Chinese herbal medicine – Herbal Reality

The significance of pulse diagnosis in traditional Chinese medicine

Jessika Thiele — Sun, 16 Feb 2025 13:06:57 +0000

Pulse diagnosis and reading form an integral part of the TCM consultation process, facilitating diagnosis and informing herbal formulations.

Now that consultations with Western doctors are often brief, one of the strengths of traditional Chinese medicine (TCM) is the emphasis put on a thorough process of verbal inquiry. Occasionally, that which has been overlooked in a patient’s conventional medical journey can be discovered by purely taking the time to ask questions and listen to the responses.

However, the insight into the body afforded to Western medicine by modern imaging, haematology and biochemical investigations, TCM has lacked in its historical development. Although such diagnostic tests have some role in modern TCM diagnosis today, historically, the direct route to understanding what was happening internally was by feeling the pulse at the radial artery and looking at the tongue. To a lesser extent, other non-verbal examinations included listening to breath sounds and the smelling of characteristic odours. Taken together, inquiry, observation, palpation, as well as listening and smelling (taken as one category) constitute the four diagnostic methods of TCM.

The historical interpretation of the radial pulse

Although tongue diagnosis gained prominence in the later history of TCM, during theMing (1368–1644) and Qing (1644–1912) dynasties, the greatest emphasis has traditionally been on diagnosing through reading the pulse. The earliest mentions of pulse diagnosis are found in the Huangdi Neijing (Yellow Emperor’s Inner Canon), a foundational TCM text dating to around 200 BCE (1). The text describes the pulse as a reflection of qi, blood, and organ function. It established the idea that different parts of the body’s condition could be assessed through palpating the radial pulse.

Wang Shuhe [180–270], a prominent physician of the Jin dynasty, compiled the Mai Jing (Pulse Classic), which remains a cornerstone text on pulse diagnosis (2). The Mai Jing systematically described the locations, methods, and classifications of pulse qualities, of which it distinguished 24, such as full, scattered, deep, and firm. The radial artery on each wrist was divided into three sections and two depths, each reflecting the condition of specific organs. Hence, the 12 pulse positions were thought to represent the 12 organs of Chinese medicine physiology.

Such exact correspondences are rather characteristic of the formation of Chinese medical theory and usually became compromised by historical and practical developments. In the case of pulse diagnosis, the most influential modification was a multi-author text, the Bin Hu Mai Xue (The Lakeside Master’s Study of the Pulse), edited by its final author, Li Shi Zhen, in 1564 (3). Li ShiZhen, who was also the compiler of one of the most important materia medica, the Bencao gangmu (Compendium of Materia Medica) (4), adjusted some of the correspondences of the pulse positions, such that the distal position on both arteries represented the upper part of the body and its organs, and, the middle and proximal represented the middle and lower parts of the body. He also increased the number of pulse qualities to 27, just short of the 28 which are currently found in modern textbooks.

The primacy of pulse qualities

In modern clinical practice, the pulse is given varying significance, largely dependent on individual practitioners. Although, as a generalisation, acupuncturists often pay more attention to the correspondence of pulse positions, whilst herbalists will ignore these or greatly simplify them in favour of an emphasis on the overriding pulse quality.

It must be said that many herbal case histories from China or, indeed, the West make no mention of pulse position. The ambiguous situation has been tactfully expressed in a well-regarded modern Chinese diagnostic text where the author states that in the face of centuries of historical use, the attribution of the six pulses (three on each wrist) “ought not to be easily agreed with nor disagreed with” (5). In my practice for instance, although I may be impressed by a pulse which is felt strongly distally but not proximally, or vice versa, it is the quality of the pulse which guides diagnosis and herbal prescribing.

A consideration of pulse qualities was, up until the early 20th century, not unique to Chinese medicine; William Osler’s The Principles and Practice of Medicine, published in 1892, included detailed descriptions of pulse characteristics such as amplitude, speed, rhythm and force (6). Whilst, in Western medicine, this knowledge has given way to other diagnostic tests, in Chinese medicine the 28 pulse qualities are still applied.

The problem with learning the 28 qualities is that when presented in its full range, and with some of the terminology such as scattered, onion stalk, and soggy, they can appear complicated and mysterious. However, the descriptions, developed over a written history of 2000 years, embody a great strength of Chinese medicine, that of reflecting the practitioner’s fundamental observations. By grouping the pulses, including the more obscure sounding ones, into their most basic categories they can be seen to have a direct resonance with our patients’ being and subsequent treatment. As such, pulse diagnosis reflects a key holistic method.

The basis of pulse diagnosis

The most famous concept of Chinese medicine is that of yin and yang, which is applied to inform the diagnosis of a condition, and then to the differentiation of the herbs used in a prescription. However, this dichotomy informs the basis of deficiency and excess cold and hot; interior and exterior.. These six dichotomies, along with the overarching concepts of yin (too little, cold, interior) and yang (too much, hot and outside) comprise the basis of diagnosis called the eight principles.

All of the 28 pulse qualities fall under these fundamental diagnostic distinctions: a strong pulse indicates a pathogen excess, whilst a weak pulse indicates a lack of physiological substance. A rapid pulse indicates an excess of heat, whilst a slow pulse indicates cold. A floating pulse indicates the recent arrival of the disease to the exterior, or that the qi is directing outward.

Whilst, finally, a deep pulse indicates the disease is in the interior. Herbal treatments are thus prescribed according to these distinctions. Therefore, where the pulse shows signs of an excess of a pathogenic substance, the practitioner will want to use herbs which reduce it by various means. In cases of a weak pulse, the practitioner will seek to supplement or tonify, with cooling or warming herbs, also treating either the exterior or interior.

In current modern practice, feeling the pulse is only one of the diagnostic inputs, and some of these might provide contradictory findings or indicate different locations of disease. The skill and experience of the practitioner is involved in identifying the central issues and this involves applying further theory about fundamental mechanisms.

Pulse qualities and some indicated herbs

A full or excess pulse is firm and forceful at all levels. It can indicate a healthy individual but in disease, it indicates an excess of a pathogen. In a combination of qualities, if a pulse is full and slow, it indicates an excess of cold, or, if it is full and rapid an excess of heat. In the former case, the herbalist might prescribe a heating herb like gan jiang (Zingiber officinale | ginger) which warms the Stomach and Spleen. In the latter case, a more cooling herb like huang lian (Coptis chinensis | Chinese goldthread) would be considered as it clears heat from the Heart and Stomach. In an extreme case, huang lian could be combined with da huang (Rheum palmatum | rhubarb) to purge heat through the bowel.

Ginger (Zingiber officinale)

Variants of a full pulse include the slippery pulse, which is said to be smooth and flowing and indicates an accumulation of phlegm or dampness and, in health, pregnancy. A primary herb for clearing phlegm is ban xia (Pinellia ternata | crow dipper) and this is often used with chen pi (Citri reticulatae | dried tangerine peel).

A full pulse whose forcefulness is expressed through having a very clear definition of its edges is designated as wiry, and described as being like the string of a musical instrument. This pulse indicates that qi has accumulated and, although qi is a physiological substance, it has now become pathogenic in its effect. The accumulation of qi is associated with symptoms caused by the movement of qi to areas where it doesn’t usually reside. These can be physical, like headaches, or emotional, like anger and other stress responses. This is often regarded as a Liver or Gallbladder (in the Chinese sense of these organs) disharmony.

The key herb for such patterns is chai hu, (Bupleurum chinense | chai hu) as well as the core formula on which many others are based: Si Ni San (Four Extremities Powder). This is comprised of chai hu and zhi shi (Aurantii immaturus | bitter orange), which both move the qi, along with bai shao (Paeoniae alba | white peony) and gan cao (Glycyrrhiza glabra | liquorice) which both soothe and harmonise the qi. The formula is so named because when qi is blocked it does not flow to the extremities, which are then often cold despite the body’s core being warm.

A weak or empty pulse is forceless and soft on all levels. It indicates a lack of qi and blood and, if only felt deeply, a lack of yang qi. Variants include the soggy pulse which is weak and floating and indicates a lack of qi accompanied by dampness, and the thready or fine pulse which especially indicates a lack of blood. Key herbs which might be indicated for such patterns include ren shen (Panax ginseng | panax), which strongly supplements the qi, and bai zhu (Atractylodes macrocephala | bai zhu), and fu ling (Poria cocos | poria) which more gently supplements the qi but also removes dampness.

Herbs which supplement the blood include shu di huang (prepared Rehmannia gluttinosa | rehmannia) and dang gui (Angelica sinensis | Chinese angelicai). The generic formula which combines herbs to supplement the qi and blood, and indicated for those with a pulse which is weak and thready, is Ba Zhen Tang, (Eight Precious Decoction). This is composed of ren shen , bai zhu, fu ling, zhi gan cao, shu di huang, dang gui, bai shao, and chuan xiong (Ligusticum chuanxiong | Sichuan lovage root).

Conclusion

The pulse categories of slow, rapid, floating and sunken similarly have a number of variations to account for all the 28 qualities. Each quality points toward key herbs and formulas although, of course, in the end this only forms part of a whole picture. Pulse diagnosis provides part of a pathway through the confounding problem with a holistic diagnosis, which is that there are often many diagnostic signs indicating an unfeasibly large array of indicated herbal treatments. Through assessing the pulse, it provides a foundation for building a picture of the core disharmony.

References

Unschuld, P.U., Tessenow, H. and Zheng, J. (2011) Huang Di Nei Jing Su Wen: An annotated translation of Huang Di’s inner classic – basic questions, 2 volumes, volumes of the Huang Di Nei Jing Su Wen Project. Berkeley: University of California Press.
Two historical accounts of Chinese pulse diagnosis which include mention of the Mai Jing are: Flaws, B. (2012) The Secret of Chinese Pulse Diagnosis. Boulder, CO: Blue Poppy Press; and Buck, C. (2015) Acupuncture and Chinese Medicine: Roots of Modern Practice. London: Singing Dragon.
Li, S. and Flaws, B. (2002) The Lakeside Masters’ Study of the Pulse, Bin Hu Mai Xue. Boulder, Colo: Blue Poppy Press.
Unschuld, P.U., Tessenow, H. and Zheng, J. (2011) Huang Di Nei Jing Su Wen: An annotated translation of Huang Di’s inner classic – basic questions, 2 volumes, volumes of the Huang Di Nei Jing Su Wen Project. Berkeley: University of California Press.
Deng, T. (1999) Practical Diagnosis in Traditional Chinese Medicine. Edited by K. Ergil. Edinburgh: Churchill Livingstone.
Osler, W. (1892) The Principles and Practice of Medicine . London: Young J. Pentland.

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An introduction to herbal energetics

Jessika Thiele — Mon, 11 Mar 2024 17:23:28 +0000

Herbal energetics are the descriptions Herbalists have given to plants, mushrooms, lichens, foods and some minerals based on the direct experience of how they taste, feel and work in the body. All traditional health systems use these principles to explain how the environment we live in and absorb, impacts our health. Unsurprisingly for cultures deeply rooted in Nature, a natural and elemental language is used to describe the tastes, qualities and effects of these plants and ingredients. You might consider that energetics are a way to describe the therapeutic character and personality of a plant.

Traditional healing systems understand that human health is an extension of environmental health and that it is the relationship between the two which health depends upon. Understanding the patterns expressed in our ecosystem and whether it is dry, humid, warm or cold, offers valuable insights into how our human organism might respond in our environment. Understanding how these patterns are expressed in individual plants leads to expertise in herbal energetics. Ultimately, on our co-evolutionary path we have developed complex physiological and psychological systems to understand and benefit from plants.

Deduced by acute sensory observation and the direct experience of generations of practitioners, herbal energetics are the way we describe nature’s natural pharmacology. The character of a plant is often described in terms of the polar opposites of temperature, moisture, direction and texture; hot-cold, wet-dry, up-down, rough-smooth but also including tastes, colour, smell, feeling and sound. The language of energetics is the language of nature, it’s the language we use to describe how we experience life and how it makes us feel. As the Chinese Traditional Inner Classic says ‘Hot diseases must be cooled and cold diseases must be warmed’, so these herbal classifications guide the herbs to be used in a treatment.

This approach to interpreting nature’s pharmacology emphasises the qualitative nature of the plant as opposed to how much of what molecule is in it. However, there are quantitative assessments in terms of strength and hierarchy of some energetics; for example the Galenical classification of ranking extremes of hot or cold in the first, second or third degree. This energetic approach is certainly more macrocosmic than microcosmic, more holistic than reductionist, more vitalistic than chemical, more systemic than cellular. And its just one of the ways that herbalists interpret how to use herbs; herbal energetics are always used in conjunction with the other aspects of knowledge based on the collective insights into specific herbal actions and doses.

We share detail on how Traditional Western, Chinese and Ayurvedic approaches describe the energetics of health. (Whilst broadly in agreement, other Galenic, Eclectic, Physiomedical, Kanpo, Native American and other health traditions contain their own particular insights we have not been able to cover here). The detail can be quite technical and nuanced so a real understanding of energetics must be learnt from a good teacher and directly experienced. It is important to remember that energetic classifications need to be interpreted in the context of the individual’s constitution and presenting patterns, as well as the seasonal climate and the dose. Herbalists always consider ‘who’ is having ‘how much’ of ‘what’ and ‘when’ in order to individualise the theory into practice.

Whilst exploring this world of energetics, experiment for yourself; some plants are hot, heating and lively – just chew some fresh ginger-, and some are much more cooling and calming – sip some chamomile tea. Some plants dry our mouth like a strong cup of black tea and some moisten it by chewing on a few linseeds or a bit of marshmallow root. All sorts of other physiological and emotional responses may be felt at more subtle levels with each herb. This polarity is also seen in concepts of yin-yang in Chinese culture and purusha-prakriti in Indian world views.

The best books on energetics are the original classics of traditional medicine (e.g. Galen, Culpepper, Charaka, Sushruta, Bhavaprakasha, Huang-ti Nei Ching, Shen Nong Bencao, Shang Han lun, Li Shizhen’s Bencao Cangmu).

Some of our favourite modern books on energetics are:

Traditional herbal medicine energetics

The three primary energetic qualities are temperature, tone and moisture. These are used to describe body systems, organs and tissues in the body. They help herbalists understands the patterns of a patient’s condition, so they can prescribe herbs personalised for them and their constitution.

Temperature

Temperature in the context of herbal energetics refers to the heating or cooling effects of herbs and foods.

Warming herbs are typically ‘hot’, ‘spicy’ or ‘pungent’ due to the presence of aromatic oils. Generally these herbs bring ‘warmth’ to the tissues by stimulating circulation and dilating the micro-capillaries thus creating an opening effect within the cardiovascular system that increases blood movement and therefore perfusion to the tissues. Warming herbs are often also diaphoretic- meaning that they stimulate the sweat reflex- this action could be seen as a contradictory as it is essentially ‘cooling’. However, the action of warming herbs remains to increase peripheral circulation and therefore is classified as warming to the body tissues. Some examples include chilli, garlic, horseradish , cinnamon and ginger. The nature of the herbs chosen depends on the affected tissues and unique presentation of the patient.

Horseradish (Amoracia rusticana/Cochlearia armoracia)

In Ayurveda, hot substances are usually used to treat cold, contracted and hypo or sluggish conditions. Beneficial to kapha and vata, it dries damp, phlegm and warms cold. As ‘like increases like’ pungent herbs encourage agni and digestion to function at optimum level. Herbs that are heating usually contain volatile oils or mustard glycosides that stimulate gastric secretions as well as assimilation of nutrients. Heating herbs have a particular affinity for the heart, head, liver and lungs and are commonly used when they are imbalanced but may damage them if used unjudiciously. Pungent, sour and salty herbs tend to be heating. In TCM warming herbs heat the body, stimulates qi and move the blood.

Cooling herbs may be used for conditions that are classified as hot or inflammatory by nature. They work via a number of different actions – some by reducing inflammation, others by detoxifying the blood or lymph or by moderating the function of specific tissues. Diaphoresis is another cooling action of herbs which works by stimulating the sweat reflex and reducing heat in the body through the skin. Examples of cooling herbs include; cleavers or burdock due to their ability to help decrease toxicity and stagnation in the tissues via the lymphatic system. Bitter herbs such as andrographis, dandelion and golden seal root have a systemic cooling effect due to their ability to enhance metabolic function and support liver detoxification which reduces inflammatory heat toxins in circulation around the body. The nature of the herbs chosen depends on the affected tissues and the unique presentation of the patient.

According to Ayurveda cooling herbs benefit pitta whilst aggravating kapha and vata; cold natured herbs soothe painful and inflammatory heat conditions. Digestion is easily damaged by cold natured herbs and should be used cautiously when there is diarrhoea and sluggish digestion from cold. Cold herbs have an affinity for the stomach, the kidneys and the bladder and can weaken them if used excessively. Bitter, astringent and sweet herbs tend to be cooling. In TCM cooling herbs cool the body, remove heat, reduces redness and bleeding. They also consider that they can slow digestion and increase urination.

Moisture

Moisture refers to the drying or moistening effects of herbs that may be astringent or unctuous, heating or cooling, in their qualities.

Drying herbs tend to have astringent or tonic qualities. This means that they pucker the tissues thus increasing their barrier functions. Drying herbs may have diuretic actions which work by increasing the output of fluid from the body. They may also be astringent due to tannin content. Drying herbs are used to help tonify the tissues to reduce excess secretions, phlegm or mucous. Drying herbs may also be used to help in tissue healing particularly where they have become flaccid and lacking in tone. Drying herbs include rose, lady’s mantle, blackberry leaf, raspberry leaf, agrimony and elderflower. Not all drying herbs will be suitable in all cases of moist/ excess fluid type conditions. Tannin rich herbs are also limited to short term use. A herbalist will select a combination of herbs based on the unique circumstances of the patient.

Any plant with a dry quality is naturally astringent, absorbs moisture and therefore reduces damp-kapha and increases dry-vata. They are usually high in tannins and may also be heating as well (as heat dries fluids). Most plants have tannins in but certain barks and fruits are especially astringent. Haritaki (Terminalia chebula) is dry.

Moistening herbs bring a demulcent or soothing effect to inflamed or dry tissues. These herbs may be used where there is irritation due to dryness or lack of productivity in the tissues. Moistening herbs tend to be rich in mucilage (a carbohydrate rich plant substance) that forms a slippery and softening protective layer over the tissues. Sometimes herbs have a moistening effect due to oil content or by their ability to nourish the tissues- others by their ability to deliver or stimulate fluid production in certain tissues. Moistening herbs that are rich in mucilage include herbs such as marshmallow, slippery elm, psyllium and aloe vera. Oily moistening herbs coconut oil and castor oil. Herbs that stimulate the production of fluids may include; fenugreek and maca. These all impact different tissues so the nature of the herbs chosen depends on the affected tissues and unique presentation of the patient.

In Ayurveda these moist herbs are referred to as Unctuous (snigdha). These herbs are soft, demulcent and oily. They are strengthening, increase virility, fertility and kapha. They are usually sweet, heavy and contain a high content of volatile oils, mucilage or essential fatty acids. Hemp seeds (Cannabis sativa) and oil are unctuous.

Tone

Tone refers to how tense or relaxed tissues are. Tone is used to describe the status of the lining of organs called epithelium or to describe the level of integrity of muscles and other tissues. Healthy tone of the tissues or muscles will usually correspond with balanced function of the organs and with a relaxed, and easy composure or stance. Too much tension impedes flow, and flaccidity means that function is at less than optimum. Herbs can affect tone in many different ways. Some herbs are able to increase tone and others are able to relax the tissues where there is excess tension or constriction. Tonics are often confused with toning herbs as ‘toning’ refers to tissue quality whereas ‘tonics’ generally refers to herbs that bring energy and are more like adaptogens.

Catnip (Nepeta cataria)

Relaxing herbs are used when there is too much tension, tightness and constriction. Constriction can be both physically restricting and mentally and emotionally. For example, it can restrict the movement of fluids and blood, as well as creativity. Symptoms of this tissue state can include muscle tension, spasms, insomnia, anxiety, emotional irritability and exhaustion. Relaxing herbs are numerous from lemon balm and chamomile to motherwort and Valerian.

Neutralising herbs are neither relaxing or toning as they operate in a neutral field with regard to tissue quality. They may however be warming, cooling , ascending descending etc.

Toning herbs are used when there is excessive slackness, softness and weakness. Atony is used to describe states where tissues are without tone, flaccid, and too relaxed to be working at optimum. They often overflow with fluids as they can’t hold onto them, and this can include runny mucus or diarrhoea. Indicators of lax/atony include poor muscle tone, weak tissues, clammy skin and random sweats. Toning herbs vary from astringents such as agrimony and meadowsweet to adaptogens such as astragalus and rhodiola.

Tastes

All traditional herbal systems use taste as a means to understand how herbs work and influence health. The Sanskrit word for taste is rasa, and it is a very pregnant word: as well as meaning taste, it can mean ‘essence’, ‘juice’, ‘sap’, ‘lymphatic fluid’, ‘flavour’ and ‘delicious’. Just saying the word sounds ‘juicy’ … raa-ssa, rasa, RASA. Flavour is the essence of life – it affects everything.

Sweet: Ayurveda considers the sweet flavour is made from the elements of earth and water. This means that it has the qualities of these two building blocks; ie earth is heavy and descending and, like water, it is wet and cold (when water is subjected to heat it becomes hot but in its ‘primordial’ state it is cold). Sweet is the flavour of love, of sharing and of compassion. We give sweets to friends as an act of sharing and companionship. It is considered the most spiritually sattvic of flavours and is used to heighten experience of clarity and awareness of the spiritual aspect of life. In TCM sweet herbs are often Qi and Spleen tonics.

We all know the sweet flavour. Its main receptors are at the front of the tongue. Sweet comes from sugars; glucose, sucrose, fructose, maltose. They are made up of short (mono) and long (poly) chains of saccharides. It is the flavour of energy. Many carbohydrates, fats and proteins are sweet and their potential energy is measured in kilajoules. Foods and herbs with the sweet flavour are considered to be tonics; they build and nourish all the tissues; licorice (Glycyrrhiza glabra), beetroot (Beta vulgaris) and shatavari (Asparagus racemosa) are sweet and nourish the deeper reproductive tissues. The sweet flavour increases ojas and the integrity of the immune system. Many renowned immune tonics have a sweet flavour and are full of immune-modulating saponins and polysaccharides – such as ginseng/ren shen (Panax ginseng) and astragalus/huang qi (Astragalus membranaceus).

Sweet substances and experiences increase fluid-kapha and reduce hot-pitta and nervous-vata. As a demulcent, soft, soothing and wet flavour it reduces some of the dryness and weakness associated with nervous imbalance. It is a tissue healer and sweet herbs are often used for hastening wound repair (eg aloe vera or licorice). Sweet benefits the mucus membranes lining the mouth, lungs, digestive, urinary and reproductive systems. The sweet taste can help to clear a dry throat and lungs by enhancing expectoration. Its cooling anti-inflammatory tendencies help to remove the intense heat of pitta or ‘-itis’ conditions (eg bronchitis). This is also helped by its softening mild laxative effect. It benefits the complexion, improves hair and nail quality and is the best flavour for a smooth voice. Following the principle of ‘like increases like’ you want to increase your sweet experiences and flavours in life to be truly nourished, loved and cherished.

Used in concentrated excess, such as with refined sugar/pastries/ice creams, it can increase mucus and promote congestion. It can cause congestion, ama, fever, chest and breathing problems, swollen lymph glands, flaccidity, heaviness, worms, fungal infections, obesity, and diabetes. Exceptions to this rule of sweet substances increasing kapha are honey, mung beans and barley; they are actually considered to balance excess moisture.

Elderberries (Sambucus nigra)

Sour: Ayurveda considers the sour flavour is made from the elements of earth and fire. Its qualities are hot, oily and light. It creates both dampness and heat in the body and mind. It stimulates digestion and clears dryness. Sour foods make the mouth moist and increase the flow of saliva. When taken in excess it draws the tissues inwards and ‘puckers’ the lips, making the body horripilate all over. This contraction creates an emotional reluctance to share things. Eating too much sour flavoured food encourages envy and can make your experience of life feel like ‘sour grapes’. According to TCM the sour flavour astringe and prevent leakage of fluids and qi, travels in the sinews, entering the Liver.

The sour flavour is found in acids; citric, lactic, malic, oxalic and ascorbic. The receptors for the sour flavour are found on taste buds on the sides of the tongue. The acids have a direct effect on digestion by promoting liver function through various mechanisms; as sour flavours can reduce stomach acid it also means that the liver needs to produce less acid neutralising alkaline fluids. Sour flavours also increase the flow of bile that helps to encourage digestion of fats. Unripe fruits are sour and are commonly used as digestive chutnies in India. Sour fruits such as amalaki (Emblica officinalis) are high in Vitamin C and protective polyphenols considered to be rejuvenating and tonic herbs. Wu wei zi (Schizandra spp) are one of the sourest and most binding of TCM herbs.

As the sour flavour aggravates heat and liquifies mucus it is not usually beneficial in hot and damp conditions. It is also considered to vitiate the blood and it is recommended that the sour flavour is avoided in skin diseases. Most fermented foods are sour; fermented yoghurt, sour dough breads, vinegar, pickles and alcohol are sour foods that increase heat and mucus in the body. Sour nourishes all the tissues bar the deepest reproductive tissue (shukra). It alleviates aggravations of the nervous system as it is said to draw scattered vitality back. It is a specific carminative useful to promote digestion whilst also removing gas and indigestion. Amalaki, lemons and pomegranate seeds (Punica granatum) are the exception to the rule that the sour flavour aggravates pitta as they actually reduce heat and inflammation.

In excess sour can cause dizziness, thirst, burning sensations, fever, itching, anaemia and skin diseases.

Salty: Ayurveda considers that the salty flavour is predominantly made from the water and fire elements. It creates moisture and heat and is heavy and sinking. A grain dropped onto the tongue is instantly moistening. A sprinkle on food enkindles digestion. It is an easily recognisable flavour and its receptors are at the front of the tongue. Its sinking and heavy effect is very grounding for the nervous system and this encourages stability. People who are solid and reliable become known as ‘the salt of the earth’. In TCM salt purges and softens, travels in the blood and enters the Kidneys.

The use of salt is a good lesson in the importance of dosage. In correct quantities it is vital to our very existence and is as essential to our health as water and food. It can save life when there is dehydration. In contrast to this a sprinkle too much will cause an ulcer and aggravate stomach acidity. Excess salt consumption also causes water retention with the concomitant results of oedema and High Blood Pressure. This physical holding is reflected in its emotional effects as it causes greed and encourages the desire for more flavour.

Salt is found in minerals and there are different types of salt classified in Ayurveda; rock, sea, black, pink and sonchala. Rock is considered the best as it is very high in minerals and, unlike the other salts, does not cause such water retention and it is not detrimental to the eyes. Salty is the rarest flavour in the Ayurvedic materia medica, not found in many herbs. It is found in shilajit, a natural mineral rock exudate, full of numerous nourishing minerals. Horsetail (Equisetum arvense), seaweeds, and celery are other examples of the salty flavour.

Salt aggravates heat-pitta and fluid-kapha. It also disrupts the blood and is contraindicated in skin diseases as well as bleeding problems. Its use in marinades reflects its softening quality and it is used to soften masses and as a demulcent to liquefy mucus. It stimulating the appetite, moistening dryness and nourishing the nervous system. It is a mild laxative at a medium dose (3g) and an emetic at higher dose (5-10g).

In excess it causes ulcers, skin diseases, grey hair, baldness and thirst.

Pungent/Acrid: Ayurveda considers the pungent flavour is a combination of the fire and air elements. Its qualities are hot, dry and light as well as penetrating and ascending. The acrid heat of hot foods and spices spreads throughout the whole system. Too much heat, whether climatic or dietary, is known to cause ‘hot’ emotions ranging from passion and excitement to anger and irritation. It is the most excitatory and volatile of the tastes. In TCM the acrid flavour disperses and moves, travels in the qi, enters the Lungs.

