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Chinese herbology (simplified Chinese: 中药学; traditional Chinese: 中藥學; pinyin: zhōngyào xué) is the theory of traditional Chinese herbal therapy, which accounts for the majority of treatments in traditional Chinese medicine (TCM). An editorial in Nature stated that TCM is largely pseudoscience, with no valid mechanism of action for the majority of its treatments.[1]
The term herbology is misleading in the sense that, while plant elements are by far the most commonly used substances, animal, human, and mineral products are also utilized. Thus, the term "medicinal" (instead of herb) is usually preferred as a translation for 药 (pinyin: yào).[2]
The effectiveness of traditional Chinese herbal therapy remains poorly documented.[3] There are concerns over a number of potentially toxic Chinese herbs.[4]
Chinese herbs have been used for centuries. Among the earliest literature are lists of prescriptions for specific ailments, exemplified by the manuscript "Recipes for 52 Ailments", found in the Mawangdui tombs which were sealed in 168 BC.
The first traditionally recognized herbalist is Shénnóng (神农, lit. "Divine Farmer"), a mythical god-like figure, who is said to have lived around 2800 BC.[5] He allegedly tasted hundreds of herbs and imparted his knowledge of medicinal and poisonous plants to farmers. His Shénnóng Běn Cǎo Jīng (神农本草经, Shennong's Materia Medica) is considered as the oldest book on Chinese herbal medicine. It classifies 365 species of roots, grass, woods, furs, animals and stones into three categories of herbal medicine:
The original text of Shennong's Materia Medica has been lost; however, there are extant translations.[6] The true date of origin is believed to fall into the late Western Han dynasty[5] (i.e., the first century BC).
The Treatise on Cold Damage Disorders and Miscellaneous Illnesses was collated by Zhang Zhongjing, also sometime at the end of the Han dynasty, between 196 and 220 CE. Focusing on drug prescriptions,[7] it was the first medical work to combine Yinyang and the Five Phases with drug therapy.[8] This formulary was also the earliest Chinese medical text to group symptoms into clinically useful "patterns" (zheng 證) that could serve as targets for therapy. Having gone through numerous changes over time, it now circulates as two distinct books: the Treatise on Cold Damage Disorders and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty.[9]
Succeeding generations augmented these works, as in the Yaoxing Lun (simplified Chinese: 药性论; traditional Chinese: 藥性論; literally "Treatise on the Nature of Medicinal Herbs"), a 7th-century Tang Dynasty Chinese treatise on herbal medicine.
Arguably the most important of these later works is the Compendium of Materia Medica (Bencao Gangmu:本草綱目) compiled during the Ming dynasty by Li Shizhen, which is still used today for consultation and reference.
There are roughly 13,000 medicinals used in China and over 100,000 medicinal recipes recorded in the ancient literature.[10] Plant elements and extracts are by far the most common elements used.[11] In the classic Handbook of Traditional Drugs from 1941, 517 drugs were listed – out of these, only 45 were animal parts, and 30 were minerals.[11] For many plants used as medicinals, detailed instructions have been handed down not only regarding the locations and areas where they grow best, but also regarding the best timing of planting and harvesting them.[12]
Some animal parts used as medicinals can be considered rather strange such as cows' gallstones.[13]
Traditional Chinese Medicine also includes some human parts: the classic
In addition to the above, many other Chinese herbs and other substances are in common use, and these include:
TCM Information: Species: Salvia miltiorrhiza. Pinyin: Dan Shen. Common Name: Salvia Root. Qualities: Bitter, Cool. Meridians: Heart, Pericardium, Liver. Actions: Invigorate blood, tonify blood, regulate menstruation, clear heat and soothe irritability.[122][123][124]
Salvia (丹参) are the deep roots of the Chinese sage plant.
TCM Information: Species: Rheum palmatum, Rheum ranguticum, or Rheum officinale. Pinyin: Da Huang. Common Name: Rhubarb Root and Rhizome. Quality: Bitter, Cold. Meridians: Heart, Large Intestine, Liver, Stomach. Actions: Purge accumulation, cool blood, invigorate blood, drain damp-heat.[119][120][121]
Rhubarb (大黄) is a large root and was once one of the first herbs that was imported from China.
