is not confined to four. Like many other theories in Traditional Chinese Medicine (TCM), the four flavors primarily indicate the temperature quality of the herbs. The theory also suggests that these temperatures can be subdivided into different degrees, but does not indicate the details of these degrees. The terms ‘very hot’, ‘hot’, ‘warm’ and ‘slightly warm’ are sometimes used. In practice, differences in temperature between herbs are usually found out from the explanations of the function, from applications given in books and from personal experience.
Moreover, hot herbs can be divided into thin-hot and thick-hot. A thin-hot herb possesses a lighter hot nature, which leads to a quicker action; it is often used to expel exterior pathogenic Cold—examples are Ma Huang ( Ephedrae herba)*, Gui Zhi ( Cinnamomi cassiae ramulus) and Xin Yi ( Magnoliae flos). A thick-hot herb possesses a strong hot nature that leads to a strong and steady action; it is used to warm the Interior and treat interior Cold syndrome—examples include Fu Zi ( Aconiti radix lateralis preparata)*, Rou Gui ( Cinnamomi cassiae cortex) and Gan Jiang ( Zingiberis rhizoma). Cold herbs can likewise be divided into thin-cold and thick-cold. A thin-cold herb can gently but quickly disperse and clear Heat in the Upper Jiao or in the superficial level of the body—examples are Bo He ( Menthae herba), Chai Hu ( Bupleuri radix), Sang Ye ( Mori folium) and Ju Hua ( Chrysanthemi flos). A thick-cold herb can strongly clear Heat and reduce Fire—examples include Huang Lian ( Coptidis rhizoma), Huang Qin ( Scutellariae radix), Huang Bai ( Phellodendri cortex) and Long Dan Cao ( Gentianae radix).
2. What are the five tastes of herbs? What are their clinical applications?
The five tastes of herbs are pungent, sour, bitter, salty and sweet. Each herb has at least one taste and most have two or three. Some herbs have no specific taste, and so are considered bland herbs. There are also herbs which have a special aromatic smell; these are called aromatic herbs. Another exception is that there are also some herbs or substances which give an astringent sensation in the mouth, so these are called astringent substances.
Originally, the tastes of herbs were defined directly from the perception in the mouth and stomach. People found that Gan Jiang ( Zingiberis rhizoma) is pungent, Gan Cao ( Glycyrrhizae radix is sweet, Huang Lian ( Coptidis rhizoma) is bitter, Wu Mei ( Mume fructus) is sour, Zhi Mu ( Anemarrhenae rhizoma) is salty, Fu Ling ( Poria) is bland and Long Gu ( Mastodi fossilium ossis) is astringent. In early medical practice, it was also found that a specific taste caused a specific reaction in the body; as medical experience increased, the study of the tastes of herbs changed. As a result, some tastes are ascribed to herbs not according to their perception in the mouth, but to their action in the body. Therefore, the five tastes of herbs no longer simply describe the taste properties of herbs but have also become a part of the theory of herbal medicine and are used to analyze and study herbs.
According to experience from medical practice, each taste possesses specific properties, which can bring about specific actions in the body. The basic actions from the tastes are as follows.
Pungency
A pungent herb has moving and dispersing characteristics, which are able to disperse Wind, Cold, Heat and Dampness and therefore treat corresponding disorders. For instance, Ma Huang ( Ephedrae herba)* can disperse the Lung-Qi, Shi Gao ( Gypsum) is able to disperse Heat from the Lung and the Stomach, Fu Zi ( Aconiti radix lateralis preparata)* can expel Cold from the Kidney, Fang Feng ( Saposhnikoviae radix) is able to expel Wind from the superficial region of the body and Chai Hu ( Bupleuri radix) can lift the Qi from the Liver and Gall Bladder.
Since pungent herbs can move quickly and expel pathogenic factors, they can also promote Qi movement, Blood circulation and water metabolism, open the meridians and reduce stagnation. For instance, Mu Xiang ( Aucklandiae radix)**, Chen Pi ( Citri reticulatae pericarpium), Sha Ren ( Amomi xanthioidis fructus) and Hou Po ( Magnoliae cortex) can promote Qi movement; Chuan Xiong ( Chuanxiong rhizoma), Dang Gui ( Angelicae sinensis radix), Chi Shao Yao ( Paeoniae radix rubra) and Yan Hu Suo ( Corydalidis rhizoma) are able to invigorate the Blood; Di Fu Zi ( Kochiae fructus) and Qin Jiao ( Gentianae macrophyllae radix) can eliminate Dampness; Jiang Can ( Bombyx batrycatus) and Quan Xie ( Scorpio)* can open the meridians.
The moving and dispersing ability of the pungent taste can also break up and eliminate pathological products. Many herbs that are able to break up congealed Blood, reduce food stagnation and dissolve Phlegm are also pungent, such as Mo Yao ( Myrrhae), E Zhu ( Curcumae rhizoma), Lai Fu Zi ( Raphani semen), Bing Lang ( Arecae semen), Ban Xia ( Pinelliae rhizoma) and Xing Ren ( Armeniacae semen).
Sweetness
A sweet herb possesses tonifying qualities. It can tonify and nourish the body, and especially its substantial aspect. Most of the herbs that tonify the Qi, Blood, Yin and Yang are sweet. For example, Ren Shen ( Ginseng radix) and Huang Qi ( Astragali radix) can tonify the Qi; Shu Di Huang ( Rehmanniae radix praeparata) and Da Zao ( Jujubae fructus) can tonify the Blood; Mai Men Dong ( Ophiopogonis radix) can nourish the Yin; Ba Ji Tian ( Morindae radix) and Rou Gui ( Cinnamomi cassiae cortex) can tonify the Yang.
A sweet herb also possesses moderate quality. It can relieve acute stomach ache, abdominal pain or cramping pain of muscles, because sweetness can nourish the Yin of tendons and therefore relaxes the muscles; Zhi Gan Cao ( Glycyrrhizae radix preparata) is a good example in such situations.
The moderate quality gives the sweet taste an ability to reduce stress, harmonize emotions and bring a relief from deep anger, fear or sorrow. Zhi Gan Cao ( Glycyrrhizae radix preparata), Xiang Fu ( Cyperi rhizoma), Bai He ( Lilii bulbus) and Sheng Di Huang ( Rehmanniae radix) are often used for this purpose.
Moreover, sweetness can also reduce the speed of a progressive pathological change, stabilize the condition and give time to restore the body resistance and to recover the function of the internal organs; therefore it can be used in critical situations. For instance, Ren Shen ( Ginseng radix) and Huang Qi ( Astragali radix) can restore the Qi; Zhi Gan Cao ( Glycyrrhizae radix preparata) and Fu Zi ( Aconiti radix lateralis preparata)* used together can rescue the Yang; Zhi Gan Cao ( Glycyrrhizae radix preparata) and Bai Shao Yao ( Paeoniae radix lactiflora) are used together to nourish the Yin.
The moderating nature of the sweet taste can also reduce the side-effects of harsh herbs and moderate the speed of other herbs, turning a harsh and quick action into a steady and constant action. For example, Zhi Gan Cao ( Glycyrrhizae radix preparata) can moderate the cathartic action of Da Huang ( Rhei rhizoma) and Mang Xiao ( Natrii sulfas) to treat constipation; it can moderate the quick action of Fu Zi ( Aconiti radix lateralis preparata)* and Gan Jiang ( Zingiberis rhizoma) to strengthen the Yang.
In addition, a sweet herb is often used to harmonize the herbs whose functions are on different directions and levels in one formula; for example, Zhi Gan Cao ( Glycyrrhizae radix preparata) is used in more than ninety percent of formulas as a harmonizing herb.
Sourness
A sour herb is astringent. It can stabilize the Qi, Blood, Essence and Body Fluids and prevent their leakage in pathological situations. Because it can stabilize the essential substances of the body, it is also considered to have a nourishing function in the body. For example, Wu Wei Zi ( Schisandrae fructus), Shan Zhu Yu ( Corni fructus) and Bai Shao Yao ( Paeoniae radix lactiflora) can stabilize the Body Fluids and treat spontaneous sweating and night sweating; Wu Wei Zi ( Schisandrae fructus) and Wu Bei Zi ( Chinensis galla) are able to stabilize the Lung-Qi to treat severe cough and shortness of breath; Suan Zao Ren ( Ziziphi spinosae semen) can stabilize the Heart-Qi, nourish the Blood and treat palpitations, restlessness and insomnia; Bai Shao Yao ( Paeoniae radix lactiflora) is able to nourish and stabilize the Liver-Yin to treat irritability; Shan Zhu Yu ( Corni fructus) can stabilize the essence of the Kidney and treat poor memory, inability to concentrate and spermatorrhea; Wu Mei ( Mume fructus) can nourish the Stomach-Yin and improve the appetite; Jin Ying Zi ( Rosae laevigatae fructus) and Wu Bei Zi ( Chinensis galla) are able to bind up the intestines and stop diarrhea as well as treat rectal prolapse.
Sour herbs are also considered to have a function of relieving toxicity and reducing swelling. For instance, Wu Mei ( Mume fructus) and vinegar are used to inhibit some parasites, fungi, bacteria and viruses.
Bitterness
A bitter herb possesses drying, reducing and downward-moving capabilities. It can dry Dampness and dissolve Phlegm. For instance, Bai Zhu ( Atractylodis macrocephalae rhizoma) can dry Dampness in the Middle Jiao and strengthen the function of the Spleen; Cang Zhu ( Atractylodis rhizoma) can dry Dampness and relieve heavy sensations in the head and the limbs; Ban Xia ( Pinelliae rhizoma) and Xing Ren (Armeniacae semen) can direct the Lung-Qi to descend, dissolve Phlegm and relieve cough.
Bitterness is very often used to reduce Heat from the internal organs. For instance, Huang Lian ( Coptidis rhizoma) can clear Stomach-Fire and treat Excessive hunger, heartburn and toothache; Zhu Ye ( Bambusae folium) can clear Heat from the Heart and lead it out of the body through the urine; Long Dan Cao ( Gentianae radix) can clear Heat, reduce Fire and dry Dampness from the Liver organ and meridian, and is effective in treating tinnitus, acute eczema and infections of the eyes and ears; Huang Bai ( Phellodendri cortex) can clear Heat from the Kidney and Bladder and therefore treats spermatorrhea and painful urinary dysfunction due to Damp-Heat in the Lower Jiao.
