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"Psychospiritual Aspects of Herbal Medicine": Ancient and Modern Chinese Traditional Medicine Dr. Michael Tierra O.M.D. Copyright © 1997 Theory and Review

Psychospiritual Aspects of Herbal Medicine	A disease is of greater complexity according to the depth of neurological and emotional involvement. In Traditional Chinese Medicine (TCM), the relationship of disease to an underlying emotional factor may only be implied. Part of the reason for this is because TCM has much finer distinction between the physical and mental
Herbs and Their Corresponding Psycho-Spiritual Properties	spheres but another is that the circumstances of recent Chinese history, namely the materialistic orientation of the communist regime, has caused the Chinese to cut away or obscure centuries of TCM psychospiritual relevancies. This is now beginning to swing back with the greater personal freedom of the Chinese
The Psychospiritual Properties of Non-Chinese Herbs	people as they progress toward a more democratic ideal and a subsequent renewed interest in the ancient classics. Considering that the present educational background of Western trained students and practitioners in TCM is based upon the materialistic model of TCM, how can we rediscover those aspects of diagnostic understanding and classification
Summary	of herbs and treatments that express the psychospiritual elements that has been missing from most of our training? If we consider the broader
About The Author	significance of the organ syndromes we can interpret the mental and emotional aspects that are associated with each as well as restore a psychospiritual understanding of the associated herbs and formulas.
	Let's take as an example the use of the single herb Cyperus rotundi (Xiang Fu) This is a common herb that grows with various species throughout many areas of the world. In fact Western herbalists who do not normally use it (though they should) may be surprised to know that cyperus or "Nutgrass" is as commonly occurring in many areas as other well known folk herbs such as plantain and dandelion. In fact, this native is specifically targeted on the label of home garden herbicides that are commercially sold to help eradicate it from North American lawns. It is quite safe to take internally as demonstrated by the history of Native use who roasted and ate it as food.
	Recently Cyperus was described in a class as an herb that "prevents the fire of the heart from penetrating to the liver". Besides the fact that I have a personal affinity for this herb commonly known as "nutgrass", (it is a close relative of Egyptian papyrus reed), I think this is one of the most interesting herbs to examine in terms of its effects on the emotions. One reason is that ostensibly cyperus has no direct sedative properties but it is in its physio-pharmaceutical dynamics that it becomes invaluable for treating depression and irregular mood swings caused by "irregular liver qi" associated with many imbalances including premenstrual syndrome in women.
	What then is meant by its "preventing the fire of the heart from penetrating the liver"? The Heart in this sense includes the mind and therefore any mental-emotional upsets. Fire comes from the Heart and in this sense is a strong emotional irritation which relates to the mind which is embedded in the Chinese concept of the Heart. The Chinese concept of the Liver includes its ability to regulate the smooth flow of Qi. When the mind is upset various metabolic functions that are responsible for digestion and hormonal regulation are disturbed and impaired.
	What does this infer concerning the psychospiritual indications for Cyperus? In Bensky, its actions and indications are that it "spreads and regulates Liver qi: for constrained Liver qi patterns --- as well as disharmony between the Liver and Spleen" . What is underscored in all this jargon is that cyperus helps to regulate depression and mood swings as well as the relationship between the emotions, stress and the process of digestion and assimilation. This latter function is represented by the Chinese concept of Spleen.
	Now lets examine how this kind of inferred reasoning can be applied to the use of one of the classical formulas. It seems that most emotional imbalances are described in the materia medica under the vague term "neurasthenia". Without delineating the finer aspects of specific emotions, nervous or neurasthenic is mentioned in connection with a number of formulas. One is Pinellia and Magnolia Combination (Ban Xia Hou Po Tang). This is the classic formula for a condition called "globus hystericus or "plum pit throat". This is a peculiar neurological symptom which I have witnessed in a number of patients of something being lodged at the base of the throat. Its cause is purported to be rooted in anxiety, fear or shock. The herbs in the formula, 6 to 9 grams each of pinellia ternata (ban xia), magnolia bark (ho pou), perilla seeds (zi su ye), 9-12 grams poria mushroom (fu ling) and 10-15 grams fresh ginger (sheng jiang) are primarily individually indicated for respiratory and digestive disorders with an accumulation of dampness or phlegm. Pinellia resolves respiratory and gastrological dampness by promoting the energetic downward flow of qi and food which makes it useful for nausea and vomiting. Other indications for this formula further imply underlying neurological and psychospiritual imbalances. They are "hysteria, gastro-intestinal neurosis, esophagiospasm, chronic laryngitis and trachitis" . The sense is that this formula is particularly useful for individuals who are blocked in their expression.
	TCM considers that all internal or chronic disease is caused by one or more of the "seven emotions". These are: anger, shock, joy, fear, brooding, anxiety and sorrow. Each of the Seven Emotions has a corresponding vice and virtue and the job of the healer is to transform the "vice" emotion associated with the disease to its "virtue" counterpart. This is literally described as "cultivating the virtue".
