The latest research review on Chinese herbs of anti myocardial ischemia

Tiejun Tang, Louise Helen Booker

Coronary heart disease (CHD) is the UK's biggest killer. Although western medicine has achieved a lot progress in treating CHD, it is still causing around 82,000 deaths each year. About one in five men and one in eight women die from the disease. In traditional Chinese medicine many herbal remedies have showed a good effect on treating angina. Many laboratory studies have been done to investigate the mechanism of treating myocardial ischemia (MI). I published a research review on this topic many years ago (Tang, T. 2003). Many progressive new reports have been published in the last 5 years. For a clinical practitioner these research updates will provide a helpful reference in treatment of CHD. For researchers and students it can provide a useful reference for future research projects. As for the general public, it has displayed some scientific evidence for Chinese herbs in treating ischemic heart disease.

1. Research on individual herb and plant monomer  

 Danshen (Salvia miltiorrhiza) is a very commonly used traditional Chinese herb in treating heart disease. It contains many sub fractions, which are mainly TanshinoneⅠ, ⅡA, ⅡB, Salvianolic acid A (SAA), and Salvianolic acid B (SAB). In an in vivo study, rat MI model was induced by permanent left anterior descending coronary artery ligation. The results showed Tanshinone IIA attenuates the MI pathological changes and improves heart function, and reduces expression of MCP-1, TGF-β₁ and macrophage infiltration. It could also decrease the expression of TNF-α and activation of nuclear transcription factor-kappa B (Z.H.Ren, 2010).        Researchers applied a myocardial infarct rats model. The rats were given different concentrations of SAA. Immunohistological analysis was performed to measure vascular endothelial growth factor and vascular endothelial growth factor receptor-2 expressions. The secretion of matrix metalloproteinase type X was evaluated in serum of post-ischemic rats. The result showed SAA potentiated the ischemia induced neovascularization. These findings show that SAA has potent proangiogenic properties by promoting the expression of proangiogenic factors (Yujuan Li, 2014).  Another study shows SAB also can markedly and dose-dependently reduce fibrinogen and malonaldehyde levels, increase the HDL level, improve blood viscosity and plasma viscosity in MI rabbits (Qian Yang, 2010). A study applied an RT-PCR and Western blot method to detect p38 MAPK gene expression. The result suggests that Tanshinone IIA play a role in protection cardiomyocytes from ischemic and hypoxic injury. The effect is based on inhibiting miR-1 expression through p38 MAPK signal pathway (Zhang, Y. 2010).

 Asperosaponin VI is a saponin from Chinese herb Xuduan (Dipsacus asper). A study investigated the anti-MI effects of Asperosaponin VI both in vivo and in vitro. The results suggested that it could provide significant cardioprotective effects against acute MI in rats. These mechanisms might be attributed to scavenging lipid peroxidation products and reactive oxygen species, increasing antioxidant defence enzymes and preventing mitochondrial damage (Chunmei Li, 2010).

Angelica sinensis polysaccharides are an active ingredient extracted from Danggui (Angelica sinensis). The cardioprotective effects were evaluated by using MI/reperfusion rats.  A.sinensis polysaccharides treatment significantly reduced myocardial infarction size, enhanced CT-1 and antioxidant enzymes activity, down regulated caspase-12 mRNA expression in rats (Song Zhang, 2010).

Juemingzi (Semen Cassiae) was proved to reduce blood lipid levels. A study investigated whether it can reduce MI and reperfusion injury. The results showed Juemingzi extract can not only significantly reduce the plasma lipid level, but it can also improve the instantaneous first derivation of left ventricle pressure and reduce infarct size (Feng Fu, 2014).

 Gegen (Lobed Kudzuvine Root) has been widely used in the treatment of myocardial and cerebral ischemia. Puerarin is a major active ingredient extracted from Gegen. A study was designed to observe the effects of puerarin on the signalling transmission mediated by P2X₃ receptor in stellate ganglia and cervical dorsal root ganglia after MI damage. The results suggested that Puerarin could reduce systolic blood pressure and heart rate, relieved pain and decreased up-regulated expression of P2X₃ mRNA and protein after MI. Puerarin was shown to inhibit the up-regulated ATP-activated currents after MI. This suggested that puerarin can relieve MI through blocking the P2X₃ signalling transmission (Shuangmei Liu, 2014).

Rougui (Cinnamomum cassia) is widely used for the treatment of ischemic heart disease. The active components, cinnamic aldehyde and cinnamic acid, can be isolated from Rougui. A study has investigated the effects of anti MI of Cinnamic aldehyde and cinnamic acid. The results showed these two extracts can decrease the ST elevation induced by acute MI, decreased serum levels of CK-MB, LDH, TNF-α and IL-6, and increased serum NO activity, increased SOD activity and decreased MDA content in myocardial tissue (Fan Song,2013).

Shanzha (hawthorn) is commonly used Chinese medicine. A study was designed to investigate the effects and mechanisms of hawthorn leaf flavonoids on acute MI/reperfusion in anesthetized dogs. The results indicated that this flavonoid can significantly decrease the degree and scope of MI, markedly inhibit the increase of myeloperoxidase activity, and IL-1 and TNF-α content induced by MI/infarction. It can also increase G protein-coupled receptor kinase 2 expression and inhibited NF-κB expression (Jianhua Fu, 2013).

Tetramethylpyrazine, sodium ferulate and puerarin are extracts from Chinese herbs Chuangxiong, Danggui and Gegen respectively. Some research has shown that these three extracts can antagonize the nociceptive or pain transmission mediated by P2X₃ and/or P2X_2/3 receptors in primary afferent neurons. They could therefore be considered as new methods for treating MI injury and cardiac arrhythmia (Shangdong Liang, 2010).

Dracocephalum moldavica L is an extract from Chinese herb Xiang Qing Lan. A study evaluates antioxidative and cardioprotective effects of total flavonoids extracted from Xiang Qing Lan. It showed remarkable scavenging effects against 1, 1-diphenyl-2-picrylhydrazyl, hydroxyl and superoxide anion radicals in vitro. It can improve the heart rate and coronary flow, raise left ventricular developed pressure and decrease creatine kinase, lactate dehydrogenase levels in coronary flow. It can also reduce the infarct size in ischemic area of heart. (Jiangtao Jian, 2014).

2. Research on compound formulas

Apart from individual herb and plant monomers, some studies have focused on compound formulas. Many traditional and modern formulas have been shown to be effective in treating MI.

