Book Review: Qin Bo-Wei 秦柏未

For those of you who hate overwrought book reviews, I’m going to make this easy on you. When I wrote to Jason Blalack about his work on the recently released Qin Bo-Wei’s 56 Treatment Methods: Writing Precise Prescriptions, my subject line read “Kid in a Candy Store”. But keep reading, Herbalists, because you deserve to know more.

The Introduction to 56 Methods is about as juicy as you’ll find in contemporary writing on Chinese Medicine. Blalack explains that the project began when he asked his mentor, Wu Bo-Ping, a direct student of Dr Qin, what the most important untranslated text in medicine was. Like something from Indiana Jones’ satchel, a dusty tome emerges and Blalack is handed the core of the present work. Consistent with this incantatory air, he engages us not only as the book’s lucid translator, but as a kind of diviner - bringing light, clarity, and however quietly, a call to action as he presents the work of legendary and neglected herbalist Qin Bo-Wei.

During a recent discussion on reevaluating Shang Han and Wen Bing theories, Volker Scheid called Qin Bo-Wei the “modern architect” of herbal prescribing. This is a particularly apt description because 56 Methods is indeed a framework, one on which a straightforward and expansive approach to herbal customization can be built. Blalack explains that Qin Bo-Wei “…extracted these treatment methods from classical formulas. They are templates, which allow the physician a way to emulate the thinking behind a prescription without being tied down to the exact ingredients or original indications,” and, “…give[s] one the ability to think flexibly and modify classic ideas (formulas) for the modern patient.”(xvi). This includes using fewer ingredients and smaller doses per formula, making this a momentous new resource for those seeking fresh approaches to modification.

There is a preponderance of debate regarding the use of established formularies these days, out of which this question often emerges: do substantial modifications of the classics approach a kind of hubris, or should we consistently endeavor to improve upon them as we attempt to more fully treat each patient? If we listen to Qin Bo-Wei and begin with unfettered diagnosis, the relative length of formulas becomes immaterial (though it should be said that with the use of his ideas they are almost certain to become shorter). This tactic certainly isn’t novel, but there persists a tendency in new and seasoned practitioners to unwittingly subvert core strategies with ill-considered layers, meaning earnest efforts to address individual symptoms can sometimes produce formulas that are as murky as their decoctions. But practitioners who invest due time in using the 56 Methods properly will gain the ability to generate treatments reflecting the true essence of it’s “precision”: formulas that are both structurally elegant and fluid.

That Blalack places as much importance on the comfortable language of his presentation as he does the book’s concepts proves a genuine desire for the material to be used. For this reader, one of the frequent disappointments of publications on Chinese Medicine, particularly those involving translation, is what sometimes seems self-serving attempts by authors to match the pithiness of their sources. This is to some degree understandable since works typically upheld as classics are of an entirely different time and stylistically minimal (Blalack prefers “terse” [xv]), but subservience to long gone scribes can leave new output unnecessarily dry, difficult to access, and wastefully shelf-bound. The remedy and privilege we experience in 56 Methods is a refreshingly conversational style that shows deep respect for all serious learners, at every level of study.

The most valuable example of this is the inclusion of a Q & A section after every formula. Among the many things Blalack’s questions to Wu Bo-Ping are capable: making the proper use of individual herbs easier to remember, reenforcing key concepts without excessive and distracting summary, and illuminating prevalent theoretical misconceptions about patterns and techniques. In the section on Wind he asks, “How can the same formula treat both a wind-cold and wind-heat presentation, and what does that mean?” (149); about a formula in the section on Dryness, “Why is he zi recommended for dry and hoarse voice instead of other typical herbs like wu wei zi and mu hu die?” (233); and more fundamentally, on Deficiency, “Can you have Spleen deficiency without dampness?” (123). This plainspoken style pervades the entire work, invokes tradition without perverting it, and more importantly underscores the great spirit of learning itself: to ask without fear and to grow as a teacher by offering better answers.

In addition to the way the way this work is framed – it’s uncluttered design and logical sequence - there are many smaller treasures to be appreciated in 56 Methods, all of which are made more powerful because they are offered in-context: substitutions for hard to find herbs; food therapies that can enhance the effectiveness of treatment methods and formulas; references to other theories when they can beget useful comparison; instructions on supplementary uses of herbs, such as moxa cakes; and indexes that actually take you to the concepts (not just the words) you’re looking for. Likewise, the appendices are substantially fleshed out but do not attempt to become books in themselves, and explanations of pao zhi, or specially prepared herbs, are coherently interwoven with discussions of the formulas (where many texts may only mention the names of these herbs among formulas’ other constituents).

