Transcript HCR-629-Class

Herb Board Review
Robert Hayden, AP, MSOM
Basic Concepts of
Chinese Herbal
Medicine
Thermal Properties
(Qi)
• Hot
• Warm
• Neutral
• Cool
• Cold
TASTES (Wei)
• Acrid (pungent, spicy) - disperses,
moves, effuses sweat
• Sour - contracts, tightens, astringes
• Salty - moistens, softens and descends
• Sweet - tonifies, moistens, harmonizes
• Bitter - drains and dries
• Bland - leaches out Dampness and
promotes urination
• Astringent - astringes
• Aromatic - penetrates turbidity
• Specific tastes often correspond to
classes of chemical compounds.
• Acids, which produce free hydrogen
ions, are detected by the presence of a
sour taste, and the strength of the acidity
is roughly proportional to the intensity of
the perception of sour.
• Metal salts containing sodium and
potassium ions are detected as a salty
taste.
• Alkaloids, some of which are highly toxic,
are generally bitter; this is why we have
a natural aversion to bitter tasting plants
as foods.
• Terpenes and essential oils usually
create an acrid or spicy taste.
• Sugars, polysaccharides and glycosides
are detected as a sweet taste.
• All the basic structural and energyproducing compounds of the body,
including sugars and starches, fats, and
proteins are sweet to taste, and
sometimes bland.
• It is for this reason most tonics are
considered to be sweet.
• Sour, salty, astringent, bitter, and acrid,
are normally present in the diet only in
small quantities of the corresponding
chemical constituents, but their
importance lies in their ability to potently
alter body functions.
Herbs which guide into
specific Organs or Meridians
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Heart
Rz Coptidis (Huang Lian);
Hb Asari cum Radice (Xi Xin)
Small Intestine
Rz et Rx Ligustici Sinensis (Gao Ben);
Cx Phellodendri (Huang Bai)
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Kidneys
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Rx Duhuo (Du Huo);
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Rx Anemarrhenae (Zhi Mu);
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Cx Cinnamomi (Rou Gui);
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Hb Asari cum Radice (Xi Xin)
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Urinary Bladder
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Rz et Rx Notopterygii (Qiang Huo)
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Lungs
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Rx Platycodi (Jie Geng);
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Rz Cimicifugae (Sheng Ma);
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Hb Allii (Cong Bai);
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Rx Angelicae Dahuricae (Bai Zhi)
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Large Intestine
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Rx Angelicae Dahuricae (Bai Zhi);
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Rz Cimicifugae (Sheng Ma);
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Gypsum (Shi Gao)
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Spleen
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Rz Cimicifugae (Sheng Ma);
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Rz Atractylodis (Cang Zhu);
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Rx Puerariae (Ge Gen);
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Rx Paeoniae Lactiflorae (Bai Shao)
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Stomach
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Rx Angelicae Dahuricae (Bai Zhi);
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Rz Cimicifugae (Sheng Ma);
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Gypsum (Shi Gao);
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Rx Puerariae (Ge Gen)
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Gall Bladder
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Rx Bupleuri (Chai Hu);
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Pc Citri Reticulatae Viride (Qing Pi)
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Liver
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Pc Citri Reticulatae Viride (Qing Pi);
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Fr Evodiae (Wu Zhu Yu);
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Rx Ligusitic Wallichi (Chuan Xiong);
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Rx Bupleuri (Chai Hu)
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Triple Burner
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Fr Forsythiae (Lian Qiao);
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Rx Bupleuri (Chai Hu);
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Upper Burner: Cx Lycii Radicis (Di Gu Pi);
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Middle Burner: Pc Citri Reticulatae Viride (Qing Pi);
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Lower Burner: Rx Aconiti Carmichaeli Praeparata (Fu
Zi)
PROCESSING OF
HERBS
• Cleaning
• Pulverizing
• Slicing
• Washing
• Soaking
Heat Preparation
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Dry-Frying (chao)
Dries herbs for storage and also increases Middle-Jiao
strengthening effects
With salt = directs actions to Kidneys, nourishes Yin
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Liquid-Frying (zhi)
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with honey = tonifying & moistening effects
