Introduction

When it comes to health and personal care, being well informed is everything. There are new fads and avenues of research everyday pointing to the next miracle cure. These can create an internet hype that makes it difficult to get a hold of the real facts behind the headlines. The practice of Chinese Herbal Medicine (CHM) has been diffusing out of China and into the international market for quite some time. In 1997, it was estimated that in the U.S. alone, about a million patients a year were treated by practitioners using traditional Chinese therapies ^[1]. In spite of this, finding information on the effectiveness and safety of CHM can be frustratingly difficult, with resources often contradicting one another. This post will attempt to provide an unbiased review of what’s out there on Chinese herbal remedies, and act as a resource to those thinking about incorporating it into their healthcare.  

CHM’s History and How it Connects to Traditional Chinese Medicine:

Chinese Herbal Medicine (CHM) is one of several practices that make up the doctrine of Traditional Chinese Medicine (TCM). The origin of TCM is rooted in the ancient philosophy of Taoism and dates back more than 2,500 years [1]. It encompasses many different disciplines including tai chi, acupuncture, dietary therapy and qi gong. One of the biggest focal beliefs of Chinese medicine is that the human body is a smaller version of the larger universe, and hence there is no difference between the body and the mind or the flesh and the psyche [1][2]. This belief dictates that practices of TCM work in harmony, with each layer further strengthening the balance of the body [2][6]. It is also the reason why a single case may include treatments from several different disciplines of TCM [6][10]. There are three other fundamental beliefs of TCM [1], and they are quickly summarized below:  

1. Chinese medicine believes that humans have a vital life force called Qi. Qi plays a part in most major aspects of life and flows throughout our body. One of its functions is regulating health.
2. Another fundamental belief, is that there exists two opposing, yet complementary, forces in nature called Yin and Yang. Their balance signifies harmony and health, and their imbalance in the body can manifest as some form of disease.
3. Lastly, Chinese medical theory states that all phenomenon, including the evolution of the human mind and body over its lifespan, can be symbolically represented using the five elements (Earth, Air, Water, Fire, Wood). Due to this, these five elements can also explain the function of the body and how it changes when diseased.

These bullet points cover the TCM belief framework in broad strokes and lay the foundation for how Chinese Herbal Medicine is theorized. If you’d like an in depth explanation of TCM’s beliefs check out this reference.  

A little about CHM:

The practice of Chinese Herbal Medicine comes from a rich and unbroken tradition that can be traced back to the 3rd century BC [6]. This fact alone arguably makes CHM one of the most valuable herbal systems in the world. The myths surrounding its beginnings tell of a compassionate ruler called Emperor Shennong (affectionately known as ‘ Divine Farmer’ or ‘Five Grains God’) .

According to legend, he first tasted a list of 100 herbs and then taught the Chinese people how to use them in medicine and diet [4][5][6].   By 1977 this list (detailed by the Encyclopedia of Traditional Chinese Medicinal Substances), had expanded to 5,767 identified substances or “herbs” that were being used as part of CHM therapy throughout China [2]. These herbs may also be combined in specific formulas and can be prescribed as a tea, powder, liquid, paste or capsule. An average practitioner will typically use about 200 to 600 herbs in their practice [2].

CHM also uses mineral and animal products along with plant derivatives for its treatments [1][6].   CHM describes many characteristics of each herb such as unique properties, flavors, compatibilities, toxicities, processing and contraindications, each governing therapeutic aspects of an herb [10]. A link between an herb’s taste and characteristics to its therapeutic properties can be seen in CHM literature as far back as the Late Sui (AD 581-618) and Early Tang (AD 618-907) Dynasties [10].

One of the key characteristics of prescribing in CHB is combining various ingredients in such a manner that they compliment each other, improving efficacy while decreasing side effects. Modern herbalism also follows this very important ideal.   For example, too high of a dose of a specific herb could yield side effects. However, if combining with one or two other herb that have similar main functions, the high dose of the original herb can be avoided while the goal of the treatment maintained.

These supportive ingredients can also fight other symptoms in the patient, battle side effects from the main ingredient or focus the actions of one of the other ingredients.   These helper ingredients are referred to as the associate drug, the adjuvant drug, and the messenger drug, with the main ingredient being the principle drug. In Chinese literature they are sometimes called the emperor, the minister, the assistant, and the envoy, respectively [10]. For more details on these theories (and there is A LOT more detail) try this paper introducing them from Pharmacy World and Science.  

