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— updated 1999-12-02
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— updated 1999-12-02
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Herbalist Review, Issue 2000 #3: TCM paradigm and western herbs: Oregon Grape root as exampleby Roger W. Wicke, Ph.D. The traditional Chinese herbal protocol for assessing one's patterns of symptoms and signs and choosing herbs and formulas appropriate for this assessment can be used to better understand the effects of all herbs and even foods, not just 'Chinese' herbs. |
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Page contents…
IntroductionThe paradigm of clinical TCM (traditional Chinese medicine) can help us understand the effects of all herbal preparations, not just herbs listed in the official Chinese materia medica. Frequently, RMHI staff and students are asked about a particular herb (Saw Palmetto, Calendula, Echinacea, Oregon Grape Root, etc.) and how to apply it. However, to do this well requires us to read between the lines of information commonly available in western herbal and medical literature. Why most people rarely ask the right questions about herbsThe western herbal and medical traditions have placed a heavy emphasis on understanding the physiological actions of drugs and herbs in the body, and while this is useful information, stopping there leaves us with many gaps in our knowledge for one simple reason: most clients or patients will describe their symptoms to us, and we will have no idea (only guesses) about their blood chemistry, hormone levels, brain-wave characteristics, etc. Some of these tests are expensive, and, moreover, it is common for people with health complaints to have their medical lab results reveal no abnormalities. Experienced physicians and health care professionals eventually learn to go by their "instincts", which means learning by experience to interpret the individual's reported symptoms, behaviors, physical appearance, smell and any other unusual characteristics. It makes no sense to interpose an extra layer of uncertainty into the clinical decision process, yet that is exactly what happens when strategies for regaining health are chosen based upon their presumed physiological effects. For example, suppose a woman has been experiencing premenstrual complaints of fatigue, irritability, constipation alternating with diarrhea, abdominal bloating and excessive menstrual cramping. While it is well known that FSH, LH, estrogen and progesterone are directly involved in regulating the menstrual cycle, adrenal and thyroid hormones may also be implicated in the listed symptoms, as well as abnormal gut flora and inadequate digestive enzyme secretion. In short, without measuring all these parameters over a monthly cycle (which would be extremely expensive), we can only speculate about what they might be. However, we do know what the symptoms are; there is very little doubt here. Therefore, it would seem to make sense to base a clinical strategy primarily on the symptoms and other easily observable clinical signs; to do otherwise would introduce an added layer of uncertainty. It is sheer folly to choose herbs based upon physiological actions that may or may not be appropriate, because without extensive lab testing we are merely speculating, and our probability of making erroneous conclusions increases. A serious problem arises in clinical decision making, however, when our information about an herb or drug consists primarily of physiological actions with very little discussion of its effect on symptoms and symptom patterns, because improvement of symptoms or appearance of side-effects are often the sole criteria for deciding whether or not to continue taking it. Often, the only clues we may gather regarding effects on symptoms is contained in the fine print under "contraindications" and "possible side-effects". (These ideas are explored in detail in chapter 2 of TCHS Volume 1.) The remainder of this report will outline the procedure that one should follow in reconstructing a tentative description of the actions of an herb not listed in the TCM materia medica, but for which information is available in the western literature. In short, I will give you some guidelines for "reading between the lines". Checklist of properties and specifications we need to determineOften when we consider the use of an herb, we already have information about it from sources ranging from ethnobotanical (folk medicine) to physiological/pharmacological. Before any herb can be used safely and reliably, the following categories of information need to be determined:
Botanical identity, preparation, dosageBefore determining appropriate clinical usage, assuring standard criteria for botanical identity (genus and species) and preparation are essential. In collection information from various sources and integrating this information, we need to be certain that all the information refers to a consistent preparation. Common names for plants are frequently unacceptable in identification, as they are too variable and uncertain. Preparation includes such aspects as harvesting, slicing, drying, and any special extraction or chemical processing. Certain plants may require special preparation to enhance desired properties or to reduce toxicity. Others may require growing in certain types of soil, specific cultivation methods, or harvesting at only certain times of year to ensure desired properties. Recommended dosages will be dependent upon the particular method of preparation. One should verify that the dosages specified among various sources are consistent. If the dosage is specified in other than dry weight of the whole herb, the method of processing or extraction is crucial to determine the concentration of the final product. ToxicityEthnobotanical literature documenting historical
usage, clinical testing, and pharmacological
toxicity testing are all useful sources of
information regarding toxicity. It has been assumed,
with good reason, that herbs and foods in common
usage for several centuries or longer would be
unlikely to have significant toxicity, or such
effects would have become common knowledge.