Compound Danshen Tablets (CDT) are formulated from a compound remedy. The ingredients are Danshen, Sanqi, and Borneol. A study investigated therapeutic mechanisms of CDT by using a metabolomic approach. Plasma extracts from sham, MI model, CDT and western medicines were used in treating rats. Plasma was analyzed by ultra-performance liquid chromatography/quadruple. The orthogonal partial least square model was built, and found that metabolites were expressed in significantly different amounts between MI and sham groups of rats. The results showed that CDT presented protective effects on MI by reversing potential biomarkers to sham levels, especially for the four metabolites in the pathway of purine metabolism. (Yonghai Lv, 2010).

Tanshinone IIA, SAB and ginsenoside Rb1 are the three major active ingredients of CDT. A report has found that the combination of these three ingredients brings nearly equal therapeutic effects on MI as CDT and it plays more stable regulated action on those 22 identified metabolites than single compound (Yonghai Lu, 2011). Another report uses an in vivo myocardial infarction model mice; endothelial nitric oxide syntheses (eNOS)/nitric oxide (NO) pathway were detected. The results showed that both Tanshinone IIA and salvianolic acid B have cardio protective function in certain levels through multiple targets related with NO production, such as eNOS phosphorylation, L-arginine uptake (Chunshui Pan, 2011).

Another study applied an ischemia-reperfusion injury rat model to examine coronary blood flow, vascular diameter, velocity of red blood cells, and albumin leakage in vivo after reperfusion. The result showed pre-treatment with CPT significantly attenuated myocardial microcirculatory disturbance, including decreased coronary blood flow and red blood cell velocity in arterioles, increased expression of CD18 on neutrophils and intercellular adhesion molecule 1 on endothelial cells, and albumin leakage from venules. It was also shown that it could significantly ameliorate the myocardial damage and apoptosis, inhibitor-κBα degradation, and expression of Bcl-2, Bax, and caspase-3 in myocardial tissues (Na Zhao, 2010).  A metabonomic study was conducted to assess the effect of Danshen, Sanqi and their compound formula for myocardial infarction in rats.  As a result, the compound was shown to exert synergistic therapeutic efficacies to exhibit a better effect on MI when compared to singular herbs (Xiaoping Liang, 2011).

Gualou Xiebai Tang is composed of Gualou (fructus trichosanthis) and Xiebai (macrostem onion). It was first recorded in JinGui YaoLue, and is one of the main formulae to treat chest pain, used since the Han Dynasty (A.D 206). A study aimed to investigate the effect of Gualou Xiebai Tang ethanol extract on myocardial fibrosis. The mRNA levels of Collagen I and Collagen III were detected by real-time PCR. The results showed that Gualou Xiebai Tang could significantly reduce the heart weight/body weight ratio as well as the left ventricle weight/body weight ratio. It also significantly alleviated the degree of inflammation, decreased myocardial collagen volume fraction, and markedly prevented the up-regulations of Collagen I and Collagen III, down regulated expressions of TGF-β1, TGFβRI, TGFβRII in the rats with myocardial fibrosis (Yongfang Ding, 2013).

 Buyang Huanwu Tang is a commonly used formula to treat ischemic heart disease. A study investigated the potential mechanism of this formula in alleviating MI in rats. The expression of the cluster of differentiation 40 (CD40) in the mononuclear cells was measured using flow cytometry, and the expressions of CD40 and its ligand (CD40L) in myocardial tissues were determined by western blotting. The results showed that Buyang Huanwu Tang could decrease the expression of CD40 in the mononuclear cells and the CD40 and CD40L expressions in myocardial tissues (Yu Liu, 2011).     

Sini Tang is has been used to treat MI for many years. A lot of research has been done in the past two decades. A recent study applied a urinary metabonomic method based on nuclear magnetic resonance and ultra high-performance liquid chromatography coupled to mass spectrometry in order to characterize MI related metabolic profiles and delineate the effect of Sini Tang on MI. Nineteen potential biomarkers in rat urine were screened out, primarily related to myocardial energy metabolism, including the glycolysis, citrate cycle, amino acid metabolism, purine metabolism and pyrimidine metabolism. The results demonstrated that Sini Tang could provide satisfactory effect on MI through partially regulating the perturbed myocardial energy metabolism (Guangguo Tan, 2012).

 Guanxin II is a relatively new formula, currently used to treat coronary heart disease. It contains 5 traditional herbs. Akt is a key protein kinase in the processes of inhibition of apoptosis in cardiomyocytes. The results of a study found that Guanxin II can significantly activate Akt kinase, increase the Bcl-2/Bax ratio, inhibit cytochrome c release, reduced caspase-9 activation, and attenuated subsequent caspase-3 activation. These results therefore suggest that Guanxin II ensures the survival of myocardium by enhancing the Akt-mediated antiapoptosis pathway (Xi Huang, 2010).

 Shen-fu injection is a modern formulation composed by Renshen (Ginseng) and Fuzi (Aconite). A study found that this formula can significantly decrease infarct size, apoptosis, caspase-3 protein expression in myocardial tissues, and increase p-Akt, p-eNOS, bcl-2 protein expression, compared to the control group (Yang Wu, 2011). 

In this field a large number of reports have been published within the past 5 years. I have included some of the major ones here. From this review we can sum up a number of points. Firstly, research methods have been updated. A large number of studies have applied the latest biomedical techniques, such as metabolomics, apoptosis, cellular signal transduction etc. These new molecular biology techniques have been widely applied in the research of Chinese herbs. Secondly, Danshen and its sub fractions have become a hot point in this field. There have been approximately 4000-5000 reports conducted annually within the past 3 years. Thirdly, most reports are conducted as laboratory research, and relatively few are clinical reports. Finally, although all the papers are published on formal academic journals, there is still an unfortunate lack of papers from the core journals. As there is a lot of research in Chinese medicine still to be done, I believe there will be much progress in the future of this field.