International Research around CHM:

While CHM is popular in China and gaining a global market, there has been little systematic scientific research on its effectiveness. This is partly because western medicine tends to dominate scientific research budgets and drown out alternative medicine (which isn’t actually alternative for much of the world). The other reason, however, is that because it is a holistic system, it doesn’t lend itself well to the isolated scrutiny so inherent to research studies.  

Since the 1980s, the Ministry of Health in China has been working to support and grow CHM and Traditional Chinese Medicine in general [4]. Efforts were made to define curriculum in teaching institutions to establish Chinese medicine as being distinct from biomedicine [4]. By the early 2000s the discipline was creating new research, mostly in molecular pharmacology and the characterization of active ingredients [9]. This renewed vigor in China was perhaps the reason that CHM began to appear in international scientific literature in the next decade.  

Chinese medicine has faced harsh criticism from western researchers over aspects of its belief system that cannot be explained by science. This includes ideas like the concept of an invisible life force ‘Qi’ that can be diagnosed and treated; or, that Chinese medicine considers certain psychological responses to be linked to specific organs, like anger to the liver and love to the heart [1][2]. For those who back the herbal arts, this discrepancy exists simply because of western science reaching its limits. For the western scientists… the data is inconclusive.  

However, there is much intrigue surrounding some aspects of Chinese medicine that we would have once thought ridiculous but modern science has since proven to be true. For example, in early Chinese medicine, they did not know that the adrenal gland was separate from the kidney, as the adrenals were never mentioned. Interestingly, the kidney is associated with energy to all organs, regulates reproduction and its corresponding taste is salt, all having to do with functions of the adrenal glands!  

What Does China Say?

In China, the use of TCM is widespread and the government is going full steam ahead with supporting and establishing the industry for a local and international market [4][9]. The use of TCM for healthcare is considered perfectly safe, as long as you consult a licensed practitioner and follow a prescribed treatment plan [6]. The industry is so big there now, that in 2015 TCM accounted for 28% of the total output value of China’s pharmaceutical companies [9]. CHM in particular is most sought after for the following conditions [4]:  

1. Gynaecological conditions like infertility, dysmenorrhoea, PMS and endometriosis
2. Psychological problems like anxiety and depression
3. Skin disease like acne, eczema and psoriasis
4. Gastrointestinal disorders
5. Urinary conditions
6. Hepatitis and HIV
7. Chronic fatigue syndromes
8. Respiratory conditions like asthma, allergies, sinusitis and bronchitis
9. Rheumatological conditions

However, this tradition places a greater emphasis on maintaining a balanced and healthy life to prevent disease from occuring in the first place. Hence, CHM supporters in China use herbal medicine to relieve active symptoms and as a preventative supplement to stop disease from occuring in the first place.   There is steadily increasing research showing that the traditional uses of an herb often coincide with the pharmacological activity of its derivatives. Users have also found CHM to be effective in treating certain chronic conditions. In short, China, for the most part, believes in the healing power of CHM and followers consider any gaps in its scientific validity a fault of the scientific method and community.  

International Use (and Misuse?):

In 2015, the export value of Chinese medicine to the United States was 3.72 billion U.S. dollars [9]. This trend has steadily been on the rise. Even though it has a huge market, herbal medicine in the U.S. is not regulated the same way that conventional medicine is [1]. The Food and Drug Administration (FDA) usually lists herbal medicines as dietary supplements, rather than drugs [1]. Dietary supplement regulations are much looser than those for drugs and they free the manufacturers from having to prove their product does what it claims [1]. This makes it difficult to find authentic herbs and also makes the entire market vulnerable to fake, poor or even contaminated products [1][2].  

One of the main concerns of the international community is the potential toxicity of Chinese herbs. This fear has two causes. The first is the prevalence of contaminated or laced herbs in the market [1][2]. There have been several reports documenting herbs being contaminated with pharmaceutical drugs, heavy metals and toxins. A study of arthritis remedies being sold in the herb stores of Taiwan showed that 30% of the samples were laced with pharma drugs [2]. There are many sides at fault for why the market is the way it is, but that does not include the practice of CHM itself. This sort of toxicity is not caused by the herb… so as long as the source is trustworthy the remedy itself is non-toxic.  

