Chinese Herbal Medicine
By Nick Lampert
Case history
In order to illustrate some of the main principles of diagnosis
and treatment in Chinese herbal medicine, I have chosen
a case of chronic fatigue. This has become a familiar condition
in our society (I don’t know how it stands in other
societies). Chronic fatigue appears in different forms.
Frequently, especially in young people, it is in the wake
of an infectious disease (say glandular fever) after which
a person cannot break back through to normal energy levels,
and in the course of constantly struggling with the pathogen,
whatever that pathogen is, energy levels continue to be
depleted. In somewhat older people, a frequent underlying
theme is a background period of intense commitment to success,
which a person then can no longer sustain, because in some
way their energies have been eroded by their life situation.
This could be described as a state of strong inner conflict
resulting from the sense, not necessarily conscious, that
‘there must be more to life than this’.
The following case is an extreme one, but because it concerns
a relatively young man, and one whose underlying constitution
was strong, the prognosis was good and a lot could be achieved
quickly. In other cases, one might need to think in terms
of much longer treatment.
Patient: Male, 33
Brief history: Loss of energy over a 5-year period, background
of many years of incredibly hard work as a marine engineer
(18 hours a day), without break; suffered collapse 6 months
before he came to see me, was hospitalised and diagnosed
with 'inflammation of central nervous system in the brain'
(whatever that might be), though other doctors disagreed
and finding a conventional diagnosis remained problematic;
there was no visible history of infection and 15,000 (sic)
blood tests (including 5000 for tropical diseases) revealed
nothing!
Signs & Symptoms
These were numerous. I shall group them into sections, which
will make it easier to explain later the nature of the Chinese
medicine diagnosis:
- Extreme fatigue
- Very nauseous, occasional vomiting; severe muscle fatigue
and pain; poor concentration; heavy sleep, 11 hours, feels
heavy in mornings; digestion not bad, but sometimes bloated,
and appetite not great.
- Palpitations, can happen any time of day, come ‘down
the body to the toes’; black spots in front of eyes;
irritable
- Easily short of breath; sinus congestion has come on
over the 5-year period
- Sometimes low-grade flu-like feelings; dry mouth
- Very frequent urination, every 30 minutes during day,
3 times at night
- Tongue: broad, red, darker edges, hint of a yellow coat
- Pulse: soft/thready, Kidney position very low
Medication: none at present (came off ibuprofen 2 months
ago)
Chinese medicine diagnosis
Background principles
In the very broadest terms, Chinese medicine is always concerned
either to improve energy levels, or to ensure that a person’s
energy is flowing freely. ‘Energy’ is an inadequate
translation of various aspects of energy, called Qi, Yang,
Blood and Yin. The Qi is the dynamic principle, the Qi of
any Organ must be abundant for it to function well and for
any process of transformation (which is a condition of life)
to occur. Blood refers to the fluid, nutritive aspect of
energy which is, if you will, the fuel from which the Qi
is derived. Qi belongs to Yang, Blood to Yin. If we represent
life as a burning candle, then the flame is the Yang, the
wax (the fuel) is the Yin. They are mutually dependent so
that if the fuel is dry there can be no flame, while if
there is no flame the fuel cannot continue to be created.
Energy can be reduced through over consumption of Qi/Yang
or Blood/Yin, or it can be depleted if there is any sort
of blockage which prevents the movement of Qi from occurring
normally, which may affect any or several of the Organs.
If someone is intensely committed to a particular type of
work but is in a state of inner conflict over it, they will
over consume Qi (this is more a matter of state of mind
than sheer quantity of work, though of course there are
limits to how much you can do however harmonious may be
your relationship to your work). If Qi is over consumed,
the person will have to draw on reserve energy, and if this
goes on for long enough, the Blood/Yin aspect will be compromised.
If the Qi is depleted, a person will be susceptible to
invasion by pathogenic factors, and because the Qi is depleted
the pathogenic factors may linger without the power to throw
them off. This further compromises the Qi dynamic so you
are in a vicious circle. In this scenario, a very common
outcome is that Dampness accumulates. Dampness is a very
general term in Chinese medicine which points to an accumulation
of fluids associated with poor digestion in the broadest
sense, in turn associated with poor functioning of the Spleen
(which is the central Organ of digestion). Accumulation
of Dampness is also very often accompanied by excessive
Heat, and the combination of Damp and Heat produce a specific
set of symptoms.
Chinese medicine diagnosis:
Retention of Dampness (with some Damp-Heat) with deficiency
of Qi (Spleen, Lung, Kidney) and depletion of Yin
The reasoning behind the diagnosis:
This patient had been obsessively hard-working for a number
of years and could not continue in that vein without hitting
a crisis. Looking at the groups of symptoms above, they
can be interpreted in the following way in Chinese medicine
terms:
(a) and (b): these symptoms point to a severe depletion
of Qi (the exhaustion) and an accumulation of Dampness:
when Damp affects the Stomach there is nausea, when it affects
the muscles there is muscle fatigue and pain. It also tends
to cloud the mind, hence in chronic fatigue syndromes poor
concentration is a very frequent complaint. Sleep may become
very heavy and the person is not refreshed in the mornings;
typically the appetite is reduced and there is some form
of digestive blockage like abdominal bloating.
(c) Depletion of energy can affect any Organ. Palpitations
suggest that the Heart energy is affected, this occurs in
particular if the Blood aspect of the Heart is involved.
If the Blood of the Liver is depleted, visual symptoms (like
black spots in front of the eyes) can occur, and can also
lead to irritability because the Liver is especially responsible
for maintaining a harmonious emotional state.
(d) Being easily short of breath means that the Qi of the
Lungs has been compromised, while sinus congestion also
points to damaged Lung function leading to accumulation
of Phlegm.
