Chinese Herbology Damone Luger PDF
Chinese Herbology Damone Luger PDF
Chinese Herbology Damone Luger PDF
Chinese Herbology
Created by
Bob Damone, M.S., L.Ac. and
Todd Luger, B.S., M.Ac.O.M., L.Ac.
acknowledgements
The contents of this reader are based upon the organization of the PCOM syllabus and are derived
from both the required and recommended resources listed on this page. The Online Reader has many
hot links to other Internet based resources. The reader also has audio files of chinese herb names. To
hear the sound with a file, just click on the arrow under the characters, if present (Explorer only).
Syllabi, study questions and other materials can be found on the secure PCOM server.
2
History of Chinese Herbal Medicine
! Major texts and their contributions
! Formulas for Fifty-two Diseases (Wu Shi Er Bing Fang, 2nd
century B.C.E. )
! Pharmacy text unearthed at Ma Wang Dui in 1973
! The text itself dates from before the second century B.C.E
! Clearly reflects the influence of demonology and magic correspondence on
early Chinese medicine
3
History of Chinese Herbal Medicine
! Shang Han Lun and the Jin Gui Yao Lue (On
Cold Damage and The Classic of Prescriptions
from the Golden Chamber, 200 B.C.E.-200 C.E.)
! Most celebrated classics of medicinal prescriptions
(103 Px. in Shang Han Lun), authored by Zhang
Zhong Jing later edited by Wang Shu He
! Introduced the six channel pattern identification for
the diagnosis and treatment of diseases caused by
exterior wind and cold
! Zhang identified the diagnosis with an herbal
formula, i.e., Gui Zhi Tang Pattern
! Major source of prescriptions. 20% of the
prescriptions in Bensky text are from these texts
4
Introduction to Chinese Medicinals
! Nomenclature
! Pinyin
! Latin pharmaceutical - plant parts
! The Four Temperatures !"
! Hot, Cold, Warm, Cool, Neutral qualifications used
include slightly cold and slightly warm
! Vary somewhat from text
! Opposite temperature is used to treat disease
5
The Five Tastes #$
! Acrid- scatters, moves Qi and blood, break up accumulations,
upbears (Yang). Used for exterior disorders and obstruction of qi
and blood
! Sweet- supplements and augments or boosts, harmonizes the
middle, relieves pain and spasms, generates fluids. Used for
various vacuity conditions
! Sour- astringes, prevents loss of qi and fluids, secures astriction,
and stops perspiration. Used for Vacuity perspiration, vacuity
diarrhea
! Bitter- draining, drying, opens channels, descends, harmonizing.
Used for bound stool due to binding of heat. Damp conditions
! Salty- softens accumulations, purges, and laxative, descends
! *Astringent- similar usage to the sour flavor stores or retains
Essence, stops diarrhea, stops hemorrhage
! *Aromatic- disencumbers the spleen and transforms dampness,
opens the orifices (not really a taste?)
! *Bland- disinhibits Dampness, percolates dampness, fluids. Used
for edema, inhibited urination
6
! It is important to note that the four
temperatures and the five tastes must be
integrated in practice; they do not stand alone.
! Examples
! bitter and cold medicinals
! bitter and warm medicinals
! bitter and acrid medicinals
! Medicinals with the combined qi and tastes of
sweet and cold and sweet and warm are used
for different purposes.
7
Upbearing, Downbearing, Floating, and
Sinking %&'(
! Examples
! For vomiting and coughing, dyspnea, etc. we
don't use floating medicinals but sinking ones
! For diarrhea, flooding and leaking, center qi
fall avoid downbearing too heavily
! For resting perspiration and thief perspiration
avoid floating medicinals
! For unresolved exterior diseases avoid sinking
! Note: One medicinal may be both upbearing
and downbearing
8
Entering channels
! First applied around 1100 CE
! Further refined to describe substances able to
guide other herbs to particular organs and regions
of the body
! Refers to either the organ function or the course of
the channel
! Represents a link between the herbal tradition and
the acumoxa tradition
9
Functions and Categories
! Ten major groups with basic qualities (8 classic plus
settle and secure)
! sweating
! emesis
! purgation
! harmonization
! clearing/cooling
! warming
! supplementing
! reducing/draining
! settling
! securing
Pao Zhi )*
! Pao Zhi is a general term for defining a group of methods of
preparing the medicinals in the Materia Medica. There are two
general terms used in Chinese:
! a.) Sheng +,-- uncooked, but not crude or fresh. May
involve special preparation methods that do not involve cooking
or heating
! b.) Shu +.-- involves cooking or heating
! Objectives of Pao Zhi methods (For specific examples see
Sionneau, pp.8-9)
! a.) Lessening toxicity
10
Specific Pao Zhi methods and their purposes
! 1) Mechanical methods- cutting, slicing, scraping,
sifting, pulverizing, defatting
! 2) Using water- rinsing and washing, moistening,
soaking, Aqueous Triturating
! 3) Using fire- cooking, steaming, baking,
steaming, roasting, charring, etc.
