Chinese Herbal Medicines: Comparisons and Characteristics

248 Pages·2009·2.33 MB·English

by  Yifan Yang MD MSc

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© 2002, Harcourt Publishers Ltd. All rights reserved.
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First edition 2002
Second edition 2010
ISBN: 978 07020 3133 5
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treating practitioner, relying on independent expertise and knowledge of the
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Foreword
Chinese herbal medicine is a medical system that The biggest challenge facing any serious practitio-
has evolved empirically over many thousands of ner, having undergone this lengthy and arduous
years, with countless millions contributing to its process, is the understanding of how to modify clas-
development and systemisation. Its’ roots reach sical prescriptions into useful and effective formu-
back to the very dawn of history, when all manner las, suitable to the presenting clinical picture—how
of methods, including trial and error played a roll in to judge the synergies of the different herbs when
the gradual amassment of the myriad facts that have combined in different groups or dosages, how to
passed down to us today. choose a particular herb over another in any given
When first embarking on its study, all but the situation. The answers, after dedicated study of the
hardiest of students will pale at the sheer quantity theoretical essentials, can usually only be gleaned
of information that has to be committed to memory. after many years of clinical practice and the observa-
Their excitement at first encountering the wonders tion of thousands of patients. At Chinese hospitals
of this vast body of knowledge, that ultimately form where junior doctors are under the clinical supervi-
the backbone of treatment, is soon swamped by the sion of old and experienced physicians, this type of
dawning realisation of the efforts required to master knowledge is more readily available to those who
it. Knowledge of each and every one of the ingredi- seek to develop their own style of practice. In the
ents’ many attributes, such as the temperature, West however, such opportunities can still be
flavour, channel association, nature, action, move- extremely hard to come by. Most useful source
ment, toxicity, interaction with other ingredients material is accessible only to those with a solid grasp
(both antagonistic and enhancing) and dosage needs of the Chinese language, and openings for extensive
to be grasped and assimilated. clinical practice under supervision are limited.
As study continues, the student soon discovers It is for this reason that I welcome the re-
that even once all this information has been secured, publication of this delightful work by Dr Yifan Yang.
the surface has barely been scratched, for now the This book offers an extremely useful grid by which
hundreds of commonly used formulas have also to to systemize the practitioner’s understanding of the
be memorised and understood. As this proceeds, it ‘real life’ qualities of the medicinal substances, by
emerges with even greater clarity that it is indeed categorizing them into groups according to their
the combinations of these medicinal substances in energetic properties, presenting their characteristics
precise quantities, which form one of the defining and clinical uses and then comparing them through
factors to an ultimately successful outcome to treat- finer analysis of their individual strengths. This is
ment. Just as in a well-crafted gourmet dish, it is information compiled from many sources, with the
the skillful combining of ingredients, that in turn unmistakable stamp ‘clinical practice’ written all
accentuate and enhance some flavours, whilst sub- over it. It will act as a reference work for serious
duing and downplaying others, that ultimately lead students and experienced practitioners alike, to
to the pleasing taste we experience when we deepen their understanding of Chinese medicine in
consume it. So too with a medicinal formula, it is a most productive way, and to apply this under-
the precise interaction of ingredients in the correct standing as it links to the principles and fundamental
quantity that makes the difference between an effi- concepts of Chinese medical theory.
cacious formula and one that will ultimately prove
ineffective. Mazin Al-Khafaji, 2010
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xxv
Preface to the first edition
When I was a medical student, endeavoring to study Chinese medical way and the diagnosis in Western
traditional Chinese herbal medicine, it was quite medicine. The whole book is written in a questions
challenging to memorize, within the space of one and answers style and it follows the chapter content
semester, the properties and functions of at least of most commonly used textbooks in Chinese herbal
300 commonly used herbs. As a junior doctor I still medicine. Each question and answer form a small
hesitated to select herbs to make my own formulae. unit, so the book can be read all the way through,
I was amazed to hear my teacher’s precise and vivid or each question can be studied individually.