Reference

1. Chunmei Li. Protective roles of Asperosaponin VI, a triterpene saponin isolated from Dipsacus asper wall on acute myocardial infarction in rats. European Journal of Pharmacology. 2010; 627(1-3): 235-241.
2. Chunshui Pan. Salvianolic acid B and Tanshinone IIA attenuate myocardial ischemia injury in mice by NO production through multiple pathways. Ther. Adv.Cardiovasc.Dis. 2011; 5(2): 99-111.
3. Fan Song. Protective effects of cinnamic acid and cinnamic aldehyde on isoproterenol-induced acute myocardial ischemia in rats. Journal of Ethnopharmacology. 2013; 150(1): 125-130.
4. Feng Fu. Semen Cassiae Attenuates Myocardial Ischemia and Reperfusion Injury in High-Fat Diet Streptozotocin-Induced Type 2 Diabetic Rats. Am. J. Chin. Med.2014; 42(1): 95
5. Guangguo Tan. Metabonomic Profiles Delineate the Effect of Traditional Chinese Medicine Sini Decoction on Myocardial Infarction in Rats. PLoS ONE 2012; 7(4): 34157.
6. Jianhua Fu. Hawthorn leaves flavonoids decreases inflammation related to acute myocardial ischemia/reperfusion in anesthetized dogs. Chinese Journal of Integrative Medicine. 2013; 19(8): 582-588.
7. Jiangtao Jiang. Ant oxidative and Cardioprotective Effects of Total Flavonoids Extracted from Dracocephalum moldavica L. Against Acute Ischemia/Reperfusion-Induced Myocardial Injury in Isolated Rat Heart. Cardiovascular Toxicology 2014.
8. Na Zhao , Yu-Ying Liu , Fang Wang.  Cardio tonic pills, a compound Chinese medicine, protects ischemia-reperfusion-induced microcirculatory disturbance and myocardial damage in rats. American Journal of Physiology - Heart and Circulatory Physiology.  2010; 298.  H1166-H1176
9. Qian Yang. Effect of Salvianolic Acid b and Paeonol on Blood Lipid Metabolism and Hemorrheology in Myocardial Ischemia Rabbits Induced by Pituitruin. Int. J. Mol. Sci. 2010, 11(10), 3696-3704
10. Shangdong Liang. P2X receptors and modulation of pain transmission: Focus on effects of drugs and compounds used in traditional Chinese medicine. Neurochemistry International. 2010; 57(7): 705-712.
11. Shuangmei Liu.  Puerarin blocks the signalling transmission mediated by P2X₃ in SG and DRG to relieve myocardial ischemic damage. Brain Research Bulletin. 2014; 101: 57-63.
12. Song Zhang. Extraction, chemical analysis of Angelica sinensis polysaccharides and antioxidant activity of the polysaccharides in ischemia–reperfusion rats. International Journal of Biological Macromolecules. 2010; 47(4): 546-550.
13. Tiejun Tang. Experimental research progress on anti myocardial ischemia herbs. Shenzhen Journal of Integrated Traditional Chinese and Western Medicine 2003；13 (2):111-113,118.
14. Xiaoping Liang, Xi Chen, Qionglin Liang. Metabonomic Study of Chinese Medicine Shuanglong Formula as an Effective Treatment for Myocardial Infarction in Rats.  J. Proteome Res. 2011; 10 (2): 790-799
15. Xi Huang. Pretreatment with a Traditional Chinese Formula, Guanxin II, Reduces Cardiac Apoptosis via the Akt Survival Pathway in Rats with Myocardial Ischemia. The Tohoku Journal of Experimental Medicine. 2010; 220(2): 157-163.
16. Yang Wu. Shen-Fu Injection Preconditioning Inhibits Myocardial Ischemia-Reperfusion Injury in Diabetic Rats: Activation of eNOS via the PI3K/Akt Pathway. Journal of Biomedicine and Biotechnology.  2011; Article ID 384627, 9 pages.
17. Yongfang Ding. Gualou Xiebai Decoction prevents myocardial fibrosis by blocking TGF-beta/Smad signalling. Journal of Pharmacy and Pharmacology. 2013; 65(9): 1373-1381.
18. Yonghai Lv. Metabolomic study of myocardial ischemia and intervention effects of Compound Danshen Tablets in rats using ultra-performance liquid chromatography/quadrupole time-of-flight mass spectrometry. Journal of Pharmaceutical and Biomedical Analysis. 2010; 52 (1): 129-135.
19. Yonghai Lv, Xinru Liu. Metabolomic strategy to study therapeutic and synergistic effects of tanshinone IIA, salvianolic acid B and ginsenoside Rb1 in myocardial ischemia rats. Journal of Ethnopharmacology. 2011; 134 (1): 45-49.
20. Yu Liu. The Roles of Buyang Huanwu Decoction in Anti-Inflammation, Antioxidation and Regulation of Lipid Metabolism in Rats with Myocardial Ischemia. Evidence-Based Complementary and Alternative Medicine. Volume 2011 , Article ID 561396, 8 pages.
21. Yujuan Li. Salvianolic acid A promotes the acceleration of neovascularization in the ischemic rat myocardium and the functions of endothelial progenitor cells. Journal of Ethnopharmacology. 2014; 151 (1): 218-227.
22. Z.H. Ren. Tanshinone II A attenuates inflammatory responses of rats with myocardial infarction by reducing MCP-1 expression Phytomedicine. 2010; 17 (3-4): 212-218.
23. Zhang Y. Tanshinone IIA Inhibits miR-1 Expression through p38 MAPK Signal Pathway in Post-infarction Rat Cardiomyocytes. Cell Physiol Biochem 2010;26:991–998 

Phenomenon of Yin/Yang in human body

Tiejun Tang

Yin &Yang is the most important conception in the basic theory of traditional Chinese medicine. The theory Yin-Yang holds that every object or phenomena in the universe consists of two opposite aspects, which are in conflict and in interdependence. The relation between Yin & Yang is the universal law of the world. In side the human body everything has yin & yang. Normally yin/yang should keep balance, if yin/yang lost balance the disease will occur. The treatment principle is trying to make the yin/yang rebalance.

In modern physiology and pathology there are many phenomenon have the characteristic of yin/ yang. In Chinese medicine we balance the yin/yang by herbs and acupuncture, actually we are regulating the function of many systems. The table below shows some examples of yin/yang phenomenon in human body.

	Yang	Yin
Autonomic nervous system	Sympathetic nerve	Parasympathetic nerve
Receptor	α-adrenoceptor	β-adrenoceptor
Thyroid function	Thyroxine	Parathormone
Pancreas	Pancreatic Glucagon	Insulin
Immune system	TH cell	TS cell
Cancer pathology	Oncogene	anti-Oncogene
Cell apoptosis	Apoptosis gene	anti-Apoptosis
Molecular biology	cAPM Cyclic adenosine  monophosphate	cGPM  Cyclic guanosine  monophosphate

What is essence of yin & yang?  An American biochemists (Goldberg;1975) had put forward a cAMP/cGMP hypothesis.  A report from Columbia University (Shrivastava;1994) had found a gene of multifunctional transcriptional regulator which can regulate the balance of cAMP/cGMP. He named this gene as yin yang-1. In my opinion yin yang-1 probably is the first messenger of yin/yang, cAMP/cGMP is the second messenger of yin/yang in molecular signal transduction. They can activate many different protein kinases and produce different biologic functions (Tiejun Tang,2004). In pace with the development of modern science, more and more yin/yang phenomenon will be discovered.

