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Classical Texts of Traditional Chinese Medicine

The Yellow Emperor's Classic of Internal Medicine

It is difficult to fathom that an ancient text dating back two millennia could be relevant in this time of modern medicine and hyper-accelerated scientific advancement; however, it has been proven so through recent scientific studies. The Yellow Emperor’s Cannon on Internal Medicine contains many herbal formulas and insights that practitioners of Chinese medicine rely on heavily to this very day.

One example is Restoration Powder herbal formula (Zai Zao San) used to dispel pathogenic exterior Cold through sweating. A clear explanation of “the symptomatology of Wind-Cold was discussed by Zhang Zhong Jing in the Discussion of Cold-induced Diseases (c. AD 220)…” ( http://www.giovanni-maciocia.com/articles/flu.html) which describes viral infections such as colds and influenza in detail. The formula contains, among other herbs, astragalus, ginseng, and fresh ginger.

Astragalus is the main ingredient in Zai Zao San and a 2013 Journal of Animal Science Biotechnology article investigated astragalus polysaccharide (APS) in vitro and in vivo and the possibility of it enhancing immunity and inhibiting H9N2 avian influenza virus in chickens. The study states that "Antibody levels for the APS treatment groups were significantly increased, and at a greater rate, than was observed for the untreated group seven days post-challenge with H9N2 virus". Additionally, the study concluded that at proper doses APS can drastically reduce the proliferation of H9N2 virus, promote cell growth, and enhance anti-H9N2 activity.

The second botanical listed in Zai Zao San is ginseng. Ginsenosides are steroidal glycosides contained exclusively in ginseng and are the active compound credited for the medicinal benefits of ginseng. A recent study published in The Journal of Ginseng Research demonstrated that the anti-viral activities of ginsenosides may provide a viable therapeutic option for the treatment of a number of viral infections; the study implied that the actions of ginseng were comparable to commonly used anti-viral pharmaceutical drugs on the market today.

As for ginger root, a study published in the 2013 Journal of Ethnopharmacology demonstrated how fresh (but not dried) ginger is effective against Human Respiratory Syncytial Virus (HRSV) by blocking HRSV induced plaque formation on airway epithelium; HRSV is a major cause of lower respiratory tract infections (http://www.cdc.gov/rsv/). Because ginger inhibits viral attachment to the lining of the respiratory system, the HRSV cannot be internalized and the viral infection is avoided.

Knowing the mechanism by which these herbs “expel evil pathogens” does not make them any more effective; however, the scientific validation may increase acceptance of Chinese herbal medicine, thus benefiting more people. This small sampling of evidence based material supporting the efficacy of classical Chinese medical texts demonstrates the value of additional research. The correlation of newly emerging studies of Chinese medicine cross referenced with ancient classic texts will help to bolster the credibility and the practice of Chinese medicine.

The Shang Han Lun

The Shang Han Lun is regarded as one of the four major classic texts of Chinese medicine; it embodies the medical knowledge of the Eastern Han dynasty (25-220 AD) and was believed to have been authored by Chang Chung-Ching. As the first text in Chinese medicine to adopt the Six Channels as a basis for diagnosis, it skillfully explains the causes and patterns of externally contracted disease. While the writings and theories of the Shang Han Lun were developed in ancient times, the herb formulas and treatment strategies are still relevant today as proven by recent scientific studies.

Chinese licorice, or Glycyrrhiza uralensis (gan cao), is an important Chinese medicine, and Licorice Combination (kan tsao tan) is featured in the Shang Han Lun as a remedy for external pathogenic evils. External pathogenic evils would include viral, bacterial, fungal, or parasitic pathogens. This “combination” is actually a simple remedy consisting of only gan cao, but the herb is also featured in many other formulas and combinations in the book. It has become clear through modern research how this one herb could be so relevant in a book focused on external pathogens as it has a strong effect on the immune system. A 2015 study in the International Journal of Biological Macromolecules isolated several polysaccharides showing the antioxidant activity of Chinese licorice. Polysaccharides compounds are widely found in herbs used for immune disorders, and phyto-antioxidant compounds have recently been shown to speed recovery in cases of influenza. Further evidence of gan cao’s benefits on the immune system are shown through a 2014 study in China that explains how flavonoids contained in gan cao are credited for anti-inflammatory effects through the modulation of cytokines secreted by macrophages.

Another popular herbal formula from the Shang Han Lun called Minor Bupleurum Decoction (xiao chai hu tang wan) has also been the focus of multiple immunological studies in recent years. A 2014 article published in the Pakistan Journal of Pharmaceutical Sciences suggested that Minor Bupleurum Decoction had an anti-tumor effect on esophageal cancer. Another promising use of Minor Bupleurum Decoction is in the case of viral myocarditis. Viral myocarditis is an inflammatory heart condition that can impact people of all ages resulting in everything from mild symptoms to death. One study suggests that myocarditis is the cause of sudden cardiac death in 8.6% of adult cardiac deaths. In young adults, up to 20% of all cases of sudden death are due to myocarditis. A study carried out in 2000 indicated that the decoction regulates T lymphocyte subsets, influences anti-cardiac antibody production helping to clear the virus, and suggests that Minor Bupleurum Decoction can play an important role in treating viral myocarditis.

