Chinese Herb Prices

You may have noticed that prices for Chinese medicinal herbs have gone through painful cost increases. We feel the pain too, and have done the best we can to make sure herbs are affordable for your patients. But the reality is that the days of cheap Chinese herbs are gone forever. However this increased cost comes with many benefits. The money goes to pay for:

• Higher standards for correct species identification, correct growing area, herb farms with Good Agricultural Practices (GAP) certification
  
• Herbs free of pesticides and preservatives, including sulfur, as well as testing and documentation.
  
• Exclusive contracts with growers and herbs grown to specification, which ensures fresher herbs. Other pharmacies may buy herbs from distributors with no exclusive contracts, which means they must buy herbs on the open market. The Chinese herb market is huge, and herbs may change hands many many times and sit in storage for months and years before they make their way to the U.S. Fat Turtle is at the tail end of a very short supply chain, from grower to processor to distributor to us and on to you and your patients.
  
• Higher wages and benefits for the workers who labor in the field to grow our herbs, and for the people who wash, slice, dry and package the raw herbs for pharmacy use. Many of us here in the U.S. are aware that our habits of buying and consumption have the potential to be ruinous to the health of our brothers and sisters on the other side of the globe. This awareness has led to the development of fair trade programs for products as diverse as coffee, chocolate, soap and cotton. Although there are not yet any fair trade certifications for Chinese herbs, you can be sure that part of your herb dollar goes to support healthy communities in the environments where they are grown and processed.
  

Chinese Herbal Pharmacy Terms of the Day: Chong Fu 冲服 and Rong Hua 溶化

Chong Fu (chōngfú 冲服) is an instruction typically added to written formulas to indicate that the herb in question should not be decocted, but ingested whole along with a swallow of the herbal decoction. Usually the herb is powdered to make this process easier, so the whole instruction might say yán mò chōngfú 研末冲服, which means "grind to powder and take drenched."

"Take drenched" is the translation from the World Health Organization term set, and it works for me even though it doesn't automatically conjure up an image. I like that we're using two words for two characters.

Herbs that are typically taken Chong Fu-style are expensive herbs like Lu Rong 鹿茸, Ge Jie 蛤蚧, Hai Ma 海马 and Dong Chong Xia Cao 冬虫夏草. (When dealing with an unfamiliar pharmacy or one in which you don't have complete confidence, a savvy herb customer should ask to see the herb in question before it is powdered. Of course, that assumes that you are somewhat familiar with how to differentiate authentic herbs and different quality levels - for more on these topics, keep an eye on Eric Brand's blog at the Blue Poppy website.)

A similar but very different instruction is Rong Hua (rónghuà 溶化), which simply translates as "melt" or "dissolve." An herb that is marked "Rong Hua" is added to the hot decoction after the cooking process has finished, but should dissolve completely when stirred in. Examples are the gelatins: Lu Jiao Jiao 鹿角胶, E Jiao 阿胶, Gui Ban Jiao 龟板胶. By contrast a powdered Lu Rong will never dissolve, and therefore must be ingested and chased with decoction for the best medicinal effect.

This is part of our ongoing series on Chinese pharmacy terms. Previously we've covered Hou Xia 后下, and we'll be covering more in the future. I would love to see more Chinese medicine doctors start appending these terms to their prescriptions. It makes your prescription more precise, it helps your herbal pharmacy, and it helps your patients!

ACTCM student Brenda Hatley on the U.S. Wushu Team

A student at the American College of Traditional Chinese Medicine has won a spot on the U.S. Wushu team. Her name is Brenda Hatley and you can read all about her at this website.

The U.S. Wushu Team is not super well-funded, so if you can please make a donation so that Brenda can go compete at the Wushu World Games in Turkey this fall!

There is a lot of cross-over between the worlds of martial art and Chinese medicine. Both developed from the same philosophical framework of Yin and Yang, the five phases, bagua, and so on. Many famous martial arts masters were also Chinese medicine doctors. Two that come to mind are Wong Fei Hung and Wang Ziping.

Wong Fei Hung has been portrayed extensively in film and television but is most famous in the U.S. from the Once Upon a time in China film series starring Jet Li. The movies are a lot of fun to geek out to if you are a fan of both martial arts and Chinese medicine - Wong is seen doing martial arts heroics and saving lives with acupuncture. There is even a scene where he educates Western doctors in acupuncture.

