East Asian herbal medicine boasts a lineage stretching back thousands of years; the first known textbook of herbal medicine is the Huang Di Nei Jing dating to 300 BCE. Herbal medicines have been used, adapted, and refined continuously over these many centuries. Today, the popularity of this ancient practice stands as a testament to both its enduring relevance and its remarkable safety and efficacy record when properly dosed and prescribed. But people rightfully have a lot of questions:
Does Chinese herbal medicine work?
Even some of the most stalwart, skeptical Western medicine institutions have, in recent years, admitted that in the era of Evidence-based medicine, the evidence for Chinese herbal medicines is starting to stack up. In 2015, pharmacologist Tu Youyou won the Nobel prize for a malaria drug based on a Chinese herbal medicine. In 2022, the Journal of the American Medical Association published the results of a randomized controlled trial and an accompanying editorial about a Chinese herbal medicine pill that dramatically lowered the risk of subsequent cardiovascular events after a heart attack.
And the National Institute of Health’s website has published a few indecisive but optimistic notes about the medicinal possibilities of Chinese herbs:
“Results from a 2013 review of 65 randomized controlled trials suggest that Asian ginseng may help improve glucose metabolism and lower blood sugar.”
“A 2013 research review found that taking astragalus may be associated with a lower risk of upper respiratory tract infections in children with nephrotic syndrome than prednisone treatment alone.”
“A small amount of research suggests that ginger dietary supplements might be helpful for menstrual cramps.”
“A small number of studies suggests that both green and black tea might have beneficial effects on some heart disease risk factors, including blood pressure and cholesterol.
“Some studies have shown that white mulberry leaves contain numerous chemical compounds that act as antioxidants and may provide therapeutic benefits.”
In the wider world of published scientific research, we have systematic reviews looking at Chinese herbal medicine’s positive impacts on symptoms of insomnia, period pain, indigestion, constipation, IBS, traumatic brain injury, thyroiditis, acute infection including with COVID-19, and female infertility amongst many others. Systematic reviews are the top tier of the research pyramid; a great number more individual articles & trials of articles looking at in vitro, in vivo, and theoretical models have been published in the last several decades and will make their way into the ranks of meta-analyses and systematic reviews with more time.
Before you order pounds of ginseng off the internet to manage your glucose metabolism and blood sugar thanks to the NIH's endorsement, read on to learn why you would probably benefit more from receiving a specific, well-vetted and thoughtfully prescribed herbal medicine than trying to navigate the complexities of herbal medicine sourcing and dosage alone.
So, Chinese herbal medicine can support people through a variety of health conditions. But is it safe?
Concerns about the safety and regulation of herbal medicines are valid. When Chinese herbal medicines are properly prescribed, dosed, and verified for authenticity and purity, they can be incredibly safe. Skeptics of herbal medicines point to a lack of regulation or FDA approval– and I actually share a lot of common ground with this perspective. Just like there are green flags I look for with multivitamins & supplements, there are green flags of safety & quality that I look for with herbal medicines. I recognize the importance of informed and thoughtful usage, especially considering potential herb-drug interactions, contraindications, adulteration, and adverse effects.
While there are a handful of herbal formulas that we can think of as standard "medicine cabinet" formulations that families can keep on hand for acute illnesses, first aid, and discomforts, for the most part herbal medicines should be prescribed and dosed individually by a trained herbalist who sources their herbal medicines extremely thoughtfully. This may seem surprising given that so many of the herbs in the Chinese Medicine pharmacopeia are essentially foods and widely-used spices, but the therapeutic dosage of these items are much higher than one would get from daily use in food.
There are layers of safety questions when using Chinese herbal medicines:
Safety Concern | Solution |
Therapeutic Dosage Even some herbs and spices used widely around the world in food can be unsafe in the wrong dosages. For example, cinnamon’s “coumarin” content (which brought us the gift of miracle drug Warfarin!) can be harmful to the liver. | Work with a Trained Herbalist Acupuncturists in the state of California are licensed by a board that tests us for our knowledge on the safe usage of our pharmacopiea. A skilled practitioner won’t be offended by asking about our training and qualifications; we’re quite proud of the work we’ve put in to be safe and effective care providers. |
Authenticity, Purity, & Adulteration The global herb trade is a $215 billion industry with products moving from various growers and countries to manufacturing facilities and vendors around the globe. In 2019, researchers found 33% of herbal supplements tested in the U.S. market contained undeclared contaminants, substitutes, and filler species, or none of the labeled species. | Verify the Sourcing Qualified and reputable vendors of herbal medicine should be able to produce Certificates of Analysis confirming the authenticity, potency, and purity of their herbal products. These CoAs use liquid chromatography to prove that batches of the herbs in question contain the compounds we would expect to find in any given herb, and that they do not contain heavy metals, molds, or other toxins. |
Herb-Drug Interactions Herbal medicines and even some foods may interfere with the functioning of some pharmaceuticals. One well-known example is that of grapefruit interfering with intestinal absorption of SSRI anti-depressants. Herbs can increase, decrease, or otherwise interfere with the functioning of some prescription medications. | Check Ingredients & Pharmaceuticals A trained herbalist will verify that you’ve provided your full list of medications and will check them for known interactions. I use the Therapeutic Research Center’s Natural Medicines Database for Professionals. This database collates published medical research and provides a rating for safety of combinations and possible adverse reactions. |
Why use whole-plant medicine? Why not take the extracted “active compound” of an herb to get its effect?