	An important aspect of thousands of classical herbal formulas described in clinical texts over the centuries was for the treatment of possession. These were used for emotional imbalances which were seen as conditions where the individual was behaving in a way that was considered not him or her self. Interestingly, the ancients saw underlying physiological conditions for these emotional diseases that were to some extent treatable with herbal formulas and diet.
	Disease was not considered fully cured until the underlying emotional cause was corrected. For this reason there are thousands of classical formulas dedicated to treating "possession". Other shamanistic methods of healing were also a significant part of Traditional Chinese Medicine as it was in Ayurvedic Medicine in India.
	Today, when we read a symptom such as "tightness or constriction in the chest or costal region" we usually associate this as a mere physical symptom. By inference, however, we learn that as a symptom of "liver qi stagnation", tightness in the chest is commonly accompanied with emotional symptoms of depression and mood swings. The classical Bupleurum and Peony Formula (Xiao Yao San) consisting of 6 to 9 grams each of bupleurum (chai hu), angelica sinensis (dang gui), white atractylodes (bai zhu), 9-12 grams each of paeonia root (shao yao) and poria mushroom (fu ling) and 1 to 3 grams each of fresh ginger and honey baked licorice. This formula which is available as a Chinese patent embodies all the uses of the individual herb cyperus. It regulates the liver and the spleen which represents the relationship of Liver's "qi regulating" function of glycogenesis (storing and releasing sugar into the blood as a constant source of energy) and the regulation and transformation of hormones with the digestion and assimilation of food as embodied in the concept of the Spleen. As such it relieves Liver stagnation and with the presence of dang gui, peony and atractylodes, tonifies blood (which in this case includes hormones).
	Bupleurum and Peony Formula has got to be one of the classic psychospiritual formulas first mentioned in the Imperial Grace Formulary of the Tai Ping Era. The translation of its name "Rambling Powder" according to Bensky , "comes from the title of the first chapter of Zhuang Zi, 'Rambling Without a Destination,' which includes many stories about soaring above restricted world view. similarly, this formula releases constraints and encourages the free-flow of Liver qi, allowing for open-mindedness and a free or rambling spirit."
	Its psycho-physiological indications are depression, mood swings, menstrual irregularities, breast distention, chest constriction, headache, dizziness, dry mouth and throat, lassitude, loss of appetite, alternate chills and fever with a wiry/taut pulse and a pale reddish tongue body. It is commonly used for irregular menstruation, PMS, breast distention and lumps, leukorrhea, menopausal disorders, uterine bleeding and chronic hepatitis.
	The theory of the Six Stages of Externally Caused Disease was first developed by Chang Chung Ching (AD 142-220), one of the most revered clinicians of Chinese medical history. His Six Stages is used even today as the basis for explaining and understanding the progression and location of an externally contracted disease entity. They are Greater Yang, Lesser Yang, Sunlight Yang, Greater Yin, Lesser Yin and Absolute Yin.
	The first Greater or Tai Yang stage is the most superficial and includes the diagnosis and treatment of colds, flus and fevers by releasing the surface layer through diaphoresis. The second Lesser or shao yang stage is when the external pathogenic factor has impressed itself more deeply on the nervous system and assumes a somewhat longer, more chronic phase. At this stage, sweating therapy is ineffective and one must resort to the use of harmonizing formulas that treat both external (acute) and internal (chronic), weakness and excess, hot and cold syndromes. Mostly formulas that are based on the use of bupleurum falcatum are used, especially Miner Bupleurum Combination. Interestingly, however, the previously mentioned "Rambling Powder" described above is also considered a Lesser Yang stage formula because it possesses opposite external-internal, eliminative and tonifying, heating and cooling herbs combined together. This tells us that whether or not the Six Stages was originally intended to include psychospiritual symptomology is irrelevant because many of the formulas first described in Chung's classic Shang Han Lun have been adopted as the basis of Japanese-Chinese medicine (Kampo) and generally have come to be associated with emotional symptomology both specifically stated and implied. It is important to mention that the stages are not necessarily progressive but indicate the depth of pathological involvement.
	Most of the bupleurum formulas associated with the various permutations of Lesser Yang stage disease include the symptom of tightness and fullness of the chest. This can be more purely physiological but in many instances reflects underlying pent-up feelings and emotions.
	Greater or Yang Ming stage, includes more definite symptoms of heat and gastro-intestinal involvement which sometimes includes acute constipation. Heat is associated with pronounced irritability and anger sometimes verging towards mania and psycho-neurosis.
	I remember the first time I discovered the value of a laxative formula for treating and sedating a particularly excess, over heated manic individual. This came after repeated failures trying various sedative herbs with no results. Major Rhubarb Combination (Da Cheng Qi Tang) which consists of 9-12 grams each of rhubarb root (da huang), magnolia bark (hou po) and green citrus peel (zhi shi) and 6-9 grams of sodium sulfate (mang xiao) is used to purge the true heat in the stomach and intestines. In other words, it is an effective laxative (which can also be used as a regulating formula to treat watery diarrhea).
	This is the classic formula for excess that is usually taken for only a few days at a time. However, as anyone who has ever had an enema or purgative may have discovered there is a feeling of inner calm and quietness afterwards that is quite different from the more suppressed drugged feeling of sedatives. The concept of excess heat psychospiritually reflects an extreme state of deep inner fullness and disturbance which if allowed to progress can include violent uncontrollable neurotic symptoms that indeed do represent a deeper level of irritation as a result of unresolved outer conflicts.