A bitter herb has a downward-moving tendency in its action, and therefore it can be used to direct the Qi and Blood downward in a specific region or in the whole body. For example, Xing Ren ( Armeniacae semen) can direct the Lung-Qi downward; Ban Xia ( Pinelliae rhizoma) can direct the Stomach-Qi downward; Bing Lang ( Arecae semen), Hou Po ( Magnoliae cortex) and Da Huang ( Rhei rhizoma) can direct the Qi in the intestines downward; Chuan Niu Xi ( Cyathulae radix) can direct the Blood downward; San Leng ( Sparganii rhizoma) and E Zhu ( Curcumae rhizoma) can direct congealed Blood downward.
Saltiness
A salty substance possesses softening and reducing qualities. As it can soften hardness, it is often used to treat chronic inflammations as well as masses, such as goiter, scrofula, hepatocirrhosis and tumors. For instance, Xuan Shen ( Scrophulariae radix) is often used for chronic pharyngitis; Mang Xiao ( Natrii sulfas) is used to soften the feces and promote bowel movement; Zhe Bei Mu ( Fritillariae thunbergii bulbus) and Hai Fu Shi ( Pumex) are able to dissolve sticky sputum; Mu Li ( Ostrea concha), Hai Zao ( Sargassum) and Kun Bu ( Eckloniae thallus) are used in treating goiter and scrofula. All of these can be used in formulas to treat tumors.
A salty substance also has a downward-moving tendency in action and it can direct the Qi, Blood and Body Fluids downwards. For instance, Xue Jie ( Daemonoropsis resina) and Su Mu ( Sappan lignum) can disperse and reduce congealed Blood; Xuan Shen ( Scrophulariae radix) can reduce Fire from the Heart and Kidney.
Blandness
A bland substance has the function of promoting urination and leaching out Dampness. For instance, Fu Ling ( Poria), Yi Yi Ren ( Coicis semen), Tong Cao ( Tetrapanacis medulla) and Hua Shi ( Talcum) can treat urinary retention and painful urinary dysfunction; they can also treat edema.
Aromatic herbs
An aromatic herb has similar functions to those of a pungent herb. It possesses moving and dispersing properties. Furthermore, an aromatic herb has a lighter but more remarkable smell, which brings about the function of penetrating the turbidity of Dampness, reviving the Spleen and transforming Dampness. It is especially used in conditions where Dampness accumulates in the Middle Jiao and the Spleen fails to transform and transport Dampness, the Spleen-Qi is not able to ascend and the Stomach-Qi is not able to descend. This pathological change leads to symptoms such as poor appetite, nausea, vomiting, diarrhea and a sticky sensation in the mouth. Huo Xiang ( Agastachis herba), Pei Lan ( Eupatorii herba), Cang Zhu ( Atractylodis rhizoma) and Sha Ren ( Amomi xanthioidis fructus) are the most commonly used aromatic herbs and are used to treat these disorders.
There are other aromatic herbs which can transform the turbidity of Dampness and harmonize the Qi and Blood in certain organs and areas besides the Spleen. For example, Yu Jin ( Curcumae radix), Qing Hao ( Artemisiae annuae herba) and Yin Chen Hao ( Artemisiae scopariae herba) can transform the Dampness from the Liver and Gall Bladder and treat distension in the hypochondriac region, nausea and irritability; Shi Chang Pu ( Acori graminei rhizoma), Su He Xiang ( Styrax) and Bing Pian ( Borneol) can transform Dampness, revive the Heart and open the orifices to treat Closed syndrome; Bo He ( Menthae herba) and Ju Hua ( Chrysanthemi flos) can clear Wind-Heat from the head to treat headache and a heavy and distending sensation of the head and eyes.
Moreover, since aromatic herbs are light and have a moving ability, they are often used to unblock Qi and Blood obstructions and relieve pain. For instance, Su He Xiang ( Styrax), Tan Xiang ( Santali albi lignum) and Sha Ren ( Amomi xanthioidis fructus) can treat severe pain in the chest and are used for angina pectoris; Mu Xiang ( Aucklandiae radix)** and Sha Ren ( Amomi xanthioidis fructus) can treat abdominal pain; Yu Jin ( Curcumae radix), Chuan Xiong ( Chuanxiong rhizoma) and Wu Yao ( Linderae radix) can treat lower abdominal pain due to disorders in the Liver meridian; Qiang Huo ( Notopterygii rhizoma), Chuan Xiong ( Chuanxiong rhizoma) and Bai Zhi ( Angelicae dahuricae radix) can relieve headache; Ru Xiang ( Olibanum) and Mo Yao ( Myrrhae) can treat pain due to Blood stagnation.
Since aromatic herbs can penetrate into the deeper regions of the body to regulate the Qi and Blood, they are also often used topically in herbal plasters, lotions or creams to treat muscular pain. The commonly used aromatic herbs are Chuan Xiong ( Chuanxiong rhizoma), Ru Xiang ( Olibanum), Rou Gui ( Cinnamomi cassiae cortex), Qiang Huo ( Notopterygii rhizoma) and Bo He ( Menthae herba). In addition, aromatic herbs are also often used topically to promote the healing process of wounds, especially the Yin-type ulcers, because the herbs can reach the deep regions of the wound, transform turbidity of Dampness and regulate the Qi and Blood. The commonly used herbs are Ding Xiang ( Caryophylli flos), Ru Xiang ( Olibanum), Chen Xiang ( Aquilariae lignum), Bai Zhi ( Angelicae dahuricae radix) and Bing Pian ( Borneol).
Astringency
An astringent herb or substance has the same characteristics as a sour substance, but no sour taste. It can stabilize the essential substances of the body and prevent the leakage of them in pathological conditions. For instance, Long Gu ( Mastodi fossilium ossis) can stabilize the Heart-Qi and calm the Liver-Yang to treat palpitations, restlessness and insomnia; Mu Li ( Ostrea concha) can stabilize the Body Fluids and treat night sweating; Shi Liu Pi ( Granati pericarpium) and Zao Xin Tu ( Terra flava usta) can bind up the intestines and treat diarrhea; Sang Piao Xiao ( Mantidis oötheca) and Shan Yao ( Dioscoreae rhizoma) can stabilize the Essence, treat spermatorrhea and enuresis.
3. Which characteristics exist in the combinations of the temperature and taste of herbs?
It often happens that there is more than one taste in one herb; combined with its temperature, they bring about the specific functions of the herb. If more tastes and temperature of herbs are combined, the range of applications is extended. The specific combination of temperature and tastes may lead to the following functions.
Pungent-hot herbs can strongly disperse Cold and Dampness, warm the Yang and activate the Qi
Heat can warm Cold and possesses the ability to move; pungency has a moving and dispersing ability, and it may accelerate the action of hot herbs. Therefore a hot-pungent herb can strongly expel Cold and Dampness, warm the Yang and activate the Qi. For instance, Ma Huang ( Ephedrae herba)* can activate the Lung-Qi, and strengthen the dispersing and descending function of the Lung; Fu Zi ( Aconiti radix lateralis preparata)* can warm the Kidney-Yang and Gan Jiang ( Zingiberis rhizoma) can warm the Spleen-Yang and both of them can expel Cold. As Cold may freeze water, a pungent-hot herb can also dissolve Damp-Cold.
Sweet-warm herbs can tonify the essential substances and their function in the body
Sweetness has a tonifying, moderating and harmonizing quality; warmth is the source and essential condition for growth, not only in nature but also in the human body. Therefore a sweet-warm herb can tonify the essential substances of the body as well as strengthening the functions of the internal organs. For instance, Huang Qi ( Astragali radix) and Ren Shen ( Ginseng radix) can tonify the Qi; Shu Di Huang ( Rehmanniae radix praeparata) and Gou Qi Zi ( Lycii fructus) can tonify the Essence and Blood.
Pungent-sweet-warm herbs can generate the Yang and strengthen the functions of the internal organs
Sweetness has a tonifying ability; warmth offers a condition of growth for the essential substances; pungency is able to spread and carry out the action from sweetness and warmth. Therefore, from a sweet-pungent-warm herb the Yang of the body and the functions of the internal organs can be generated. For instance, Dang Gui ( Angelicae sinensis radix) can warm the body, tonify the Blood and promote the Blood circulation; Rou Gui ( Cinnamomi cassiae cortex) and Ba Ji Tian ( Morindae radix) can generate the Kidney-Yang.
Pungent-bitter herbs can disperse and descend the Qi and Blood
Since pungency moves outwards and upwards and bitterness moves downwards, a pungent-bitter herb can move the Qi in two directions simultaneously to activate the Qi movement and Blood circulation as well as water metabolism. For instance, Xing Ren ( Armeniacae semen) can regulate the Lung-Qi to relieve coughing; Ban Xia ( Pinelliae rhizoma) can regulate the Stomach-Qi and treat nausea and poor appetite; Lian Qiao ( Forsythiae fructus) can regulate the Qi in the chest and relieve irritability; Xiang Fu (Cyperi rhizoma) can circulate the Liver-Qi and treat Liver-Qi stagnation; Chi Shao Yao ( Paeoniae radix rubra), Mu Dan Pi ( Moutan cortex) and Yan Hu Suo ( Corydalidis rhizoma) can promote Blood circulation and treat Blood stagnation.
Pungent-bitter-warm herbs can dry Dampness
Bitterness has drying properties, and pungency and warmth can disperse Dampness. Pungent-bitter-warm herbs rather than pungent-hot herbs are often used to dry Dampness, because Dampness is a Yin, sticky pathogenic factor that results in a lingering pathological process and it cannot be removed quickly. The action of pungent-bitter-warm herbs is more steady and constant and is more suitable for this situation than a quickly moving pungent-hot herb. For example, Qiang Huo ( Notopterygii rhizoma) and Cang Zhu ( Atractylodis rhizoma) can expel Wind-Damp-Cold pathogenic factors; Hou Po ( Magnoliae cortex) and Chen Pi ( Citri reticulatae pericarpium) can dry Dampness in the Middle Jiao and transform Phlegm in the Lung as well as promote Qi movement.