explanations: ‘Oh, this is a wonderful herb, it is This book is written for serious practitioners
pungent and warm, yet not drying in nature, it and students who have already learned the
moves in a quick, yet gentle way, it can tonify the basic functions of the Chinese herbs and want to
body without cloying; the perfect choice for chronic master Chinese herbal therapy step by step. The
diseases.’ ‘This herb is very hot, so it can quickly information in the discussion of clinical applications
spread the warmth to the entire body, dispelling can be used to enrich the understanding of the
the Damp-Cold just like the sun with the fog’ and characteristics of the herbs rather than to discuss
‘This is the strongest herb among herbs that regulate the treatment of certain diseases both in the sense
the Qi.’ of Traditional Chinese Medicine and Western
The above way of teaching, to compare the medicine.
strength and characteristics of herbs, is applied, but For students and junior practitioners, this book
unfortunately it is not used regularly. The primary offers a method of learning and memorizing the
teaching method in books and lectures in the last functions of herbs through the approach of compar-
few decades still simply states the basic functions ing the characteristics and the strength of herbs with
and provides elementary examples of applications. related functions or natures. Each question may be
However, this method lacks precision in quality and used to stimulate discussion and in reviewing lec-
quantity, and is not vivid and emphatic in nature, tures. The answers might just clarify confusions and
and as a result students have to spend much more help the student delve deeper.
time on study and practice to really master the For experienced practitioners, this book offers a
characteristics of herbs and to grasp strategies to comprehensive knowledge of Chinese herbal medi-
make their own formulae skillfully. cine and a deeper understanding of the theories and
First as a student, then as a teacher and doctor concepts of Traditional Chinese Medicine. The fine
of traditional Chinese herbal medicine, I have analysis of the characteristics of herbs helps the
searched for a new way of studying and teaching. In practitioner to make a formula with better quality
this book, I have aimed to discuss the features of and results. The discussion of clinical applications
herbs instead of enumerating the common func- can be used in clinical practice to enlarge the treat-
tions. Comparison is used as the main tool in ment range.
explaining the fine differences between herbs that The knowledge gained of each herb is not solely
have the same or similar functions. Moreover, 117 developed from my own experience. During my
figures are provided to show the differences in tem- work in the Department of Chinese Herbal Formu-
perature and strength of single herbs that have the las at Beijing University of Traditional Chinese
same function. The theories and concepts of Chinese Medicine, the study of herbs was largely done
herbal medicine are used as principles throughout through discussion and debate with colleagues and
the analysis and explanation. The clinical applica- from a large number of ancient medical texts. From
tions of single herbs are presented according to the practicing what I have learned, first on patients in
differentiation of syndromes in the traditional China and now in the West, I have developed a B
xxvii
Preface to the first edition
deeper understanding of the herbs and gained expe- herbal medicine: the ancient, yet effective therapy,
rience and confidence in Chinese herbal therapy. I and an art that is full of wisdom, philosophy and
have tried to bring together my understanding of strategies.
herbs and a new way of studying in this book, and I
hope it can be of benefit both to those who have Yifan Yang
studied and those who wish to study Chinese The Netherlands 2002
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xxviii
Notes on the second edition
In the second edition of this book, as well as keeping the herb. Banned and protected substances are
to the concise writing style of the first edition, I have marked with two asterisks (**). Please note that
improved and added more on the safe use of Chinese Traditional Chinese Medicine takes the standpoint
herbal medicine in Chapter 1 (The theory and that all harsh herbs that have strong effects on
concepts of Chinese herbal medicine). I have also pathogenic factors in the body can easily cause side-
added precautions for the use of herbs in several effects and that these herbs all belong to the toxic
chapters. Moreover, three specific lists are given herbs group. Practitioners should always keep firmly
as appendices to assist practitioners in their daily in mind, not only the banned toxic herbs that are
clinical work: (1) Daily dosages for individual crude potential causes of damage to the liver, kidney and
herbs above 6–9 grams; (2) Commonly used herbal heart in Western medicine, but also the herbs
combinations and their applications; (3) Commonly (which are not always flagged with an asterisk in this
used Chinese words in herbal names. book) with strong properties and functions that may
In the second edition, the pharmaceutical names bring the same risks if they are not used in the
of herbs are given in parentheses after the Chinese correct situation, at the correct dosage and for the
Pinyin names and follow the current commonly used correct duration of time.