It is primarily found in the aromatic volatile oils, resins, oleo-resins and mustard glycosides. All these compounds are used to stimulate, invigorate, dry and clear the accumulation of wet, stagnant and congestive conditions. The essential oils of ginger (Zingiber officinale) and black pepper (Piper nigrum) are often used for clearing mucus congestion or warming a cold condition. Pungent resins such as guggul (Commiphora mukul) and frankincense (Boswellia serrata) also invigorate the flow of blood, scrape out toxins and reduce cholesterol. The aromatic cardamom (Elettaria cardamomum) is an excellent digestive for encouraging sluggish digestion. Unlike the other tastes it does not have a specific taste bud receptor site but works through irritation of local tissue and nerve endings.

Trikatu (Zingiber officinale, Piper longum and Piper nigrum)

Pungent herbs and foods are a panacea for excess dampness as they dry the excess moisture and mucus. Pungent herbs are vital for any weight-balancing programme as they stimulate the metabolism and reduce fat. They directly cook and burn toxic-ama as well as also clearing it via diaphoresis. The heat encourages vasodilation of the pores of the skin and encourages the body to sweat, therefore throwing off unmetabolised wastes through the skin. The pungent flavour usually increases vata but, in moderation, it can also help to remove the cold stiffness of the joints whilst also encouraging the elimination of wind and digestive cramps. The heat of pungent herbs irritates pitta and should not usually be used where there is inflammation, especially with aggravation of the plasma (rasa) and blood (rakta) tissues. Its drying effect on bodily fluids can cause constipation.

In excess it creates burning, dizziness, thirst and excessive dryness. Ginger (Zingiber officinale) and cooked garlic (Allium sativum) are the exceptions to the rule that pungent flavours aggravate vata; in fact they benefit it as they increase digestion and reduce intestinal gases.

Bitter: Ayurveda teaches that bitter is created from a combination of space and air elements. Its dominant qualities are cooling, drying and light. It creates space in the body by draining and drying excess fluids. Too many bitter herbs can literally ‘space you out’ and leave you feeling disorientated. Many psychotropics are bitter; eg Psilocybe spp. It has a particular affinity for the blood (rakta). Bitters are usually classified as ‘alteratives’ as they alter the chemical balance of the blood by clearing stagnation and torpor. As they encourage the flow of bile and the activity of the liver this may account for some of bitter’s detoxifying activity. Too much bitter flavour can weaken the kidneys, cause excess urination and emotionally encourages fear and anxiety. In TCM the bitter flavour drains and dries, travels in the bones and enters the Heart.

Whereas in Western herbalism bitters are associated with a tonic effect, in Ayurveda they are considered depleting. The tonic affiliation comes from the low dose, digestive stimulating and liver promoting perspective bitters are associated with. The depleting and cleansing view comes from the experience that relatively larger doses of bitter herbs are cooling, reducing, detoxifying, laxative and diuretic. This is a reminder that any substance can be a food, a medicine or a poison depending on how much is given, who is eating it, when it is eaten and where it is taken.

The bitter flavour is found in sesquiterpenes, anthraquinones, alkaloids and some glycosides. Plants with these properties are renowned for their anti-inflammatory, anti-bacterial, anti-pyretic and digestive secretion enhancing activities. These compounds are usually found intermixed with pungent and aromatic or astringent tasting plants; all drying flavours. Neem (Azadiracthta indicia), andrographis (Andrographis paniculata) and chamomile (Matricaria chamomilla) are well-known bitters famed for their ability to clear infection, heal skin problems and purify the blood.

Bitter herbs clear damp-kapha and hot-pitta whilst aggravating dry-vata. Excess dampness and heat are reduced as the bitter flavour drains them out of the system. Bitters also promote peristalsis and urination. They are often indicated in lung conditions, especially with infections manifesting with green and sticky mucus. They excel at clearing itching, swelling and oozing on the skin. A little is used as a stimulant to the appetite as the light quality can enhance the appetite and clear the palate. Higher doses are used to kill worms and parasites in the intestines and blood. Bitter herbs also benefit overweight conditions as they can dry and scrape away the adhesions and fatty accumulations.

When misused or incorrectly prescribed they can cause too much dryness and wasting in the body and mind; this can upset the nervous system causing constipation, dizziness, weakness, reduction in semen and dryness of the whole body.

Bilberry (Vaccinium myrtillus)

Astringent: Astringent is the driest flavour. Ayurveda considers that the astringent flavour is created from a predominance of the earth and air elements it is heavy, cold and dry. As it draws inwards, it dries and reduces. On eating something astringent your whole mouth contracts and draws the mucus membranes closer together. Having too many ‘dry’ and unfulfilling experiences can leave you with a lack of taste for life and even resentful at its lack of zest.

The astringent flavour is found in tannins. These polyphenols are particularly concentrated in the bark, leaves and outer rind of fruits of plants and trees. They appear to offer some form of outer protection by repairing wounds and neutralising bacteria. They are especially soluble in water; hence the drying nature of a strong cup of tea left to steep for too long. Astringency is often found in combination with plants that also taste sweet or sour. Bibhitaki (Terminalia belerica), haritaki (Terminalia chebula), arjuna (Terminalia arjuna) and guggul (Commiphora mukul) are especially astringent.

Therapeutically the astringent flavour clears damp-kapha and hot-pitta whilst aggravating dry-vata. It is very useful where there is any leakage of body fluids; bleeding (externally and internally), excessive sweating, enuresis, diarrhoea, excess catarrh, leucorrhoea and premature ejaculation. It holds tissues together and astringent herbs are often used as a wash to help heal wounds. This holding effect also prevents loose and flaccid tissue from accumulating. Using astringent herbs is appropriate to treat sinking problems such as prolapses. Its effect on the digestive system benefits diarrhoea by astringing the bowel and stopping excessive downward flow. This also helps absorption by drawing fluids and nutrients inwards. Astringents are used for pitta inflammations to draw the swelling inwards, cool the heat and also drying any damp suppuration.

These dry, rough and light qualities are similar to vata. Because astringent tastes contract the tissues and obstruct the flow of prana and nervous energy in the system it is detrimental to vata. In excess it can cause vata diseases like rigidity, pain in the heart, convulsions and retention of gas, urine and faeces.

Guna: The qualities of the herbs

The specific ‘quality’ of a herb indicates its potential therapeutic activity.

There are twenty qualities listed in Sushruta but these five listed below are the main ones used in Ayurvedic herbal energetics:

Light (laghu)

Plants, foods and minerals that are light have a quality that moves upwards, are easily digested and also remove sluggishness and heavy-kapha. Aromatic and warming herbs often have a light quality. The bitter and astringent flavoured herbs are usually light in nature. Leaves, seeds and fruits are mainly light. The aromatic Cardamom (Elettaria cardamomum) seeds are light.

Heavy (guru)

Substances that are heavy sink downwards, are difficult to digest, increase kapha and nourish the whole system. They benefit nervous-vata by opposing its light, dry qualities. Heavy natured herbs are often sweet, salty or sour. Roots, resins, nuts and barks are often heavy. Licorice (Glycyrrhiza glabra), is heavy.

Penetrating or Sharp (tikshna)

Herbs with a penetrating or sharp quality are usually pungent, acrid and aromatic. They spread deeply into the tissues, open the channels and by their intense nature increase hot-pitta and reduce sluggish-kapha and stuck-vata. Lemons and vacha (Acorus calamus) have penetrating properties.

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Chinese herb sustainability: Who is responsible?

Jessika Thiele — Thu, 21 Sep 2023 17:44:27 +0000

Sustainability of herbal medicines and supply chains are very complex topics and issues vary between plants and cultures. This article sheds light on some of the issues with plants from Traditional Chinese Medicine.

1: The Qinling mountains are the source of 20 di dao herbs

There is no doubt that the expansion of Chinese herbal medicine around the world is having a negative impact on the environment and threatens an increasing number of wild plant species. Do we want to be a part of this problem or part of the solution?

It is a complex question as we may feel we have little control over the root causes, but it may be helpful to ask who is actually responsible for the solution.

Let’s start with the Chinese government. Should they not protect the wild plants? In fact, there is more land area given over to protected nature reserves in China (14.8%) (1) compared to 0.7% in the UK (2, 9). In such unpolluted areas such as in the Qinling Mountains, emphasis is given over to forestry and herb cultivation. Land in the lowlands is facing increasing pressure from building use, pushing herb farmers back into the hills where many of them come from. This is a good development. They are valuable ‘di dao’ areas. Similar to the terroir appellation for wine, di dao areas are renowned for having specific ecological characteristics that produce herbs with superior qualities and benefits. These regions are recognised as optimum regions to source certain specific species of herbs.

It is estimated that around 80% of the medicinal herb species by species number (not volume) used in Chinese herbal medicine are wild sourced (3). The concerning matter is that the output of wild collecting is reducing each year. In 2007 the Chinese Academy of Science with the State Forestry Administration produced their blueprint for the conservation of wild plants including medicinal plants. A positive outcome is that it has many important and far reaching policies including the protection of di dao regions.

One example that we may not even have considered is the extraction of wild Glycyrrhiza uralensis (gan cao) from the northern regions of China.

In the wild, gan cao is one of the important ground cover plants stabilising the shifting sands at the fringes of the Gobi desert. Removal of the ground cover is largely responsible for the increasing dust storms experienced in Beijing. The situation is being monitored using satellite imagery and steps are being taken to restore the habitat.

2007: China’s Strategy for plant conservation

3: Landsat images used to monitor retreat of ground cover including gan cao

4: Rehabilitation of desert ecology around the Gobi desert

5: Sustainable harvesting of Glycyrrhiza (gan cao) by Fair Wild Foundation

For us herbalists we think of gan cao as a common and ecologically sustainable herb, but only if it is taken in a sustainable manner from the wild, which it is not. The most rigorous standards for sustainable collection are run by The FairWild Foundation. Liquorice can be sustainably harvested under FairWild standards (4) and there are projects in Khazakhstan, Georgia, Uzbekistan and Spain currently in place. Anecdotal conversations with suppliers indicate that cultivated liquorice contains lower levels of the sweet glycyrrhizic acid compared to wild harvested.

6: Ephedra sinica (ma huang)

Desert regions are also the natural habitat for Ephedra sinica (ma huang). In 2013, Ephedra sinica was declared ‘near threatened and rapidly declining’ according to the IUCN Red list of threatened species (5). It is the first Chinese herb to be protected by quotas. Issuing licences for collecting is an effective control which may be the way ahead for other herbs in this delicate ecosystem. You can read more about the sustainability of liquorice in our article “The sustainability of liquorice”.

Another important part of the 2007 Conservation Policy is to develop key labs for the cultivation of medicinal plants which are endangered. This is not a new policy as they have been trying to cultivate over 400 species of Chinese herbs for the past 50 years with considerable success. Since the 1955 to 2015 the land areas given over to medicinal herb cultivation has increased from 400.000 square hectares to 9.330.000 square hectares. Although this is a vital part of the programme towards sustainability, the use of toxic pesticides and increase in heavy metals in the soils has rendered some products unsuitable for use (6).

A more ecologically sensitive method is being explored for some herbs including Glycyrrhiza (7)and Fritillaria by establishing a method called ‘natural fostering’ by planting the herb crops within their natural habitat. Although the yields are not high enough to replace commercial cultivation, the quality of the herb most resembles that of the wild harvested.

Some of these herbs are not easy to cultivate. A national award was given for the commercial cultivation of Gastrodia elata (tian ma).

7: Gastrodia elata (tian ma) grows on Armillaria fungus infected logs

8: Harvesting tian ma from buried oak logs

9: Wild and cultivated tian ma

10 : Song bei mu (not flowered) / Qing bei mu (flowered)

It is now possible to not only sustainably produce this rare orchid but the smaller plants are then introduced into the wild to increase wild stock

You can identify commercially grown and wild harvested tian ma in the markets in whole root form at least. However, for other species it is not so easy and currently most suppliers source their herbs from large markets where the source is unknown.

A key herb chosen in the 2007 report concerns Fritillaria species. In particular Fritillaria cirrhosa (chuan bei mu) Over 1 million yuan was allocated for the one species alone to improve cultivation. As an important ingredient of traditional cough medicine, this plant is estimated to fuel a 400 million dollar industry. Cultivation is now proceeding in Sichuan but, although protected in the wild, the livelihood of poor people is pushing the collection of more and more rare Fritillaria species through indiscriminate harvesting methods.

You can see that the bulbs on the left are closed compared to the right where they have opened. The opening of the bulb indicates that it has flowered and hence less damaging for the continuation of the species. Wild collection training and increased incentive to sustainably collect will help but these are often illegal harvesters in a poverty area.

The other major development is the establishment of GAP centres in each region of China.

11: Modern GAP controlled processing centre

12: Small scale traditional processing of Gastrodia elata (tian ma)

13: Herb farmer and son

14: Cultivation of Fritillaria thunbergii in Zhejiang

The standard and sourcing provenance of the herbs can be greatly improved with these GAP centres compared to individual small growing and harvesting. Whilst this is a good plan overall, it does have implications which are less helpful.

Many small farmers rely on the increase in price afforded by processing.

By having to sell their raw product to the GAP centre to be processed, their income is greatly reduced. Without a stable income many young farmers are simply leaving the industry which is hard and unsustainable.

Herb prices are also very volatile for the farmer- fluctuating according to the amount of herb on the market. This is why there is provision in the conservation plan to stabilise herb prices. It may not be enough to stop the exodus of young farmers.

What can we do as consumers at the end of these long supply chains? Firstly, we need to be vigilant when choosing our herbs and ask more questions. We can make choices. For example, we can try to avoid using herbs which are endangered.

We can use zhe bei mu (Fritillaria thunbergii) instead of chuan bei mu. Zhe bei mu is cultivated in Zhejiang province. It is doubtfully native in China.

Zhe bei mu is easily to differentiate macroscopically from chuan bei mu due to its larger size and open structure.

It is true that zhe bei mu is more for excess heat and early nodes than the gentler chuan bei mu. However, we can adjust the dosages and formulation accordingly. Our formulas are designed to be flexible.

15: Chuan bei mu (left) compared to zhe bei mu (right)

16: Nan sha shen (left)/Bei sha shen (right)

17: Even the expert cannot tell wild from cultivated Dendrobium in Chengdu market

18: Althaea officinalis (Marsh mallow)

Another example is that of sha shen. There are 2 official species for this herb. Nan sha shen from the south is sourced from Adenophora tetraphylla which is not endangered in the wild. In the north the source is Glehnia littoralis which is now on the critical endangered list in the wild (8).

In sliced form they are easy to tell apart as the nan sha shen shown on the left is much looser than the harder bei sha shen, which also shows a distinct cambium ring. We should revert to only using nan sha shen unless we have assurance that the Glehnia has been cultivated.

We can also become aware of other herbs which are being pushed toward extinction in the wild. We should ask of our supplier if these herbs are wild collected or cultivated. They may not claim to know the answer, but they should make the extra effort to find out. At the same time they should be better at labelling the source species as it is often left vague where several substitutions exist.

Does the responsibility rest with our suppliers or ourselves as consumers?

The RCHM Approved Suppliers Scheme does offer at least some dialogue to move more into sourcing control. All the suppliers in this scheme are aware of the problem and attempting to check their sources. Affiliated with the BHMA’s Herbal Practitioner Supplier Scheme, whilst it lacks specific reference to sustainability, it does keep dialogue between practitioners and suppliers open.

Once a herb has reached the CITES lists for endangered species it is already serious. In order to obtain CITES certification for a small batch of herbs coming to the UK, the cost and time taken means that the herb is simply dropped. One issue faced by suppliers trying to meet new expectations is that the cost of the herb will usually need to be increased. From their experience the customer is unwilling to pay for this increased selectivity. Put simply, herbalists will normally still buy on the basis of cost in the same way as we want cheap food at the supermarket despite the implications.

One interesting area is that of finding suitable substitutes for endangered herbs. We have had to do this with animal products, so it can and needs to be done. As with animal products there is often not one simple replacement. We need to know exactly what the herb is doing in the formula and its importance. It may require simply dropping it and increasing other herbs or finding a few herbs to do the same job. It is a creative process which would require an article in itself.

Dendrobium orchid species used as sources for the Chinese herb shi hu, are another plant threatened in the wild.

Although it is also cultivated in small amounts it is impossible to tell in the markets.

Perhaps we could consider herbs closer to home. The western pharmacology and use of our native Althaea officinalis (marshmallow) indicate it is a possible substitute for the orchid Dendrobium nobile (shi hu).

The switch to using more locally based herbs in TCM is another topic in itself and beyond the scope of this discussion. As is the increasingly common but difficult question of cultivating authenticated Chinese herbs in the UK

So, to answer the initial question posed in the title, we are all responsible for the situation of unsustainable use of herbs and we all need to find our own solution. We may have to restrict or substitute our materia medica as we have already done by eliminating animal products. Or we may have to be prepared to pay more for authenticated sustainable herbs which will cost more to produce and monitor.

Either way, we cannot avoid it. It is a challenge that is inherent in the term ‘unsustainable’.

References

Zhijun Ma et al Ministry of Education-key labs for biodiversity science: Conserv Biol 2019 33(5) 1066-1075
UKBI – C1. Protected areas | JNCC – Adviser to Government on Nature Conservation. Published December 14, 2022. https://jncc.gov.uk/our-work/ukbi-c1-protected-areas/
ShilinC, PeigenX Introduction to the sustainable utilisation of Chinese Herbal Medicine. China Medical Technology Publication 2006
FairWild Foundation. Liquorice — FairWild Foundation. FairWild Foundation. Published online August 1, 2023. https://www.fairwild.org/ingredients/liquorice
The IUCN red list of threatened species. IUCN Red List of Threatened Species. https://www.iucnredlist.org/
Xu R, ChenJ, ChenS Medicinal plant resources achieve rational development China Pharmaceutical 2009 18
Wei SL, Wang WQ, Wang H. [Study on licorice resources and their sustainable utilization in center and western area of China]. PubMed. Published March 1, 2003. https://pubmed.ncbi.nlm.nih.gov/15015299/
Leon C, Yu-Lin L. Chinese Medicinal Plants Herbal Drugs and Substitutes: An Identification Guide: An Identification Guide. Vol 1. Kew Publishing; 2017.
Morris S. How much of England is protected for nature? Government may fail in delivering 2030 nature target. Evening Standard. https://www.standard.co.uk/news/environment/england-land-sea-protected-nature-uk-government-target-b1033834.html. Published July 27, 2023.

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Mushrooms for cancer care

Jessika Thiele — Thu, 31 Aug 2023 10:33:15 +0000

There has been much scientific interest in fungi for cancer care in recent years, and for good reason. This article shares some of the research in this fascinating branch of oncology and herbalism.

The demand for medicinal mushrooms has been gradually growing and is expected to continue doing so in the next decade (1). With increasing research, the general public is becoming more and more aware about the health benefits of these fascinating members of the fungal kingdom.

Medicinal mushrooms have been used in East Asia for thousands of years, with records of this being left in the Chinese herbal book Shen Nong Ben Cao, which dates to 200AD (2). Medicinal mushrooms are still used within traditional Chinese medicine (TCM) as part of the mainstream medical system in China (3). The anti-tumour properties of mushrooms have been extensively researched in Japan, where the active constituent of shiitake is used intravenously in conventional treatment protocols (2).

Mushrooms are neither plants nor animals, they belong to a completely different category: the fungal kingdom. Mushrooms are metabolically closer to animals but structurally closer to plants. Both plants and mushrooms have a cell wall formed by long chains of sugar molecules called polysaccharides. The long sugar (glucose) chain in plant cell walls is called cellulose. In mushrooms, the structure of these long glucose chains is slightly different to cellulose, as it has side chains attached to the main chain, making it a more complex structure. These mushroom polysaccharides or complex glucose chains are responsible for many of mushroom’s health benefits, including immunomodulatory effects and anti-tumour activity (2).

Reishi mushrooms (Ganoderma lucidum)

Some fungi are composed of a network of thread-looking long chains growing underground, called the mycelium or mycelial network, and a visible fruiting body, the so-called mushroom. Mushrooms are the visible part of fungi, and they are responsible for producing spores and helping fungi reproduce. Mushrooms are fungi’s reproductive organs, as they bear the spores the fungus will use to spread and propagate itself (4).

The main biologically active compounds found in mushrooms with an anti-tumour and immunomodulatory action are the polysaccharides and triterpenes. Polysaccharides are water-soluble and triterpenes are alcohol or ethanol-soluble. Some research has suggested that the degree of anti-tumour activity is related to the degree of branching and solubility of the polysaccharides. The more branching, the higher the anti-cancer activity in vitro (5).

Mushrooms trigger a wide range of immunological changes that are useful in having an anti-cancer effect. Some of these changes include the following (2):

Increase in natural killer (NK) cells
Increase cytotoxic T-cell activation
Decrease pro-inflammatory cytokines
Apoptosis of cancer cells

Some mushrooms such as turkey tail have also been shown to minimise chemotherapy side effects, being helpful when taken concomitantly with conventional treatment.

Almond mushroom (Agaricus subrufescens)

This mushroom is originally from Brazil but has been widely used in Japan, as a farmer of Japanese descent living in Brazil sent some spores to Japan in the 1960s. It is reported to being taken by 31% of patients with urological cancers in Japan (2).

Almond mushrooms (Agaricus subrufescens)

The polysaccharides in almond mushrooms have been shown to have strong activity in vitro and in vivo against different cancer cell lines. This mushroom is particularly good when used synergistically with chemotherapy and radiotherapy (6). Not only has it been shown to improve the efficacy of chemotherapy or radiotherapy when used in combination, but it is also effective at decreasing the side effects of chemotherapy such as appetite loss, alopecia, generalised weakness and emotional instability (7). There are a couple of clinical studies reporting almond mushroom taken daily as a tea increases red cell production and quality of life in patients receiving chemotherapy for acute non-lymphocytic leukaemia and late-stage gastrointestinal cancers (8).

Almond mushroom has also been shown to significantly increase NK cells in both, human volunteers (9), and also in patients with cervical, ovarian and endometrial cancer being treated with chemotherapy (10).

Cordyceps (Cordyceps sinensis)

Cordyceps is a very interesting mushroom that in the wild grows through an insect host, either parasitically or in symbiosis. Cultivated cordyceps however mostly grows on grain-based substrates instead of insects (2).

Cordyceps (Ophiocordyceps sinensis)

Cordyceps containing polysaccharides have significant immune-modulating properties that are useful in cancer care. It also contains molecules called nucleoside derivatives (similar to the component parts of DNA). One of the most widely researched nucleosides in cordyceps with anti-tumour properties has been cordycepin (11). Cordycepin has been found to induce apoptosis (or what is the same, induce death of cancer cells) and to improve treatment outcomes in different cancer types such as in oral, colorectal, bladder, leukaemia, melanoma, multiple myeloma, breast and prostate (12, 13).

Cordyceps is however contraindicated in hormone-dependent cancers such as breast cancer or prostate cancer when these are hormone-driven. This is because cordyceps can increase levels of sex hormones levels (i.e., oestrogen and testosterone), and therefore should not be used in hormone-dependent cancers (2). As cordyceps can be useful in bringing down glucose levels, it should be used with caution by people taking insulin to avoid unwanted hypoglycaemic episodes.

Turkey tail (Trametes versicolor)

Turkey tail is the most widely researched mushroom for cancer care and is used alongside conventional treatment in China and Japan. Turkey tail has been traditionally used to improve immune function and has a long traditional use for tumours. The two polysaccharides that have been studied in large-scale clinical trials are PSK and PSP (2).

Turkey tail (Trametes versicolor L.)

The polysaccharide PSK in turkey tail can be beneficial for cancer care through numerous mechanisms. It has been shown to increase immune cell production and improve the immune status of the patient, which enables them to fight cancer cells off more efficiently (14). It can increase cytotoxic T cells, which are immune cells that can destroy cancer cells (14). PSK has also been shown to increase survival in certain cancers (oesophageal, gastric, colorectal, nasopharynx, lung and uterine) (15). For example, in patients with advanced gastric cancer, PSK doubled 2-year survival rates when given alongside chemotherapy and surgical intervention, and in patients with colorectal cancer, it improved 8-year survival (15).

A meta-analysis confirmed that turkey tail increased survival and that it also significantly reduced chemotherapy and radiotherapy side effects (16). Turkey tail is therefore a promising mushroom that can be used to support patients with cancer when the right preparation is used.

Maitake (Grifolia frondosa)

Maitake (Grifolia frondosa)

Maitake is another mushroom with potent anti-cancer properties. Polysaccharides are the main active constituents of maitake, specifically the isolated D-fraction and MD-fractions. These have potent immunomodulatory and anti-tumour actions (17).

Maitake MD-fraction used in combination with the fruiting body showed improvement of disease progression and an increase in immunocompetent cells in 58% of liver cancer patients (7 of 12), 68% of breast cancer patients (11 of 16) and 62% of lung cancer patients (5 of 8) (18). It was a small study, however these results still warrant attention for the Maitake mushroom as a potential candidate for cancer support as well as further research into its anti-tumour properties.

Other studies have confirmed amelioration of chemotherapy side effects such as loss of appetite, nausea, vomiting, alopecia, and leukopenia (2).

Reishi (Ganoderma lucidum)

Reishi (Ganoderma lucidum)

Reishi is a well-known mushroom whose properties and reports of its medicinal use can be found in Chinese literature dating back to 200 AD. We now know that reishi has a wide range of actions, many of them relevant in cancer care as it is an anti-inflammatory, immunomodulator, it increases cytotoxic T cells, and it induces apoptosis. The main constituents responsible for reishi’s therapeutic actions are polysaccharides and triterpenes (2).

Polysaccharides are immunomodulators, increasing Th1 cytokine levels including NK cells and decreasing Th2 cytokine levels (19). There have been several randomised clinical trials indicating that patients taking polysaccharide preparations of reishi were 1.37 times more likely to have a positive response to chemo or radiotherapy (2).

Triterpenes have shown a significant cytotoxic activity against cancer cell lines, and potent inhibition of NF-kappaB nuclear transcription factor (20). NF-kappaB is overexpressed in some cancer cell lines, allowing cancer cells to survive and spread. Reishi’s triterpenes inhibiting this transcription factor is another useful anti-tumour mechanism of action. Triterpenes in Reishi have been shown to specifically promote cell death and inhibit cancer cell growth of prostate cancer cells by blocking androgen receptors (21).

Polysaccharides are water-soluble and triterpenes are ethanol soluble, so this is an important consideration to take into account when preparing commercial Reishi for therapeutic purposes.

Reishi’s triterpenes have been reported to have anti-coagulant effects, so people taking blood-thinning or anticoagulant medications should be monitored and take reishi with caution (2). Reishi is not contraindicated in pregnancy but because of this anticoagulant effect it should be taken with caution during pregnancy and it is best to work with a practitioner if you want to take reishi when pregnant.

Shiitake (Lentinula edodes)

Shiitake (Lentinula edodes) mushrooms growing on trees

Shiitake is yet another well-known mushroom widely used for culinary purposes. It is very nutritious as it contains high levels of B vitamins, and is a good source of vitamin D2 if exposed to sunlight or IV light before or after harvesting (22).

The main active constituents of shiitake are the polysaccharide lentinan as well as other polysaccharides. Lentinan containing shiitake has been used in Japan for centuries for cancer care, but the anti-tumour properties of lentinan were first reported in 1960s by Japanese researchers. Most trials have studied the effect of lentinan given intravenously, but it appears to also have good orally bioavailability, although therapeutic oral doses will need to be higher (2).