Wang Ziping (1881-1973) of Cangzhou in Hebei province, and was an expert in several martial arts including bajiquan, piguaquan and xingyiquan. He was also an expert bone-setter and traumatologist. You can learn more about him at this website. His daughter Wang Jurong also became a well-known martial artist, and his granddaughters are also continuing the family tradition.

My martial arts teacher, Dr. Alex Feng, is also a Chinese medicine doctor, and was my original inspiration for going into the Chinese medicine field. Tom Bisio and Frank Butler are both martial artists with successful Chinese medicine practices, and Tom Bisio wrote a popular book on how to treat martial arts and other sports injuries using Chinese medicine. The list goes on and on.

As a practical matter, knowledge of the body and how it moves is essential in both martial arts and medicine. Observation, timing and sensitivity are all skills that are strengthened and reinforced by cross-training in martial arts and Chinese medicine. If you're studying one, consider studying the other as well.

One of the coolest things we saw at Mayway's facility in Hebei, China -

- the complete process of how a whole herb gets from the field to us here at Fat Turtle. Keep in mind this is leaving out the whole process of quality control in the field, which we'll cover in another blog post. There is a whole host of site visits, macroscopic examination (which essentially means having a master herbalist/agronomist examine the herbs and see if they have the correct morphology), microscopic examination, testing and et cetera to make sure the herbs are the correct species and fall well under the limits for heavy metals, pesticide residue, et cetera.

(We weren't allowed to take pictures inside the facility, which is too bad, because they had some very cool-looking equipment in there - I'll be supplementing with pictures from the internet.)

Once a batch of herbs has been accepted, it goes something like this:

• Herbs are washed with water from Mayway's on-site well, which is quite deep, although I don't remember if they ever told us exactly how deep.
  
• When we were there, they had uncut Ze Xie 泽泻 (alisma) banging around in a stainless steel washer that looked something like a concrete mixer that was open at both ends - roughly cylindrical, with jets of water shooting in.
  
• The next step is soaking - most herbs have to be thoroughly soaked to make slicing possible.
  
• From there it's on to the slicing. Each herb has a particular way it has to be cut. When we were in there blue-suited workers were feeding long uncut pieces of Sang Bai Pi into a machine that looked quite similar to this one. A blade at the end comes down at regular intervals and turns it into the familiar-looking orange and white piece we use at the pharmacy.
  
• From there it's on to drying. Just as there are several different slicing machines for different herbs, there are a few different drying machines. Some can be dried relatively quickly at high heat without any damage - this machine looks something like a huge industrial bread toaster, similar to this thing. Others, like Ju Hua 菊花 (chrysanthemum) and other flowers, have to be dried gently at relatively low temperatures. These herbs are dried on racks in temperature- and humidity-controlled cabinets that look like this.
  
• After that it's off to sorting. We walked in on a roomful of blue-suited workers hand-sorting Bai Zi Ren 柏子仁 (biotae)... huge piles of tiny seeds on stainless steel tables. If they saw one that was off-color, they threw it out. http://www.blogger.com/img/blank.gif
  
• Next, weighing and packaging. There are at minimum three people involved in packaging any one half-kilo package of raw herb. One person scoops an approximate amount into a bag. The next one weighs it and adjusts it to half a kilo. The third http://www.blogger.com/img/blank.gifperson takes the correct-weight bag and seals it, usually in a vacuum process that sucks all the air out. Mayway then takes another step and double-bags, injecting nitrogen into the space between the two bags. This is to cushion the herbs during transport.
  
  Then the herbs get taken downstairs, where they wait until they've accumulated a shipping container full. The herbs are then trucked to Tianjin, the nearest port city, and it's off to Oakland...

What does all this mean? For one, now we understand why Chinese herbs are relatively expensive. It's only because of the low cost of labor that herbs don't cost more than they already do.

It also has important ramifications for the domestic herb industry. High Falls Garden in upstate New York and the Chinese Medicinal Herb Farm in Northern California are producing small amounts of Chinese herbs every year, and at some point we'll need a facility that can process the herbs. Just as the growth of clinical Chinese medicine pushes the growth of the Chinese pharmacy industry, people who farm or gather Chinese herbs will spur an herb-processing industry.