style.
Throughout the book, banned toxic herbs are Yifan Yang
marked with an asterisk (*) following the name of The Netherlands 2009
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xxix
Explanation of the figures
• At the end of each chapter, a group of figures • The herbs which will be compared are
are presented. There are more herbs listed and presented on the abscissa.
compared in the figures than are in the text • The strength of a particular action of the herbs
since it is easier and clearer to compare the is indicated on the ordinate.
temperature and the strength of many herbs • If the herbs are very similar in strength of a
in this way. These figures can be used as a particular action, the strength is summed up
supplement to the text, but they can also be from the temperature, meridians they enter,
used separately from the text. tendency of action and other functions.
• The dark red, medium red and pink bars
represent the temperatures, very hot, warm and Note on Chinese herb names
slightly warm respectively of the herbs. In the text, herb names are given in Pinyin. In each
• The black, gray and light gray bars represent the question, the pharmaceutical name of the herb
temperatures, very cold, cold and slightly cold follows the first mention of the herb. In the figures,
respectively of the herbs. the pharmaceutical names are given in the caption
• The white bar represents a neutral only. A full list of Pinyin and pharmaceutical names
temperature. appears as Appendix IV.
B
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Acknowledgements
I would like to express my gratitude to my teachers I would also like to thank Dr X. Yang BA, MB,
at Beijing University of Traditional Chinese Medi- BChir from the University of Cambridge, UK, Dr
cine, where I studied and worked for 13 years. I am D. Zajac PhD from the University of Reading, UK,
especially grateful to Professor Wang Mianzhi. He Mr M. Tjioe MD, Mr A. Van Dinteren MD, Mrs K.
was my first teacher of Chinese herbal formulas N. Tan MD and Mrs B. E. Sciarone MD from The
when I was a medical student, my tutor for my Netherlands, for checking the manuscript and for
Master’s degree in medical science, and the director their indispensable advice, and Dr J. Weng PhD
of the department where I worked. I was amazed from the University of Reading, UK for the beauti-
by his lectures, particularly the detailed analysis on ful figures and for his valuable suggestions. I would
the characteristics of herbs, the combinations of like to thank my friend Dr Gao Yuan from China
herbs and the structure of formulas, which for helping me to check some text in the original
came from his deep understanding, knowledge and ancient books, and Mr Charles Wauters from The
experience of Traditional Chinese Medicine. I Netherlands for helping me to check the pharma-
learned a lot from his lectures and during the time ceutical names of the herbs with his knowledge as a
when I was his assistant. Furthermore, his devoted pharmacist. I am also grateful to the team at Elsevier
spirit on the work of Chinese medicine, his princi- Ltd for their expertise and efficiency in the proce-
ples of life, and his tireless and kind manner to dure of publishing this book.
patients always encouraged me in the endless study Finally, I am still grateful to my daughter Chuan
and practice. for her understanding, love and support.