Different trials have shown increased survival, improved quality of life and reduced chemotherapy side effects in patients with oesophageal, hepatocellular, colorectal, breast and metastatic prostate cancer (23). Furthermore, lentinan increased survival in several studies when used in combination with chemotherapy in advanced gastric cancer (24).

Final thoughts

When treating chronic, complex or serious conditions it is always best to approach a qualified integrative healthcare practitioner. Many supplements bought on the high street are of poor quality, and a practitioner will also be able to give good evidence-based guidance on dosage and duration of medicinal mushroom use.

#As this article has touched on, there are many nuances when working with herbs and serious conditions and sometimes one can unwittingly exacerbate issues. A qualified herbalist and integrative practitioner will be able to discern and guide you safely.

You can learn more about herbal approaches for caring for cancer in our podcast with herbal oncologist Chanchal Cabrera. Also take a look at our resource page “Where to find a herbalist“.

References

Global Medicinal Mushroom Market: By Type: Reishi, Lion’s Mane, Chaga, Turkey Tail, Shiitake, Cordyceps, Others; By Form: Powder, Whole, Slice; By End Use: Antioxidant, Immune Enhancer, Others; Regional Analysis; Historical Market and Forecast (2018-2028); Market Dynamics; Competitive Landscape; Industry Events and Developments: https://www.expertmarketresearch.com/reports/medicinal-mushroom-market
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National Cancer Institute. (2023). Medicinal Mushrooms (PDQ®)–Patient Version.
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Smith, J., Rowan, N., & Sullivan, R. (2002). Medicinal mushrooms: their therapeutic properties and current medical usage with special emphasis on cancer treatments. Cancer Research UK.
Kobayashi, H., Yoshida, R., Kanada, Y., Fukuda, Y., Yagyu, T., Inagaki, K., … & Terao, T. (2005). Suppressing effects of daily oral supplementation of beta-glucan extracted from Agaricus blazei Murill on spontaneous and peritoneal disseminated metastasis in mouse model. Journal of cancer research and clinical oncology, 131, 527-538.
Ahn, W. S., Kim, D. J., Chae, G. T., Lee, J. M., Bae, S. M., Sin, J. I., … & Lee, I. P. (2004). Natural killer cell activity and quality of life were improved by consumption of a mushroom extract, Agaricus blazei Murill Kyowa, in gynecological cancer patients undergoing chemotherapy. International Journal of Gynecologic Cancer, 14(4).
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Ahn, W. S., Kim, D. J., Chae, G. T., Lee, J. M., Bae, S. M., Sin, J. I., … & Lee, I. P. (2004). Natural killer cell activity and quality of life were improved by consumption of a mushroom extract, Agaricus blazei Murill Kyowa, in gynecological cancer patients undergoing chemotherapy. International Journal of Gynecologic Cancer, 14(4).
Xie, J. W., Huang, L. F., Hu, W., He, Y. B., & Wong, K. P. (2010). Analysis of the main nucleosides in Cordyceps sinensis by LC/ESI-MS. Molecules, 15(1), 305-314.
Tuli, H. S., Sharma, A. K., Sandhu, S. S., & Kashyap, D. (2013). Cordycepin: a bioactive metabolite with therapeutic potential. Life sciences, 93(23), 863-869.
Ruma, I., Putranto, E. W., Kondo, E., Watanabe, R., Saito, K. E. N., Inoue, Y., … & Sakaguchi, M. (2014). Extract of Cordyceps militaris inhibits angiogenesis and suppresses tumor growth of human malignant melanoma cells. International journal of oncology, 45(1), 209-218.
Habtemariam, S. (2020). Trametes versicolor (Synn. Coriolus versicolor) polysaccharides in cancer therapy: Targets and efficacy. Biomedicines, 8(5), 135.
Kidd, P. M. (2000). The use of mushroom glucans and proteoglycans in cancer treatment. Alternative medicine review, 5(1), 4-27.
LY Eliza, W., K Fai, C., & P Chung, L. (2012). Efficacy of Yun Zhi (Coriolus versicolor) on survival in cancer patients: systematic review and meta-analysis. Recent patents on inflammation & allergy drug discovery, 6(1), 78-87.
Mayell, M. (2001). Maitake extracts and their therapeutic potential-a review. Alternative Medicine Review, 6(1), 48-60.
Nanba, H., Kodama, N., Schar, D., & Turner, D. (2000). Effects of Maitake (Grifola frondosa) glucan in HIV-infected patients. Mycoscience, 41, 293-295.
Gao, Y., Zhou, S., Jiang, W., Huang, M., & Dai, X. (2003). Effects of Ganopoly®(A ganoderma lucidum polysaccharide extract) on the immune functions in Advanced‐Stage cancer patients. Immunological investigations, 32(3), 201-215.
Dudhgaonkar, S., Thyagarajan, A., & Sliva, D. (2009). Suppression of the inflammatory response by triterpenes isolated from the mushroom Ganoderma lucidum. International immunopharmacology, 9(11), 1272-1280.
Jiang, J., Slivova, V., Valachovicova, T., Harvey, K., & Sliva, D. (2004). Ganoderma lucidum inhibits proliferation and induces apoptosis in human prostate cancer cells PC-3. International journal of oncology, 24(5), 1093-1099.
Takamura, K., Hoshino, H., Sugahara, T., & Amano, H. (1991). Determination of vitamin D2 in shiitake mushroom (Lentinus edodes) by high-performance liquid chromatography. Journal of Chromatography A, 545(1), 201-204.
Taguchi, T. (1983). Effects of lentinan in advanced or recurrent cases of gastric, colorectal, and breast cancer. Gan to Kagaku ryoho. Cancer & Chemotherapy, 10(2 Pt 2), 387-393.
Oba, K., Kobayashi, M., Matsui, T., Kodera, Y., & Sakamoto, J. (2009). Individual patient based meta-analysis of lentinan for unresectable/recurrent gastric cancer. Anticancer research, 29(7), 2739-2745.

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The sustainability of liquorice

Jessika Thiele — Sun, 02 Jul 2023 19:26:12 +0000

“Inflorescence of Glycyrrhiza glabra” by Pharaoh han is licensed under the Creative Commons Attribution-Share Alike 3.0 Unported licence

Liquorice is one of the most valued herbal medicines globally, yet its population sizes are shrinking rapidly. This article shares insights on the sustainability of this plant and solutions to protect it.

Liquorice (Glycyrrhiza glabra) is a herbaceous perennial plant of the Leguminosae or Fabaceae family. Liquorice has a long history of use as medicine and food, stretching back thousands of years in parts of Africa, Asia and Europe (5). The scientific name Glycyrrhiza originates from the ancient greek “glyka” meaning sweet and “rhiza” for root. The Glycyrrhiza genus includes 20 species, however only four of these are commonly used. These are G. glabra, G. echinata, G. inflata and G. uralensis. Out of these four, G. glabra is the one most commonly described in medicinal monographs, though some treat all 4 species interchangeably, and all are commonly traded interchangeably as Liquorice root on the market (1-4).

Due to its long history of use as medicine and for its sweetness, there has always been a high demand for liquorice, but due to the rise in popularity of natural remedies, particularly in developed countries and an increasing demand across various industries, wild populations of liquorice are becoming progressively overused.

Uses of liquorice

Medicinally, liquorice is often used in combination with other herbs to treat ailments of the respiratory system such as asthma and coughs, the digestive system, cardiovascular system and diseases of the liver (1,3,5). As such it can be frequently found in many traditional Ayurvedic, Chinese or Western herbal formulations.

Today, the largest sectors in which Liquorice root and its extract are used are the tobacco, food and pharmaceutical industries and a smaller proportion in the cosmetic industry. One of the largest importers is the tobacco industry, which adds liquorice extract to tobacco as a taste additive and to prevent desiccation. Due to its sweetness (50 to 100 times sweeter than sucrose) glycyrrhizin is often used in the food industry as a sweetener (6). Another trade of liquorice is focused on the extraction of glycyrrhizin which is included in medicinal preparations in countries such as China and Japan (2,7).

Where does it grow?

Liquorice grows in steppes, semi-deserts, deserts and can be found growing in the wild in northern Africa, Mediterranean areas of Europe, western and central Asia. It is a pioneer species that copes well with overused or damaged land and it deals well with soils that have a high salt content, a problem that has become a major environmental issue in Central Asia (9). In many cases the plant is also cultivated, for example in France, Italy and Spain, though most of the liquorice that is on the market today is wild harvested (4). Due to its widespread habitat across multiple continents, and its overall large population, the IUCN (The International Union for Conservation of Nature) ranks the threat to liquorice as least concern (10). However, in certain areas of the world, it is increasingly under threat. Due to the ever-increasing global demand for liquorice, climate change, desertification, change in harvest methods, land use or over-harvesting, more and more plant populations around the world are being threatened (9-12).

The plants usually need to grow at least 3-5 years before the root is big enough to be harvested. The long woody roots can grow between 2.5-3 metres in depth. Traditionally the roots are then harvested by hand, which is hard work that involves digging up the root. With this method only the first metre or so of root is harvested, leaving the rest in the mostly undisturbed earth to regrow. More commercial operations involve a tractor ploughing a shallow trench 40-60cm deep in the soil, exposing roots that are then collected by hand. This is more time efficient and less hard work for the harvesters, but has far greater impacts on the local flora and fauna.

Liquorice on the global market

“Liquorice Trade of Aleppo”, made available by the Matson (G. Eric and Edith) Photograph collection at the Library of Congress

The picture on the right shows liquorice trade in Aleppo. I was struck by the volume of liquorice root in this picture. It was taken over 100 years ago, since then the global liquorice trade has grown massively. I wonder what this would look like today. According to future market insights, the global market of liquorice in 2022 was $848.9 million USD and is expected to grow to $1,418.4 million USD with a 5.3% growth rate by 2032 (8). Its prognosis of this rapid growth is explained with the rising trend of using herbal remedies in Europa and the USA.

However, as the same specific commodity code is being used for Liquorice root and extract, it can be difficult to distil which countries are big players in producing extracts and which are big players in growing and exporting the root (4).

Historical export figures from Turkey may mirror the decline of local populations due to over-harvesting. Turkish export numbers from the last century report yearly figures as high as 20.000t, declining to 1.500t towards the end of the last century. The species was deemed rare in Turkey in the 1990s (13). In Hungary and Bulgaria it is also considered rare or threatened.

Today the leading producers of wild-collected liquorice root on the global market include Afghanistan, Pakistan, Uzbekistan, Turkmenistan, Kazakhstan, Armenia, Azerbaijan, Georgia, and China (4). Part of the problem in figuring out the effects of liquorice harvests is that many picking sites are located in extremely remote areas of the world, sometimes in areas that are politically unstable and unsafe for travelling.

To give some perspective: In 2022 the global herbal supplement market had a value of 98.8 Bn USD. The liquorice trade is therefore 0.85% of the herbal supplement trade. With thousands of medicinal plants available, this shows the prevalence of liquorice root in herbal medicine.

Regulating the liquorice trade

In some countries the harvest of liquorice is now more regulated to protect the local populations and long-term trade. In Kazakhstan for example, where the harvest is being done by ploughing the earth with a tractor and then picking the root by hand, the land has to be tilled and flooded afterwards to restore the liquorice populations. And the land has to be left for six years before the next liquorice harvest, to let the population recover (9). Similarly, a series of guidelines and policies have been introduced in China, where wild liquorice populations have decreased by 60% between 1980 and 2009 (4), to protect local liquorice stands (12). But how well are these regulations working?

Tighter regulations have decreased the overall available liquorice on the market, which leads to an increased conflict between supply and demand and makes illegal harvest practices even more attractive. As is common practice with resource economy, the harvesters of natural resources only get very little of the actual market price. With liquorice, the price has increased tenfold on its journey from harvester to global market (9). In Kazakhstan, most wild liquorice harvesters are from rural villages, typically with low income, that rely solely on the root harvest as a source of stable income. The only way to create more income is to harvest more, leading to highly unsustainable rates (9). Unlicenced harvesters move in swiftly onto liquorice stands without permission and use tractors to turn over deep layers of earth to expose liquorice roots. Sometimes the local vegetation is first burned.

After the harvest, the soil is then left exposed, and any remaining roots are left to dry out, not allowing plants to recover. As a result, the local ecosystems are massively disrupted. Following this, it seems clear that regulations are not alone effective to support people to harvest sustainably, when prices are being dictated by a global market, and harvesters get so little. Challenging living situations are commonly a factor that drives people to unsustainable practices. This is a good example of how ecological sustainability is often closely intertwined with human access to welfare and justice. Fair wages are needed to support people to harvest sustainably. The other core element to sustainability is traceability. Part of the problem with the illegal harvest is that it easily finds its way onto the global market, which also gives little incentive for anyone else to comply with local regulations. International certification schemes are the main tools used today to guarantee a certain quality, sustainability or fair wage.

Standards such as organic and fairtrade are well known today, however they do not address all the problems of sustainability associated with wild harvesting. Indeed standards dealing with this matter are fairly young in the scheme of things. Between 2001 and 2006 the International Standard for Sustainable Wild Collection of Medicinal and Aromatic Plants (ISSC-MAP) was developed in order to ensure sustainability in the wild collection system. It defines guidelines and provides tools to collectors, producers and decision makers for the planning and implementation of a sustainable resource management system based on the Good Agricultural and Collection Practices guidelines. Following this, in 2006 FairWild, a Swiss-government supported certification scheme was started, with the aim of supporting social as well as ecological and economic sustainable use of habitats all over the world.

Getting wild liquorice collections sites and companies certified brought its own challenges as most of the places liquorice comes from are extremely remote and hard to get to, which has made any traceability hard to carry out (14). Some sources of liquorice are in areas of the world where diplomatic relations and trade have been diﬃcult or disrupted over the years, especially Afghanistan, Pakistan, Iran, Iraq, and Syria which have made collaboration difficult (14). On top of this, it is not only producers that have to cooperate, but major suppliers also have to take responsibility and support sustainable practices.

One example of a successful relationship between plant and human community can be found in northern Spain. Here, a group of local farmers collect liquorice root in sustainable ways, assuring the recovery of their local environment. Together with FairWild, Herbes del Moli and with UK company Organic Herb Trading, they are supplying sustainably sourced liquorice to the global market, with full traceability and with full support for the growers. Through FairWild funds, some of the economic value created is guaranteed to flow back into the local community, supporting education projects and necessities as in this case a van for the collectors, shelter from the fierce sun and a clean place to prepare their meals in the field (15).

There are more projects like these around the globe, and currently FairWild is running some trials with liquorice harvest in Afghanistan. It takes a long time to establish these relationships and it requires many players to work together to achieve a sustainable community. But it is worth it if it means that all players involved, including harvesters, ecosystems and plants get to be treated sustainably, fairly and with respect.

References

European Medicines Agency Ema. Liquiritiae Radix, European Medicines Agency. 2022; Available at: https://www.ema.europa.eu/en/medicines/herbal/liquiritiae-radix (Accessed: April 13, 2023).
Li JY, Cao HY, Liu P, Cheng GH, Sun MY. Glycyrrhizic acid in the treatment of liver diseases: literature review. Biomed Res Int. 2014;2014:872139. doi:10.1155/2014/872139
Zhang QH, Huang HZ, Qiu M, et al. Traditional Uses, Pharmacological Effects, and Molecular Mechanisms of Licorice in Potential Therapy of COVID-19. Front Pharmacol. 2021;12:719758. 2021 Nov 26. doi:10.3389/fphar.2021.719758
Schindler, C., Heral, E., Drinkwater, E., Timoshyna, A., Muir, G., Walter, S., Leaman, D.J. and Schippmann, U. Wild check – Assessing risks and opportunities of trade in wild plant ingredients. Rome, FAO. 2022 https://doi.org/10.4060/cb9267en
Fiore C, Eisenhut M, Ragazzi E, Zanchin G, Armanini D. A history of the therapeutic use of liquorice in Europe. J Ethnopharmacol. 2005; 99(3):317-324. doi:10.1016/j.jep.2005.04.015
Saulo A; Sugars and Sweeteners in Food. Food Safety and Technology. 2005;
Hayashi, H., Sudo, H. Economic importance of licorice Plant. Biotechnology. 26, 101–104 2009.
Futuremarketinsights.com: https://www.futuremarketinsights.com/reports/licorice-root-market (Accessed April 24, 2023).
Gemedzhieva, N., Khrokov, A., Heral, E., Timoshyna, A.; Sweet Dreams Assessing Opportunities and Threats in Kazakhstan’s Wild Liquorice Root Trade. Traffic, 2021.
IUCN red lists https://www.iucnredlist.org/species/203353/2764319#population (Accessed April 24, 2023).
Esmaeili, H., Karami, A., Hadian, J., Ebrahimi, S., Otto, L.; Genetic structure and variation in Iranian licorice (Glycyrrhiza glabra L.) populations based on morphological, phytochemical and simple sequence repeats markers. Industrial Crops and Products, Volume 145. 2020.
Han, Y., Pang, X., Zhang, X., Han, R., Liang, Z.; Resource sustainability and challenges: Status and competitiveness of international trade in licorice extracts under the Belt and Road Initiative. Global Ecology and Conservation 34 (2022) e02014. 2022.
Lange, D.; Europe’s medicinal and aromatic plants: their use, trade and conservation. TRAFFIC international. 1998.
Brinckmann, J., A.; The long road to sustainable liquorice. 2020.
FairWild. Meet the Collecters: FairWild Liquorice in Spain. https://www.fairwild.org/news/2019/6/4/meet-the-collectors-fairwild-liquorice-in-spain (Accessed April 28, 2023).

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The Register of Chinese herbal medicine’s response to media backlash against herbs

Jessika Thiele — Wed, 03 May 2023 18:19:35 +0000

Herbal medicine often faces negative press, from ill-informed sources. Here the Register of Chinese Herbal Medicine have gathered a panel of experts to respond to a recent misleading media article.

Herbal medicines rightly face’s scrutiny from the press. However, the media is often contradictory, with the tendency to a negative bias that lacks professional input. Given this context, is it surprising that journalists rarely consult herbalists for their expertise? One of the most recent media publications from the Daily Mail claims that “Health experts issue warning to pregnant women over traditional Chinese medicine”. This contradicts another Daily Mail headline “Chinese medicine could double the chances of childless couples conceiving”. No wonder the public are confused. We recommend that journalists contact the relevant experts and professional bodies to ensure their articles reflect a balanced view.

The Register of Chinese Herbal Medicine (RCHM) have responded to the issue of using Chinese herbs during pregnancy with a press release to contextualise the mistaken claims and critically analyse the research referred to, which is full of methodological flaws. Crucial details such as whether the medicines were self-prescribed or prescribed under the advice of a properly trained and qualified practitioner were not included in the research.

Experts include Dr Trevor Wing; fellow of the Royal Society of Medicine and a Fellow of the RCHM, Lily Lai; PhD, a BMJ published academic and practitioner who specializes in UK fertility treatment, and Dr Trina Ward; a PhD researcher and practitioner and Sarah Price PhD; a leading academic, all contributed.

We encourage you to read this response and share it amongst your peers and networks: RCHM Press Release – response to Daily Mail Article 25-04-2023

Also for more knowledge on media bias and herbal medicines see our article: Perceptions of herbal medicine in the media.

For articles on herbal medicines and pregnancy see below:

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Ethnopharmacology: Where science and traditional wisdom meet

Jessika Thiele — Thu, 01 Sep 2022 18:14:10 +0000

Outside display with Isatis tinctorum (da qing ye) in flower

Ethnopharmacology is a branch of science which integrates traditional herbal medicine and modern scientific analysis. This article shares how it has been used to give a deeper understanding of traditional Chinese medicine.

This article was first written for the Register of Chinese Herbal Medicine and has been copied with permission.

The focus of this article is to provide background information to complement the information presented on the public interpretation sign in the new ethnopharmacology display bed within the Bristol Chinese Herb Garden. In particular, it is designed to provide some scientific evidence for statements made on the sign and to present the baseline for additional articles to be posted on the RCHM outreach website. What Is Ethnopharmacology?

There are several definitions depending on your area of work (1). The one I use is: The integrated study of traditional herbal medicine with modern scientific analysis. It is a deceptively simple definition which amalgamates a range of disciplines including botany, pharmacology, anthropology, and cultural medical systems of health and disease.

As a recent branch of ethnobotany, it also incorporates the botanical identity, quality and sustainability of wild herb plants through conservation and cultivation. Unlike modern drugs which are standardised to a single chemical ingredient, the quality of a herb is variable as it depends on many factors such as how it is grown and processed.

The aim that lies behind this project is not only to draw together research from traditional herbal medicine and modern science, but to give equal emphasis to both. In this way we can understand the strengths and weakness of each. There is then potential to enter a real dialogue between European and Traditional Chinese Medicine (TCM). The integration of these two systems is currently a major part of the modernisation of TCM within China.

The living pharmacy collection

The ethnopharmacology collection has been given a particular emphasis. One of the most pressing medical needs currently is to counteract antibiotic drug resistance. We have decided with this collection to gather plants which have both a long-term traditional use, and also modern history of scientific research in this area of medicine.

Although many are used in Chinese herbal medicine, the list includes plants from other herbal traditions. Some of the most important and hardy herbs are grouped together in a dedicated outside display bed and others are in other areas of the botanic garden. More tender herbs will be kept in the relevant zone of the greenhouse complex.

List of plants

Anti-bacterial/parasitic/cancer herbs

Thyme (Thymus vulgaris)

Reynoutria japonica (hu zhang)
Phellodendron japonica (huang bai)
Mahonia fortunei (gong lao mu)
Berberis vulgaris (berberis)
Rheum palmatum (da huang)
Salvia officinalis (sage)
Salvia rosmarinus (rosemary)
Thymus vulgaris (thyme)
Melaleuca alternifolia (tea tree)
Tanacetum vulgare (feverfew)
Glycyrrhiza glabra (gan cao)
Artemisia annua (qing hao)
Isatis tinctorium (da qing ye/ ban lan gen)
Nigella sativa (nigella seed)
Scutellaria baicalensis (huang qin)
Dryopteris crassirhizoma (guang zhong)
Reynoutria multiflora (he shou wu)
Morus alba (sang ye, sang bai pi, sang zhi, sang shen)
Zingiber officinale (sheng jiang)
Cinnamomum vernum (cinnamon)
Curcuma longa (jiang huang)
Geranium strictipes
Arctostaphylos uva ursi (bearberry)
Andrographis paniculata (andrographis)
Pelargonium sidoides
Coptis chinensis (huang lian)

Immune tonics (adaptogens)

Astragaulus propquuinqus (syn membranaceus ) (huang qi)
Schisandra chinensis (wu wei zi)
Panax quinquefolius (xi yang shen)

The display board

Interpretation of such a complex subject is a much bigger challenge than simply explaining Chinese medicine as in the case of the ‘use class’ display. It has to be easily explained by the garden tour guides and also needs to satisfy the requirements for a leading university for accurate statements based on scientific validation.

I have decided that the best approach is to isolate a few fundamental principles with examples. The background can then be enlarged through articles on the website which can be kept up to date with research papers when needed.

Ethnopharmacology interpretation board

Principle 1: New drugs from old herbs

Artemisinin molecule with unstable double bond oxygen group

Around 40% of approved drugs during the last 30 years are derived from plants (4). Some studies have also indicated that of 122 plant derived drugs, 80% of their use in modern medicine was related to the same medical application used in the original traditional medicine (5).

Herb plants from China and the far east are one of the richest regions for drug prospectors today (2,7). China has over 30,000 species of plant, of which 3000 have been claimed to have specific traditional medicinal use. The process of finding and testing the chemicals is a long and expensive process and funding has reduced considerably in developing new drugs from natural materials (1). However, there are several which show potential to assist with drug resistance (1,3).

In 1967 the Vietnamese army asked China to assist with persistent malaria in the troops. Herbs were sourced from traditional herbal medical texts. These texts are known as the ‘Ben Cao’ and are a major resource as documented records of herbal use for over 2000 years (6,8).

They represent a long-term human clinical trial but without the control required by scientific RCT (random controlled trials). Traditional herbs which have been used for malaria symptoms were screened. The most effective was the herb Artemisia annua (qing hao) which first appeared in the Shen Nong Ben Cao written around 150AD. This led to the discovery of the drug artemisinin, as the main active anti-malarial component.

The sesquiterpene lactone (9,10,12) drug artemisinin has a unique and highly unstable structure due to the double bond trioxane group shown at the bottom of the molecule.

The effect of the trioxane bond is to oxidise iron to form toxic free radicals. The malaria parasite Plasmodium vivax survives by digesting the host’s haemoglobin. It is more sensitive to the free radicals than the human host cells and hence the parasite is killed, and the malaria halted. The drug also attacks in a second way at the same time to disrupt the DNA of the parasite. Artemisinin has also been found to kill the liver fluke parasite responsible for schistosomiasis which is second only to malaria as a parasitic killer in the tropics (16,17).

Artemisia annua is source of qing hao herb

The effect on cancer cells is also interesting. Some cancer cells are also high in iron and are also damaged by the iron oxidising effects of artemisinin. Because artemisinin is so unstable, it proved very difficult and expensive to synthesise as a drug. New strains of Artemisia annua were cultivated with 20 times the content of artemisinin.

Genetically modified yeast has also been developed, which manufacture the drug, making it less dependent on the plant source (13). It is often forgotten that chemical synthesis of drugs is an important factor in the conservation of the original wild herb plants which would otherwise be over-exploited.

As this was a new method of attack compared to the quinine drug, artemisinin was able to provide an effective treatment for the problem of drug resistance which had developed with quinine drugs and had fewer side effects compared to piperaquine alone. Initially the mortality rate was 30% lower compared to treatment with quinine (14,15).

Artemisinin is a very fast acting drug with a half-life of 1 hour, hence it is best used with a slow release drug to combat the parasite and prevent resistance. WHO guidelines now state that it should not be used on its own for this reason (18). Despite its initial dramatic Artemisia annua effect, drug resistance to artemisinin is becoming apparent (20). Adaptation is occurring.

There is no doubt that concentrated artemisinin as a drug is a more powerful antimicrobial than the herb. Artemisinin as a drug however, is not exactly the same as Artemisia annua the herb.

Artemisia annua also contains many other chemicals including the anti-inflammatory scopoletin, which could explain its ability to reduce fever. One of these other chemicals is a methylated flavonoid which increases the action of the artemisinin, although it does not actually kill the parasite itself. Could these play a part in its action in preventing drug resistance to artemisinin?

Principle 2: Chemical cocktails

Yellow berberine drug seen in Phellodendron amurense bark (huang bai)

A single herb plant has manufactured many chemicals which have evolved to enable growth and reproduction and to protect themselves from environmental stress. Plants have an immune system which can react within seconds to a predator to protect them from being eaten or resist disease pathogens such as virus or bacteria. As these pathogens have evolved new methods of attack, so the plant has manufactured new chemicals. But they also retain the old chemical defences creating a historical armoury and ability to act in several ways at the same time.

Bacteria and other pathogens that attack humans are not that different in structure than those that attack plants. They have similar cell walls and use similar methods to attack. Hence it is not surprising that they can also work for human pathogens.

One drug that has attracted research is the alkaloid berberine. This is a chemical found in many herbs used in most traditional medicine systems for treating infection and also the underlying inflammation. Examples include Phellodendron amurense, Coptis chinensis, Mahonia species, and Berberis species.

Isolated berberine alkaloids in pure form do have antimicrobial activity. When there are only a few bacteria they secrete a chemical that attracts other bacteria. However, when the bacterial colony reaches a certain size, they produce a different chemical which causes them to secrete a slimy biofilm over the entire bacterial colony.