11
Pao Zhi Methods Using both water and
fire
Contraindications of Medicinals
! According to Traditional Theory and Experience
! Pregnancy
! Qi and taste runs counter to therapeutic goals
! Qi and taste may damage the correct
! Drug/Herb interactions - basic ideas
! a) don't take any herbs and drugs at the same time
! b) don't combine herbs and drugs with similar effects
! c) keep abreast of documented drug/herb
interactions via Medline, etc.
! Toxicity – Aristolochic Acid, ban xia, fu zi
12
Typical Forms of Administration
! Tang /
! a. The most common method today
! b. Readily absorbed
! c. Most appropriate to acute disorders
! d. Most easily tailored to individual
! e. No aluminum, non-metal best, or coated
! f. Mention variations on this in modern times as in
powder extracts.
! g. Mention issues with extractable components - re:
pharmacognosy
! h. Discuss drafts (Zhu san) as alternative (see san)
! i. Cooking times for light and heavy herbs
13
Double-click to start, Single click to stop
Herb Forms Movie
27
Dosage
! Textbook range - daily decoction, if not otherwise
indicated
! For our purposes:
! Low dosage range: 1-5 grams
! Medium dosage range: 6-15 grams
! High dosage range: 15- 30 grams or more
14
Principles of Herb Combining;
Polypharmaceutics; Traditional Synergistics
! Chinese herbs mostly used in combination
! There are several methods of combining herbs
to produce a desired clinical result.
! These methods of combination were laid out in
the Shen Nong Ben Cao Jing.
15
Principles of Herb Combining;
Polypharmaceutics; Traditional Synergistics
! 4. Mutual Suppression- (xiang sha 37) reverse of
mutual counteraction. One substance reduces the
undesirable side effects of another, but the emphasis is
on the substance that performs the action. For example
Sheng Jiang suppresses the toxicity of Ban Xia
! 5. Mutual Antagonism- (xiang e 38) Two substances
may minimize or reduce each other's original
therapeutic effects
! 6. Mutual Incompatibility- (xiang fan 39) Two
substances which, when used together causes side
effects produced by neither alone
! 7. Single Effect- (dan xing) Use of a single medicinal
substance to treat a patient (i.e. use of Ginseng as a
single treating Collapse of Qi
! 1) Chief
! Principal ingredients directed towards the primary disease
and or s/s being addressed by the formula. Formula often
named after it
! Examples: Gui Zhi in Gui Zhi Tang, Ma Huang in Ma Huang
Tang, Zhi Gan Cao in Zhi Gan Cao Tang, Cang Er Zi and Xin Yi
Hua in Cang Er Zi San, Shi Gao in Bai Hu Tang
! 2) Deputy
! 1) Aids the chief
! 2) Directed towards coexisting pattern, disease or s/s
! Examples: Gui Zhi and Xing Ren in Ma Huang Tang, Zhi Mu in
Bai Hu Tang,
16
Formula Composition; hierarchy of ingredients
! 3) Assistant
! 1) Aids the chief and deputy in treating the primary pattern or disease
! 2) Moderates or eliminates harmful effects of chief or deputy, e.g. Chai
Hu and Bai Shao used together
! 3) Has effect opposite to the chief ingredient for mixed picture diseases,
e.g. Huang Lian and Gan Jiang in Ban Xia Xie Xin Tang, Zuo Jin Wan
Formula Modification
! Very Common
! Example: Gui Zhi Jia Hou Po Xing Zi Tang
! Taking Gui Zhi Tang and adding Fang Feng and Xin Yi
Hua for nasal congestion, or adding Qiang Huo and Fang
Feng to Bu Zhong Yi Qi Tang for wind damp in the upper
body combined with spleen qi deficiency and sinking of qi
! Can also subtract an ingredient, as in Yue Ju Wan where
you can remove Zhi Zi if the patient lacks heat s/s and has
cold s/s
! Can be loosely based on a traditional Px., using the
classical Px. as a template and branching off.
