There are thousands of substances that have been used in Chinese Medicine-plant, mineral, animal, and more. There are many ways to categorize these substances: by plant part, by the Latin names, etc. The traditional Chinese categories are based upon their actions in the human body. This month I will go through the categories (in the traditional order most herbals are written in) and briefly describe what the category does.


Firstly, I'd like to refresh the concept that instead of directly treating a symptom, Chinese medicine looks for the pattern behind the symptom and seeks to correct the pattern, which then causes the symptoms (which may appear unconnected) to disappear. For example, instead of an herb for stomach pain, a practitioner would first determine which cause of several possible causes is behind the stomach pain (through feeling the pulse, asking questions, looking at the tongue, etc.) and then choose the right treatment principle based on their differentiation of the signs and symptoms. Stomach pain could be caused by food stagnation (from overeating) in which case digestive aids would be used. Alternatively, the liver could be overacting on the stomach and the treatment principle would be to calm the liver. This is generally common sense, yet the structure and teachings of Chinese medicine contain centuries of observation and experience that can help us to think about disease in a deeper way.


It is also important to note that there may be a pathogen behind the pattern; the Chinese description and treatment of heat, for example, can line up with a bacterial infection according to modern understandings. It wasn't so long ago (1850's) that Drs. Koch and Semelweiss provided documentation of contagious bacterial diseases. Chinese Medicine had long recognized contagious epidemics, but lacking microscopes they used the metaphors of wind, defensive energy, heat, etc. to discuss them and devise treatments for them. The treatments in many cases work wonderfully-herbs that kill particular bacteria are prescribed for a particular infectious presentation. Observation of the symptoms and response to treatment was the important thing in developing the medical system. Knowing what the particular bacteria looks like and exactly how it is transmitted has been an invaluable advance in medicine around the world. While many people opt to use Traditional Chinese Medicine independent from modern lab techniques, it may be that the traditional herb categorization coupled with microscopes, MRIs, and blood tests will continue to bring both Chinese Medicine and modern medicine to a higher level. I cringe to find myself endorsing the domination of herbal medicine by pharmaceutical companies. However, in the interest of doing the greatest good for the greatest number of people, the more accurately herbs can be dosed, prescribed, and understood, the better medical practice will be. Chinese Medicine does not embrace the revisionist New Age notion that infectious disease is caused by thoughts and not bacteria-there are many causes of disease according to the traditional Chinese theories, including emotions, food, and epidemics. Chinese Medicine does, however, encourage a multi-tiered treatment approach of strengthening the defensive energy, treating the symptoms, and also treating the roots.


With those important points out of the way, the traditional herb categories can be discussed and examined with both respect for the centuries of clinical experience which formed them and also a forward looking view of how they may be understood using our modern understandings. As we go through the 18 main categories and the many subcategories, notice how they progress from external diseases to internal conditions-the order of the categories is not random.

The first category is Herbs that Release the Exterior. The Exterior is the surface level of the body-the skin and defensive shield. These herbs are used to treat the initial stages of colds and flus, and some types of allergies. There are two subcategories-warm herbs which release exterior cold and cold herbs which release exterior heat. Ginger and mint are respective examples of these two categories. While it is an oversimplification, exterior cold is generally what we think of as a common cold, and is likely to be viral in nature. The warm herbs usually are intended to bring on a sweat to push the invading cold forces out. The cool herbs which release exterior heat also induce perspiration, but are more used in cases we'd think of as flus, with a sore throat and feverish feeling instead of chills with a runny nose.


The second category is often needed if the first category fails to abort the invading pathogens. It is called Herbs that Clear Heat, and contains many potent anti-infective agents. Subcategories are Herbs that Drain Fire, which is extreme heat causing fever, Herbs that Cool the Blood, for even deeper, long-term fever, Herbs that Clear Heat and Dry Dampness, which is especially applicable in cases of fever and infection with yellow or green phlegm and/or diarrhea, and Herbs that Clear Heat and Relieve Toxicity, which can be applied if there are toxic symptoms such as boils and rashes or foul-smelling diarrhea. Lastly, this category has the subcateogyr of Herbs that Clear and Relieve Summerheat, which is often clearly linked to bacterial or parasitic infection by food or mosquitoes. This subcategory includes Qing Hao, the Chinese wormwood which is currently one of the most effective substances to treat resistant strains of malaria.


The third category is Downward Draining Herbs, which are varying types of laxatives. Inducing bowel movements is sometimes a life-saving technique, and also can aid the body to expel toxic materials and parasites. There are three subcategories: Purgatives such as rhubarb root and aloe for a general laxative effect, Moist Laxatives such as the Omega-3 rich Cannabis Seeds which are used for dry-type constipation (such as in the elderly and malnourished), and Harsh Expellants which are semi-toxic herbs which cause explosive diarrhea in a pinch.


