The Roots of Chinese Herbal Medicine

(originally published in Qi Journal Spring 2004 issue),

by Sean Fannin


In the search for answers to mental, physical and even spiritual health people are trying herbs and supplements at an unprecedented rate. Many have begun taking Chinese herbs such as Ginseng and Dang Gui (Tang Kuei) on their own, with the understanding that they have been used for thousands of years. However, without a traditional framework it is the case of "herbs but no formula," a traditional description of randomly selected herbs used out of the theoretical context of Chinese herbalism.

Health & Chinese Herbal Medicine

Within the theoretical framework of traditional Oriental medicine health is achieved through the development of a harmonious relationship with nature, meaningful interactions with others, and a balance between the physical substances and physiological processes of the body. Functional relationships are examined and categorized, resulting in a flexible view that is rational and systematic. Health is seen as a continually adapting, shifting state of balance.

From the traditional perspective, this changing, adaptable state of health comes from the normal or correct movement of qi. Qi can be translated as influence, energy, vital function and breath. Within nature the transformations of qi can be seen in the cyclical movement of day and night, the phases of the moon, and the changing seasons. The environmental forces of wind, dampness, dryness, warmth, cold and summer heat (a specific quality of heat) are expressions of the qi at a specific time and place.

Within the body, qi is the energy that allows the functioning of life through warmth, movement, transformation, containment and defense. It is the energy that maintains and safeguards the integrity of the body and mind, containing and preserving what is necessary to life and repelling what would be harmful. The attributes of qi within the body can be seen in the energy,warmth and vital movement of life. All transformations and movements within the body, whether physical or emotional, depend on the correct and balanced function of the qi.

When something throws off the correct balance and movement of the qi the whole body is affected. The resulting abnormal movement of qi can then become the beginning of disorder within the body. This is seen as the root of a health problem. Addressing a health problem within Chinese medicine begins with the process of identifying the underlying cause or root of the issue. Zhu Dan Xi, a famous physician from the Yuan Dynasty, emphasized this by writing: "Just as grass has its roots, so disease has its root. If one cuts off the leaves without eradicating the root, the grass will still stand there..."

Pattern Identification

Identification of the root cause of imbalance takes place through pattern assessment, which includes the traditional diagnostic arts of pulse taking, observation of the tongue and body and detailed questioning. This process is at the heart of Chinese herbalism, as any specific symptom or condition can be caused by many different underlying patterns of unbalanced or abnormal qi. If the underlying patterns are not identified then a therapeutic strategy can't be effectively developed and the herbal treatment will result in a haphazard effect. When people with a specific complaint choose an herb symptomatically a certain number of them feel better, a certain number feel worse and a certain number feel no different at all. Xu Da Cun (Hsu Ta-chu'n) , a scholar-physician who lived in the eighteenth century, described this in the following passage from Forgotten Traditions of Ancient Chinese Medicine:

If someone fails to inquire about the cause of the original illness, and about the cause of a concomitant illness, and if he simply states, "Such and such illness is to be treated with such and such drug," his therapy may hit the illness by chance, and the drug tossed into the patient may indeed sometimes effect a cure. But if he uses them again to treat people who are seemingly suffering from an identical illness, it may well be that he not only fails to effect a cure but, contrary to his expectations, adds to the severity of the illness.


Yin and Yang

The process of identifying the root cause of a health problem begins with assessing how the qi is functioning. The functioning of the qi within the body can be described through the principles of yin and yang, mutually balancing opposites. As universal principles, yin and yang include such pairs as heaven & earth, hot & cold, light & dark, action & receptivity, motion & stillness and so on. The dynamic, active principle is termed yang, while the receptive, containing principle is termed yin. In terms of practical application within the body, the balance of yin and yang is usually described through the specific manifestations of hot and cold, excess and deficiency and internal and external. While all of these pairs are important to the assessment process the most clinically significant are hot & cold and excess & deficient.

Temperature is a very direct manifestation of the qi of the body. Temperature can refer to someone's internal energetic tendency of having a hot or cold pattern or to the inherent energetic temperature of a food, herb, or other substance.

