Chinese Herbal Medicines: Comparisons and Characteristics

247 Pages·2010·3.319 MB·English

by  Yifan Yang

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
B
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
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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© 2010, Elsevier Limited. All rights reserved.
© 2002, Harcourt Publishers Ltd. All rights reserved.
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First edition 2002
Second edition 2010
ISBN: 978 07020 3133 5
British Library Cataloguing in Publication Data
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Library of Congress Cataloging in Publication Data
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Notice
Neither the Publisher nor the Author assumes responsibility for any loss or
injury and/or damage to persons or property arising out of or related to any
use of the material contained in this book. It is the responsibility of the
treating practitioner, relying on independent expertise and knowledge of the
patient, to determine the best treatment and method of application for the
patient.
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Printed in China
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
B
xxix
Chapter Six
6
Herbs that transform Dampness
1 What are the indications for remove Dampness may injure the Yin and increase
Heat, so the course of treatment will be longer than
herbs that transform and drain
if treating disorders caused by only one exogenous
Dampness? What are the
pathogenic factor.
characteristics of the
syndrome of Dampness
2 What are the characteristics
accumulation?
of the herbs that transform
and drain out Dampness?
Herbs that transform and drain Dampness are used
What precautions should
for treating syndromes of accumulation of Damp-
ness in the body. These syndromes are usually due be observed in the use of
to disturbance of the water metabolism, which is a
these herbs?
result of dysfunction of the Lung, Spleen, Kidney,
Bladder or San Jiao meridians.
The symptoms of Dampness accumulation are Herbs that transform and drain Dampness are able
edema, scanty and difficult urination, retention of to eliminate it by promoting urination and reducing
urine, fullness of the chest, a large amount of the accumulation of water; therefore they can treat
phlegm, asthma, distension of the abdomen, diar- those syndromes and symptoms caused by the accu-
rhea, pain in the joints and heaviness of the body. If mulation of Dampness or water. These herbs have
Dampness is complicated with Heat in the Middle the following characteristics.
or Lower Jiao, then disorders such as jaundice, skin
diseases and infections from various pathogenic
microorganisms may be present. Bland taste
Dampness is a Yin pathogenic factor and it has a
stagnating tendency. This characteristic is shown not Since a bland taste has the ability to leach out
only by the symptoms, such as heaviness, fullness Dampness by promoting urination, most of the
and numbness of the body, but also by a lingering, herbs that increase urination and drain out Damp-
recurrent or chronic course to the disease. ness are bland, including Fu Ling (Poria), Zhu Ling
If Dampness is complicated by other pathogenic (Polyporus), Ze Xie (Alismatis rhizoma), Hua Shi
factors, especially Heat, it will be very difficult to (Talcum), Yi Yi Ren (Coicis semen), Tong Cao (Tet-
separate these out because to clear Heat may injure rapanacis medulla), Che Qian Zi (Plantaginis
the Spleen-Yang and increase Dampness, and to semen) and Deng Xin Cao (Junci medulla). B
81
part two Comparisons and characteristics of the commonly used Chinese herbal medicines
Sweet, bland and cold In treatment, herbs that regulate the Liver-Qi or the
Qi of the San Jiao meridian should also be used
Blandness has the ability to leach out water or because Qi stagnation may directly obstruct the
Dampness and it has a descending tendency in water passage and cause water accumulation. Fur-
action. Cold can clear Heat, and sweetness and Cold thermore, in treating accumulation of Dampness
can generate the Yin and Body Fluids, which may caused by weakness of the Qi and Yang of the Heart,
have been injured by pathogenic Heat or by the Lung, Spleen and Kidney, herbs that drain out
draining action of some herbs. These herbs are suit- Dampness can be prescribed only if they are com-
able for treating water accumulation that is compli- bined with herbs that tonify the Yang and Qi.
cated with Heat, especially when the accumulation Herbs that treat Cold-Dampness have a pungent-
is in the Lower Jiao. Sweet-bland-cold herbs are also warm, bitter-warm or bland nature, and they should
suitable for situations where draining actions are be used with caution because they can consume the
required in this area. The commonly used herbs in Yin if they are used in large dosage and for a long
this category are Hua Shi, Yi Yi Ren, Tong Cao, period of time. The herbs that treat Damp-Heat
Deng Xin Cao, Zhu Ling, Ze Xie and Che Qian Zi. have a bitter and cold nature, which can injure the
Yang of Spleen and that may increase the dampness
Sweet, bitter and cold accumulation. Therefore, the dosage and treatment
period should be carefully considered. Moreover,
pregnant women should use these herbs with caution
Some of the herbs are sweet, bitter and cold in
as these aromatic, pungent, bitter and bland herbs
nature. They are excellent herbs for treating Damp-
can activate Qi and Blood, and the bitter and bland
Heat accumulation. Because bitterness can dry
herbs usually move downwards. These actions may
Dampness and direct Fire downwards, sweetness
bring danger to the pregnancy.
