TCM Medicinal Therapy
Chinese medicinal therapy (phytotherapy) along with dietetics belong to the "interior methods". In view of its widespread use in China and its therapeutic range, it is by far the most important method of treatment in TCM.
Medicinal therapy consists of prescribing formulas made from plants and parts of plants, more rarely mineral natural materials or components of animal origin. Animals that are considered endangered species are not used in serious TCM. Decoction is the most commonly used method of preparing Chinese medicinal plants. In textbooks on Chinese herbal medicines, several thousand individual agents (medicinal drugs) are described. These pharmacological presentations, some of which are quite detailed, admittedly use terms and views based on traditional Chinese pathology that Western doctors are not familiar with. So before a doctor can prescribe Chinese medicinal formulations in our country, he must earn a second, specialist degree, the curriculum of which is considerably more substantial than for conventional training courses in acupuncture. A doctor must learn to think in the opposites of yin and yang, must understand what the functional circles of the "liver" or "spleen" mean and must also be able to mentally grasp illness factors such as "wind" or "cold", just to mention a few examples. And finally, he should also have a good command of diagnostic TCM methods and be in a position to induce individual healing processes and accompany these processes therapeutically with medicines. There is no need to reiterate that the phytotherapist must know his medicines, including all of their contra-indications. Without the knowledge outlined here, the therapist could only stab in the dark, the therapeutic benefit of his prescriptions would be uncertain and risks for the patient could not be ruled out. For this reason, Chinese medicinal therapy is not suitable for self-treatment - just the opposite of the exterior methods such as acupressure, Tuina massage or Qigong.
Comments on the History of Chinese Phytotherapy
True knowledge of China's traditional medicinal therapy that goes beyond an interest solely from a cultural-historical viewpoint has only existed in the West for about forty years at the most. This is amazing when you consider that this is probably the most sophisticated phytotherapeutic system ever developed by mankind.
Chinese phytotherapy also thanks its unparalleled maturity to the fact that it was continuously developed over a long period of time. This was not the case with European medicine which underwent a number of paradigm changes in the last two and a half thousand years in which medical knowledge that had been collected up to that point was more or less allowed to sink into oblivion. Especially the modern age with its belief in progress has practically thrown overboard the nearly two thousand year old treasure of experience that was once European medicine. The development of science in China followed the principle of "one as well as the other": new ideas and systems in medicine were simply placed along side the old. The old was not tossed out. Just the opposite, the innovators often cite classic authors to justify their own, revolutionary ideas. That would be unthinkable for us. No modern orthodox medical practitioner would seriously refer to Hippocrates, Galenus, Avicenna or Paracelsus.
The tolerant way in which the Chinese culture deals with the store of experience of older generations (which very much suits the basic empirical-scientific character of medicine) has allowed a true treasure of observations, findings and therapeutic schools to arise in phytotherapy from which each period and each culture can take what it needs.
Symptomatic Therapy or Treatment of the Root Causes of the Illness?
The pluralism of schools and opinions that is expressed in the pathologies of Chinese medicinal therapy allows the use of Chinese medicinal formulations, for example, for purely symptomatic treatment. This is sometimes beneficial if the problem is to stop acute uterine bleeding or to lower a dangerous fever. But as a rule, if there is an acute medical indication, the medicines used in orthodox school medicine will be prescribed since this is the area in which their strength lies. However, this strength has a snag because doctors are inclined to treat chronic illnesses by repeatedly prescribing medicines for acute problems - with the known consequences. This approach is foreign to Chinese phytotherapy. Its goal is to solve problems, meaning not to "stabilise" the patient on permanent medication but to end or revert the process of becoming chronic and, in an ideal case, to heal. The old conflict between a "pure symptomatic" and a "causal" therapy approach has been discussed in China for two thousand years. The "tip" of the illness - the symptoms - is only given preferential treatment if they are dangerous or very tormenting; otherwise, treating the root causes of the illness has priority.
How Is the Effect of Chinese Drugs Described? Two Examples
The descriptions of the effect of a medicine in Chinese textbooks on medicines follow a uniform scheme, which is clearly distinguished from Western ideas about the effects of medicines.