This alteration in response to bacterial population numbers is known as quorum sensing. Berberine is thought to destroy the biofilm protection defences by the bacteria. Berberine can also weaken the bacterial cell wall and enter the bacteria causing more damage. The bacteria have evolved a mechanism known as an ‘efflux pump’ which literally pumps the berberine back out. As a counter strategy the plant produces another chemical (5 methoxyhydnocarpin) which inhibits the action of the efflux pump.

One of the reasons that penicillin was so effective for so long was that it contains two lines of attack on the pathogen. When we subject a pathogen to a single attack, it is relatively easy for it to evolve a response.

A simple attack promotes a simple evolutionary defence and drug resistance can develop more quickly. This may explain why plants have often developed diverse chemical strategies. These may include chemicals which can attack in more than one way, or a group of chemicals which can launch a complex attack or increase the action of each other.

Principle 3: Synergy – more than the sum of the parts

Scuttellaria baicalensis (huang qin)

The ability for a mixture of chemicals to have a greater effect than ether on its own is termed synergy. We can see this in all the examples given but I would suggest that synergy is central to the action of all herbs and it is what distinguishes the action of a drug from that of a herb.

Synergy has been observed where a herb or extracted chemical from a herb is given at the same time as an antibiotic drug which has ceased to become effective as in drug resistance. The combination can be more powerful than either the herb alone or the antibiotic (38-47).

The root of Scutellaria baicalensis (huang qin) is a traditional Chinese herb that has been used for at least 200 years as a herb in the damp heat class (6,7,8).

From a western perspective it has been employed for reducing fever, treating hepatitis and for infection in the lungs, bowel and bladder. The main active component has been isolated as the polyphenolic flavonoid drug baicalein. Phenolic compounds are often used as antimicrobial compounds (3).

Recently attention has been turned on the ability of baicalein to kill cancer cells. Drugs used in the treatment of cancer are also becoming less effective due to drug resistance by cancer cells (4-52). Baicalein as a drug has shown potent activity against pancreatic cancer cells, which are by nature fiercely resistant to cell death (21-24).

It also has few side effects which is a bonus when treating this disease. The mechanism of action on cancer cells is multi layered. In this case 3 mechanisms have been found. It appears to decrease the ability of the cancer cells to produce a protein which enables the cancer cell to evade cell death.

All cells, including cancer cells, have a programme which causes the cell to die. This is called apoptosis. Baicalein is causing this apoptosis programme to be triggered in the cancer cell. Finally, baicalein inhibits the fat metabolism pathway that enables proliferation of the cancer cells. In other words, this appears to be a highly sophisticated multi action weapon developed by the plant. Plants also suffer from cancer diseases.

Baicalein is also only 1 of 50 flavonoids in the plant which act more effectively if used together as opposed to a single drug extract (25-27). A whole extract of Scutellaria baicalensis has been demonstrated to resensitise drug resistant MRSA bacteria to become susceptible again to conventional antibiotic (26-31).

The use of complex whole herb extracts at the same time as a lower dose of strong antibiotic drugs is a novel approach to antibiotic resistance. Synergy research has become a new development in the pharmaceutical industry so we may see a new approach developing in the future (38,39,40).

Principle 4: Regulate the immune system

Astragalus membranaceus is a member of the pea family (Fabaceae)

All the above examples are focused on killing parasites. This is a natural way of approaching the problem. The battle between pathogens and host is as old as cellular life evolved and drug resistance is not a new event. The creation of concentrated antibiotics drugs has been a true life saver and the search for new antibiotic drugs with new strategies of attack will continue as it has done in plants.

However, if a person is weak then it is just as important to regulate the host immune system.

Herbal medicine does not have the same power to deal with acute infection, but it does have a potential role in long-term balancing of the immune system. Within the Chinese materia medica there are herbs which are traditionally used to strengthen the immune system.

One key herb is Astragalus propinquus (huang qi). Over 100 chemicals have been isolated from this herb including polysaccharides, flavonoids and saponins (7). Most attention with respect to immunity has centered on the effects of the saponins which are steroidal in form.

Unbalanced immunity can be deficient leading to a lack of response. However, it can also be excessive causing allergies, autoimmune diseases or chronic inflammation. The pharmacology of Astragalus has yet to be studied in any real detail but there is some evidence that in vitro, these saponins promote B cell proliferation and antibody production.

Whilst it may appear that Astragalus does have some components in the form of steroidal saponins, which have effects similar to or are synergistic with the drug interferon (7) which triggers immune responses, as a whole herb it has demonstrated an ability to control chronic bowel inflammation from an overactive immune response (54,55).

Panax ginseng root (ren shen) has adaptogenic properties

Astragalus membranaceus belongs to a class of herbs which are considered to be adaptogenic. This means they have the ability to help the body adapt to stress, which includes attack by a pathogen.

The action of adaptogens is complex but thought to work in general through the hormone mechanism by regulation of cortisone and adrenal function (53).

Plants also have a well developed hormonal system, and the structure of hormones across plants, insects and man is similar. It is interesting to note that the chemistry of these steroidal compounds in astragalus, which is in the plant family of Fabaceae, are similar to other key adaptogenic herbs in an unrelated family. Panax ginseng (ren shen) and Eleutherococcus gracilistylus (wu jia pi) in Araliaceae also contain steroidal based glycosides.

Panax ginseng (ren shen) has been studied in more depth and it appears that there are 2 main groups of steroidal glycosides at work. The first are the triol gingenosides (Rg1) which stimulate the body and the other are the diol gingenosides (Rb1) which are sedating and calming.

The action of these on the body is considered to be via the hypothalamus and adrenal glands (56). Contradictory actions within a single herb are not uncommon and this may be how they can regulate. This is also seen in sugar regulation where the whole extract of Panax will reduce blood sugar levels in hyperglycaemia but raise it in hypoglycaemia. They are more homeostatic in action than simply synergistic.

What can we gain from this type of analysis? With the combined knowledge of traditional herbal experience and modern scientific precision we can learn from plants which have been working on the problem of drug resistance for millions of years longer than humans.

References

More insight on TCM and the gardens in Bristol are shared on the RCHM youtube channel.

General references

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Artemisia Annua
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Scutellaria baicalensis
Bonham M, Posakony J, Coleman I, Montgomery B, Simon J, Nelson P. Characterization of Chemical Constituents in Scutellaria baicalensis with Antiandrogenic and Growth-Inhibitory Activities toward Prostate Carcinoma. Clinical Cancer Research. 2005;11(10):3905-3914. doi:10.1158/1078-0432.ccr-04-1974
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Fujita M, Shiota S, Kuroda T et al. Remarkable Synergies between Baicalein and Tetracycline, and Baicalein and β-Lactams against Methicillin-ResistantStaphylococcus aureus. Microbiol Immunol. 2005;49(4):391-396. doi:10.1111/j.1348-0421.2005.tb03732.x
LUO J, YAN D, YANG M. Study of the anti-MRSA activity of Rhizoma coptidis by chemical fingerprinting and broth microdilution methods. Chin J Nat Med. 2014;12(5):393-400. doi:10.1016/s1875-5364(14)60049-2

Berberine
Zuo G, Li Y, Han J, Wang G, Zhang Y, Bian Z. Antibacterial and Synergy of Berberines with Antibacterial Agents against Clinical Multi-Drug Resistant Isolates of Methicillin-Resistant Staphylococcus aureus (MRSA). Molecules. 2012;17(9):10322-10330. doi:10.3390/molecules170910322
Zhang S, Zhang B, Xing K, Zhang X, Tian X, Dai W. Inhibitory effects of golden thread (Coptis chinensis) and berberine on Microcystis aeruginosa. Water Science and Technology. 2010;61(3):763-769. doi:10.2166/wst.2010.857
Stermitz F, Lorenz P, Tawara J, Zenewicz L, Lewis K. Synergy in a medicinal plant: Antimicrobial action of berberine potentiated by 5′-methoxyhydnocarpin, a multidrug pump inhibitor. Proceedings of the National Academy of Sciences. 2000;97(4):1433-1437. doi:10.1073/pnas.030540597
Stermitz F, Beeson T, Mueller P, Hsiang J, Lewis K. Staphylococcus aureus MDR efflux pump inhibitors from a Berberis and a Mahonia (sensu strictu) species. Biochem Syst Ecol. 2001;29(8):793-798. doi:10.1016/s0305-1978(01)00025-4
Wojtyczka R, Dziedzic A, Kapa M. et al; Berberine Enhances the Antibacterial Activity of Selected Antibiotics against Coagulase-Negative Staphylococcus Strains in Vitro. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6272005/. Published 2014. Accessed September 1, 2022.

Synergy
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Cancer
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Immune regulation (adaptogenic)
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The post Ethnopharmacology: Where science and traditional wisdom meet appeared first on Herbal Reality.

Chaga (Inonotus obliquus): A mushroom with many medicinal properties

Jessika Thiele — Thu, 21 Apr 2022 18:16:04 +0000

Medicinal fungi like chaga have boomed in popularity in recent years. This article shares some of the potential ways it can support our health.

Chaga mushroom

Chaga (Inonotus obliquus) is a black, parasitic mushroom, which looks on the outside like a lump of burnt, craggy charcoal; it belongs to the Hymenochaetacea family of fungi. The genus Inonotus is widespread is widespread in North America, Asia and Europe and comprises around 100 species, represented in Europe by four species, one of which is Inonotus obliquus.

Chaga (Inonotus obliquus)

The term ‘chaga’ most probably derives from Russian; chaga is also known as birch conk (a woody growth), clinker polypore, cinder conk and black mass, and may usually be found on the boles of birch trees, (1) though occasionally on other trees: on alder, ash, beech, chestnut, hornbeam, plane-tree, poplar, maple, rowan, oak, walnut, and willow. However, reports on the growth of chaga on trees besides beech are often unreliable as the fungus growing on the other kinds of tree are similar and often confused with chaga. (2)

Chaga grows externally on the bark of the host tree, be it living, dead, standing or fallen. Under the black surface, the chaga mycelium is an orange/brown colour. It causes the decomposition of live boles and usually grows to around between 25-40 centimetres; it dries to a consistency similar to that of hard cork. Chaga usually infects trees that are 30-40 years old through wounds in the bark and can continue to grow on the bole for another 30-80 years. On old trees the growth of chaga can exceed 50 cm in diameter. (3)

Low in calories, high in fibre, and rich in minerals and vitamins, chaga has been used as a traditional medicine in various cultures since time immemorial, particularly in Russia, China, Poland (4) and the Baltic countries. It is also used for food in China. (5) Chaga is used to treat diabetes, parasites, tuberculosis, inflammation, gastro-intestinal problems, heart disease and several kinds of cancer. (6)

Perhaps the oldest reference to the use of chaga as a medicine is by Hippocrates (c. 460–370 BCE) in his Corpus Hippocraticum, in which is described the use of infusions of chaga to wash wounds. (7)

For medicinal treatments chaga is usually ground to a fine powder and made into a tea, which tastes like mushrooms. It is also available in capsule form as a supplement, sometimes in combination with other mushrooms, such as cordyceps.

However, many commercial products are simply unprocessed powdered chaga without having been extracted. This means the active compounds are not bioavailable and so one must be careful when buying a product that the quality is good and that the preparation process is clearly explained if it is simply a powder and not an extract.

Chaga and cancer

Chaga (Inonotus obliquus)

The chaga mushroom has been the subject of many scientific investigations to explore its medicinal properties, particularly by researchers in South Korea. (8) Chaga has been shown to be effective in reducing cancerous tumours, thereby suppressing the progression of cancer, through promoting energy metabolism. (9)

In the semi-autobiographical novel Cancer Ward by Aleksandr Solzhenitsyn, set in Russia and first published in 1968, cancer patients are prescribed chaga tea.

Several studies on mice and on human cells in vitro have demonstrated the effectiveness of chaga as an anti-tumour agent, effective in the treatment of several kinds of cancers, including cancer in the colon, (10) liver, (11) prostate, breast, (12) lung, stomach, and cervix. (13)

Compounds known as triterpenes/triterpenoids have been extracted from chaga and found to be effective in killing breast cancer cells. (14)

The chaga fungus contains inotodiol (a lanostane triterpenoid), which has anti-tumour properties. (15) Inotodiol and betulin (another triterpenoid with a lupane structure) are found almost exclusively in the fungus growing on birch trees. (16)

Betulin forms up to 30% of the dry weight of silver birch bark; it is found in large amounts in chaga and has anti-cancer properties. (17) It is currently believed that the anti-cancer potential of the mushroom is primarily due to the high content of polysaccharides (18) in the mushroom. (19)

The immune system

Chaga has the full spectrum of immune-stimulating phytochemicals found in other mushrooms, such as in maitake and shitake, (21) which are widely consumedin Japan. It has been found that the compounds in mushrooms in general that inhibit tumour growth do so mostly by stimulating the immune system. (22)

Chaga may be useful as an immune enhancer in people with either suppressed or compromised immune systems, who may develop auto-immune diseases such as psoriasis, rheumatoid arthritis or type 1 (auto-immune) diabetes. Chaga is a potent immune modulator and could also be used to treat people whose bone marrow has been damaged by chemotherapy. (23)

Inflammation

Many studies have confirmed chaga’s anti-inflammatory properties. (23) One study (24) concluded that chaga could be useful to treat inflammation, notably in bowel disease. It has now evident that inflammation is implicated in numerous health issues, including anxiety, unipolar and bipolar depression, schizophrenia, post-traumatic stress disorder, asthma, rheumatoid arthritis, cardiovascular disease, obesity, diabetes, osteoporosis, Alzheimer’s disease, certain cancers and stroke.

Eight out of ten of the leading causes of death in the USA involve inflammation. (25) More research is needed for specific inflammatory processes and conditions, however it would be a viable investigation route to see how chaga can effect illnesses where inflammation is involved.

Anti-oxidant

Chaga (Inonotus obliquus)

Besides being anti-inflammatory, chaga is also rich in anti-oxidants, (26) the main anti-oxidants being polyphenols and triterpenoids. As noted above, triterpenoids are effective against some forms of cancer. Antioxidants can prevent or reverse damage to cells caused by aging, the environment or lifestyle.

Polyphenols can help manage both blood pressure and blood sugar levels, and reduce chronic inflammation. There are around 8,000 kinds of polyphenols, which are in many kinds of foods in greater or lesser quantities. Some of the commonly consumed polyphenols include flavonoids, such as quercetin and catechins, which are in fruits; capsaicinoids, in chili peppers; lignans and stilbenes, in vegetables and whole grains; resveratrol in red wine; and ellagic acid in berries.

High levels of anti-oxidants are in chokeberries, elderberries and blueberries. (27) However, several surveys indicate that the highest levels, by far, of anti-oxidants in plant sources are in chaga. (28)

Chaga is particularly rich in the antioxidant known as superoxide dismutase (SOD), which has been shown to reduce free radical damage, preventing wrinkles and having an anti-cancer effect. (29) Several extracts from chaga, including polysaccharides, have also been shown to have neuroprotective effects in degenerative diseases such as Alzheimer’s and Parkinson’s. (30)

Diabetes

Studies on the effect of particular compounds in chaga have indicated that after four weeks they can significantly reduce the body weight, blood glucose levels, and plasma insulin levels of mice with diabetes. (31) It has been shown that the polysaccharides in chaga have hypoglycaemic activity, reducing blood sugar levels. (32)

Other studies, (33) also on rats and mice, confirm that chaga is antioxidant, can reduce blood sugar, and provided further indications that chaga would most probably be effective against diabetes in humans.

Anti-bacterial, anti-parasitic, anti-viral

Chaga (Inonotus obliquus)

Two studies suggest the anti-bacterial and probiotic effect of chaga; another study indicates the anti-parasitic properties of polysaccharides in extracts from chaga. (34) The betulin in chaga can easily be converted to betulinic acid, which has been shown to have antiviral activity against HIV and malaria. (35)

Polysaccharides extracted from chaga have been shown to be effective against other viral infections, including herpes, feline influenza (and other feline viral infections), and hepatitis C. (36)

It has been found that chaga modulates immune responses through secretion of cytokines in immune cells, and regulates antigen-specific antibody production. Chaga can increase serum levels of chemoprotective cytokines, (37) which are proteins that regulate the immune system and stimulate white blood cells, which protect against harmful bacteria and viruses.

Cytokines are also implicated in SARS-Covid infection, which causes illness through a cytokine ‘storm’. The triterpenoid inotodiol found in chaga, mentioned above, has been found to induce the proliferation of T-cells, which act against viral infection. (38) So, it may be that chaga can protect against the SARS-Covid virus.

Cholesterol

Besides its other effects, chaga has also been shown to be able to reduce levels of total cholesterol in rats, (39) high levels of some forms of cholesterol being a factor in heart disease. It seems that it is the antioxidant effect of chaga that reduces cholesterol.

Testosterone

It has also been found that the polysaccharides in chaga increase in mice the production of sperm and testosterone, and ameliorate impaired reproductive function. (40)

The birch tree

Birch (Betula alba)

Birch trees are native to northern latitudes of the world: to Russia, Siberia, northern Europe, Canada, Alaska, northern China and Korea. There are far more birch trees in Scotland than in England. The ancient Balts, Slavs and Finns regarded the birch as a sacred tree.

In pre-Christian Ireland, birch was considered as one of seven sacred trees. (41) The name ‘birch’ derives from the Proto-Indo-European (PIE) root *bher∂g, which means ‘shine’/’brilliance’/’white’, reflected in names such as Albert, Herbert and Robert. (42)

The Celts saw in the birch the deity Brigit/Brigid, whose name derives from the same root, *bher∂g. Brigit was the muse of healers and bards in pre-Christian Ireland, where smitten boys would place fresh, green birch twigs in front of the house of the one they were courting. (43)

Birch twigs used to be used in Europe for the beating of bounds and the flogging of delinquents – and formerly lunatics – to expel evil spirits. In Scandinavia the first leaves of birch mark the beginning of the agricultural year. The witches’ broom used to be made from birch and ash. (44)

In India, the birch tree is called bhūrja in Sanskrit. In north India, texts used to be inscribed on birch bark, which is used by North American Ojibwa Indians for many other purposes, such as for tools, mats, canoes and baskets. (45) The sap of birch trees is used to make a sugar substitute, known as xylitol. Birch sap has less sugar than maple and is used as a syrup by Lithuanians. (46)

In herbal medicine the sap of birch is believed to stimulate urine and bile, purify the blood, and strengthen the urinary tract. (47) Tea made from the leaves of white birch is used for dissolving kidney stones and as a laxative. Twigs and leaves are added to bath water as a treatment for itchy skin and hair loss, while the inner bark is simmered for fever. (48)

Conclusion

Chaga (Inonotus obliquus)

In the last couple of decades, numerous scientific studies have indicated the potential for chaga to treat several common diseases, including cancer and diabetes, as an immune-system booster, as an antioxidant, and against harmful viruses.

Although the scientific tests so far have been almost exclusively conducted on rats and mice, and many of these studies lack in-depth experiments, (49) it seems highly likely that such effects would be replicated at least to some degree in humans. It should, however, be cautioned that chaga can prevent blood clotting, (50) so it should not be used by anyone using blood-thinning medication.

As mentioned above, the birch tree is revered in several cultures, notably by the Balts, Slavs and Finns. It has been suggested by some commentators (51) that this reverence for the birch tree may derive from the fact that one of the main places where the red, spotted, fly-agaric mushroom (Amanita muscaria) may be found is beneath birch trees.

Fly-agaric has psychedelic effects and is used for shamanic purposes in some cultures in Siberia and North America. (52) It was famously, though incorrectly, (53) identified in the late 1960s by R. Gordon Wasson – one of the great mycologists of the 20^thcentury – as the ‘nectar of immortality’, the ritual drink known as soma, (54) which is revered by the Brahmins of India. However, leaving this suggestion aside, perhaps, as a speculation, reverence for the birch tree has, instead, practical roots in the ancient use of chaga as a wondrous medicine.

References

Betula fontinalis, Betula lenta, Betula lutea, Betula papyrifera, Betula pendula (silver birch), Betula pubescens/alba (white birch).
Szychowski et al. (2021:293).
Szychowski et al. (2021:293).
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In one survey (WebMD 2020) it is reported that the foods with the highest levels of antioxidants are (per half-cup serving) chokeberries (1,123 mgs), elderberries (870 mgs), blueberries (535 mgs) and blackcurrants (485 mgs). Blackberries, raspberries and strawberries have around 160 mgs. Per ounce, cloves contain 542 mgs, and peppermint 427 mgs. Dark chocolate has 249 mgs per tablespoon (milk chocolate has just 35 mgs). Of all nuts, the most polyphenols are in chestnuts, with 347 mgs per ounce. Other sources of polyphenols include flax seeds (229 mgs per tablespoon); a small artichoke has around 260 mgs; a small red onion has around 170 mgs; an olive has around 20–25 mgs; and a cup of coffee has about 35 mgs of polyphenols.
Acai berries reportedly contain 165 oxygen radical absorbent capacity (ORAC) units, pomegranates 105, and blueberries 24; chaga contains 1,104 (Chichaga 2015; Wild Kingdom 2022).
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How to become a Herbalist

Jessika Thiele — Wed, 30 Mar 2022 19:17:45 +0000

There are many things to think about when training in herbalism, and this article guides you on what to look for to make sure you get the most out of your training.

There is a growing interest in herbs, herbalism and plant medicine in general. More and more articles appear in the media and on social media, including some ads that pop up claiming to fully train herbalists from £50.00 and in alarmingly short periods of time. It takes time to become a herbalist and even when the training is completed, it is a continuing process of life long discovery and learning.

A plant science professor friend said to me that herbalists are rather unique since we have cross disciplinary learning covering plant sciences, human , clinical knowledge as well as understanding the philosophy of healing. We are a quite unusual people in these times of reductionist and specialist trainings. The interdisciplinary art and science of herbalism gives a worldview that is most valuable for the times we live in.

In this article we will explore the journey to becoming a herbalist practitioner.

“There are people and plants who form part of the herbal network or web as the mycorrhizal network underpinning the world of plant medicine, and the clinical professional herbalists are like the fruiting bodies that pop up and help to spread and extend the web.” – Andrew Flower

The herbal network includes growers, wildcrafters, manufacturers, educators, historians, researchers, chefs and cooks, scientists, lifelong enthusiasts and also the practitioners. Without the mycelium and supporting biome, the practitioners would not come into being.

With such a diverse ecosystem, there are many ways to be part of it and many paths to be explored and some people decide they do indeed want to become practitioners.

Becoming a herbalist practitioner

Each person’s journey to becoming a herbal practitioner is highly personal and may be influenced in various ways:

Family or community
Successful treatment of a condition by a practitioner or someone in the community
Reading
Botanical gardens or places in nature
An enthusiastic teacher at primary or secondary school
Workshops
Introductory training leading to more in-depth studies
Apprenticing to a practitioner

These are some of the things that may kindle an interest in pursuing this vocation.

Anyone who starts to explore the rich ecosystem of herbal healing will at some point decide whether they are a lay enthusiast or wish to take their learning to a deeper level to become a professional/vocational herbalist.

Many people start with a foundation or introductory course to see if this path is indeed for them and there are some excellent ones such as:

This list of foundation trainings is not exhaustive, there are others of excellent quality and it really depends on what kind of course, teaching methodology and teachers appeal to you. There are also quite a few herbalists running short introductory taster courses in domestic herbalism, gathering or growing herbs.

You can find a list of herbal practitioner schools and courses on our Study herbalism page.

Pathways to becoming the herbalist one wants to be

In order to become a herbalist one needs to decide on one’s pathway, although this may evolve and change of time and as one studies.

When choosing where to train, it is important for a person to identify the best fit for them.

Some people like a more reductive biomedical or scientific approach and some prefer a more experiential and relational approach. It is important to explore the approaches taken by the various training establishments before making a choice.

One also needs to decide on the style of practice and the energetic system they wish to learn-TCM, Ayurveda, Western traditions, ethnic energetics from one’s own cultural background, Biomedical, Psycho-emotional, Relational for example. Some trainings are multifaceted, combining several approaches. There is no single way to practise herbalism so it is important to find what feels right for you.

There are also the practicalities of time available and finding a course structure that fits into your life commitments.

Then there is whether you prefer more online or in person learning, although most of the courses combine a mixture of the two as an adaptation to the times we live in.

Finally, there is the element of cost.

Thankfully, these days there is a breadth of training available and many of the schools are now working together to ensure inclusivity, diversity and mutual support between schools to open up student centred learning which helps the student become the kind of herbalist they wish to be and excel at it. It is exciting to see many of the schools collaborating to build a student centred approach with the possibilities of exchanges and decentralisation of learning but with the mentorship and guidance of the chosen ‘home’ school there to support and evaluate progress.

The purpose of undertaking a training is to gain the core competencies needed to be a herbalist of quality and of practitioner capacities.

Evaluation of competencies

The core competencies needed to become a proficient herbalist include most, if not all, of the following:

Safety (herbal safety, red flags, drug herb interactions , posology or dosage facts)
Professionalism-legal and ethical practice. Understanding the scope and limit of practice
A knowledge of materia medica, the herbs used in one’s tradition, and sources of sustainable supply of herbs
The capacity to study and integrate evidence from different knowledge sources including traditional, creative, and scientific. Both literary sources and direct experience
The capacity to assess and diagnose
A knowledge of medicine making, pharmacy, pharmacognosy and dispensing.
Nurturing diversity and inclusivity and developing a culturally appropriate paradigm, including an understanding of the history and politics of plant medicine ( removing erasure, colonialism, commodification and appropriation)
Patient-centred care-integrative and holistic. Acknowledging the importance of physical, emotional, mental and spiritual aspects of wellness. The capacity to offer advice on diet, lifestyle and other factors contributing to health and wellness in an achievable manner taking account of financial, cultural and other factors.
Reflective practice
Practice-based learning
Sustainability-ecological, social and economic
Communication skills

For a person training to be a herbalist there are 2 main options as regards the evaluation of competencies gained.

Most people attend their school/college of choice and work through the programme gaining competencies until they reach their final assessments and graduate.

Other people may have gained competencies in another country or in several locations and therefore their experiential learning needs to be evaluated to ensure they have gained the required competencies.

In the latter case some of the schools offer a bridging training whereby any gaps in studies and competencies are filled rather than having to undertake a complete programme. Alternatively, several of the professional associations offer a grandparenting process to enable those who have not undertaken an accredited course to identify any gaps and give advice on how to fill these to achieve the required level of competencies needed. These processes are often honed to make them more user friendly in many instances.

Along the journey to becoming a herbalist there may be many influences and detours, explorations and experimentations. And when one gets the piece of paper the learning and development does not stop- it is more of a starting point again since there is so much to learn and explore. This is the evolution of the practitioner. It truly is a lifelong journey. Continuing professional development and reflective practice are a valuable and necessary part of the practitioner’s work.

It is also important to check if one can get insurance as a herbalist with the course they choose to embark on. Check if schools are accredited with a verified regulating body and call the school, and insurance companies to be sure. This applies if you plan to take on patients as a practitioner.

What kind of herbalist do you want to be?

Once a person has become a practitioner the next step is to decide how they are going to use their skills and this may change over time. It may also be influenced by how they came to decide to be a herbalist in the first place.

Some people choose to have a consulting practice working in a clinic one to one with patients as their entire work.

Others may decide to use their skills in developing products and supplying these OTC either in a shop setting or over the internet.

Some may decide they wish to work with the plants-growing harvesting and processing.

Some go into research whether historical, lab based, ethnobotanical and traditional herbal practice or one of the other fascinating areas of this discipline.

Some go into a more artistic way of working- story telling and writing, drawing, painting, dyeing, fabricating, performance art.

Then there are those who wish to use their knowledge to share information and skills with those who wish to use herbs for the health of themselves, their family and community. They may run workshops and short course about plant identification, wild crafting, growing herbs, simple medicine making or other skills. They help people learn how to safely harvest and prepare their own domestic remedies from the plants growing around them and also from kitchen materials and ingredients like ginger, cabbage, cinnamon, salt and many more.