Species: Rehmannia glucinosa. Pinyin: Shu Di Huang. Common Name: Chinese Foxglove Root Prepared with Wine. Qualities: Sweet, Slightly warm. Meridians: Heart, Kidney, Liver. Actions: Tonifies blood, tonifies liver and kidney yin, treats wasting and thirsting disorder, nourishes jing.[116][117][118]
TCM Information: Species: Rehmannia glucinosa. Pinyin: Sheng Di Huang. Common Name: Chinese Foxglove Root. Qualities: Sweet, Bitter, Cold. Meridians: Heart, Kidney, Liver. Actions: Clears heat, cools blood, nourishes yin, generates fluids, treats wasting and thirsting disorder.[114][115]
Rehmannia (地黄) is a root where the dark, moist part of the herb is used.
Species: Paeonia lactiflora or Paeonia veitchii. Pinyin: Chi Shao. Common Name: Red Peony Root. Quality: Sour, Bitter, Cool. Meridians: Liver, Spleen. Actions: Clears heat, cools blood, invigorates blood and dispel stasis to treat irregular menses, dysmenorrhoea, amenorrhea, abdominal pain, and fixed abdominal masses.[112][113]
TCM Information: Species: Paeonia lactiflora. Pinyin: Bai Shao. Common Name: White Peony Root. Quality: Bitter, Sour, Cool. Meridians: Liver, Spleen. Actions: Tonify liver blood, calms liver yang, alleviates flank/abdominal pain from liver qi stagnation or liver and spleen disharmony, preserves yin and adjusts nutritive and protective levels, regulates menses for blood deficiency problem.[109][110][111]
Peony (白芍, 赤芍) comes in two varieties: bai shao (white) and chi shao (red), the root of the plant is used in both varieties.
TCM Information: Species: Ephedra sinica or Ephedra intermedia. Pinyin: Ma Huang. Common Name: Ephedra Stem. Quality: Pungent(Acrid), Slightly Bitter, Warm. Meridians: Lung, Bladder. Actions: Induce sweating and release exterior for wind-cold invasion with no sweating, promotes urination, move lung qi for wheezing, cough or asthma.[106][107][108]
Ephedra (麻黄)
TCM Information:
The use of the licorice plant (甘草) Glycyrrhiza glabra L. is thought to help treat hepatitis, sore throat, and muscle spasms.
Ginger (姜, 薑) is a herb and a spice that is used in Chinese cuisine. There are four main kinds of preparations in Chinese herbology: fresh ginger, dried ginger, roasted ginger, and ginger charcoal, all made of the rhizomes.
TCM Information: Species: Coptis chinensis. Pinyin: Huang Lian. Common Name: Coptis Rhizome. Qualities: Bitter, Cold. Meridians: Heart, Large Intestine, Liver, Stomach. Actions: Clears heat and drains damp, drains fire(especially from heart and stomach), eliminates toxicity.[95][96][97]
Coptis chinensis (黄莲) is a rhizome that is one of the bitterest herbs used in Chinese medicine.
Species: Cinnamomum cassia. Pinyin: Rou Gui. Common Name: Cinnamon Bark. Quality: Pungent (Acrid), Sweet, Hot. Meridians: Heart, Kidney, Liver, Spleen. Actions: Tonifies kidney yang, leads fire back to its source, disperses cold, encourages generation of qi and blood, promotes blood circulation, alleviates pain due to cold, dysmenorrhea.[92][93][94]
TCM Information: Species: Cinnamomum cassia. Pinyin: Gui Zhi. Common Name: Cinnamon Twig. Quality: Pungent (Acrid), Sweet, Warm. Meridians: Heart, Lung, Bladder. Actions: Induce sweating, warms and unblocks channels, unblocks yang qi of the chest, treats dysmenorrhea.[89][90][91]
Studies show that cinnamon reduces serum glucose, triglyceride, LDL cholesterol, and total cholesterol in people with type 2 diabetes, and the findings suggest that the inclusion of cinnamon in the diet of people with type 2 diabetes will reduce risk factors associated with diabetes and cardiovascular diseases.[82][83][84][85][86][87][88]
Cinnamon (桂枝, 肉桂), mostly gui zhi and rou gui, are twigs and bark from large tropical trees.