Reference:

1.     ND Goldberg, MK Haddox, SE Nicol, DB Glass, CH Sanford.  Biological regulation through opposing influences of a cGMP and cAMP. The yin yang Hypothesis. Advances in Cyclic Nucleotide Research, 1975; 5: 307-30.

2.     Shrivastava,-A; Calame,-K. An analysis of genes regulated by the multi-functional transcriptional regulator Yin Yang-1.  Nucleic-Acids-Res. 1994 ; 22(24): 5151-5.

3.     Tiejun Tang. The nuclear factor yin-yang 1 and the yin/yang theory of TCM  Shaanxi Journal of Traditional Chinese Medicine. 2004；25（3）: 239-242.

The truth about TCM

Tiejun Tang

If there is a yin, there is a yang,
If yin and yang keep balanced, you will be in good health;

If there is a blockage inside body, it will cause a pain,
If the obstruction is removed, the pain will be released;
If there is a qi stagnation, the blood stasis will following,
If there is a qi deficiency, the blood deficiency will following;

If the qi stagnation in the liver meridian, the depression will occurs,
If the qi stagnation in the stomach and intestine, the distension will emerge,
If the liver yang excess, there will be dizziness or hypertension,
If the kidney yin deficiency, hot flash and night sweat will arise,
If there is a disharmony between kidney and heart, insomnia will occurs,
If there is a disharmony between liver and spleen, it will lead to a IBS,
If there is damp-heat in bladder, there is UTI;

If you have too much dampness, the obese will arise,
If you drinking too much alcohol, the damp-heat produce,
If you smoking too much, the heat toxin will damage your lung;

If you want be healthy, you should take care yourselves,
If there is heat, cool it,
If there is cold, warm it,
If there is dryness, moisten it,
If there is dampness, dry it,
If there is deficiency, supplement it, and
If there is excess, drain it;

If you like to try, I will make you fine,
If you want to know more, I  would like to tell you why.

How to decoct Chinese herbs?

KnowHow Herbal Remedy

Tiejun Tang

KnowHow Acupuncture is not only an acupuncture clinic, we also provide Chinese herbal medicine treatment. In KnowHow, there are 200 high quality raw herbs that can be selected for decoction, a traditional method of taking Chinese medicine. Two years ago, I published an article talking about the advantages of decoction in my blog. Selecting herbs according to the patient’s individual condition can ensure precise and effective treatment. Moreover, the prescription is adaptable as the condition changes and the active ingredients of the herbs are easily absorbed by the body. However, some patients may find taking a herbal decoction inconvenient as it tends to have a bitter taste, be quite costly and takes a long time to decoct.

What is the second option for taking a herbal formulation? KnowHow concentrated herbal tablets can be a good alternative. Let’s see its manufacturing process:      

As we can see from the manufacturing process detailed above, the tablets of KnowHow are made differently from other types of Chinese herbal tablets and pills. As there is a decocting and concentrating process, the properties of the tablets are similar to those of a decoction. Also, as the tablet is highly concentrated, there is no need for large doses, as can be the case with other herbal tablets. Usually, three tablets twice a day are enough for most conditions.

The recipes for KnowHow herbal tablets come from classic herbal formulae used for hundreds, even thousands, of years. They also come from my personal experience treating common ailments in the UK. All of the ingredients come from natural herbs. We use no animal or mineral substances, and no endangered species. The labeling on the pills clearly states the Latin and Chinese names of each herb, the expiry date of the tablets and the clinic address,

KnowHow concentrated tablets are an efficient, convenient and most of all, safe herbal remedy. 

Acupuncture may protect your liver from alcoholic damage

Tiejun Tang

Do you drink? How often do you get drunk? What is your best hangover cure? Perhaps it’s time to throw out those egg yolks and try needles instead, as new research suggests that acupuncture on certain points on the body can reduce liver damage caused by alcohol.

It is widely known that over-consumption of alcohol can cause liver damage. There are three main stages of liver disease caused by alcohol: alcoholic fatty liver disease, alcoholic hepatitis and cirrhosis. According to NHS Choices, it is estimated that 90-100% of heavy drinkers have alcoholic fatty liver disease, one in four drinkers with fatty liver disease will develop alcoholic hepatitis and one in five drinkers with fatty liver disease will develop cirrhosis. Death rates linked to alcoholic liver disease have risen by more than two-thirds (69%) in the past 30 years in UK.

The best way to treat alcoholic liver disease is to stop drinking alcohol. Western medicine use Disulfiram (sold under the brand name Antabuse), and Acamprosate to help people abstain from alcohol. However, this may lead to a severe and sometimes fatal reaction known as a disulfiram–alcohol reaction. It is widely known that drinking alcohol can be harmful to the liver, however habitual alcohol abuse remains a problem deeply ingrained into British society. Often, heavy drinkers find it difficult to abstain from alcohol due to the addictive nature of the drug.

A recent study in China ^[1] suggested that electric acupuncture on Taichong (LV3) – the third point on liver meridian, could protect the liver from alcohol damage. Researchers used 40 rats divided into a control group, a model group, a group using electro-acupuncture on LV 3 and a group using electro-acupuncture on non-acupuncture points. The rats were administered 40ml/kg of distillate alcohol for 12 hours – enough to overwhelm the liver and create mild liver injury. Rats were then treated for 30 minutes using the acupoint LV3. At the conclusion of the study, liver tissues were collected and ALT and AST liver markers, enzymes present in the blood at elevated levels when there is liver damage, were measured. Within the acupuncture on LV3 group, ALT and AST levels were significantly reduced, whereas the control group exhibited elevated levels of these enzymes. Another study ^[2], utilising the same experiment model whereby fatty liver disease is measured in rats, suggested that electro-acupuncture at Zusanli (ST36) could significantly reduce fatty degeneration of hepatic cells. These research results could spell good news for heavy drinkers.

If you find it difficult to give up drinking altogether, why not try to minimize the damage that can be caused by alcohol? Acupuncture could provide a convenient solution for the heavy drinker. Apart from the two acupoints mentioned above, a variety of acupoints can be selected, creating a ‘point prescription’ according to the different symptoms of each individual case.  Some Chinese herbs may also be effective in protecting the liver from alcohol damage. The best time to seek acupuncture treatment is the day after a night of heavy drinking, or few hours before a heavy drinking session. Remember: no acupuncture whilst drunk!