Practitioners may work with in their local communities with special interest groups, schools, community gardens, active retirement groups and many other groups to educate and teach safe community herbalism.

By broadening the concept of what a herbalist is from purely a consulting practitioner we see how those who have trained can use their expertise and knowledge to further promote and educate people about the value of our medicine so that we can work towards once again having a herbalist in every community and communities where herbal medicine is seen as a first choice in health care and a vibrant and valuable part of keeping ourselves well and treating disease. All this helps to shift the societal culture forwards to a place where this potentially most sustainable form of medicine is once again central in our culture. This is the way it is for over 60% of the world’s population.

The post How to become a Herbalist appeared first on Herbal Reality.

Sweet ‘n’ Sour: The importance of taste and food energetics in Traditional Chinese Medicine

Jessika Thiele — Sun, 06 Mar 2022 15:46:43 +0000

Food plays a critical role for maintaining balance and harmony. Charles Buck explains how tastes are used to enhance our wellbeing.

Food plays a critical role for maintaining balance and harmony in Traditional Chinese Medicine. Taste is a signifier of the “energetics” of a food, and therefore what role it will play in the body. In this article, Charles Buck explains the philosophy behind this, and how tastes are used to enhance wellbeing.

Traditional Chinese food energetics

Ginger (Zingiber officinale)

Eating lunch in our clinic reception Dr Liu winced.
What’s the matter? we asked.
Oh, my food today is very bitter – it tastes horrible!
Why are you eating that if it tastes so bad? Are we not paying you enough?
No, I need to balance the tastes my diet, and so I sometimes eat bitter things.
Dr Liu had put a massively bitter vegetable in her lunch, and she had done it on purpose!

It’s not just traditional-style doctors that balance their food intake like this, most people brought up in Chinese culture have at least a basic understanding of the ancient principles of a healthy diet.

People know that diet is an important key to staying healthy and that this is partly about including all of the five main flavours: sweet, sour, salty, pungent, bitter. Actually, there’s a sixth one – blandness, plus the Japanese have added yet another – umami-savoury – but let’s not get too distracted.

Taste	Herb
Pungent	Onion, garlic, ginger, radish, mint, mustard, chilies
Sweet	Honey, cherry, chestnut, banana, parsnip
Sour	Lemon, grapefruit, vinegar, plum, mango,
Bitter	Bitter gourd, hops, lettuce, andive, coffee, chicory
Salty	Salt, meat, fish, seafood, seaweed

Bitterness is not found in many foods probably because it the most unpalatable flavour. In the far east the best known vegetable with this taste is bitter gourd – a knobbly cucumber-like vegetable that is so extremely bitter even most Chinese struggle to get it down. Apart from beer, the nearest we get to consuming bitter substances here in the west is chicory – which is only mildly bitter. Dr Liu was eating it to make up for its lack in her routine diet and for its reputation as a de-tox food that helps the body to remove heat and dampness from the body. Most Chinese herbal medicines that have this de-tox effect also taste very bitter.

The roots of China’s traditional view on diet go way back to the dawn of high-civilisation in China at the start of the Han dynasty around 220BC. The qualities of foods were detailed in a key founding textbook of Chinese medicine and acupuncture the Huangdi Neijing (the Yellow Emperor’s Classic of Internal Medicine), a textbook that is still considered important reading today in Chinese medicine universities.

Chinese people have always had a strong cultural pressure to take care of themselves, to do everything possible to maintain good health. This is the result of a cultural belief that your ancestors were taking note of your behaviour and any lack of care would bring bad luck. Your body was not entirely yours but was gifted to you from your ancestors and had to be treated respectfully to avoid ill fate raining down on you.

With especially bad misbehaviour ill fortune could fall not just on you but on your whole family and, worse still, on your whole town – bad stuff happening would be your fault! To this day many older people raised in the traditional ways ask to keep any body parts removed during surgery so later they can go to their grave whole, with no parts lost in life’s journey and with less risk of ancestor displeasure.

So, for over 2000 years body care – yangsheng – has been an obsession for both the general population and the educated classes. It is not only good for your health but is a good thing for everyone that you take good care of yourself and a crucial way to do this is through good diet.

Here in the west dieticians have emphasised the nutritional properties of foodstuffs; measuring calories, fats, vitamins, trace elements and so on. Sometimes the simplifications can seem absurd; oranges are vitamin C, potatoes are carbohydrates, whole grains are fibre… and so on.

The assumption is that there is a universal good diet that supplies the nutritional components we need for health. For sure such insights are valuable in many ways but, from the perspective of Chinese medicine something important is missed out.

How food affects us from a TCM perspective

One thing that is distinctive about the Chinese approach is that their physicians have always taken more interest in understanding the effects that different foods have on our bodies. Like medicines, foods were considered to have a pharmacologic influence our bodies – the only difference is they do this in a milder way than full-blown medicines.

However, the fact they are consumed day-in day-out, year-in year-out they can have a big influence accumulated over time. Also, like medicines, foods can influence our inner workings either in ways that are either beneficial or unsuitable for us. Chinese medicine believes that foods should match your body state – which itself can change from time to time. For example some foods are more suitable for us in the winter and others in the summer.

Where nutritional science used words to describe the chemical properties of foods and medicines, Chinese doctors sought terms to described their effects – their energetic properties, the things that happen to you when you consume them.

This is one reason the language and thinking style of your professional Chinese medicine physician differs from that used by your doctor. It is not that one way is right and the other wrong or one is better than the other, they just focus on different things. Like having one map that shows roads and another that represents the landscape.

To be in tune with the Dao -the path of nature – included the idea of eating foods that match your body state and that accord with your age, the seasons and your personal constitution.

It is as though China’s ancient physicians had heard Hippocrates say “let food be your medicine” and today most Chinese people have a repertoire of simple food remedies – ginger and spring onion soup for the beginnings of a cold, watermelon for heat stroke, radish root to help digestion.

The notion of balance is at the heart of this and this includes the idea, as Dr Liu said, of not constantly eating the same few things but including all the variety of tastes in one’s diet. The Neijing text (written around 200BC) describes the effects of eating too much of specific flavours, saying things such as; excess sweetness makes the flesh go flabby, too much pungent food weakens your qi and yin, salty foods will dry your tendons out.

So foods were described less in terms of nutritional content and more in terms of what effect substances have on the body – harmful or therapeutic depending on the interaction between the food and your body state.

The effects of each taste on our bodies

“Pungent flavours disperse, sour flavours pucker up, sweet flavours harmonise, the bitter flavour hardens the salty flavour softens.” – Neijing SuWen Chapter 22

Pungent-acrid foods, such as garlic, chillies and Szechuan peppers, tend to affect those aspects of our bodies associated with the lungs – the nose and sinus’s and the sweat glands of the skin and have an invigorating and outward and upward moving effect. And, sure enough, onions and chillies make your nose run!

Bitter foods were found to have drying, detoxifying and downward moving effects on body functions and were often found to have a cooling effect.

To our modern minds some of this can seem a bit odd because in our culture we are accustomed to different perspectives. Recently though, science is beginning to find support for many of Chinese medicine’s teachings such as the idea that flavours can be linked to effects. Most antibiotic drugs are extremely bitter taste that Chinese medicine would say suggests they can be used to remove heat and fire toxins.

Interestingly, receptors for tastes, that were believed to be confined to the tongue are now being discovered in our internal organs – bitterness can be ‘tasted’ by the heart!

The more closely we investigate China’s ancient medical wisdom the more remarkable it gets. When we move up a level up from looking at responses to individual flavours we find new subtlety in the way that the tastes coordinate together.

Sweetness is a said to calm and mollify, to take the edge off pain, to soften urgency and slow things down – something that has also been noticed by science. Pungency is the opposite – it moves, stimulates and enlivens. That sweet chilli sauce on the Chinese supermarket shelves is revealed as a balanced medicinal food substance!

The sweetness balances and softens the chilli’s harsh pungency which itself counters the cloying-stagnating effects of sweetness. Combining sweet and sour also has a rationale. Digestion requires good coordination of stomach and liver functions – sweetness is said to strengthen the digestive organs and sourness helps the liver function properly. In this view food flavours can be combined not just to taste good but strategically for health benefit.

Besides studying the effects of flavours China’s traditional approach to medical science considered other attributes of things we might consume. Substances could be classified by their temperature energetic as hot, warm, neutral, cool and cold and these qualities interact with our physiology in positive or negative ways. It seems self-evident that a person with a high fever would do well to avoid foods and other substances with a heating effect but a person with a chilly constitution might do well to include warming substances in their diet such as ginger, cinnamon or cloves.

Early thinkers also had a sense of direction. Some types of melon stalk can make you vomit so the effect on your stomach is to make it’s qi go the wrong way – upwards instead of downwards. Although toxic in high doses, bitter almond kernels were found to ease coughs – a sign that the movement of your lungs is going upwards instead of down, so this medicinal substance can be said to have a descending effect on the qi of the lungs.

Sweating happens when your fluids move outwards so substances that make you sweat, foods such as ginger and chillies and medicines such as ephedra, by definition, have an outward pushing effect on your body. What we consume should be appropriate to our needs and there are many ways we can look at this.

How this wisdom is used

Looking into Chinese medicine we find an appealing yin-yang outlook in which the infinite complexity of the body and nature as a whole is approached using simple binary choices. In terms of body function we can ask; is this hot or is it cold? are things moving or getting stuck, are they moving in the proper direction?

Is there a lack of something that needs to be supplied or is there an excess of something that should not be there and that needs to be removed? Where is the problem happening? Is it on the exterior of the body or on the interior? Where on the interior?…..

This binary approach to analysis is interesting because it is plainly rational and because it emphasises an understanding of function. It uses a consistent and time-tested way of labelling physiology and pathology and of matching dysfunction to suitable medical interventions – be they diet, medicinal substances or physical interventions such as acupuncture.

China’s medicine is a search for appropriateness – finding out ways to interpret the readout from our bodies to know when things are starting to go wrong, labelling that dysfunction so that you can know what is most suitable for that person at that time. Knowing a little of this system helps us do a good job of managing our own health. However sometimes we slip into actual illness and this is a time when should seek the expertise of a degree-trained TCM professional.

Keep your ancestors happy – Look after yourself!

Resources

In the UK, the leading professional practitioner registers that recognise degree-qualified clinicians are:

The Register of Chinese Herbal Medicine (RCHM) https://rchm.co.uk/
The British Acupuncture Council (BAcC) https://acupuncture.org.uk/
The Association of Traditional Chinese Medicine (ATCM) http://www.atcm.co.uk/

You can find a practitioner suitable for you, and places to study on our resources page.

The post Sweet ‘n’ Sour: The importance of taste and food energetics in Traditional Chinese Medicine appeared first on Herbal Reality.

Traditional Chinese medicine herbal classifications glossary

Jessika Thiele — Sun, 30 Jan 2022 11:09:10 +0000

Traditional Chinese Medicine is a comprehensive and holistic health system incorporating herbal medicine, acupuncture, diet, lifestyle, meditation, massage and exercises that appreciates the connection and interplay of mind, body and spirit and takes into account a person’s individual constitution and the unique presentation of their health condition.

It is based on a philosophy of binary forces, the most fundamental being yin and yang. This concept of polarity further extends to form the eight principles upon which TCM diagnosis is made (the ba gang bian zheng), which ask the questions: Is the condition in the interior or exterior? Is it hot or cold in its nature? Yin or yang? Excess or deficient?

With this information, a herbal formula may be carefully constructed that aims, where possible, to address both the root (ben) and branch (biao) (i.e. the underlying cause and its symptomatic presentation) of a condition, to restore the individual to a state of physical, mental and spiritual equilibrium.

Traditional Chinese medicine terms

Blood (xue) The TCM concept of blood incorporates that substance which we understand in biomedicine, but extends further and is seen as the material substance that supports our mental and emotional functions. It is also seen to nourish the eyes, tendons, skin and hair.

Cold (han) May refer to environmental cold affecting the body or an absence of warmth within the body. This can occur for a variety of reasons, including poor circulation or a deficiency of yang energy. Also describes the thermal characteristics of a herb.

Damp-heat (shi re) Conditions of dampness with heat signs, often associated with offensive discharges. Conditions can include hepatitis, inflammatory conditions, skin conditions such as acne and boils and dysenteric disorders. May be internally-generated or externally-contracted from the environment or a diet rich in damp, hot substances (e.g. alcohol).

Dampness (shi) Excess fluids in the body manifesting in the likes of oedema, swellings, sensations of heaviness, aches, excessive discharges, bloating, fluid accumulation and loose stools. Also refers to climatic dampness which can penetrate the body or exacerbate existing damp pathologies.

Deficient (xu) a state of insufficient qi, blood, yin, yang, essence or fluids.

Essence (jing) Inherited, constitutional essence stored in the Kidneys that provides the substance for development and growth.

Excess (shi) A condition of too much of a particular substance/ energy (e.g. fluids, blood, yang) overall or in a particular location in the body, or of a pathogen in the body (e.g. wind, cold, damp).

External (biao) On the external and superficial aspects of the body (i.e. skin and muscles). Also refers to pathogenic factors which attack from the outside (e.g. wind-heat and wind-cold).

Five Palm Sweat Characteristic sweat associated with Yin deficiency appearing on the palms, the soles of the feet and chest.

Fu The hollow Yang organs of the body

Heat (re) Excess of warmth in the body, typically involving a sensation of heat, degree of inflammation and, or, hyperactivity (as in hyperthyroidism, behavioural hyperactivity etc). Heat may also lead to dryness manifesting in thirst, dry skin or constipation. Can be from excess (e.g. febrile disease) or deficient (e.g. yin deficiency leading to heat) causes and from external or internal origins, of which febrile disease and yin deficiency are also good examples, respectively.

Internal (li) Conditions of the interior of the body, affecting the internal organs. The cause of which may have arisen from either internal or external factors

Jiao The three jiaos are divisions of the trunk of the body into the upper (Heart, Lungs) middle (Spleen, Stomach) and lower (Liver,Kidneys) regions of functionality.

Jin Ye Body Fluids; Jin refers to the lighter fluids, Ye to the denser fluids

Jue Yin Arm and leg channels of the Pericardium and the Liver

Ke Cycle The cycle of mutual control in the Five Elements system

Kong Qi Qi derived in the lungs from the air

Liver yang rising (gan yang shang kang) A common presentation in modern clinics in the west where the yang energy of the Liver is unrestrained by Liver yin and is said to ascend causing ailments such as headache, irritability, anger, insomnia and hypertension.

Mingmen Fire The nature of the essential warming energy of Kidney Yang. Considered to be vital in maintaining the heat in the body.

Phlegm (tan) Accumulation of thick fluids anywhere in the body, in particular the respiratory and digestive systems. Broader than the western concept of phlegm, it can also result in symptoms as diverse as epilepsy and goitre. Can coexist with heat or cold signs.

Qi (chi) The Chinese term for the life force or vital energy of the universe, which is fundamental to all aspects of life. It permeates the whole body and concentrates in the channels.

Qi External In Chinese medicine, any factors influencing the body from outside.

Shao Yang San Jiao and Gall Bladder channels

Shao Yin Heart and Kidney channels

Spirit (shen) A broad concept referring to everything from our mental functions, thoughts, memory, emotions and sleep as well as the more ethereal concept of our ‘spirit’. As mind and body are inextricably linked in TCM, the Shen is believed to reside in the Heart and is nourished and supported by blood and yin.

Tai Yang The Small intestine and Bladder channels

Tan Yin The Lung and Spleen channels

Wei Qi Defensive Qi, which protects the body from invasion by external pathogenic factors. It flows just beneath the skin.

Wind (feng) A pathogenic factor typified by conditions with rapid onset, movement of symptoms, spasms and tremors. Can be internally-generated (e.g. from Blood or yin deficiency or severe heat) or externally-contracted as in common colds and viruses where environmental wind combines with cold, heat or damp.

Traditional Chinese medicinal herbal actions

Aromatically Transform Damp (fang xiang hua shi) Fragrant medicinals that restore digestive function, for example in cases of bloating, indigestion, food poisoning and gastroenteritis, by strengthening digestion and alleviating dampness. Examples include huo xiang (Agastache rugosa) and cang zhu (Atractylodes lancea).

Aromatically clear the Orifices of the Heart (fang xiang kai qiao) Fragrant herbs that revive the senses and consciousness to treat conditions such as seizures, epilepsy and stroke by acting on the central nervous system (eg. bing pian (Bornoleum syntheticum) and shi chang pu (Rhizoma acori) which stimulate and inhibit it, respectively) and stimulating the cardiac (e.g. su he xiang (Liquidambar orientalis)) and respiratory systems.

Astringents: Stabilize and Bind (gu se) Return bodily structures to their intended positions and stop abnormal leakage and discharge of bodily substances. They address conditions such as prolapse, diarrhoea, cough, urinary incontinence and excessive sweating or menstruation. Examples include wu wei zi (Schisandra chinensis) and shan zhu yu (Cornus officinalis).

Calm the Shen (Spirit) (an shen) An unsettled shen, or spirit, may stem from a variety of disharmonies and result in symptoms such as palpitations, anxiety and insomnia. Suan zao ren (Ziziphus spinosa) and he huan pi (Albizzia julibrissin) are examples of herbs that calm the spirit via differing routes; by nourishing blood and yin (suan zao ren) and alleviating qi stagnation (he huan pi).

Cathartics (jun xia) are harsh, short-term use expellants such as gan sui (Euphorbia kansui) and da ji (Euphorbia pekinensis) that strongly expel excess fluids accumulating in the chest and abdomen, manifesting in the likes of oedema, severe constipation, pleurisy and ascites, via the stools and urination.

Clear Heat and Dry Damp (qing re, zhao shi) These herbs are cool, drying and bitter in nature, often with antibacterial, anti-inflammatory and anti-viral properties. They alleviate damp-heat conditions in the body, a common presentation in modern clinics in the west. These may manifest internally or externally. Common internal patterns include damp-heat in the Liver (eg. jaundice, hepatitis), Bladder (urinary tract infections) and intestines (gastritis). Eczema is a common external manifestation of damp-heat.Herbs include the ‘three yellows’ (huangs): huang qin (Scutellaria baicalensis), huang lian (Coptis chinensis) and huang bai (Phellodendron amurense) which alleviate damp-heat from the upper, middle and lower jiaos, respectively.

Clear and Relieve Summerheat (jie shu) Diuretic and antipyretic herbs (e.g. he ye (Nelumbo nucifera) that relieve thirst to treat ‘summerheat’, a condition of fever with sweating, thirst and diarrhea typical to the Summer.

Clear Heat and Relieve Toxicity (qing re, re du) Strongly clear heat to relieve ‘toxin’ (e.g. purulent infections, dysentery and some viral infections). Examples include jin yin hua (Lonicera japonica) and lian qiao (Forsythia suspense).

Cool the Blood (liang xue) Typically used in the more serious stages of febrile disease where heat from infection has led to symptoms such as bleeding (e.g. nosebleeds, vomiting of blood, bleeding under the skin) high fever, thirst, irritability and delirium. E.g. sheng di (Rehmannia glutinosa).

Cool and Transform Phlegm-Heat (qing re, hua tan re) Treat phlegm-heat conditions, especially cough with hot phlegm (ie. thick, difficult to expectiorate, yellow, brown or green sputum). In such cases a herb such as qian hu (Peucedanum praeruptorum) may be used. Herbs in this category may also relieve other conditions stemming from phlegm-heat including goitre, nodules and convulsions.

Dispel Wind-Damp (qu feng shi) Herbs such as du huo (Angelica pubescens) exert anti-inflammatory and analgesic effects that treat ‘bi zheng’ – acute or chronic pain (e.g. arthritis, sciatica), typically in the joints, tendons and muscles, caused by impaired flow of qi and blood due to internal (e.g. weak constitution, low immunity) and external (wind, damp or cold) factors.

Drain Dampness (xie shi) These herbs have a broad scope for all damp conditions but are commonly used to promote urination and fluid circulation to remove dampness, with or without heat, to alleviate issues involving fluid stagnation and retention including edema, painful or difficult urination, urinary stones and phlegm conditions. E.g. fu ling (Poria cocos)

Drain Fire (xie huo) Cold herbs that strongly purge ‘fire’ – a more severe heat, typically affecting the upper body, from febrile disease and other origins, resulting in symptoms such as high fever, red face and eyes, thirst, extreme headaches and pronounced irritability or possible delirium. E.g. zhi mu (Anemarrhena asphodeloides)

Expel Parasites (qu chong) Treat internal and external parasites such as roundworms and tapeworms and are often combined with purgative herbs. E.g. shi jun zi (Quisqualis indica)

Extinguish Wind and Stop Tremors (xi feng, zhi jing) Treat wind of internal origin stemming from yin deficiency, Liver yang rising, blood deficiency or high fever. Common examples include gou teng (Uncaria rhynchophylla) and tian ma (Gastrodia elata).

Invigorate the Blood (huo xue) herbs that treat blood stasis conditions such as stabbing pain, abscesses and ulcers, abdominal masses, angina and ischemia often via the cardiovascular and haematological systems by exerting vasodilatory (e.g. chuan xiong (Ligusticum wallichii)), antiplatelet (e.g. hong hua (Carthamus tinctorius)), anticoagulant (e.g. dan shen (Salvia Miltiorrhiza)) and thrombolytic (e.g. e zhu (Curcuma zedoaria)) effects.

Moisten the intestines (hua chang) huo ma ren (Cannabis sativa) and yu li ren (Prunus japonica) are the primary TCM medicinals for lubricating the intestines to guide out stools. The former gently nourishes yin and blood to achieve this and the latter relieves constipation from qi stagnation. They are especially appropriate for the weak or elderly. Other herbs, such as dang gui (Angelica sinensis), moisten the intestines as a subsidiary action.

Purgatives (gong xia) Bitter, cold herbs that strongly promote bowel movements, typically where excessive heat has caused stagnation. E.g. da huang (Rheum palmatum).

Regulate the Qi (li qi) Alleviate conditions where qi is not flowing leading to stagnation of digestive qi (i.e. gas, bloating, abdominal pain etc), Liver qi (depression, irritability, flank pain etc) or Lung qi (cough, wheeze, stifling sensation of the chest etc). E.g. chen pi (Citrus reticulata) is commonly used for stagnant digestive qi.

Release the Exterior (jie biao) Cooling and warming pungent herbs that treat conditions of exterior wind-heat and wind-cold, respectively, typically via promoting perspiration. These herbs stimulate the immune system and are commonly used in cases of the common cold and influenza. gui zhi (Cinnamomum cassia) warms and treats exterior wind-cold and bo he (Mentha haplocalyx) cools and relieves exterior wind-heat.

Relieve Food Stagnation (xiao shi) Promote digestion by stimulating gastric secretions and peristalsis, thus helping to relieve digestive complaints such as abdominal bloating and discomfort, belching, gas, diarrhoea, reflux, nausea and vomiting. E.g. shan zha (Crataegus pinnatifida)

Stop Bleeding (zhi xue) Arrest bleeding by astringing (i.e. contracting blood vessels) with herbs such as bai ji (Bletilla striata), clearing blood stasis (eg. san qi (Panax notoginseng), cooling the blood (e.g. da ji (Cirsium japonicum) or warming (e.g. ai ye (Artemisia argyi)). Used in cases of nosebleed, coughing blood, heavy periods, blood in the stool, uterine bleeding and trauma.

Tonify the Blood (yang xue) Herbs such as shu di huang (Rehmannia glutinosa) and dang gui (Angelica sinensis) nourish the blood to alleviate blood deficiency (which may or may not coincide with a diagnosis of anaemia) characterised by symptoms such as pallor, worry, palpitations, poor memory, dizziness, dry skin, insomnia, light periods or absent periods.

Tonify the Qi (bu qi) Boost overall bodily or organ (especially Lung and Spleen) function. Examples include ren shen (Panax ginseng) and dang shen (Codonopsis pilosula) and indicated symptoms may include fatigue, poor appetite, loose stools (Spleen qi deficiency) or shortness of breath, pallor and a weak voice (Lung qi deficiency).

Tonify the Yang (bu yang) Strengthen the warming, activating yang energy of the body, in particular of the Kidneys (the seat of all yin and yang energy in the body) but also of the Spleen and Heart, alleviating symptoms such as: exhaustion, cold extremities, sore low back, low libido, impotence, infertility (Kidney yang deficiency), fatigue, poor appetite, bloating after eating, loose stools (Spleen yang deficiency) and palpitations, sweating and discomfort in chest (Heart yang deficiency).

Tonify the Yin (bu yin) Nourish the cooling, moistening yin aspect of numerous organs where chronic illness, febrile disease or poor lifestyle choices have depleted it. In particular, these herbs nourish the yin of the Kidneys, Lungs, Liver and Stomach. Depending on the organ or organs affected, signs of yin deficiency may include: night sweats, insomnia, a sensation of heat in the palms and soles, a dry mouth at night (Kidneys), a dry cough (Lungs), dry eyes, scanty menstruation (Liver) or epigastric pain, constipation and thirst (Stomach).

Treat Cough and Stop Wheezing (zhi ke, ping chuan) Stop cough and wheeze from both exterior and interior conditions, depending on the herbs with which they are combined, by redirecting Lung qi downwards, transforming phlegm and moistening the Lungs. Common examples include xing ren (Prunus armeniaca) and pi pa ye (Eriobotrya japonica) which especially benefit externally-contracted coughs with wheezing and cough with difficulty expectorating, respectively.

Warm the Interior and Expel Cold (wen li, qu han) Herbs such as gan jiang (dried Zingiber officinalis) are used in cases of yang deficiency with concomitant cold signs. These may include cold extremities, loose stools and a pale complexion. Herbs in this category may also be used where external cold has penetrated the organs, predominantly disrupting digestive function (e.g. cold-type gastroenteritis).

Warm and Transform Phlegm-Cold (wen, hua tan han) Herbs such as ban xia (Pinellia ternata), are prescribed for cough and wheeze with phlegm of the cold type, i.e. coughs with copious, clear or white sputum and other cold signs. They also very often benefit the digestion as this is seen as the place of origin of phlegm, the lungs being the ‘storehouse’.

Some of the classifications here were created with the help of Chinese Herbal Medicine: Materia Medica by Dan Bensky and Chinese Medical Herbology and Pharmacology by John K. Chen and Tina T. Chen

Traditional Chinese herbal medicine treatment methods

TCM physicians use eight treatment methods (ba fa)

Han fa – Sweating ‘When it is at the level of the skin, use sweating to discharge it!’
Tu fa – Vomiting ‘When it is at the upper level, draw it up and out’ – (rarely used today)
Xia fa – Draining downwards ‘When it is at the lower level, lead and draw it down’
He fa – Harmonising a broad category used to integrate and bring a formula together.’
Wen fa – Warming ‘Warm that which is cold.’
Qing fa – Clearing ‘Clear that which is warm…treat hot with cold.’
Xiao fa – educing ‘Pare away that which is firm, disperse that which is clumped.’
Bu fa – Tonify ‘Tonify that which is deficient. Augment that which is injured.’

You can read more about TCM formulations and how they work in our article The art and science of herbal formulation: Traditional Chinese medicine.

Traditional Chinese herbal medicine energetics

Temperature: Hot, Warm, Cold, Cool, Neutral
Taste: Acrid, Sweet, Bitter, Sour, Salty, Astringent, Bland
Acrid: Disperses and moves, travels in the qi, enters the Lungs
Aromatic: Penetrate ‘turbidity’ (poorly digested food and drink or pathological states of bodily substances such as mucus and urine) to awaken digestion or cognitive functions.
Astringent: Stops bleeding
Bitter: Drain and dry, travels in the bones, enters the Heart
Bland: Leech dampness and promotes urination
Salty: Purge and soften, travels in the blood, enters the kidneys
Sour: Astringent and prevent leakage of fluids and qi, travels in the sinews, enters the Liver
Sweet: Tonify, harmonise, moisten, travels in the flesh, enters the Spleen

Bibliography

Bensky, D. and Gamble, A. (1993) Chinese herbal medicine: Materia medica. Seattle: Eastland Pr.
Chen, J.K., Chen, T.T. and Crampton, L. (2012) Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press, Inc.