TCM Information: Species: Bupleurnum chinense. Pinyin: Chai Hu. Common Name: Hare's Ear Root. Quality: Bitter, Pungent(Acrid), Cool. Meridians: Gallbladder, Liver, Pericardium, San Jiao. Actions: Treats alternating chills and fever, clears lesser yang disorders, relieves liver qi stagnation, raises yang qi to treat prolapse, treats certain menstrual disorders.[79][80][81]
the treatment of liver diseases, skin ailments, arthritis, menopausal syndrome, withdrawal from corticosteroid use, nephritis, stress-induced ulcers, and mental disorders.
Bupleurum (柴胡) is believed to be useful for
TCM Information: Species: Atractylodes lancea. Pinyin: Cang Zhu. Common Name: Atractylodes Rhizome. Quality: Pungent(Acrid), Bitter, Warm. Meridians: Spleen, Stomach. Actions: Strong to dry dampness, strengthens the spleen, induce sweating, expel wind-cold, clears damp-heat from lower jiao, improves vision.[76][77][78]
Atractylodes (白术) is believed to be important in the treatment of digestive disorders and problems of moisture accumulation.
TCM Information: Species: Astragalus membranaceus. Pinyin: Huang Qi. Common Name: Astragalus Root, Milkvetch Root. Quality: Sweet, Slightly warm. Meridians: Lung, Spleen. Actions: Raise yang qi to treat prolapse, tonify spleen and lung qi, tonify wei qi, increases urination, promotes drainage of pus, generates flesh.[73][74][75]
Astragalus (黄芪) is a root used for immune deficiencies and allergies.
TCM Information: Species: Angelica sinensis. Pinyin: Dang Gui. Common Name: Chinese Angelica Root. Quality: Sweet, Pungent(Acrid), Warm. Meridians: Liver, Heart, Spleen. Actions: Tonify blood, invigorate blood, regulate menstruation, relieve pain, unblock bowels by moistening intestine.[70][71][72]
Dang Gui (当归, Angelica sinensis or "female ginseng") is an aromatic herb that grows in China, Korea, and Japan.
TCM Information: Species: Lycium barbarum. Pinyin: Gou Qi Zi. Common Name: Chinese Wolfberry. Quality: Sweet, Neutral. Meridians: Liver, Lung, Kidney. Actions: Tonifies kidney and lung yin, tonifies liver blood, tonifies jing, improves vision.[67][68][69]
Wolfberry (枸杞子) is grown in the Far East and is grown from shrubs with long vines. The shrubs are covered with small trumpet-shaped flowers, which turn into small, bright red berries. The berries are usually fresh and sometimes used when dried.
Mushrooms have long been used as a medicinal food and as a tea in Chinese herbology. Clinical, animal, and cellular research has shown some mushrooms may be able to up-regulate aspects of the immune system.[63][64][65][66] Notable mushrooms used in Chinese herbology include Reishi and Shiitake.
Species: Panax quinquefolius. Pinyin: Xi Yang Shen. Common Name: American Ginseng. Quality: Sweet, Slightly bitter, Cold. Meridians: Heart, Kidney, Lung. Actions: Tonifies lung and spleen qi, tonifies lung yin, cools fire from lung yin deficiency, generates fluids.[61][62]
Species: Elutherococcus senticosus. Pinyin: Ci Wu Jia. Common Name: Siberian Ginseng. Quality: Pungent (Acrid), Slightly bitter, Warm. Meridians: Spleen, Heart, Kidney. Actions: Tonifies spleen and kidney, mildly tonifies heart qi, promote blood circulation, calms shen.[59][60]
TCM Information: Species: Panax ginseng. Pinyin: Ren Shen. Common Name: Chinese Ginseng. Quality: Sweet, Bitter, Warm. Meridians: Lung, Spleen, Heart. Actions: Tonifies yuan qi to treat collapse of qi, tonifies spleen and lung, generates fluids, mildly tonifies heart qi.[56][57][58]
The use of ginseng (人参) is well over two thousand years old in Chinese medicine. Ginseng contains ginsenosides. The amount of ginsenosides in ginseng depends on how the plant was cultivated and the age of the root. Wild ginseng is rare and commands the highest prices on the market. Red Panax ginseng is the most popular form of ginseng and it is usually packaged as a liquid or tea. Ginseng comes in two kinds, red and white. The color of the ginseng depends on how it is processed. White ginseng is unprocessed and dries naturally. Red ginseng is processed with steam and is believed to be more effective. Native Americans have used American ginseng for dry coughs, constipation, and fevers.