Western medicine prefers to identify an illness by the organ or tissue afflicted. Accordingly, the effect of the medicine is usually understood in relation to the organ: celandine has an effect on bile passages, foxglove on the heart, Furosemide stimulates the elimination of water through the kidneys, Diclofenac inhibits inflammation and joint pain, etc.
The Chinese term for illness goes beyond organs. Illnesses are general disturbances. The organ is only a host or the victim of the illness. Chinese medicine has developed terms with which the effect that medicinal plants (or foods) have on the entire organism can be described. Among the numerous categories in which the effect of Chinese drugs is described, two are presented here: taste and temperature.
In principle, taste cells react to ingested substances just like all other cells of the body but fortunately they also have a connection to the brain. The sensation of taste thus provides information on the effect of a substance on the entire organism. Chinese pharmacology takes advantage of this circumstance to describe the effect of medicinal herbs. The scale of taste qualities includes (from yang to yin): hot, sweet, neutral, sour, bitter, salty. The following assignments have proved useful; most of them can be re-enacted through "taste meditation".
- Hot stimulates the flow of Qi, drives upward and outward, promotes secretion, may cause sweating. In excessive quantities it drains, consumes Qi and fluids.
- Sweet nourishes and harmonises. In excessive quantities it leads to constipation and interior heat, makes tired, fat and excited.
- Sour contracts and thus prevents overexertion of Qi and fluids. In excessive quantities it hinders exchange of substances and communication.
- Bitter reduces Qi, calms, dries and draws off through the lower organs. In excessive quantities it causes dryness and saps vitality.
- Salty has a softening and dissolving effect in the deep layer. In excessive quantities it causes a state of bloatedness and loosens the connection between yin and yang.
The "neutral" taste plays a special role. It does not burden the organism with new impulses in the direction of a certain effect but opens a space in which that which is already present can enter to be processed and eliminated. The Chinese call this process the "separation of the turbid and the clear". Drinking hot water and eating rice which is usually not spiced in China fulfils this task just like the addition of neutral tasting plants when formulating medicines.
Daily meditation, day dreaming, also has - on another level - a comparable effect profile. An example: After work I sit down in a chair, no television, no newspaper, no input. Pretty soon a film starts - my own film. Memories well up, pleasant and unpleasant. My emotional life comes to life. Rage, guilty conscious, worries, but also joy, thankfulness or contentedness. All of these emotions have been stuck, like labels, on events and occurrences that I have stored inside me. So remembering creates some order in my emotional life, brings a little clarity to the cloudy disorder inside me. That is why those people who shy away from the effort of this process and instead turn on the television after work for relaxation and distraction are ill advised. Speaking in Chinese, they are in danger of collecting interior phlegm and thus hindering interior communication.
This applies to taste analogously. Neutral - not hot, not sweet, not sour, not bitter, not salty - has a clarifying effect. Clarity helps when I should decide what I need. With an alert sense of taste we have a fine sensorium at out disposal for that which is good for the body in its respective state. Chinese phytotherapy takes advantage of this. As a rule, a medicine should not be repugnant to the patient. If it is sensed as clearly unpleasant, this is often a sign that the medicine must be changed.
The Behaviour of Temperature
All medicines are assigned, corresponding to their warming or cooling effect on the organism, on a scale of seven from cold (yin) through neutral to hot (yang).
In the course of illnesses, states of cold or heat often develop. These do not necessarily correspond to a subjective feeling of temperature but are clearly defined in regard to symptoms and their main focus may be more psychological ("boiling with rage" or more physical (e.g. a high fever).
If you are in stable physical condition - and only then, you can try out these effects on yourself. After taking a "warm" medicine, I feel pleasantly warm, digestion, metabolism and circulation are stimulated; I am awake, lively and communicative. An overdose causes me to sweat, unpleasant sensations of heat appear and I can no longer control the flow of my words. I become excited, my sleep is disturbed and finally, drying and exhaustion follow.
"Cooling" medicines have the opposite effect, from feeling refreshed to permanently freezing and to paralysis of the dynamics of metabolism and emotionality.