The post Traditional Chinese medicine herbal classifications glossary appeared first on Herbal Reality.

Keeping your lungs healthy

Jessika Thiele — Sun, 30 Jan 2022 10:13:20 +0000

Shaylee Grant explores what we need to keep our lungs healthy.

“For breath is life, so if you breathe well you will live long on earth.” – Sanskrit Proverb

The breath

The breath is revered across cultures as a grounding force which ultimately connects us with life, and that marks the beginning and end of life. We can go for days without water, weeks without food but only minutes without air.

In Chinese medicine it is where circulating qi is generated, in Ayurveda it is where prana is received. Both of these terms essentially describe our life force. In TCM the lungs are the source of our vitality, and they extract qi from the atmosphere (“heavens”). You can read more about the TCM perspective on respiratory health here, and more about the Ayurvedic perspective on respiratory health here.

“Heaven’s Qi flows freely to the Lungs”

“The Lungs are the root of Qi” (10 p69)

Every single system in our body relies on oxygen, the breath and therefore our lungs. Effective breathing can have remarkable effects for mental wellbeing, and there are even studies being conducted for using breathwork to deal with PTSD.

It can also help us sleep better, improve immunity and digestion. It is key for regulating our nervous systems, which are vital for mental health and clarity. A healthy respiratory system is key for processing oxygen in our body, as well as removing carbon dioxide and our lungs are the main organ responsible for this.

“When the breath is unsteady, all is unsteady; when the breath is still; all is still. Control the breath carefully. Inhalation gives strength and a controlled body; retention gives steadiness of mind and longevity; exhalation purifies body and spirit.” – Goraksasathakam

Optimising our breath and respiratory system is critically important for restoring the body and minds harmony. Ayurveda offers practices such as pranayama, and TCM offers Qigong as a way to work with the breath. Breathwork is increasingly popular across Western cultures now too.

How the lungs work

The lungs are known as the main organs of the act of breathing. They control the entry of air, without which the body would quickly die. Thus, their function is of great importance to overall health and quality of life.

The two lungs sit in the upper third of the thorax. The left lung has two lobes and is slightly larger than the right, which has three lobes. When breathing, the movement between the lungs and the chest wall is facilitated by the pleura.

The lungs contain bronchi (airways) which branch into smaller airways, alveoli, blood vessels, lymph vessels, connective tissue, and nerves. The bronchi not only transport the air, but they also warm and humidify it, while removing particulates. The alveoli are the site of gaseous exchange with the blood.

The natural defences of the lungs include both the innate and the adaptive immune systems. In the upper airway, airborne particles are captured by either the nasal hairs or the mucosa. These particles are either expelled through sneezing, blowing one’s nose, or the mucus is swallowed into the digestive tract.

The particles captured in the lower airways by the mucus there are expelled by the mucociliary escalator, where the small hairs of the respiratory tract beat together to bring mucus up the tract to be coughed or swallowed. The airways also contain a number of anti-microbial chemicals and immune cells to help deal with pathogens.

The lungs have their own closed circulation with the heart, and thus any issue with their health will immediately impact upon the circulatory system. The lungs are also an organ of elimination, as they excrete gaseous acidic waste on the exhalation. Other organs that share eliminatory function are the bowels, kidneys, and skin. If there is a lack of functionality in the lungs, these other systems will experience strain.

Some problems with respiratory health include asthma, COPD, cystic fibrosis, tuberculosis, bronchitis, pneumonia, emphysema and lung cancer. Also pollution effects the lungs, so some extra nourishment can be very helpful for people living in cities.

Nutrition

It is clear that good nutrition is essential for overall health, and the lungs are no exception. The development of the lungs starts in the third week after conception, and continues until the age of 22. While in development, the foetus must receive sufficient nutrition and oxygen in order to properly develop the lungs.

Otherwise, structural changes occur in the airways that present limited recovery potential (1). In children, the Mediterranean diet with little processed food has been associated with a reduced risk of developing asthma, while the Western diet has been linked to an increased risk (2).

There are a variety of nutrients that support the function of the lungs. Foods such as fruit and vegetables that are high in vitamin C and beta-carotene have been shown to support lung function, as well as fish which is high in omega-3 fatty acids. Additionally, vitamin C, beta-carotene and vitamin E have been shown to reduce phlegm production in the respiratory tract, the over-production of which is involved in a number of respiratory pathologies (3).

Flavonoids, which are found in fruits, vegetables, dark chocolate, wine, nuts, seeds, and most herbs, have been shown to reduce symptoms of asthma. Magnesium may improve the condition of the smooth muscle in the bronchioles, promoting relaxation instead of over-constriction. Vitamin D may also be useful, as a deficiency may lead to a reduced ability to fight off infection (3).

Environment

There are environmental factors that contribute to the health of the lungs that must be considered. Air contamination is a concern, especially to those who may have weakened immune systems, children or the elderly. This contamination may come in several forms, such as fungi/mould, dust, smoke, chemical fumes or toxic particles.

Exposure to these contaminants may depend on one’s occupation, lifestyle and/or living situation. These may be linked to the increased urbanisation of the world, and climate change. For instance, ozone is one example of environmental detriments to lung health. Ground level ozone is created when engine gasses and sunlight interact.

This is a phenomenon in urbanised areas and is linked to hospital admissions (4). The impact of the increasing prevalence of dust storms in the wake of climate change is also being linked to declining respiratory heath (5).

Examples of disease caused by occupational exposure to toxic particulates are silicosis and asbestosis. Silicosis is caused by silicon-containing compounds that people who work in quarrying, mining, stone masonry, glass working, and pottery are commonly exposed to. Silicosis can lead to the development of tuberculosis which leads to further complications. Asbestosis is caused by inhaling the fibres of asbestos, and is found in asbestos miners as well as construction workers who were involved in building works with the material. Asbestos gradually destroys lung tissue (6).

Lifestyle changes for healthy lungs

Exercise is supportive of lung health. Exercise is broadly defined, as it can be sport or gardening or cleaning. The general recommendation is to take 30 minutes of exercise.

Exercise strengthens the muscles. If their function is made more efficient, the require less oxygen and produce less carbon dioxide, which reduces the load on the circulatory and respiratory system transporting and excreting these two gasses. Exercise also strengthens the heart, which is in close relationship to the lungs and so benefits pulmonary circulation (9).

Smoking has extremely detrimental effects to lung health. Apart from depositing dangerous tar residues it increases mucus production in the airways, and inhibits the tiny hairs, or cilia, that are key to the function of the mucociliary escalator (7).

This all makes the lungs much more prone to developing breathing difficulties, chronic disease and infection. Smoking is also the cause of most lung cancers and cases of COPD (which encompasses both chronic bronchitis and emphysema) (8).

Herbs to keep your lungs healthy

There are a variety of herbs that can support the lungs, depending on the presenting issue. As most herbs have multiple actions, the following classifications are made for the sake of simplicity, and this is certainly not an exhaustive list. Always consult a medical professional and herbalist if you are experiencing challenges with your lung health.

Elecampane (Inula helenium)

Tonics

These support the overall function of the lungs.

Elecampane (Inula helenium) has a spasmolytic on the bronchioles and has a long tradition of use in asthma, bronchitis, whooping cough, tuberculosis and pleurisy.
Horsetail (Equisetum arvense)

Expectorant herbs aid the body in excreting excess mucus that may be building up in the respiratory tract. They are divided into warming, relaxing and stimulating.

Warming expectorants

These are used when the lungs are congested and suffering from cold and damp:

Ginger (Zingiber officinalis): The classic remedy
Cinnamon (Cinnamonum spp): Most often combined with ginger
Fennel (Foeniculum vulgare)
Aniseed (Pimpinella anisum)

Relaxing or antispasmodic expectorants

Useful where the lungs are tight, wheezing and any cough is dry:

Thyme (Thymus vulgaris): Particularly effective at relieving spasmodic coughing though may also help where there are excess levels of mucus
Coltsfoot (Tussilago farfara): Generally avoided due to pyrrolizidine content
Ma huang (Ephedra sinica): Not available in the USA and restricted in the UK to practitioners
Hyssop (Hyssopus officinalis)

Stimulating expectorants

Typically emetics are used in low doses for helping to move stubborn congestion in the base of the lungs:

Lobelia (Lobelia inflata): In the UK restricted to practitioners, with additional relaxing properties to provide a rounded effect on the lungs
Squills (Scilla spp): A strong emetic mostly used in a syrup
White horehound (Marrubium vulgare)
Liquorice (Glycyrrhiza spp): Combining a gentle stimulating with demulcent action for a range of lung and cough conditions – a true lung amphoteric!

Demulcents

These herbs help to soothe the respiratory tract in conditions that feel dry and scratchy.

Marshmallow (Althea officinalis): For irritated and dry conditions of the airways with unproductive and tickly coughs. Marshmallow can help provide long-term relief in lung infections by allowing time for the inflamed and infected mucosa to heal.
Mullein (Verbascum thapsus): Mullein is a wonderfully soothing remedy for the lungs, used to good effect in irritating, hacking coughs with bronchial congestion (flowers have additional stimulating properties)
Iceland moss (Cetraria islandica)

Antitussives

Remedies that can suppress a cough – usually because they contain cyanide-producing constituents.

Wild cherry (Prunus serotina)

Anticatarral

These herbs help reduce the amount of mucus being produced from the airways.

Horseradish (Amoracia rusticana)
Elderflower (Sambucus nigra)
Ribwort plantain (Plantago lanceolata)

Immunomodulatory and anti-allergic

These herbs moderate immune function to an appropriate level, if the respiratory tract is being affected by pathogens or hypersensitivity.

Echinacea (Echinacea purpurea)

Elderberry (Sambucus nigra): Have a specific action in preventing an enzymes produced by the flu virus from attaching to the cilia in the mucosal membranes of the lungs so can be helpful for viral respiratory infections
Echinacea (Echinacea angustifolia or purpurea): A useful preventative if you are prone to upper respiratory problems like frequent colds, sore throats, sinuses, middle ear pain, or viral infections like flu
Baical Skullcap (Scutellaria baicalensis): Commonly used for asthmatic conditions (especially when associated with secondary bronchitis), hypersensitivity conditions like hayfever and allergic rhinitis. It has a reputation in China of being effective also in acute viral infections of the airways.
Nettle (Urtica dioica): Particularly for allergies that target the respiratory system.
Reishi (Ganoderma lucidum): Together with Cordyceps sinensis, G. lucidum has the most extensive range of indications and combines well with it in treatment of lung and liver conditions, as well as to provide all-round adaptogenic support.
Cordyceps
Black seed (Nigella Sativa): Has been shown to be useful for asthma, allergic rhinitis and other respiratory conditions as it has anti-inflammatory and bronchodilatory effects

Other commonly used herbs:

Andrographis: For reducing symptoms in viral respiratory infections including the common cold, flu and sore throat
Ashwagandha
Astragalus
Bibhitaki has astringing and strengthening action on the mucus membranes throughout the body, especially in the lungs
Catnip
Haritaki
Horseradish is also effective against conditions that are characterised by the presence of an obstruction, commonly within the respiratory system. The pungency of horseradish will help to eliminate obstructions and expel them from the body by coughing up
Trikatu (Zingiber officinale, Piper longum and Piper nigrum): It is a heating combination that dries mucous secretions and excess phlegm whilst also rejuvenating the lungs.
Tusli (Ocimum tenuiflorum): When used as a hot tea, tulsi clears kapha and mucus from the lungs and upper respiratory tract. It is of value in respiratory infections and fever where it reduces temperature by encouraging sweating whilst its penetrating nature clears dampness and toxins.
Vasaka

Most of these herbs can be made into a tea or decoction, except for those restricted to practitioners. They can be used acutely, however the immunomodulatory herbs are often used prophylactically as well. Aromatic herbs may also be used as part of a steam inhalation to bring their antimicrobial benefits into the airways directly, while adding moisture.

There are many types of breath practices that can help with building control over the breath as well as calming the system, which allows for more efficient breathing. There are physiotherapists who specialise in breathing. There are also other practices such as Butyeko, Wim Hoff, pranayama, and Inspirational breathing. Two of our favorite breathwork practitioners are Georgie Lawlor and James from Breathe With James.

References

Arigliani M, Spinelli AM, Liguoro I, Cogo P. Nutrition and Lung Growth. Nutrients. 2018;10(7):919. Published 2018 Jul 18. doi:10.3390/nu10070919
Berthon BS, Wood LG. Nutrition and respiratory health–feature review. Nutrients. 2015;7(3):1618-1643. Published 2015 Mar 5. doi:10.3390/nu70316184.
Kelly Y, Sacker A, Marmot M. Nutrition and respiratory health in adults: findings from the Health Survey for Scotland. European Respiratory Journal. 2003;21(4):664-671. doi:10.1183/09031936.03.000557026.
Hoffmann D. Medical Herbalism. Rochester: Inner Traditions; 2003.
Schweitzer MD, Calzadilla AS, Salamo O, et al. Lung health in era of climate change and dust storms. Environ Res. 2018;163:36-42. doi:10.1016/j.envres.2018.02.001
Wilson K, Waugh A. Ross And Wilson Anatomy And Physiology In Health And Illness. New York: Churchill Livingstone; 2010
Walker B, Colledge N, Penman I, Ralston S. Davidson’s Principles And Practice Of Medicine. London: Elsevier Saunders; 2014.
Health Effects of Cigarette Smoking. Centers for Disease Control and Prevention. Published 2021. Accessed December 30, 2021.
Your lungs and exercise. Breathe (Sheff). 2016;12(1):97-100. doi:10.1183/20734735.ELF121

The post Keeping your lungs healthy appeared first on Herbal Reality.

The history of ephedra: A powerful lung medicine from China

Thu, 06 Jan 2022 16:46:53 +0000

Ephedra is a powerful plant used to support lung health. Molecules from it have been the basis for pharmaceuticals, and the plant is now only legally allowed to be prescribed by herbalists. This article explains the fascinating history behind the plant and its medicinal use.

Ma Huang is a plant used in Traditional Chinese Medicine (TCM) for a wide range of conditions and is most famous today as a treatment for asthma. The plant drug consists of the aerial parts – leaves, stems, flowers – of several species of Ephedra, particularly Ephedra sinica.

The isolated chemical ephedrine is popular as a drug to enhance athletic performance, promote weight loss, and relieve colds and flu. When it was first discovered its main use in pharmacy was as a bronchodilator to open up the airways of asthma sufferers.

The use of Ma Huang to suppress cough can be traced back to the oldest written record of Chinese medicinal plants. This article explores the history of the use of ephedrine and Ma Huang as a bronchodilator, and how the effects can be understood through both the lenses of chemistry and physiology, and traditional Chinese philosophies of healing.

The botany and chemistry of ephedra species

Ephedra species have been found in the fossil record going back 125 million years, when dinosaurs still walked the earth (1).There are around 71 species of ephedra recognised by current taxonomy, with a wide distribution through most of Asia and Europe, North Africa and the Horn of Africa, and the Western sides of South and North America (2). It is the only genus in the family Ephedraceae.

The botanical classification of this group of plants has been particularly difficult there are many close similarities in appearance between species. Ephedra species mostly grow as shrubs, consisting of long slender green stems that can photosynthesise. Their leaves appear as small scales on the stem and often turn brown and drop off.

Ephedra spp. have been confused with very ancient group of plants, the horsetails (Equisetum spp.) both historically and more recently in the herbal medicine trade (3).Market surveys today have found several species of Ephedra are sold as Ma Huang, sometimes differentiated as varieties of Ma Huang, but not always (4).

Ephedra sinica is the species most widely used for its medicinal properties. This species is found growing wild in Mongolia, Southern eastern provinces of Russia and in Northeastern China (5). While ephedrine is the most well known constituent, it contains 6 other structurally similar alkaloids in lesser concentrations with similar effects. Not all Ephedra species contain ephedrine type alkaloids (6).

The drug Ma Huanghas always been defined in Chinese Materia Medica texts as the aerial parts of several species of Ephedra. The less commonly used root of Ephedra spp. is known as Ma Huang Gen, which has long been seen as acting in opposition to the aerial parts; for example being prescribed “for checking excessive perspiration of a weak patient” (7). This traditional understanding has been corroborated by studies showing that chemicals that cause blood pressure to lower are only found in the root (8).

The discovery of ephedrine

Ma Huang has been traded from China to Japan from at least the 16^th century, where it was incorporated into Japanese herbal medicine as a treatment for colds and flu in a combination with four to six other herbs known as Maoto, based on the Chinese formulation Ma Huang Tang (9).

The active chemicals of Ma Huangwere first isolated in 1887 by a professor at Tokyo University, Nagajosi Nagai. Of particular interest was a new chemical that was named after the plant as ephedrine.

However, it was not until 1923 that researchers at Peking Union Medical College, K.K. Chen and Carl Schmidt, began investigating in detail how it could be used as a drug (10). They found that ephedrine acted in a very similar way to adrenaline, though with a milder, but longer lasting, effect (11).

Adrenaline, also known as epinephrine, is a hormone produced in the adrenal glands above the kidneys that acts as an essential messenger in the fight or flight response – this is how the body prepares itself to deal with a potentially dangerous situation.

Adrenaline helps stimulate a range of changes including increased heart and breathing rate, slowing down digestion, releasing energy sources into the blood, dilation of blood vessels to the muscles, constriction of peripheral blood vessels, central nervous stimulation and bronchodilation. This response is coordinated by the sympathetic nervous system, that is why ephedrine is classed as a ‘sympathomimetic’ as it mimics the body’s natural messenger chemicals to activate receptors of this system.

Because of this effect ephedrine has become a popular drug for athletes to improve performance. It has also been used as a weight loss drug because it suppresses appetite and increases the rate that fat tissue uses and releases energy. It is also widely used in combination with caffeine in over the counter cold and flu remedies for opening nasal passages to relieve sinusitis (12).

However, care should be taken in dosage and duration of use, especially if taking any other medications that produce similar effects. It can lead to anxiety, restlessness, insomnia and a tolerance develops, and in extreme cases of improper use has caused heart attack and stroke. (13)

Both Ephedra spp. and ephedrine should not be taken by people with hypertension, diabetes, hyperthyroidism orglaucoma (14). Because of these concerns there have been bans imposed on the use of ephedrine in sports and weight loss supplements by various regulatory bodies around the world.

Ephedrine as bronchodilator

Ephedra berry

Of particular interest for respiratory health is the bronchodilatory effect of ephedrine (15).When you breathe in air enters through the mouth and down the trachea, which divides into the left and right bronchi to enter the lungs, the bronchi further divide into many bronchioles, which then divide to join the many alveoli where gas exchange takes place.

People suffering from asthma experience a tightening of the bronchioles causing coughing, wheezing and shortness of breath. The bronchi and bronchioles are lined with smooth muscle, which relaxes and opens up in response to adrenaline and ephedrine, this bronchodilatory effect relieves the symptoms of asthma.

While adrenaline had been used for treating asthma it had significant issues: it had to be injected, its effects were short lived, and it was chemically unstable.

Ephedrine solved all these problems, leading to excitement amongst physicians in Europe and the USA, where it was widely adopted for treating asthma from 1926 the 1950s (16). Work on adrenaline led to the synthesis in the laboratory of several similar chemicals, one of which was salbutamol which became the next main treatment for asthma.

When used as an asthma treatment, and for Chronic Obstructive Pulmonary Disorder (COPD), ephedrine was commonly combined with two weaker bronchodilators: caffeine and theopylline, chemicals which were also isolated from a Chinese herbal medicine: tea (Camellia sinensis) (17).

The history of ma huang

Figure 1: Shen Nung seated on a rock, wearing simple garments fashioned from leaves, holding a small plant; a selection of roots and plants are also shown on a ledge by his side. Watercolour, China, 1920. (21)

According to legend, the mythological Chinese ruler Shennong (神农) discovered the medicinal effects of tea when tea leaves from the twigs in his fire were carried up the hot air into his pot of boiling water. This was just one of the hundreds of herbs he tested on himself to identify their properties and taught people their uses, along with the practice of agriculture.

He is credited with writing The Shen Nong Ben Cao Jing (神农本草经), the oldest surviving written record of Chinese materia medica, thought to have been compiled in the 1^st or 2^nd Century CE. It is variously translated to English as The Divine Farmer’s Materia Medica, The Herbal Classic of the Divine Farmer, or Divine Husbandman’s Classic of the Materia Medica (18,19,20).

This text has been continously referred to in texts on Chinese materia medica ever since, and many of the uses of herbs it describes are still employed today(22). It covers 365 herbs in total, corresponding to the natural cycle of days in a year, that are divided into three scrolls:

“120 ‘upper’ (shang) herbs, which can be taken daily to lengthen the lifespan; 120 ‘middle’ (zhong) herbs, which can be taken to prevent and hold back illness; and 125 ‘lower’ (xia) herbs which treat illness, are mostly toxic and should not be taken for a long time(23)”.

Ma Huang appears on the ‘middle grade’ scroll, which would match with the use of Ephedra spp. today – the use of ephedrine for acute infections only, and not longer term use for general health such as athletic training and weight loss.

The text describes Ma Huang as:

“bitter and warm. It is nontoxic, treating mainly wind stroke cold damage, headache, and warm malaria. It effuses the exterior [through] sweating, eliminates evil heat qi, suppresses cough and counterflow qi ascent, eliminates cold and heat, and breaks concretions and hardness, accumulations and gatherings. Its other name is Long Sha (Dragon Sand). It grows in rivers and valleys.”

Figure 2: Print from the 1833 text ‘Theory of diseases treated with ephedra decoction’ (29)

The translator notes that a renowned scholar, known as ‘Chancellor in the Mountains’, Tao Hong-jing (452-536 CE) later wrote, “Ephedra is the first choice in treating cold damage and resolving the muscles” and that, combined with “Sinnamon Twig, Armeniaca, and Licorice” it “may effect the cure of a tai yang pattern of wind cold in the exterior with pain and stiffness in the head and back of the neck, fever, generalized joint pain, a floating, tight pulse, absence of sweating, chest fullness, and panting”(24).

This is perhaps the first description of the Ma Huang Tangformulation that became so poular for respiratory infections, consisting of: Ma Huang (aerial parts of Ephedra spp.), Gui Zhi (twig of Cinnamomum spp.), Xing Ren (kernel of fruit of Prunus armeniaca) Can Gao (root of Glycyrrhiza spp.).

Writing 1,000 years after Tao Hong-jing, Li Shizhen (25) compiled a Compendium of Materia Medica, the Pents’ao Kang Mu, including 1,900 substances and referencing 900 previous works, critiquing them where necessary. Like his father and grandfather before him he travelled the countryside as a physician, both treating people and learning remedies from them.

Ephedra is described and recommended for stimulating circulation, as a diaphoretic (to induce sweating) and antipyretic (to prevent or reduce fever). According to contemporary TCM herbalists Chen and Chen in the text “It was also believed to be useful in the treatment of cough and as a result the stem became an important ingredient of many antitussive preparations.” (26).

Which they do themselves in their indications for Ma Huang: “Relieves Wheezing and Dyspnea, Stops Cough Wind-cold constriction of the Lung leading to Lung qi reversal: Ma Huang ventilates Lung qi and is useful in treatment of wheezing, dyspnea and cough characterized by wind-cold attacking the exterior that leads to abnornormal rising of Lung qi.” (27).

Approaching the use of ma huang, ephedra spp. and ephedrine

Ephedra

As is so often the case, exploring the history of this herbal medicine indicates it has been used for a range of conditions on its own and in combination with other herbs, and that fully understanding these uses requires detailed knowledge of philosophies of healing of the time.

Seen through a contemporary biomedical lens, some connections can be made between these texts and the studied effects of ephedrine. The focus on sweating and treating cold and resolving the muscles can be linked to the increased blood flow to the muscles caused by ephedrine.

From the mention of ‘suppressing cough’ and curing ‘chest fullness and panting’ in the The Herbal Classic of the Divine Farmer (Ben Cao Jing) we can assume it was used for treating conditions that we today would classify as asthma. This indication can be found throughout the history of writing on the materia medica of TCM, though it is important to note that it is normally accompanied by a detailed discussion of the cause of the disease and the particular manifestation in specific patients.

A full understanding of these aspects requires a detailed knowledge of the healing principles of TCM, from the concept of the flow Qi, generally translated as ‘life force’, the elements and their relation to the organs, and the importance of the tastes of herbs, and how these combine. Asthma, cough and shortness of breath have many manifestations that will be caused by the interplay of environmental, internal, physical and emotional causes.

Based on research on ephedrine, a standard European reference on herbal medicines understands Ma Huang in biomedical terms as vasoconstricting, bronchodilating, and central [nervous system] stimulating properties (28).

However, like many herbal medicines the chemical constituents of the whole herb are not fully characterised or understood, and these may also aid in managing asthma, coughs and colds. For example research on Ephedra sinica shows it contains chemicals that have anti-inflammatory, anti-bacterial, anti-fungal, antioxidant and anti influenza effects that could explain other ways the herb extracts can work in treating respiratory infections (29,30).

Ephedra is just one example of a medicinal plant with rich history, that’s traditional uses can now partially be explained by modern science. This plant can only be prepared and prescribed by licensed herbalists, due to its potential side effects. We really recommend seeing a herbalist for a personalised treatment plan for all sorts from respiratory health to other ailments. You can find one on our resources page here.