Sweet-cold herbs can generate Yin
Since sweetness can tonify the substantial aspect of the body, and Cold can clear Heat and protect the Yin, a sweet-cold herb is able to nourish the Yin of the body and is commonly used for different kinds of Yin deficiency syndromes. For instance, Mai Men Dong ( Ophiopogonis radix) can generate the Heart-Yin and Stomach-Yin; Lu Gen ( Phragmitis rhizoma) and Bai He ( Lilii bulbus) can nourish the Lung-Yin; Yu Zhu ( Polygonati odorati rhizoma) can nourish the Stomach-Yin; Bai Shao Yao ( Paeoniae radix lactiflora) can nourish the Liver-Yin; Sang Shen ( Mori fructus) can nourish the Kidney-Yin.
Sweet-bitter-cold herbs can clear Heat and generate Yin and Body Fluids
Since sweetness has a tonifying ability, and bitterness and Cold can clear Heat and direct it to descend, sweet-bitter-cold herbs can reduce Fire and nourish the Yin. They are used for syndromes of Yin deficiency with Excessive-Heat and when the Heat has consumed the Yin of the body. For instance, Sheng Di Huang ( Rehmanniae radix) can reduce Heat from the Heart, Liver and Kidney and nourish the Yin of the three organs; Tian Men Dong ( Asparagi radix) can reduce Fire from the Lung and Kidney and nourish the Yin there; Sang Ye ( Mori folium) can clear Lung-Heat and moisten the Dryness there; Ju Hua ( Chrysanthemi flos) can clear Liver-Heat, nourish the Yin and brighten the eyes.
Sour-cold herbs can generate and stabilize the Yin
Sourness can hold and stabilize the essential substances of the body and Cold can clear Heat and protect the Yin. A sour-cold substance can thus generate and stabilize the Yin of the body. For instance, Bai Shao Yao ( Paeoniae radix lactiflora) and Han Lian Cao ( Ecliptae herba) are able to clear Heat and nourish and stabilize the Liver-Yin; Tian Hua Fen ( Trichosanthis radix), also called Gua Lou Gen, can clear Heat and nourish the Lung-Yin and Stomach-Yin.
Bitter-cold herbs can clear Heat, reduce Fire and eliminate Damp-Heat
Bitterness and Cold both have a clearing ability and both move downwards; Cold can clear Heat and bitterness enhances this action. Therefore a bitter-cold combination is widely found in herbs that clear Excessive-Heat, reduce Fire, relieve Heat toxicity and drain downward. Since bitterness can dry Dampness and Cold can reduce Heat, a bitter-cold herb can also clear and dry Damp-Heat. Bitter-cold herbs are especially used in situations where strong Excessive-Fire flares up and must be reduced strongly and quickly in order to stop the development of the disease. For instance, Huang Lian ( Coptidis rhizoma), Huang Qin ( Scutellariae radix) and Huang Bai ( Phellodendri cortex) can clear Heat and dry Dampness in the Upper Jiao, Middle Jiao and Lower Jiao respectively; Long Dan Cao ( Gentianae radix) can reduce Liver-Fire and eliminate Damp-Heat from the Liver meridian; Da Huang ( Rhei rhizoma) can reduce Heat and promote bowel movement; Zhi Zi ( Gardeniae fructus) can drain Damp-Heat and promote urination. Bitter-cold herbs are usually not used for a long period of time as they can injure the Yin and Qi, especially that of the Stomach. They strongly suppress Fire downwards, but this action works against the up-flaring nature of Fire and therefore may cause constraint of Fire and lead to the development of a chronic hidden Fire syndrome.
Pungent-cold herbs can disperse and reduce constraint of Fire
Since pungency has a moving and dispersing ability, and Cold can clear Heat, a pungent-cold herb can disperse and clear Heat which is caused by accumulation of Qi, Blood, Dampness or food. Following the nature of Fire, which always flares upwards and outwards, pungency disperses Heat, separates the strength of Heat and Cold, clears Heat and reduces Fire. Pungent-cold herbs can clear Heat completely. For instance, Shi Gao ( Gypsum) can disperse and reduce the Heat from the Lung and Stomach; Ci Shi ( Magnetitum) can disperse Heat from the Heart and direct it to descend; Xia Ku Cao ( Prunellae spica) can disperse and clear Liver-Fire; Lian Qiao ( Forsythiae fructus) can disperse and clear Heat in the chest; Bo He ( Menthae herba) and Man Jing Zi ( Viticis fructus) can clear Heat in the head; Yu Xing Cao ( Houttuyniae herba cum radice) and Bai Jiang Cao ( Patriniae herba) can treat abscesses and relieve Heat toxicity; Mu Dan Pi ( Moutan cortex) and Chi Shao Yao ( Paeoniae radix rubra) can disperse and remove congealed Blood and promote Blood circulation.
Pungent-bitter-cold herbs can clear Heat in a moving state
Pungent-bitter-cold herbs have the strong points of both pungent-cold and bitter-cold herbs, which were analyzed earlier. They are very effective and strong in dispersing and clearing Heat and directing it to descend without the possibility of forming hidden Heat, the side-effect of bitter-cold herbs. For instance, Qian Hu ( Peucedani radix) can clear Lung-Heat; Man Jing Zi ( Viticus fructus) can expel Wind-Heat in the Upper Jiao; Niu Bang Zi ( Arctii fructus) and Ye Ju Hua ( Chrysanthemi indici flos) can reduce swelling and relieve toxicity; Yu Jin ( Curcumae radix) and Yi Mu Cao ( Leonuri herba) can clear Heat in the Blood and promote Blood circulation.
Salty-cold substances can clear heat and soften and eliminate hardness
Since Cold clears Heat and moves downward, and saltiness can soften hardness, salty-cold substances are often used to loosen Phlegm, soften stools and treat tumors. For instance, Hai Ge Ke ( Meretricis/Cyclinae concha) and Hai Fu Shi ( Pumex) can be used for Phlegm-Heat syndromes when the Phlegm is very thick and sticky; Mang Xiao ( Natrii sulfas) is used to soften the stools and treat constipation; Hai Zao ( Sargassum), Xuan Shen ( Scrophulariae radix) and Mu Li ( Ostrea concha) can soften hardness and treat tumors.
4. What are the applications of the concept that herbs enter meridians?
All herbs enter meridians; some enter one, some enter two or three, some even enter all the meridians. According to the meridian-entering concept, each herb works on its specific meridian as well as the organ which it enters. For instance, Ma Huang ( Ephedrae herba)* enters the Lung and Bladder meridians, activates the dispersing function of the Lung-Qi and excites the movement of the Yang-Qi in the Bladder meridian, and therefore expels Wind-Cold in the superficial region of the body; Rou Gui ( Cinnamomi cassiae cortex) enters the Kidney meridian and warms and tonifies the Kidney-Yang; Fu Zi ( Aconiti radix lateralis preparata)* is so hot and pungent that it is able to enter all the meridians and expels Cold there; Zhi Gan Cao ( Glycyrrhizae radix preparata) is sweet and moderate and also enters all the meridians and harmonizes their functions.
In most cases, each herb enters one main meridian and enters other meridians secondarily. For instance, Huang Qi ( Astragali radix) mainly enters the Spleen meridian and enters the Lung meridian secondarily; Shu Di Huang ( Rehmanniae radix praeparata) mainly enters the Kidney meridian and enters the Liver meridian secondarily; Dang Gui ( Angelicae sinensis radix) mainly enters the Liver meridian and enters the Spleen meridian secondarily.
Although most of the herbs enter two or three meridians, their functions focus on only one meridian, through which the other functions are carried out in the secondary meridians. For instance, Huang Qi ( Astragali radix) mainly enters the Spleen meridian, while it secondarily enters the Lung meridian. It can strongly tonify the Spleen-Qi, and strengthen the transportation and transformation function of the Spleen. When the Spleen-Qi is sufficient, it can generate and support the Lung-Qi as well as the Defensive Qi; however, the main function of Huang Qi is to tonify the Spleen. In clinical practice, Huang Qi treats poor appetite, lassitude and loose stools, as well as shortness of breath and a tendency to catch cold from a weak constitution.
In clinical practice, the concept of herbs entering specific meridians is very important for achieving good therapeutic results. Take treating headache as an example, how do you select the appropriate herbs? One method is to choose the herbs that enter the specific meridian which passes through the region of pain. For instance, Chuan Xiong ( Chuanxiong rhizoma) enters the San Jiao (Triple Jiao) and Gall Bladder meridians and is particularly effective for treating headache on the sides of the head; Qiang Huo ( Notopterygii rhizoma) enters the Bladder meridian and is effective for treating pain in the neck and occipital area; Bai Zhi ( Angelicae dahuricae radix) enters the Stomach meridian and is effective for treating pain in the forehead; Wu Zhu Yu ( Evodiae fructus) enters the Liver meridian and treats pain on the top of the head.
Some herbs especially enter one meridian and are used as envoy herbs. For instance, Jie Geng ( Platycodi radix) enters the Lung meridian and is often used as an envoy to guide the other herbs into the Lung; it can also guide the Spleen-Qi upwards so that it enters the Lung to strengthen the Lung-Qi. Another example is Zhi Gan Cao ( Glycyrrhizae radix preparata), which mainly enters the Spleen meridian. Because the Spleen is the source of Qi and Blood, the foundation of life, Zhi Gan Cao ( Glycyrrhizae radix preparata) is considered as an agent that can enter all meridians and tonifies and harmonizes the functions of all the meridians and organs. For the same reason, it often plays a role of harmonizing the function of herbs which enter different meridians in one formula.
5. Do the taste and the color of herbs influence their function? What is the relationship between the taste of herbs and the internal organs, and what is the relationship between their color and the internal organs? What are the clinical applications?
