COUNTERING THE SIDE EFFECTS OF MODERN MEDICAL THERAPIES WITH CHINESE HERBS

All medical treatments, whether ancient or modern, are associated with a certain degree of risk for adverse effects, often called side effects. In general, the more drastic the intervention, the more likely and more severe the adverse outcomes. Thus, massage therapy and dietary modifications-examples of external and internal therapies which are usually not considered drastic-have relatively few and minor adverse effects. Nonetheless, there are strong massage techniques and radical dietary modifications that can yield adverse effects, even if the overall outcome is positive. By contrast, surgery and potent drugs-examples of external and internal therapies that are usually deemed invasive or drastic-have more frequent and more serious adverse effects. Still, the overall outcome may be far better than if these techniques were not employed or if gentler alternatives were attempted.

Chinese herbal therapies that have been used in China over the past 2,000 years include toxic herbs, herbs used in large doses, and herbs that are intended to produce strong reactions so as to save the patient from a serious disease. A relatively small group of Chinese herbs have been used to counteract the adverse effects of other herbs for many centuries; this aspect of Chinese medical practice has continued with the introduction of Western medical therapies. There was a great increase in this area of Chinese medicine during the 1970's (continuing into the present) as the result of intensive adoption of Western medical therapies for cancer (chemotherapy, radiation, and surgery) which almost always produce significant adverse effects.

PERSPECTIVE

In the practice of traditional Chinese medicine, certain adverse effects of treatments have long been known and accepted; some of the adverse consequences are, in fact, the desired actions:

• Acupuncture may cause pain or bleeding. An acupuncture needle reaction (deqi), described as soreness, numbness, or distending feeling, but interpreted by many Westerners as discomfort and pain, is deemed an essential part of effective acupuncture therapy in China; persistence of this reaction is considered an adverse effect of excessive stimulation. Bleeding was a necessary consequence of some early acupuncture practices (using the needles to lance boils) and remains an intended result of certain techniques
• Moxibustion causes pain and blistering. By the traditional method of application, moxibustion also causes scarring. All these reactions are deemed essential to successful moxa treatment according to the traditional texts.
• Cupping causes pain and bruising; bruising is taken as a sign of good effect;
• Herbs can cause nausea and, if not selected properly, worsening of the disease (or death, according to the traditional commentaries). Further, there can be allergic reactions to herbs. Some herbs used in China are highly toxic, and the dosage of low-toxicity herbs used in some treatments is sufficiently high to produce non-specific toxic reactions, such as dizziness, thirst, and gastro-intestinal distress. In some cases, vomiting, diarrhea, or sweating are intended consequences of the herbal therapies, indicating that the therapy is having an effect.

Little has been done about adverse effects of the physical Chinese medical therapies, other than to administer them in a more gentle manner, an adjustment often made in the West (e.g., use finer needles and less stimulation for acupuncture; perform moxibustion only to the point of heating the skin, with no blistering or scarring, etc.). Avoidance of herbs that are problematic is a common approach taken in the West (e.g., eliminate toxic herbs, reduce the dosage of non-toxic herbs, cease administering herbs that appear to cause a reaction). Still, counteracting the adverse effects of herbs has always been a major concern in China and there is a considerable amount of accumulated knowledge and experience in this field that can be transposed to the problem of countering drug side effects. Modern research has helped expand upon the efforts made by traditional doctors in the past.

Some Chinese doctors have argued that the side effects of herbal therapies actually arise from a failure to formulate a prescription appropriate to the full diagnostic picture and with proper compensation for any herbal toxicities. This view would suggest that well-trained, competent, and experienced practitioners can avoid side effects for virtually all their patients. Such an opinion is consistent with the idea that individual herbs may produce side effects, but that those effects can be reduced through proper formulation. This idea is extended to the administration of drugs in carefully designed formulations (with herbs and/or other drugs). However, it is always possible that individuals will have unique and unpredictable reactions to herbal ingredients within a formula (4, 33). Also, such claims of the ability to avoid adverse effects are an ideal that cannot consistently be met, especially by average practitioners who have limited training and experience.