There are over three hundred herbs that are commonly being used today. Some of the most commonly used herbs are Ginseng (人参, 人參, rénshēn), wolfberry (枸杞子), Dong Quai (Angelica sinensis, 当归, 當歸, dāngguī), astragalus (黄耆, 黃耆, huángqí), atractylodes (白术, 白朮, báizhú), bupleurum (柴胡, cháihú), cinnamon (cinnamon twigs (桂枝, guìzhī) and cinnamon bark (肉桂, ròuguì)), coptis (黄莲, 黃蓮, huánglián), ginger (姜, 薑, jiāng), hoelen (茯苓, fúlíng), licorice (甘草, gāncǎo), ephedra sinica (麻黄, 麻黃, máhuáng), peony (white: 白芍, báisháo and reddish: 赤芍, chìsháo), rehmannia (地黄, 地黃, dìhuáng), rhubarb (大黄, 大黃, dàhuáng), and salvia (丹参, 丹參, dānshēn).
Collecting American ginseng to assist the Asian traditional medicine trade has made ginseng the most harvested wild plant in North America for the last two centuries, which eventually led to a listing on CITES Appendix II.[55]
TCM recognizes bear bile as a medicinal.[53] In 1988, the Chinese Ministry of Health started controlling bile production, which previously used bears killed before winter. Now bears are fitted with a sort of permanent catheter, which is more profitable than killing the bears.[54] More than 12,000 asiatic black bears are held in "bear farms", where they suffer cruel conditions while being held in tiny cages.[53] The catheter leads through a permanent hole in the abdomen directly to the gall bladder, which can cause severe pain. Increased international attention has mostly stopped the use of bile outside of China; gallbladders from butchered cattle (niú dǎn / 牛膽 / 牛胆) are recommended as a substitute for this ingredient.
Parts of endangered species used as TCM drugs include tiger bones[46] and [52]
The traditional practice of using (by now) endangered species is controversial within TCM. Modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text discuss substances derived from endangered species in an appendix, emphasizing alternatives.[45]
Successful results have however been scarce: artemisinin, for example, which is an effective treatment for malaria, was discovered from an herb traditionally used to treat fever.[1] Although advocates have argued that research had missed some key features of TCM, such as the subtle interrelationships between ingredients, it is largely pseudoscience, with no valid mechanism of action for the majority of its treatments.[1]
Regarding Traditional Chinese herbal therapy, only few trials exist that are considered to be of adequate methodology by modern western medical researchers, and its effectiveness therefore is considered poorly documented.[3] A 2012 Cochrane review found no difference in decreased mortality when Chinese herbs were used alongside Western medicine versus Western medicine exclusively.[40] A 2010 Cochrane review found there is not enough robust evidence to support the effectiveness of traditional Chinese medicine herbs to stop the bleeding from haemorrhoids.[41] A 2008 Cochrane review found promising evidence for the use of Chinese herbal medicine in relieving painful menstruation, compared to conventional medicine such as NSAIDs and the oral contraceptive pill, but the findings are of low methodological quality.[42] A 2007 Cochrane review found there is not enough evidence to support or dismiss the use of Chinese medicinal herbs for the treatment of influenza.[43] A 2005 Cochrane review found that although the evidence was weak for the use of any single herb, there was low quality evidence that some Chinese medicinal herbs may be effective for the treatment of acute pancreatitis.[44]
However, many adverse reactions are due misuse or abuse of Chinese medicine.[4] For example, the misuse of the dietary supplement Ephedra (containing ephedrine) can lead to adverse events including gastrointestinal problems as well as sudden death from cardiomyopathy.[4] Products adulterated with pharmaceuticals for weight loss or erectile dysfunction are one of the main concerns.[4] Chinese herbal medicine has been a major cause of acute liver failure in China.[39]
A 2013 review suggested that although the antimalarial herb Artemisia annua may not cause hepatotoxicity, haematotoxicity, or hyperlipidemia, it should be used cautiously during pregnancy due to a potential risk of embryotoxicity at a high dose.[38]
