Chinese Herbs

Differential Diagnosis in Chinese / Asian Medicine: 

As acupuncturists / herbalists, we sometimes hear people say things like, “I’ve heard this particular herb helps [some condition]. Should I take it?” and so starts a conversation about how Chinese medicine works. 

One thing to consider is that Chinese Medicine doesn’t tend to use herbs singularly. They’re often combined with other herbs to create custom formulas based on the individual presentation of the patient. These formulas may be modifications of base formulas and there are many, many options here. It’s sort of like being a cook in the kitchen deciding whether your chicken preparation will be based predominantly by flavors in a curry, a basil-cream, lemon-tarragon, or whatever sauce. The options are endless. 

There are advantages of using multiple herbs over singular herbs. An herb in a formula may be considered a primary herb in the formula and be called its Chief. We might use herbs that reduce or increase the effects of other herbs making them stronger or weaker in the formula, depending on what we’re looking to achieve. We may have Deputy, Assistant – Envoy herbs depending on the function of a particular herb, or group of herbs, in the formula.

A formula that works wonders for one patient may not be effective for another patient with the same condition.

This is because in Chinese medicine, we look at varying patterns present in a person, ascertain Chinese medical diagnoses that represent those patterns, and recommend herbs, acupuncture, or other modalities/procedures based on those working (and changing) diagnoses. 

Let’s consider an example. A patient comes in with a request for herbs and acupuncture to help resolve previously diagnosed eczema. The practitioner will take a look at the patient’s primary concern and consider common Chinese diagnoses that those with eczema may have, ask broad questions to consider other patterns of disharmony, come up with a working Chinese medical diagnosis or diagnoses, and make treatment recommendations based on the diagnoses. Please note that diagnoses change over time as do individual practitioner approaches to treatment. 

It’s not uncommon for a patient to seek treatment for one particular health concern, but have other health issues. For example, someone’s little toe is bothering them every time they walk and so they may be looking for support in this one area. An herbalist building a custom formula will take into consideration whether that person has ample digestive strength to tolerate an herb formula, if they sleep poorly, are in a high stress environment, etc. Herbs will be added or removed from base formulas to accommodate the individual presentation of the person seeking remedy.

We choose treatments based on the constellation of multiple patterns of disharmony present and we change the formula as that constellation changes. 

So here’s the thing: this is also true for acupuncture. The practice of acupuncture includes individual or combinations of points. There are countless approaches to point selection. The practitioner may select points based on their unique studies under specific teachers who may have their own stylistic approaches.

The medicine is old, but it’s not stagnant and evolves over time. The options are also endless.

I’m always saying to people that when choosing an acupuncturist, ask them questions about how they approach treatment, what kinds of studies they undertake (we keep studying long after school), and look to see if you resonate with the conversation and approach. Be open to new ideas but understand that if one practitioner doesn’t “fit” with you, there’s many more in practice who may have a style that feels better to you. 

Evolving Ancient Medicine

Often when I see writings about Chinese medicine, including my own, there’s some mention about how old it is, which is thousands of years.

Sometimes we may be highlighting this, in part, to help substantiate it, as if to lend credence. Of course, just because something’s old doesn’t make it better, nor does it make it worse. But with thousands of years of practice, it does mean that there’s been a lot of experience, many treatments, and many patients.

Even if one can’t quickly go find the perfectly matching RCT (randomized-controlled trial) that best matches the condition for which one seeks medical evidence of efficacy, that doesn’t necessarily mean that acupuncture hasn’t helped someone with it before. It also doesn’t mean it doesn’t exist (might need translation.)

So, how old is this medicine?

A longer timeline of Chinese medical history can be found at http://www.shen-nong.com/eng/history/chronology.html , but summarized parts of it (with my notes) are here:

~2000 BC, Antiquity: Yellow Emperor & Shen-nong: They are said to be the founders of traditional Chinese medicine (TCM).

1700-1100 BC, Shang: Inscriptions on bones describe the use of wine and hot water, use of needles and knives for surgical instruments, diseases and illnesses discussed.