My own copy of Qin Bo-Wei’s 56 Treatment Methods, now just a few months old, is already becoming tattered and has quickly risen above the flotsam of the usual “standards”, ones upon which so many of our current ideas about Chinese herbalism are based. I likewise hope that all those invested in this field give the 56 Methods a prominent place - not only on their bookshelves but in the application of their art.

Order now from Amazon or Eastland Press

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(*) On the second image in this post, Willem de Kooning’s Excavation, 1950: If you’ve read this blog before you’ll know something of my predilection for comparing most everything to art. In this case, I found it unthinkable not to include an image by Willem de Kooning, a New York School abstractionist working at the same time as Qin Bo-Wei. As unaware of each others’ work as they most surely were, both de Kooning and Qin breathed new life into classical structures by seeing through them - realizing the potential of those frameworks to be effective in ways they hadn’t been before and by stripping down the pillars that history had applied to their respective crafts. Stylistically, de Kooning immediately jumped to mind because of his architectural approach to the canvas - one that appears deceptively loose in that a great deal of time was spent in establishing the foundation of his outwardly graceful works.

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All parenthetical references above from: Blalack, Jason, Ed. Qin Bo-Wei’s 56 Treatment Methods: Writing Precise Prescriptions. Seattle: Eastland Press. 2010.

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©Great Wave, LLC, 2011. No part of this article may be reproduced without the express permission of Great Wave, LLC.

Tu Si Zi Tidbits

Tu Si Zi 菟丝子 (cuscuta chinensis/ Chinese dodder seed) is something we’ve been getting a lot of requests for in the last couple of months, both in formulas and as a single herb. The single inquiries seem to be coming primarily from Western herbal practitioners and enthusiasts working with infertility. I don’t know what started this recent cuscuta flurry, but it brings to light once again this herb’s supply problems since 1996, when dodder landed on the USDA’s Animal and Plant Protection Inspection Service (APHIS) quarantine list.

The USDA categorizes cuscuta as a noxious weed, whose loose viable seeds could lead to parasitic infestation - starving crops like asparagus, tomato, and chrysanthemum of nutrients, as well as compromising resistance to disease. There is a large variety of dodder all over North America, which can potentially result in choking expanses of stringy overgrowth (below, left). However damaging, I must admit that having grown up in the Southeast US I have a lasting fondness for similar expanses of kudzu (ge gen) - vast, blanketing topiaries of mythical beasts (kudzu in Tennessee, below right).

Great Wave used to order tu si zi in “cakes”. This preparation, called tu si bing 吐絲餠 (cuscuta silk cakes) is made from seeds that have been boiled until they are a thickened meal and then further blended. The resulting paste is mixed with rice flour or wine, dried, and then sliced to create the cubes seen below. This process unfortunately doesn’t satisfy the USDA, and cakes like this have been unavailable for over a year. We now acquire tu si zi in prepackaged, controlled amounts (see the miniature “tea bags” below). The good news for the infestation police is that the default packaging method for raw material at Great Wave is brewing bags, meaning tu si zi always leaves us as a bag within a bag (and, well, within yet another bag: the outer packaging).

A weed it may be, but tu si zi is a wonderfully useful Chinese herb. With consistent responsibility by practitioners and importers, it will hopefully remain available to us for a long time to come. To see the full noxious weeds list at the USDA’s APHIS portal - updated just yesterday - click here. (Note that rou cong rong [cistanches] is also listed in the section on parasitic weeds.)

Thanks again for reading!

Michael :o)

© Great Wave, LLC, 2011

Extracts Pt 1: What Are They?

How many of us, seasoned and intern herbalists, have wondered about the best way to use extracts? Questions surrounding granules and powders are among the most common we get here at Great Wave:

What is the best way to convert a successful raw formula into granules? How should the 5:1 industry standard for extraction be considered? What are fillers and how do they affect dosing? What about herbs that are already processed, like gelatins? Unfortunately, there aren’t perfect answers to some of these questions, and for good reason because each one is only part of numerous issues involving the nature, manufacture, and contemporary use of Chinese herbal extracts. This first in a series on these questions will begin at the beginning: what these non-raw products actually are.

