Chinese Medicine

Chinese Herbal Medicine is one of the greatest and most studied herbal systems of medicine in the world, with an unbroken tradition from the 3rd century BC.

Throughout its history Chinese Medicine has continually developed in response to changing clinical conditions, and has been sustained by research into every aspect of its use. This process continues today with the development of modern medical diagnostic techniques and knowledge.

Because of its systematic approach and clinical effectiveness it has for centuries had a very great influence on the theory and practice of medicine in the East, and more recently has grown rapidly in popularity in the West. It still forms a major part of healthcare provision in China, and is provided in state hospitals alongside western medicine. Chinese medicine includes all oriental traditions emerging from Southeast Asia that have their origins in China.

In Chinese medicine, patients are diagnosed according to Chinese medicine physiology and pathology, which differs from Western medicine as far as it is mostly concerned with internal function and dysfunction rather than anatomy and anatomical changes. Great importance is placed on finding out causes for the dis-ease in the body, for example too much stress, faulty diet and so on, and what effect this has on certain organs or tissues. Treatment is aimed at restoring balance so that the body and mind can continue to be healthy.

Also, the tradition of Chinese medicine as a whole places great emphasis on lifestyle management in order to prevent disease before it occurs. Chinese medicine recognises that health is more than just the absence of disease and it has a unique capacity to maintain and enhance our capacity for well being and happiness.

Herbal Medicine and Modern Pharmacology


There is a growing body of research which indicates that traditional uses of plant remedies and the known pharmacological activity of plant constituents often coincide. However, herbal medicine is distinct from medicine based on pharmaceutical drugs. Firstly, because of the complexity of plant materials it is far more balanced than medicine based on isolated active ingredients and is far less likely to cause side-effects. Secondly, because herbs are typically prescribed in combination, the different components of a formulae balance each other, and they undergo a mutual synergy which increases efficacy and enhances safety. Thirdly, herbal medicine seeks primarily to correct internal imbalances rather than to treat symptoms alone, and therapeutic intervention is designed to encourage this self-healing process.

Chinese herbal medicine has a role to play in the treatment of the following conditions: (taken from the Register of Chinese Medicine – RCHM)

  • Skin disease, including eczema, psoriasis, acne, rosacea, urticaria
  • Gastro-intestinal disorders, including irritable bowel syndrome, chronic constipation, ulcerative colitis
  • Gynaecological conditions, including pre-menstrual syndrome and dysmenorrhoea, endometriosis, infertility
  • Hepatitis and HIV: some promising results have been obtained for treatment of Hepatitis C, and supportive treatment may be beneficial in the case of HIV
  • Chronic fatigue syndromes, whether with a background of viral infection or in other situations
  • Respiratory conditions, including asthma, bronchitis, and chronic coughs, allergic and perennial rhinitis and sinusitis
  • Rheumatological conditions (e.g. osteoarthritis and rheumatoid arthritis)
  • Urinary conditions including chronic cystitis
  • Psychological problems (e.g. depression, anxiety)

Many of these conditions, especially in their chronic forms, create great difficulty for conventional medicine, whilst Chinese Herbal Medicine has a great deal to offer. The results that can be expected and how long a patient will have to take the herbs for will depend on the severity of the condition, its duration, and the general health of the patient.

With Chinese medicine, it is important to highlight again and again that each patient gets his or her individual prescription, one that is exactly right for him or her. That way side effects are minimized and the clinical outcome maximized.

For example, two patients with eczema may receive very different herbal prescriptions depending on their clinical manifestations, and what else may go on in the body. One patient may have pale flaky very itchy skin and he or she may have constipation or scanty menstrual periods or dizziness. This patient may be diagnosed with ‘blood deficiency’, so the herbal formula needs to incorporate lots of herbs that increase nutrient levels in the body, as well as maybe moistening and activating the bowels so that constipation can be overcome. Another patient may have an eczema that is very angry, red and weepy, this would be more in the category of ‘damp-heat’ in the body and needs a very different approach to the case above.

Case examples

Plaque psoriasis

P, 31, suffered with widespread plaque psoriasis since he was 19 years old. Recently it has gotten more active and widespread. After diagnosing him, I prescribed him his individual herb formula as well as herbal creams. After a course of four months of taking the medicine, his skin is clear, and he can stop the herbs.