1100-221 BC, Zhou Dynasty: Organized medical system in the emperor’s court. Specialties in surgery, diet, disease, veterinarians. The Huang Di Nei Jing: The Yellow Emperor’s Internal Classic: A&P of the human body. Foundation for TCM. Yin Yang and Five Element Theory.

221 BC-220 AD, Qin and Han Dynasties: Earliest reference to Chinese pharmacology: Shennong Bencaojing. List of 365 Chinese medicines and herb prescriptions / combos. Zhang Zhongjing: establishes diagnosis based on signs and symptoms. Shang Han Lun

220-580 AD, Chinese Middle Ages: Pulse Classic. Earliest complete reference guide to acupuncture and moxibustion. 349 acupuncture points with therapeutic properties for each. A handbook written for Emergencies.

618-907 AD, Sui and Tang Dynasties: Imperial Medical Academy. The first medical encyclopedia comprised of 30 volumes and 5,300 prescriptions, also disease prevention and health preservation. (Sun Si Miao) — NOTE: Preventive health

960-1279 AD Song Dynasty: First official prescription book with 16,834 prescriptions. (weblink lists ~40 books/treatises during this period) — NOTE: That’s a lot of prescriptions! 

More dynasties and many more books: The Jin Yuan period, Ming Dynasty, Qing Dynasty, Modern China (1950 future medical policy to include both Chinese and Western medicine options)…

There’s been a lot of time to practice, theorize, iterate, publish, proliferate, and evolve. 

Balance

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Our bodies are in transition. We are always in transition. As long as we are alive, change is inevitable. Chinese medicine looks at normal and abnormal patterns of change and gently moves the body towards harmonious balance.

This constant ebb and flow is also recognized in Western medicine through a primary concept of homeostasis, meaning we maintain balance in the body through multiple physiological processes. Homeostasis is the continual balancing act. There are many examples of homeostasis in the body: I can’t begin to count them all nor do I believe science has identified them all. We are all still learning. 

A simple example illustrating homeostasis is our body’s relatively narrow range of normal temperature. If we get too hot, we sweat to cool down. If we get too cold, we shiver to generate warmth. 

A concept of balancing is essential to Chinese medicine. If something is moving too fast, we attempt to slow it. Too slow, quicken it. Too hot, cool it. Too cold, warm it. Too wet, dry it. Too dry, moisten and lubricate it. And so on…

Where did this ancient but ever-evolving medicine look to produce theories of change in the human body? They went macro: they looked at patterns of change in nature, on the land, in the sea, and in the sky. They looked at harmonious nature, always in flux, and they considered what happens when the ever-balancing act is not functioning properly. If we move outside the norm of balance, we either recover and get back in balance, or we develop pathology. Chinese medicine has treatments to support normal physiology as well as pathophysiology. It’s all a spectrum. 

Examples with conditions and balancing treatment principles: 

Too hot: fever -> clear heat

Too cold: some infertility -> warm the uterus

Too wet: moist rash -> dry it out

Too dry: itchy flaky skin -> moisten and lubricate

Too slow: elderly constipation -> move the bowels

Too fast: anxious mental chatter -> slow, calm mind

Or, another way to consider this is to examine one common condition, for example, constipation. We look at the root, the cause of constipation, to determine principles of treatment. Example:

Constipation caused by slow motility -> move the bowels (abdominal massage, acupuncture)

-or- 

Constipation caused by dry stools -> moisten (fluid intake) and lubricate (oily foods)

-or-

Constipation caused by too much heat creating dryness -> clear heat and moisten

Whereas constipation is one common symptom, there are different treatments depending on cause. Chinese medicine seeks to discern patterns of harmony and disharmony in the body to help bring them back into balance.

One reason Chinese medicine can preventively treat a condition is because patterns of disharmony arrive before disease. If we can recognize the pattern early, it’s easier to treat.

Commonly quoted but still so useful to remember, “An ounce of prevention is worth a pound of cure.” -Benjamin Franklin