Chinese herbology: Difference between revisions

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{{Short description|Traditional Chinese herbal therapy}}

[[File:Xi'an traditionnal medecine market (20).JPG|thumb|right|Dried herbs and plant portions for Chinese herbology at a [[Xi'an]] market]]

{{Alternative medicine sidebar}}

'''Chinese herbology''' ({{zh|s=中药学|t=中藥學|p=zhōngyào xué}}) is the theory of traditional Chinese herbal therapy, which accounts for the majority of treatments in [[traditional Chinese medicine]] (TCM). A ''[[Nature (journal)|Nature]]'' editorial described TCM as "fraught with [[pseudoscience]]", and said that the most obvious reason why it has not delivered many cures is that the majority of its treatments have no logical [[mechanism of action]].

The term [[herbology]] is misleading in the sense that, while plant elements are by far the most commonly used substances, animal, human, and mineral products are also utilized, among which some are poisonous. In the ''[[Huangdi Neijing]]'' they are referred to as {{lang|zh|毒藥}} ({{zh|p=dúyào}}) which means toxin, poison, or medicine. [[Paul U. Unschuld]] points out that this is similar etymology to the Greek ''[[Pharmakon (philosophy)|pharmakon]]'' and so he uses the term "pharmaceutic". Thus, the term "medicinal" (instead of [[herb]]) is usually preferred as a translation for {{lang|zh|药}} ({{zh|p=yào}}).

Research into the effectiveness of traditional Chinese herbal therapy is of poor quality and often tainted by bias, with little or no rigorous evidence of efficacy. There are concerns over a number of potentially toxic Chinese herbs.

[[File:Zh pharmacopoeia 1.JPG|thumb|right|150px|Chinese pharmacopoeia]]

Chinese herbs have been used for centuries. Among the earliest literature are lists of prescriptions for specific ailments, exemplified by the manuscript "''Recipes for 52 Ailments''", found in the [[Mawangdui]] which were sealed in 168&nbsp;BC.

The first traditionally recognized herbalist is [[Shennong|Shénnóng]] ({{lang|zh|神农}}, lit. "Divine Farmer"), a mythical god-like figure, who is said to have lived around 2800&nbsp;BC. He allegedly tasted hundreds of herbs and imparted his knowledge of medicinal and poisonous plants to farmers.  His ''[[Shennong Ben Cao Jing|Shénnóng Běn Cǎo Jīng]]'' ({{lang|zh|神农本草经}}, ''Shennong's [[Materia Medica]]'') is considered as the oldest book on Chinese herbal medicine. It classifies 365 species of roots, grass, woods, furs, animals and stones into three categories of herbal medicine:

# The "superior" category, which includes herbs effective for multiple diseases and are mostly responsible for maintaining and restoring the body balance. They have almost no unfavorable side-effects.

The original text of Shennong's ''Materia Medica'' has been lost; however, there are extant translations. The true date of origin is believed to fall into the late Western Han dynasty (i.e., the first century BC).

The ''[[Shanghan lun|Treatise on Cold Damage Disorders and Miscellaneous Illnesses]]'' was collated by [[Zhang Zhongjing]], also sometime at the end of the [[Han Dynasty|Han dynasty]], between 196 and 220 CE. Focusing on drug prescriptions, it was the first medical work to combine [[Yin and yang|Yinyang]] and the [[Wuxing (Chinese philosophy)|Five Phases]] with drug therapy. This [[Formulary (pharmacy)|formulary]] was also the earliest Chinese medical text to group symptoms into clinically useful "patterns" (''zheng'' {{lang|zh|證}}) that could serve as targets for therapy. Having gone through numerous changes over time, it now circulates as two distinct books: the ''[[Shang Han Lun|Treatise on Cold Damage Disorders]]'' and the ''[[Jingui Yaolue|Essential Prescriptions of the Golden Casket]]'', which were edited separately in the eleventh century, under the [[Song Dynasty|Song dynasty]].