Endometriosis

M, 38, suffers from severe endometriosis. Her pain levels are severe throughout her menstrual cycle, often so severe that she cannot sleep or function or do her job well. She also feels extremely hot and steamy. After diagnosing her and prescribing her her own individual formula, she gets good improvement, limiting her pain to her period only. Soon her period pain is also reduced. All in al she has active treatment over six months, during which time her prescription changes as her body changes.  She continues on a low dose prescription to now to keep her endometriosis from flaring up.

Polycyctic ovarian syndrome (PCOS)

P, 38, comes with the aim of conceiving. She has been rejected for NHS funded fertility treatment due to her weight. Her periods are very irregular. We later find out that she often does not even ovulate. She is put on several different formulae after an extensive Chinese medicine diagnosis is carried out. This case is complicated, as herbs have to be used that regulate her cycle as well as herbs have to be chosen that work with her digestive metabolism. Diet changes have to be made, sugar and white flours reduced as much as possible. Her cycle slowly becomes more regular. After nine months she starts to ovulate well. After 13 months she conceives, and has a gorgeous little girl now. 


Herbal Medicine Supplier – Avicenna & Herbprime

Avicenna Herbs

Our prescriptions are prepared individualy for the patient, either in a concentrated powder/pill form from Herbprime or in a freshly made form from Avicenna. 

We use Avicenna for our loose herb prescriptions, as they offer a unique preparation method for our patients. That way the patients receive herbs that are most effective and most convenient for them to take without the need of time-consuming cooking, which in most cases reduces compliance.

Avicenna is both a clinic and a working herbal pharmacy.  Their Chinese herbs are sourced directly by them from reputable sources and individual herbal prescriptions are tailor-made on the premises by their fully qualified Chinese pharmacists. Herbs can be provided dried or decocted (ready-to-drink).

Herbs are dispatched to the patient by courier in the UK or abroad.

The ready-made decoction service for easy-to-use sachets

Avicenna is amongst the very few clinics in Europe to offer a decoction service for herbal prescriptions. In 2003 they introduced cutting edge machinery as used in Chinese hospitals, which enables us to prepare individual herbal prescriptions in liquid form that come in sealed, easy-to-use sachets.

This high pressure and temperature-controlled decoction method extracts much higher proportions of the active ingredients and makes taking herbs more effective, convenient and palatable as well as ensuring consistent quality of the product.

They also offer a bespoke pill making service. Pills are custom made on prescription using the high quality authenticated herbs from our own dispensary.

Dermatology: skincare products

Avicenna also offers a bespoke range of custom made products which have been exclusively developed over 20 years by renowned skin specialist Mazin Al-Khafaji to enhance the effect of his herbal prescriptions.

The products are made in small batches and mixed by hand and enriched with herbal ingredients. These products are available to associated health professionals only on prescription to their patients.

The skincare products are made from highly concentrated, natural and pure ingredients and herbal powders. They do not contain any artificial colours or preservatives, petrochemical substances or steroids.

 

An extensive interview

with Mazin Al-Khafaji, founder of and clinician at the Avicenna Clinic:

Mazin Al-Khafaji is well known to RCHM readers as a gifted and innovative practitioner and author, and as a fervent advocate of raising the standards and reputation of Chinese medicine in the UK. In recent years he has carried through exciting changes in clinical organisation and dispensing practice at the Avicenna Centre for Chinese Medicine in Brighton and Hove.

Q. What does your clinic specialize in?
For many years I've held the dream of replicating what I have done in my own practice and extend it to other practitioners working at the clinic. I realized after completing my studies in China over 20 years ago that by focusing mainly on certain types of conditions (in my case particularly skin, allergic and autoimmune disease) I could develop a greater insight into treatment protocols and approaches, that would otherwise always remain elusive if I saw all-comers. I reasoned that if I could encourage others to do the same, then the standard of Chinese medicine would be raised, and we could as a group offer the very best chance of success to our patients for a whole range of conditions that I know Chinese medicine can be very effective for. So at the moment we also have practitioners who have specific experience in treating cancer and side effects of conventional cancer therapy, endometriosis, cardiac and respiratory disease as well as both male and female fertility.

We are in the process of creating our own research facility with access to our specialist library of Chinese books and medical articles. We hold regular discussion groups and have a system of mutual support amongst the practitioners who join our clinic.

We also collect clinical data (for example we have amassed a vast amount of data on liver function tests of patients undergoing treatment with Chinese herbs to assess safety) and have run simple pilot studies to attempt to ascertain the effectiveness of what we are doing.  Most recently Andrew Flower has completed the first clinical trial in the use of Chinese herbs, in which he not only explores the efficacy of Chinese herbs in the treatment of endometriosis, but is also developing protocols for researching the best approach to conducting trials without losing touch with Chinese medicine's unique approach to treatment. The plan and hope is that over the years we at Avicenna will follow this up with more research, exploring benefits of treatment for a variety of conditions.