There’s no harm in enjoying a night out, but don't forget your liver! A happy liver makes for a long and healthy life.

Reference:

1. Chen BJ. 2011. Effect of electroacupuncture of "Taichong" (LR 3) on liver function in mild alcoholic liver injury rats. Zhen Ci Yan Jiu  36(6):419-22.

2. Wang Wei. 2004, Effects of electroacupuncture at “Zusanli” (ST 36) on alcoholic fatty liver rat model. Chinese Acupuncture & Moxibustion  2004 -12.

Preserving the Whole (Heiner Fruehauf & My tutor professor Deng Tietao)

Goodbye Asante and Hello Middlesex

Tiejun Tang

I quitted my job at Asante Academy of Chinese Medicine on 15^th August 2013. I had worked in Asante for 8 years and 4 month since April 2005. Eight years is longer enough to keep a lot of memories in my mind, and I had met many very nice colleagues, many lovely students and many patients. Some of them became my good friends. I would like to say thank you to Dr Ke for given me the opportunity to meet so many good people, to teach so many students and to serve so many patients. Thank you to my dear colleagues for everything you did for me in the past days. Thank you to all the staffs of Day Treatment Centre in Whittington hospital.  At the time to say good bye, I send my best wishes to all of you.

Eight years time is nearly a quarter in my 34 years Chinese medicine career. My first job was at Xijing Hospital, the Forth Military Medical University, it last 5 years and ended because of my MSc study. My second job was at the First Military Medical University, it last for 12 years, but these 12 years was interrupted by my PhD study and post doctoral research work at two other universities. Asante work is the longest job in my career without any interruption. Before I came to UK, I had spent 26 years time to accumulate my Chinese medicine knowledge in China. As a medical practitioner, I believe that if you want to give your patient a better service you should continue updating your medical knowledge. That is why I never stop continuing professional development for higher degree. The patient’s precious life and health is in your hand. You cannot make any mistakes at any time.

From September I will join a completely new teaching clinic of Middlesex University which is based near Hendon campus. I will continue my clinical treatment and teaching work in that new clinic. New term will be a new start. I will meet new colleagues, new students and new patients. In this complementary medicine clinic we will have Chinese medicine, western herbal medicine and ayurveda. Three branches of traditional medicine will work together. I think this combination will give patients more benefits. I am very sure the new clinic will become one of the best teaching clinics in complementary medicine field.

If you are my patient or used to be my patient, you are more than welcome to see me at the new teaching clinic of Middlesex university.

You also can see me at my private clinic in Harley street central London. You can book your private or student treatment session online at www.harleystreetchineseacupuncture.co.uk

Acupuncture Pain Clinic in Whittington Hospital

Tiejun Tang

Acupuncture pain clinic in Whittington hospital was established in 2002, just one year after Asante Academy funded. This year is its ten years anniversary. At beginning it opened 2 half days per week, and gradually developed to 4 half days every week. Many current and former Asante staffs used worked in Whittington hospital. I covered one half day weekly since 2005. I am the only person which worked in this pain clinic more than 7 years. I should have something to sum up.

Currently, we provided about 2000 acupuncture treatment every year in this pain clinic. The total number of the treatment in the past 10 years should be about 15,000.

The patients suffered from different kinds of pain. The western medicine diagnosis including: chronic and acute lower back pain, sciatica, arthritis, tennis elbow, frozen shoulder, carpal tunnel syndrome, migraine, trigeminal neuralgia, endometriosis, fibromyalgia, and pain after surgical operation etc. All the patients were referred through their GP. Most of them had got a clear diagnosis through blood test and CT or MR scan. Many of them have taken pain killers for a long time.

We applied acupuncture in every patient and plus cupping in some severe cases. Most of patients have got some improve after 5-10 sessions. In some cases, they have got a significant improvement.

Why acupuncture can release pain? Traditional Chinese medicine theory believes the pain is caused by obstruction of meridians. “There is a blockage there is a pain”. The reason of the obstruction can be different in individual cases. Qi stagnation, blood stasis, pathological cold and phlegm are the common reasons. Acupuncture can regulate the function of Zang-Fu organs, balance Yin & Yang, regulate the circulation of qi and blood and dredge the meridians. “When the obstruction is removed the pain will be subsided.”

About the mechanism of acupuncture release pain, many modern researches have been done. In 1980 there was a report from St. Bartholomew's Hospital of London. The author use Low-frequency electroacupuncture to treat patients with pain. After electroacupuncture the β-endorphin levels in cerebrospinal fluid were rose significantly in all subjects. A recent study showed after electrical acupuncture stimulation at Hegu (LI4), it will cause simultaneously response at blood oxygenation level dependent (BOLD) and cerebral blood flow (CBF).

Except pain clinic we also have cooperation with labour ward of Whittington hospital. We use acupuncture to release the pain before and during the labour. In recent years Asante had opened two more pain clinics in North Middlesex Hospital and Royal Free Hospital. I am sure in the future more and more patients will have chance to get acupuncture service in NHS hospitals.

Reference:

Vicky Clement-Jones(1980). Increased β-endorphin but not met-enkephalin levels in human cerebrospinal fluid after acupuncture for recurrent pain. The Lancet, 316(8201): 931-988.

Yue Zhang (2012). Simultaneous CBF and BOLD mapping of high frequency acupuncture induced brain activity. Neuroscience Letters. 531(1): 1-62.

How to treat urinary tract infection with Chinese herbal medicine?

Tiejun Tang
Urinary tract infection (UTI) is a very common disease. It might occur in any age groups. It is more common in women than in men - it's estimated that half of all women in the UK will have a UTI at least once in their life and one out of every 2,000 healthy men will develop one each year.



If you’ve got urgent frequent urination and pain or a burning sensation when urinating, you might have UTI. A urine sample test can diagnose this disease easily.

Most of UTI are easy to treat if the patients have a good reaction to antibiotic. Many acute UTI can be cured in couple of days. But in some cases, the antibiotic seems no effect or less effect when you use it at second time. Why antibiotic doesn’t work? That is because the pathogenic bacteria can be different in different patient, or even the same patient’s different infection. Usually antibiotic only target on a certain bacteria, if the antibiotic doesn’t match the bacteria, it will no effect. The other reason is bacteria get resistance to antibiotic. In this condition acute UTI will change to chronic one. Mild urethritis might develop into cystitis or even pyelonephritis. What can you do when you facing this situation? Traditional Chinese medicine can help you to get rid of UTI.