Succeeding generations augmented these works, as in the ''[[Yaoxing Lun]]'' ({{zh|labels=no|s=药性论|t=藥性論|l=Treatise on the Nature of Medicinal Herbs}}), a 7th-century [[Tang dynasty]] Chinese treatise on herbal medicine.

There was a shift in emphasis in treatment over several centuries. A section of the [[Neijing]] Suwen including Chapter 74 was added by Wang Bing [{{lang|zh|王冰}} Wáng Bīng] in his 765 edition. In which it says: {{lang|zh|主病之謂君，佐君之謂臣，應臣之謂使，非上下三品之謂也。}} "Ruler of disease it called Sovereign, aid to Sovereign it called Minister, comply with Minister it called Envoy (Assistant), not upper lower three classes (qualities) it called."  The last part is interpreted as stating that these three rulers are not the three classes of Shénnóng mentioned previously. This chapter in particular outlines a more forceful approach. Later on Zhang Zihe [{{lang|zh|張子和}} Zhāng Zĭ-hé, aka Zhang Cong-zhen] (1156–1228) is credited with founding the 'Attacking School' which criticized the overuse of tonics.

Arguably the most important of these later works is the ''[[Compendium of Materia Medica]]'' (''Bencao Gangmu'':{{lang|zh|本草綱目}}) compiled during the [[Ming dynasty]] by [[Li Shizhen]], which is still used today for consultation and reference.

The use of Chinese herbs was popular during the [[medieval age]] in western Asian and Islamic countries. They were traded through the Silk Road from the East to the West. [[Cinnamon]], [[ginger]], [[rhubarb]], [[nutmeg]] and [[cubeb]] are mentioned as Chinese herbs by medieval Islamic medical scholars Such as [[Rhazes]] (854– 925 CE), [[Haly Abbas]] (930–994 CE) and [[Avicenna]] (980–1037 CE). There were also multiple similarities between the clinical uses of these herbs in Chinese and Islamic medicine.

There are roughly 13,000 medicinals used in China and over 100,000 medicinal recipes recorded in the ancient literature. Plant elements and extracts are by far the most common elements used. In the classic ''Handbook of Traditional Drugs'' from 1941, 517 drugs were listed – out of these, only 45 were animal parts, and 30 were minerals. For many plants used as medicinals, detailed instructions have been handed down not only regarding the locations and areas where they grow best, but also regarding the best timing of planting and harvesting them.

Some animal parts used as medicinals can be considered rather strange such as cows' gallstones.

Furthermore, the classic [[materia medica]] ''[[Bencao Gangmu]]'' describes the use of 35 [[traditional Chinese medicines derived from the human body]], including bones, fingernail, hairs, dandruff, earwax, impurities on the teeth, feces, urine, sweat, and organs, but most are no longer in use.

Typically, one batch of medicinals is prepared as a [[decoction]] of about 9 to 18 substances. Some of these are considered as main herbs, some as ancillary herbs; within the ancillary herbs, up to three categories can be distinguished. Some ingredients are added in order to cancel out toxicity or side-effects of the main ingredients; on top of that, some medicinals require the use of other substances as [[catalysts]].

{{main|Chinese patent medicine}}

'''Chinese patent medicine''' ({{zh|t=中成藥|s=中成药|p=zhōngchéng yào|labels=no}}) is a kind of [[traditional Chinese medicine]]. They are standardized [[Herbalism|herbal]] formulas. From ancient times, pills were formed by combining several herbs and other ingredients, which were dried and ground into a powder. They were then mixed with a binder and formed into pills by hand. The [[Binder (material)|binder]] was traditionally honey. Modern teapills, however, are extracted in stainless steel extractors to create either a water decoction or water-alcohol decoction, depending on the herbs used. They are extracted at a low temperature (below 100 degrees Celsius) to preserve essential ingredients. The extracted liquid is then further condensed, and some raw herb powder from one of the herbal ingredients is mixed in to form an herbal dough. This dough is then machine cut into tiny pieces, a small amount of excipients are added for a smooth and consistent exterior, and they are spun into pills.