Q. When did you start to run your own herbal dispensary?
A. I started with a small number of herbs to supply my own practice immediately after my return from China in 1987.  During my 4-year stay in China in the early eighties I visited many dispensaries and experienced at first hand how herbs were being used in hospitals and every day life. It became clear to me then that the quality and processing of the herbs are of crucial importance for running a successful practice. I wanted to make sure that my patients received the best available treatment and to optimize the chance of success - so I always aimed to source the highest quality stock available from different suppliers at the time.

Q. What is it like now?
A. As the quality of herbs and services supplied were always my highest priority I just kept on building up the dispensary to suit the development of my own practice.

Since I first started we have steadily expanded so that today we run an extensive herbal pharmacy offering additional services to cater for every aspect of our busy treatment centre.

We now almost exclusively import all our herbs directly from China and keep a permanent stock of over 450 carefully sourced and authenticated herbal ingredients. We also offer a number of specialist services geared towards enhancing clinical practice. We employ a fully qualified Chinese pharmacist who underwent specialist training for a full five years in China and amongst other things has particular expertise in pharmacognosy. We also have access to an extensive research library as well as solid links with colleagues and educational institutions in China. We are now also registered “RCHM Approved Suppliers” so that not only do we keep maintaining good working practice in our dispensary, storing the herbs correctly, monitoring temperature and humidity etc, but we can also control the quality of herbs used in the trials we plan to conduct at Avicenna in the future.

Q. Why is quality so important and how do you authenticate herbs?
A. As herbs are a natural product, there can be a vast variation in quality. For centuries the Chinese have graded medicinal ingredients to reflect this variation. Where and how an herb was originally grown, how it was harvested and processed so that it can be used medicinally is of crucial importance. In China there are five commonly marketed classes of quality for most herbs and the difference in price can be substantial, however this ultimately reflects the difference in an herb's efficacy and the results one can expect to achieve in clinical practice.

Authentication of herbs is clearly very important and not a simple matter. It takes a lot of practical experience and training to be able to authenticate herbs and differentiate superior quality, and it is for this reason that I went out of my way to find a fully trained pharmacist to be in charge of our dispensary.

Q. Do you only prescribe raw herbs?
A. Yes, I only use raw herbs. In my experience the results achieved by using raw herbs far surpass any other form of administration such as powders, granules or pills in ready-made formulae.

The main advantage to patent remedies is that of course you retain the supremely important ability to alter a classical formula by adding or removing ingredients to better suit the exact pattern manifesting in the patient being treated. Whilst the major advantage over granules and powders, is the extraction that occurs with the cooking process.

The heat applied acts as a catalyst that binds the various active ingredients together, thus forming a myriad of new substances that are literally more than the sum of the original parts. In essence a chemical reaction takes place when the herbs are cooked, and new synergistic actions between the ingredients are then produced, which is where the true magic of herbal medicine comes into play.  

You can usefully draw a parallel with cooking of food.  Imagine the result of taking the desiccated ingredients of a recipe and simply adding water to rehydrate them. You certainly won't end up with the same flavors that you would do if you cooked the ingredients together from the beginning.

Q. How is your dispensary different to a commercial herb supplier?
A.  Our priorities are completely different; our first concern is not commercial interest, but the enhancement of the therapeutic. We combine ordinary dispensing of dry herbs with all sorts of specialist services that I have introduced over the years to benefit the daily clinical practice at Avicenna. We pursue the methods that we know from experience produce results.

This ranges from the frequent use of “pao zhi” to our modern decoction service to the daily manufacturing of bespoke herbal products for individual requirements.

It is of the utmost importance that we know what we prescribe and that what goes into our medicines is what we think it is, and of course that it is of the best available quality for the purpose.

For instance, as we import our own stock, we authenticate all herbs in China at the point of sale, then again as they come into this country, where we immediately reject inferior stock. Several of our herbs are stocked in varying processed forms depending on individual requirements — and we use a number of different preparation methods (“pao zhi”) to alter the main actions and properties of certain herbs thereby changing their function and indication.

Q. Tell us more about pao zhi
A. Even though pao zhi is a major element within TCM, unfortunately it seems to hardly feature in the practice of herbal medicine in the West. It is now a dying art and yet it is an integral part of traditional Chinese Medicine.