Chinese medicine believes the symptoms of UTI are due to bladder damp-heat. Many herbs have a good function to expel dampness and clean away the heat from bladder. When antibiotic doesn’t work on UTI, Chinese herbal medicine often reveals a good effect. To release bladder damp-heat, Bazheng San is the first choice. This traditional formula was original recorded in He Ji Ju Fang -- an authorized pharmacopoeia of Song Dynasty (1151 A.D.) The original formula of Bazheng San contained nine ingredients: Cheqianzi, Jumai, Bianxu, Huashi, Zhizi, Gancao, Mutong, Dahuang and Dengxincao. In this formula Mutong should be removed because it might cause kidney function damage. Tongcao can be selected as an alternative. Huashi is a mineral, it should be removed if there is a legal limitation in some countries. Pugongying and Diding can be added if more white blood cell in the urine. Daji, Xiaoji and Baimaogeng can be added if more red blood cell in the urine or hematuria. According to patients individual constitution more modification on the ingredients and dosage should be done about this formula.

Chinese herbal medicines have a multiple target effect on many bacteria, it never cause resistance. When you have above troubles in UTI treatment, why not to try something new?

Metabolic Syndrome and its TCM Food Therapy

Tiejun Tang
Last month I delivered two lectures, one for TCM Student Society of Middlesex University, the other for the annual general meeting of ATCM. In these two lectures I talked a same topic -- Metabolic Syndrome and its TCM Food Therapy. The audiences are very interested in my talk. Many people ask me for handout, somebody suggest me to publish this paper in ATCM journal. I prefer to put this article in my blog first, to share my knowledge to more readers all over the world.

Metabolic syndrome (MS) is a group of common diseases. It became more and more popular due to the life- style of modern society. Chinese medicine herbs have a good effect in the treatment and prevention of MS. Patients often need a long term treatment. Most of patients don’t like to take the herb decoction for too long time, many treatment have to be terminated for this reason. If we use herbs as a daily food therapy, that will be much more acceptable for most of the patients. In this paper I will introduce some TCM food therapy methods on the treatment of MS.
The definition of metabolic syndromeAlthough the conception of metabolic syndrome originated in late 1950s, but it used to have a different definition. Until Reaven (G.M Reaven 1988) noticed that hyperlipidaemia, hypertension and insulin resistance often cluster together, he put forward the conception of X-syndrome, nine years later Zimmet (P.Z. Zimmet 1997) suggested to use the conception of metabolic syndrome. In 1999 WHO gives the work definition of metabolic syndrome it refers to a clustering of cardiovascular disease risk factors, including type 2 diabetes, hyperlipidaemia, hypertension and obesity.
The diagnostic criteriaThe diagnostic criteria of MS are various in different countries. NCEP (National Cholesterol Education Program) criteria and IDF & AHA (International Diabetes Federation & America Heart Association) criteria are applied in America. EGIR (European Group for the study of Insulin Resistance) criteria are applied in most of the European countries. The WHO criteria (1999) is following:
Require presence of one of:

•  Diabetes mellitus
•  Impaired glucose tolerance
•  Impaired fasting glucose or
•  Insulin resistance

AND two of the following:

•  BP: ≥ 140/90 mmHg
•  Dyslipidemia:TG: ≥ 1.695 mmol/L & HDL-C ≤ 0.9 mmol/L (male), ≤ 1.0 mmol/L (female)
•  Central obesity: waist:hip ratio > 0.90 (male); > 0.85 (female),
• or body mass index > 30 kg/m2
•  Microalbuminuria: urinary albumin excretion ratio ≥20 µg/min
• or albumin:creatinine ratio ≥ 30 mg/g

The prevalence of MSThe prevalence of the MS varies with country, race and the definition used. One study in the USA found a prevalence of 44% in the over-60s. A study in the Shanghai found a prevalence of 17.14% (1/6) in the age of 20-74 (Lei Chen. 2003). A report showed that the prevalence of metabolic syndrome in western London is various in different races. South Asians have higher prevalence than African-Caribbeans and Europeans (T.Tillin.2005).
Traditional Chinese medicine’s philosophy about MSAccording to Chinese medicine’s theory MS falls within the category of Xiaoke (消渴) and Xuanyun (眩晕). The etiology of MS is due to: a) Improper diet causing by over eating fat and sweet food; b) Emotional disorder causing by stress work and depression ; c) Spleen deficiency due to many chronic disease; d) Kidney and liver deficiency due to ageing; e) Yin-Yang loose balance and phlegm obstruction; f) Sluggish qi and blood circulation due to lack of exercise; Commonly used treatment principle should be: a) Expel dampness and phlegm; b) Remove the qi stagnation; c) Activate qi and blood circulation; d) Invigorating the spleen; e) Tonify kidney.
Food therapy formulas:

1. Gouqi Juhua Tea
Ingredients: Gouqizi (Fructus Lycii) 10g add 500ml water, boil 2 minute, add Juhua (Chrysanthemum) 10g, green tea 5g，Covered and soak for 30min. Drink once or twice daily.
Clinical application: hypertension, arteriosclerosis, coronary heart disease, diabetes, hyperlipemia, dry eyes and blurred vision.
2. Shanzha Jueming Tang
Ingredients: Shanzha (Hawthorn Fruit) 20g, Juemingzi (Semen Cassiae) 10, Prepare method : add 500ml water, boil for 30 min, drink once a day.
Clinical application: hyperlipemia, cholesterol or triglyceride, hypertension, arteriosclerosis, coronary heart disease, constipation, food retention.
3. Yumixu Tang
Ingredients: Yumixu (Corn Stigma) washed and soaked with boiled water for 5 min, or boil with water for 5 minute, drink once a day.
Clinical application: diabetes, hypertension, cholecystitis, hepatitis, nephritis.
4. Sanqi Shanyao Zhou
Ingredients: Sanqi (Radix Notoginseng）5g, Shanyao (Rhizoma dioscoreae) 60g, Jingmi (rice) 60g. Prepare method: above ingredients add water 500 ml, boiled for 1 hour，drinking the porridge.
Clinical application: diabetes, hypertension, anaemia, irregular menstruation, scanty menstruation.
5. Gegen Fen Zhou
Ingredients: Gegenfen (Radix Puerariae) 30g, Jingmi (rice) 50g; Prepare method ：add water 500 ml, boiled for 1 hour, drinking the porridge.
Clinical application: diabetes, hypertension, coronary heart disease, hyperlipoidemia.
6. Shanzha Shouwu Tang
Ingredients: Shanzha (Hawthorn Fruit) 30g, Heshouwu (Radix polygoni multiflori) 18g, Zexie (Rhizome of Oriental Waterplantain) 12g; Prepare method：Above ingredients add water 600 ml, boiled for 1 hour. Drink the decoction twice a day.
Clinical application:　hyperlipemia, Diabetes hypertension, coronary heart disease．
7. Ju Huai Cha
Ingredients: Juhua (Chrysanthemum) 3g, Huaihua (Flower of Japanese Pagodatree) 3g, Green tea 3g; Prepare method ：Put above ingredients in a cup, add boiled water, soaked 5 minute, drink the tea once daily.
Clinical application:　Hypertension，Headache，Dizzness．
8. Xiakucao Jiangya Cha
Ingredients: Xiagucao (Spike Prunella) 10g, Cheqiancao (Herba plantaginis) 12g; Prepare method: above ingredients washed, and put them in a cup, add boiled water, covered and soaked for 5 minute, drink the tea once a day.
Clinical application：Hypertension，Headache，Dizzness．
9. Danshen lucha Yin
Danshen (Rdix salviae miltiorrhizae) 9g, Green tea 3g; Prepare method： Put Danshen power and green tea in a cup, add boiled water, covered and soaked 5 minute, drink the tea once or twice daily.
Clinical application：Coronary heart disease，Angina，Hyperlipoidemia．　
DiscussionWestern medicine is effective in treating MS but it has to use many tablets at the same time. Patient has to take one table for blood sugar, one for cholesterol, and one or two tablets for control blood pressure. Usually these medicines are quite effective to control sugar, cholesterol and blood pressure, but each medicine will cause some side effects if used long term. These side effects will lead to some new troubles, such as liver function damage, low libido, edema, dry cough, headache, and even heart failure. That is the biggest trouble of west medicine.