	Suspecting that many may not normally consider the appropriateness of adding laxative herbs or the use of this particular formula for these psychospiritual conditions I recommend considering the addition of at least a small amount of a laxative (deeply releasing) herb to any formula when the total emotional picture includes an excess conformation with aggressive or manic tendencies. Even if the stool becomes slightly looser over the course of one to three months, it is still a valuable approach to eliminating deep excess emotional constraint and works better than relying solely on such as valerian, skullcap, passion flower, calcium for instance, for excess individuals. More deficient individuals with extreme emotional irritation and constraint can benefit from a more infrequent addition (perhaps once or twice a week) of a small amount of a laxative herb such as rhubarb root along with a more tonifying approach.
	The three yin stages indicate even deeper levels of pathological penetration and subsequent depletion. They also reflect psychospiritual stages of resignation in the Greater, Tai Yin stage, weakening of the will in the Lesser or Shao Yin stage and finally despair in the Absolute or Chueh Yin stage. One of several formulas effective for all three stages is Prepared Aconite Decoction (Fu zi Tang). This formula consists of 6-9 grams prepared aconite (fu zi), 9-12 grams each of white atractylodes (bai zhu) and poria (fuling) and 3-6 grams of ginseng.
	One might not suspect psychospiritual indications from the physiological indications for this formula which mostly are for coldness and arthritic conditions aggravated by cold and dampness. However, to understand the more subtle indications we might get a clue from the homeopathic indication for aconite which are symptoms caused by shock. Here the sense is of something so threateningly shocking that it literally leaves us in colloquial language 'cold and bent out of shape'.
	We need to ask ourselves whether individuals whose obvious complaint accompanying all other symptoms is coldness, might also experience deep seated insecurities and fears? When the answer is affirmative we have one of the most decisively potent indications for the use of this type of formula whose physiological symptoms can range from the common cold, influenza, to rheumatic and arthritic, edema, cold abdominal pains, apoplexy, bell's palsy, dermatitis, eczema and urticaria. Since most of these symptoms can and commonly do occur without extreme coldness, deficiency and accompanying psychospiritual fear and insecurity, simply reading the overt pathological indications can be very misleading when attempting to decide on whether or not this formula is appropriate.
	The classical Five Elements represents an integrated view of nature and the human condition that reflected ancient Confucian ideals. Through it, climate, directions, organs, colors, sounds, foods, flavors and herbs where all classified in a manner reminiscent of the Native American Medicine Wheel and the four cardinal directions. Emotions are also associated with each of the Elements as well. Further, ancient Chinese doctors such as Sun Szu Mo (Ad 590-682), the Milton Erickson of ancient China, were famous for using the emotion of one element to help transform another.
	Thus, with the element of Wood, anger associated with the Liver is used to transform obsession or off-centeredness associated with the Earth-Spleen; with the element of Earth associated with the Spleen and Stomach, contentment or satisfaction is used to transform the fear of an imbalanced Water-Kidney; caution associated with Water-Kidney is used to moderate the imbalanced over excitement associated with Fire-Heart; joy and playfulness associated with Fire-Heart is used to transform grief associated with the imbalanced Metal-Lungs; sadness associated with Metal-Lungs is used to overcome anger associated with the imbalance of Wood-Liver; anger of Wood-Liver was used to motivate complacency and spaciness of an imbalanced Earth-Spleen. I think one can find in this interesting corollaries in recent times with Ericksonian hypnosis and NLP.
	Herbs and Their Correxponding Psycho-Spiritual Properties
	In Chinese medicine there are a number of herbs that can be inferred to possess corresponding psycho-spiritual properties. There is an entire category of "Herbs that nourish the Heart and Calm the Spirit". They are used for palpitations, anxiety, insomnia from deficient Heart Blood and Deficient Liver Yin.
	The idea of the Heart as the supreme controller of the mind and body and the Liver as the smooth regulator of qi reflects the Chinese psychospiritual perspective. If we consider the heart as the center of consciousness and the liver as its regulator we see how a number of psychological conditions are seen as an imbalance of these functional systems.
	A number of the herbs used in Chinese medicine have acceptable counterparts in the West but are not presently gathered. One is Polygala tenuifolia, called "Yuan Zhi" which translates as "profound will". This herb is classified as having a bitter (clearing), acrid (circulating) and warm energy. It enters the organ meridians of the Heart, Kidney and lungs. It is used to Calm the Spirit and facilitate the flow of heart Qi. It is especially useful for individuals with restlessness and "excessive brooding or constrained, pent-up emotions." Like its North American counterpart, it is also used as an expectorant to clear phlegm from the lungs. However, unlike Polygala senega, the expectorant properties of Chinese polygala are its third level of properties while the Western Senega Snakeroot was primarily used as an expectorant. Interestingly, according to Vogel, Senega snakeroot was "the chief remedy for heart trouble among the Potawatomis and Meskwakis".
	Other Calm Spirit Herbs that can be found growing in North America are as follows:

