Chinese Herbal Medicine

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Today’s guest post was written by Seattle-area tea lover Brett Boynton. Brett has been selling and serving fine tea in Seattle since 2001. He is an active tea educator and the author of Black Dragon Tea Bar blog. You can visit Brett and his friend Cinnabar’s teashop, Phoenix Tea, at 902 SW 152nd St in Burien, WA, or visit their online store.

Puer tea (普洱茶), from Yunnan (雲南) province in southern China, comes in two forms, raw puer (sometimes called green puer or sheng cha) (生茶) and ripe puer (sometimes called black puer or shu cha) (熟茶). The complex flavors found in a cup of puer tea are the result of many variables, such as where the tea was grown, the quality of the leaf, the manufacturing conditions, and the vintage. The form of the tea (loose leaf or compressed into shapes) does not necessarily indicate quality.

Raw puer is prepared from sun dried green tea leaves and is primarily handmade. The leaves are sometimes sourced from organic or wild tea bushes. Old tea trees, which can be well over 100 years old, are also sometimes used to make very fine teas. After the leaves are processed and sorted, they will be compressed into cakes, bricks or other shapes by heavy molds. Raw puer gets darker, richer and smoother if aged slowly in dry conditions. When a raw puer is approximately 1 to 5 years old it will probably still taste like a fresh herbaceous green tea with varying degrees of sweetness, smokiness, and complexity.

Ripe puer can be purchased loose leaf, or compressed into cakes and bricks. Ripe puer differs from raw tea because it has a pile fermentation step included in its manufacture. This is a carefully controlled process that results in a dark and earthy brew. Young ripe puer (1 to 5 years old) is often not very smooth and may still have a harsh odor left over from fermentation. Loose leaf ripe puer tends to taste fuller and smoother sooner, because it has more leaf surface exposed to air. Compressed teas, on the other hand, will mellow slower, depending on how tightly they were compressed and how thick they are.

Both styles of puer tea will get better with age if they are stored properly (ie. dry, dark and away from any odors). Ripe puers are made to be enjoyed sooner, and thus the vintage does not play as important of a role as it does with raw puer. In fact, some puer experts have written that ripe puers do not improve after reaching a certain point. This is in contrast to raw puer, which seems to get better indefinitely as long as storage conditions remain ideal.

Collecting and aging raw puer cakes is a rewarding hobby for many tea lovers. I, for one, enjoy experiencing the tastes of a tea as it changes over time. I also like to keep a scrapbook of the beautiful wrapping papers used to store the cakes. Puer tea has the wonderful ability to bring people together and help them to relax. It is the ideal brew for many unforgettable tea tastings.

Brewing Tips:
Puer can be prepared as if it were a black tea using Western-style tea brewing parameters to very good effect, but for the best possible flavor it should be brewed gongfu style in a small Chinese vessel, such as a gaiwan (a covered cup) or a yixing clay teapot.

To begin, rinse your teaware with boiling water to clean and preheat it.
If you’re using loose-leaf puer, measure out between one and two teaspoons of dry leaf, if you have a brick or a cake of puer, carefully break off a small chunk roughly the size of a quarter, or if you’re using a mini tuocha, simply remove the paper wrapper because it is already the right amount of tea.
Next, pour water over the tea leaves inside the brewing vessel. I like to use freshly boiled water (about 210º F) for puer tea. Slightly cooler water is fine too and will yield a mellower cup.
Wait a couple seconds, then discard this infusion (this water can be used to rinse your teacups again). This optional rinsing step is called “awakening the leaves.”
After your leaves have been rinsed, take a moment to smell them before pouring hot water over them again. This begins the first steep. It is recommended, when steeping a puer tea for the first time, to start by infusing the leaves for 15 to 60 seconds. Four factors to consider in the length of steep time are: amount of leaf, temperature of water, size of brewing vessel, and personal taste. Ask your tea merchant for their advice when you buy a new puer, and with practice it will become easier to determine.
When time is up, decant all of the tea liquor into a small pitcher to stop the infusion. Now, pour the tea into small cups and relish the unique and wonderful flavor of your creation. You should re-infuse the same leaves many times. Generally speaking, each infusion should be slightly longer than the previous one, but I have found very good results from steeping the second infusion about 10% shorter than the first and the third infusion approximately the same length of time as the first. Then, I will begin to increase the steeping time. As with all things, experimentation and practice is the key.