According to the Five Elements theory, the colors and tastes of herbs particularly influence certain internal organs and meridians. This relationship suggests a method of selecting herbs to treat disorders of certain internal organs and meridians. In clinical practice, the therapeutic effects will be better if the combinations of the taste and the color as well as the function of herbs are considered. Furthermore, in this way, the formula is smaller and more efficient because each herb has multiple functions.
Herbs with a sour taste enter the Liver and Gall Bladder. Green in Chinese is called ‘ Qing’ which also links with the Liver. For instance, Shan Zhu Yu ( Corni fructus), Chi Shao Yao ( Paeoniae radix rubra) and Bai Shao Yao ( Paeoniae radix lactiflora) are sour and enter the Liver; Qing Pi ( Citri reticulatae viride pericarpium), Qing Hao ( Artemisiae annuae herba) and Qing Dai ( Indigo naturalis) have a green color and they enter the Liver too.
Herbs with a bitter taste enter the Heart. Red in Chinese is called ‘ Hong’, ‘ Chi’, ‘D an’ or ‘ Zhu’ which link with the Heart. For instance, Huang Lian ( Coptidis rhizoma) and Ku Zhu Ye ( Bambusae amarae folium) are bitter in taste and enter the Heart; Dan Shen ( Salviae miltiorrhizae radix), Chi Shao Yao ( Paeoniae radix rubra) and Hong Hua ( Carthami flos) are red in color and also enter the Heart and promote the Blood circulation.
Herbs with a sweet taste enter the Spleen. For instance, Gan Cao ( Glycyrrhizae radix), Long Yan Rou ( Longanae arillus) and Da Zao ( Jujubae fructus) are sweet and enter the Spleen. Yellow in Chinese is called ‘ Huang’ and it links with the Spleen. The color of many herbs can turn to yellow or brown when they are dry-fried or baked. They are easily digested and accepted by Stomach and Spleen. In this way, it is believed yellow enters the Spleen, such as Zhi Huang Qi (processed Astragali radix), Chao Bai Zhu (dry-fried Atractylodis macrocephalae rhizoma), Jiao Mai Ya (deep dry-fried Hordei fructus germinatus), Jiao Shen Qu (deep dry-fried Massa medicata fermentata) and Jiao Shan Zha (deep dry-fried Crataegi fructus).
Herbs that have a pungent taste enter the Lung. White in Chinese is called ‘ Bai’ and it links with the Lung too. For instance, Ma Huang ( Ephedrae herba)*, Bo He ( Menthae herba) and Sheng Jiang ( Zingiberis rhizoma recens) are pungent and enter the Lung meridian; Shi Gao ( Gypsum), Chuan Bei Mu ( Fritillariae cirrhosae bulbus), Yu Zhu ( Polygonati odorati rhizoma) and Yin Er ( Tremellae) are white in color and also enter the Lung.
Herbs with a salty taste enter the Kidney. Black in Chinese is called ‘ Hei’, ‘ Xuan’ or ‘ Wu’ which links with the Kidney too. For instance, Rou Cong Rong ( Cistanchis herba)** and Xuan Shen ( Scrophulariae radix) are salty and enter the Kidney; Xuan Shen is also black in color, as is Hei Zhi Ma ( Sesami semen nigricum) which enters the Kidney too.
It must be mentioned, however, that it is not always true that the five kinds of color of herbs must enter the correspondent organs. For instance, Huang Qin ( Scutellariae radix) enters the Lung, Huang Lian ( Coptidis rhizoma) enters the Heart, and Huang Bai ( Phellodendri cortex) and Sheng Di Huang ( Rehmanniae radix) enter the Kidney although they are all yellow in color.
This consideration of the characteristics of herbs is also applied to clinical practice in other ways. A small amount of herbs or food with a certain taste will benefit the corresponding organ while a large amount of a certain taste will damage the same organ. For instance, sweetness may strengthen the function of the Spleen, but an excess of sweet herbs or food may injure the transportation and transformation function of the Spleen; sourness can soften the Liver, but an excess of sour herbs or food may injure the Liver.
In order to enhance specific functions of herbs or let herbs enter specific meridians, herbs can be processed with vinegar, honey and salt. For instance, Chai Hu ( Bupleuri radix) and Xiang Fu ( Cyperi rhizoma) have a stronger effect in spreading the Liver-Qi after being processed by vinegar; Bai Zhu ( Atractylodis macrocephalae rhizoma), Mai Ya ( Hordei fructus germinatus), Shen Qu ( Massa medicata fermentata) and Shan Zha ( Crataegi fructus) are more effective in promoting digestion after they are dry-fried till they turn brown; Zhi Mu ( Anemarrhenae rhizoma) and Huang Bai ( Phellodendri cortex) are stronger in reducing Empty-Fire in the Kidney after they have been processed by salt.
6. What are the tendencies of action of the herbs in the body and what are the applications?
The tendency of action of a substance refers to the direction of movement of that substance in the body (e.g. upwards, downwards, outwards or inwards). This feature of a herb depends on several of its properties.
First of all, the temperature and the taste of a herb determine its tendency. The warm, hot, pungent and aromatic herbs tend to move upwards and outwards; the cold, cool, bitter, bland and salty herbs tend to move downwards; the sour and astringent herbs move inwards and the sweet herbs stay in their original place.
The tendency of action is also decided by the functions of the herbs. Generally speaking, herbs which tend to move upwards and outwards can be found in relation to functions such as releasing the Exterior, inducing vomiting, expelling Wind and Cold, dispersing Fire and Dampness, spreading the constraint of Qi, opening the orifices, unblocking the meridians and lifting the clear Yang. Herbs that tend to move downwards can be found in relation with functions such as clearing Fire, promoting bowel movement, promoting urination, directing the Liver-Yang or the Lung-Qi to descend, soothing the Stomach-Qi and calming the Spirit, as well as eliminating Phlegm, Blood stasis, food stagnation and parasites.
Another factor that decides the tendency of action is the nature of the herb. Generally speaking, flowers are light and tend to move upwards, whereas mineral substances are heavy and tend to move downwards. There are some exceptions, however; for instance, Xuan Fu Hua ( Inulae flos) can direct the Lung-Qi to descend and eliminate Phlegm, and Shi Gao ( Gypsum) can direct the Lung-Qi to descend and disperse Heat from the Lung.
In addition, processing can change action tendencies. Generally speaking, herbs processed by alcohol move upwards, those processed by ginger juice move outwards, those processed by vinegar move inwards and those processed by salt move downwards.
There are also herbs that move generally about the whole body without a special direction. For instance, Chuan Xiong ( Chuanxiong rhizoma) can invigorate the Blood and promote Blood circulation; it moves in the four directions mentioned above. Xiang Fu ( Cyperi rhizoma) can spread the Liver-Qi and also moves about the whole body.
The tendency of action of herbs is widely used in treatment to regulate Qi movement, Blood circulation and water metabolism, as well as that to eliminate accumulations of Qi, Blood, food, Phlegm and water.
Furthermore, the tendency of action of herbs is used to strengthen the functions of the internal organs and their cooperation. This tendency is especially important in the strategy of herbal combination as demonstrated by the following examples.
Regulating the Lung-Qi, eliminating Phlegm, reducing Fire, and regulating Qi in the Chest
Ma Huang ( Ephedrae herba)* disperses and lifts the Lung-Qi; Xing Ren ( Armeniacae semen) directs the Lung-Qi to descend and transforms Phlegm. They are used together to regulate the Lung-Qi.
Sang Ye ( Mori folium) disperses Wind-Heat; Sang Bai Pi ( Mori cortex) clears Heat and directs the Qi of the Lung to descend. They are used together to expel Wind-Heat from the Lung, bring down the Lung-Qi and relieve wheezing.
Jie Geng ( Platycodi radix) lifts the Lung-Qi and Xing Ren ( Armeniacae semen) directs the Lung-Qi to descend; both can eliminate Phlegm and stop cough. They are used together to regulate the function of the Lung and remove Phlegm.
Xi Xin ( Asari herba)* disperses the Lung-Qi and Wu Wei Zi ( Schisandrae fructus) stabilizes the Lung-Qi. They are used together to relieve Cold-type wheezing.
Ma Huang ( Ephedrae herba) disperses Lung-Qi and disperses Heat from the Lung and Shi Gao ( Gypsum) directs the Lung-Qi to descend and clears Heat from the Lung. They are used together to relieve Heat-type wheezing.
Zhi Zi ( Gardeniae fructus) descends Heat in the chest and Dan Dou Chi ( Sojae semen praeparatum) disperses Heat in the chest. They are used together to treat irritability due to constraint of Qi and Heat in the chest.
Regulating the Qi in the Middle Jiao and promoting digestion
Bai Zhu ( Atractylodis macrocephalae rhizoma) strengthens the Spleen-Qi and promotes transportation and transformation of the Spleen in the Middle Jiao; Zhi Shi ( Aurantii fructus immaturus) directs the Qi to descend in the intestines and removes the accumulation of food, Phlegm and Qi. They are used together to promote digestion.
Huang Lian ( Coptidis rhizoma) descends Stomach-Fire and Sheng Ma ( Cimicifugae rhizoma) disperses Stomach-Fire. They are often used together to treat toothache.
Ban Xia ( Pinelliae rhizoma) disperses stagnation of Stomach-Qi and accumulation of Phlegm; Huang Qin ( Scutellariae radix) clears Heat that is caused by the accumulation in the Stomach. They are used together to regulate the Stomach and effectively treat nausea and poor appetite, especially under stress.
Zhi Ke ( Aurantii fructus) enters the Lung and Stomach meridians, disperses the Qi and opens the chest; Zhi Shi ( Aurantii fructus immaturus) directs the Qi to descend in the intestines. They are used together to treat distension in the chest and abdomen.
Regulating the intestines and promoting bowel movement
Da Huang ( Rhei rhizoma) reduces Heat and purges accumulation in the intestines and Hou Po ( Magnoliae cortex) disperses the Qi and directs it to descend. They are used together to treat constipation.
Da Huang ( Rhei rhizoma) descends the Qi in the intestines and moves stools, and Jie Geng ( Platycodi radix) ascends the Lung-Qi to accelerate the Qi’s downward movement in the Large Intestine. They are used together to treat constipation and distension in the abdomen.
