FAQ about Chinese Herbal Applications
- How to use the Five Element Theory in herbal applications?
- What is the most common dosage form of Chinese medicine?
- What is the proper way to make a herbal decoction?
- Can Chinese herbs be boiled twice?
- If decoction overcook and the solution dried up, can I add water to re-boil?
- Can you explain what toxicity in Chinese Medicine means?
- How do toxic side effects of Chinese medicines happen?
- What are the consequences of misuse Chinese medicines?
- What is the best way to choose a proprietary Chinese medicine ?
- Can Chinese medicine and western medicine be taken together?
- Are Chinese medicines applied in standardized dosages?
Q : How to use the Five Element Theory in herbal applications?
A: The Five Elements Theory is used as a tool for grouping objects, and as a method for analyzing pathological changes in traditional Chinese medicine (TCM). According to the Theory, all things can be divided into five elements (metal, wood, water, fire and earth). Our body's five yin organs (heart, liver, spleen, lung and kidney) correspond to the five elements based on their functional properties. TCM makes use of the interrelationships between the five elements to treat diseases or organ dysfunctions, for example in tonifying and reducing therapies. In case of deficient disharmony patterns, besides tonifying the deficient organ, it is necessary to tonify its counter-generation partner in order to speed up the recovery. For example, in treating liver (wood) deficiency, water generates wood, so physicians will also tonify the kidney (water) to reinforce treatment. In case of excess disharmony patterns, besides reducing the particular organ, it is also necessary to reduce its generation partner in order to depress the excitatory conditions effectively. For example, in treating excessive fire in the liver (wood), wood generates fire, so physicians will also reduce the heart (fire) so as to relieve the excessive fire indirectly.
Q : What is the most common dosage form of Chinese medicine?
A: The most common dosage form in Chinese medicine is oral solution or decoction. Chinese herbal decoctions are characterized by their quick absorption, favorable therapeutic outcomes and minimal side effects. The ingredients in the decoctions can be modified, increased or decreased on a daily basis, allowing physicians to tailor to the patient's changing conditions and needs. Flexibility is one of the main reasons why this method is still being used after thousands of years.Q : What is the proper way to make a herbal decoction?
A: Just like cooking, it is important to follow the proper steps. Incorrect preparation may impact on the intended effects. A ceramic clay or crockery pot with a lid works best; however, an enamel or glass pot can also be used. Iron, aluminium and copper pots should be avoided because chemical interaction can occur and affect the original nature of the ingredients.
Uncontaminated cool water is best. Physicians may recommend using rice wine or a combination of water and wine for certain types of decoctions.
Add water until the herbs are lightly submerged; soak for 20-30 minutes so the effective contents can be easily extracted when boiled. Bring to a boil quickly and then turn the heat down as required for the time given.
The specific time and heat used in preparing your decoction are determined by the properties and nature of the ingredients. Generally, cold and flu or purgative decoctions are boiled on high heat for 20-30 minutes. Tonic or other decoctions that contain rich sticky substances are decocted for a longer time (approximately one hour) with mild heat and more water. In order to achieve the best results, your physician should clarify what type of decoction you are preparing, the appropriate amount of water that should be used and how long it should be boiled.
The herbal compounds and the liquids are commonly boiled down to one glass or 250ml. Then it should be filtered into a container while straining the dregs. If the decocted herbal ingredients are overheated or burnt, the whole decoction should be discarded because damaged ingredients can produce undesirable effects.
Certain ingredients must be treated differently due to their special properties. If they are in your prescription, the ingredients are usually packed separately. For example, shells and minerals have to be smashed and decocted first; volatile and aromatic substances like peppermint and Amomum fruits are added near the end and are cooked for 5 minutes only. Substances like Biond Magnolia flower and Plantain seed must be wrapped in gauze, because they make the decoction turbid or irritate the throat. Expensive substances such as deer horn and ginseng are sliced and boiled separately, so that their active ingredients are not affected by other herbs. Their decoctions can either be taken together with other decoctions or drunk separately. Some colloid ingredients like honey or malt sugar should be melted into the warm finished decoction directly. Some rare aromatic substances like musk are ground into powder and taken with a decoction or lukewarm water.
If preparing your own decoction seems like a daunting task, many herbal shops and physicians can provide this service when asked.
Q : Can Chinese herbs be boiled twice?
A: Sometimes the same set of prescription can be boiled twice. When decocting for a second time, less water (approximately 500ml) is used or just enough to cover the surface of the ingredients. It is usually mixed the first decoction and the second decoction together, then divide it into two portions for daily serve, or take it as advised by the doctor. Medicinal materials that have rich sticky textures, or those with tonifying effect can usually be re-boiled, in order to extract most of the active ingredients. Prescriptions for cold and influenza, for example, is not suitable for re-boiling, because the active ingredients in the herbs such as peppermint and villous amomum fruit can easily evaporate.
Since the natures of ingredients in each prescription are different, whether to decoct again should be according to the instructions on the prescription. If you have any questions, always consult your doctor or pharmacist.
Q : If decoction overcook and the solution dried up, can I add water to re-boil?
A: No! This is mostly due to too high temperature or too long decoction time, which may have destroyed the active ingredients in the herbs and affected the overall efficacy. Sometimes, even the chemical properties of the herbs changed, taking the decoction may cause adverse reactions to the individuals. Q : Can you explain what toxicity in Chinese Medicine means?