Pharmacological research showed the ingredients of Yumixu contains flavone, glycoside, trace element, organic acid, glucide, multi-vitamin. It showed a better effect than 2.5mg Glibenclamide in diabetic patients. There are many effective ingredients in these herbs like tanshinone in Danshen; flavone in Juhua; phytomelin in Huaihua; Notoginseng leaf saponins and flavone in Sanqi; lycium barbarum polysaccharide and Carotene in Gouqizi etc.

Shanzha, Juemingzi and Heshouwu can reduce blood lipid; Juhua, Xiakucao and Gouqizi are good for high blood pressure; Danshen, Sanqi and Gegen can improve coronary circulation and benefit heart. In clinical practice, according to patient’s diagnosis we can select one or two from the nine formulas above. Patients can take the tea or porridge every day or every other day. MS can be get control by daily food therapy. Some MS cases didn’t show a lot of symptoms, many patients didn’t paid enough attention to this disease, but MS put the patients in a high risk of heart attack or stroke. Taking action to reduce the potential risk is better than to wait until the attack has occurred. This is a very important treatment principle of traditional Chinese medicine.

Reference:

1. Lei Chen. (2003). Prevalence of metabolic syndrome among Shanghai adults in China. Chinese Journal of Cardiology. 31(12): 909-912.
2. Reaven GM.(1988). Role of insulin resistance in human disease. Diabetes. 37(12):1595-607.
3. Tillin. T. (2005). Metabolic syndrome and coronary heart disease in South Asians, African-Caribbeans and white Europeans: a UK population-based cross-sectional study
4. Diabetologia 48(4): 649-656.
5. Zimmet PZ et al. (1997). The global epidemiology of non-insulin-dependent diabetes mellitus and the metabolic syndrome. Journal of Diabetes and its Complications. 11(2): 60-68.

Deng’s Herbal Tea

Tiejun Tang
Drinking herbal tea is a very popular for keeping healthy in the southern China. People often drink some herbal tea for clearing heat and detoxification. It is called Liang Cha in Cantonese, mean cold tea. Drinking Liang Cha can keep you away from flu and many other unwell during the hot summer. Deng’s Herbal Tea is a new form of Liang Cha, which was invented by my tutor professor Deng Tietao. Due to its good prescription and excellent pharmaceutical technology, it became one of the most popular healthy products in China.

Deng’s herbal tea is composed of six natural herbs. They are Jinyinhua, Baimaogen, Juhua, Sangye, Pugongying and Gancao. It has heat clearing and detoxification function, so it can be used to treat and prevent common cold and flu which is due to wind-heat. It also has a function of benefiting liver and cooling blood, it can reduce the harm of alcohol and smoking, it is good for heavy drinker and smoker. Because it is good at clearing the heat from lung and stomach, Deng’s herbal tea also can clean acne for any age groups. The modern pharmacology research shows it has an antivirus, immune enhance and diuresis functions.

Deng’s herbal tea has different formulations. Pop can is easier to dink at anytime and any condition. Granule is suitable for family and office worker. Lozenge is easier to carry and taken. Syrup is good for release constipation and moisten lung because it is prepared with honey. There is a no sugar granule special for diabetic population.

The weather of UK is not as hot as southern China. Is it necessary to drink Liang Cha? My answer is yes. For the most British their heat is not from the weather, it is from their life style. According to Chinese medicine’s theory, mutton, lamb, any baked food, chocolate, alcohol and smoking are easy to produce heat or damp-heat. If any one of the above mentioned is your favourite, you probably will have more heat in constitution. You need Liang Cha to expel these pathological fires. Deng’s Herbal Tea is a right choice.

Infertility and its TCM treatment

Tiejun Tang
First of all, I need to identify the concepts of the three key words in this topic.

Infertility: The infertility diagnosis standard of World Health Organization (WHO) is that couples who failed to conceive after 12 months of contraceptive-free intercourse if the female is under the age of 34, or 6 months of intercourse if the female is over the age of 35. Couples who have never been able to conceive are classified as primary infertility, whilst others are called secondary infertility.
TCM: traditional Chinese medicine, which includes Chinese herbal medicine, acupuncture, moxibustion, and electric acupuncture in some conditions.

Treatment: I am very cautious in using the word “treatment” here. A new advertising code had been announced by The Advertising Standards Authority (ASA) in March 2011. The code lays down strict restrictions to advertisements of complementary medicine practices. Wordings such as “cure”, “treatment” are prohibited from the advertisement of our leaflet or clinic website. Some practitioners use wordings like “management” or “help” instead. I never use the word “cure” in my leaflet, because in medicine, it can never be 100% sure that any disease could be cured. I think “treatment” just means the process of a therapy. It doesn’t indicate whether the result will be positive or negative. Why are we not allowed to use the word “treatment” in advertisement? What is the difference amongst “treatment”, “management” and “help”? What a strange code! The code also declared that objective claims must be backed by evidence. Substantiation will be assessed on the basis of the available scientific knowledge. I have two reasons why I used “treatment” here and also in my other blog articles. Firstly, this blog is not a clinic website, hence it is not an advertisement. Secondly, I always show some scientific evidence to support my opinion

The causes of infertility can be due to either the female or male or both parties. In some cases, the cause can be unexplained. In UK the statistic data of 2009 is shown below.