In essence pao zhi is used to alter or enhance the function of an ingredient by processing it before it is decocted. The methods used vary enormously and include baking, dry frying, frying in sand, frying in a variety of liquids with honey or wine, infusion in vinegar or alcohol, steaming, boiling or simmering with oil, calcining and many others.

These processes produce changes that are not just of marginal benefit, they really do represent a whole new level of sophistication to an already elaborate and intricate system of understanding of ingredients and how they interact with each other and the human body.

For example we all use Huang Bai (Cortex Phellodendri) to treat damp heat in the lower jiao as well as for clearing xu heat. Actually the former function is achieved by using the unprocessed Huang Bai (Sheng Huang Bai), whereas if we wished to clear xu heat, Chinese medicine teaches us that we should never use Sheng Huang Bai, because it's far too bitter and will in fact injure the fluids and in time desiccate the yin. To bring into play its function of controlling the ministerial fire and subduing xu heat, only salt fried Huang Bai (Yan Chao Huang Bai) should be used.

On a very real level you can experience this for yourself by tasting the two types of Huang Bai. The Sheng Huang Bai is very bitter and unpleasant when chewed, whereas the simple process of soaking the bark in salt water for a short while, before dry frying it, will alter the taste completely, so that there is almost no bitter flavor remaining.

As if that's not enough, countless generations of doctors have discovered that by soaking the self same bark in yellow alcohol before dry frying or baking, will alter Huang Bai's (now known as Jiu Chao Huang Bai) function so that it excels in entering the blood level and clearing damp heat from the upper Jiao, making it an extremely effective medicine for treating eczema of the face and ears.

By stocking dozens of pao zhi medicines, or performing this processing ourselves we have the flexibility to maximize the use of the ingredients we use, and further enhance the synergistic action of various herbs, exploiting the full range of their interactions for the benefit of our patients.

Q. Tell us more about the decoction service?
A. During one of my visits to China a few years ago, I became aware that this was now the preferred method of preparing herbs in Chinese hospitals and recognized immediately that this method would overcome many of the problems traditionally associated with patients having to prepare their own herbs as well as delivering outstanding and consistent treatment outcomes.

At Avicenna we have now successfully been offering this option to our patients since 2003 when we imported the machinery used to decoct and pack the herbs.

In essence the herbs prescribed (anything between 1 to 6 weeks worth) are thoroughly mixed, placed in a muslin bag and soaked for an hour in the pressurized chamber of the machine. The lid is secured and heat applied. Since the vessel is totally enclosed, the steam formed will build up the pressure so that the water will boil at around 125-130° C, rather than the normal 100° C. Once the cooking process is complete (usually 20 minutes), the pressurized liquid is sent to a second machine where it is immediately vacuum packed in sachets. Each sachet (ranging is size from 50 ml for babies and children, to 280 ml, and everything in-between) is then preserved for up to 2-3 month with no deterioration in its contents without the need for refrigeration.

Q. Where are the herbs decocted?
A.  In our on-site dispensary. We have our own processing facility where we prepare all our decoctions. Currently we have a dozen or so such machines. Individual decoctions are custom-made and dispensed in predetermined sized portions within a couple of hours from receipt of prescription. Decocted herbs can be collected by the patient or be sent out to them if they live further afield on the same day and delivered within 24 hours.

Q. What are the benefits of decocted herbs?  
A. There is considerable research and clinical data from trials in Chinese hospitals to endorse the benefits and superior results of decocted herbs under high pressure, as opposed to them being cooked on a stove at home. The high pressure and temperature controlled decoction method extracts significantly higher proportions (as high as 30-40%) of the active ingredients of the herbs thereby making the formula much more powerful and effective and enhancing the synergistic effect of the ingredients.

For example one study by Zhe Jiang Chinese Medicine Research Institute (repoted in Zhe Jiang Zhong Yi Za Zhi, Vol-9. 2005; Weiqing Liang, Junxian Zheng, Jinbao Pu, Kemin Wei) looked at a variety of components such as flavonoids, alkaloids, polysaccharides extracted in order to compare potency of the traditional method of decocting the herbs on a stove with the high pressure method when using the decoction machines. When they looked at flavonoids for example extraction rates in ingredients where flavonoids are considered an important component of the medicinal effect, they found the following:

 

 

SHAN ZHA

MAI DONG

GAN CAO

CHEN PI 

ZHI MU

HUANG QI

Extraction rate

by machine

  0.0765%

  0.0651%

  0.787%

  3.22%

0.378%

   0.365%

Extraction rate

trad. method

  0.0456%

  0.0356%

  0.563%

  1.71%

0.221%

   0.233

 