Many women find that the last few weeks of pregnancy are fraught with a myriad of discomforts. As the baby reaches his or her birth weight many moms find it more difficult to move around and function as they did before. One common complaint at this time is ankle swelling. For some women, it is a mild annoyance that shows up at the end of a busy work day, for others it is more severe. In my own pregnancies my ankles were so swollen that the only shoes I could wear were flip-flops. Thankfully, it was August and the weather warranted the footwear. When women develop swelling in the face and hands it is a more concerning sign, and they should report this to their obstetric care provider. Ankle swelling, however, does not usually cause any harm, but it can be very uncomfortable. In Traditional Chinese Medicine there is a common herbal treatment for the condition that any woman should be able to make at home. As a Westerner, the sound of it may not be very appealing, but it is actually quite good, and it works! In Chinese Medicine terms this formula fortifies the Spleen, disinhibits dampness and scatters swelling.

Li Yu Luo Bo Yin, or Carp and Radish Soup

Ingredients:

1 one-pound Carp (Li Yu), gutted and scaled, head and tail removed (or also skinned if desired)

120g (about one cup) chopped daikon radish (Luo Bo)

 

Directions:

Put the ingredients in a pot and cover with water. Bring to a boil then reduce heat and simmer covered until fish is cooked through. Drink the broth and if desired, eat the carp and radish.

 

 

I have not yet done any posts regarding specific cases in my office but this one stood out to me as a success story that should be shared. It is not uncommon for patients to come to me as a “last resort.” After seeing western doctor after western doctor and getting no results, or being offered a multiple drug regimen with multiple risks and side effects people become frustrated. They want to get better, they think they CAN get better, and they try acupuncture in a “last ditch” effort to get better. These cases are especially exciting to me for two reasons. One, often these are situations in which TCM excels. Whenever someone’s situation is “mysterious” or unresponsive to western medicine, it is often quite responsive to acupuncture and herbs. Two, when they get better, they are so thankful and it warms my heart to know that they have been helped after so much time feeling desperate and frustrated. It is particularly satisfying when they report back to their western physician that they have indeed gotten better with this medicine. It plants a seed in that physicians head that maybe there is something to this Asian medicine.

So, back this case I want to share.

A 27 year old man came to me 2 months ago with a five year history of urinary frequency, small bladder capacity and pain. His bladder could not hold the normal amount of urine and when it became “full” he would have severe, sharp lower abdominal pain that could only be resolved by urinating. He woke 3 to 4 times a night to pee, and had trouble falling asleep due to lower abdominal discomfort. He had been through every western bladder/kidney/prostate test available including a very invasive Cystoscopy. He had been to three different Urologists, none of whom could offer him a diagnosis or a treatment plan. The last of which prescribed him antidepressants. Now, side note, this happens ALL THE TIME. My patient was not the least bit depressed. He had some anxiety around the urination issue, but nothing outside of what would be considered normal considering the intensity of the pain and the lack of diagnosis. I have seen this so often I am no longer surprised when it happens. When western medicine cannot find the cause of a physical problem, patients are given antidepressants. Maybe this was all “in his head”, but this man decided he did not want to take drugs that he didn’t think he needed and sought out alternatives.

During his initial visit I discovered that the man had lower back pain as a result of an injury in which he was run over (!) by an ATV when he was 7 years old. He did not require surgery but several of his lower lumbar vertebrae were permanently damaged. This piece of information would mean nothing to a urologist but it meant a lot to this TCM doctor. In addition to back pain he suffered from knee pain that he chalked up to “getting older” at his mere 27 years. His urine was usually clear, although occasionally cloudy and was slow to come out. His hands and particularly his feet, were always cold. He was always thirsty, for room temperature water, but he was afraid to drink because of the bladder problem. He felt fatigued all the time which he didn’t feel was caused by the night waking.