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with vinegar = analgesic, astringent, bloodinvigorating, toxicity-relieving effects
with wine = clears channels, expels wind, alleviates
pain
with ginger juice = protects stomach, stops vomiting
• Calcining (duan) - makes shells and
minerals easier to pulverize
• Quick-frying (pao) - reduces toxicity or
harshness
• Dry-curing/Baking (hong/bei) - mainly to
dry flowers or insects
• Other methods:
• Steaming
• Boiling
• Quenching
• Simmering
Preparing to Decoct
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Decoct First:
Toxic substances: Chuan Wu, Fu Zi, Cao Wu
Shells & Minerals: Shi Jue Ming, Long Gu, Mu Li, Ci
Shi, Zhen Zhu, Dai Zhe Shi, Gui Ban, Bie Jia, Shi Gao
Other: Shui Niu Jiao, Si Gua Luo
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Add Near End:
Bo He, Mu Xiang, Sha Ren, Bai Dou Kou, Qing Hao
(all aromatics); Da Huang (to purge)
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Wrap in gauze:
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Xuan Fu Hua, Che Qian Zi, Hua Shi, Qing Dai
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Decoct Separately:
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Ren Shen, Xi Yang Shen, Lu Rong
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Dissolve In Strained Decoction
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E Jiao, Yi Tang
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Take With Strained Decoction
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Chuan Bei Mu, San Qi, Niu Huang, Zhu Sha, Zhu Li
Types of Administration
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Water Decoctions (tang) - most common method
Tang implies decoction is taken warm; if it is to be
taken at room temperature, it is called Yin (e.g.: Zuo
Gui Yin)
Most active ingredients in Chinese Formulas are best
extracted in water -- especially tonics
Ingredients can be tailored to each patient (vs pills)
Long shelf life of intact herbs, especially roots & barks
(vs powders)
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Powders (san) - require less preparation time (no
soaking) and less cooking time (increased surface
area means active ingredients are extracted quickly);
quality degrades quickly, short shelf life
Pills (wan) or tablets (pian) - easiest to administer,
high compliance; disadvantage is that ingredients are
fixed by manufacturer, so can not be customized
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Other internal methods:
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Medicinal wines, Congees, Syrups
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External
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Ointments, Plasters, Liniments, Washes, Soaks
Herb Combining
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Traditional theory differentiates six principles involved
in the combining of two herbs: mutual accentuation,
mutual enhancement, mutual counteraction, mutual
suppression, mutual antagonism, and mutual
incompatibility.
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Mutual accentuation occurs whenever two substances
with similar functions are combined; in cases where
the disharmony requires emphasis of a certain type of
action, rather than increase the dosage of one herb
beyond the recommended maximum, another herb
with similar functions is added.
The combination of Rx Scutellariae (Huang Qin) and
Rz Coptidis (Huang Lian) to strongly clear Damp Heat
would be one example.
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Mutual enhancement may result when two substances
with slightly different but related functions are
combined.
An example would be the combination of Rz
Atractylodis Macrocephalae (Bai Zhu) with Poria (Fu
Ling) to strengthen the Spleen Qi and drain
Dampness.
Both herbs possess both functions to a certain degree,
but Fu Ling emphasizes draining Dampness more,
and Bai Zhu emphasizes strengthening the Spleen.
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Mutual counteraction and mutual suppression are the
reduction of toxicity or side effects of one herb by
combining it with another.
Mutual suppression describes interactions that actively
neutralize toxicity, whereas mutual counteraction
refers to interactions where toxicity is still present but
whose effects are minimized.
Common example: using Rz Zingiberis Recens
(Sheng Jiang) to reduce the toxicity of Rz Pinelliae
(Ban Xia).
Rx Glycyrrhizae (Gan Cao) reduces the harshness of
many herbs and "smoothes out the rough edges" of
formulas.
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Mutual antagonism occurs when two substances
reduce or neutralize each other's beneficial effects.
Mutual incompatibility occurs when two substances
interact to create toxicity not present in either taken
separately.
Prohibited herb combinations
19 Antagonisms & 18 Incompatibilities
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Mutually antagonistic substance combinations are to
be avoided, not necessarily because of dangerous
interactions, but because the valuable properties of
the substances may be diminished by such
combinations.
Certain of these combinations consist of substances
that are highly toxic individually, and are listed here
only because the data appears in the traditional
literature.