Associating the Heart and Kidney
Huang Lian ( Coptidis rhizoma) reduces Excessive-Heat from the Heart; Rou Gui ( Cinnamomi cassiae cortex) strengthens the Kidney-Yang and warms the vital Fire. They are used together to treat insomnia due to the disharmony of the Heart and Kidney according to the Five Elements theory.
Lifting the Yang and strengthening the Exterior
Huang Qi ( Astragali radix) strengthens and stabilizes the Defensive Qi; Fang Feng ( Saposhnikoviae radix) disperses Wind from the Exterior. They are used together to regulate the opening and closing of the pores, strengthen the body resistance and prevent cold infections.
Regulating the Liver-Qi
Chai Hu ( Bupleuri radix) lifts and disperses the Liver-Qi; Bai Shao Yao ( Paeoniae radix lactiflora) directs Heat downward and stabilizes the Yin of the Liver. They are used together to treat Liver-Qi stagnation.
Dang Gui ( Angelicae sinensis radix) tonifies the Blood and promotes the Blood circulation of the Liver; Bai Shao Yao ( Paeoniae radix lactiflora) nourishes the Blood and stabilizes the Yin of the Liver. They are used together to soften the Liver and treat Liver-Qi stagnation caused by Blood deficiency.
Dispersing and descending the constraint of Qi and Fire
Chai Hu ( Bupleuri radix) lifts and disperses Liver-Qi; Xiang Fu ( Cyperi rhizoma) promotes Liver-Qi movement. They are used together to treat Liver-Qi stagnation.
Chai Hu ( Bupleuri radix) lifts and disperses Liver-Qi; Zhi Ke ( Aurantii fructus) broadens the chest. They are used together to reduce tight sensations in the chest.
Long Dan Cao ( Gentianae radix) strongly descends Heat and drains Fire from the Liver; Chai Hu ( Bupleuri radix) lifts and disperses constrained Fire and Qi in the Liver. They are used for Excessive-Fire in the Liver.
Huang Lian ( Coptidis rhizoma) directs Fire downwards from the Stomach; Sheng Ma ( Cimicifugae rhizoma) lifts and disperses constrained Qi and Fire in the Stomach. They are used together to treat Excessive-Heat in the Stomach.
Shi Gao ( Gypsum) descends Fire from the Spleen and Stomach; Fang Feng ( Saposhnikoviae radix) disperses constrained Heat and Qi. They are used for eliminating hidden Fire in the Spleen.
Subduing the Liver-Yang
Dai Zhe Shi ( Haematitum) and Shi Jue Ming ( Haliotidis concha) direct the Liver-Yang to descend; Qing Hao ( Artemisiae annuae herba) and Mai Ya ( Hordei fructus germinatus) lift constrained Qi from the Middle Jiao. They are used together to harmonize Qi movement in the process of bringing down the Liver-Yang.
Calming the Spirit
Long Gu ( Mastodi fossilium ossis) calms the Heart and Liver; Chai Hu ( Bupleuri radix) lifts the Liver-Qi. They are used together to treat restlessness and insomnia.
Ren Shen ( Ginseng radix) tonifies the Heart-Qi and Wu Wei Zi ( Schisandrae fructus) stabilizes it. They are used together to treat restlessness and palpitations caused by Heart-Qi deficiency.
Harmonizing the Qi and Blood and treating disorders in certain regions of the body
Gui Zhi ( Cinnamomi cassiae ramulus) disperses the Defensive Qi and Bai Shao Yao ( Paeoniae radix lactiflora) nourishes the Nutritive Qi. They are used together to harmonize the Nutritive and Defensive levels.
Qiang Huo ( Notopterygii rhizoma) tends to expel Wind-Damp-Cold from the upper body; Du Huo ( Angelicae pubescentis radix) tends to expel Wind-Damp-Cold from the lower body. They are used together to treat Bi syndrome in the entire body.
There are also situations where special attention should be paid towards the tendency of action. For instance, herbs which move upwards are not suitable for use alone in cases of Liver-Yang rising, such as in hypertension, hot flushes in menopause or in patients with constipation; equally, downward-moving herbs are not suitable for use alone in diarrhea, heavy menstruation and pregnancy.
The tendency of action of herbs can also be used to reduce the side-effects of some herbs. For instance, the sweet Shu Di Huang ( Rehmanniae radix praeparata) is too sticky to be digested, so the pungent Sha Ren ( Amomi xanthioidis fructus) is often used at the same time to remove the stagnation; the hot Fu Zi ( Aconiti radix lateralis preparata)* and the cold Da Huang ( Rhei rhizoma) move too quickly, but the sweet Zhi Gan Cao (honey-fried Glycyrrhizae radix preparata) can moderate their harsh nature and reduce the speed.
7. What are the specific functions of the specific parts of a plant?
The commonly used herbs are usually the roots, leaves, barks, stems, flowers, fruits and seeds of the plants. Sometimes, different parts of plants give specific functions to the herbs. In TCM theory, similes and allegories are used to explain the links between plants and the human body. The details are as follows.
• The peel of fruits and the bark of plants (in Chinese called ‘ Pi’) enter the superficial layer of the human body. For instance, Chen Pi ( Citri reticulatae pericarpium), Sheng Jiang Pi ( Zingiberis rhizoma recens cortex), Da Fu Pi ( Arecae pericarpium), Fu Ling Pi ( Poriae cocos cortex) and Sang Bai Pi ( Mori cortex) can eliminate Dampness in the superficial layer of the body and treat edema.
• The twigs of tree (in Chinese called ‘ Zhi’) enter the limbs and the meridians. For instance, Gui Zhi ( Cinnamomi cassiae ramulus) can warm the meridians, promote the movement of Yang-Qi in the meridians and treat cold limbs; Sang Zhi ( Mori ramulus) can expel Wind-Dampness from the meridians, relax tendons and treat Bi syndrome; Gou Teng ( Uncariae ramulus cum uncis) can reduce Heat from the Liver, extinguish Wind and control convulsions.
• The vines (in Chinese called ‘T eng’) enter the collaterals. For instance, Ji Xue Teng ( Spatholobi caulis et radix) can tonify the Blood, promote the Blood circulation and relieve pain, numbness of the limbs and tingling sensations in the muscles; Ye Jiao Teng ( Polygoni multiflori caulis) can tonify the Blood, relieve uneasy feelings in the body due to Blood deficiency and improve sleep; Hai Feng Teng ( Piperis caulis) and Luo Shi Teng ( Trachelospermi caulis) can expel Wind-Dampness from the collaterals and treat Bi syndrome.
• The sprout enters the Heart and promotes the function of the internal organs. For instance, Lian Zi Xin ( Nelumbinis plumula) clears Heat from the Heart; Mai Ya ( Hordei fructus germinatus) generates and lifts clear Qi of the Spleen and Stomach, thus it can promote digestion.
• Some seeds (in Chinese called ‘ Zi’ or ‘ Ren’) enter the Kidney. For instance, Jiu Cai Zi ( Allii tuberosi semen), Tu Si Zi ( Cuscutae semen), Fu Pen Zi ( Rubi fructus), Yi Zhi Ren ( Alpiniae oxyphyllae fructus) and Sha Yuan Zi ( Astragali complanati semen) can tonify the Kidney-Essence and strengthen the Kidney-Yang.
There are also the following regular patterns.
• Most of the flowers (in Chinese called ‘ Hua’) are light in weight and nature and have an ascending tendency. For instance, Ju Hua ( Chrysanthemi flos) and Mi Meng Hua ( Buddlejae flos) can expel Wind-Heat from the Liver meridian and benefit the vision; He Huan Hua ( Albiziae flos) calms the Mind and disperses constrained Qi in the chest, so is often used for depression; Jin Yin Hua ( Lonicerae flos) can disperse and clear Heat from the Upper Jiao; Hou Po Hua ( Magnoliae officinalis flos) can disperse stagnation of Qi, spread the accumulation of water in the Middle Jiao and promote digestion.
• Many seeds or fruits are heavy in weight and nature and have a descending tendency. For instance, Xing Ren ( Armeniacae semen), Ting Li Zi ( Lepidii/Descurainiae semen) and Su Zi ( Perillae fructus) can direct the Lung-Qi to descend and treat wheezing and cough; Zhi Shi ( Aurantii fructus immaturus), Bing Lang ( Arecae semen) and Sha Ren ( Amomi xanthioidis fructus) can bring down Qi in the Large Intestine and promote bowel movement.
• Many seeds contain lipids and can moisten the intestine and treat constipation. For instance, Huo Ma Ren ( Cannabis semen), Yu Li Ren ( Pruni semen), Xing Ren ( Armeniacae semen), Tao Ren ( Persicae semen) and Hei Zhi Ma ( Sesami semen nigricum) can moisten the intestines and promote bowel movement.
• Mineral substances are heavy in weight and nature and have a descending tendency. For instance, Zhen Zhu Mu ( Concha margaritifera usta) and Ci Shi ( Magnetitum) can calm the Mind; Long Gu ( Mastodi fossilium ossis), Mu Li ( Ostrea concha) and Shi Jue Ming ( Haliotidis concha) can direct the Liver-Yang to descend; Dai Zhe Shi ( Haematitum) can subdue rebellious Stomach-Qi.
This relationship holds not only between humans and plants, but also between human and animal products. For instance, Chan Tui ( Cicadae periostracum) can treat skin disorders; Sang Piao Xiao ( Mantidis oötheca) can tonify the Kidney; worms and snakes are able to unblock the collaterals as they have the habit of drilling holes, for instance Di Long ( Pheretima), Jiang Can ( Bombyx batrycatus), Bai Hua She ( Agkistrodon acutus)* and Wu Shao She ( Zaocys).
8. What are the proper dosages when prescribing herbs?
The exact dosage of each herb is usually given in textbooks of Chinese herbal medicine. Nowadays, herb weights are given in metric units (grams or milligrams) instead of in traditional Chinese weights ( Liang, Qian and Fen). The dosage of a single herb mentioned in books is always the dosage for 1 day. The dosages of the herbs in a formula are more complicated and they are not always for 1 day. In addition, the herbs are weighed according to different systems in different dynasties, so it is important to read the preparation of the formula carefully, as well as possess some knowledge of the classic in which the formula was recorded.