As easy as it is for healthy persons to experience these effects by drinking cooling or heating medicines in a self-test, people with chronic illnesses do not react in a clear manner. Because the organism has mobilised physiological heat against cold blockades again and again during the course of the illness, and, the other way around, states of heat cause cold reactions, chronically ill persons usually have both qualities side by side. The combination of cooling and warming plants in a formulation can help clear up such interlocking heat-cold states
In the textbooks on medicines, the area of cooling medicines is divided into seven subgroups, depending on which layer is to be cooled and whether drying or moistening is to take place at the same time.
Medicinal Therapy in Practice
Chinese diagnostics utilise all senses in order to gain a picture of the patient and his illness that is as comprehensive as possible. Every sign of life in the ill person can help gain clarity on his interior processes. This can be his voice as well as the state of his excrements, his sense of temperature, his prevailing mood, his sleep. The in-depth diagnostic talk with the therapist is supplemented by observing the tongue and feeling pulse. It is then the task of the therapist to find the central thread in the multitude of diagnostic information: where are the obvious or hidden changing points in his biography at which point immunological or psychological stress knocked vital functions off-track and which medicinal formulations can help the organism get back on track?
The individual formulations finally prescribed, consisting of up to eight individual agents (in China up to twenty-four) are purchased in the form of herb packets in the pharmacy and decocted by the patient (or the pharmacist) exactly according to directions and then stored in the refrigerator. They should be taken in regular intervals throughout the day after diluting the extract taken from the refrigerator with hot water. When the herbs that were prescribed are used up in one, two or three weeks, the patient gets in touch with his therapist to see whether the formulation needs to be changed or can be simply repeated.
Medicinal Therapy as a Process of Dialog
Chinese medicinal treatment lives from the dialog between the doctor and patient. The doctor must regularly find out what the patient perceives as changes while taking the medicine. At the same time, the state of therapy and what developments may be expected with the next formulations must be clarified
In the beginning it is often elimination processes through the intestines and bladder that are selectively stimulated. Does the patient feel relief in other areas now that these relieving processes are underway? Is he becoming calmer, is he clearer? Does he notice any change in his pain? Has his sense of temperature normalised? Very often, particularly in the initial phase of therapy, dreaming activities are increased. Things, occurrences and people can show up in dreams that lie far in the past and were long forgotten. If the patient becomes tired, which often happens in the beginning of therapy, this is - as a rule - a good sign. Stimulation of interior tidying processes uses up vital energies. If the therapeutic process falters or, if just the opposite, negative activities are observed such as agitation, heavy sweating, over-reactions of mucous membranes similar to those of allergies, it is time to change the formulation.
As to be expected with methods that have such a deep effect, there is a good chance for successful treatment of most illnesses.
The treatment ideal of classic TCM - to recognise dangerous developments early on so that just light therapeutic impulses are sufficient to correct the deviation that has occurred and restore balance - is for many the trademark of the old Chinese medicine.
Unfortunately, we TCM therapists see our patients much later than what would be ideal, usually only when the possibilities of orthodox medicine have been depleted. And this is where the astounding part comes in: The concept of development so very central to the Chinese view of illness does not just help in the early stage of an illness. Often enough it also proves helpful in terminal stages that seem hopeless by allowing, in a retrogressive perspective, to diagnostically trace the development of the illness back to the initial roots and work the problem through therapeutically. There are good chances of success for such diagnoses as headaches and backaches, arthrosis, intestinal inflammation, asthma, neurodermitis, gynaecological disorders, sleep disturbances, depression, panic attacks, polyneuropathy and restless legs. The limits of the method are seen less in regard to certain diagnoses than in the individual treatment constellation. Relative impediments to treatment are long years of taking cortisone, psychopharmaceuticals, pain killers, etc. and the lack of ability for dialog or the lack of willingness to be questioned about the medicines being taken
It is not easy to answer the question concerning the side effects of Chinese medicines because the question is raised from the view point of Western pharmacology. This point of view distinguishes between desired and undesired effects of medicines. One effect is stated on a package of tablets, for example "against headaches", the other on the package insert, perhaps "may cause gastric bleeding". This division is foreign to TCM. The textbooks on medicines describe the effects of plants on the entire organism. These descriptions contain the experiences that Chinese doctors have recorded on the individual agents over the course of many centuries. Whether the change that a patient experiences from a plant preparation is desired or undesired depends on the diagnostic correctness of what is prescribed. If, for example, Scrophularia root, which causes cold, is given to a patient who suffers from "interior cold", he will react with diarrhoea, nausea and other "cold symptoms". So the question of side effects is a question of making the correct diagnosis.