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xxxi
Chapter One 
1
The theory and concepts of Chinese 
herbal medicine
either a Cold or Heat syndrome in combination with
1  What are the four flavors  
other hot or cold herbs. For instance, Fu Ling (Poria)
of Chinese herbs? What are 
can be used with Fu Zi (Aconiti radix lateralis pre-
their applications in clinical  parata)* to warm the Kidney-Yang and reduce
edema; it can also be used with Xiao Ji (Cirsii
practice?
herba) to treat painful urinary dysfunction due to
Heat in the Bladder. These are the basic applications
The four flavors are called ‘Si Qi’ in Chinese. ‘Si’ of the four flavors.
means ‘four’, and ‘Qi’ means ‘the special quality of The four flavors are amongst the primary proper-
the herb’. In this context it indicates the tempera- ties of herbs but, in fact, the number is not confined
ture of the herbs, namely hot, warm, cold and cool. to four. Like many other theories in Traditional
Hot and cold herbs are opposite in nature, and cor- Chinese Medicine (TCM), the four flavors primarily
respond to the Yang and Yin. Cool and warm herbs indicate the temperature quality of the herbs. The
have the same nature as cold and hot, but to a lesser theory also suggests that these temperatures can be
degree. Each herb possesses one of these four subdivided into different degrees, but does not indi-
temperatures. However, there are also herbs that cate the details of these degrees. The terms ‘very
are neither hot nor cold, and are not included in the hot’, ‘hot’, ‘warm’ and ‘slightly warm’ are sometimes
four flavors. They are classified as ‘Ping’, meaning used. In practice, differences in temperature
‘neutral’. between herbs are usually found out from the
In clinical practice, hot or warm herbs are used explanations of the function, from applications given
to warm the body and to treat Cold syndromes. For in books and from personal experience.
example, Gan Jiang (Zingiberis rhizoma) is able to Moreover, hot herbs can be divided into thin-hot
warm the Middle Jiao and treat abdominal cramp and thick-hot. A thin-hot herb possesses a lighter
and diarrhea; Dang Gui (Angelicae sinensis radix) hot nature, which leads to a quicker action; it is
can warm the Blood and alleviate pain due to Cold often used to expel exterior pathogenic Cold—
in the Blood. A cold or cool herb is used to clear examples are Ma Huang (Ephedrae herba)*, Gui Zhi
Heat and to treat Heat syndromes. For instance, Shi (Cinnamomi cassiae ramulus) and Xin Yi (Magno-
Gao (Gypsum) can clear Heat in the Lung and liae flos). A thick-hot herb possesses a strong hot
Stomach and therefore it can reduce fever, wheezing nature that leads to a strong and steady action; it is
and thirst; Sheng Di Huang (Rehmanniae radix) can used to warm the Interior and treat interior Cold
reduce Heart-Fire in order to treat restlessness and syndrome—examples include Fu Zi (Aconiti radix
insomnia. A neutral herb can be used when the lateralis preparata)*, Rou Gui (Cinnamomi cassiae
syndrome is not characterized by Heat or Cold. For cortex) and Gan Jiang (Zingiberis rhizoma). Cold
instance, Fu Ling (Poria) can promote urination and herbs can likewise be divided into thin-cold and
reduce edema. A neutral herb can also be used in thick-cold. A thin-cold herb can gently but quickly B
3
part one Theory and concepts
disperse and clear Heat in the Upper Jiao or in the Heat and Dampness and therefore treat correspond-
superficial level of the body—examples are Bo He ing disorders. For instance, Ma Huang (Ephedrae
(Menthae herba), Chai Hu (Bupleuri radix), Sang herba)* can disperse the Lung-Qi, Shi Gao (Gypsum)
Ye (Mori folium) and Ju Hua (Chrysanthemi flos). is able to disperse Heat from the Lung and the
A thick-cold herb can strongly clear Heat and reduce Stomach, Fu Zi (Aconiti radix lateralis preparata)*
Fire—examples include Huang Lian (Coptidis can expel Cold from the Kidney, Fang Feng (Saposh-
rhizoma), Huang Qin (Scutellariae radix), Huang nikoviae radix) is able to expel Wind from the
Bai (Phellodendri cortex) and Long Dan Cao (Gen- superficial region of the body and Chai Hu (Bupleuri
tianae radix). radix) can lift the Qi from the Liver and Gall
Bladder.
