The system of herbal medicine that developed in China differs in several significant ways from European herbal medicine. The most obvious difference is that the Western herbal tradition focuses on “simples,” or herbs taken by themselves. In contrast, traditional Chinese herbal medicine (TCHM) makes almost exclusive use of herbal combinations. More importantly, these formulas are not designed to treat symptoms of a specific illness; rather, they are tailored specifically to the individual according to the complex principles of traditional Chinese medicine. For this reason, TCHM is potentially a deeply holistic healing approach. On the other hand, it is both more difficult to use and to study than its Western counterpart.
TCHM is widely used in Asian countries, both in its traditional holistic form and in a simplified disease-oriented version. There have been a few properly designed scientific trials of TCHM, but the evidence base remains highly inadequate. In addition to questions regarding effectiveness, there remain serious safety concerns to be resolved.
History of Chinese Herbal Medicine
Chinese herbal medicine has a long historical tradition, although it is not quite as ancient as popularly believed. Ancient herbology in China focused on potions whose function was part medicinal and part magical, and it lacked a substantial theoretical base. Sometime between the second century B.C.E. and the second century A.D., the theoretical foundations of traditional Chinese medicine were laid, but the focus was more on acupuncture than on herbs. 1 Only by about the 12th century A.D. were the deeper principles of Chinese medicine fully applied to herbal treatment, forming a method that can be called TCHM. This was further refined and elaborated during various periods of active theorizing in the 14th through the 19th centuries. Western disease concepts entered the picture in the 20th century, leading to further changes.
In China today, TCHM is used alongside conventional pharmaceutical treatment. Considerable attempts have been made to subject TCHM to scientific evaluation; however, most of the published Chinese studies on the subject fall far short of current scientific standards. (For example, they generally lack a placebo group.)
In neighboring Japan, a variation of the TCHM system known as Kampo has become popular, and the Japanese Health Ministry has approved many Kampo remedies for medical use. The scientific basis for these remedies remains incomplete, but several studies of minimally acceptable quality have been reported.
Principles of Traditional Chinese Herbal Medicine
Even a basic introduction to the principles of TCHM exceeds the scope of this article. Consider the following nothing more than a taste of this vast medical system.
According to the principles of all Chinese medicine, health exists when the body is balanced and its energy is freely flowing. The term “energy” refers to Qi, the life energy that is said to animate the body. The term “balance” refers to the relative factors of yin and yang—the classic Taoist opposing forces of the universe. Yin and yang find their expression in various subsidiary antagonists such as cold vs. heat, dampness vs. dryness, descending vs. ascending, at rest vs. active, and full vs. empty.
In an ideal state, yin and yang in all their forms are perfectly balanced in every part of the body. However, external or internal factors can upset this balance, leading to disease. Chinese medical diagnosis and treatment involves identifying the factors that are out of balance and attempting to bring them back into harmony. Diagnosis is carried out by means of “listening” to the pulse (in other words, taking the pulse with extraordinary care and sensitivity), observing and palpating various parts of the body, and asking a long series of questions.
It is important to realize that diagnosis according to TCHM differs greatly from Western diagnosis. To understand this, consider two hypothetical patients with the single Western diagnosis of migraine headaches. The first might be said to have “dryness in the liver and ascending Qi,” while another might be diagnosed with “exogenous wind-cold.” Based on these differing diagnoses, entirely different remedies might be applied. In other words, there is no such thing as a TCHM remedy for migraines per se; rather, treatment must be individualized to the imbalance determined by traditional theory.
The herbal formulas used in TCHM consist of four categories of herbs: ministerial, deputy, assistant, and envoy. The ministerial herb addresses the principal pattern of the disease. Deputy herbs assist the ministerial herb or address coexisting conditions. Assistant herbs are designed to reduce the side effects of the first two classes of herbs, and envoy herbs direct the therapy to a particular part of the body. For example, in the case of “dryness in the liver and ascending Qi” described above, an herbalist might employ a ministerial herb to reverse ascending Qi, a deputy herb to exert a moistening effect, an assistant herb to prevent the stagnation of Qi (Qi stagnation is said to be a side effect of moistening herbs), and an envoy to carry these effects to the liver.
TCHM remedies can also be designed to fit all common causes of migraines simultaneously, mostly by multiplying the number of ingredients. Practitioners of TCHM frown upon this “one-size-fits-all” approach, but it is often popular among consumers and easier to test scientifically.
Types of Chinese Herbal Remedies
To use Chinese herbal medicine in the most traditional fashion, you must visit an herbalist’s shop. There, experienced herb preparers will chop, grind, fry, and slice dried herbs according to the prescription given by an experienced herbalist. You will walk home with a packet of dried herbs that need to be prepared according to the instructions, which typically involve adding water, boiling for several hours in a ceramic pot, pouring off the liquid, adding more water, and repeating the process twice more. Certain herbs are supposed to be added right at the end, while others require extra-long preparation.
If you don’t wish to carry out such a complex process, or if a classic herbal shop is not available, you may wish to move one step away from tradition and purchase an already-prepared Kampo formula. There are several hundred such formulas designed to match the most commonly seen forms of imbalance. Available in powder, capsule, or tablet form, they can be used much more conveniently than fully traditional herbs. Many Kampo combinations are licensed in Japan and are manufactured there on a large scale by reputable manufacturers.
The lowest level of TCHM, scarcely deserving the name at all, involves so-called Chinese Patent Remedies, which consist most commonly of tiny brown spheres in small brown bottles. They are marketed both for classical imbalances and western disease categories. Patent remedies are inexpensive and widely available. However, there have been so many scandals involving dangerous contaminants not listed on the label that we recommend avoiding this form of treatment entirely. (See Safety Issues .)
In the West, herbal medicine is part of folk medicine. However, in China there is a distinct tradition of Chinese folk medicine that is separate from the orthodox, rather academic TCHM approach. In this Chinese folk medicine, herbs are used more simply, somewhat in the manner of Western herbal medicine. Herbs most commonly used in this manner include astragalus , dong quai , ginger , kudzu ( Pueraria lobata ), licorice , lycium , Panax ginseng , and schizandra . For more information on the use of these herbs, see the appropriate individual articles.
Besides herbs, substances that we might consider supplements are utilized in TCHM. These include extract of human placenta, 76 glandular extracts, and a variety of minerals.