Types of Extracts

The three most common types of extracted Chinese herbs in the West are granules made with dextrin, granules made with starch, and pure dried extracts (pictured respectively, above). The first several steps in making all of them begins with the oldest and most evidenced form of extraction, water decoction. Industrial scale extractors boil hundreds of pounds of single herbs at time; the extract is concentrated; the resulting material is used to make a final product.

The first two types of granules mentioned above are made using excipients, sometimes called fillers. Excipients in herbal products can sometimes arouse an unusually negative response in practitioners, but they are a fundamental part of creating virtually all extracts. Excipients are indeed inert, but are typically used at the lowest possible volume to produce the consistent extract ratio and granule body upon which most clinicians rely.

The significant differences in extract production occur just before and during finishing, when the decision is made to develop granules, pure extracts, or other products like tea pills. The basic outline of production:

• Raw herb testing and processing
• Extraction (cooking)
• Concentration by low temperature evaporation
• Drying and finishing, which will include the entry of excipients if needed
• Packaging (bottles, sachets, etc.)

Pure Dried Exctracts

Granules made without excipients are not technically “granules”, but a product made from pure, fully-dried extract. The result is something called jin gao fen (jin gao 浸膏, extract; fen 粉, powder). Pure dried extracts are highly water-soluble, routinely clump as a result, and are therefore the most rarely used among Western practitioners. For a closer look at the production of these extracts at Mayway’s Hebei facility in Anguo, including details on raw herb processing, visit our earlier posts, Field to Clinic Part 1 and Field to Clinic Part 2.

Granules Made with Dextrin

After the concentration process, semi-viscous jin gao is sprayed into a chamber with measured amounts of dextrin. Combined and dried, they form the final granule. This type of granule is preferred when the form of administration is dissolution in water. Dextrin is more water-soluble than starch and can be used in lower amounts during the production process. This means less “filler” and a final product with a higher concentration of herb. These granules keep longer in arid climates because they can become sticky with moisture. Semi-viscous and completely dried forms of jin gao are pictured below.

Granules Made with Starch

Granules made with starch are created very similarly to those with dextrin, only with the use of starch during drying and finishing. This product is preferred when the draft method is desired - a powder that is poured on the tongue and then “chased” with liquid. Granules made with starch survive better in areas with high humidity because they aren’t as water-soluble, but a greater amount of this excipient is needed to create a consistent finished product, meaning the likelihood of lower herb concentration.

Other excipients are used in foreign markets - lactose, fiber, and crude herb powder made from extraction dregs, for example - but it is rare to find products made with them in the West.

Full-Spectrum vs. Standardized Extracts

Among the variances in extract production is how manufacturers determine the amount and quality of specific chemical constituents in the finished granule. In the production of full-spectrum extracts, minimum levels of marker chemicals are identified in the raw and final product. The result is an extract that closely mirrors a traditional decoction in terms of chemical levels.

Standardized extracts produce granules with very specific levels of chemical constituent, using as much source material as needed - with the possible addition of pure chemical - to meet that target level.

Different Herbs, Different Processes

Another vital consideration when producing granules is the nature of individual herbs and their traditional relationship to decoction. Considering herbs not typically cooked as others - or those not historically decocted at all - is something that practitioners using raw herbs are likely familiar with. But for those using the granule form of these herbs, a significant amount of extra care is involved. This too is part of standard extract production.

For example, gelatins like lu jiao jiao are already processed and exist as concentrates in their “raw” form. Cooking them is unnecessary and they are traditionally dissolved into the final decoction. In most cases, the granule form of gelatins are not concentrated (the extract ratio is 1:1). Da huang is a good example of an herb that needs to be decocted in specific ways for desired effects: for shorter times to free the stool; longer to quicken the blood. Minerals may be the most fussy category of extracted herbs given their low water solubility. Manufacturers have different ways of dealing with this fact and usually choose one of two methods: boiling, as with most other herbs, or a hybrid method of production that involves grinding the raw material and mixing it with an excipient.

Now that we know what extracts are, that they aren’t all built the same and therefore aren’t intended to be used in the same way, we can address some of the more complicated questions: What are concentration ratios? What is the difference between extract singles and extract formulas? What is the best way to use all of this information during prescription? Visit our next post for answers, or simply Subscribe to receive this blog’s posts via email.