2  What are the five tastes of  Since pungent herbs can move quickly and expel
pathogenic factors, they can also promote Qi move-
herbs? What are their clinical 
ment, Blood circulation and water metabolism, open
applications? the meridians and reduce stagnation. For instance,
Mu Xiang (Aucklandiae radix)**, Chen Pi (Citri
reticulatae pericarpium), Sha Ren (Amomi xanthioi-
The five tastes of herbs are pungent, sour, bitter,
dis fructus) and Hou Po (Magnoliae cortex) can
salty and sweet. Each herb has at least one taste and
promote Qi movement; Chuan Xiong (Chuanxiong
most have two or three. Some herbs have no specific
rhizoma), Dang Gui (Angelicae sinensis radix), Chi
taste, and so are considered bland herbs. There are
Shao Yao (Paeoniae radix rubra) and Yan Hu Suo
also herbs which have a special aromatic smell; these
(Corydalidis rhizoma) are able to invigorate the
are called aromatic herbs. Another exception is that
Blood; Di Fu Zi (Kochiae fructus) and Qin Jiao
there are also some herbs or substances which give
(Gentianae macrophyllae radix) can eliminate
an astringent sensation in the mouth, so these are
Dampness; Jiang Can (Bombyx batrycatus) and
called astringent substances.
Quan Xie (Scorpio)* can open the meridians.
Originally, the tastes of herbs were defined
The moving and dispersing ability of the pungent
directly from the perception in the mouth and
taste can also break up and eliminate pathological
stomach. People found that Gan Jiang (Zingiberis
products. Many herbs that are able to break up
rhizoma) is pungent, Gan Cao (Glycyrrhizae radix
congealed Blood, reduce food stagnation and dis-
is sweet, Huang Lian (Coptidis rhizoma) is bitter,
solve Phlegm are also pungent, such as Mo Yao
Wu Mei (Mume fructus) is sour, Zhi Mu (Anemar-
(Myrrhae), E Zhu (Curcumae rhizoma), Lai Fu Zi
rhenae rhizoma) is salty, Fu Ling (Poria) is bland and
(Raphani semen), Bing Lang (Arecae semen), Ban Xia
Long Gu (Mastodi fossilium ossis) is astringent. In
(Pinelliae rhizoma) and Xing Ren (Armeniacae
early medical practice, it was also found that a spe-
semen).
cific taste caused a specific reaction in the body; as
medical experience increased, the study of the
tastes of herbs changed. As a result, some tastes are Sweetness
ascribed to herbs not according to their perception
in the mouth, but to their action in the body. There-
A sweet herb possesses tonifying qualities. It can
fore, the five tastes of herbs no longer simply
tonify and nourish the body, and especially its sub-
describe the taste properties of herbs but have also
stantial aspect. Most of the herbs that tonify the Qi,
become a part of the theory of herbal medicine and
Blood, Yin and Yang are sweet. For example, Ren
are used to analyze and study herbs.
Shen (Ginseng radix) and Huang Qi (Astragali
According to experience from medical practice,
radix) can tonify the Qi; Shu Di Huang (Rehman-
each taste possesses specific properties, which can
niae radix praeparata) and Da Zao (Jujubae fructus)
bring about specific actions in the body. The basic
can tonify the Blood; Mai Men Dong (Ophiopogonis
actions from the tastes are as follows.
radix) can nourish the Yin; Ba Ji Tian (Morindae
radix) and Rou Gui (Cinnamomi cassiae cortex) can
Pungency tonify the Yang.
A sweet herb also possesses moderate quality. It
A pungent herb has moving and dispersing charac- can relieve acute stomach ache, abdominal pain or
B teristics, which are able to disperse Wind, Cold, cramping pain of muscles, because sweetness can
4