Here we discuss only the dosage of single herbs. To achieve the therapeutic results, it is important not only to choose the proper herbs, but also to use the proper dosage. For a junior practitioner, it is not so easy to remember the dosage of each herb, so it is necessary to find an easy way to memorize them.
Generally speaking, in Chinese texts the common dosage of most crude herbs is about 3–9 grams orally per day, which is divided into two or three portions and used during the course of the day. However, in the West it is generally not practical to prescribe the crude herbs for oral use since it takes too much time every day to prepare the decoction and the smell is not always pleasant. Concentrated herb powders produced in Taiwan and Hong Kong are thus more commonly used. It should be noted that the strength of the concentrated powder is six times stronger than that of the crude herbs, thus the given dosage of most single powdered herbs is 0.5–1.5 grams per day. According to my own experience, however, the correct dosage is generally somewhat lower, at 0.2–0.5 grams.
Although the dosage range of most herbs can be remembered in this way, there are some exceptions. In the exceptions mentioned in the following paragraphs, the dosage of the herbs should be memorized individually.
Poisonous herbs
Some poisonous herbs can be dangerous for patients if they are overdosed. The dosage of these herbs should be remembered by heart. As the toxic dose varies for each individual, the therapeutic range is small and only experienced doctors must prescribe these herbs.
The commonly used poisonous herbs are Fu Zi ( Aconiti radix lateralis preparata)*, Wu Tou ( Aconiti radix)*, Xi Xin ( Asari herba)*, Ma Huang ( Ephedrae herba)*, Yang Jin Hua ( Flos Daturae)*, Lei Gong Teng ( Tripterygii wilfordii caulis)*, Wu Gong ( Scolopendra)*, Quan Xie ( Scorpio)*, Bai Hua She ( Agkistrodon acutus)*, Mang Chong ( Tabanus)*, Zhe Chong ( Eupolyphaga seu opisthoplatia)*, Nao Yang Hua ( Rhododendron molle flos)*, Tian Xian Zi ( Hyoscyamus niger semen)*, Shan Dou Gen ( Sophorae tonkinensis radix)*, Sheng Ban Xia ( Pinelliae rhizoma), Tian Nan Xing ( Arisaematis rhizoma), Bai Fu Zi ( Typhonii rhizoma praeparatum)*, Wei Ling Xian ( Clematidis radix), Xian Mao ( Curculinginis rhizoma), Cang Er Zi ( Xanthii fructus), Wu Zhu Yu ( Evodiae fructus), Hua Jiao ( Zanthoxyli fructus) and Yuan Zhi ( Polygalae radix).
Poisonous substances that are used for special pathological situations, but are not often used, are Ku Lian Pi ( Meliae cortex), He Shi ( Carpesii fructus), Gua Di ( Pedicellus cucumeris), Li Lu ( Veratri nigri radix et rhizoma), Chang Shan ( Dichroae febrifugae radix), Gan Sui ( Euphorbiae kansui radix)*, Da Ji ( Knoxiae radix)*, Yuan Hua ( Genkwa flos)*, Shang Lu ( Phytolaccae radix)*, Qian Niu Zi ( Pharbitidis semen)*, Ba Dou ( Crotonis fructus)* and Zhu Sha ( Cinnabaris)*
Minerals
Mineral substances can be used at 30 grams per day in traditional decoctions. These include Shi Gao ( Gypsum), Ci Shi ( Magnetitum), Long Gu ( Mastodi fossilium ossis), Mu Li ( Ostrea concha), Zhen Zhu Mu ( Concha margaritifera usta), Shi Jue Ming ( Haliotidis concha) and Wa Leng Zi ( Arcae concha). If the concentrated powder is prescribed, the dosage should be about 1–2 grams.
Light herbs
Herbs that are light in weight should be used in a lower dosage: 0.5–3 grams for crude herbs and 0.1–0.5 grams for concentrated powder, such as Tong Cao ( Tetrapanacis medulla), Deng Xin Cao ( Junci medulla), Ma Bo ( Lasiosphaera) and Chan Tui ( Cicadae periostracum).
The dosage of single herbs can be varied within the normal dosage range in the following conditions:
• Bland herbs, which promote urination and leach out Dampness, can be used in relatively large dosage; these include Fu Ling ( Poria), Yi Yi Ren ( Coicis semen), Che Qian Zi ( Plantaginis semen) and Hua Shi ( Talcum).
• Tonifying herbs can be used in relatively large dosage; these include Huang Qi ( Astragali radix), Shu Di Huang ( Rehmanniae radix praeparata), Mai Men Dong ( Ophiopogonis radix) and Bai He ( Lilii bulbus).
• Herbs that are used alone should be in relatively large dosage, whereas in a formula the dosage should be smaller. For instance, Pu Gong Ying ( Taraxaci herba) can be used by itself at 15 grams per day to treat carbuncle, but at only 6 grams in a formula with other herbs for treating carbuncle.
• The dosage should be varied according to the constitution and the age of the patient. For acute diseases, if the patient is young, or the constitution is quite good, the dosage of the herbs that expel exogenous pathogenic factors should be large. For chronic diseases, or if the patient is old and weak, the dosage of the herbs that expel the pathogenic factors should be smaller. The tonifying herbs should be started with a smaller dosage, then the dosage should be increased gradually because their cloying nature may cause indigestion.
• The dosage should be varied during the course of treatment. For acute diseases, or in the active stage of chronic diseases, the dosage should be high. When the situation is under control, the dosage should be reduced. Herbs that open the orifices, or induce sweating, diarrhea or vomiting, are used only once. Afterwards, the dosage must be adjusted according to the condition of the patient.
There are also herbs that should not be used at a high dosage for more than 4 weeks. These include herbs that disperse the Lung-Qi, disperse Wind, Cold and Dampness, strongly reduce Heat-toxin, drain downward, break up Qi stagnation, remove congealed Blood, remove food stagnation, calm the Mind and subdue the Liver-Yang. These herbs are usually used to treat asthma, rheumatic or rheumatoid arthritis, acute infections, tumors, emotional disturbance, insomnia or hot flushes and night sweats in menopause. In chronic disease, after intensive treatment for 1–4 weeks, these herbs should be used in a lower dosage to keep the condition stable; meanwhile, herbs that tonify or harmonize the functions of internal organs should be used if necessary. The intensive treatment can be repeated according to the disease and the condition of the patient.
Some gentle tonifying herbs can be used for months or even years in low dosage for the purpose of keeping the condition stable, strengthening the body resistance or maintaining good health. In this case, if the treatment course is long, it is better to have breaks. The best time for the break is summer because Summer-Heat or Damp-Heat may weaken the function of the Spleen and the herbs may place extra burden on the Spleen and cause digestive problems.
• The dosage should also be varied according to season and climate. In summer or in tropical countries, herbs that expel Wind and Cold and disperse the Lung-Qi should not be used in high dosage because the pores are not tightly closed. However, in winter or extremely northerly latitudes, herbs that expel Wind, Cold and Dampness and induce sweating should be used in high dosage.
9. What is the proper dosage for children?
Children have special physiological and pathological characteristics, which are quite different from those of adults. As their internal organs, muscles and bones are delicate and their physiological functions are not fully developed, children become ill more easily than adults, and diseases also develop quickly. However, as the body and the emotions of children are less impaired from chronic diseases, stress and medicine than those of adults, the reaction to herbal treatment is quicker and so children recover sooner from diseases than do adults. Therefore, for children, the treatment course is shorter than for adults and it should be stopped when the pathogenic factors are eliminated.
The dosage for children is varied according to age:
• infants: 1/10 of the adult dosage
• infants–1 year old: 1/6 of the adult dosage
• 1–2 years old: 1/4 of the adult dosage
• 2–4 years old: 1/3 of the adult dosage
• 4–6 years old: 1/2 of the adult dosage
• 6–14 years old: 2/3 of the adult dosage.
10. How is a herbal decoction prepared?
The commonly used form of Chinese herbal medicine is the decoction. The preparation of the decoction directly influences the therapeutic result. In the traditional way, the herbal decoction should be prepared every day during the treatment course. The procedure is as follows.
1. Put the dry, crude herbs in an earthenware or stainless steel pot, pour cold water in the pot until the water is 3–4 cm above the herbs, and let the dry, crude herbs soak in the water for at least 1 hour.
2. Afterwards, place the pot on the fire, heating with a strong flame. When the liquid is boiling, turn the heat down to gentle, cook the herbs for 20 minutes and then strain the decoction from the pot. (Note, however, that herbs that expel Wind-Cold or Wind-Heat should be cooked for 10 minutes less and tonifying herbs should be cooked for 10 minutes longer each time.)
3. Pour another 200 ml of cold water onto the herbs in the pot and cook for a further 20 minutes, strain this decoction and then mix the two decoctions together; the total liquid should be about 200–250 ml.
4. Finally, divide the decoction into two or three portions, and drink each portion warmed over the course of the day in two or three lots.
Because some herbs have different qualities, there are also some special procedures for preparation.
Decocting first
Some substances are heavy and do not easily release the inactive ingredients into the decoction; these should be cooked for 30 minutes before adding the other herbs. Most are mineral substances, such as Ci Shi ( Magnetitum), Long Gu ( Mastodi fossilium ossis), Mu Li ( Ostrea concha), Shi Jue Ming ( Haliotidis concha) and Shi Gao ( Gypsum). Some toxic herbs should also be cooked longer to reduce their toxicity—for instance Fu Zi ( Aconiti radix lateralis preparata)* and Wu Tou ( Aconiti radix)*.
Decocting later
Some aromatic or pungent herbs have active ingredients that will be destroyed by long cooking and these should be added to the pot 5 minutes before the end of cooking. Examples are Bo He ( Menthae herba), Qing Hao ( Artemisiae annuae herba), Huo Xiang ( Agastachis herba) and Xiang Ru ( Moslae herba). Also, in order to increase certain actions, some herbs are cooked for less time than normal. For instance, Da Huang ( Rhei rhizoma) can be cooked for a shorter time to increase its purgative action.