Urinary frequency can be the result of several different TCM patterns. In this case all signs pointed to one thing: Kidney yang vacuity with blood stasis in the bladder. I was fortunate that his symptoms painted such a clear picture, as this isn’t always the case with such chronic conditions. I believed that the Kidney vacuity was primary, and had existed since that terrible childhood accident, if not before, and the blood stasis was a result of the bladder not functioning well for so long. (Chronic conditions often develop blood stasis over time.)

Treatment was simple. We were to start with acupuncture and moxibustion weekly and would add herbs if we didn’t see results in 6 visits. For you TCM geeks out there I used a combination of BL23, 28, Du4, Ki7, Sp8, Ht7, Ren2, 4, 6, and Ki11 over the course of 6 sessions. I applied moxa to the points on the low back and lower abdomen. The results have been great with progressive improvement after each treamtment. After the first couple of visits he noticed a reduction in the number of times he woke at night to pee. After the 5th he noticed a reduction in daytime frequency and a big reduction in anxiety. After the 6th visit he reported he was peeing around 5 times a day (as opposed to hourly) and he was only waking once a night to urinate with a big reduction in fatigue. Although we have reached our 6 visit goal we have determined that more treatment will be necessary as it would be best if he were not waking at all at night. We will continue weekly treatment until we accomplish that and if it hasn’t been accomplished in 3 more visits we will add a granular herbal formula. For the TCM geeks: Jin Gui Shen Qi Wan + Lian Zi, Fu Pen Zi, Tu Si Zi, Suan Zao Ren, Yuan Zhi

In addition to the physical improvement mentioned above, one of the things that stands out to me when I think about this patient is how much his affect has changed in the two months I’ve known him. The first few visits he was somewhat “tightly wound” so to speak. He was visibly uncomfortable, a little defeated in his tone, and all around frustrated. Now when he comes in he is downright cheerful and bright. I hope that he continues to improve and that he can get on with being a normal healthy 27 year old with a life that does not revolve around having a bathroom nearby.

 

 

 

At the farmer’s market this weekend I came across this year’s first batch of Stinging Nettles, or Urtica dioica. Nettles are one of those plants that remind me how miraculous the planet is. Just when everyone is suffering from allergic rhinitis (stuffy nose) the plant that treats that symptom is ready for harvest. Nettles have many uses, but allergic rhinitis is what they are famous for. In Chinese Medicine we say that Nettles clear heat and leach dampness, making them suitable for treating phlegm-damp obstructing the nasal passages. Dry them and add them to your Chrysanthemum infusion for a great allergy treatment. They should be used with caution, however, in those with a yin deficient presentation, as they are diuretic (make you pee) and can be quite drying. Another use of the herb is Wind-Damp Impediment, such as arthritis, and historically they were applied topically as a counter-irritant for this purpose. Taken internally, they also treat arthritic conditions or painful, stiff joints.

The whole arial parts can also be cooked as a delicious spring vegetable. They have a very high mineral content making them an ideal food for those with anemia or for those concerned about developing osteoporosis. Here is a recipe for sauteed stinging nettles that I found on Chow.com:

  • 1 pound stinging nettles
  • 2 tablespoons olive oil
  • 1 large shallot, sliced lengthwise and thinly sliced
  • 1 teaspoon kosher salt
  • 4 medium garlic cloves, minced
  • 1/2 cup water
  • Zest of 1 medium lemon
  • Juice of 1/2 medium lemon
  • Wearing thick rubber gloves, clean the nettles by soaking them several times under cold running water, then drain. (Do not touch raw nettles with your bare hands. If you do not have rubber gloves, use tongs to handle the nettles.) Separate the tender leaves from the tough stems, discarding the stems. (Use scissors for this process if you don’t have protective rubber gloves.)
  • Heat the oil in a large frying pan over medium heat until shimmering. Add the shallots and salt and cook, stirring occasionally, for about 2 minutes. Add the garlic and cook until the shallots have softened, about 2 minutes more.
  • Using tongs, add half of the nettles and the water to the pan. Cook, stirring often, until the nettles have begun to wilt, about 2 minutes. Add the remaining nettles and cook, stirring often, until wilted, about 3 minutes more. (Add more water a tablespoon at a time if the pan becomes too dry.)
  • Remove the pan from heat. Stir in the lemon zest and juice. Season with salt and freshly ground black pepper and serve.

