Pharmacology of TCM

Speaking of "herbs". - If we speak of "herbs", please note that this is just a short form of speaking about any kind of substance used in TCM pharmacology, including minerals and substances derived from animals.

Basic data of TCM pharmacology. - As mentioned above, the question of "How Much" is a basic one in any aspect of medicine.
How many patients in your hospital have been treated with TCM herbs last year? Which diseases were treated, and how many of each? Which ones were treated with herbs alone, which ones with acupuncture, which ones with acupuncture and herbs? Which percentage was treated in cooperation with the Western-style colleagues?
Which herbs were most frequently used? Which have been the most frequently used prescriptions in your hospital, in your city, in China? Which quantities of a certain herb were produced, in tons and daily doses?
Which therapeutic principles like BU YANG or BU QI (“supplement YANG” or “replenish QI”), SAN HUO (“dissipate Fire”), “nourish YIN” (YANG YIN) etc. have been used with which frequency?
Have there been discussions or research at your hospital, concerning the question of TCM "treatment standard" of certain diseases?

TCM herbs and chemical drugs. - For anyone working clinically, this is a common situation: There is a patient regularly taking some Western-style drugs. The doctor (in China or elsewhere) considers using TCM pharmacology, mainly herbs. Now there are four possibilities:
1) A certain TCM herb or herb combination is equally efficient but has fewer side effects; so it can replace the chemical drug.
2) Combining a chemical drug and TCM herbs gives better result than just one of them.
3) The chemical drug is so powerful that no effect of the herb(s) can be felt.
4) The TCM herbs reduce the effect of the chemical drug, or vice versa.
There are some friends of alternative medicine rejecting any kind of chemical drugs, but we don't share their position. As everywhere, the proof of the pudding is the eating, and the proof of the medicine is the condition of the patient. The question if chemical drugs or TCM herbs are the better choice, cannot be answered ideologically, but has to be checked by clinical tests. And it's hard to believe that these tests haven't been made systematically in China. Which herbs can be taken together with ACE-inhibitors, and which ones not? Are there herbs reducing the effect of beta blockers? Which ones can improve their effect? Which TCM herbs influence female hormones and should not be taken together with contraceptives? Is there any use of combining steroids with TCM herbs, or is this just a waste of money, or is it even harmful?
This has to be checked in detail. If we really respect TCM pharmacology and want to use it in a responsible way, we have to do these tests for any important chemical drug, checking the interaction with any important TCM herbs. If these tests have been done, it is hard to understand why the results aren't mentioned in the books published for us. If they have not yet been done, we would be thankful for any hospital doing them and informing us about the results. We shall be equally thankful for any personal experience, concerning this question of interaction between TCM herbs and chemical drugs.

TCM pharmacology and the actual situation. - The first thing in teaching and writing is always the same: Opening eyes towards reality.
If it is reality that modern TCM treats only a reduced spectrum of diseases, this reality must show in our books and our teaching, because otherwise we are irresponsible teachers and authors.
If TCM cannot cure diseases like cancer or HIV infections but can relieve the side effects of chemical treatment, this should be said clearly. There should be some consequences concerning the theoretical foundation of this treatment.
If TCM is used in combination with chemical drugs, theory can be some guide for clinical tests. But the only aspects which really counts must be clinical experience.
If it is reality that TCM is a secondary medical system even in China, and reality that even TCM teachers think mainly in terms of modern medicine, then they should stop presenting old statements like a prayer-wheel.
Do you agree?

Comparing and looking for standards. - The better is the enemy of the good. Of course it is good to have a choice among 20 or 50 herbs, when dealing with a disease. It is good to have a choice among 30 prescriptions. But we don't believe that all of them are equally effective. Single herbs must be compared, prescriptions must be compared, and patent medicines must be compared as well, at least if they tell us their ingredients (and if they don't, they should be rejected anyway). Which one has the best effect under a given situation? Which one can be combined with which chemical drug? Which one is preferred by the patients?
If these researches have been done in China, they don't have to be done again in our countries. So, your information about such comparing studies will be very welcome.