Some rare, expensive herbs, such as Ren Shen ( Ginseng radix) should be prepared separately
Herbs that are traditionally used in powder form should be added to the prepared decoction without cooking; an example is San Qi ( Notoginseng radix) powder. Gels and syrups such as E Jiao ( Asini corii colla), Yi Tang ( Maltose) and honey, as well as egg yolks, should also be dissolved in the prepared decoction without cooking.
11. What is the usual way to take herbal medicine?
The patient should pay attention to the method of taking herbal medicine to ensure the therapeutic result.
Herbal medicine should always be taken warm. If the herbal medicine is a decoction it should be taken when warm; herbal medicines that expel Wind-Cold are better taken hot. If the medicine is a concentrated herbal powder, it should be dissolved in boiling water and taken after it has cooled a little. Pills, tablets or capsules should be taken with warm water. There are some exceptions, however, such as if the patient suffers from an Excessive-Heat syndrome, in which the Heat is so strong that the person cannot tolerate warm drinks and the reaction to drinking warm decoctions is vomiting. In this condition, herbal medicine can be used when it is cool.
Another situation is when a patient has a Cold syndrome and cannot tolerate herbs that are warm in nature because of the obvious conflicts between the natures; then the decoction can be taken when it is cool.
The timing of taking herbal medicine is also varied according to the disease and the condition of the patient. Usually, the medicines are taken 1 hour before or after the meal on a rather empty stomach because then the body can absorb the herbs properly. There are some exceptions, though. Tonifying herbs are better taken 1 hour before a meal; medicines which promote digestion and strengthen the Stomach, or herbs that irritate the Stomach, should be taken directly after the meal; medicines which drain downwards or eliminate parasites should be taken in the morning on an empty stomach; herbs which calm the Mind and improve sleep should be taken before the patient goes to bed; herbs which control the attack of diseases such as asthma and malaria should be used 1 to 2 hours before the attack.
12. How should children be given herbal medicine?
As herbal medicine is administrated in rather small dosage and the diet of children is often simple compared with that of an adult, the method of giving herbal medicine to children also differs from that for adults.
For infants, the herbal powder can be tipped on the nipple while the baby is breast feeding or bottle feeding.
For children under 5 years, the herbal powder can be given mixed with milk, yogurt, lemonade or water. There is no strict time regulation of taking medicine between the meals, but the frequency is the same as in adults. If the herbal medicine is a pill or tablet, it should be first dissolved in a little water. For children under 5 years of age, it is forbidden to prescribe pills, tablets or capsules because children of this age cannot swallow them properly, especially when they are nervous, ill or reluctant to take the medicine.
For children older than 5 years, the method of taking the medicine is somewhere in between the usual method for adults and that for smaller children because they can understand why they should take the medicine and so can cooperate better.
Of course, herbs prescribed for children should not be too strong in taste or smell. After the herbs are taken, favorite drinks can then be given as refreshment.
13. What are the contraindications and cautions when using Chinese herbal medicine?
In order to ensure the therapeutic effects of Chinese herbal medicine and the safety of the patients, it is important to know the contraindications of using Chinese herbal medicine so as to avoid mistakes and accidents.
The contraindications of Chinese herbal medicine can be divided into contraindications of particular syndromes, caution about herb combinations, caution during pregnancy and caution about diet.
Contraindications of particular syndromes
• When treating Cold syndromes, herbs with a cold nature should not be used; equally, hot herbs should not be used in Heat syndromes. When the Qi, Yang or Fire and Wind are ascending in a pathological condition (e.g. in hypertension), herbs that move upwards and outwards should not be used; if the Qi and Yang are sinking (e.g. in diarrhea), herbs that move downwards should not be used. However, these contraindications apply only to the use of single herbs; they may be used in certain herb combinations, or formulas in some conditions. For instance, Ma Huang ( Ephedrae herba)* is a pungent and hot herb, it can strongly disperse the Lung-Qi, expel Wind-Cold and is able to treat Exterior syndrome and asthma. It is forbidden to use it in patients suffering from Wind-Heat syndrome; it is also forbidden to be used alone for patients with shortness of breath due to Heat in the Lung so the Lung-Qi is not able to descend (e.g. in asthma, asthmatic bronchitis or pneumonia). However, in the latter condition it can be used with Shi Gao ( Gypsum), which is cold and able to direct the Lung-Qi to descend and clear the Heat. In this case, the two substances are used in a ratio of 1 (Ma Huang) to 4 (Shi Gao), so overall the combination has a cooling and descending action.
• If there is an Exterior syndrome then sweet, cloying, tonifying herbs and sour or astringent herbs should not be used because they will keep the pathogenic factors in the body and reduce the strength of the herbs that expel the exogenous pathogenic factors. This mistake is called ‘closing the door and keeping your enemy in’. This contraindication applies to single herbs as well as to the main actions of herbal combinations. If the body resistance of the patient is too weak, a small amount of herbs that strengthen the body resistance and tonify the Qi can be used in combination with a larger amount of herbs that expel the exogenous pathogenic factors, in order to assist the herbs that expel exogenous pathogenic factors.
• If the patient sweats easily during the course of an Exterior syndrome, this suggests that the pores are open at that moment, therefore herbs that induce sweating and expel exogenous pathogenic factors should not be used at that time because they are too strong and may cause overdispersion of the Qi and Body Fluids. For instance, if a patient with asthma catches a cold and the asthma is worsening and also the patient’s Defensive Qi is weak, although the syndrome is caused directly by Wind-Cold the patient may sweat and feel dry in the mouth, so Ma Huang ( Ephedrae herba) cannot be used alone in this condition. However, it can be used with Shi Gao ( Gypsum) but the dosage of Shi Gao must be much higher than that of Ma Huang.
• Before tonifying herbs and astringent herbs are applied, the body should be comparatively clean; that is, there should be no accumulations of Phlegm, water, food, Fire, Qi and Blood, because most of the sweet tonifying and the astringent or sour herbs may retain the pathogenic factors in the body and complicate the syndrome. The correct procedure is first to remove pathogenic factors, and especially the substantial pathogenic factors, and then start treatment with tonifying herbs. There are some exceptions, however. If accumulations are caused by deficiency of Qi, Blood, Yin or Yang, it is impossible to remove these pathogenic factors completely at first. In this case, tonifying herbs should be added in combination with the reducing herbs. The ratio between the two sorts of herbs must also be varied depending on the change of strength in the pathogenic factors and the person’s resistance.
• If the Stomach of the patient is weak or sensitive, then harsh herbs should not be chosen, such as very hot or very cold herbs or herbs with strong tastes. In TCM, the Stomach and Spleen are regarded as the foundation of life, not only in physiology but also in pathology. ‘If there is only one percent Stomach-Qi, there is still one percent chance of recovery of the patient’ is a saying found in many classics. Restoring the Stomach to a good condition is considered as the first step in achieving different therapeutic results. In other words, protecting and strengthening the transportation and transformation functions of the Stomach and Spleen will allow the herbs to be absorbed by the body.
Cautions about herb combinations
There are three groups of herbs that are forbidden to be used together, otherwise toxicity and side-effects may occur.
1. Gan Cao ( Glycyrrhizae radix) may not be used with Gan Sui ( Euphorbiae kansui radix)*, 
( Knoxiae radix)*, Yuan Hua ( Genkwa flos)* or Hai Zao ( Sargassum).
( Knoxiae radix)*, Yuan Hua ( Genkwa flos)* or Hai Zao ( Sargassum).2. Wu Tou ( Aconiti radix)* may not be used with Chuan Bei Mu ( Fritillariae cirrhosae bulbus), Zhe Bei Mu ( Fritillariae thunbergii bulbus), Gua Lou ( Trichosanthis fructus), Ban Xia ( Pinelliae rhizoma), Bai Lian ( Ampelopsitis radix) or Bai Ji ( Bletillae tuber).
3. Li Lu ( Veratri nigri radix et rhizoma) may not be used with Ren Shen ( Ginseng radix), Bei Sha Shen ( Glehniae radix), Nan Sha Shen ( Adenophorae radix), Ku Shen ( Sophorae flavescentis radix), Xuan Shen ( Scrophulariae radix), Dan Shen ( Salviae miltiorrhizae radix), Xi Xin ( Asari herba)*, Bai Shao Yao ( Paeoniae radix lactiflora) or Chi Shao Yao ( Paeoniae radix rubra).
As Gan Cao ( Glycyrrhizae radix) and Wu Tou ( Aconiti radix)* are very commonly used, the first two groups of the herbs should be learnt by heart.
There are also nine pairs of herbs that are traditionally forbidden to be used together. It is believed that such combination can minimize or even neutralize the therapeutic effects:
• Liu Huang ( Sulfur)* antagonizes Po Xiao ( Glauberis sal)
• Shui Yin ( Hydrargyrum)* antagonizes Pi Shuang ( Arsenicum)*
• Lang Du ( Euphorbiae fischerianae radix)* antagonizes Mi Tuo Seng ( Lithargyrum)*
• Ba Dou ( Crotonis fructus)* antagonizes Qian Niu Zi ( Pharbitidis semen)*
• Wu Tou ( Aconiti radix)* antagonizes Xi Jiao ( Rhinoceri cornu)**
• Ya Xiao ( Nitrum) antagonizes San Leng ( Sparganii rhizoma)
• Ding Xiang ( Caryophylli flos) antagonizes Yu Jin ( Curcumae radix)
• Ren Shen ( Ginseng radix) antagonizes Wu Ling Zhi ( Trogopterori faeces)
• Rou Gui ( Cinnamomi cassiae cortex) antagonizes Chi Shi Zhi ( Halloysitum rubrum).
Among these nine pairs, the first five are rarely used in clinical practice because their functions are so different that they can hardly be combined to treat one syndrome and some of them are very poisonous so they are also hardly used nowadays. However, the last four pairs would possibly be combined to treat one syndrome, so these must be memorized by heart.
Cautions during pregnancy
During pregnancy, herbs can influence physiological changes in both the pregnant woman and the fetus, especially during the first 3 months. Generally speaking, it is better to keep the pregnancy as natural as possible, and try to avoid all kinds of treatment if they are not really necessary at that moment. According to the strength and characteristics of the herbs, there are some herbs which are forbidden to be used during pregnancy and others that should be used with caution.