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Sulphur (Liu Huang) antagonizes Sal Glauberis (Po
Xiao)
Hydrargyrum (Shui Yin) antagonizes Arsenicum (Pi
Shuang)
Rx Euphorbiae (Lang Du) antagonizes Lithargyrum (Mi
Tou Seng)
S Tigli (Ba Dou) antagonizes S Pharbitidis (Qian Niu
Zi)
Nitrum (Ya Xiao) antagonizes Rz Sparganii (San Leng)
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Fl Caryophilli (Ding Xiang) antagonizes
Curcumae (Yu Jin)
Tuber
Rx Aconiti (Wu Tou) antagonizes Cornu Rhinoceri (Xi
Jiao)
Rx Ginseng (Ren Shen) antagonizes Excrementum
Trogopterori (Wu Ling Zhi)
Cx Cinnamomi (Rou Gui) antagonizes Halloysitum
Rubrum (Chi Shi Zhi)
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Mutually incompatible substances that are prohibited
for use in combination because of possibly dangerous,
toxic or otherwise undesirable side-effects.
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Rx Glycyrrhizae (Gan Cao)
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incompatible with:
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Rx Euphorbiae Kansui (Gan Sui)
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Rx Euphorbiae seu Knoxiae (Da Ji)
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Flos Daphnes Genkwa (Yuan Hua)
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Hb Sargassi (Hai Zao)
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Rx Aconiti (all types - Wu Tou; Fu Zi)
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incompatible with:
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Bulbus Fritillariae (Bei Mu)
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Fr Trichosanthis (Gua Lou)
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Rz Pinelliae (Ban Xia)
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Rz Ampelopsis (Bai Lian)
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Rz Bletillae (Bai Ji)
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Rz et Rx Veratri (Li Lu)
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incompatible with:
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Rx Ginseng (Ren Shen)
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Rx Glehniae (Sha Shen)
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Rx Salviae Miltiorrhizae (Dan Shen)
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Rx Sophorae (Ku Shen)
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Hb Asari cum Radice (Xi Xin)
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Rx Paeoniae Lactiflorae (Bai Shao)
Materia Medica
Review
Herbs that Release
the Exterior
Introduction to the Category
Herbs that Release the
Exterior
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Used for Wind-Cold (Taiyang stage), or Wind-Heat
(Wei level) invading Exterior.
Typically acute, but may also use for Exterior
components of chronic disease.
Primarily act by diaphoresis (promote sweating).
Acrid tastes scatter and disperse; relatively light herbs
"float" to the surface.
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Warm Acrid herbs generally either enter LU & UB, or
LU & ST or SP.
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LU - regulating the WEI Qi, governs Exterior.
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UB - target head/neck
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ST/SP - digestive upsets w/ External Evils.
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Cool Acrid herbs enter LU & LR.
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LR - red, itchy eyes;
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Wind-Heat + Blood Heat rashes (LR stores Blood).
Warm Acrid Release
Exterior
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Ma Huang - Ephedra / Hb Ephedrae
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Warm, acrid, bitter
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LU, UB
A&I: Wind-Cold Exterior XS. Wheezing. Bi pain.
Edema due to Wind-Cold.
Cautions: Causes heavy sweating. Caution in
deficiency sweating or wheezing, HTN, insomnia
Dose: 3-9 g
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Gui Zhi - Cinnamon Twig / Rm Cinnamomi
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Warm, acrid, sweet
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LU, UB, H
A&I: Wind-Cold Exterior Deficiency. Bi pain limbs &
shoulders. Chest pain due to HT Yang Def. Ab pain,
masses due to cold & blood stasis.
C&C: Contraindicated in warm febrile disease, Yin def
+ heat. Caution in pregnancy
3-15 g
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Zi Su Ye - Perilla Leaf / Fm Perillae
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Warm, acrid, aromatic
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LU, SP
A&I: Wind-Cold. Moves qi in chest & stomach: nausea,
vomiting, morning sickness, seafood poisoning.
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C&C: Do not boil long time
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3-9 g
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Jing Jie - Schizonepeta / Hb Schizonepetae
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Sl. warm, acrid, aromatic
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LU, LR
A&I: Wind-Cold OR Wind-Heat. Vents wind from
blood: skin eruption, itching.
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Char to stop bleeding.
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3-9 g
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Fang Feng - Ledebouriella / Rx Ledebouriellae
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Warm, acrid, sweet
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LR, UB, SP
A&I: Wind-Cold. Wind-Damp Bi pain. Spasms due to
exterior Wind
C&C: Spasms due to blood deficiency. Contraindicated
in yin def heat
3-9 g
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Qiang Huo - Notopterygium / Rz + Rx Notopterygii
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Warm, acrid, bitter, aromatic
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K, UB
A&I: Wind-Cold. Wind-Cold-Damp Bi pain, esp upper
body. Guides to Taiyang, Du channels: headache
C&C: Contraindicated in pain due to blood deficiency
or yin deficiency
3-9 g
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Bai Zhi - Dahurian Angelica / Rx Angelicae Dahuricae
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Warm, acrid
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LU, ST
A&I: Wind-Cold. Early-stage swelling w/pus. Sinus
pain, HA in Yangming channels.