USING SWEET HERBS TO COUNTER SIDE EFFECTS

A long-standing principle of Chinese medical practice is that sweet-tasting herbs counter the toxicity and adverse effects of other herbs. One of the fullest elaborations of this principle was reported in Anticancer Medicinal Herbs (1) among historical references to the action of Sophora subprostrata (shandougen):

The drug [S. subprostrata] removes toxic materials in many drugs....It is said in the Elucidation of Materia Medica that 'It neutralizes toxicity with its sweet taste and eliminates heat with its cold nature. Toxic drugs are usually hot and sweet, and toxicity is removed spontaneously when combined with drugs that are cold, sweet, and bitter.'

The ability of sweet-tasting substances to counteract toxicity has been mentioned in the Shennong Bencao Jing (ca. 100 A.D.) and relied upon extensively in the formulations of the Shanghan Lun (ca. 220 A.D.), especially in relation to incorporating licorice and jujube. In this case, a concern is mentioned about hot drugs, which was one of the big concerns about the herbs used in ancient times. Hot herbs attained a special status in Chinese medical practice as a result of the concept, developed in Zhang Zhongjing's Shanghan Lun (220 A.D.), that cold was the major disease-causing influence. The principle of using cold-natured and bitter-tasting herbs to counter all kinds of hot toxins was elucidated at least as early as the Neijing Suwen (ca. 100 B.C.). In the event that a cold toxic herb is to be utilized instead, a sweet and bitter taste with warming nature would be the most likely quality of the herb(s) used to counteract toxicity.

Raw licorice root is sweet, bitter, and neutral, and in the same plant family as sophora (Leguminosae; this is the family of beans, also called legumes). It is well known for its toxicity-relieving properties for both hot and cold natured herbs. In the Shoushi Baoyuan (1616 A.D.), it is said that: "licorice is always employed to dissolve all possible poisonous effects of drugs (19)." The detoxifying effect of licorice is described this way in the Oriental Materia Medica (2): "Glycyrrhizin [a major active constituent of licorice] and its calcium salt possess detoxifying action on bacterial toxins (diphtherin, tetanin), poisonous foods and drugs, and toxins of metabolic products. Glycyrrhizin, when degraded, yields glucuronic acid, which in the liver will combine with toxic materials to form glucuronide to produce a detoxifying action."

In the Selected Compilation of Materia Medica, it is reported that: "When extremely hot and extremely cold drugs are prescribed, licorice must be added to mediate the intensity (1)." An example of this technique is represented in the traditional formula Liuyi San (Six to One Powder, referring to the ratio of amounts of the two ingredients). The principal ingredient, talc, is used to clear summer heat and promote diuresis; according to the Chinese-English Manual of Commonly Used Prescriptions in Traditional Chinese Medicine (35): "A small amount of licorice is added to inhibit the cold and slippery action of talc."

Another example is Sini Tang, which contains the toxic and hot herb aconite, along with ginger and licorice. According to the Chinese-English Manual of Commonly Used Prescriptions in Traditional Chinese Medicine, licorice serves to "inhibit the toxicity of crude aconite when it is used together with ginger."

Jujube, a sweet herb commonly combined with licorice in formulas, is described (1) this way in the Annotation of Shen Nong's Herbal: "The herb, being sweet in taste, removes poison of any substance, and is used to harmonize drugs in a prescription." The book Chinese-English Manual of Commonly Used Herbs in Traditional Chinese Medicine (36), lists this action of jujube: "moderate the potency of drugs: for counteracting the toxicity or side effects of potent drugs, such as genkwa, euphorbia, lepidium, etc. Recently, also used for anaphylactoid purpura and bronchial asthma." Among the pharmacological actions of jujube listed in this text is "protect the liver from damage."