Herbs that are forbidden include poisonous or harsh herbs which are used for breaking up congealed Blood and draining downwards, such as Ba Dou ( Crotonis fructus)*, Qian Niu Zi ( Pharbitidis semen)*, 
( Knoxiae radix)*, Shang Lu ( Phytolaccae radix)*, Ban Mao ( Mylabris)*, She Xiang ( Moschus)**, San Leng ( Sparganii rhizoma), E Zhu ( Curcumae rhizoma), Mang Chong ( Tabanus)* and Shui Zhi ( Hirudo).
( Knoxiae radix)*, Shang Lu ( Phytolaccae radix)*, Ban Mao ( Mylabris)*, She Xiang ( Moschus)**, San Leng ( Sparganii rhizoma), E Zhu ( Curcumae rhizoma), Mang Chong ( Tabanus)* and Shui Zhi ( Hirudo).If it is really necessary, some herbs can be used during the pregnancy, such as in conditions of tumor, bleeding due to stagnation of Blood, severe deficiency of Qi and Blood and severe internal coldness, where if the pathological situation is not treated it may injure the woman and the fetus; however, the dosage and treatment course must both be controlled carefully. Herbs that are to be used with caution include all the substances that promote Qi movement and Blood circulation, especially in the Lower Jiao, and herbs that remove the obstruction of food and Phlegm, promote bowel movement and promote urination and have pungent or lubricating properties; examples include Tao Ren ( Persicae semen), Hong Hua ( Carthami flos), Da Huang ( Rhei rhizoma), Zhi Shi ( Aurantii fructus immaturus), Fu Zi ( Aconiti radix lateralis preparata)*, Gan Jiang ( Zingiberis rhizoma), Rou Gui ( Cinnamomi cassiae cortex), Dong Kui Zi ( Malvae semen), Hua Shi ( Talcum), Fu Ling ( Poria) and Ze Xie ( Alismatis rhizoma).
Cautions about diet
Caution about diet means, on the one hand, that certain kinds of food should not be taken in certain syndromes or diseases and, on the other hand, that certain kinds of food should not be taken when certain herbs are used.
Generally speaking, during herbal treatment, all cold, raw, heavy and spicy food should be avoided. It is wise to suggest that patients drink light tea instead of coffee, do not take fresh drinks and fruits directly from the refrigerator, and eat lightly cooked vegetables rather than salads.
If heavy food is eaten, it is better to take some tea or orange juice afterwards to remove the fat, or to take semiskimmed milk and to take less candy, sugar, chocolate and alcohol.
For Cold syndromes, raw and cold food should be avoided; for Heat syndromes or syndromes of Liver-Yang rising, spicy and heavy food, coffee and alcohol should be avoided. For syndromes of Damp-Phlegm or Damp-Heat accumulation, sweet, heavy food, milk products, nuts and alcohol should be avoided. For skin disorders or wounds characterized by itching, weeping and redness, seafood, spicy food and alcohol should be avoided.
For some herbs mentioned in the classics, certain foods are contraindicated. For all of the substances that tonify the Blood, strong tea should be avoided. Dan Shen ( Salviae miltiorrhizae radix) and Fu Ling ( Poria) are contraindicated with vinegar; Sheng Di Huang ( Rehmanniae radix), Shu Di Huang ( Rehmanniae radix praeparata) and He Shou Wu ( Polygoni multiflori radix) are contraindicated with onion, garlic and radish; Gan Cao ( Glycyrrhizae radix), Huang Lian ( Coptidis rhizoma), Jie Geng ( Platycodi radix) and Wu Mei ( Mume fructus) are contraindicated with pork; Tu Fu Ling ( Smilacis glabrae rhizoma) and Shi Jun Zi ( Quisqualis fructus) are contraindicated with tea; Chang Shan ( Dichroae febrifugae radix) is contraindicated with onion.
14. Which herbs can be used as substitutes for substances that are banned or unavailable?
Traditional Chinese herbal medicine has a long history, which dates back 5000 years to the beginning of the Chinese civilization. It is the result of people’s effort to utilize nature for survival and is developed on the basis of long-term observation, study and practice under the guidance of ancient philosophy.
However, as the relationship between humans and nature has changed with time, some ingredients in TCM have become unavailable or protected and banned by legislation. Traditional herbal medicine must accommodate such change. Beside the usage of cultivated herbs and synthetic ingredients in the clinical practice, one can also use herbs with similar actions as substitutes. However, one must always bear in mind that, due to the specific function and characteristic of each herb, the therapeutic result of the substituted herb will never be completely the same as the original one.
The suggested substitutes are as follows:
• Xi Jiao ( Rhinoceri cornu)** can be replaced by Shui Niu Jiao ( Bubali cornu). It can be also replaced by Da Qing Ye ( Isatidis folium) and Sheng Ma ( Cimicifugae rhizoma) at a ratio of 10 : 1.
• Hu Gu ( Tigris os)** can be replaced by Qian Nian Jian ( Homalomenae rhizoma) and the bones of cat, pig or ox.
• Ling Yang Jiao ( Antelopis cornu)** can be replaced by Shan Yang Jiao ( Naemorhedis cornu). It can also be replaced by Shi Jue Ming ( Haliotidis concha) and Qing Dai ( Indigo naturalis) with a small amount of Chai Hu ( Bupleuri radix).
• Lu Rong ( Cervi cornu)** can be replaced by the combination of Ba Ji Tian ( Morindae radix) and Rou Gui ( Cinnamomi cassiae cortex). It will also be helpful if venison is included in the patient’s diet.
• Gui Ban ( Testudinis carapax)** can be replaced by the combination of Shu Di Huang ( Rehmanniae radix praeparata) and Shan Zhu Yu ( Corni fructus). Meat and bone-marrow are also recommended in the patient’s diet.
• Bie Jia ( Trionycis carapax)** can be replaced by Shu Di Huang ( Rehmanniae radix praeparata) and Sheng Di Huang ( Rehmanniae radix) with Mu Dan Pi ( Moutan cortex).
• She Xiang ( Moschus)** and Niu Huang ( Bovis calculus)** should be replaced by synthetic ones.
• Tian Ma ( Gastrodiae rhizoma)** can be replaced by Gou Teng ( Uncariae ramulus cum uncis), Man Jing Zi ( Viticis fructus), Ju Hua ( Chrysanthemi flos) or Bai Ji Li ( Tribuli fructus) to pacify the Liver and extinguish Liver-Wind, or combined with Xia Ku Cao ( Prunellae spica), Di Long ( Pheretima) and Jiang Can ( Bombyx batrycatus) to eliminate Wind-Phlegm.
• Shi Hu ( Dendrobii caulis)** can be replaced by the combination of Sheng Di Huang ( Rehmanniae radix) and Shu Di Huang ( Rehmanniae radix praeparata).
• Gou Ji ( Cibotii rhizoma)** can be replaced by Gu Sui Bu ( Drynariae rhizoma).
• Bai Ji ( Bletillae tuber)** can be replaced by Zi Zhu Cao ( Callicarpae folium).
• Guang Mu Xiang ( Aucklandiae radix)** can be replaced by Chuan Mu Xiang ( Vladimirae radix), Qing Pi ( Citri reticulatae viride pericarpium) or Sha Ren ( Amomi xanthioidis fructus).
• Hou Po ( Magnoliae cortex) can be replaced by Zi Su Geng ( Perillae caulis et flos) and Chuan Mu Xiang ( Vladimirae radix) to regulate Qi and reduce distension. To direct Qi downward and remove dampness and food stagnation it can be replaced by Cang Zhu ( Atractylodis rhizoma), Zhi Shi ( Aurantii fructus immaturus) and Ban Xia ( Pinelliae rhizoma).
• The use of Zhu Sha ( Cinnabaris)* is forbidden. It can be replaced by Long Chi ( Mastodi fossilia dentis) and Zhen Zhu ( Margarita usta) with Huang Lian ( Coptidis rhizoma) to calm the Mind.
• Guan Mu Tong ( Hocquartiae manshurensis caulis)* is a poisonous herb and its use is forbidden. It should be replaced by Chuan Mu Tong ( Clematidis armandii caulis) with careful control of both the Chinese name and the Latin name, or it can be substituted by Zhi Zi ( Gardeniae fructus) or Tong Cao ( Tetrapanacis medulla) with Huang Lian ( Coptidis rhizoma) or Long Dan Cao ( Gentianae radix).
15. What attention should be paid to some common names of herbs in Traditional Chinese Medicine?
Traditional Chinese herbal medicine has a long history of discovering plants which can be used for medical purposes. The accumulation of the knowledge and experience increases with time. In this development, some plants that have a similar appearance share the same common names. Although there are differentiating names to the plants, people still often use only the common names, which can bring confusion—even danger—in the practice as some of the herbs are toxic. Thus practitioners should pay special attention to the differentiating names and also check the Latin names to ensure that the correct herb is prescribed before applying them in practice. The most commonly used herbs with common names and differentiating names are as follows:
• Chuan Bei Mu ( Fritillariae cirrhosae bulbus) and Zhe Bei Mu ( Fritillariae thunbergii bulbus)
• Chuan Niu Xi ( Cyathulae radix) and Huai Niu Xi ( Achyranthis bidentatae radix)
• Nan Sha Shen ( Adenophorae radix) and Bei Sha Shen ( Glehniae radix)
• Nan Wu Jia Pi ( Acanthopanacis cortex) and Bei Wu Jia Pi ( Periploca sepium bunge)
• Han Fang Ji ( Stephaniae tetrandrae radix) and Mu Fang Ji ( Aristolochiae fangchi radix)*
• Guan Mu Tong ( Aristolochia manshurensis caulis)* and Chuan Mu Tong ( Clematidis armandii caulis)
• Qing Mu Xiang ( Aristolochia debilis)*, Chuan Mu Xiang ( Vladimirae radix), Guang Mu Xiang ( Aucklandiae radix)** and Mu Xiang ( Aucklandiae radix)**.