Cold patterns are caused either by a lack of qi within the body or by the external influence of cold. If there is not enough heat (a lack of the normal activity of the qi) within the body then there will be feelings of cold and a slowing of mental and physiological activity. This may manifest with signs such as a pale tongue, weak and slow pulse, weak digestion, loose stools, low energy or fatigue and frequent colds. In addition, anxiousness will override creative energy and there may be an emotional withdrawal.

Heat patterns are caused by excessive activity of the qi in the body, a lack of cooling fluids and substances in the body or by the external influence of heat. If the qi becomes overactive and is not restrained then the body will overheat and physiological activity will increase. Some manifestations of this might include a red tongue and complexion, a strong and rapid pulse, insomnia, agitated feelings, rashes, constipation and increased sensitivity and reactivity to external factors.

It is also possible to have a mix of both hot and cold patterns. Mixed patterns are a little more complicated. They occur when there are a combination of factors leading to a mixture of warm and cool signs within the body. This may manifest in such signs as a tongue with pale body and red tip, a pulse that is weak, thin and rapid, sensations of a cold lower body and hot upper body, feeling tired and restless simultaneously, and so on.

Deficiency & excess refer to the relative strength of the normal qi of the body as well as the strength of any pathogenic factors. Deficiency refers to a weakness or lack of something within the body. For example, lung qi deficiency means that the lungs are not functioning as well as they should, leading to shortness of breath, wheezing, fatigue and frequent colds.

Excess means that there is too much of something within the body. A flu would be an example of a superficial or external excess condition. In the case of a flu, the excess refers to external or environmental factors that have entered the body.

If there is a balance of the qi as manifested through normal temperature and relative strength then there will be clear thinking, appropriate emotional response, abundant energy, restorative sleep, good immune function and healthy digestion. Once the pattern of imbalance has been identified an herbal treatment strategy is developed.

Traditional Properties of Herbs

Throughout history in both the East and the West there has been an unfortunate tendency to look for an herbal magic pill, a remedy that will heal physical conditions and restore and augment mental functioning. Most of all, it will work on everyone despite their individual circumstances. While it is natural to desire these things, it can easily be seen that there is no herb that will have these effects on all who use it.

Within Oriental medicine, the traditional view of herbs is that no substance is either "good" or "bad" in and of itself. The measure of value lies not in the herb itself, but, to a large degree, in how it is applied. If the pattern of imbalance within the patient is understood and the nature and functions of an herb or herbal combination are understood, then it can be applied usefully and has a relatively high value. If however, an herb's nature and function are not understood, or a person's condition is not, the herb cannot be usefully applied and will most likely create a random effect of limited value. Thus, depending on its application, the same herb can be both valuable or worthless. Some of the most poisonous substances have produced some of the most potent medicines, and some of the most "harmless" plants have caused unpleasant reactions in people.

To determine how an herb can be usefully applied, Oriental medicine classifies medicinal substances according to their nature/temperature, their flavor, and their specific actions. This guides the use of the herb and indicates how it may be best combined with others.

Inherent Temperature/Nature

The most fundamental classification of herbs is by temperature or "nature." This refers to what effect an herb produces on the body in terms of temperature. Many people intuitively understand the idea of temperature. If asked whether Cinnamon produces a warming or cooling effect most people would say "warming" without hesitation. If however, someone wanted a cool, refreshing herb they might choose Mint.

There is a natural range of temperatures among herbs and other medicinal substances. Some are hot or warm, others cold or cool, while still some have no noticeable effect either way. This last group, usually called neutral substances, make up a minority of medicinal substances.

In this context temperature has little to do with the actual physical temperature of an herbal remedy. For example, if a cooling herb was served as a hot tea, the person drinking it would first feel a small amount of short-term heat generated from the warm water with an overall cooling effect coming from the herb. However it is served, the inherent nature of the plant determines its thermal nature.