The fourth category is Herbs that Drain Dampness. These are mainly diuretics for water retention and swelling, though some herbs are also used to treat the fatigue, phlegm, and heavy feelings that can accompany a mold allergy. Many tonic formulas for the digestion contain some of the important herbs from this category such as Fu Ling/Poria as assistants to help counter the effects of damp foods such as sweet, sticky treats and glutinous grains.


The fifth category is Herbs that Dispel Wind-Dampness and mainly is prescribed for arthritis and aching joints which are worse in damp, stormy weather. Some of these are still very useful options for such pain. Others are hopefully falling out of favor, such as tiger bone and dog bone. Tiger bone is not primarily considered a sexual tonic (that would be the tiger penis), but as a remedy for aching bones. While cat bone is usually substituted (honestly or deceptively) today, this is one case where if the plant herbs don't have a suitable effect I would prefer someone to try Celebrex. It is one thing to make a bone-stock with beef bones for the minerals and gelatin most bones contain and another thing entirely to take part in the international smuggling of endangered species. While the differences between the pharmacology of tiger, cat, dog, and cow bones are an interesting research question, efforts would be better spent researching many other areas for the treatment of arthritis, such as exercise, food allergies, and basic nutrition. This category has about 23 herbs in most material medica compilations, and only about 7 of them are animal substances. One of these substances is silkworm excrement and another is snake sheddings, so out of the animal substances, only 2 of them are from endangered wild cats should be retained in the texts as historical examples. It is interesting to note that several rare and unusual substances were dropped from Chinese Materia Medica over time, including such medical wonders as the rope which hanged a criminal and various human tissues. Dried human placenta and carbonized human hair are still mentioned and used to this day and certainly have effects on the body (as hormone supplement and coagulant, respectively).


The sixth category is Herbs that Transform Phlegm and Stop Coughing. This is divided into Cool Herbs which transform Phlegm-heat (indicated by yellow phlegm), Warm Herbs which transform Phlegm-cold (indicated by white or clear phlegm), and Herbs that Relieve Coughing and Wheezing. Tuberculosis once killed 1 out of 7 Europeans, mostly through a long period of debilitating coughing. It would be interesting to find out how effective some of these herbs are for treating tuberculosis. In China today, air pollution causes so many chronic coughs (as does smoking cheap cigarettes). Syrups made with these herbs are used as treatment. According to Chinese medical theory, auto smoke would be likely to induce a nasty sort of phlegm-heat, but not bacterial in origin. Of course the best and true cure is to clean up the air. However, for people in the unfortunate situation of having to live in such crowded, polluted situations these herbs, coupled with a diet rich in antioxidants, may help prevent degenerative lung diseases.


Category seven is Aromatic Herbs that Transform Damp. These are often used for digestive dampness leading to diarrhea or loose stools. Cardamom is one of these herbs, often used as a culinary spice.


Category eight is Herbs that Relieve Food Stagnation-these are probably more needed when the food isn't cooked in a way that facilitates easy digestion (with herbs such as Cardamom, Ginger, or Si Chuan Pepper). Food Stagnation is that terrible feeling that you have overeaten and will be in misery for hours. A couple of these herbs are malted, sprouted grains, which contain many enzymes which help break down starches to simpler sugars and thus speed up digestion. Hawthorne Berry is another herb in this category-sweet Hawthorne candies are available in many Chinese groceries.


The ninth category is Herbs that Regulate the Qi, and are used for a broad variety of syndromes involving Qi stagnation. Citrus peels are prominent in this cateory-there are at least 7 varieties of citrus peel with slightly different strengths and functions. Qi Stagnation is commonly indicated by dull pains, and may be a more severe, chronic type of food stagnation in the intestines. Qi movers are often also combined with Qi tonics, as adding energy and promoting free circulation of the energy is good to do at the same time-if there are Qi blockages and more energy is added, it can make the traffic jam worse, so to speak.


Category ten is Herbs that Regulate the Blood. The subcategories have markedly different functions: the first subcategory is herbs which stop bleeding and the second is herbs which invigorate blood circulation (which could make bleeding worse). There are a variety of types of bleeding, of course, from internal bleeding from ulcers to external bleeding from wounds. Individual herbs are described for different types of bleeding, and often require specific preparation and administration to be effective. Blood movers (the second subcategory) are often given for menstrual pain (especially with clots and dark blood) and are given along with blood tonic herbs.


The eleventh category is Herbs that Warm the Interior and Expel Cold. This situation can arise after a prolonged illness that affects the digestion. The cold usually affects the stomach and is a worse condition than either food stagnation or digestive Qi stagnation. It often can be thought of as extinguishing the digestive fire-these herbs are used to stoke the fire more. This type of cold can have body coldness, deep paleness, clear vomiting or watery diarrhea. Dried Ginger, Cloves, and Aconite are all in this category.