Thanks again for reading,

Michael :o}

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© Great Wave, LLC, 2011

Niu Xi Nitty Gritty

If you use any of the varieties of niu xi in your dispensary, especially in raw form, it’s important to know them apart because they raise a number of issues involving correct nomenclature, identification, and clinical use. More below on the niu xi’s you’re likely dispensing, as well as a couple you may not know about - which you may also be dispensing!

We should always remember that an herb’s pinyin name can refer to more than one substance: that noted in historical texts and formulas, as well as other herbs substituted for it. The shorthand “niu xi” has a long history of use and has often meant both huai niu xi (achyranthis bidentate radix) and chuan niu xi (cyathule radix). While the importance of discriminating between the two is documented, “niu xi” still implies huai niu xi when used today. As many of us already know, most pharmacies will simply dispense this variety when only “niu xi” is requested. We distinguish these here at Great Wave as “niu xi (chuan)” and “niu xi (huai)”.

huai niu xi (怀牛膝 acyranthis bidente radix)

The use of “chuan niu xi” well illustrates the kinds of problems that arise when pinyin is used as an herb’s sole moniker. Below are pictures of chuan niu xi and another herb that also goes by that name, wei niu xi. Wei niu xi (from strobilanthes forrestii) also invigorates blood, clears heat and promotes urination, but is considered to be an unacceptable substitute for chuan niu xi. Not long ago, our pharmacy’s primary supplier ran out of chuan niu xi and we received this variety from another leading distributor (never to be dispensed, of course).

Authentic chuan niu xi 穿牛膝 (left) and wei niu xi 味牛膝 (right)

Yet another form, tu niu xi (from achyranthis longifolia), likewise invigorates blood, but is primarily used for draining fire, resolving toxicity, and promoting urination. It has no tonifying capabilities. ¹  Bensky, Clavey and Stoger’s Chinese Herbal Materia Medica places it in the Clear Heat and Reolve Toxicity category; huai and chuan niu xi in the Invigorate Blood category. Chinese Medical Herbology and Pharmacology by John and Tina Chen discusses it as a supplement in its notes for chuan niu xi.

tu niu xi 土牛膝

When it comes to using huai and chuan niu xi, preparation is important. Materia Medica states that the principal action of huai niu xi (indexed as “niu xi”) is to invigorate blood and dispel blood stasis, but contingent upon its use in unprepared form (notable since virtually no one in the West uses unprocessed Chinese herbs). Pharmacology makes no distinction in this regard, stating only that huai and chuan niu xi are best distinguished by the potency of their actions. ²  It gives chuan niu xi the stronger ability to perform this function and says that huai niu xi, while able to invigorate blood and dispel stasis, has the principal action of supplementing the Liver and Kidney; strengthening sinew and bone - an herb well suited for addressing pain in the lower body associated with vacuity. Below is a visual comparison of huai and chuan niu xi’s actions when used in prepared form.

Thanks for reading, everyone. Visit again soon for a return to our series on granules!

Do more herbs, Folks, Michael ;o)

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1. Chinese Herbal Materia Medica, 3rd Ed.

2. Chinese Medical Herbology & Phamacology, 2004

© Great Wave, LLC, 2011

Field to Clinic Part 2

Field to Clinic Part 1 chronicled raw herb processing at Mayway’s Hebei facility during my visit in April. This one will discuss production of their powdered herbs, or what most of you know as Plum Flower brand extracts. The information presented here will be greatly expanded upon soon in a series about the production and use of all powders and granules: content and extraction methods, concern over herbs cooked together (formulas) vs. those prepared singly, and the ever confounding issues surrounding yield, “concentration”, and dosing. But for now, back to the basic production process.

extract powder

Once the raw herbs are cleaned and prepared (according to pao zhi needs, etc.), they are cooked in massive, vacuum-sealed extractors over 12 feet in girth and 2o feet in length - stove top boilers for the gods. The increased internal pressure means faster boiling at lower temperatures and increased efficiency of the extraction process.

The solvent is water, save cases in which a given herb has been traditionally prepared otherwise. Rou cong rong, for example, was traditionally steamed with wine and is now commonly extracted with both water and alcohol. Extraction temperatures will likewise vary: herbs with a lighter body and whose constituents are more easily obtained are cooked at lower temperatures; stronger herbs, or those whose desired medicinal value can only be withdrawn in such a way, may be subjected to “military fire.”

