Qi Spot

The past month has been brutal, scheduling wise.  I shan’t bore my handful of readers with the details of the non-essentials.  One of the things keeping me busy though, is having a 4th year medical student rotate with me in Traditional and Integrative Medicine.  For a whole month, I have a future M.D. to “convert” to Chinese medicine heh heh.

Anyway, during one of our rounds, she mentions to me that the subject of Chinese herbal medicine was brought up during her rounds with another doctor.  This other doctor encouraged her to study Philippine herbs instead of Chinese herbs because obviously, using indigenous resources is more cost-efficient than importing from China.  Also, indigenous materia medica would also be more apt and appropriate for the environment in which it grows.  Ma Huang works well in northern China for example, but not in tropical Philippines.

This got me thinking.  Just what IS the essence of Chinese medicine?  When I talk to most westerners about Chinese materia medica, most people think of stuff like Ginseng or Cordyceps.  In other words, they think about the individual materials.  Some folks with more experience might think of individual formulas – I know of a local nephrologist who actually tells patients with stones to take an over the counter stone “melting” formula from China with much success.

But is that what Chinese medicine is?  The individual materia medica?  The Formulae?

No.

The World Health Organization defines traditional medicine as “the sum total of knowledge, skills and practices based on the theories, beliefs and experiences indigenous to different cultures that are used to maintain health, as well as to prevent, diagnose, improve or treat physical and mental illnesses.”  If used outside it’s indigenous culture, it is termed alternative or complementary medicine.  (http://www.who.int/mediacentre/factsheets/fs134/en/).

Hence, the idea of medicine is not the drugs, not the acupuncture, not the materia medica.  I’ve even given this example to medical students – if for example, a person takes a certain common antibiotic but uses it for “off-label” purposes (as is rampant in the Philippines), is that person practicing medicine?  Sure, that person is using a medical tool, but not based on the knowledge, skill, and practice on which the art of medicine is based.

Chinese medicine, it can be imputed, is not about the individual materia medica.  It is about the unique theory that the practice is based on.  In particular, Chinese herbal medicine is not about the individual materia, it is about how they are used and the framework in which they are used.

Ephedra has it’s specific indications in Chinese Medicine.  Weight loss is not one of them.  Therefore, using ephedra in weight loss  - even if the ephedra is a commonly used Chinese materia medica – is not practicing Chinese medicine.

American Ginseng is grown in Wisconsin in the United States.  Frankincense and Myrrh are more associated with the Middle than the Far East.  Yet all are used in Chinese herbal medicine so long as they can be made to fit within the tradition.

So how do I reconcile my student’s story with this?

Philippine herbs can be studied and classified according to the system of Four Natures and Five Tastes.  Once this is done, it is a matter of substituting appropriate local medicinals for the imported ones, but STILL WITHIN THE FRAMEWORK OF CHINESE MEDICAL THEORY.  Let’s take a formula – Dang Gui Bu Xue Tang – with two ingredients Dang Gui and Huang Qi.  What if we can find two local materials that can be used to replace either one (with dose adjustments of course).  We could help more people at less cost.

That would be a true integration of cultures.

Tammy Cohen, in this article, talks about the impending ban on unregulated or unlicensed herbal medicines in the EU.  Now, many of my comrades in the “alternative” medicine field are up at arms regarding this.  It does indeed look like a big bad Pharmacorp conspiracy to drive natural remedies underground.  However, I am reminded of the fact that there is truly a need to regulate the “herbal medicine” industry.

Why is this so?  This is because there are unscrupulous dealers and “healers” out there who are merely trying to make a quick buck.  They can be considered guilty of the very “crimes” we accuse Big Pharma of.  I for one have seen cases in our hospital (the Philippine General Hospital) of renal failure from an overdose of herbs like ginseng.  The whole renal-failure-due-to-ephedra in that weight loss clinic a few years back was not so much because the herb was bad, but because some wannabe herbalist was using it against it’s intended purpose.  He was using Ma Huang (Herba ephedrae)’s diaphoretic and diuretic properties to effect weight loss DESPITE the fact that any cursory glance at a Chinese herbal textbook would let one know to stop Ma Huang intake once perspiration occurs lest yin deficiency (excess fluid loss) occurs.  A toxic “off label” use, so to speak.

Chinese Herbs: Safe and Effective When Used Properly

Now for some commentary on the article:

Today, with the ease of the internet, you can self-diagnose, order next day delivery, and even learn how to make your own.

Sigh, if only it were that simple.  Chinese Medicine prides itself in customization of the treatment to an individual patient.  Two people with seemingly similar symptoms might get totally different treatments based on pattern discrimination.

But renewed debate about the safety of these remedies was sparked last week following the news of an EU crackdown on herbalists and Chinese medicine practitioners who operate unregulated at present. Under the new law, from 2011 sales of all herbal remedies except for a small number of products for minor ailments will also be banned. Regulators warn that many of us believe that “herbal” is synonymous with “safe”, whereas herbal remedies can be deadly.

Now this is not good.  The answer to unregulated herbal remedies should be obvious: regulation.  Yet the proposed solution is similar to the Ma Huang incident in America: do we censure the idiot herbalist wannabe or ban the misused herb? We ban the misused herb because it is easier, more convenient, and possibly more profitable for (fill in the blank).