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A couple of years ago I posted this about Chrysanthemum tea. I wanted to revisit the topic, as I have been seeing so many patients lately suffering from Spring allergies which are causing itchy, watery, sometimes burning eyes. Chrysanthemum is the perfect herb for this symptom. It clears windheat (itching, burning) and enters the Liver channel, directly affecting the eyes which are ruled by the Liver. It is also useful for headaches caused by allergies. To brew a medicinal-strength infusion of the herb, put a handful of the dried flowers in a mug with about 8 oz hot water. Steep, covered, for a minimum of 10 minutes, preferably 15. This tea will be bitter and adding honey is fine. Another option is to infuse a larger pot of the flowers, then let cool and put in the fridge. Enjoy as a cold tea on warm spring days when allergies are in full effect.

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I rarely tout the value of any given herbal product, but I just have to say a few words about Spring Wind’s Burn Cream. While cooking last night I got a fairly bad burn on the inside of my wrist. (This makes me a “real” chef, just ask Anthony Bourdain) After running it under cold water for awhile, and finishing making, serving and eating the meal, I applied this Burn Cream. Since it is absorbed into the skin, I reapplied it several times before going to bed. I was pretty sure the burn was bad enough that I would be applying the cream several times today. Instead, when I woke up and looked at my wrist, the burn was barely visible. A slight discoloration was still there, but there was no blister, no pain, no signs of the burn from the day before. As with many Chinese Medicine topicals, Spring Wind’s Burn Cream is not an odorless, clear product. Most effective herbal topicals are a little messy, and smell like…..herbs! The smell is not offensive, but you know when you put it on that the product is made with plants and this is a good thing. This is a product that should be in everyone’s medicine cabinet.

 

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The following is a delicious recipe from the book Hungry Monkey by fellow Seattlite Matthew Amster-Burton. It is a family favorite in our house and I make it when I feel the need for some healthy comfort food. The recipe includes star-anise, which is a digestive aid, green onion which helps ward off colds, and and garlic, which does both. I highly recommend giving this easy, delicious recipe a try.

Sticky Chinese-Style Spareribs
From Hungry Monkey by Matthew Amster-Burton

serves 4

1 rack pork spareribs (about 3 1/2 lbs), trimmed and cut into individual ribs
1 bunch scallions, cut into 2 inch lengths
4 cloves garlic, smashed and peeled
2 star anise
1/4 c rock sugar or 2 Tb granulated sugar
1/2 c soy sauce
1 1/2 c low-sodium chicken broth
2 Tb hoisin sauce
2 Tb rice vinegar

Place all ingredients in a slow cooker and cook on low heat 7-8 hours or until the meat is very tender. Serve with rice.

Tinctures are alcohol-based preparations and a common way of making herbal medicine in Western herbalism. For most plants, alcohol is a better solvent than water, and some herbs have components that can ONLY be extracted with alcohol. In addition, the alchohol acts as a preservative for the plant material, extending the shelf life of the medicine. Some tinctures are made using glycerin or vinegar, although this is less common. Tinctures are quite strong, certainly stronger than infusions and simple Western decoctions. Dosage varies by herb but is generally considered between 5-15 drops, 3-4 times per day. To take a tincture, the drops can be simply taken straight from the bottle, or they can be added to water or another beverage. If alcohol is an issue, for instance for children, the drops can be placed in a small cup of steaming hot water so that the alcohol will evaporate and the herb content will be left. The water can be drunk warm, or left to cool first.

Directions for making a tincture at home, as written in The New Holistic Herbal by David Hoffmann:

1. Put 120 grams (4 ounces) of chopped or ground dried herb into a container that has a tight-fitting lid, such as a mason jar.