	Semen Biotae or Arbor vitae seeds --- these are useful for irritability, insomnia, forgetfulness, palpitations and anxiety caused by Deficient Heart Blood.
	Mimosa tree bark (Albizzae Julibrissin) ---- grown as an ornamental and is used for insomnia, irritability, a sense of constriction in the chest and constrained emotions. The Chinese name "He Huan Pi" translates as "Common Happiness Bark"
	Polygonum Multiflorum ---- The root of this herb is the famous blood and liver tonic, "Ho Shou Wou" commonly misnamed "Fo Ti Tieng". The Caulis or vine is called "Ye Jiao Teng" which translates as "Vine to Pass Through the Night". It is this latter part that is used in this category. The plant is somewhat invasive and easily grown now in a number of North American botanical gardens. It is classified as sweet, slightly bitter with a neutral energy, entering the heart and liver. It is especially useful for dream-disturbed sleep.
	Common Western Skullcap (Scutellaria laterifolia) ---- is simply classified as a nervine in Western herbalism. However, Western herbalists find that if the leaves of this herb is taken in sufficient dosage and frequency (every two hours) it is very effective for treating addictions. Chinese skullcap (S. baicalensis) uses the more substantial root more for its anti-inflammatory damp heat drying properties.

At first one might think that these are altogether different species with different properties. While that is true to a certain extent, from another perspective, we see that Chinese skullcap also enters the Heart (along with the Lung, Gall Bladder and Large Intestine) which suggests that it also has a role in effecting the mind and consciousness. In this case by clearing heat and detoxifying it helps calm excitability just as Western skullcap detoxifies drugs and other toxins from the blood that perpetuate addictive tendencies and unrest.