The use of jujube to counter side effects of genkwa, euphorbia, and lepidium was evident in the Shanghan Lun formulas. In Commonly Used Chinese Herb Formulas with Illustrations (37), the traditional formula Tingli Dazao Xiefei Tang (Lepidium and Jujube Combination) is listed. The two herbs that comprise the formula are described as follows: "Lepidium is bitter, cold, slippery, and sharp in nature. It opens and drains the lungs, purges fire, and expels sputum. To prevent its violent action from harming the lungs, lepidium is subordinated to jujube, which soothes the stomach and harmonizes the action of lepidium so that normal respiration is not harmed." Genkwa and euphorbia appear together in a single prescription of the Shanghan Lun called Shizao Tang, literally, Ten Jujubes Decoction. According to Formulas and Strategies (3), "The name of this formula is a tribute to the importance of the ten jujubes which are taken to moderate the harsh, downward-draining action of the other herbs, and thereby protect the stomach qi."

The hot, spicy herb evodia is a key ingredient of Wuzhuyu Tang (Evodia Combination); according to Formulas and Strategies: "The envoy, sweet jujube, moderates the acrid, drying properties of the chief and deputy ingredients [evodia and ginger].

Honey, which is sweet and neutral, is described in the Oriental Materia Medica to have these properties: "strengthens the middle warmer, moistens dryness, controls pain, removes toxins." In the text's section on applications, it is mentioned that honey treats aconitine toxification. Aconitine is the main active constituent of aconite, which is the herb that causes more toxicity problems than any other used in China (because of its high frequency of use and high toxicity).

Soybeans are another legume that have a sweet taste and detoxifying quality. According to Chinese Dietary Therapy (48): "For poisoning or untoward reactions caused by taking poisonous food by mistake or hot-natured drugs, take soy bean milk, or soy bean in a decoction made with licorice."

An example of utilizing several of these sweet-tasting herbs together to counter modern drug side effects is the combination of Gancao Fen Mi Tang (Licorice and Honey Decoction) with Gan Dou Tang (Licorice and Soja Decoction), made with licorice, oryza (guya, rice sprout), honey, and soja (dandouchi, processed black soybean; sweet and bitter tasting). In a clinical trial (14), patients undergoing chemotherapy for various types of cancer were administered this combination of herbs or, as a control, just the chemotherapy. Among those receiving the herbs, the white blood cell count either remained above 5.0 (million/liter or thousand/ml) or quickly recovered to that level after chemotherapy in 77% of the patients, and remained above 4.0 or quickly recovered to that level after chemotherapy in 13%. The comparable figures for the controls were 66% and 5% respectively.

Along similar lines, the ancient formula of the Shanghan Lun, Zhizi Gancao Shi Tang, can be adopted to treat adverse reactions to drugs. The formula is comprised of just three herbs: licorice, soja, and gardenia. Gardenia adds a bitter and cooling component to the therapy described above. This prescription has been utilized as an adjunct to cancer therapy in Japan (especially for esophageal cancer, since the traditional use of the herb formula included swellings in the throat), and for reactions to herbs and drugs such as allergy reaction (urticaria) and nausea. Other processed soybean products, such as miso, have the reputation of protecting against adverse effects of chemicals and radiation.

Dolichos, another legume (hyacinth bean), is described (1) in Properties of Medicinal Herbs: "Dolichos is sweet in taste and slightly warm in nature, removes toxic materials of all herbs and plants and is administered through chewing the raw drug or in decoction." A formula used for countering the immune suppression in cancer patients (1) is made with dolichos, astragalus, codonopsis, rehmannia, and tortoise shell (note: all these herbs have a sweet taste). Dolichos is traditionally applied in the treatment of summer heat syndrome, and its action there may be to alleviate bacterial toxins that cause nausea, vomiting, and diarrhea. According to the Oriental Materia Medica, dolichos is also useful for "alcohol intoxication."

Phaeseolus (ludou; mung bean), another legume, is mentioned in the Chinese-English Manual of Commonly Used Herbs in Traditional Chinese Medicine as being able to "relieve metallic and drug poisoning: for preventing and treating the poisoning of lead, arsenic, alcohol, and aconite." Oriental Materia Medica simply states that phaseolus "removes all toxins." A traditional prescription, Mahuang Lianqiao Chixiaodou Tang (Ma-huang, Forsythia, and Phaseolus Combination) uses one type of phaseolus (chixiaodou), along with ginger, jujube, licorice, morus bark, forsythia, and ma-haung to treat pruritis. It was recently shown to treat skin reactions to paint and other toxic and allergenic materials.