In female infertility the common reasons are shown below.

In a clinical study from Germany (Paulus, 2002), 160 patients who were undergoing assisted reproduction therapy were divided into two groups randomly: embryo transfer with acupuncture (n=80) and embryo transfer without acupuncture (n=80). Acupuncture was performed at 25 minutes before and after embryo transfer. In the control group, embryos were transferred without any supportive therapy. The results showed clinical pregnancies were documented in 34 out of 80 patients (42.5%) in the acupuncture group, whereas pregnancy rate was only 26.3% (21 out of 80 patients) in the control group.

Another report is from Denmark (Lars G. 2006). Patients treated with IVF/ICSI (intracytoplasmic sperm injection) were divided into three groups. Group 1 received acupuncture on the day of embryo transfer (ET), group 2 on ET day and again 2 days later, and both groups were compared with a control group that did not receive acupuncture. Results showed clinical pregnancy rates were significantly higher in group 1 as compared with controls (37 of 95 [39%] vs. 21 of 87 [26%]) and ongoing pregnancy rates were also higher in group 1 as compared with controls (34 of 95 [36%] vs. 19 of 87 [22%]). The clinical and ongoing pregnancy rates in the group 2 (36% and 26%) were higher than in controls, but the difference did not reach statistical difference. Conclusion can be drawn that acupuncture on the day of ET significantly improves the reproductive outcome of IVF/ICSI, as compared with no acupuncture.

Acupuncture also has good effect in treating male infertility. In a prospective controlled study, statistical evaluation of the transmission electron microscopy data showed a significant increase after acupuncture in the percentage and number of sperms without ultrastructural defects in the semen. A statistically significant improvement was also detected in acrosome position and shape, nuclear shape, axonemal pattern and shape, and accessory fibers of sperm organelles. (J. Pie. 2005)

In addition to acupuncture, Chinese herbs can also greatly increase the chances of pregnancy. There is an experimental study which showed that Erzhi Tiangui Decoction could significant raise the quality of oocyte in mice (F. Lian 2004). A clinical track study showed Wenshen Antai Decoction can also increase the pregnancy rate after re-transplant of IVF (D. Li. 2009).

Fertility problems affect one in seven couples in the UK. Many couples choose IVF or IUI, but they have to be prepared for the low success rate and the high cost. Much evidence showed that acupuncture and Chinese herbs can treat infertility for both male and female. Only a few reports amongst many were mentioned above. TCM treatment can help get natural pregnancy, prevent miscarriage and increase the success rate of IVF, although the success rate would vary with different treatment plans and different causes of infertility.

Reference:Lian Fang, Sun Zhen-gao, Zhang Jian-wei, et al.(2004). Experimental Study on Effect of Erzhi Tiangui Recipe on Quality of Oocyte in Mice. Chinese Journal of Integrated Traditional and Western Medicine. 24(7):625-7.

Li Dong (2009). Increase of pregnancy rate by Wenshen'antai Decoction combined with assisted reproductive technology in patients with embryo transplant failure. Journal of Beijing University of Traditional Chinese Medicine. 32(2):

Pei J, Strehler E, Noss U. et al. (2005). Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertility and sterility, 84 (1): 141-147

Paulus WE, Zhang M, Strehler E, et al. (2002). Influence of acupuncture on the pregnancy rate in patients who undergo assisted reproduction therapy. Fertil and Steril. 77 (4): 721–4.

Westergaard LG, Q Mao, M Krogslund. et al (2006) Acupuncture on the day of embryo transfer significantly improves the reproductive outcome in infertile women: a prospective, randomized trial. Fertility and sterility, 85(5): 1341-1346.

Decoction is the best formulation

Tiejun Tang
There are several different formulations in Chinese herbal medicine. Pills, tablets, powders, capsules are commonly used patent remedies. In addition to these formulations, there is another commonly used formulation – decoction. It means several different raw herbs mixed together, soaked in the water for a period of time and then boiled over fire for about an hour, filtrate them and drink the liquid. It is the most traditional method in Chinese herbal medicine and in my opinion, it is the best formulation. The reasons are below.

Firstly, decoction can give a patient an individual treatment. The treatment principle of Chinese medicine is based on syndrome differentiation diagnosis. In the clinical practice each individual case might need different herbs. Even the same disease with different patient, it may need different prescription because their symptoms are not exactly the same. For example, if two people catch cold at same time. Mr. A has a sore throat, headache, and high temperature; but Mr. B suffers sneezing, blocked and runny nose, with normal temperature. If we treat using a decoction, we will select different herbs according to patient’s clinical manifestation. A good prescription will suit the individual patient only, just like a tailor made suit for an individual person according to their measurements.

Secondly, decoctions have good adaptability. The patient’s symptoms might change during the treatment process. At different stages of the same disease, the patient might need different herbs. We can amend the prescription by changing some herbs or adjusting the dosage of some herbs. It’s better to amend the prescription once a week according to symptoms. Let’s take irritable bowel syndrome (IBS) as an example. Patients suffering from IBS often alternate between diarrhoea and constipation. When diarrhoea happens we need to use Baizhu, Yiyiren, Huoxiang, Peilan etc to tonify the spleen and expel dampness. When constipation happens we need to remove Yiyiren, Huoxiang, Peilan and add Maziren, Juemingzi to moisten the intestine and release constipation. This adjustment can be used more often in some acute diseases and less often in stabile chronic disease.

Thirdly, decoction is more easily absorbed by the patient. After drinking into the stomach, the effective substances in the decoction will be absorbed through the gastrointestinal system and into the blood within half to one hour. The result is much quicker than other formulations.

The disadvantage of decoction is that it requires a little preparation time. The patient needs to spend some time boiling the herbs every day. The other disadvantage sometimes is its taste which is usually quite bitter. You can add some sugar or honey before drinking it. Many people gradually get used to the bitter taste after taking them for a period of time. Some even start to like the "magic coffee", because they get a lot of benefits from the herbal decoction.

Decoction is the best formulation, but a good treatment depends on correct diagnosis. Nevertheless, if disease is misdiagnosed, no formulation will work. However, if you get it right, you are sure to hit the target spot on!