Long-term toxicity, which is occasionally difficult
to detect or verify even with pharmacological
screening (e.g., the Ames test for mutagens Herbs not in common usage, but for which historical
reports exist of their use, are more problematical.
In these cases, an understanding of the history of
the period from which the report originated is
crucial to determining its likely accuracy and
authority. For example, much of European literature
on herbal medicine originated during a time of
periodic persecution of herbalists ("witches") and
midwives. Species of the plant genus Senecio, for example, are
now known to contain toxic pyrrolizidine alkaloids
that can induce liver cancer in a high proportion of
animals fed this plant. The pharmacological basis of action of herbs, while
providing only an incomplete basis for choosing
herbs clinically, has nevertheless provided useful
information in understanding the toxicity of herbs
containing well studied phytochemicals. Examples of
this include the solanaceous plants Belladonna and
Hyoscyamus (atropine, hyoscyamine, scopolamine),
Ephedra (ephedrine), Rauwolfia (reserpine), and
Digitalis or foxglove (digitalis). Taste and thermal qualities (hot/cold)Once an herb has been determined to be safe after proper identification and screening for toxicity, its taste and thermal nature ("hot"/"cold") should be determined by simple taste testing, preferably by a group of people with a known range of constitutional characteristics and body types (or symptom-pattern tendencies, in TCM) so that any variation in reactions can be correlated with their predispositions. The TCM system of classifying herbs place a great
importance on taste and thermal nature. While these
qualities are considered to be of minor significance
in western allopathy and given little scientific
priority, this is puzzling given that the senses of
taste and smell are the most important early-warning
defense system that the body uses to prevent one
from consuming deadly and poisonous plants. Rotten
and spoiled food, likewise, exudes numerous chemical
signals that cause instinctive revulsion and
sometimes vomiting. Appetite and cravings normally
act to stimulate consumption of necessary nutrients,
and the taste and smell of foods will trigger
physiological reflexes that result in secretion of
necessary salivary, gastric, and pancreatic enzymes.
It should, therefore, be expected that any rational system of clinical herbology would include taste as an important criterion in classifying herbal properties. Lacking the funds to build an expensive phytochemistry lab, we would be wise to make use of the sensitive chemical analyzers that nature has provided to us at no expense. Regarding hot and cold, these ideas are discussed in Chapter 2 of TCHS Volume 1.
As examples, black and chili peppers are very hot,
cinnamon is warm, milk of magnesia is very cold, and
herbs like goldenseal and coptis are cold. In the next section we will discover how these simple taste and thermal classifications (based on TCM clinical theory) will provide insights for translating physiological information from western herbal literature into the more clinically useful language of symptom-sign patterns. TCM clinical functionsRather than describe the physiological actions of an herb (and force one to guess what ultimate effect this will have on the client's symptoms), the TCM functions specify the patterns of symptoms and signs that are likely to be relieved by taking it. Note that this means we do not choose herbs based upon some speculated physiological phenomenon that may or may not be occurring, nor do we choose herbs based on single symptoms, as many people do when they go to a health food store (what herb will help relieve my headache, stomach pain, etc.?) The totality of the symptoms and physically observable signs (complexion, behavior, posture and gait, voice and speech quality, etc.), as a pattern, comes closest to giving us a set of clues, when considered together, that will maximize our likelihood of eliminating herbs that may result in side-effects and of choosing herbs most likely to be appropriate for the totality of symptoms and signs presented by the individual at the moment. The symptom-sign patterns of TCM require much study to learn, recognize, and differentiate; all I can do here is to state the basic principle. ContraindicationsContraindications in the TCM system are almost a reverse image of the clinical functions and are also defined in terms of patterns of symptoms and clinical signs for which an herb should be avoided or used cautiously. Single symptoms are rarely listed as contraindications because they are not specific or circumscribed enough. The best way to explain this is by example, as in the case of Oregon Grape Root outlined below. Example: Oregon Grape (Mahonia)To illustrate how one would apply the preceding
guidelines to arrive at a working clinical
description of an herb not classified by the TCM
materia medica, let's examine the potential clinical
uses of the herb commonly know as Oregon Grape
(Mahonia repens, or according to some botanists,
Berberis repens) Root, which is a plant that grows