Consider your morning cup of coffee; could a caffeine pill replace it? While caffeine pills offer a concentrated dose of the “active compound” most of us are after in our morning cup of joe, they pale in comparison to the holistic experience of savoring a freshly brewed cup of coffee and the multitude of cascading effects coffee across our systems. Coffee contains a myriad of compounds beyond caffeine: cholorgenic acids, trigonelline, acetaldehyde. and other antioxidants and flavonoids. Each contributes to its distinct flavor and physiological effects. Similarly, herbal medicines harness the synergistic interactions of multiple compounds, a concept supported by the burgeoning field of network pharmacology.
A potent example comes to us from the annals of pharmaceutical history. Aspirin was developed from Willow bark, which was a traditional medicine for pain in Indigenous communities across Europe, parts of Northern Africa, & North America. Chemists of the late 1800’s isolated Salicylic Acid as the “active ingredient” at work in this plant medicine, and set about creating a synthetic version. They successfully created acetylsalicylic acid and gave birth to Aspirin.
The trouble with this story is that salicylic acid is much less abundant in Willow bark than in a dose of aspirin, and yet research shows Willow Bark has just as powerful pain relieving and anti-inflammatory effects as Aspirin. What’s more, Willow Bark does not irritate the gastric mucosal lining as we know Aspirin does. With more investigation over 100 years after the discovery of the wonder-drug Aspirin, we now know that the flavanoids and polyphenols of Willow bark are an important part of it’s therapeutic effect and are even more beneficial in conjunction with salicylic acid than salycylic acid alone.
Why does my formula have so many different herbs in it? Why take a whole formula?
Some formulas are as simple as 3 or 4 herbs, and others may have 15 herbs. Just as there are reasons to use whole-plant medicine, there is also a beautiful logic behind many of the formulations of herbal medicines. All the individual herbs have flavors, temperatures, strengths and possible contraindications or challenges. As with so much of the wisdom of East Asian medicine, the name of the game is balance. For example, we design formulas to have the right mix of “warming” or “cooling” for a patient, to balance energizing herbs with relaxing herbs, or to have the right amount of bitter or sour or other flavors. Admittedly, these flavor considerations are not designed so that the formula will taste good to you– the taste in this system is part of the therapeutic effect and balance.
Herbs that “tonify” or build our qi or blood are often balanced by herbs that "drain dampness", boost digestion, or otherwise settle the stomach. Most formulas have at least an herb or two that comes from the “harmonizing” category of herbs— making the formula easy to digest and utilize.
A compelling example of the benefits of traditional herbal network prescription approaches comes from the research done around wonder-herb turmeric and it's most exciting compound: curcumin. Adding turmeric to your diet or taking a curcumin extract won't automatically allow you to reap the anti-inflammatory benefits; curcumin doesn't stay in the bloodstream very long and is therefore not very "bioavailable" to act on your tissues. But, when combined with a compound found in pepper, piperine, researchers found that "in humans, curcumin bioavailability was increased by 2,000% at 45 minutes after [oral administration]." Adding just a little bit of pepper to your turmeric latte (as a well-versed herbalist would have you do), means you'll get a lot more benefit out of that cup of tea.
The field of network pharmacology seeks to understand the complexities of the effects of combinations of traditional herbal medicines. The case for pursuing this research is strong considering our lack of progress on complex diseases. I love this quote from a Clinical Pharmacology journal in 2020:
”decades of pharmaceutical development [have] produced hundreds of popularized and largely successful drugs. However, ‘the single-symptom, single-disease, single-drug concept’ has not been as influential on certain degenerative diseases, including hypertension, depression, diabetes, inflammation, and cancer. While they may have marginal success in management, all too often, singular drug therapies are inadequate, and multiple drugs or increased dosages are recommended, causing an increase in adverse reactions and heightened toxicity, without achieving the needed metabolic therapeutic result.”
In short: complex conditions require complex formulations.
My friend’s acupuncturist gave her some herbs for headaches; I have headaches, too. Can I take her prescription?
There’s a classic saying in East Asian medicine: “One disease, many treatments; one treatment, many diseases.” Two people coming to the clinic complaining of chronic headaches may, by the East Asian Medicine system of deduction, have very different causes of their headaches and therefore would receive very different acupuncture and herbal medicine prescriptions to treat those headaches. At the same time, two people may come to the clinic with very different symptoms that are generated by the same root cause and therefore they would receive similar acupuncture and herbal medicine prescriptions despite the difference of their primary symptoms & reasons for seeking care.