Reading about toxic drugs. - We dislike reading in our newspapers that our national drug administration forbids the use of some traditional Chinese herb for weight reducing, without having been informed about toxic side effects of this herb by our Chinese TCM books. This situation must end, or it will mean the end of trusting TCM in Western countries.
We have to say goodbye to the old superstition - still shared by many Chinese, too - that Western drugs, because chemically produced, have side effects, whilst Chinese herbs, because naturally grown and used for thousands of years, have none. We have to realize that many herbs, minerals or drugs derived from animals contain highly potent substances which, when taken for longer time, have side effects as well. Any highly effective herb has contraindications, side effects and dangers, and often a limited duration for its intake. Special attention should be paid to the question if children and/or pregnant women can take a certain herb. All these aspects have to be carefully researched and published.
Maybe there are some books in Chinese doing this adequately. Then, they should be translated as quickly as possible. If you have done research concerning these questions, your results will be highly appreciated.

For example, DAN SHEN (Radix Salviae Miltiorrhizae). - We have been witness of a case of retinal detachment being lasered and afterwards treated with DAN SHEN for a year. As a result, there was blood in the eye and a new detachment. By chance, the eye surgeon heard about the herb, and immediately he forbade its use. He knew that DAN SHEN makes the small blood vessels permeable, which may be fatal in some cases of stroke or, like in this case, of retinal detachment.
If the surgeon knew this danger, it should have been known to others as well. But the majority of the TCM books we consulted don't mention it. Fairly irresponsible, as we think. Do you agree?

How to describe risks and side effects. - For many years, Western drug companies disliked to talk about risks and side effects of their drugs. But after some major law suits, their attitude changed. Soon every drug, including good old Aspirin, came with a long list of possible risks and side effects, even if it might appear only once in a million cases.
This practice helped the companies to avoid law suits. But it didn't really help the patients, because all the risks were so smartly mixed together that people thought: As it seems, all drugs are equally dangerous, so if I take one of them, I might as well take all the rest, too.
Nowadays, more and more companies describe risks and side effects in a better way: They distinguish between effects showing frequently (more than 1 among 10 cases), less frequently, seldom or very seldom (less than 1 among 10,000 cases). The same should information should be given, when dealing with TCM drugs. Which percentage of the people taking a certain drug or herb get head ache? How many of them get sleepy or restless? Which percentage has diarrhea or constipation?
So, when you tell us about your experiences concerning risks, side effects or interferences with chemical drugs, please try to consider these aspects.

Pesticides and Herbicides. - Another nasty problem. TCM herbs, when imported to Western countries, cost ten and sometimes hundred times more than in China. One reason is that they have to be checked for herbicides and pesticides first, and a lot of the delivered stuff has to been rejected or thrown away. This is an international problem. More and more peasants earn their living by growing these herbs, and when there are dangerous insects in the field, they think first of their contracts and their income and second about later consequences. Forbidding the use of chemical pesticides is useless if it cannot be controlled effectively. Research must find better ways of biological and ecological protection.
As far as we know, there has been some progress concerning this question. Can you tell us about the measures adopted? How can we make sure that the peasants don’t use herbicides or pesticides any more?

Which is a fair price for a ginseng root? - This is something hard to understand for outsiders: You enter a Chinese pharmacy or department store, and in a precious box you see a ginseng root costing 1,000,000 Yuan RMB. At the same time, you can buy one pound of the cheapest ginseng for some 200 Yuan RMB.
This situation is indeed "traditional", as many sources confirm, for example Wong&Wu in 1931: "Ginseng is one of the most expensive drugs, the Manchurian root sometimes costing 500 times its weight in silver." However, this proves only that there have always been people believing in the power of an old and man-like ginseng root and willing to pay this price. It doesn't prove the pharmacological value.
So we'd like to ask you: Do you, personally, believe so much in the power of an old ginseng root, that you think a price difference of 1000 times and more might be justified?
And do you believe that the pharmacological efficiency of such a root is really better if it resembles a human figure?
We'd like to know what Chinese TCM experts think about this question.

The value of a "secret". - There are some people believing that things which anyone knows and discusses are worthless, whilst keeping them secret proves their value. We don't share this belief. On the contrary: We are convinced that keeping things secret often doesn't hide knowledge, but the lack of knowledge. The more openly things are discussed, the better the chance to improve them, whilst keeping them secret leaves them unchanged forever. Even a diamond becomes beautiful only after grinding and polishing. Medical knowledge, when just found, is seldom perfect, so when you keep it secret it will stay in this muddy state of half-right-half-wrong forever.
Paul Unschuld, in one of his books, describes how the Taiwan administration once persuaded old TCM practitioners to reveal their "secrets". The result? Some old prescriptions, mostly the same or not even as good as those in well-known classics. This is not surprising: Most secrets, when finally revealed, are thoroughly disappointing.
Would you agree? Or do you think that most of these secrets contained precious experiences? Do you believe that there are still many of these old secrets unrevealed, possibly the most interesting ones?