Ares extracting qin pi with military fire

One of the key steps in any extraction process is the collection of an herb’s essential oils, which leave the decoction with steam. With the use of an additional circuit, these oils are retained with that steam, cooled, and then collected in a separate chamber. In most cases they are reintroduced into the product before finishing.

Once the cook is completed, the liquid decoction is separated from the crude herb and moved to what is alternately called the concentration or condensing process. In a separate chamber, the liquid is further cooked at a lower temperature to reduce the majority of the solvent. This creates a thick, pasty substance called jin gao, which may then be used to make a number of different products: jin gao fen, the pure powdered extracts found inside Plum Flower bottles, granules (yes, they really are something apart), tablets or tea pills.

In the case of powders, the resulting jin gao is then spray dried, a common method of processing thermally sensitive products like food and pharmaceuticals. The simplified illustration I’ve created below shows only one type of spray drying machine. It certainly doesn’t picture Mayway’s proprietary machines, but the general process for all similar contraptions is the same: the extract is transferred to the spray chamber to be evenly distributed. With the use of hot gas, the extract moves downward in helix-formation, within a chamber sometimes called a “cyclone”. The gas removes all the remaining solvent in a matter of seconds (as few as 10!), and the final, finely textured herb powder is collected at the bottom.

simple spray-drying model

From there, it is quickly moved to the bottling area, which is crucial for pure extract powders because they are extremely sensitive to moisture and tend to clump.

Again, the process for making extract granules is different and will be featured in upcoming posts.

Hope you join me again soon!
Michael :o)

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© Great Wave, LLC, 2011

Field to Clinic: Part 1

Late last month I returned from China, an invitee of Mayway to tour their Hebei processing facility, view area cultivation sites, and discuss some of the most important issues facing prescribing communities everywhere in the world. This post will be the first of two covering the farm and facility visits.

No matter how many years you’ve been working with Chinese herbs, seeing the entire undertaking of moving herbs from soil to clinic is a jaw-dropping experience. Many of the smaller questions about what we use to treat our patients every day are answered upon sight (“So that’s how they do that!”), but a number of new ones quickly emerge when you see each step of the process.

Harvesting tian hua fen in Anguo

Many Chinese herbs require special processing methods, a couple of which I describe here, but most follow a similar path through the Mayway facility. The first step for all of them is a vigorous washing. The machine I saw at work was a long, cylindrical pressure washing machine, open at both ends with a moving central barrel. Once herbs are finished there, most all are soaked to allow for easier processing – breaking, slicing, dicing, and so on. More obstinate herbs are transferred to steamers before being broken down further.

Slicing techniques are unique to the body of each herb. Many are deftly handled by mechanized choppers - sang bai pi for example, which I saw getting moved through a long chamber with what looked like a small guillotine at the end. Other herbs require a hands-on approach, and seeing is really the only means of believing. In the picture below, workers use a custom-built device that allows them to more quickly hand slice jie geng. It’s a bit like a cobbler’s bench with a pedal-controlled bar that holds the root in place.

Hand slicing jie geng

The next step is drying, which is also specific to the nature of the herbs: more delicate herbs like flowers are dried at lower temperatures, while more robust ones really take the heat. Yet other herbs quickly move on to separate machines for pao zhi processing, which may char or roast them.

Sorting follows. What immediately reminded me of German artist Katharina Fritsch’s sculpture Company at Table (I’ll ask you to forgive the art nerd reference, but you can expect them to show up regularly in this blog), was a room of sixteen workers diligently separating tiny mountains of bai zi ren by hand. Each had a small metal bowl before them and a large sanitized bin between their legs. Imperfect seeds were placed in the bowl, the golden good ones moved to the big container below.

Company at Table.  Katharina Fritsch. 1988

Hand sorting bai zi ren

The final stage is packaging, which requires a team of individuals working together on single packages. Herbs are weighed, bagged, vacuum-sealed, and then double-bagged with nitrogen gas between the two packages for cushioning. After this, the little pillows are stored and prepared for shipping.

For me, witnessing all of this opened a number of new topics with just as many questions, not least of which is cost or, more specifically, value. More on this sprawling topic later.

Michael :o)

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© Great Wave, LLC, 2011