These medicines are not [[patent]]ed in the traditional sense of the word. No one has [[exclusive right]]s to the formula. Instead, "patent" refers to the [[standardization]] of the formula. In China, all Chinese patent medicines of the same name will have the same proportions of ingredients, and manufactured in accordance with the PRC Pharmacopoeia, which is mandated by law. However, in western countries there may be variations in the proportions of ingredients in patent medicines of the same name, and even different ingredients altogether.

Several producers of Chinese herbal medicines are pursuing FDA clinical trials to market their products as drugs in U.S. and European markets.

Chinese herbal extracts are herbal decoctions that have been condensed into a granular or powdered form. Herbal extracts, similar to patent medicines, are easier and more convenient for patients to take. The industry extraction standard is 5:1, meaning for every five pounds of raw materials, one pound of herbal extract is derived.

There are several different methods to classify traditional Chinese medicinals:

* The Four Natures ({{zh|labels=no|t=四氣|s=四气|p=sìqì}})

* The specific function.

The Four Natures are: hot ({{zh|labels=no|t=熱|s=热}}), warm ({{zh|labels=no|t=溫|s=温}}), cool ({{lang|zh|凉}}), cold ({{lang|zh|寒}}) or neutral ({{lang|zh|平}}). Hot and warm herbs are used to treat [[Traditional Chinese medicine#Eight principles of diagnosis|cold]] diseases, while cool and cold herbs are used to treat hot diseases.

{{anchor|Five Tastes}}

[[File:Wuxing en.svg|thumb|right|200px|The Five Phases, which correspond to the Five Flavors]]

The Five Flavors, sometimes also translated as ''Five Tastes'', are: acrid/pungent ({{lang|zh|辛}}), sweet ({{lang|zh|甘}}), bitter ({{lang|zh|苦}}), sour ({{lang|zh|酸}}), and salty ({{zh|labels=no|t=鹹|s=咸}}). Substances may also have more than one flavor, or none (i.e., a bland ({{lang|zh|淡}}) flavor). Each of the Five Flavors corresponds to one of the [[Traditional Chinese medicine#Zang-fu|zàng organs]], which in turn corresponds to one of the [[Traditional Chinese medicine#Five Phases theory|Five Phases]]: A flavor implies certain properties and presumed therapeutic "actions" of a substance: saltiness "drains downward and softens hard masses"; sweetness is "supplementing, harmonizing, and moistening"; pungent substances are thought to induce sweat and act on [[Traditional Chinese medicine#Qi|qi]] and [[Traditional Chinese medicine#Xue|blood]]; sourness tends to be astringent ({{zh|labels=no|t=澀|s=涩}}) in nature; bitterness "drains [[Traditional Chinese medicine#Six Excesses|heat]], purges the bowels, and eliminates [[Traditional Chinese medicine#Six Excesses|dampness]]".

These categories mainly include:

* [[Traditional Chinese medicine#Eight principles of diagnosis|exterior]]-releasing or exterior-resolving

* substances for external application

Many herbs earn their names from their unique physical appearance. Examples of such names include ''Niu Xi'' (Radix cyathulae seu achyranthis), "cow's knees," which has big joints that might look like cow knees; ''Bai Mu Er'' (Fructificatio tremellae fuciformis), white wood ear,' which is white and resembles an ear; ''Gou Ji'' (Rhizoma cibotii), 'dog spine,' which resembles the spine of a dog.

Color is not only a valuable means of identifying herbs, but in many cases also provides information about the therapeutic attributes of the herb. For example, yellow herbs are referred to as ''huang'' (yellow) or ''jin'' (gold). Huang Bai (Cortex Phellodendri) means 'yellow fir," and ''Jin Yin Hua'' (Flos Lonicerae) has the label 'golden silver flower."