The second reason behind this fear is that some Chinese medicines can cause serious harm on their own, or after interacting with other treatments, if their use is not regulated by a physician. Most of this fear is residual from the unfortunate death of pitcher Steve Bechler, an American professional baseball player for the Baltimore Orioles, in 2003 due to ephedra induced weight loss [5]. Ephedra based dietary supplements were banned from sale in the U.S. in 2004 by the FDA [1].

While it is certainly can be dangerous, and should probably be regulated, ephedra, or as the Chinese call it, ma huang is one of the oldest herbs of the CHM tradition. When it was banned, ephedra was popular for its ability to induce weight loss. However, the Chinese have used it as a remedy for respiratory issues like asthma, bronchitis and congestion for 3,000 years [5].

Cases like Bechler’s show that CHM remedies must be taken according to their traditional use, unless you’re going to do proper research and consult with your healthcare team. Even then, speaking to your doctor (make sure they are educated on the topic of interest) is always recommended before starting any new treatment. Many popular fads in “Chinese remedies” have hardly anything to do with the actual practice of CHM and often do its consumers a lot of harm. Avoid those.  

A Few More Things to Think About:

  Before you begin using CHM to treat your symptoms, here are a few more things to consider:  

• CHM is more effective for some diseases and side effects than others. While the theory of CHM is old, there is a lot of new research being conducted since its popularization in the international arena. A good place to start is to look for PubMed articles on applications of CHM for your condition.
• Some CHM ingredients may be sourced from endangered plants and/or animals. Talk to your supplier and your health team about avoiding, or if necessary, finding regulated sources for these ingredients.
• Make sure that your CHM healthcare provider is a licenced professional. You can find information on credentials and licensing here. If you have multiple people on your health team, please make sure they are in touch so that your treatments don’t interact and cause adverse side effects.

While CHM is an old and established medical practice that certainly has some merit, many of its theories fall outside the realm of scientific understanding. This is perhaps why, even when CHM remedies work (sometimes better than pharmaceutical medicine), scientists hesitate to give them credit. It will take science a while yet to fully understand and appreciate the healing potential of CHM. In the meantime, if you think the answers to your health concerns lie with CHM, do your research, become part of the community and seek out authentic and trustworthy connections.  

References

1. (NCCIH), N. (2018, July 16). Traditional Chinese Medicine: In Depth. Retrieved from https://nccih.nih.gov/health/whatiscam/Chinesemed.htm#hed2
2. Ergil, K. V., Kramer, E. J., & Ng, A. T. (n.d.). Chinese herbal medicines. Western Journal of Medicine,176(4), 275-279. Retrieved September, 2002.
3. HY, T., AL, Z., D, C., CC, X., & GB, L. (2013). Chinese herbal medicine for atopic dermatitis: A systematic review. Journal of the American Academy of Dermatology.
4. OBRINGER, F. (2011). Chinese Medicine and the Enticement of Heritage Status. China Perspectives.
5. PCOM, P. (2017, December 18). Ma Huang Herb Misused and Abused. Retrieved from https://www.pacificcollege.edu/news/blog/2014/07/07/ma-huang-herb-misused-and-abused
6. RCHM. (n.d.). WHAT IS CHINESE HERBAL MEDICINE. Retrieved from http://rchm.co.uk/what-is-Chinese-herbal-medicine/
7. The Kidneys: A Traditional Chinese Medicine Perspective . (2018). Health Action Network Society. Retrieved 4 December 2018, from https://www.hans.org/blog/post/the-kidneys-a-traditional-chinese-medicine-perspective
8. Kidney Health | TCM World. (2018). TCM World. Retrieved 4 December 2018, from https://www.tcmworld.org/what-is-tcm/the-five-major-organ-systems/kidney-health/
9. Xinhua, 陈. (2016, December 6). Chinese government committed to promoting TCM tradition, development: White paper. Retrieved from http://www.chinadaily.com.cn/china/2016-12/06/content_27583567.htm
10. Zhu, Y., & Woerdenbag, H. J. (1995). Traditional Chinese herbal medicine. Pharmacy World and Science.