References

Ickert-Bond, S.M., Rydin, C. and Renner, S.S., 2009. A fossil‐calibrated relaxed clock for Ephedra indicates an Oligocene age for the divergence of Asian and New World clades and Miocene dispersal into South America. Journal of Systematics and Evolution, 47(5), pp.444-456.
Plants of the World Online. Facilitated by the Royal Botanic Gardens, Kew. Published on the Internet; https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:328160-2 Retrieved 02 Jan 2022.
Yoshizawa, C., Kitade, M. and Mikage, M., 2005. Herbological studies on Chinese crude drug Ma-huang. Part 1-On the botanical origin of Ma-huang in ancient China and the origin of Japanese Ma-huang. Yakushigaku zasshi, 40(2), pp.107-116.
Hu, S.Y., 1969. Ephedra (Ma-huang) in the new Chinese materia medica. Economic Botany, pp.346-351.
Plants of the World Online. Facilitated by the Royal Botanic Gardens, Kew. Published on the Internet; https://powo.science.kew.org/taxon/urn:lsid:ipni.org:names:383460-1 Retrieved 02 Jan 2022
Abourashed, E.A., El‐Alfy, A.T., Khan, I.A. and Walker, L., 2003. Ephedra in perspective–a current review. Phytotherapy research, 17(7), pp.703-712.
Hu, S.Y., 1969. Ephedra (Ma-huang) in the new Chinese materia medica. Economic Botany, pp.346-351
Tamada M, Endo K, Hikino H, Kabuto C. 1979. Structure of Ephedradine A, a hypotensive principle of Ephedra roots. Tetrahedron Lett 10: 873–876.
Yoshino, T., Arita, R., Horiba, Y. and Watanabe, K., 2019. The use of maoto (Ma-Huang-Tang), a traditional Japanese Kampo medicine, to alleviate flu symptoms: a systematic review and meta-analysis. BMC complementary and alternative medicine, 19(1), pp.1-11.
Lee, M.R., 2011. The history of Ephedra (ma-huang). JR Coll Physicians Edinb, 41(1), pp.78-84.
Chen, K.K. and Schmidt, C.F., 1926. The action and clinical use of ephedrine: an alkaloid isolated from the Chinese drug Ma Huang. Journal of the American Medical Association, 87(11), pp.836-842.
Abourashed, E.A., El‐Alfy, A.T., Khan, I.A. and Walker, L., 2003. Ephedra in perspective–a current review. Phytotherapy research, 17(7), pp.703-712.
Lee, M.R., 2011. The history of Ephedra (ma-huang). JR Coll Physicians Edinb, 41(1), pp.78-84.
Abourashed, E.A., El‐Alfy, A.T., Khan, I.A. and Walker, L., 2003. Ephedra in perspective–a current review. Phytotherapy research, 17(7), pp.703-712; Chen, J.K., Chen, T.T. and Crampton, L., 2004. Chinese medical herbology and pharmacology (Vol. 1267). City of Industry, CA: Art of Medicine Press.
Barnes, J., Anderson, L.A. and Phillipson, J.D., 2003. Herbal medicines: a guide for healthcare professionals (No. Ed. 2). pharmaceutical press. p.244
Lee, M.R., 2011. The history of Ephedra (ma-huang). JR Coll Physicians Edinb, 41(1), pp.78-84.
Schultze‐Werninghaus, G. and Meier‐Sydow, J., 1982. The clinical and pharmacological history of theophylline: first report on the bronchospasmolytic action in man by SR Hirsch in Frankfurt (Main) 1922. Clinical & Experimental Allergy, 12(2), pp.211-215
Daniel, Gillian, 2015. The Legend of the Divine Farmer. Public Domain Review. Published 03 Nov 2015. Retrieved 02 Jan 2022 https://publicdomainreview.org/essay/the-legend-of-the-divine-farmer
Nugent-Head, J., 2014. The First Materia Medica: The Shen Nong Ben Cao Jing. Journal of Chinese Medicine, (104).
Evans, L., 2017. Reading of the Divine Farmer’s Classic of Materia Medica: Shen Nong Ben Cao Jing Du. The Journal of Chinese Medicine, (114), pp.64-65.
Shen Nung seated on a rock, wearing simple garments fashioned from leaves, holding a small plant; a selection of roots and plants are also shown on a ledge by his side. Watercolour, China, 1920?. Wellcome Collection. https://wellcomecollection.org/works/z5w9zzbf/images?id=z9szdx4b . Published 1920. Accessed January 6, 2022.
Chen, J.K., Chen, T.T. and Crampton, L., 2004. Chinese medical herbology and pharmacology (Vol. 1267). City of Industry, CA: Art of Medicine Press.
Nugent-Head, J., 2014. The First Materia Medica: The Shen Nong Ben Cao Jing. Journal of Chinese Medicine, (104). p.24
Yang, S., 1998. The divine farmer’s materia medica: a translation of the Shen Nong Ben Cao Jing. Blue Poppy Enterprises, Inc.. pp.51-52.
Li, M. and Liang, Y., 2015. Li Shizhen and The Grand Compendium of Materia Medica. Journal of traditional Chinese Medical Sciences, 2, pp.215-216.
Chen, J.K., Chen, T.T. and Crampton, L., 2004. Chinese medical herbology and pharmacology (Vol. 1267). City of Industry, CA: Art of Medicine Press. p.14
Chen, J.K., Chen, T.T. and Crampton, L., 2004. Chinese medical herbology and pharmacology (Vol. 1267). City of Industry, CA: Art of Medicine Press. p.36
Barnes, J., Anderson, L.A. and Phillipson, J.D., 2003. Herbal medicines: a guide for healthcare professionals (No. Ed. 2). pharmaceutical press.
Theory of diseases treated with ephedra decoction, Chinese. Wellcome Collection. https://wellcomecollection.org/works/pxhq48mb . Published 1833. Accessed January 6, 2022.

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The Chinese herbal medicine approach to inflammation: Solving the “Turmeric Paradox”

Peak — Fri, 29 Oct 2021 15:22:21 +0000

Alex Jacobs explores how Chinese Herbal Medicine can help to treat a range of inflammation symptoms.

Inflammation is the healing response of the body to tissue damage. The four characteristic signs and symptoms of inflammation are redness, pain, heat and swelling. These are familiar symptoms that we all know and most of us will have experienced to varying degrees within our lives. We have a knock and we know almost instinctively that its likely to get red, hot, swollen and painful.

Chinese Herbal Medicine (CHM) has a long tradition of treating these four symptoms of inflammation, but how can herbs possibly treat these very physical symptoms? And then there is ‘the turmeric paradox’…

Many of us will now be aware of the countless studies showing the powerful effects of turmeric and its active ingredient Curcumin on inflammation (1). However, Chinese medicine classifies turmeric as warming in nature.

Have a cup of turmeric tea and see for yourself, it has a gently warming effect. It is part of the zingiberaceae family which also includes ginger. So if inflammation is defined as causing redness, swelling and heat, how can something warming reduce it?

In this article, you are going to be let into the secrets of how practising Chinese herbalists actually think and how we can construct highly nuanced, tailored and effective approaches to treating inflammation with herbal medicine. With this knowledge, the turmeric paradox will be solved!

Before we get started with the Chinese medicine, let’s learn a little more about why we get those four symptoms with inflammation. In Tortora and Derrickson’s Principles of Anatomy and Physiology, they explain:

‘Inflammation is an attempt to dispose of microbes, toxins, or foreign material at the site of injury, to prevent their spread to other tissues, and to prepare the site for tissue repair in an attempt to restore tissue homeostasis.’ (2)

This definition in essence has two parts. The first is dealing with infection, a defensive response. The second relates to repairing the tissue and restoring homeostasis or balance. Even though there is much to say about how herbal medicine fights infection and the powerful anti-microbial actions of herbs, in this article we are going to focus on the second, repairing tissue and restoring balance.

So why these four symptoms? Redness and swelling are caused by vasodilation and increased permeability, which leads to greater blood flow into the affected area. Heat not only helps fight infection but it also increases the efficiency of tissue repair. Pain is an instruction to the brain to stop activity that harms the body and take care of the affected area.

Simply, the body is doing its best to facilitate blood flow in and out of the affected area in order to promote a healing response. Here is where we find the most significant point of convergence with Chinese medicine thinking, ‘FLOW’. There is a famous Chinese medical saying.

通則不痛，不通則痛 – tong ze bu tong, bu tong ze tong. It translates to ‘Where there is flow, there is no pain. Where there is no flow, there is pain.‘ It is a play on words because both the word for flow and the word for pain in Chinese are both pronounced ‘tong’ albeit with different tones.

One could say then that the Chinese medicine approach to inflammation is a detailed in-depth examination of all the different factors that cause flow to be disrupted in the body. In this article, we will look at how the climate influences flow through temperature and fluid balance. As we go, I will give you examples of everyday and culinary herbs that you can try and experience the effect for yourself.

Climate and flow

The temperature and humidity of the climate fluctuates from season to season, day to day and during the day night cycle. It is also markedly different according to which geographical region we live in. Despite all of these fluctuations, the body must maintain its own balance between extremes of heat and cold on the one hand and dampness and dryness on the other. Temperature and fluid balance profoundly affects flow.

Turmeric (Curcuma longa)

Temperature: Heat and cold

Did you know that you can hear the difference between hot and cold water? Try it out, in a blind test, have a friend pour hot water into a cup and cold water into a cup and ask you which is which, ten times out of ten you will give the right answer. This is something that we know but we don’t know we know!

It is a knowing we aren’t necessarily aware we have. But why do they sound different? They sound different because temperature affects the viscosity or ‘thickness’ of the water. At low temperatures, water is more viscous and flows slower and less freely. At higher temperatures it is less viscous and flows faster and more freely. This is easier to see in a thicker substance like honey.

Our blood is a fluid and it obeys these same principles. If our body fails to maintain a warm enough temperature, the Chinese observed that ‘flow’ or circulation of fluids start to ‘congeal’ and flow less smoothly. If the solution to inflammation is promotion of flow, then restoring this flow is key. If the fluids of the body are cold, then quite simply, we need to warm them up.

One of the first herbs we will go to when blood is not flowing due to cold is Cinnamon. Cinnamon is spicy sweet and warm. It also has an amazing ability to promote flow out towards the limbs and extremities. The spiciness invigorates the flow of blood and the sweet flavour harmonises.

If there is chronic stagnation of flow in the blood from cold over a period time, this can lead to a more entrenched stagnation. One might think of how a river can start to get silted up and blocked over time. When the water stands still, it stagnates. In this kind of situation, we need something not only to warm the flow and invigorate the blood, but also to go a little deeper and stir up the metaphorical silt sitting at the bottom.

And now we get to solve ‘the turmeric paradox’. Turmeric is spicy and warm, but it is also bitter. The warmth and spiciness, like Cinnamon, warms and invigorates the blood. However, the bitterness drives the effect deeper and has a ‘dredging’ effect. In the Chinese materia medica it is said to have the ability to disperse clumping in the circulation.

So, turmeric powerfully restores flow and through this helps reduce inflammation. In the right circumstances, it does this in the best way. Instead of suppressing the natural inflammatory healing response, it assists it and makes it more efficient.

Chronic blood stagnation is one of the most common effects of ageing. As we age, our constitutions weaken and so does our circulation. Over time, the circulation of blood stagnates, so much so that it can be visible to the eye, for example with varicose veins. This makes turmeric an ideal tea for the elderly.

Turmeric actually came later on to the Chinese pharmacopeia, with its origins in Central Asia and long being used by Ayurveda and Middle-Eastern medicine traditions. However, when it arrived, brought to China along the Silk Road, the Chinese embraced it, classified it and it quickly became a frequently used herb within the medicine.

Too much heat in the blood can also affect circulation. Heat can cause the blood to move ‘recklessly’ and to flow outside of the vessels. It can also dry the body out and cause dehydration. For this reason, Chinese medicine also uses cooling herbs to treat flow. However, we are warm-blooded mammals with a necessity to keep our body temperature elevated against the forces of nature.

Consequently, we must always be careful not to cool the body down too much and lose the root of our energy. For this reason, Chinese medical practitioners prescribe herbal formulae and balance the temperature by combining both warming and cooling herbs.

Fluid balance: Dampness and dryness

We probably all know someone who had terrible chronic aches and pains in the body and then they went on holiday and they all disappeared. The UK has a damp climate. Excessive dampness obstructs flow. If someone suffers from pain caused by excessive dampness and they go to a hot dry country, perhaps to a desert environment, the climate becomes the cure.

In Chinese medicine, there are countless different ways we can deal with damp in the body: we can give herbs to transform it; to dry it; to leach it out through the urine; to take it out through the bowel; to disperse it; or even in some cases, to sweat it out. By getting diagnosed from a well-trained practitioner, they can make a nuanced decision in choosing the correct strategy to deal with the damp in the body.

Coix seeds

Even though there are many different herbs and strategies to deal with damp, there is one which is used in everyday cooking in China that is very safe, very effective and has a wide variety of applications. Its Chinese name is Yi Yi Ren and it is variously called Job’s Tears, Coix seed or Chinese pearl barley in English. It has a bland taste.

Bland foods sometimes have the ability to ‘leach’ damp out through the urination. You can cook with it and put it in your food or you can boil it in water and drink it as a tea. The Chinese consider it particularly effective in treating damp that lodges in the joints.

One of its great benefits is that it not only drains damp, but also clears stagnant heat while at the same time having a nourishing quality. This gives it a very balanced effect. It is a medicinal which is very often found in damp type pain conditions.

Dryness causes the blood flow to stagnate, just as water lacks the power to flow when there is insufficient amounts. For dryness, we can use the sweet flavour to moisten and the sour flavour to astringe and help retain the fluid we have. A classic Chinese medicine combination for pain is to bring together the sweetness of licorice root with the sour, bitter, cool but nourishing quality of white peony root. These two herbs combined are one of the most famous two herb combinations for pain, particularly when the cause is lack of fluids.

Just getting started… This is a brief introduction to Chinese medicine thinking on how herbs influence flow but there are so many more factors that Chinese medicine practitioners consider.

Opening and closing

Ginger (Zingiber officinale)

The Chinese understood that the body has a mechanism to open and close towards the exterior. If its cold the pores will close down and warmth and fluids will flow more interiorly to protect the internal organs. If it is hot the pores open and warmth and fluids flow to the exterior to help the body cool down.

If this opening and closing of ‘the exterior’ of the body becomes unregulated it can also profoundly affect the quality of flow in the body and the temperature and fluid balance. Chinese medicine has innumerable tomes just dedicated to this question and how to address these imbalances with different herbs and formulae.

Opening, exterior releasing, sweat promoting herbs tend to be spicy like ginger and cinnamon. Closing, exterior consolidating herbs tend to be sour like white peony root. When you pair these herbs together they balance opening and closing and regulate the exterior. Now you know why ginger, lemon and honey is so good for colds!

Emotions and flow

Rose (Rosa centifolia)

You can use this spaImagine for a moment, something that makes you really angry, properly furious. Now become aware of your physical body. You may be aware that you are clenching muscles up and down the body, your heart rate may have gone up, you may feel hot, flushed and red in the face, mind racing.

Emotions have a tangible and profound effect on flow in the body and effect everything from our internal organs to the blood circulation. If emotions are unregulated, either over-expressed or repressed, they constantly through our physiological balance out. Many Chinese herbs have profound effects on our emotions through re-establishing flow.

Many of these herbs have powerful aromas that harmonise the mind but also move our qi. When our qi moves, our blood moves. Examples of these would include mint, rose or jasmine.

Internal disharmonies

Many diseases and ailments also cause inflammation, pain or discomfort. Constipation can cause heat, dryness and stagnation in the body. Diabetes can cause peripheral neuropathy, numbness in the extremities. The after effects of severe colds and flus can lead to chronic pain as is being seen worldwide in the now common presentation of ‘Long Covid’. The skilled diagnosis and intervention of a Chinese herbalist can at the least ameliorate the symptoms of these internal conditions but in many cases get right to the root of them and restore the whole body back to balance.

Range of treatments

Camphor

So far we have only talked about taking herbs internally. However, herbs are just as often used as externally applied oils, creams and pastes especially when treating pain. They are most commonly added to a base of Camphor and Menthol.

Camphor is very warming and Menthol is very cooling. Which creates a powerful dynamic. They are both also very aromatic. Aromatic herbs ‘penetrate’ deeply into the tissues and they also powerfully move stagnated fluids. Different herbs are added to this base to create different effects; some more warming, some more cooling; some more draining and drying, some more nourishing.

Please note: Camphor and Menthol are powerful ingredients and should only be prepared by professionals. Camphor is only suitable for external use and should not be taken internally.

The number of Chinese herbs in active use is enormous, each with their own character and specific uses. When combined together into different formulas, they can be tailored to have highly specific effects particular to individual patients’ needs. The Register of Chinese Herbal Medicine (RCHM) requires high quality degree-level qualifications for membership assuring the public that the practitioner can provide a skilled, professional and safe service. RCHM practitioners also use herbs from approved suppliers that are checked for safety and quality on the one hand and ethical sourcing. No animal products or endangered species are used.

Chinese herbal medicine has successfully been used to treat pain conditions, from the mild to the severe, from the acute to the chronic for thousands of years. It is our hope that we can raise awareness of the great depth of practice that it has to offer.

If you would like to find out more about herbal medicine in the UK or find a practitioner, you can visit the Register of Chinese Herbal Medicine at www.rchm.co.uk. You can also follow us on Facebook at https://www.facebook.com/RegisterofChineseHerbalMedicine.

References

Zeng L, Yu G, Hao W, Yang K, Chen H. The efficacy and safety of Curcuma longa extract and curcumin supplements on osteoarthritis: a systematic review and meta-analysis. Biosci Rep. 2021;41(6). doi:10.1042/bsr20210817
P.817 Tortora, G.J., Derrickson, B., 2006. Principles of anatomy and physiology. John Wiley & Sons, Hoboken, NJ.

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The art and science of herbal formulation: Traditional Chinese medicine

Simon Mills — Fri, 29 Oct 2021 15:22:13 +0000

Herbalist Sebastian Pole explores what’s in a traditional Chinese herbal formulation.

In Traditional Chinese Medicine, a formula is known as fang ji. This saying combines the meaning behind the creativity and the creation of a herbal prescription. ‘Fang’ is the actual paper the formula is written on, ‘ji’ is the practice of formula creation and administration itself.

In TCM, understanding the classical formulae is as essential as understanding the theory, the treatment strategy and the individual herbs themselves (this package is known as (li fa fang yao). It is a perfectly logical approach to help guide the practitioner in pursuit of a successful clinical outcome.

The first job in creating a formula is to differentiate the root causes from the manifesting signs and symptom branches of an illness. TCM practitioners are always seeking to determine what is the ben – the root – and what is the biao – the branch. Simply put, you treat the manifestations of illness in acute disease and you treat the root patterns in a chronic syndrome, though of course, clinical necessity means you are often treating both root and branch at the same time. As TCM is not primarily disease orientated but more strategy orientated, this leads to what is probably one of the most insightful dictats in traditional medicine:

‘Yi bing tong zi, Tong bing yi zi’
‘One disease has different treatments,
Different diseases have the same treatment’.

This is entirely obvious and basic in clinical experience; for example, one person’s upset tummy is not the same as another’s. Whether you call it IBS, Crohn’s or Ulcerative colitis, from a TCM perspective the patterns can include various configurations of heat-cold-wind-damp. Get it wrong at your patient’s peril.

Conversely a well-known formula such as Si wu tang; including Dang gui (Angelica sinenis), Bai shao yao (Peonia lactiflora), Chuan xiong (Ligusticum chinensis), Gan cao, (Glycyrrhiza uralensis) can be used for a range of diseases such as anemia, amenorrhoea, constipation, dry skin or insomnia.

Chinese treatment strategy

Along with viewing whether a disease is mainly influenced by the interior or the exterior, hot or cold, excess or deficiency, yin or yang, TCM physicians use eight treatment methods (ba fa):

Sweating (han fa) ‘When it is at the level of the skin, use sweating to discharge it!’
Vomiting (tu fa) ‘When it is at the upper level, draw it up and out’ – (rarely used today)
Draining downwards (xia fa) ‘When it is at the lower level, lead and draw it down’
Harmonising (he fa) a broad category used to integrate and bring a formula together.’
Warming (wen fa) ‘Warm that which is cold.’
Clearing (qing fa) ‘Clear that which is warm…treat hot with cold.’
Reducing (xiao fa) ‘Pare away that which is firm, disperse that which is clumped.’
Tonify (bu fa) ‘Tonify that which is deficient. Augment that which is injured.’

(References from the Inner Classic)

The herbalist is guided by what herbs to choose by linking the taste of a herb with its temperature qualities; a bitter-cooling herb will clear heat and drain damp, an acrid-warming one will disperse cold. As medical insight evolved, this knowledge of how herbs work developed into a further classification within Chinese herbalism of how to most usefully combine herbs; to mutually accentuate and enhance benefits as well as avoid antagonising or counteracting any intended actions. And this insight created a map for making a formula.

The pattern of formula construction commonly taught in Chinese herbal medicine is guided by the hierarchical concept of assigning a Leader, a Deputy, an Assistant, an Envoy. Traditionally these were couched in the cultural world of monarchs, rulers and class ranking. It’s the practice of synergy in action.

Select the lead herb, or herbs, that act like the Leader in charge. These should be delivering the strongest and most specific effect on the presenting pattern.

Then you should support those leading herbs with some help from the Deputy; herbs that are specific but perhaps at a lower dose than the primary Leaders. The Deputy may also be of primary focus for a secondary yet concomitant pattern.

Next you need to bring in the Assistant. Like all leaders and deputies, they may need some support in implementation. And they may need help in mitigating any extremes in the other herbs (too hot, too cold, potential toxicity).

The Envoy acts as a messenger herb helping to both guide the formula to a specific system in the body as well as smooth the journey, acting as a so-called ‘harmoniser’ to the formula.

And like all recipes, the classical formulae are really ‘ideas’ from which clinicians can take inspiration and shape to the needs of their client; by adding or subtracting species specific to the presenting pattern, adjusting the dose, modifying the form the prescription is consumed in (tea, pill etc).

Chinese herbal medicine formula review

TCM has thousands of classical formulae that are used as such templates; they are added to, subtracted from, mixed together – all with the intent of refining what is appropriate to each individual.

A widely-used formula is Xiao Yao Wan, The Free and Easy Wanderer:

Chinese name	Common name
Chai hu	Bupleurum	9g Leader
Dang gui	Angelica	9g Leader
Bai shao yao	White peony	9g Deputy
Bai zhu	White atractylodes	9g Deputy
Fu ling	Poria	9g Assistant
Bo he	Mentha	3g Envoy
Zhi gan cao	Honey-roasted liquorice	3g Envoy
Wei jiang	Roasted fresh ginger	3g Envoy

Decocted in 500ml for 30mins and taken warm 2x/day over 2 days.

Together the formula spreads Liver Qi, strengthens the Spleen, and nourishes the Blood and is used for anxiety, tension, depression, pre-menstrual syndromes.

Chai Hu and Bo He are like the light breeze and sunshine in the morning, Spreading the Qi and opening the channels.
Bai Shao Yao protects Liver Blood and works with Dang Gui to build Fluids.

Bai Zhu works with Spleen; a strong Spleen makes good Blood. Bai Zhu supplements Dang Gui’s ability to nourish Blood.
If the Sheng Jiang is roasted it protects the Middle Jiao and Spleen better.

Zhi Gan Cao harmonises the formula and tonifies the Spleen.

A Chinese herbalist will use this recipe as a basis from which to personalise the formula by emphasising various aspects as needed; more Blood tonics to build Blood, more Qi regulators to move Qi, Shen quietening herbs to alleviate distress, Spleen Qi tonics to help digestion etc. It’s the poetry of herbalism in action.

Chinese herbal classifications

Release the Exterior (warm, acrid herbs)
Release the Exterior (cool, acrid herbs)
Drain Fire
Cool the Blood
Clear Heat and Relieve Toxicity
Purgatives
Cathartics
Drain Dampness
Dispel Wind-Damp
Cool and Transform Phlegm-Heat
Warm and Transform Phlegm-Cold
Treat Cough & Wheezing
Aromatically Transform Damp
Regulate the Qi
Stop Bleeding
Invigorate the Blood
Warm the Interior and Expel Cold
Tonify the Qi
Tonify the Blood
Tonify the Yang
Tonify the Yin
Stabilize and Bind (astringents)
Nourish the Heart and Calm the Spirit
Aromatically clear the Orifices of the Heart
Extinguish Wind and Stop Tremors
Expel Parasites

References and further reading

You can find more about Traditional Chinese Herbal Medicine on our TCM herbalism page.

Ayurvedic Pharmacopoeia of India, Government of India, 2001, India
Bartram, T, Encyclopedia of herbal medicine, Grace Publishers, 1995, UK
Bensky, D and Gamble, A, Chinese herbal medicine: Materia medica, Eastland Press, 1989, USA
Bensky, D and Gamble, A, Chinese herbal medicine: Formulas & Strategies Eastland Press, 1993, USA
Bhishagratna, K, Susruta Samhita, Chowkhamba Press, 1996, India
Bone, K, Clinical applications of Ayurvedic and Chinese herbs, Phytotherapy Press, 1996, Australia
Bone, K, A Clinical guide to blending liquid herbs, Churchill Livingstone, 2003, UK
Bone, K and Mills S, The principles and practice of phytotherapy, 2^nd edition Churchill Livingstone, 2013, UK
British Herbal Medicine Association, British Herbal Compendium, BHMA, Vols 1 and 2, 1992, 2006, UK
British Herbal Medicine Association, British Herbal Pharmacopoeia. BHMA, 1983, UK
Che, Chun-Tao & Wang, Zhi & Chow, Moses & Lam, Christopher. (2013). Herb-Herb Combination for Therapeutic Enhancement and Advancement: Theory, Practice and Future Perspectives. Molecules (Basel, Switzerland). 18. 5125-41. 10.3390/molecules18055125.
Chen J and Chen T, Chinese medical herbology and pharmacology, Art of medicine press 2004, USA
Dash, B, Fundamentals of Ayurvedic medicine, Konark Publishers, 1978, India
Dash, B, Materia medica of Ayurveda, Jain Publishers, 1991, India
Dash, B and Sharma, R, Charaka Samhita, Chowkhamba Press, 1996, India
Dwarkanath, C, Introduction to Kayachikitsa, Chaukhambha press, 1996, India
Ganora, L, Herbal Constituents, Foundations of Phytochemistry, 2019, USA
Gogte, V, Ayurvedic pharmacology and therapeutic uses of medicinal plants, Bhavan’s Book University, 2000, India
Govind das Vicharita, Bhaishajya Ratnavali, Motilal Banarsidas, 1997, India
Hoffman, D, Medical herbalism, The science and practice of herbal medicine, Healing Arts Press, 2003, USA
Kaptchuk, T, The web that has no weaver: understanding Chinese medicine, Congdon and Weed, 1983, USA
Lad, V, Textbook of Ayurveda: Fundamental Principles, The Ayurvedic Press, 2002, India
Lad, V, Textbook of Ayurveda: General Principles of Management and Treatment, 2012, The Ayurvedic Press, 2002, India
Maclean, W and Lyttleton, J, Clinical handbook of internal medicine, Volume 1& 2, University of Western Sydney, 2002, Australia
Meulenbeld, G, The Madhava Nidana and its chief commentary: chapters 1-10, Leiden and Brill, 1974, Holland
Meulenbeld, G, Reflectons on the basic concepts of Indian pharmacology, in studies on Indian medical history edited by G Meulenbeld and D Wujastyk, Forsten, 1987, Holland
Meulenbeld, G, A history of Sanskrit medical literature, Egbert Forsten. 2001, Holland
Mills, S, The essential book of herbal medicine, Penguin Arkana, 1991, UK
Murthy, P, Sarangadhara Samhita, Chowkhamba Press, 2001, India
Murthy, S, Vagbhata’s Astanga Hridayam, Krishnadas Academy, 1991-1995, India
Murthy, S, Madhava Nidana (Roga viniscaya) of Madhavakara, Chaukambha Orientalia, 1995, India
Murthy, S, Sarangadhara Samhita, Chaukhamba Orientalia, 1995, India
Murthy, S, Bhavaprakasha of Bhavamisra, Krishnadas Academy, 2001, India
Nadkarni, A, Indian materia medica, Popular Prakashan, 1954, India
Namjoshi, A et al, The Ayurvedic formulary of India, Government of India Press, 1978, , India
Paranjpe, P, Indian medicinal plants: forgotten healers, Chaukhamba Sanskrit Pratishthan, 2001, India
Paranjpe, P, Ayurvedic medicine, the living tradition, a guide to Ayurvedic generic formulations Chaukhamba Sanskrit Pratishthan, 2003, India
Rang, H, Dale, M, and Ritter, J, Pharmacology, Churchill Livingstone, 1999, UK
Reddy, R, Bhaisajya kalpana vijnanam, Chaukhambha Sanskrit Bhavan, 2001, India
Sexena, N, Yogaratnakara, Chaukhambha Orientalia, 1995, , India
Sharma, P, Cakradatta: a treatise on the principles and practices of Ayurvedic medicine, Chaukhamba Publishers, 1998, , India
Svoboda, R, Prakruti: Your Ayurvedic constitution, Geocom, 1988, USA
Svoboda, R, Ayurveda: life, health and longevity, Penguin/ Arkana, 1992, India
Svoboda, R and Lade, A, Tao and Dharma, Lotus Press, 1995, USA
Tierra, M, Planetary herbology, Lotus Press, 1992, USA
Tillotson, A, The one earth herbal sourcebook, Twin Streams, 2001, USA
Tirtha, S, The Ayurveda encyclopedia, Ayurvedic Centre Holistic Press, 1998, USA
Trease and Evans, Pharmacognosy 16^th edition, Harcourt 2009, UK
Tobyn, G, Culpepper’s medicine: a practice of holistic medicine, Element, 1997, UK
Williamson, E, Major herbs of Ayurveda, Churchill Livingstone, 2002 (Williamson 1), UK
Zhou, Xian & Seto, Sai Wang & Chang, Dennis & Kiat, Hosen & Razmovski-Naumovski, Valentina & Chan, Kelvin & Bensoussan, Alan. (2016). Synergistic Effects of Chinese Herbal Medicine: A Comprehensive Review of Methodology and Current Research. Frontiers in Pharmacology. 7. 201. 10.3389/fphar.2016.00201.