Unique flavors define specific names for some substances. ''Gan'' means 'sweet,' so ''Gan Cao'' (Radix glycyrrhizae) is 'sweet herb," an adequate description for the licorice root. "Ku" means bitter, thus Ku Shen (Sophorae flavescentis) translates as 'bitter herb.'

The locations or provinces in which herbs are grown often figure into herb names. For example, ''Bei Sha Shen'' (Radix glehniae) is grown and harvested in northern China, whereas ''Nan Sha Shen'' (Radix adenophorae) originated in southern China. And the Chinese words for north and south are respectively ''bei'' and ''nan''.

''Chuan Bei Mu'' (Bulbus fritillariae cirrhosae) and ''Chuan Niu Xi'' (Radix cyathulae) are both found in Sichuan province, as the character "chuan" indicates in their names.

Some herbs, like Fang Feng (Radix Saposhnikoviae), literally 'prevent wind," prevents or treats wind-related illnesses. Xu Duan (Radix Dipsaci), literally 'restore the broken,' effectively treats torn soft tissues and broken bones.

Many herbs indigenous to other countries have been incorporated into the Chinese materia medica. ''Xi Yang Shen'' (Radix panacis quinquefolii), imported from North American crops, translates as 'western ginseng," while ''Dong Yang Shen'' (Radix ginseng Japonica), grown in and imported from North Asian countries, is 'eastern ginseng.'

From the earliest records regarding the use of medicinals to today, the toxicity of certain substances has been described in all Chinese materia medica. Since TCM has become more popular in the Western world, there are increasing concerns about the potential toxicity of many traditional Chinese medicinals including plants, animal parts and minerals. For most medicinals, efficacy and toxicity testing are based on traditional knowledge rather than laboratory analysis. The toxicity in some cases could be confirmed by modern research (i.e., in [[scorpion]]); in some cases it could not (i.e., in ''[[Curculigo]]''). Further, ingredients may have different names in different locales or in historical texts, and different preparations may have similar names for the same reason, which can create inconsistencies and confusion in the creation of medicinals, with the possible danger of poisoning. [[Edzard Ernst]] "concluded that adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation." Research suggests that the toxic heavy metals and undeclared drugs found in Chinese herbal medicines might be a serious health issue.

Substances known to be potentially dangerous include [[aconitine|aconite]], secretions from the [[Asiatic toad]], powdered centipede, the Chinese beetle (''[[Mylabris phalerata]]'', Ban mao), and certain fungi. There are health problems associated with ''[[Aristolochia]]''. Toxic effects are also frequent with ''[[Aconitum]]''. To avoid its toxic adverse effects ''[[Xanthium sibiricum]]'' must be processed. [[Hepatotoxicity]] has been reported with products containing ''[[Reynoutria multiflora]]'' ([[Synonym (taxonomy)|synonym]] ''Polygonum multiflorum''), [[glycyrrhizin]], ''[[Senecio]]'' and ''[[Symphytum]]''. The evidence suggests that hepatotoxic herbs also include ''[[Dictamnus dasycarpus]]'', ''[[Astragalus membranaceous]]'', and ''[[Paeonia lactiflora]]''; although there is no evidence that they cause liver damage. Contrary to popular belief, ''[[Ganoderma lucidum]]'' mushroom extract, as an adjuvant for cancer immunotherapy, appears to have the potential for toxicity.

Also, adulteration of some herbal medicine preparations with conventional drugs which may cause serious adverse effects, such as [[corticosteroid]]s, [[phenylbutazone]], [[phenytoin]], and [[glibenclamide]], has been reported.