Substances known to be potentially dangerous include aconite,[28] secretions from the Asiatic toad,[33] powdered centipede,[34] the Chinese beetle (Mylabris phalerata, Ban mao),[35] and certain fungi.[36] There are health problems associated with Aristolochia.[4] Toxic effects are also frequent with Aconitum.[4] To avoid its toxic adverse effects Xanthium sibiricum must be processed.[4] Hepatotoxicity has been reported with products containing Polygonum multiflorum, glycyrrhizin, Senecio and Symphytum.[4] The evidence suggests that hepatotoxic herbs also include Dictamnus dasycarpus, Astragalus membranaceous, and Paeonia lactiflora; although there is no evidence that they cause liver damage.[4] Contrary to popular belief, Ganoderma lucidum mushroom extract, as an adjuvant for cancer immunotherapy, appears to have the potential for toxicity.[37]
From the earliest records regarding the use of medicinals to today, the toxicity of certain substances has been described in all Chinese materiae medicae.[27] Since TCM has become more popular in the Western world, there are increasing concerns about the potential toxicity of many traditional Chinese medicinals including plants, animal parts and minerals.[4] For most medicinals, efficacy and toxicity testing are based on traditional knowledge rather than laboratory analysis.[4] The toxicity in some cases could be confirmed by modern research (i.e., in scorpion); in some cases it couldn't (i.e., in Curculigo).[28] Further, ingredients may have different names in different locales or in historical texts, and different preparations may have similar names for the same reason, which can create inconsistencies and confusion in the creation of medicinals,[29] with the possible danger of poisoning.[30][31][32] Edzard Ernst "concluded that adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation."[1] Research suggests that the toxic heavy metals and undeclared drugs found in Chinese herbal medicines might be a serious health issue.[2]
Many herbs indigenous to other countries have been incorporated into the Chinese materia medica. Xi Yang Shen (Radix Panacis Quinquefolii), imported from North American crops, translates as 'western ginseng," while Dong Yang Shen (Radix Ginseng Japonica), grown in and imported from North Asian countries, is 'eastern ginseng.' Similar examples are noted in the text whenever geography matters in herb selection.[26]
Some herbs, like Fang Feng (Radix Saposhnikoviae), literally 'prevent wind," prevents or treats wind-related illnesses. Xu Duan (Radix Dipsaci), literally 'restore the broken,' effectively treats torn soft tissues and broken bones.[26]
Chuan Bei Mu (Bulbus Fritillariae Cirrhosae) and Chuan Niu Xi (Radix Cyathulae) are both found in Sichuan province, as the character "chuan" indicates in their names.[26]
The locations or provinces in which herbs are grown often figure into herb names. For example Bei Sha Shen (Radix Glehniae) is grown and harvested in northern China, whereas Nan Sha Shen (Radix Adenophorae) originated in southern China. And the Chinese words for north and south are respectively "bei" and "nan."[26]
Unique flavors define specific names for some substances. "Gan" means 'sweet,' so Gan Cao (Radix Glycyrrhizae) is 'sweet herb," an adequate description for the licorice root. "Ku" means bitter, thus Ku Shen (Sophorae Flavescentis) translates as 'bitter herb.'[26]
Color is not only a valuable means of identifying herbs, but in many cases also provides information about the therapeutic attributes of the herb. For example, yellow herbs are referred to as 'huang' (yellow) or 'jin' (gold). Huang Bai (Cortex Phellodendri) means 'yellow fir," and Jin Yin Hua (Flos Lonicerae) has the label 'golden silver flower."[26]
Many herbs earn their names from their unique physical appearance. Examples of such names include Niu Xi (Radix Cyathulae seu Achyranthis), "cow's knees," which has big joints that might look like cow knees; Bai Mu Er (Fructificatio Tremellae Fuciformis), white wood ear,' which is white and resembles an ear; Gou Ji (Rhizoma Cibotii), 'dog spine,' which resembles the spine of a dog.[26]
These categories mainly include:
This classification refers not just to the Lung and the Liver channels. The Traditional Chinese concept of the Lungs includes the function of protecting the body from colds, and menthol is thought to cool the Lungs and purge heat toxins caused by wind-heat invasion (one of the patterns of common cold).