! Add an ingredient to base formula and get a completely
different action: Yi Tang in Gui Zhi Tang
17
Release Exterior
Medicinals
Flavors: Acrid
Temp: Cool
Channels: Lung
18
>? ma2 huang2 Ephedrae Herba
19
@A gui4 zhi1, Cinnamomi Ramulus
20
Formula for Cold Damage
! Ephedra Decoction (>?/ ma2 huang2
tang1)
! ephedra (>? ma2 huang2, Ephedrae Herba)
! cinnamon twig (@A gui4 zhi1, Cinnamomi
Ramulus)
! apricot kernel (GH xing4 ren2, Armeniacae
Semen)
! mix-fried licorice (IJK zhi4 gan1 cao3,
Glycyrrhizae Radix Preparatae)
21
RS bo4 he2, Menthae Herba
22
TU chai2 hu2, Bupleuri Radix
23
Medicinals that Clear
Heat and Drain Fire
Flavor: Bitter
Temperature: Cold
Channels: Many
Etiology
of Heat
24
Four Aspects (Wei, Qi, Ying, Xue)
! Review Overall System Briefly
! Establish Basic Definition of Qi4 Aspect Heat
25
VW shi2 gao1, Gypsum Fibrosum
26
VW shi2 gao1, Gypsum Fibrosum
! Clears heat and drains fire - qi level heat
! Topical use
27
"# zhi1 mu3, Anemarrhenae Rhizoma
28
Clear Heat and Cool the
Blood
Flavor: Bitter
Temperature: cold
Channels: Liver, Heart, Kidney
29
Blood Aspect Heat
! Pathomechanisms
30
,Z? sheng1 di4 huang2,
(Rehmanniae Radix)
31
,Z? sheng1 di4 huang2,
Rehmanniae Radix
Flavor: bitter
Temperature: cold
Channels: many, esp. yang
32
Damp Heat Signs and Symptoms
! Etiology
! Treatment Principles
! Areas of action
33
?\ huang2 qin2, Scutellariae
Radix
34
?\ huang2 qin2, Scutellariae Radix
35
?] huang2 lian2, Coptidis Rhizoma
36
?^
huang2 bai3,
Phellodendri
Cortex
37
?^ huang2 bai3, Phellodendri Cortex
38
_` re4 du2, heat toxin
! Definition in TCM (Wiseman and Ye)
! Pathomechanisms
! Depressed heat
! Heat toxin
! Blood stasis
! Swelling
! Rotting of the flesh
39
gCh jin1 yin2 hua1
Lonicerae Flos
40
gCh jin1 yin2 hua1, Lonicerae Flos
41
]D lian2 qiao2, Forsythiae Fructus
42
Yin Qiao San!$%&
! Releases exterior, clears heat
! Used for wind heat
! Esp. in throat conditions and fever
! Includes lian qiao, jin yin hua, bo he and gan
cao - all used for sore throat
85
Flavor: bitter
Temperature: cold
Channels: many
43
Medicinals that Drain
Dampness
Flavor: bland, bitter
Temperature: neutral to cold
Channels: spleen, kidney, bladder
Etiology of
Dampness
44
ij fu2 ling2, Poria
45
ij fu2 ling2, Poria
46
Aromatic Medicinals
that Transform
Dampness
Flavor: acrid, aromatic, bitter
Temperature: warm
Channels: spleen, stomach
,- Hou4 Po4
Magnoliae Officinalis Cx
47
Hou Po
Magnoliae Officinalis Cortex
96
48
'()*+,-./-,01+2(3,4156,0/72
! Flavor: Acrid
! Temp: Warm
! Channels: many, esp. yang
! C/C: yin xu, qi xu, dryness
97
8. Du2 Huo2
Angelicae Pubescentis Radix
49
Du Huo
Angelicae Pubescentis Radix
! Dispels wind dampness and alleviates pain-
guiding herb for lower back and legs - acrid flavor
! Disperses wind cold dampness and releases the
exterior- external contraction with body pain
! Shao Yin channel headache and toothache-
channel theory connection to throat and tongue
! Cautions and contraindications- dryness, wind
! Dosage- low to medium
50
Etiology of Qi
Stagnation
9/ Chen2 Pi2
Citri Reticulatae Pericarpium
51
Chen Pi
Citri Reticulatae Pericarpium
• Flavor: sweet
• Temperature: warm
• Channels: spleen and stomach
52
0! Shan1 Zha1
Crataegi Fructus
Shan Zha
Crataegi Fructus
! Reduces food stagnation and transforms
accumulations - meat and greasy foods
53
Downward Draining