However, many adverse reactions are due to misuse or abuse of Chinese medicine. For example, the misuse of the dietary supplement ''[[Ephedra (medicine)|Ephedra]]'' (containing [[ephedrine]]) can lead to adverse events including gastrointestinal problems as well as sudden death from [[cardiomyopathy]]. Products adulterated with [[pharmaceutical]]s for weight loss or erectile dysfunction are one of the main concerns. Chinese herbal medicine has been a major cause of [[acute liver failure]] in China.

Most Chinese herbs are safe but some have shown not to be. Reports have shown products being contaminated with drugs, toxins, or false reporting of ingredients. Some herbs used in TCM may also react with drugs, have side effects, or be dangerous to people with certain medical conditions.

{{Further|Traditional Chinese medicine#Efficacy|Drug research}}

Only a few trials exist that are considered to have adequate methodology by scientific standards. Proof of effectiveness is poorly documented or absent. A 2016 [[Cochrane review]] found "insufficient evidence that Chinese Herbal Medicines were any more or less effective than placebo or Hormonal Therapy" for the relief of menopause related symptoms. A 2012 Cochrane review found no difference in decreased [[mortality rate|mortality]] for [[SARS]] patients when Chinese herbs were used alongside Western medicine versus Western medicine exclusively. A 2010 Cochrane review found there is not enough robust evidence to support the effectiveness of traditional Chinese medicine herbs to stop the bleeding from [[haemorrhoids]].  A 2008 Cochrane review found promising evidence for the use of Chinese herbal medicine in relieving [[dysmenorrhea|painful menstruation]], compared to conventional medicine such as [[NSAID]]s and the oral contraceptive pill, but the findings are of low methodological quality. A 2012 Cochrane review found weak evidence suggesting that some Chinese medicinal herbs have a similar effect at preventing and treating [[influenza]] as [[Antiviral drug|antiviral]] medication. Due to the poor quality of these medical studies, there is insufficient evidence to support or dismiss the use of Chinese medicinal herbs for the treatment of influenza. There is a need for larger and higher quality randomized clinical trials to determine how effective Chinese herbal medicine is for treating people with influenza. A 2005 Cochrane review found that although the evidence was weak for the use of any single herb, there was low quality evidence that some Chinese medicinal herbs may be effective for the treatment of acute [[pancreatitis]].

Successful results have been scarce: [[artemisinin]] is one of few examples, as effective treatment for [[malaria]] derived from ''[[Artemisia annua]],'' which is traditionally used to treat fever. Chinese herbology is largely [[pseudoscience]], with no valid [[mechanism of action]] for the majority of its treatments.

[[File:Seahorse Skeleton Macro 8 - edit.jpg|thumb|upright|Dried [[seahorse]]s like these are extensively used in [[traditional medicine]] in China and elsewhere.]]

The traditional practice of using (by now) [[endangered species]] is controversial within TCM. Modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text discuss substances derived from endangered species in an appendix, emphasizing alternatives.

Parts of endangered species used as TCM drugs include tiger bones and [[rhinoceros horn]]. Poachers supply the [[black market]] with such substances, and the black market in rhinoceros horn, for example, has reduced the world's rhino population by more than 90 percent over the past 40 years. Concerns have also arisen over the use of [[turtle]] [[plastron]] and [[seahorse]]s.

TCM recognizes [[bear bile]] as a medicinal. In 1988, the Chinese Ministry of Health started controlling bile production, which previously used bears killed before winter. Now bears are fitted with a sort of permanent [[catheter]], which is more profitable than killing the bears. More than 12,000 [[asiatic black bears]] are held in "bear farms", where they suffer cruel conditions while being held in tiny cages. The catheter leads through a permanent hole in the abdomen directly to the [[gall bladder]], which can cause severe pain.

Increased international attention has mostly stopped the use of bile outside of China; gallbladders from butchered cattle ({{zh|labels=no|t=牛膽|s=牛胆 |p=niú dǎn}}) are recommended as a substitute for this ingredient.

Collecting [[American ginseng]] to assist the Asian traditional medicine trade has made ginseng the most harvested wild plant in North America for the last two centuries, which eventually led to a listing on [[CITES Appendix II]].