(e) The recurrent low-grade flu-like feelings and dry mouth
suggest the continued presence of Heat alongside the Dampness,
though if the Heat was a major feature there would be more
marked signs of it.
(f) Very frequent urination is a symptom of depleted Kidney
energy, which is regarded as the grounding for the body-mind
energy as a whole. If urinary symptoms start to appear in
a young person under the circumstances of this case, it
is a strong indication that remedial measures are urgently
required.
(g) a red tongue with some yellow coat can be seen as a
sign of the presence of Damp-Heat; in this context, it could
also point to the development of Yin deficiency and internal
heat from that source (like an engine with insufficient
lubrication). It is not uncommon to find complex combinations
of Dampness, which in a sense is an over accumulation of
fluids, and Yin deficiency which indicates a depletion of
the fluid/nourishing aspect.
(h) The pulse is a form of weak pulse which is hardly a
surprise, and the Kidney position in particular is very
low, confirming that the underlying reserves are threatened.
Treatment principle: to transform and
drain Damp, support Qi and nourish Yin
(Dosage in grams is given after each herb, the formula
to be taken in decoction over two days, amounting to about
70 grams a day)
(1)
The first prescription comprised herbs to:
Tonify Qi: Huang qi 20, Ren shen 12, Bai Zhu 12, Zhi Gan
cao 6
Resolve and transform Damp: Fu ling 12, Huo xiang 10, Sha
ren 12, Shi chang pu 10
Transform Phlegm: Ban xia 12, Chen pi 10
Clear Heat and raise the Yang: Sheng ma 10
Nourish Yin: Mai men dong 12
Response after 2 weeks: less tired, slightly less nausea,
less irritable, far fewer palpitations, less sinus congestion,
no flu-like feelings, less dry mouth.
Developed some epigastric discomfort and acidity since taking
the herbs, also became constipated with slight abdominal
pain.
(2)
I continued the same approach, modifying the formula to
deal with constipation and other digestive symptoms. It
now comprised herbs to:
Tonify Qi: Huang qi 20, Ren shen 12, Zhi gan cao 6, Bai
zhu 12
Resolve and transform Damp: Fu ling 10, Huo xiang 10, Shi
chang pu 10
Transform Phlegm: Ban xia 12, Chen pi 10
Alleviate epigastric symptoms: Huang lian 6, Wu zhu yu 4
Nourish Yin: Mai men dong 12
Alleviate constipation: Huo ma ren 15
Response after 2 weeks: Tiredness definitely more under
control, lot less muscle fatigue, lot less nausea, less
short of breath, no palpitations, no visual disturbances,
motivation improved, no flu-like feelings, concentration
improved though still not great, constipation and abdominal
pain remain, little change in urination pattern
(3)
The patient had made very good progress, which shows how
quickly a Chinese herbal formula can help to ‘switch’
a person into a different mode. The outcome of the treatment
thus far suggested that a major part in his case was played
by the retention of pathogenic factors (in particular Dampness,
but also Heat to some extent), and in someone whose underlying
constitution is quite good, the effect of a treatment designed
to clear pathogens can be dramatic.
However, the urinary problem remained, which suggested that
the Kidney (Yin and Yang) deficiency needed to be addressed
more, so I next added more herbs for this, switching to
a formula that was overall more tonifying with less emphasis
on clearing pathogenic factors.
Also, the digestive complications persisted. Digestive symptoms
like bloating can be encouraged by certain herbs, and I
suspected Huang qi, so I replaced that with Dang shen, and
to deal with the abdominal pain added herbs to move and
descend Qi.
Hence the next formula comprised herbs to:
Tonify Qi: Dang shen 15, Zhi gan cao 6
Resolve Damp/Phlegm: Ban xia 10, Chen pi 8
Transform Damp and regulate Qi: Hou po 12, Zhi shi 15
Nourish Blood and Yin: Dang gui 15, Bai shao 15, Mai men
dong 15, Sheng di huang 12
Support Kidney Yang: Rou cong rong 15
Response:
4 weeks on this produced a very good result in most respects
(energy levels, nausea, quality of sleep, concentration,
mood, muscle aches); no change however in urination pattern.
At this point I lost touch with the patient who was living
far away, so I don’t know if the urinary symptoms
cleared up later. It is very possible that, since his Spleen
(day to day) energy had improved so much, the reserve energy
of the Kidneys would eventually have been replenished and
the urinary aspect would have got better as well, but this
theory remains unproven!
About the Author
Nick Lampert. I started my work life as an academic in a
field quite unrelated to Chinese medicine, enjoyed that
for a number of years but then felt increasingly constrained
by it. After a classic mid-life crisis, I broke away in
pursuit of something where the benefits of my activities
could be more directly felt. I studied acupuncture at the
International College of Oriental Medicine (1989-90) and
the London School of Acupuncture and Traditional Chinese
Medicine (1990-92), and Chinese herbal medicine at the School
of Chinese Herbal Medicine (1994-96) in London. I have been
to China (Nanjing) twice on short clinical courses, first
for additional acupuncture training in 1992 and then for
further herbal training in 1996.
In 1995 I joined Margaret Ehrenberg and Charmian Wylde
to set up the Birmingham Centre for Chinese Medicine, where
I now work. I practice herbal medicine and acupuncture in
about equal proportions.
Within the field of Chinese herbal medicine, I see mainly
cases relating to skin disease, respiratory conditions,
digestive disorders, chronic fatigue syndromes, and some
gynaecological problems. All these are, in my experience,
areas in which Chinese herbal medicine has a great deal
to offer. In terms of the delivery of the herbs I am very
much committed to traditional herbal teas, though to a limited
extent I also use concentrated powders and prepared (patent)
medicines in pill form.