Flavor & Function

Over the continuous practice of more than a hundred generations, herbalists have observed that the flavor of an herb indicates its general function. There are five flavors that are recognized as indications of function: Sour, Bitter, Sweet, Spicy, and Salty.

Herbs that are Spicy will tend in general to create a dispersing and moving effect. Sweet herbs are used to tonify or strengthen weakness or deficiency within the body. Many sweet herbs are considered to be "superior" meaning that they can be used nutritively over longer amounts of time to strengthen the qi, blood and essence of the body. Bitter herbs are used to clear excesses within the body and are usually cooling. Herbs that are sour are used as astringents, meaning that they hold in and prevent leakage of fluids, energy, etc. Salty herbs are used for resolving specific types of congestion, or to strengthen the body in certain circumstances.

Most herbs have a dominant flavor with one or two secondary flavors. This indicates primary function and secondary functions. These functions have been further defined into categories, which refer to the specific traditional functions & uses of the herb or medicinal substance.

In order to successfully apply an herb or herbal combination, the underlying pattern of imbalance must be identified. Once this occurs and the internal strategy has been formulated, the appropriate herbal strategy is selected. The assessment guides the strategy. For hot conditions cooling herbs are used, while cold conditions are addressed with warming herbs. For excess conditions dispersing herbs are used, while in deficiency conditions supplementing or strengthening herbs are indicated.

Herbal Formulas

Most herbal formulas contain somewhere between 3 and 21 ingredients. Formulas are written with a structured hierarchy, regardless of the number of herbs. The hierarchy is based on the court of Imperial China. As such, there are four categories of herbs - Emperor or Sovereign herbs, Minister herbs, Assistant herbs, and Envoy herbs. There are usually one to three Sovereign herbs, one to six Minister herbs, one to nine (or more) Assistant herbs, and one to two Envoy herbs, if any are used.

The Sovereign herb rules the formula by addressing the primary pattern or underlying issue. It is supported by the Minister herb or herbs, which further address the primary pattern. Assistant herbs support the Minister herbs, simultaneously address a lesser pattern that is occurring, or smooth out the harshness of the other ingredients. Envoy herbs guide the actions of the formula to a specific area, or harmonize the other categories.

Formulas are most commonly based on traditional combinations that have been in use for many years (sometimes hundreds of years or longer). They are then modified or combined with other formulas to address a person's unique situation and combination of patterns, in conjunction with other strategies.

Formulas and Patterns

Regardless of how well constructed a formula is, if it does not match the pattern of imbalance it is relatively useless. Pattern assessment allows a suitable herbal strategy to be developed. Qin Bo Wei, one of the most gifted traditional Chinese physicians of the twentieth century, described this process as: Disease Factor + Location + Symptoms = Pattern = Formula.

In a clinical essay published in A Qin BoWei Anthology, he went on to elucidate: "the disease factor is the original source of the disorder, while the location of the disorder is where the illness lies. These two factors should be clearly understood because they are the focus of our thinking in using medicinals. The symptoms are the overall presentation of the pathogenic condition and, with treatment, the symptoms will most often disappear once the disease factor disappears..."

In other words, understanding the underlying cause of any particular condition leads to identifying the fundamental pattern of imbalance. This pattern is then addressed with an herbal formula or formulas, education, qigong, acupuncture and other methods. If the assessment was accurate and the treatment appropriate, then the symptoms, like the blades of grass that Zhu Dan Xi described metaphorically, will naturally fall away.

Summary

Chinese herbalism offers a comprehensive system that addresses health issues at their most fundamental level. It is based on the principle that any treatment or strategy must result from the identification of a pattern of imbalance. To do this the qi of the body is observed through the principles of yin and yang, particularly in the clinical manifestations of cold and heat, deficiency and excess and internal and external. When the pattern of imbalance has been identified a strategy is developed that utilizes herbal combinations and the various methods of Oriental medicine. Herbs are selected based on their temperature, flavor and function, and are systematically combined to specifically balance the underlying issues that are causing the presenting signs and symptoms. This approach works to restore the correct movement of qi within the body thus promoting health and nourishing life.