Rhinoceros horn. - Even today, there are still some books recommending rhinoceros horn, for example "The Chinese Materia Medica", (edited by the Beijing University of TCM, published 1998 by Academy Press). Here we read: "Rhinoceros horn has the strongest action of clearing heat, removing heat from the blood, as well as arresting convulsion … For the cases of excessive heat in the blood, bleeding due to blood-heat, wind provoked by extreme heat, excessive heat in both Qi and blood systems, it is the drug of choice."
These lines are annoying for several reasons. First, we think that the authors just copied them from some other book, as usual without telling the source. Second, we are quite sure that most of these supposed qualities of rhinoceros horn have never been scientifically researched, but just been attributed due to the outward uniqueness of this animal (like some parts of bears or tigers, which are also supposed to have nearly magic qualities). Third, TCM authors should know that these animals are on the verge of extinction. Everyone willing to pay much money to obtain a piece of rhino horn participates in the killing of the last of these animals. So, even if this horn might really be "the drug of choice" in certain cases, we consider it irresponsible to propagate it.
Which is your opinion? Would you agree? Or do you think it justified to inform about such remedies, because they are part of a "cultural tradition"?

TCM pharmacology without TCM theory. - As Paul Unschuld has shown in his books, for nearly 1500 years TCM pharmacology has developed largely without making use of the WU XING and the doctrine of systematic correspondences. Only in the 12th century, ZHANG YUANSU propagated the idea that each drug could be attributed to a certain cannel, e.g. MAHUANG "attributed to the lung and bladder channel" (TAIYIN / TAIYANG).
Our question: How does modern TCM judge the fact that TCM theory and TCM pharmacology during the major part of written history developed separately?
Second: Do you really believe that herbs or minerals can indeed enter or influence a certain channel? And if you do: How could we or these authors possibly find it? Or is this one more idea mainly derived from philosophical speculation?

Chronobiology and Pharmacology. - Above, we raised the question of chronobiology concerning acupuncture. But in fact, this seems to be even more important in case of TCM pharmacology.
Anything swallowed has to pass the stomach. But the activity of stomach and intestines is very different under different conditions and times of the day. This must have an effect on the absorption of any drug, pill or decoction, be it chemical and natural. Most chemical drugs recommend a certain time of the day, and furthermore, if they should be taken before, after or with the meals. So we think it quite surprising that this kind of information is missing in our TCM books. Is it really without any importance if some TCM herb decoction is taken in the morning or in the evening, or before, after or with the meals?
When doctors give their prescription to their patients, they usually tell them how to prepare the decoction, how to take it, and when to take it. This is done according to which rules or habits?

What about the BA FA? - These basic 8 therapeutic methods of TCM drug treatment include "diaphoresis, emesis, purgation, mediation, warming, cooling, tonification and resolution". Again, we have to think about the spectrum of diseases nowadays treated by TCM therapy being totally different from the spectrum in former times. So that we have to ask: Which of these 8 methods are still frequently used? Which one is most frequently used in your hospital, which one second, third etc.?

SARS and TCM. - In Western countries, creating and using some new chemical drug takes several years of investigation and clinical tests. To find TCM remedies seems to be much faster. During the SARS epidemy in 2003, it took just some weeks to give an official recommendation which TCM herbs should be used.
Now, we’d like to know: Which was the most effective TCM prescription(s)? Which of the ingredients are considered the most important? Who were the people who decided about the nationwide recommendation? Which were the criteria for their decision? Where and how dit they test it? How long did this take? Which were the alternatives? Have there been suggestions from other regions recommended locally? Has the “official” recommendation been compared to other possibilities?

Was LI SHIZHEN perfect? - If not (and we suppose that he wasn't) even he will have committed some mistake now and then (for example in his book about pulse diagnosis). But who has enough energy, courage and authority to check the BENCAO GANGMU systematically?
Or has this task already been done? Then, please inform us about possible mistakes or misunderstandings of the great pharmacologist.
You ask, why you should do so?
Because this is the greatest merit of an eminent teacher: To have pupils who surpass him.
Thus, let's go on being curious, asking questions and correcting errors - raising TCM to a new level worldwide, in the spirit of the great LI SHIZHEN!


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