can tonify the body, and Cold can clear Heat, the
bitter-cold nature of these herbs can strongly reduce
Heat, and their sweet-cold nature can generate the 3 What are the commonly
Yin and Body Fluids, which may have been injured used methods for eliminating
by pathogenic Heat or by the draining action of some
Dampness?
herbs. These herbs can be used for a longer period
of time than the bitter-cold herbs that dry Dampness
and clear Heat. The commonly used herbs are Di Dampness is one of the six exogenous pathogenic
Fu Zi (Kochiae fructus), Shi Wei (Pyrrosiae folium) factors. It is also a pathological product caused by
and Jin Qian Cao (Lysimachiae herba). disorder of water metabolism in the body. The associ-
ated organs are the Kidney, Bladder, Small Intestine,
Entering the Bladder, Kidney and Spleen, Lung and San Jiao. To eliminate the accumu-
Small Intestine meridians lation of Dampness or water, there are several possi-
bilities. The commonly used strategies are as follows.
Because, according to TCM, urination is carried out
Promoting urination and leaching
by the Kidney, the Bladder and the Small Intestine,
most of the herbs enter these meridians. They also out Dampness
enter other meridians such as the Lung, Spleen and
Bland or bland-sweet-cold herbs, which enter the
Large Intestine. They can also regulate the function
Bladder, Small Intestine and Kidney meridians, can
of these organs and meridians and improve water
promote urination and reduce accumulation of
metabolism.
water or Dampness directly. They are particularly
Moreover, some herbs that drain Dampness can
suitable for use where there is water accumulation
open up meridians and collaterals. They also have
in the Lower Jiao. The commonly used herbs are Fu
the function of increasing the secretion of milk and
Ling (Poria) and Ze Xie (Alismatis rhizoma).
therefore treat lactation problems.
Drying Dampness
Herbs that transform and drain out Dampness
should be used with caution. Generally speaking, Pungent-bitter-warm herbs can dry Dampness
B they are suitable only for treating Excess syndromes. directly. They are particularly suitable when water
82
Herbs that transform Dampness Chapter 6
or Dampness accumulates in the Middle Jiao. The Warming the Spleen-Yang and
commonly used herbs are Cang Zhu (Atractylodis transforming Dampness
rhizoma), Hou Po (Magnoliae cortex), Ban Xia
Pungent-hot herbs that enter the Spleen meridian
(Pinelliae rhizoma) and Du Huo (Angelicae pubes-
are able to strengthen the Spleen-Yang, accelerate
centis radix).
the transportation and transformation of the Spleen,
Bitter-cold herbs are able to clear Heat and dry
and therefore transform Dampness. The commonly
Dampness and they are often used for transforming
used herbs are Sheng Jiang (Zingiberis rhizoma
Damp-Heat. Examples are Huang Qin (Scutellariae
recens) and Gan Jiang (Zingiberis rhizoma).
radix), Huang Lian (Coptidis rhizoma), Huang Bai
(Phellodendri cortex) and Zhi Zi (Gardeniae fructus).
Dispersing the Lung-Qi and regulating
Expelling Dampness the water passage
Pungent herbs have the function of expelling Wind Since water is moved by the Qi in the body, herbs
and can also disperse and transform Dampness. that can disperse the Lung-Qi can also disperse
These herbs can be used alone if the Dampness Dampness; examples are Ma Huang (Ephedrae
accumulates in the Upper Jiao. They can also be herba)* and Jie Geng (Platycodi radix).
used in combination with other methods for treating For the same reason, herbs that direct the
Dampness in the Middle Jiao and Lower Jiao. The Lung-Qi to descend can also be used to regulate the
commonly used herbs are Fang Feng (Saposhnikov- passage of water and eliminate Dampness; examples
iae radix), Qin Jiao (Gentianae macrophyllae radix) include Sang Bai Pi (Mori cortex), Xing Ren (Xing
and Qiang Huo (Notopterygii rhizoma). Ren) and Ting Li Zi (Lepidii/Descurainiae semen).
Aromatically transforming Dampness
Promoting the Qi movement and
Because aromatic herbs can penetrate turbidity,
eliminating Dampness
revive the Spleen and transform Dampness, they are
particularly suitable for situations where Dampness Since the movement of Qi can accelerate water
obstructs the sense orifices. These herbs are Huo metabolism, herbs that promote Qi movement can
Xiang (Agastachis herba), Pei Lan (Eupatorii herba), treat accumulation of Dampness. This strategy is
Cao Guo (Tsaoko fructus), Sha Ren (Amomi xanthi- often combined with other methods. The commonly
oidis fructus) and Qing Hao (Artemisiae annuae used herbs are Xiang Fu (Cyperi rhizoma), Chen Pi
herba). (Citri reticulatae pericarpium), Da Fu Pi (Arecae
pericarpium) and Hou Po (Magnoliae cortex).
Strengthening the function of the Spleen
and transforming Dampness
4 Fu Ling (Poria) can promote
Herbs that tonify the Qi of the Spleen so as to
urination, tonify the Spleen
strengthen the function of water transportation and
and calm the Mind. What are
transformation are often used in a Dampness syn-
drome; examples are Bai Zhu (Atractylodis macro- its characteristics compared
cephalae rhizoma) and Huang Qi (Astragali radix).
with other herbs which have
Warming the Kidney-Yang and the same function?