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Medicinal mushrooms: An introduction

Peak — Fri, 29 Oct 2021 15:21:45 +0000

Neither plants nor animals but sharing characteristics of both, mushrooms have much to offer to modern medicine.

Medicinal mushrooms represent a fascinating and hitherto neglected category of nature’s pharmacopoeia. Neither plants nor animals but sharing characteristics of both mushrooms have much to offer for a number of disease categories including:

Cancer
Auto-immune conditions
Neurodegenerative conditions
Chronic viral infections

Medicinal mushrooms and their actions

Key to their ability to assist with many of these areas is the immune-modulating activity of the beta-glucans, proteoglycans and related polysaccharides which are important structural components of the mushroom cell wall.

Receptors with specific binding sites for such polysaccharides are found on many of the cells that make up the immune system and they have also been shown to have a prebiotic effect on the gut flora, promoting the growth of beneficial bacteria, enhancing intestinal barrier integrity, increasing levels of short-chain fatty acids and enzyme activity.

Given their positive immunological and prebiotic activity it is perhaps not surprising that increased mushroom consumption has been correlated with reduction in the risk of developing cancer in a number of large-scale epidemiological studies including three looking specifically at breast cancer risk and one at prostate cancer with regular mushroom consumption linked to a lower cancer risk in all cases, especially in older age groups.

As if that was not enough reason to reconsider mushrooms as an important food category for health maintenance, especially as we get older, mushrooms also produce an array of secondary metabolites with diverse health benefits.

Of these one of the most common is lovastatin, which like most other such secondary metabolites is produced by mushrooms and other fungi for its anti-microbial properties, in this case its anti-fungal action.

Other such compounds include:

Triterpenes from several species including Reishi with actions including anti-inflammatory, sedative, anti-allergic, anti-hypertensive
Diterpenes including erinacines and hericenones from Hericium species with NGF-promoting properties
Nuceoside-derivatives such as Cordycepin with anti-viral, anti-inflammatory properties in Cordyceps species
Ergothioneine, an antioxidant amino acid found in porcini and oyster mushrooms with anti-ageing properties
Cordycepin and Long-Covid: Cordycepin (3’-deoxyadenosine) one of the key active molecules found in Cordyceps species, especially Cordyceps militaris is a close relative of Didanosine (2’,3’-dideoxyadenosine – used as part of HAART treatment for HIV/AIDS under the brand name Videx) and like Didanosine exhibits strong anti-viral activity. In addition it is a potent anti-inflammatory and contributes to Cordyceps’ traditional therapeutic use to increase energy and support the Lungs and Kidneys, including promoting steroid hormone production. With recent studies also pointing to protective properties for both cordycepin and Cordyceps militaris against lung injury from acute inflammation it is rapidly emerging as a promising candidate to help address the symptoms associated with Long Covid.

Mushrooms are also the only non-animal food to contain significant quantities of vitamin D with ergosterol in the cell wall converted to vitamin D2 on UV-exposure.

Traditional views on mushrooms as medicine

Reishi mushroom (Ganoderma lucidum)

While awareness of mushrooms’ health benefits is relatively recent in countries such as the UK and USA, in others, especially in East Asia it has long been part of herbal traditions with the earliest Chinese materia medica, the Shen Nong Ben Cao, dating to around 200AD, including several still in use today:

Ling zhi (Ganoderma lucidum – Reishi)
Fu ling (Poria cocos)
Zhu ling (Polyporus umbellatus)

All of these are classified in the ‘Superior’ category of herbs, herbs which are considered safe to take for long periods of time without side effects and of which it is said that prolonged use will ‘lighten the body and confer longevity’. Indeed, G. lucidum has long been thought to be the plant Chi mentioned in a number of Taoist texts as a plant that brings happiness and immortality, although it is now believed that Chi and its classical categorisation according to six colours actually refers to a number of different species.

Over time the incorporation of mushrooms into the materia medica expanded so that in Li Shi Zhen’s authoritative work, the Ben Cao Gang Mu (1578), 21 mushrooms are listed as having medicinal properties and the reverence with which medicinal mushrooms, especially Reishi are held in Chinese culture is attested to by their extensive depiction in paintings, carvings and embroidery.

A modern perspective on medicinal mushrooms

Turkey tail (Trametes versicolor)

In the last few years awareness of mushrooms’ health benefits and the commercial possibilities they offer has seen interest in them take off in Europe and North America with a proliferation of new mushroom-based products and extended coverage in mainstream media such as the BBC and National Geographic magazine.

Unfortunately, even more so than with other herbs this increased interest has been accompanied by a proliferation of conflicting and competing claims and together with an opaque supply chain has resulted in a confusing landscape for those wishing to explore this area.

In order to address the need for education around medicinal mushrooms Mycology Press recently launched The Mushroom magazine and is currently setting up the Medicinal Mushroom Information Centre.

References

Mycotherapy of cancer: an update on cytotoxic and antitumor activities of mushrooms, bioactive principles and molecular mechanisms of their action.
Popović V et al. Curr Top Med Chem. 2013;13(21):2791-806.
A Critical Review on Health Promoting Benefits of Edible Mushrooms through Gut Microbiota.
Jayachandran M, Xiao J, Xu B. Int J Mol Sci. 2017 Sep 8;18(9):1934.
A Review of Mushrooms as a Potential Source of Dietary Vitamin D. Cardwell G, Bornman JF, James AP, Black LJ. Nutrients. 2018 Oct 13;10(10):1498.
Cordycepin: a bioactive metabolite of Cordyceps militaris and polyadenylation inhibitor with therapeutic potential against COVID-19.
Akalesh Kumar Verma. J Biomol Struct Dyn. 2020 Nov 23;1-8.

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Ephedra: ma huang or ephedrine? A lesson for herbal practitioners

Peak — Fri, 29 Oct 2021 15:21:39 +0000

Ephedra is a valuable herb. It is however banned in the USA. We take a look at this story and what we can learn.

What is ephedra?

Ephedra sinica

Ephedra or ma huang, is provided commercially as the dried young stems of three species of perennial herbs, Ephedra sinica Stapf., E. equisetina Bge., or E. intermedia Schrenk + C.A. Meyer.

Ephedra sinica is a native of northern China and Inner Mongolia. Each of the three species has slightly different appearances and characteristics.

E. sinica is the less branched, with nodes more spaced out on the stem. All samples are dry and brittle, with little odour and a slightly bitter taste.

Note: The North American ephedra E. nevadensis (known as Mormon tea), contains little or no ephedrine or other alkaloids.

Traditional and clinical activity

Ma huang is mentioned in the Han dynasty Shen Nong Ben Cao Jing (Divine Farmer’s Classic of the Materia Medica) (1) for its benefits on lung obstructions like wheezing. Its principal action through Chinese traditions was as a heating medicine, to treat febrile congested catarrhal conditions of the respiratory system. It promotes sweating, calms dyspnoea and is indicated for ‘exterior repletion cold damage patterns with aversion to cold’ (2).

It features frequently in formulae recorded in the Shang Han Lun (on Cold Damage) (3) in which it is often combined for additional warming effect with cinnamon and ginger. In modern terms the old indications translate as some of the preliminary symptoms of ‘flu, at the stage where the patient is feeling chilled and is shivering, and when sweating has not yet broken out (when the body temperature is showing as high yet the person still feels chilled: this means the temperature is still rising).

Headaches and diffuse pains around the body which appear at this stage are additional indications for the use of this remedy. Its effect in such cases is to provide a considerable perspiration and to provide a feeling of warmth, this (vasodilation and diaphoresis) leading to a fall in actual body temperature.

Its virtues are also evident in dealing with symptoms of dyspnoea: breathlessness and a feeling of constriction in the chest, including asthma. It may be applied generally to associated conditions of hypersensitivity in the airways, such as allergic rhinitis (including hayfever and ragweed sensitivity).

The warming quality of this remedy however dominate all its other effects. It is reflected in its role as as a circulatory stimulant, in dispersing catarrhal congestion, and as a diaphoretic in fevers. Closely associated with the above is the action of ma huang on fluid accumulations in the body.

Whether through its diaphoretic or diuretic effects, it acts to relieve symptoms of oedema. The total combination means for example that as far as the lungs are concerned, the remedy is applicable to bronchial congestive conditions as well as to asthmatic drying of the airways, and that it is ideal for bronchial asthma.

Traditional doses range from 1-5 grams per day, with lower amounts in many classic formulae.

As with other traditional remedies there has been a modern adaptation in the use of ma huang to new indications. Other heroic remedies that have switched roles (and reduced doses) include hawthorn (from fever management to heart and vascular remedy), feverfew (to a migraine treatment), and valerian (from a robust convalescent tonic to a sleep remedy) and, in each case with a reduction in dose and extension of treatment time.

Ma huang has morphed into ‘ephedra’, a prime modern remedy for bronchospasm, especially associated with allergic conditions. From being a marvellous treatment for healthcare emergencies it became a remedy that could be used in the long term, and at lower doses. Modern herbal practitioners have found it also useful in other symptoms of allergy as well, such as urticaria and atopic eczema.

Pharmacological activities

Ephedra sinica contains phenylalanine-derived protoalkaloids, notably ephedrine, pseudoephedrine, norephedrine, norpseudoephedrine, and l-methylephedrine. Pharmacopoeial specifications are that the herbs should contain not less than 1.25% of alkaloids calculated as ephedrine. Analyses show the range in commercial samples is between 0.5-2.5% and that ephedrine can account for between 30-90% of the alkaloid content; pseudoephedrine can go as high as 27%, though usually less (4).

Ephedrine is a sympathomimetic agent, acting indirectly to enhance the release of norepinephrine from sympathetic neurons, and directly by stimulating alpha and beta adrenergic receptors. It increases heart rate and cardiac output, and because it also constricts blood vessels, has a hypertensive effect.

In the lung, ephedrine acts via the beta-adrenergic receptors to relax bronchial smooth muscle, achieving an effect analogous to adrenaline without the need for injection. Because of its lipid solubility, ephedrine crosses the blood-brain barrier where it acts as a central nervous system stimulant, promoting both noradrenaline and dopamine levels (5). It has an action here comparable to amphetamines (6).

In the whole plant, this impact is qualified by the action of pseudoephedrine, the basis of a familiar decongestant medicine (e.g. Sudafed), which has more beta-adrenergic activity.

Although it is a banned in sports by the World Anti-Doping Agency (WADA) a recent meta-analysis (7) concluded that pseudoephedrine had minimal stimulant action, and is less hypertensive action than ephedrine. This means that blood supply to the skeletal muscle and periphery is increased, the bronchial airways are dilated, there is relaxation of the gut and reproductive musculature.

With the contribution of other constituents, e.g. alkaloids phenylpropanolamine (norephedrine), and cathine, as well as non-alkaloidal fractions that have demonstrated to be safer (8), this means that the whole herb does not have the same effects as the isolated ephedrine.

Dose levels in therapeutic use usually deliver less ephedrine than taken in isolation for weight loss or athletic performance. In traditional practice the higher doses in a range are generally applied to acute indications, in this case mostly fever management. Most herbal practice and traditional formulations provide ephedra at the lower end of the range, with modern western herbalists rarely prescribing more than 1g equivalent per day.

At this level the patient could be consuming between 10-25 mg of ephedrine equivalent. The highest therapeutic intake, for a high alkaloid yielding batch taken at maximum dose could be around 100mg per day. Doses under 50mg are not thought to raise blood pressure (9).

Clinical trials for ephedrine use daily doses ranging from 24-150mg. However commercial supplements can deliver many hundred milligrams.

Commercial decongestants like Sudafed deliver a dose of up to 240mg of pseudoephedrine, up to a hundred times that found in a daily dose of ephedra.

Even with a corresponding lower level of risk the herbal practitioner will be cautioned against the use of ephedra in cases of hypertension, a history of cardiovascular disease, and to use with care at the same time as antidepressant medication.

The RAND review of ephedrine (and a little ephedra)

Dry ephedra

In 2001 the RAND Corporation (the USA’s largest independent health policy research organization, often used by government agencies) was engaged by the federal Agency for Healthcare Research and Quality to review the alarming increase in adverse case reports and litigation following the widespread use of ephedrine products in weight loss and athletic enhancement.

In 2003 Agency released the report of Rand’s Southern California Evidence-Based Practice Center (10) which concluded that there was evidence that these products are related to a two- or three-fold increase in side effects such as nausea, vomiting, jitteriness, and palpitations. Furthermore, the evidence suggested a link between these products and catastrophic events such as sudden death, heart attack or stroke.

RAND researchers based their findings on a detailed review of 52 clinical trials of ephedrine or herbal ephedra for weight loss or athletic performance in humans.

They searched the medical literature and other sources for both published and unpublished medical trials of the substances. They also analyzed more than 1,500 “adverse event reports” related to herbal ephedra and 125 such reports related to synthetic ephedrine-containing products, which were collected by the U.S. Food and Drug Administration. Researchers discovered 70 additional adverse events in the medical literature and received a computer file of more than 18,000 adverse events from Metabolife, a maker of ephedra products.

Paul Shekelle, the RAND and Veterans Affairs physician who headed the study noted that “with regard to catastrophic events, these findings are a strong signal that there is a link between use of ephedra or ephedrine and the occurrence of death, heart attack, stroke, seizures, and serious psychiatric symptoms…. It is more likely than not that there is a relationship, although the available evidence falls short of the conventional level of scientific proof.”

The RAND study also found some evidence of benefits of ephedra and ephedrine for weight loss. Dietary supplements containing ephedra, the drug ephedrine, and ephedrine plus caffeine promoted modest short-term weight loss, averaging about two pounds per month more than among people taking a placebo. However, none of the studies reviewed followed participants for longer than six months, less than the 12 months accepted as necessary to establish a drug’s value as a weight-loss aid.

Although many of the ephedra supplements and ephedrine products are taken for boosting athletic performance, researchers found no evidence that ephedra—and only a little evidence that ephedrine—enhances physical performance. They found no evidence that any of the products improve long-term physical performance among athletes or the general public.

I was invited on the Technical Expert Panel to review this report. Our reviews were recorded in the archives of the US National Institutes of Health, including my contribution.

“After reading the RAND report, my first impression is the following: What are we evaluating — ephedrine or herb ephedra? The latter is not a single-chemical entity and cannot be assumed to be ephedrine. Even assuming the herb ephedra in the literature is defined to contain specific dosage levels of ‘ephedrine,’ what efforts were made to ascertain that this ‘ephedrine’ is indeed ephedrine and not a mixture of ephedrine-type alkaloids, or, worse, different types of alkaloids that are also present in ephedra? Any study or report on a natural product (not just a single-chemical compound) must clearly define what the material under study or being reported is. I don’t see such a definition in this report. Despite the limited availability of useful data, this report’s conclusions regarding the efficacy of ephedrine (the single-chemical drug), in the presence and the absence of caffeine, in short-term weight loss and athletic performance, appears to be sound.“

This generated a reply from the authors that did not completely address the point.

“We agree that the lack of specificity is a problem. We have modified the conclusions to be more specific to only these herbal combinations studied. In the RCTs of herbal ephedra included in the efficacy analysis, the dose of ephedrine alkaloid was stated.“

Outcome of the RAND report

On February 9, 2004, the US Food and Drug Administration (FDA) issued a final rule prohibiting the sale of dietary supplements containing ephedrine alkaloids (ephedra) because such supplements present an unreasonable risk of illness or injury.

Ephedra in the UK

Practitioners have continued to be grateful for the benefits of ephedra in the UK. However in recent years reliable supplies have been very hard to source.

Ephedra is included on a list of the Schedule 20 Part 2 herbs in the European Medicines Regulation 2012. These herbs may only be used by ‘qualified Medical Herbalists’ in their prescriptions and are not on General Sale. Other herbs on this list are:

Adonis vernalis
Aspidosperma quebracho-blanco
Atropa belladonna (herba)
Atropa belladonna (radix)
Chelidonium majus
Cinchona spp.
Colchicum autumnale
Convallaria majalis
Datura stramonium
Gelsemium sempervirens
Hyoscyamus niger
Lobelia inflata

Since the 2012 legislation there have been suggestions that the status of all Schedule 20 herbs will be reviewed.

The US experience of ephedra and ephedrine should provide us with a heads up … we should tell our story better.

References

J. Needham, L. Gwei-Djen, H. Hsing-Tsung (2013) Science & civilisation in China-Vol 6-1: biology and biological technology Cambridge University Press ed.
Yen Kun-Ying (1992) The Illustrated Chinese Materia Medica. SMC Publishing Taipei.
Mitchell C, Feng Y, Wiseman N. transl. (1999) Shang Han Lun on Cold Damage. Paradigm Publications, Brookline, Massachusetts.
Evans WC. (1989) Trease and Evans’ Pharmacognosy. 16th Ed. WB Saunders, London p 376
Hardman JG, Limbird LE, Gilman A. Eds (2001). Goodman and Gilman’s The Pharmacologic Basis of Disease. McGraw-Hill, New York.
Martin W R, Sloan J W, Sapira J D, Jasinski D R. (1971) Physiologic, subjective, and behavioral effects of amphetamine, methamphetamine, ephedrine, phenmetrazine, and methylphenidate in man. Clin Pharmacol Ther. 12(2): 245–58
Gheorghiev MD, Hosseini F, Moran J, Cooper CE. (2018) Effects of pseudoephedrine on parameters affecting exercise performance: a meta-analysis. Sports Med Open. 5;4(1): 44
Odaguchi H, Hyuga S, Sekine M, et al. (2019) [The Adverse Effects of Ephedra Herb and the Safety of Ephedrine Alkaloids-free Ephedra Herb Extract (EFE)]. Yakugaku Zasshi. 139(11): 1417-1425
Astrup A, Toubro S. (1993) Thermogenic, metabolic, and cardiovascular responses to ephedrine and caffeine in man. Int J Obes Relat Metab Disord. 17(Suppl 1):S41–3
Shekelle P, Morton SC, Maglione M, et al. (2003) Ephedra and Ephedrine for Weight Loss and Athletic Performance Enhancement: Clinical Efficacy and Side Effects. Rockville (MD): Agency for Healthcare Research and Quality (US); (Evidence Reports/Technology Assessments, No. 76.)

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The Jade Screen Project

Peak — Fri, 29 Oct 2021 15:21:37 +0000

The Jade Screen Project (JSP) offers immune-enhancing and anti-viral herbal formulae for front line workers in the fight against Covid-19.

What is the Jade Screen Project?

“Everybody had the same terrible, terrible fatigue. So I just told everybody about the ‘trial’ and everybody… and, and those who signed up… you know, just, just got better. Really, really quickly.” – JSP service user

The Jade Screen Project (JSP) offers immune-enhancing and anti-viral herbal formulae for people working in the NHS, care homes, and those providing essential support services, that might reduce the risk and potential severity of infection.

We want to step forward to help those who are on the front line at greater risk of infection from Covid-19, by offering free CHM. We want to give it for free because we feel they deserve this level of support, as they are putting their lives on the line.

The Jade Screen is taken from the name of an ancient formula, which was used to protect people from infection. The formula’s name was derived from the Feng Shui practice of placing a screen made of the jade stone in rooms to protect people from draughts, the reference to jade reflects value and strength, and screen indicates a barrier – together it is considered something both protective and precious to have around the home.

The Jade screen, both the formula and the metaphor of protection, is our inspiration to offer our support to people working in environments where there is an increased risk due to high viral load.

Setting up The Jade Screen Project

The Jade Screen Project (JSP) was set up in April 2020 by a small group of Chinese herbal medicine practitioners in response to the rapidly developing healthcare crisis caused by Covid-19, and its potentially devastating effect on frontline workers. The name of the project was derived from a famous 13^th century Chinese herbal formula designed to protect against infectious disease.

Our aims were to replicate findings in Hong Kong from the 2002-3 SARS epidemic and anecdotal reports from Wuhan, China, in 2020, that described the use of immune regulating and anti-viral herbal medicines in helping to protect healthcare workers from contracting disease.

Our second aim was to provide herbal support for people who had contracted the virus and were managing the disease at home, and our third objective was to use herbal medicine to promote recovery from the chronic symptoms of disease now known as ‘Long Covid’.

Setting up the project was exciting and exhausting. We conducted rapid reviews on all the English and Chinese language literature describing the treatment of Covid-19 and similar coronaviruses with Chinese herbal medicine (CHM). Most of the data described the treatment of acute disease and various protocols that had been tested or were biologically plausible as preventative interventions.

We quickly formulated this review into treatment guidelines and ran three training seminars to inform our herbal colleagues of our findings. Seminars were free and were conducted via Zoom. Over 100 herbal practitioners attended, 50 of whom then signed up to provide a network of herbalists prepared to treat frontline workers.

We now had a theoretical framework we could apply to treating Covid and a group of practitioners prepared to treat frontline workers free of charge. In parallel to these encouraging developments we approached Balance Healthcare Ltd, who agreed to provide heavily discounted herbs for the project.

We desperately needed funding to enable to project to become operational and this was generously provided in the form of two £5000 grants from the Earthsong Foundation. Chinese herbal medicine in the UK now had a portal which it could use to make a contribution to the fight against the pandemic.

Herbal Medicine for frontline workers

We saw our first patient, a policeman with acute Covid symptoms, on May 1^st 2020, and we have now treated 230 frontline workers coming from an astonishing array of occupational backgrounds including surgeons, care workers, teachers, GPs, youth workers, nurses, mental health workers, pharmacists, train and bus drivers, and physiotherapists. Initially our treatments tended to focus on providing preventative herbal formulae with a smaller number of people presenting with acute disease.

Over time there has been an increasing emphasis on helping people with the debilitating chronic symptoms of Long Covid. In light of the recent introductions of the vaccine we decided that from January 2021 we should focus our limited resources on supporting people with acute disease and with Long Covid.

In addition to the generous support of Earthsong we have raised over £10,000 in donations from professional bodies and individuals who have want to help the project, or who have been the recipients of JSP treatments. This is fantastic but unfortunately it is not enough to enable us to continue providing free herbal care-especially to patients with Long Covid who require complex and expensive interventions to help restore them to good health and enable their return to work. We need to find new sources of funding to enable us to continue to provide herbal support to frontline workers who have risked their health to provide vital services that we all depend on.

Who are the practitioners?

We are a group of experienced practitioners and researchers of Chinese herbal medicine (CHM) who want to make a positive contribution during the current pandemic. We are committed to providing accessible, high quality, evidence-based care using herbal medicines.

We are very moved by the response from the CHM community, who have registered as JSP practitioners and are all offering their services free of charge.

As a measure of our offering the best service we can, we have elected to choose practitioners for our service who are registered members of their professional association, so we can be sure of the high standard of the treatment we are offering.

These practitioners have also undergone specialised training in Covid-19 infection management based on research from Chinese treatment protocols currently used in the pandemic.

We also carried out our own survey of experienced practitioners based in different countries to find out their own clinical CHM experience with patients who have been affected by COVID-19.

What is Chinese herbal medicine?

Chinese herbal medicine (CHM) is an ancient system of medicine developed and refined in China and other East Asian countries over the past 2000 years, using the active compounds available from hundreds of different plants. Although they are not refined and isolated as they are in modern drugs these plants enable what has been described as a polypharmacy that allows many compounds to operate together to generate a therapeutic effect.

CHM herbal formulas are normally between 10-15 different herbs containing plant extracts that have immune-regulating, anti-viral, and anti-inflammatory effects. These individualised formulas are worked out after the practitioner notes down the precise nature of the symptoms, as well as any underlying health conditions and medication being taken.

CHM has demonstrated a preventative effect in previous coronavirus epidemics – a large study from 2003 during the SARS outbreak in Hong Kong compared 1,063 healthcare workers taking CHM with 36,111 who did not, and found that those who did had a much lower infection rate.

CHM is part of an array of support and advice that a qualified herbalist can offer. Having seen the evidence from both our clinical practice and research into the benefits of herbal medicine, we feel strongly about stepping forward to support those who are putting their lives on the line, and helping them during this incredibly difficult and stressful time.

We have seen in our clinics the results of the support we offer our clients, and through researching treatment protocols used over centuries in response to pandemics, infectious respiratory diseases and rehabilitation from chronic illness, we strongly believe that our skills and experience will be useful for those right at the edge of the crisis.

What is the research?

Reishi mushroom (Ganoderma lucidum)

A final word on how we are evaluating the project. In April we submitted a research proposal on preventative care to St Thomas’s Hospital and over the summer we had discussions with the Department of Primary Care in Southampton University about a research project treating patients with Long Covid.

Sadly, for reasons that to be frank escape me, neither project was considered to be worth developing. In the absence of formal academic support we have used MYMOP (a validated patient centred outcomes measure) to assess the results of our interventions and we have also conducted a number of in-depth interviews with JSP patients to explore their experience of the project.

We are currently conducting a service evaluation to look at all aspects of what we do that will hopefully result in quantitative and qualitative data being written up and published. We hope that this might provide a rigorous rationale to persuade funders and professional researchers to investigate the project.

There are studies on the front page of the Jade Screen Project website, for those interested in the science behind CHM being able to supress viral replication, and inhibition of the SARS protein entering the cell’s receptor sites, which is how the virus enters the cells. There are also studies showing how herbs may have anti-inflammatory and immunoregulatory effects by reducing cytokine levels and enhancing immune mechanisms.

Several studies have confirmed the ability of mushrooms in general to increase the effectiveness of both our innate and adaptive immune response to a range of pathogens, including viruses. Reishi has a strong anti-inflammatory activity, as well as the quality to curb viral replication. Covid-19 enters cells via angiotensin-converting receptors, which the triperpenes and proteins from Reishi have been shown to block.

Herbs such as Patchouli and Japanese Knot Weed are considered to have anti-inflammatory and immune-protective qualities, that are amongst a wide range of herbs available to herbalists. These three herbs in particular are very useful in our formulae, where we call them by their Chinese names of Ling Zhi, Huo Xiang and Hu Zhang.

A meaningful contribution in the fight against Covid-19

“Good luck with the project and everything. I hope that would be great to see it more in the mainstream and helping more and more people because I know it can do that now.” – JSP service user

In the meantime we soldier on, making a small but meaningful contribution in the fight against Covid-19. My experience, and that of my colleagues, is that CHM can help manage acute disease and significantly speed up recovery from Long Covid. I hope we can find a way to continue and develop the support we provide to frontline workers and to extend it to the growing numbers of people who have been laid low by this disease.

We’re not asking the people on the frontline to pay for either the herbs, or the consultations, as we feel they deserve our support and have put their lives on the line for all of us.

All donations we receive will go towards paying for their herbs. Our time, research and consultations are being gifted as a token of our thanks for their courageous work. We are hopeful that our support will help to protect those who are in such a perilous situation.

All the money donated via our donation pages goes directly to paying for the herbs, which have been provided at a generous discount, allowing your money to go even further.

All admin costs are covered by internally generated donations, meaning all our fundraising from the public can go directly to covering the cost of the herbs.

Please help us to support those who really deserve it! If you can’t support us financially, please do share our page on Facebook and Instagram, and let your friends know, especially if they are working on the front-line and you feel they would benefit from our support.

All donations that were received by the Jade Screen Project went towards funding herbal medicine for our frontline workers.

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