At the heart of East Asian herbal medicine lies the principle of personalization, customization, and harmony. Unlike the one-size-fits-all approach of pharmaceuticals, herbal medicines are prescribed based on each patient's unique "pattern of disharmony" and specific constitution. This holistic perspective acknowledges that two individuals presenting with similar symptoms may require vastly different treatments based on underlying causes.
What types of things are included in the Chinese Medicine pharmacopeia?
There are several hundred commonly used herbs in the published Chinese Medicine texts of pharmacy. Licensed Acupuncturists in the state of California are tested on the safe use of more than 250 of these herbs for our licensing examination.
Some of the ingredients in our pharmacy are roots, leaves, or branches of plants, some are fruits or seeds, and some are derived from animals or resins. Some can be found in the grocery store: cinnamon, ginger, licorice, cardamom, goji berries, and honey come to mind. Others may be less familiar or at least surprising in that they're used medicinally: roses, chrysanthemum, forsythia, magnolia, and citrus peel to name a few.
Just like western medicine has advanced since the days of prescribing cocaine, there are medicinals that have been phased out of use for safety, lack of efficacy, and animal welfare reasons. You won’t find me prescribing tiger’s bone in the clinic, but if you’re an omnivore, beef bone broth will do the same trick tiger’s bone once did.
You mentioned some “medicine cabinet” herbal formulas people can keep on hand for first aid and illness. What would you recommend?
Gan Mao Ling*: This formula is for "Wind-Heat" or "Wind-Cold" invasions-- meaning catching a cold. It includes herbs that have broadly anti-viral and anti-bacterial properties and can be taken at the first signs of a cold. It should be taken every few hours (as directed on the bottle) for several days when symptoms set in and taken for several days after they resolve. It is most effective when taken very early in the progression of an illness.
Bi Yan Pian*: This is what I take when my allergies act up. It's not for long-term or daily use and won't address the root cause of allergies; keep it on hand for acute stuffy/runny noses and itchy eyes either in conjunction with or to replace your regular anti-histamine.
Sombra Warm Therapy Gel or Extra Strength Tiger Balm*: Both of these topical formulations contain menthol and camphor, FDA-approved "analgesic" or pain relieving ingredients, plus a handful of other herbs that are known for treating aches and pains. They're great for discomfort related to sore muscles and injuries, and can even be used to help a muscle warm up for working out.
Curing Pills*: This formula is used for "food stagnation" -- or that post-Thanskgiving meal feeling. Like Bi Yan Pian, this is not a formula for daily use and won't address the root causes of digestive issues, but is well-loved for stomach upset or discomfort from over-indulgence. ***This formula is not appropriate for anyone with Celiac disease as there is gluten.
Purple Cloud Ointment: This classic combination of Zi Cao & Dang Gui has been used for centuries for a broad spectrum of skin concerns. Called the "windex" of Chinese medicine, it has broad applications for inflamed or infectious skin conditions.
*In full transparency, your Fullscript purchase via these links helps support my work in the Glowing Gate Acupuncture clinic. Recommending these to you via Fullscript has the added benefit of extremely high standards for quality control. Unfortunately, quality control can be a challenge in the age of global shipping and powerful internet marketing schemas-- see the Safety Concern table above to learn more about why I like to recommend specific purchases via Fullscript or prescribe herbs in my office from my own vetted supply.
This month, I celebrated a goal of mine as an Acupuncturist: I brought my herbal pharmacy in-house and can now hand my patients customized liquid extracts of herbal formulas before they leave my office. As an herbalist, I am a huge advocate for the use of herbal medicines, which also means I am an advocate for herbal safety and informed consumption. If you're interested in a custom herbal blend, you can start care in the Glowing Gate Acupuncture clinic or book a telehealth herbal medicine consult.
About the Author
Ally Magill, LAc., is a Licensed Acupuncturist, herbalist, educator, and labor & postpartum doula. She graduated with her Master's degree from AIMC Berkeley where she studied Traditional Chinese Medicine with a focus on Herbal Medicine & Reproductive Health.
She studied Five Element Acupuncture at the Maryland University of Integrative Health before joining AIMC for the herbal & integrative medicine portion of her Master’s degree.
Ally began her Acupuncture training at MUIH studying Worsley Five Element Acupuncture & Classical Chinese Medicine. She applies the gentle techniques & treatment style of J.R. Worsley in all of her treatments. Endlessly curious, she is an avid reader & researcher and can often be found researching treatment strategies, reading new and old perspectives on East Asian Medicine, and learning how to better serve and empower her patients. She is an enthusiastic outdoorsperson & previously worked as an outdoor educator in the woods and farms of Maryland. Ally earned a Bachelor of Arts in Geography at Vassar College in 2013. Her studies focused on the nexus of human geography, environmental studies, political power, and movements for justice.