In addition to Chinese licorice, cinnamon (rou gui) and ginger (sheng jiang) are featured in many formulas of the Shang Han Lun and have been the focus of a multitude of studies in recent years. One of those studies focuses on a common condition known as giardia which is a common parasitic infection often affecting children. The most common drug of choice for the condition is called Metronidazol (MTZ) which contains toxic chemicals and is not ideal for the treatment of children; additionally, giardia is becoming resistant to MTZ. A study conducted in 2014 conducted on mice and published in the Iran Journal of Parasitology suggests that extracts of cinnamon and ginger are a promising natural substitute for MTZ.

In a time of “super-bugs” and resistant strains of pathogenic viruses, parasites, and bacteria, it would make sense that additional studies of herbal medicines would be warranted, especially when considering the large body of scientific evidence suggesting that Chinese herbs can play a significant role in protecting our health from an ever-growing threat of pathogenic infections and immune-related diseases. While these are but a few of the countless studies that have been published in professional medical journals featuring the herbs and formulas of the Shang Han Lun, they help to demonstrate that this historical text will remain an important resource for modern Chinese medical practitioners in to the future, and will continue to offer herbal treasures and effective treatment strategies for many modern medical needs.

References:

Chang J., Wang K., Yeh C., Shieh D., Chiang L.: Fresh ginger (Zingiber officinale) has anti-viral activity against human respiratory syncytial virus in human respiratory tract cell lines. Journal of Ethnopharmacology 2013 Jan 9; 145(1):146-51
Hongtu, W. (1999) Clinical Applications: The Yellow Emperor’s Canon of Internal Medicine: Beijing, China: New World Press p. 128-131
Jae-Hyoung S., Hwa-Jung C.: Antiviral activity of ginsenosides against coxsackievirus B3, enterovirus 71, and human rhinovirus 3: Journal of Ginseng Research 2014 Apr 29; 10.1016/j.
Kallon S., Li X., Ji J., Chen C., Xi Q., Chang S., Xue C., Ma J., Xie Q., Zhang Y: Astragalus polysaccharide enhances immunity and inhibits H9N2 avian influenza virus in vitro and in vivo. Journal of Animal Science Biotechnology 2013 Jun 21; 4(1):22.
Veith, I. (1949) The Yellow Emperor’s Classic of Internal Medicine: Berkely, CA: University of California Press p. 51-55

Chung-Ching Chang (Author), Hong-Yen Hsu (Author), William G. Peacher (Author): Shang Han Lun: Wellspring of Chinese Medicine Paperback – April, 1995: pages 167-208.
Greta Young and Robin Marchment BA(Hons)Monash Adv Dip HS(Acup) ACNM Dip Lang(Chinese) Dip Chinese Herbal Medicine SSNT Cert Gynaecology(China): Shang Han Lun Explained, 1eJan 7, 2009
Zhang CH1, Yu Y1, Liang YZ2, Chen XQ1: Purification, partial characterization and antioxidant activity of polysaccharides from Glycyrrhiza uralensis. International Journal of Biological Macromolecules. 2015 Jun 5;79:681-686. doi: 10.1016/j.ijbiomac.2015.05.060.
Liu Z, Zhong JY, Gao EN, Yang H.: Effects of glycyrrhizin acid and licorice flavonoids on LPS-induced cytokines expression in macrophage. Zhongguo Zhong Yao Za Zhi. 2014 Oct;39(19):3841-5.
Meyer M1, Jaspers I2: Respiratory protease/antiprotease balance determines susceptibility to viral infection and can be modified by nutritional antioxidants. American Journal Physiology Lung Cell MolPhysiol. 2015 Jun 15;308(12):L1189-L1201. doi: 10.1152/ajplung.00028.2015. Epub 2015 Apr 17.
Li X1, Sun M2, Zhao Z3, Yang J3, Chen K3: Research on effect of minor bupleurum decoction of proliferation and apoptosis of esophageal cancer cell strain eca-109 cell. Pakistan Journal Pharmacology Science. 2014 Sep;27(5 Suppl):1675-9.
Kallon S., Li X., Ji J., Chen C., Xi Q., Chang S., Xue C., Ma J., Xie Q., Zhang Y: Astragalus polysaccharide enhances immunity and inhibits H9N2 avian influenza virus in vitro and in vivo. Journal of Animal Science Biotechnology 2013 Jun 21; 4(1):22.
Zhongguo Zhong: Myocardial protection and immunoregulation of minor bupleurum decoction and its decomposed preparations on coxsackie B3m viral myocarditis in mice. Xi Yi Jie He Za Zhi. 2000 Aug;20(8):599-602.
Wang X1, Liu F, Wei K.:Schultz JC, Hilliard AA, Cooper LT, Rihal CS. Diagnosis and Treatment of Viral Myocarditis. Mayo Clinic Proceedings. 2009;84(11):1001-1009.
Mahmoud A1, Attia R1, Said S2, Ibraheim Z3: Ginger and cinnamon: can this household remedy treat giardiasis? Parasitological and histopathological studies. Iran Journal Parasitology. 2014 Oct-Dec;9(4):530-40.