A: In TCM, toxicity is interpreted as broad-sense and narrow-sense ways. Broad-sense toxicity refers to general drug bias that ancient people viewed; narrow-sense toxicity refers to the toxic side effects of Chinese medicinal materials. Traditionally, Chinese medicinal materials are divided into three categories: high toxicity, minor toxicity, and non-toxicity, which belong to narrow-sense toxicity. According to the Chinese Medicine, herbs in high toxicity category are more likely to cause severe side effects such as shock, nausea, numbness of the lips and limbs, the sample ingredients include toad venom, raw croton, and cinnabar. Herbs in minor toxicity category, if the dosage is too large, will cause adverse effects such as slight breathing difficulty, abnormal heartbeat and dizziness, sample ingredients are bitter apricot and ginkgo nut. Herbs in non-toxicity category are usually mild in nature and less likely to have side effects.
Nevertheless, most Chinese medicinal materials are safe if applied according to syndrome differentiation and with the correct dosage for the appropriate length of time.
Q : How do toxic side effects of Chinese medicines happen?
A: Except for Chinese medicines that are potent or toxic in property, it is unlike to have toxic side effects when using Chinese medicines appropriately. Chinese medicines are essential items in every Chinese household. The most common reason for the occurrence of side effects is too large dosage or taking for too long time. Other reasons include improper dosage form, unreasonable herbal combinations, misuse, improper decoction, and constitutional intolerance. For example, it was reported that some herbs containing aristolochic acids (AAs) may damage kidney function if used improperly, so they have been banned directly.
In sum, if Chinese medicines are used according to TCM theory, selected carefully, and stop using when condition relief, it is safe. In other words, used under professional instructions and read the labels.
Q: What are the consequences of misuse Chinese medicines?
A: The most outstanding feature of TCM is diagnosis and treatment based on syndrome differentiation. Through the four diagnostic skills, the symptom pattern of a specific disease is identified, then an appropriate prescription will be fitted to it. For example, when treating gastroptosis (abnormal drooping of the stomach), physicians will select herbs with uplifting property and those with descending property would be avoided, this can reduce counteraction between the herbs. If individual condition and the nature of disease are not clearly understood, prescription is applied randomly, it will bring potential risk to the patients, become aggravated or lead to other health problems.
Common poisoning signs include abdominal pain, nausea, vomiting, chest tightness, shortness of breath, palpitations, headaches, dizziness, restlessness, urinary urgency or difficulty.
Some Chinese medicines are extremely strong and contain toxic ingredients. If the dosage is slightly improper or misused, it could lead to poisoning and even death. The Chinese Medicine Council of Hong Kong listed 31 types of potent/toxic Chinese herbal medicines. Always obtain prescriptions from a registered TCM physician and follow their advice regarding preparation.
In case of poisoning, seek medical attention as soon as possible.
Q : What is the best way to choose a proprietary Chinese medicine ?
A: In Hong Kong, a proprietary Chinese medicine refers to any proprietary product composed solely of any Chinese herb as the active ingredient and formulated in a finished dose form. The product must meet some registration requirements. Each Chinese patent medicine has its own applicable range. When choosing proprietary Chinese medicines, the most important thing is to read the label on the product carefully, so as to understand whether the medicine is suitable for your particular health need. In addition, though even a proprietary Chinese medicine that contains the same herbal ingredients can be originated from different manufacturers, one should always buy a product made by a reputable source. As preparation of Chinese herbal products rely on special skills, a difference in manufacturing can have subtle differences in effects. The best way is to seek advice from medical professionals or the manufacturers of the medicine before taking the medicine.
Proprietary Chinese medicine itself is a drug, and it is best to purchase under professional guidance.
Q : Can Chinese medicine and western medicine be taken together?
A: For drug safety, a cautious attitude should always be in mind. Both TCM and western professionals think that western medicines and Chinese medicines should not be taken simultaneously. The reason is that some chemicals in Chinese medicines may react with western medicines. Using the two together also may affect the efficacy of both medicines, and their interaction may produce toxic effects which could endanger health. One should leave around a 4-hour interval between taking these different kinds of medicines. Ideally, the individual should first consult a TCM physician before taking any medicine.Q : Are Chinese medicines applied in standardized dosages?
A: After thousands years of clinical practices, ancient physicians summarized the usual dosage of each Chinese herb. When modern TCM physicians prescribe for their patients, they will generally consider the recommended dosage listed in the Chinese Medicine, Herbal Prescription, Chinese Pharmacopoeia, or clinical medication manual. However, because Chinese medicinal materials have quality differences, and individual condition must also be considered, the dosage prescribed by each physician will be slightly deviated.Written by:
CM Promotion Group - School of Chinese Medicine, CUHK.References:
Chinese Pharmaceutics Chinese Pharmaceutics Identification Published by Shanghai Science and Technology Publishing House, 6th edition.Translated and Edited by:
Jennifer Eagleton, BA, MA (Asian Studies), Integrated Chinese Medicine Holdings Ltd. Lawrence Lau, Ph.D., Integrated Chinese Medicine Holdings Ltd.
Rose Tse, Integrated Chinese Medicine Holdings Ltd.