The Five Flavors, sometimes also translated as Five Tastes, are: acrid/pungent(辛), sweet(甘), bitter(苦), sour(酸), and salty(咸).[21] Substances may also have more than one flavor, or none (i.e., a bland(淡) flavor).[21] Each of the Five Flavors corresponds to one of the Five Phases:[22] A flavor implies certain properties and therapeutic actions of a substance: saltiness "drains downward and softens hard masses";[21] sweetness is "supplementing, harmonizing, and moistening";[21] pungent substances are thought to induce sweat and act on qi and blood; sourness tends to be astringent(涩) in nature; bitterness "drains heat, purges the bowels, and eliminates dampness".
The Four Natures are: hot(热), warm(温), cool(凉), cold(寒) or neutral(平), in terms of temperature.[21] Hot and warm herbs are used to treat cold diseases, while cool and cold herbs are used to treat heat diseases.[21]
There are several different methods to classify traditional Chinese medicinals:
Chinese herbal extracts are herbal decoctions that have been condensed into a granular or powdered form. Herbal extracts, similar to patent medicines, are easier and more convenient for patients to take. The industry extraction standard is 5:1, meaning for every five pounds of raw materials, one pound of herbal extract is derived.[20]
Several producers of Chinese herbal medicines are pursuing FDA clinical trials to market their products as drugs in U.S. and European markets.[19]
These medicines are not patented in the traditional sense of the word. No one has exclusive rights to the formula. Instead, "patent" refers to the standardization of the formula. In China, all Chinese patent medicines of the same name will have the same proportions of ingredients, and manufactured in accordance with the PRC Pharmacopoeia, which is mandated by law. However, in western countries there may be variations in the proportions of ingredients in patent medicines of the same name, and even different ingredients altogether.
Chinese patent medicines are easy and convenient. They are not easy to customize on a patient-by-patient basis, however. They are often used when a patient's condition is not severe and the medicine can be taken as a long-term treatment.
Chinese patent medicine (traditional Chinese: 中成藥, Simplified Chinese: 中成药, pinyin: zhōngchéng yào) is a kind of traditional Chinese medicine. They are standardized herbal formulas. From ancient times, pills were formed by combining several herbs and other ingredients, which were dried and ground into a powder. They were then mixed with a binder and formed into pills by hand. The binder was traditionally honey. Modern teapills, however, are extracted in stainless steel extractors to create either a water decoction or water-alcohol decoction, depending on the herbs used. They are extracted at a low temperature (below 100 degrees Celsius) to preserve essential ingredients. The extracted liquid is then further condensed, and some raw herb powder from one of the herbal ingredients is mixed in to form an herbal dough. This dough is then machine cut into tiny pieces, a small amount of excipients are added for a smooth and consistent exterior, and they are spun into pills. Teapills are characteristically little round black pills.
Typically, one batch of medicinals is prepared as a decoction of about 9 to 18 substances.[17] Some of these are considered as main herbs, some as ancillary herbs; within the ancillary herbs, up to three categories can be distinguished.[18] Some ingredients are added in order to cancel out toxicity or side-effects of the main ingredients; on top of that, some medicinals require the use of other substances as catalysts.
Each herbal medicine prescription is a cocktail of many substances, usually tailored to the individual patient.
[16][15][14]
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