Chinese Asparagus root (Asparagus Cochinchinensis) ---- called Tian Men Dong, is the root of an herb classified as a lung and kidney yin tonic. It has both sweet and bitter flavors and a cold energy. It is used to replenish the vital essence and promote the secretion of body fluids. It also has expectorant and mild laxative properties. As a 'sweetish' flavored yin tonic it is thought to foster the energy of tolerance and compassion. For this reason, Chinese pharmacists would always reserve the sweetest root for their personal use. I have recently identified a species of this valuable plant (Asparagus sprengeri) as a common ornamental easily grown and available from nurseries as "asparagus fern".

Licorice root ---- is commonly used as a tea for Buddhist monks. Called 'the Peacemaker' herb by the Chinese because of its anti inflammatory cortisone-like properties, licorice root tea helps calm and prepare the mind for meditation. It is possible to cite countless further examples comparing herbs described in the Chinese Materia Medica with comparable ones used in the West.

	Sometimes, in order to understand the emotional property of an herb we have to read into the description of its physical indications. What sort of emotional makeup would you consider a woman with a "pale, ashen face, complaining of tinnitus, palpitations and irregular menses" to have? What about a man who is described as having "shallow respiration, cold limbs, low energy, palpitations, anxiety, forgetfulness and possible insomnia? Both of these are physiological descriptions taken from Bensky's book. The first are indications for the use of Dang Gui while the second is for ginseng.
	I can easily foresee when differences between Western and Chinese herbalism will be less obvious. This is because if Western herbalism has any hope of succeeding as an accepted clinical model in the West it will be through a combination of the diagnostic methods of TCM in combination with simpler Western naturopathic medical diagnosis. Further, increasing numbers of Chinese medicinal herbs are now beginning to be cultivated in North America and finally, non-Chinese herbs will be classified to conform to the evolved Chinese diagnostic system. There is already a good start considering that most of the common Western herbs regarded as "weeds" such as yarrow, plantain, dandelion and chickweed are also used in Chinese folk medicine despite the fact that most are infrequently used in 'official' clinical practice (perhaps out of professional snobbery or exclusiveness) by Chinese herb doctors.
	The Psychospiritual Properties of Non-Chinese Herbs
	To understand the psychospiritual attributes of Western herbs they must first be classified to conform to the Chinese diagnostic system by applying Chinese energetics and organ/meridian classifications to non-Chinese herbs. Then the understanding of the psychospiritual effects of Western herbs can be better understood in terms of the emotional significance of Western herb properties.
	To begin, let's review the principles outlined in Planetary Herbology. The energetic heating or cooling properties are determined by relating the properties with their flavors and ultimate effects. In this, the flavors alone are not reliable since, for instance the spicy flavor is considered heating but then there are also spicy-cool herbs that are cooling such as echinacea. This is because the ultimate effect of echinacea is as an anti-inflammatory.
	Organ/meridian assignments are based upon the affinity between an herb and a particular organ. What the TCM regards as Meridian assignments is dynamic functional organ processes as it relates to herbal usage. This becomes a rich input to the understanding of a non-Chinese herbs sphere of usage.
	Following is a brief overview of associated organ/meridian symptomology:

	The Heart includes the mind and consciousness, the Small intestine is its yang counterpart and refers to the absorption and circulation of nutrients or the 'separation of the pure from the impure'.
	The Kidneys include the entire endocrine system while the Bladder is involved with more purely diuretic functions.
	The Spleen represents general metabolic and assimilative capacities while the stomach relates to the more superficial aspects of digestion.
	The Lungs are involved with the circulation of qi, oxygen metabolism and the discharge of metabolic waste such as carbon dioxide from the lungs.
	The Colon is the Lungs yang compliment and is responsible for elimination of waste.
	The Liver is responsible for regulating digestive, hormonal, and bodily processes. The Gallbladder moves bile and clears heat.