Now there are two situations in which actually unpleasant and, at least from the patient's point of view, undesirable reactions may occur during medicinal therapy. One is early reactions in the beginning when a new decoction is taken. The organism must adjust to the therapeutic impulses resulting from the medicine and it reacts with slight indisposition, unusual temperature sensations or similar. These occurrences should clear up in three days; otherwise the correctness of the formulation should be questioned. The other is complaints caused by therapeutic mobilisation of accumulated metabolic waste products such as tiredness, headache and flatulence. But these complaints are also of a temporary nature and can be seen as a positive sign of the medicine's effect.
Safety of Medicines
In Germany, practically only dried plants or parts of plants are used, i.e. roots, leaves, blossoms, tubers/bulbs, etc. The pharmacist calls these raw drugs. These plants are cultivated, cut into small pieces and, if necessary, processed and dried in China before they are delivered to European importers. The quality consciousness of the Chinese is very high when it comes to their medicinal plants but there are always black sheep and, of course, there is the possibility of mix ups. The quality of a raw drug is evaluated according to categories, the three most important of which will be named here:
- Identity - Is the medicine that the patient receives identical with that in the prescription?
- Impurities - This mainly concerns pesticides, heavy metals and fungi toxins.
- - Medicinal quality - Does the medicinal root look wilted and sick or does it burst with vitality, do the colour and odour correspond to the reference drug, can certain components be determined (in individual cases)?
In the years past, individual incidents concerning the use of Chinese medicines have caused quite a media circus. Even if the criticism of Chinese medicinal therapy overshot the goal by far, it did enhance public awareness on the question of quality and woke up the pharmacy authorities all over Germany.
In the meanwhile, the following procedure for quality assurance has pretty much been set in place: The medicines must be sold in a pharmacy. The importer must have the imported goods regularly examined and certified by authorised institutes according to the criteria given above. The pharmacist may only buy certified products. The German Pharmacy Council controls the pharmacies, the importers and even the suppliers in China. So if your prescription is filled at a pharmacy, you can be sure of the quality.
Is Chinese Medicinal Therapy Possible in Europe?
In China, herbal medicines are normally dosed five to ten times higher than what is conducive for our patients. This rather puzzling discrepancy between Western and Eastern patients, which has also been well-known in China for decades, raises the question whether Chinese medicinal therapy as it is practiced in China can be unconditionally transferred to European circumstances. The answer - a clear no - led to the foundation of "DECA" nearly twenty years ago. This work group of doctors intensively works on adapting the Chinese treatment concepts to the situation in the West. The result is medicinal formulations that are not only dosed lower but also with just eight individual agents at the most and thus much more calculable in composition than the twenty or more plants found in traditional prescriptions in China. This modern and at the same time effective and understandable treatment methodology has also made it possible to establish two clinics in Germany in which patients with severe chronic illnesses are treated.
For five years now, the Bavarian State Research Center for Agriculture has carried out a trial to cultivate Chinese medicinal plants. The first results are highly promising and in the foreseeable future we can count on obtaining quality controlled Chinese herbs from German farmers.
We see that the Chinese medicinal therapy is even starting to gain a foothold in European agriculture. Why not? If we, with the greatest matter-of-factness, expect Chinese doctors to master Western surgery and medicinal therapy, why shouldn't we Europeans not be able to incorporate the knowledge that has been handed down in China and use it to the benefit of our patients? Among other things, Europe owes its great intellectual vitality to the ability to assimilate and process foreign cultural influences. In the Middle Ages it was Persian and Arabian doctors that were the source of substantial impulses for the development of European medicine. Today, the "big treasure house" of Chinese medicine could take on this role. We take from this what seems to be missing in the West and through further development adapt it to our needs.