Medicinals
54
1: Da4 Huang2
Rhei Radix et Rhizoma
55
234 Huo3 Ma2 Ren2
Cannabis Semen
56
*5 Gan1 Sui4
Kansui Radix
57
Medicinals that
Transform Phlegm
Flavor: acrid
Temperature: warm or cold
Channels: lung
115
Phlegm Etiology
116
58
Phlegm Patterns
117
118
59
Zhi Ban Xia (pinelliae rz prep)
! Dries damp, transforms phlegm, descends
rebellious qi - lung dz, spleen damp patterns
! Descends rebellious qi - GI, vomiting
! Dissipates nodules and reduces clumps -
phlegm obstruction or lumps anywhere
! C/C: yin vacuity, fire excess, bleeding
! Dosage - low to medium
! Representative Rx: Er Chen Wan
119
60
Etiology
of Cough
GH Xing4 Ren2
Armeniacae Semen
61
Four Causes of Bleeding in TCM:
Etiology Pathomechanism
62
[k
San Qi (Notoginseng Radix)
! 1. Stops bleeding and transforms blood stasis
! a. Internal bleeding- hematuria, hematemesis,
hemafecia, epistaxis
! Also used for bleeding due to blood stasis, since it
also quickens the blood
! b. External bleeding- when trauma severs the network
vessels and blood escapes
! 2. Reduces swelling and alleviates pain
! Dosage - low to medium
! C/c: pregnancy
63
89; Chi4 Shao1 Yao4, Paeoniae
Radix Rubra
lM
Chi Shao (Paeoniae Radix Rubra)
64
:; Chuan1 Xiong1, Chuanxiong
Rhizoma
mnChuan Xiong
(Chuanxiong Rhizoma)
! 1. Invigorates blood and promotes movement of qi-
! a. Gynecological applications
! b. Used for combined patterns of qi stagnation and
blood stasis
! 2. Expels wind and alleviates pain-
! a. Externally contracted wind causing pain-
! b. Used for impediment (bi zheng)
! Dosage - low to medium
! C/c: liver yang or fire rising
65
Medicinals that Warm the Interior
66
of Zhi Fu4 Zi3, Aconiti Radix
Lateralis Praeparata
of Zhi Fu Zi
(Aconiti Radix Lateralis Preparata)
67
Vacuity Patterns
Medicinals that
Supplement Qi
68
pq
Ren Shen (Ginseng Radix)
pq
Ren Shen (Ginseng Radix)
69
pq
Ren Shen (Ginseng Radix)
70
Ren Shen (Ginseng Radix) pq
! 1. Powerfully tonifies the primal qi (yuan qi)
! a. For qi or yang desertion- especially red Korean ginseng. Used in high
dosages
! 2. Tonifies and augments lung qi
! a. Lung qi vacuity cough, sob, sweating, low voice
! 3. Strengthens spleen and tonifies stomach qi
! a. Spleen and stomach vacuity patterns
! b. Center qi fall
! 4. Generates fluids and alleviates thirst
! a. White ginseng is used here
! b. Xiao ke disease
! c. When fluids and qi have been injured by heat disease
! 5. Benefits the heart qi and calms spirit
! a. Heart qi vacuity patterns with shyness, depression, spiritual fatigue,
anxiety with palpitations, etc
! Abstracts
71
Lt Bai Zhu
(Atractylodis Macrocephalae Rhizoma)
72
JK
Gan Cao (Glycyrrhizae Radix)
! 1. Supplements spleen qi
! a. Zhi Gan Cao better for this function
! 2. Moistens lung and stops cough
! a. Used when dryness consumes lung fluid
! 3. Clears heat and fire toxin
! a. Used for welling abscess and sore throat due to fire toxin
! 4. Moderates spasms and alleviates pain
! a. For yin and blood insufficiency failing to nourish the sinews
! 5. Moderates and harmonizes characteristics of other herbs
! 6. Antidote to toxic substances
! Dosage low to medium
! C/c: hi BP, bloating, dampness
73
Formulas that Supplement Vacuity
! I) Qi Vacuity
74
uv
Lu Rong (Cornu Cervi)
uv
Lu Rong (Cornu Cervi)
75
uv
Lu Rong (Cornu Cervi)
76
Medicinals that Supplement Blood
153
.Z?