Chinese herbal medicine is most famous for its tonic herbs-Ginseng for Men, Dang Gui/Tang Kwei , and Astragalus for the Defensive energy. Tonic herbs make up the 12th category, and are divided into Qi tonics, which often work through the digestive glands to increase the creation of Qi from food but sometimes act as supportive stimulants on their own, Blood Tonics, which can help for certain types of anemia with paleness, weakness, shortness of breath, or menstrual problems such as infrequent or scanty menses. Herbs that tonify Yin are the next subcategory of the Tonics, and are moistening and fluid-building herbs useful for dryness symptoms (including chronic dry cough) and repletion of various body fluids, including the sexual fluids. The last subcategory is the Yang Tonics, which are the heating tonics most often associated with an aphrodisiac function. This includes Deer Antler, Horny Goat Weed, Cordyceps, and Walnuts.


Category thirteen is Herbs that Stabilize and Bind. Many of these are astringent herbs which stop sweating, diarrhea, lack of bladder control, spermatorrhea, and other leakages. Before returning someone to health and strength through tonics, it is important to plug the holes and stop an abnormal leakage of fluids. Otherwise, the tonifying herbs will just leak out before they can have a lasting effect.


The fourteenth category is Herbs that Calm the Spirit. These are often used for mental disoders from mild anxiety/insomnia to various types of dementia. The first subcategory is Herbs that Anchor, Settle, and Calm the Spirit. Most of these are minerals, not plants. Some of them are calcium supplements, which can aid in anxiety, heart palpitations, and insomnia from mineral deficiency. Oyster shell and dragon bone (now heat-treated cow bone powder, but formerly dinosaur fossils) are representative of this function. Cinnabar, which is a combination of mercury and sulphur, can definitely cause lowered mental function via mercury poisoning, which can cause "Mad Hatter's Disease." This is a definite case where using traditional Chinese herbs without investigating their modern chemical functions can be lethal. Mercury, unlike mint, is NOT on the "Generally Recognized as Safe" (GRAS) list. The second subcategory is Herbs that Nourish the Heart and Calm the Spirit. These are all plant substances which can help some emotional and mental conditions, especially if accompanied by chest discomfort and palpitations. Of course, heart conditions should be under the care of a "normal" physician, if only for diagnostic monitoring via EKG, etc.


Category fifteen is Aromatic Substances that Open the Orifices. Some of these are like smelling salts that restore consciousness. Calamus (Shi Chang Pu) is a psychoactive stimulant that can be helpful in small doses but excessively altering in large doses.


The sixteenth category is Substances that Extinguish Wind and Stop Tremors. These are used for conditions ranging from epilepsy to Shaking Palsy (the original name for Parkinson's Disease) and paralysis. Some of these lower blood pressure, which can help prevent strokes and seizures. Others, including Scorpion and Centipede, have neurotoxins which in small doses can reduce otherwise uncontrollable tremors.


Category seventeen is Herbs that Expel Parasites-a more important category than most Americans think. Parasites can be at the root of many long-term debilitating conditions, and parasites can set in opportunistically when an organism has been weekend from other diseases or aging. These were the first herbs used with the intention of killing infectious organisms, as the organisms are usually visible to the naked eye. They are for short term use, though one of them is a popular recreational herb in South East Asian countries-Bing Lang, or Betel nut. While the preparation of the recreational Betel nut from the pharmaceutical Betel nut, they both have some anti-parasitic effect, which is a potential benefit from the red nuts chewed and spit by many Asians in the same vein that Westerners will chew tobacco. It has similar negative effects on dental health, including increasing of oral cancers. It has a short-lived stimulant buzz and an acrid taste.


The final category is Substances for External Application. Many of these are for itching, rash, and fungal infections, though others are to treat pain or increase local circulation, such as camphor. Some of these, such as Arsenic, may be useful for fighting specific types of skin infections when used for a short period of time under careful supervision for toxicity reactions. Even so, if the less toxic herbal treatments don't work, many patients would wisely opt for the current Western dermatologic substances with similar function but less toxicity. For chronic, unresponsive, or subclinical complaints with the skin or a certain area of the body damaged by trauma, certain preparations of these herbs, such as the Dit Da Jow from various martial arts traditions, can be superior agents to assist in healing of soft-tissue or skin injuries.


Those are the 18 categories and the numerous subcategories of Chinese herbal medicine. In the study of TCM, most students spend at least a year studying the main herbs in these categories singly, then another year or so studying the formulas, which have similar categories but are themselves combined of groups of herbs from these 18 categories.