{{See also|List of medicines in traditional Chinese medicine}}

Chinese herbology is a pseudoscientific practice with potentially unreliable product quality, safety hazards or misleading health advice. There are regulatory bodies, such as China GMP (Good Manufacturing Process) of herbal products. However, there have been notable cases of an absence of [[quality control]] during herbal product preparation. There is a lack of high-quality scientific research on herbology practices and product effectiveness for anti-disease activity. In the herbal sources listed below, there is little or no evidence for efficacy or proof of safety across consumer age groups and disease conditions for which they are intended.

There are over 300 herbs in common use. Some of the most commonly used herbs are [[Ginseng]] ({{zh|labels=no|s=人参|t=人參|p=rénshēn}}), [[wolfberry]] ({{zh|labels=no|c={{linktext|枸杞子}}|p=gǒuqǐzǐ), [[dong quai]]}} (''[[Angelica sinensis]]'', {{zh|labels=no|s=当归|t=當歸|p=dāngguī}}), [[astragalus]] ({{zh|labels=no|s=黄耆|t=黃耆|p=huángqí}}), [[atractylodes macrocephala|atractylodes]] ({{zh|labels=no|s=白术|t=白朮|p=báizhú}}), bupleurum ({{zh|labels=no|c=柴胡|p=cháihú}}), cinnamon (cinnamon twigs ({{zh|labels=no|c=桂枝|p=guìzhī}}) and cinnamon bark ({{zh|labels=no|c=肉桂|p=ròuguì}})), [[coptis]] ({{zh|labels=no|s=黄连|t=黃連|p=huánglián}}), ginger ({{zh|labels=no|s=姜|t=薑|p=jiāng}}), hoelen ({{zh|labels=no|c=茯苓|p=fúlíng}}), [[licorice]] ({{zh|labels=no|c=甘草|p=gāncǎo}}), ''[[ephedra sinica]]'' ({{zh|labels=no|s=麻黄|t=麻黃|p=máhuáng}}), [[peony]] (white: {{zh|labels=no|c=白芍|p=báisháo}} and reddish: {{zh|labels=no|c=赤芍|p=chìsháo}}), [[rehmannia]] ({{zh|labels=no|s=地黄|t=地黃|p=dìhuáng}}), rhubarb ({{zh|labels=no|s=大黄|t=大黃|p=dàhuáng}}), and salvia ({{zh|labels=no|s=丹参|t=丹參|p=dānshēn}}).

In Chinese herbology, there are 50 "fundamental" herbs, as given in the reference text, although these herbs are not universally recognized as such in other texts. The herbs are:

{| class="wikitable"

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<!--Please only use species names; a lot of these are informal/outmoded Latin terms-->

In addition to the above, many other Chinese herbs and other substances are in common use, and these include:

{{div col end}}

{{Div col|colwidth=30em}}

* [[Chinese classic herbal formula]]

{{Div col end}}

{{reflist|colwidth=30em}}

* {{Cite book  |first1=John K. |last1=Chen |first2=Tina T. |last2=Chen |year=2004 |url=http://aompress.com/book_herbology/index.html |title=Chinese Medical Herbology and Pharmacology |isbn=0-9740635-0-9 }}

* {{Cite book |last1=Xu |first1=L. |last2=Wang |first2=W. |year=2002 |url=https://books.google.com/books?id=36dhuXGm3OgC&q=traditional+chinese+medicine+herb&pg=PA1|title=Chinese materia medica: combinations and applications |publisher=Donica Publishing |edition=1st |isbn=978-1-901149-02-9 }}

* {{Wikiquote-inline|Traditional Chinese medicine}}

{{Traditional Chinese medicine}}

{{Medicinal herbs & fungi}}

{{Authority control}}

{{二次利用|date=6 January 2023}}

{{DEFAULTSORT:Chinese Herbology}}