‘steaming’ the Dampness
Pungent-hot herbs that enter the Kidney meridian Fu Ling is sweet, bland and neutral, and enters the
are able to strengthen the Kidney-Yang, to ‘steam’ Heart, Spleen, Stomach, Lung and Kidney meridi-
the water, to separate the clean water from the ans. It is able to drain out Dampness by promoting
turbid part and accelerate the water metabolism. urination. It can also tonify the Spleen and calm the
They are often used for chronic or severe cases of Mind.
accumulation of water or Dampness in the body. Compared with the other herbs that transform
The commonly used herbs are Fu Zi (Aconiti radix Dampness, Fu Ling is characterized by being used
lateralis preparata)*, Rou Gui (Cinnamomi cassiae for both Damp-Heat and Damp-Cold syndromes to
cortex) and Wu Yao (Linderae radix). promote urination and drain out Dampness; this is B
83
part two Comparisons and characteristics of the commonly used Chinese herbal medicines
because it is bland and neutral in nature. Because it ans. It is able to drain out Dampness by promoting
is sweet and bland, it drains out Dampness without urination, and tonifies the Spleen. It can also calm
the side-effect of injuring the Yin and Yang of the the Mind gently.
body. In clinical practice, it is often used for treating Fu Ling Pi is the peel of Fu Ling. Unlike Fu Ling,
accumulation of water and Dampness in the Middle it does not have the function of tonifying the Spleen
or Upper Jiao, manifesting as edema, heaviness of and calming the Mind, but it is especially effective
the body and difficult urination, such as in the dis- for transforming Dampness in the skin and subcuta-
eases of the Kidney, Lung, Liver and Heart. neous regions by promoting urination; therefore it
Comparing Fu Ling with other herbs that tonify can treat edema and puffiness.
the Spleen, its neutral and gentle nature brings this The parts of the fungus around the root are called
herb its characteristic actions: Fu Ling is white in Fu Shen. Fu Shen has the same function as Fu Ling,
color and has no taste; it has a gentle action of toni- but its effect in calming the Mind is stronger, which
fying the Spleen-Qi but is without a cloying nature. is why it has ‘Shen’, meaning ‘Mind’ or ‘Spirit’, in
It can therefore be used for treating chronic disor- its name.
ders and for people who have a weak constitution Chi Fu Ling means, in Chinese, ‘the red Fu Ling’.
and are very sensitive to the tastes of most herbs. In fact, it is completely different from Fu Ling.
For the same reason, this herb is also recommended Although it can promote urination and treat water
in prescriptions for children. It is also an ideal herb accumulation in the Lower Jiao, it is cold in nature
for putting in biscuits, cakes, soup or porridge and and is used to treat Damp-Heat syndrome. It cannot
using in the diet over a longer period of time. tonify the Spleen, nor calm the Mind.
Another characteristic of Fu Ling is that it not only
tonifies the Spleen, but also transforms Dampness
and moves it downwards. Unlike most of the tonify-
6 Fu Ling (Poria), Zhu Ling
ing herbs, which place extra burden on the Stomach
and must be used with herbs that regulate the Qi, (Polyporus), Ze Xie (Alismatis
Fu Ling can be used alone without any side-effects.
rhizoma) and Yi Yi Ren (Coicis
It is especially useful in patients suffering from
semen) are all sweet and
edema, difficult urination and diarrhea caused by
Spleen deficiency. bland, and are able to
Comparing Fu Ling with other herbs that calm
transform and drain out
the Mind, it is most suitable for treating restlessness,
Dampness. What are the
palpitations and insomnia due to deficiency of the
Heart-Qi and Spleen-Qi. These patients may also differences between the
suffer from poor appetite, tiredness, excessive
four herbs?
thinking, depression and restless sleep. In most
cases, there is a history of chronic disease or long-
term mental stress. Fu Ling has no special taste, so Fu Ling, Zhu Ling, Ze Xie and Yi Yi Ren are all
it is a good herb for children suffering from restless sweet and bland. Sweetness can tonify the body and
sleep, crying at night and indigestion. blandness can drain out Dampness. These four herbs
are characterized by being able to drain out Damp-
ness without the side-effects of consuming the Yin
5 What are the differences
and Qi of the body. All four can be used for the
between Fu Ling (Poria), Fu situations where Dampness accumulates in the
Middle Jiao and Lower Jiao, obstructing the Qi and
Ling Pi (Poriae cocos cortex),
water passage. Manifestations of this condition are
Fu Shen (Poriae cocos distension of the abdomen, feelings of heaviness in
pararadicis) and Chi Fu Ling the body, edema in the legs and difficult urination
or retention of urine. In clinical practice, the four
(Poriae cocos rubrae)?
herbs can be used for ascites, edema and oliguria due
to disease of the heart, liver or kidney.
Fu Ling is sweet, bland and neutral, and enters the However, there are some differences in their
B Heart, Spleen, Stomach, Lung and Kidney meridi- strengths. For promoting urination and draining out
84