C&C: Contraindicated in yin deficiency, late-stage
swelling
3-9 g
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Xi Xin - Asarum / Hb Asari
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Warm, acrid
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LU, K
A&I: Wind-Cold. Wind-Cold-Damp Bi pain. Warms LU:
cold phlegm. Nasal obstruction, headache.
C&C: Contraindicated in blood deficiency or yin
deficiency. NEPHROTOXIC. Use low dose.
1-3 g
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Sheng Jiang - Fresh Ginger / Rz Zingiberis recens
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Warm, acrid
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LU, SP, ST
A&I: Wind-Cold. Warms middle & stops vomiting.
Warms LU. Detoxifies other herbs.
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C&C: Contraindicated in yin deficiency heat
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3-9 g
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Xin Yi Hua - Magnolia Flower / Fl Magnoliae
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Warm, acrid
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LU, ST
A&I: Wind-Cold nasal obstruction (or any type nasal
obstruction depending on how combined)
C&C: Caution: Pregnancy. OD: red eyes, dizziness.
Boil in cheesecloth or coffee filter.
3-9 g
Cool Acrid Release
Exterior
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Bo He - Mint / Hb Menthae
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cool, acrid, aromatic LU, LR
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A&I: Wind-heat, clears head and eyes. Moves liver Qi.
Vents rashes
C&C: Not for Def Heat. May reduce lactation. Not to be
boiled more than five minutes.
1.5-6 g
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Niu Bang Zi - Arctium Fruit / Fr Arctii
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cold, acrid, bitter
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LU, ST
A&I: Wind-heat sore throat. Releases toxins & vents
rashes. Moistens intestine
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C&C: Contraindicated in patients with diarrhea.
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3-9g
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Chan Tui - Cicada Slough / Periostracum Cicadae
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cold, sweet, salty
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LU, LR
A&I: Wind-heat sore throat. Vents rashes, relieves
itching. Clears eyes. Stops spasms/ convulsions.
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C&C: Caution during pregnancy
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3-9g
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Sang Ye - Mulberry leaf / Fm Mori
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cold, sweet, bitter
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LU, LR
A&I: Wind-heat dry cough. Clears liver heat &
brightens eyes.
4.5-15g
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Ju Hua - Chrysanthemum flower / Fl chrysanthemi
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sl cold, sweet, bitter
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LU, LR
A&I: Wind-heat, clears head & eyes. Calms liver &
brightens eyes.
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C&C: Caution in Qi deficiency, diarrhea
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4.5-15 g
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Man Jing Zi - Vitex Fruit / Fr Viticis
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cool, acrid, bitter
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A&I: Wind-heat headache or eye pain. Damp Bi
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LR, UB, ST
C&C: Caution for headaches or eye problems due to
def Yin or Blood.
6-12 g
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Dan Dou Chi - Prepared Soybean / Sm Sojae
Preparatum
cold, sweet, sl bitter LU, ST
A&I: Mildly releases exterior. Relieves restlessness.
Inhibits lactation
6-12g
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Ge Gen - Pueraria root / Rx Puerariae
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cool, acrid, sweet
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SP, ST
A&I: Exterior pattern stiff neck. Vents rashes. Raises
Yang & stops diarrhea. Promotes fluids & relieves
thirst.
Roasted yellow for diarrhea.
Pueraria flower (Ge Hua) is sweet & neutral, relieves
alcohol toxicity
6-12 g
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Chai Hu - Bupleurum root / Rx bupleuri
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cool, bitter, acrid
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LR, GB, PC, TB
A&I: Shaoyang pattern. Liver Qi stagnation. Raises
Yang-Qi.
C&C: Contraindicated for rising liver Yang or deficient
Yin. Overdose causes nausea/vomiting
3-12 g
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Sheng Ma - Cimicifuga rhizome / Rhizoma
Cimicifugae
cool, acrid, sweet
LI, LU, SP, ST
A&I: Vents rashes. Upper body fire toxins. Raises
Yang-Qi. Envoy, guides herbs upwards.
C&C: Contraindicated for xs above w/ def below, latestage rashes, def Yin or rising liver heat
1.5-9g