2. Pour half a liter (1 pint) of 30% (60 proof) vodka on the herbs and close tightly. (Be sure the herbs are completely covered to prevent any mold from growing on the plant material)

3. Keep the container in a warm place for two weeks and shake it well twice every day. (Be sure to label the jar with contents and date, epecially if you have more than one tincture brewing at a time.)

4. After decanting the bulk of the liquid, pour the residue into a muslin cloth suspended in a bowl.

5. Wring out all the liquid. The residue makes excellent compost.

6. Pour the tincture into a dark bottle. It should be kept well stoppered. (Again, labeled with contents and the date.)

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Infusions

An infusion is a water-based preparation in which a cup of hot water is poured over a teaspoon of dried herbs,  is covered for 10-15 minutes, and then the herbs are strained. I should mention that the difference between a beverage tea, such as a cup of chamomile before bed, and a medicinal tea is that to be considered medicinal the tea MUST be covered so that the medicinal qualities of the volatile oils do not escape in the steam. Because they are also infused for a longer period of time medicinal teas are not necessarily tasty, and honey, sugar or licorice can be added to make them more palatable. The advantage of this method is that it is fast, easy, relatively safe, and very accessible for most people. This is a good method for self-care and the functions of many dried herbs can be found in books and online. The disadvantage is that they are not incredibly strong medicine and there are herbs in which the medicinal components of the plants are not released in hot water alone and must either be boiled for some time or extracted with alcohol.

Decoctions

Like infusions, decoctions are a water based preparation. The difference is that the herb material is cooked in water for an extended period of time over a flame, such as on a stove. The Western herbal technique is to put one teaspoon of dried or three teaspoons of fresh herb material for each cup of water into a pot. The water is then brought to a boil and left to simmer for ten to fifteen minutes. Again, they should be covered especially if the herbs used contain volatile oils. The decoction is then strained and administered while still hot in a single dose.

Chinese herbal decoctions are a bit more complicated. A mixture of anywhere from 2 to 20 dried herbs are combined and put into a pot. If the herbs are especially hard, such as bark, twigs or roots, the plants are either cut into small pieces, or ground into a powder and placed in a muslin bag.  The herbs are covered with about 4 cups of water and left to sit for a bit to soften them up. The water is then brought to a boil and simmered for 40-60 minutes or until 2 cups of water remain. The herbs are strained and the liquid is reserved. The herbs are then covered a second time with 4 cups of water and the process is repeated until 2 cups remain. The herbs are strained and the water is added to the first batch of liquid. The herbs are discarded. The 4 remaining cups of liquid are drunk over the next 2 days, one cup twice a day.

Some herbs are left out of the pot originally and added at the end of the decoction, such as bo he (mint). Some are cooked for much shorter periods of time with a lid (to protect those oils again!) and some are cooked longer to reduce any toxicity that might occur with that particular herb. Due to this, when making a Chinese decoction it is important to know a bit more about the qualities of specific herbs or to follow directions given by a trained herbalist. This means that decoctions have the disadvantage of not being particularly good for self-treatment, but they do have the advantage of being very strong and great for acute situations. They are also very messy, take time and effort, smell up a house, and generally taste terrible. For this reason, many Western clinics no longer prescribe them because compliance with taking herbal formulas is low.

I encourage anyone who has the opportunity, to use a Chinese medicinal decoction at least once to experience it. It is an ancient form of medicine, very effective, and a wonderful experience. A lot of healing is gained when one works closely with one’s own herbs. To look at them dried, sift through them, smell them, try to identify them (is that a dried insect???) and then to smell them cooking before taking them internally is all a part of the healing process. It may not be the most practical way to take herbs on a long term basis, but it will bring someone closer to the roots of Chinese Medicine.

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Around the world there are many different ways in which herbs can be taken to treat physical and emotional complaints. In China, the most common forms of herbal medicine are decoctions, granules, syrups, pills and injections.  Of those, pills have become the most popular in modern Western practices, since many Western patients are not comfortable cooking smelly herbs in their homes and drinking decoctions and granules that taste bitter. Western herbalists use these same methods as well, but also infusions, tinctures and capsules. I would like to take a few posts to describe each of these methods, and discuss the advantages and disadvantages of each.

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