	This is a greatly abbreviated summary of particular aspects of organ meridian function. For a more complete description of organ syndrome functions I would recommend referencing Chinese-Planetary Herbal Diagnosis.
	We can then consider the psychospiritual qualities of non-Chinese herbs by following the same inferential processes as we consider the Western herbal properties and their psychospiritual effects. Following is a list of some of the more relevant frequently used Western herbal properties with representative herbs:

	Diaphoretics: opening, relieving surface tension. Indications: colds, flus, fevers, nervous tension. Herbs: lemon balm, catnip, mint, yarrow flowers
	Alteratives or blood purifiers: releasing, purifying, detoxifying. Indications: toxic conditions, infections, inflammations. Herbs: red clover, dandelion root, burdock root, stillingia.
	Cholagogues (bile discharging): pent up feelings and emotions, frustration, unresolved anger, hostile aggression. Indications: hypertension, liver disease, gastrointestinal problems, heart problems, constipation. Herbs: barberry root, leptandra, artichoke leaves.
	Laxatives: letting go, blocked, extremely irritation and anger. Indications: constipation, hepatitis, appendicitis. Herbs: rhubarb, cascara, buckthorne.
	Demulcents and emollients: soothing, nourishing. Indications: for irritating pains, dryness, ulcers and to promote healing. Herbs: marshmallow root, slippery elm, comfrey root, acacia
	Diuretics: inflexibility, rigidity of thought. Indications: edema, rheumatic complaints, bodily stiffness, urinary problems. Herbs: parsley root, gravel root, pipsessewa, uva ursi.
	Nervines and antispasmodics: tension, anxiety, exhaustion; Indications: insomnia, spasms, anxiety, nervousness. Herbs: valerian, skullcap, lady's slipper.
	Stimulants: lack of drive and motivation, lack of inspiration, dullness, fear, insecurity, feeling of being stuck. Indications: coldness, congestion, diseases accompanied with mucus and phlegm, digestive weakness. Herbs: cayenne and black pepper, ginger, cinnamon.
	Emmenagogue or Blood moving: Not being turned on or inspired, lack of creativity, boredom (also for stimulants). Indications: menstrual irregularities, coldness, painful arthritic blockages, forgetfulness and amnesia. Herbs: angelica, wild ginger, motherwort.
	Tonics: weakness, negativity, vulnerability, unable to understand or assimilate outer influences. Indications: weak digestion, fatigue, coldness, susceptibility to disease Herbs: digestive bitters, ginseng, astragalus

	These are only a few of the properties but hopefully enough to inspire further curiosity and investigation.
	Summary
	Traditionally herbal medicine has been closely associated with treating psycho-spiritual aspects of disease and imbalance. Holistic Planetary Herbalism must deal not only with curing physical symptoms but transforming psychospiritual emotional and personality imbalances that are most often the underlying cause of many chronic diseases. By broadening our understanding of the therapeutic properties of herbs and formulas to include their psycho-spiritual properties, it is possible to add specific herbs and formulas to help remove underlying psycho-physical blockages.
	Obviously, this will result in greater compassion and healing accordingto its finest definition as the integration of body, mind and spirit.
	About the Author
	Dr. Michael Tierra L.AC., O.M.D. is one an internationally respected herbalist and author of several books on herbs and magnet therapy including the best selling Way of Herbs (publ by Pocket Books). He is also the author of the East West Herbal Correspondence Course which is a comprehensive 36 lesson course that the student can complete at their own pace. For information call 1 800 717-5010 and/or check out the course propectus at the Planetherbs website (http://www.planetherbs.com).

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