“Research we conducted last year found a significant proportion of people believed ‘herbal’ means ‘benign’,” says Richard Woodfield, Head of Herbal Policy at the Medicines and Health care products Regulatory Agency (MHRA). “That means people are more liable to self-medicate, and to neglect to inform their doctors, even though there’s a risk that the herbal remedy will react with any prescription drugs. They’re also more vulnerable to fraudulent, even criminal operators who put products out which are heavily adulterated with dangerous pharmaceuticals.”

Unfortunately this paragraph rings true, as I mentioned before.  The last statement in particular can refer to unscrupulous Chinese patent medicine manufacturers who include steroids or valium in their so-called “Chinese medicines”.

The actress Sophie Winkleman is reported to have taken aconite, or monkshood, found in some ‘herbal Valium’ last month to calm her nerves prior to her wedding to Freddie Windsor….

The plant while relatively harmless in licensed homeopathic remedies in which it is rigorously diluted, can be extremely dangerous, in herbal remedies, even lethal.

Aconite, or fu zi in Chinese medicine, is known to be toxic which is why it is usually prepared first by stir-frying with fresh ginger.  Even then it is still used with other medicinals to reduce toxicity and enhance therapeutic effects.

The article describes many more instances, but I won’t mention them anymore here.  The next few paragraphs are important (because I obviously agree with them)

The MHRA believes regulating the herbal medicine industry is the best way to limit abuses and ensure consumers are aware of potential dangers. All herbal medicines sold over the counter in the UK should according to the law be licensed. The MHRA assesses them on safety, quality and patient information. By 2011 a new scheme, which is currently being rolled out, will be in place.

“Check for products which have the THR (Traditional Herbal Register) or Product Licence (PL) number on the label,” advises Richard Woodfield.

Many herbal practitioners want even further regulation.”We want to be registered,” says Dee Atkinson, spokesperson for the National Institute of Medical Herbalists and herself a qualified medical herbalist. “Herbs are not harmless, they are drugs, just as pharmaceuticals are drugs and as such they should be prescribed by a qualified, registered practitioner.

I wish I could emblazon that last paragraph in gold lettering, plug it to Christmas lights and put a mariachi band to announce it.  It is SO SO SO SO TRUE!!!  Especially for Chinese medicine.

From Personalliberty.com (http://www.personalliberty.com/news/research-uncovers-anti-inflammatory-properties-of-ginseng-19422913/) posted October 30, 2009.

According to the results of a new study, the herb ginseng—which has been used in traditional Chinese medicine for millennia—may be a natural anti-inflammatory agent.

The news comes from the University of Hong Kong where scientists isolated seven ginseng compounds, called ginsenosides, which they say show strong immune-suppressive effects.

Using human immune cells, which they treated with extracts of ginseng, they discovered the seven ginsenosides had the ability to selectively inhibit expression of the inflammatory gene CXCL-10.

Allan Lau, lead researcher on the team, says the beneficial effects of ginseng may result from the combined effects of ginsenosides which appear to target different levels of immunological activity.

However, he added that “further studies will be needed to examine the potential beneficial effects of [the herb] in the management of acute and chronic inflammatory diseases in humans.”

Ginseng is a perennial fleshy plant native to cooler climates of eastern Asia, including northern China, Korea and eastern Siberia. Extracts and nutritional supplements containing ginseng are available in many health stores across the U.S.

Now for my usual commentary.  The article speaks pretty much for itself, but is missing a few crucial pieces of information:

Firstly, people should know that siberian ginseng is not a true ginseng in that it does not contain the said ginsenosides.  It has a similar range of function to true ginseng but was only called a ginseng as a marketing tactic.

Secondly, American ginseng, while a true ginseng, has a slightly cooling nature compared to chinese and korean ginseng.  What does this mean? It means that it is more suitable for warm climates as too much “heat” inducing foods and herbs will be detrimental to one already constantly exposed to heat.  Hence, in my native Philippines, I believe that american ginseng is more suitable.  That is, unless the patient also has pathogenic cold that requires heat to counter it.

Ginseng Root

Thirdly, while this stuff is beneficial AND can be taken by itself, it is still OVERDOSEABLE (if there is such a word).  In the Philippine General Hospital, I have heard some cases of people taking too much Korean Red Ginseng (VERY firey, see statement two…) and ending up with Kidney failure.  From a TCM point of view this makes perfect sense – too much fire consumes the water (kidneys).  Hence, we should NOT tolerate the idea that “supplements” are not drugs and are thus safe or that herbal medicines are natural and hence there is no such thing as an overdose.

And fourthly, look at the Ginseng root.  It is called renshen (man root) in chinese because it looks like a human being with hands and feet .

And Happy All Saints’ Day!

Source:

Personal Liberty News Desk. “Research Uncovers Anti-inflammatory Properties Of Ginseng” personalliberty.com. 30 October 2009.  accessed 1 November 2009 <http://www.personalliberty.com/news/research-uncovers-anti-inflammatory-properties-of-ginseng-19422913/>