in coniferous forests throughout the mountainous
western U.S. Preparation Toxicity: Information from Hoffman Indications according to western herbal sourcesAccording to Michael Moore David Hoffman Hoffman also lists indications according to Priest and Priest: "catarrhal disorders of stomach, intestines and urinary organs. Hepatic torpor, bilious headache, eczema, herpes, psoriasis, acne, facial blotches and pimples." Indications listed by Ellingwood include "scaly, pustular and other skin disease due to the disordered conditions of the blood; ...pimples, roughness, eczema capitis, eczema genitalis, pruritis, scaly eczema, psoriasis, pityriasis, chronic dermatosis, glandular indurations, ulcerations, syphilis." Supporting researchMany of the clinical uses suggested by Moore and
Hoffman are supported by scientific studies of
Mahonia and closely related species and by
studies of known chemical constituents and their
physiological activity. These constituents include a
family of compounds known as isoquinoline alkaloids,
including berbamine, berberine, canadine,
columbamine, corydine, corypalmine, corytuberine,
hydrastine, isoboldine, isocorydine, jatrorrhizine,
magnoflorine, mahonine, oxyacanthine, palmatine,
tetrahydroberberine, tetrahydrojatrorrhizine; other
constituents include resin and tannin. The chemical constituent thought to be the most
important clinically is berberine TCM evaluation of Oregon Grape Root (Mahonia)Now we need to sift through the preceding indications and research conclusions and combine this information with the TCM taste and thermal characteristics, to arrive at a description of the properties of Mahonia in terms of TCM-style patterns of symptoms and signs. This process is much like piecing the parts of a puzzle together, and organizing the pieces into logical groups may help us to better evaluate them. Our relevant evidence may be separated into several types:
First, let's consider evidence of type (A), above: (A1) Mahonia is a purely bitter tasting herb
with no secondary tastes (sweet, sour, salty, etc.),
similar in quality of bitterness, but somewhat less
intense, to the following Chinese herbs: Scutellaria
baicalensis root (huang/ qin/), Coptis rhizome (C.
chinensis, C. deltoidea, C. omeiensis, or C.
teetoides; huang/ lian/), and Phellodendron bark (P.
amurense or P. chinense; huang/ bai~). (A2) Several of the herbs mentioned in (A1), while
very different botanically, share the feature of
containing some of the same isoquinoline alkaloids
as contained in Mahonia. Coptis (huang lian)
contains berberine, columbamine, and palmatine;
Phellodendron (huang/ bai~) contains berberine,
jatrorrhizine, magnoflorine, and palmitine. (A3) While similarity of certain chemical constituents is no guarantee of similarity in clinical function of the whole herb, it is one of many factors that can suggest such a possibility. That the Chinese herbs Coptis and Phellodendron are similar both in phytochemistry and subjective taste to Mahonia is cause for further evaluation. (A4) The broad-spectrum antibiotic activity of
Mahonia (due to its constituent berberine)
against Mycobacterium tuberculosis, Bacillus
subtilis, Salmonella enteritidis, E. coli, and
various fungi, and its inhibitory effects against
endotoxins of E. coli and Vibrio cholerae are very
similar to the antibiotic activity of Coptis and
Phellodendron against Salmonella, Shigella,
Mycobacterium tuberculosis, Pseudomonas,
Streptococcus, and Staphylococcus. Now, let's consider evidence of type (B) for Mahonia: (B1) The antibiotic activity described in (A4), together with the listed indication of "catarrhal [inflammation of the mucous membranes] disorders of stomach, intestines and urinary organs" strongly suggests that the primary function of Mahonia is to "Clear Damp Heat", which is also the primary function of the Chinese herbs Coptis and Phellodendron. (B2) Damp Heat conditions are characterized by the
presence of a majority of the following symptoms and
signs: sticky, thick, and yellow or green mucous
discharges; watery, oozing skin eruptions; tendency
toward foul-smelling loose stools, or constipation
alternating with diarrhea; nausea, reduced appetite,
reduced thirst although may complain of dry mouth,
abdominal fullness and distention; a ponderous heavy
sensation of the body; torpor, fatigue; tongue
coating yellow and greasy-wet; tongue tissue color
reddish; complexion yellowish; radial pulse quality
slippery and rapid. (B3) The TCM paradigm subdivides Damp Heat conditions according to which body functions are affected (these functions are often loosely translated as "Organs"). The western indications of "catarrhal [inflammation of the mucous membranes] disorders of stomach, intestines and urinary organs", plus "hepatic torpor, bilious headache, eczema, herpes, psoriasis, acne, facial blotches and pimples", suggests that the functional domains of Liver, Stomach, Intestines, and Urinary Bladder are the primary targets of Mahonia, as would be classified in the TCM system. In addition the "Lungs" should be considered for inclusion also since TCM theory considers many skin diseases to be within the domain of the Lungs.