Shu Di Huang (Rehmanniae Radix Preparatae)
77
.Z?
Shu Di Huang (Rehmanniae Radix Preparatae)
.Z?
Shu Di Huang (Rehmanniae Radix Preparatae)
! Abstracts
78
wx Dang gui
(Angelicae Sinensis Radix)
wx
(Angelicae Sinensis Radix)
79
wx Dang Gui (Angelicae
Sinensis Radix)
80
Medicinals that Nourish Yin
81
yz{Mai Men Dong (Ophiopogonis Radix)
82
Astringent
Flow Chart
83
d|} Shan Zhu Yu (Corni
Fructus)
84
Formulas that Supplement Vacuity
! III) Nourish Yin
! Liu Wei Di Huang Wan (Six-Ingredient Pill
with Rehmanniae)
! Shu Di Huang (Rehmanniae Rx. Prep.) 6-30g.
! Shan Zhu Yu (Corni Fr.) 6-10
! Shan Yao (Dioscoreae Rz) 6-15
! Fu Ling (Poriae) 6-15
! Ze Xie (Alismatis Rz. ) 6-12
! Mu Dan Pi (Moutan Cx. ) 6-12
85
~•H Suan Zao Ren
(Zizyphi Spinosae Semen)
86
~•H Suan Zao Ren
(Zizyphi Spinosae Semen)
87
ۥ Long Gu
(Fossilia Ossis Mastodi)
ۥ Long Gu
(Fossilia Ossis Mastodi)
! Settles anxiety and calms the spirit
88
Etiology and Pathomechanisms of
Internal Wind
89
‚ƒGou Teng (Uncariae
Ramulus cum Uncis)
90
‚ƒGou Teng (Uncariae
Ramulus cum Uncis)
! Extinguishes wind and alleviates spasms
91
The Method of Opening the Orifices
! Primarily an emergency symptomatic treatment
taking three major forms:
! 1) Clearing the heart and opening the orifices
! 2) Transforming phlegm and opening the orifices
! 3) Expelling dampness and opening the portals
92
„… She Xiang (Moschus)
93
Medicinals that Expel Parasites
! A basic understanding of parasitic disease was
gained early in the history of Chinese medicine
! “Inch white worm is a result of eating
uncooked beef.”
! (Zhu Bing Yuan Hou Lun, Chao Yuan Fang 610c.e.)
! Parasites are now listed as neutral or
miscellaneous causes of disease
! In modern CM, the term parasites mostly refers to
cases of worms
! Hookworm, pinworm, roundworm, and tapeworm
94
Medicinals that Expel Parasites
! Choice of medicinal depends on the parasite
involved
! Combined with other categories
! Food stagnation
! Attacking precipitants (purgatives)
! Clearing heat
! Warm supplementation
! Warm interior
! Specialized methods exist including taking timing of
therapy into consideration
! i.e., first take strong parasite formula soon followed by
purgative formula
95
Etiology
of Heat
Etiology of
Dampness
Etiology of Qi
Stagnation
Phlegm Etiology
116
Phlegm Patterns
117
Etiology
of Cough
Four Causes of Bleeding in TCM:
Etiology Pathomechanism