When alkaloids extraction rates where measured in ingredients where alkaloids are considered an important component of the medicinal effect, they found the following differences:

 

 

CHUAN XIONG

GAN CAO

XU DUAN

MU XIANG

Extraction rate

by machine

           0.04%

   0.28%

   0.19%

   0.094%

Extraction rate

trad. method

         0.025%

   0.19%

  0.091%

   0.045

As we can see, even for ingredients with high volatile oil contents such as Mu Xiang (Aucklandiae Radix) this approach is able to maximize extraction, even though it was cooked together with the other ingredients for the full 20 minutes. Since the volatile oils cannot escape out of the pot, they are preserved. There are a few heat sensitive ingredients such as Gou Teng (Uncariae Ramulus cum Uncis) or Da Huang (Rhei Radix et Rhizoma) however that still have to be added once cooking is complete in order to retain their efficacy, but for the majority of ingredients that is not the case.

Q. Is patient compliance better?
A. Without doubt. The decocted liquid herbs actually seem more palatable, somehow smoother and therefore easier for patients to drink. And there are none of the problems traditionally associated with decocting such as the need to remember to soak and cook the herbs daily, adding ingredients at the end of cooking etc. One of the other big benefits I have heard reported by patients is the lack of smell associated with cooking the herbs at home. In my experience in the past, this could end up draining the last bit of resolve from patients who were able to cope with all the inconveniences, but finally unable to deal with the uproar from other family members because of the smell. The decocted herbs come in convenient sachets, which makes taking the herbs regularly much simpler. The sachets can easily be transported so that patients don't have to interrupt treatment when working, travelling or on holiday. Once prepared the decoction is stable and has a shelf life of up to 70 days. All this amounts to much better patient compliance and therefore better results.

Q. What are the bespoke products you mentioned earlier?
A. There are two main areas really. The first is the external application of medicine and the making of creams, ointments, gels, washes, vinegar soaks etc. The biggest aspect that I have worked on has been in developing creams for the skin. You see although TCM's traditional ointments can be very effective, being in essence medicated oils (oils that have had herbs gently cooked in them thus transferring the active principles from the plants into the oil) with very finely powdered herbs and bees wax added to make ointments, they tend to be very greasy and messy, and not at all user friendly.

Creams, which are in essence the combining of a water part with an oil part using emulsifiers to bind them together are much nicer for the patient to use, and have the added advantage of not only being able to combine both water and oil extracted herbs along with the raw powdered herb that we add, but also other wonderful ingredients for the skin, such as vitamin E, A, aloe vera as well as CO2 extracts of plants that can increase the ability of the cream to for example reduce inflammation, or aid in granulation and healing of the skin in a very substantial way.

The science of making creams was never developed in traditional Chinese medicine so I have experimented by drawing upon the best from traditional and modern methods in making a product that is both effective and easy to use.

The second area is the making of pills from individual prescriptions of raw herbs in cases where administering the herbs in decoction form might be difficult or inconvenient for some reason.

Making pills is a fairly elaborate process that involves processing the herbs in a specially designed Extraction machine, which first decocts the medicine, before evaporating off the liquid to end up with a high quality concentrate of the original formula. This first procedure is exactly the same as the one used for the decoction machines that I described earlier, (i.e. cooking the herbs under high pressure and therefore high temperature where maximum extraction is achieved).

Once the used herbs are removed, instead of packing the liquid medicine in sachets, it is evaporated off by between 96 -98% in order that we end up with a very concentrated extract of the decoction. If we just slowly boiled this liquid down at normal atmospheric pressure, which means at a 100° C, much of the efficacy would be lost because prolonged simmering (several hours would be needed) would be very destructive. So the Extraction machine uses an ingenious but simple way of evaporating off the water part without compromising the efficacy of the medicine. By applying a strong vacuum to the liquid, which takes advantage of the fact that low pressure means low boiling point, the decoction is then boiled off to remove water, but not by evaporation at 100° C, but rather by simmering at 30° C or less which preserves the active principles. Once most of the water has been removed, we end up with a paste that is then mixed with some malt, honey, or starch to get the right consistency, before being put through yet another machine (very similar to a pasta making machine) which cuts and rolls the paste into small pills.

Making the pill ourselves means we don't lose the advantage of using an individual prescription tailored exactly to the patient's needs at the time of consultation.  Pills in particular can be useful where a patient has difficulty drinking the medicine or where they have a chronic condition that may require months of treatment.

 




Wimpole Street Clinic

Gatefield Clinic

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