Finally, by considering evidence of type (C), we will strengthen many of the conclusions of type (B) by examining the TCM functions of Coptis and Phellodendron, which we already strongly suspect of being very similar to Mahonia in their clinical functions: (C1) Coptis, according to the TCM materia medica
(C2) Phellodendron drains Damp Heat, especially of
the Intestines and Urinary Bladder, and quells Fire
Poison. (C3) By comparing the TCM functions of Coptis and Phellodendron with the evidence of type (B), we conclude that Coptis is more similar in function than Phellodendron to the functions of Mahonia repens. The special emphasis in the western sources on the use of Mahonia for liver conditions leads us to conclude that Mahonia is perhaps more focused on clearing Liver Damp Heat than is Coptis. (C4) While no mention is made in the western sources of any use of Mahonia for insomnia or palpitations (of the Heart-Fire type), the interesting note that constituents of Mahonia have been shown to block the action potential of transitional pacemaker cells (7-O-demethylisothalicberine) and induce relaxation of aortic tension (berbamine, oxyacanthine) suggests that an unrecognized function of Mahonia is to clear Heart Fire, similar to Coptis. (C5) To summarize all our evidence, we can now tentatively suggest that Mahonia would have the following TCM clinical functions:
(C6) Furthermore, the TCM contraindications for both Coptis and Phellodendron, and most likely Mahonia repens also, include:
How does the TCM description help us more selectively and effectively use Oregon Grape root?In reviewing the indications from Hoffman, Moore, and other western herbalists, it becomes clear from the TCM description of Oregon Grape Root (C5) how to interpret many of the listed indications. For example, when it is said to be a useful laxative in cases of constipation, we now strongly suspect that it would not be useful in types of constipation associated with conditions of weak digestion, poor appetite, pale complexion, pale tongue, and fatigue ("Deficiency of Spleen and Stomach Qi"). In fact this type of condition is likely to be aggravated by Oregon Grape. Regarding its reputed quality as an "intestinal strengthener", we would be skeptical, as many conditions of weakened peristalsis accompany conditions of "Deficiency of Spleen Qi", for which herbs like Coptis and Phellodendron are contraindicated. For similar reasons, Coptis and Phellodendron are contraindicated in nausea and vomiting associated with "Deficiency Cold of the Spleen and Stomach". While Hoffman writes that Oregon Grape is useful in "stomach and gall-bladder conditions, especially where there is associated nausea and vomiting", this statement is too general, and the TCM functions and contraindications make this clear. Another example of where caution must be exercised is in cases of chronic hepatitis (according to Hoffman: "liver stimulant... lowers bilirubin levels in cases of hepatitis") characterized by Deficiency of Liver Yin: jaundice, subcostal pains, irritability, insomnia, plus all the signs of Deficiency of Yin (C6, above). In fact, Oregon Grape should probably be contraindicated in any condition characterized by Deficiency of Yin, even though certain symptoms or conditions listed in the western indications may be present. Such contraindications may sometimes be overcome by combining with other herbs that counteract undesirable effects, but this subject is beyond the scope of this report. Regarding the listed TCM contraindication of avoiding long-term use, note that the strong antibiotic actions of Mahonia, Coptis, and Phellodendron should remind us of the dangers of using any antibiotic for prolonged periods because of the damage to the intestinal flora that often results from such use. Normal intestinal flora is known to be essential to normal bowel function and absorption of nutrients, and this correlates with the statement by the ancient Chinese that bitter herbs may damage Spleen and Stomach. SummaryThe clinical indications for the use of many western herbs, including Oregon Grape Root, are often too general. By comparing data from phytochemical research, ethnobotanical (folk-medicine) records, historical usage, and TCM descriptions of similar herbs, we can systematically sift through the evidence to increase the specificity of clinical usage and contraindications. These conclusions are tentative and must be verified by clinical observation. While the average clinician may give lip service to understanding herbs in terms of their physiological actions, in the typical clinical setting this knowledge is of only theoretical interest, because the physiological parameters are unknown due to constraints of expense and time. What is easily known or verified are the client's symptoms, his or her tongue and pulse qualities, behavior, and body characteristics. Clients and patients would ultimately benefit if researchers and authors would begin compiling herbal information in a form that is more easily accessible to clinical herbalists. Research on the clinical effects of herbs should begin to differentiate medical conditions more specifically into the clinical subtypes that in TCM are found to be essential in applying an herb correctly and without side-effects. |
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