Just as ranchers need slaughterhouses if they raise cattle on any kind of large scale, the U.S. herb industry will need processing facilities if they hope to grow to a sustainable size. What will these facilities look like? Will herb farming ever become a large enough industry to support such a venture? Maybe the answer is vertical integration - a farm with a processing facility on site, owned by the same people. These are important things to think about for the future. If you have any ideas, please share!

Mayway Factory Tour in China

I'm sitting on a plane at LAX hoping desperately to get this blog post off before the crew tells me I need to turn it off. I'm on my way to Beijing, and then on to Anguo, Hebei province, about two hours south and west by bus from Beijing. Mayway is opening the doors to their herb processing facility for a tour! Mayway is one of the oldest and biggest Chinese herb companies in the U.S., and one of Fat Turtle's trusted partners.

Fat Turtle remains open during this time - Annie, Hieu and Yiqun are ready to assist you and fill your orders. I'll be back in a week, hopefully having learned a lot and with lots of pictures to share.

Subscribe to Chinese Medicine Database

Note: today's post comes to us from Jonathan Schell, the driving force behind the Chinese Medicine Database, an online resource for doctors/practitioners, students, scholars, researchers and translators. If you are involved in Chinese medicine on any level and haven't heard of this wonderful resource, you owe it to yourself to check it out.

This was originally a post from the facebook page for the Chinese Medicine Database and has been reprinted in its entirety, with permission.

Today I am feeling especially driven. Maybe it was because I was sick for a week, and maybe it is because of the Tsunami in Japan, but I so passionately want -- to have so many more Chinese medical texts translated! We have the people just waiting to work, but just lack the funds.

I believe that the more texts that we translate, the more face of what we know as Chinese or Asian medicine will be changed. The thing is I need a few hundred people like yourselves to stand with me and bring this to fruition! A number of... you subscribe already, but I ask those of you that don't what would it take for you to subscribe?

I am not asking for me. I have yet to make money on the Database. I ask because what Book makes you salivate enough that you are willing to throw down your $20.00 per month to make it happen? Economy be damned. I believe that we are reaching a pivotal point with our field. We are big enough to be noticed, but not organized enough to fend for ourselves.

And so here it is -- my passionate howl into the vastness of Facebook -- In my opinion we are heading as a profession towards being absorbed. I put a time of 20 years to it. If you talk to people at the schools there is always more emphasis being put on Western techniques and less time in teaching Chinese medicine. The incentives are on merging Chinese medicine with Western medicine. And as with the most recent financial crisis -- we know that the incentives dominate the course of events.

I am not just passionate about the Classics because I am a big history buff, and love to talk about the past. No in fact I am a clinician just like the majority of you. The Classics serve to prod me into other states of consciousness which provides me with alternative insights. But why as a profession should we care about them? Because in my opinion, they are the only leg that we will have to stand on that irrefutably defends the uses for and the mechanisms of Chinese medicine. No person or organization can doubt 2,000 years worth of written material if it is readable in your own language. But if it is another person's language, we in the West have a tendency to think of things as primitive.

So when we are struggling to not be absorbed in 20 years, and we are all struggling -- it will be too late, my friends, to ask that our academics translate the texts to justify our position. There will be no time left, it would be like trying to raise wheat in winter. No, the time to bear the brunt of this work is before we need it, when we are strong and fresh, and not embattled defending our techniques -- loss of this to PT's, loss of that to Chiropractor's, loss of this other thing to MD's.

I am sorry to say that I don't have the $13 million dollars to translate the 400 main texts in my possession, because if I did I would spend it towards that purpose. But each of you has $20.00 and I have $20.00 and over the years 1,000 of us putting together our collective $20.00 will start to make a dent in that $13 million.

In 20 years I want to be able to say to my son, and your children -- "You know -- everyone said it was impossible -- that it would never happen -- but we pulled together as a community -- and WE MADE IT HAPPEN!" That would be truly awesome! And I think would change the face of Chinese Medicine as we know it.

I am one man, with a team of translators ready to work. I ask you whether you believe in the project or not, would you join me -- to say that you were part of it? To say to your children that we made something so amazing happen that it changed the way our profession understands the medicine? I built this system for us, to be used by us, so that we are never in the dark again.

This is what I am passionate about, and the fire to "Get to work" rages inside of me. I am tired of limping along, I want to start this Wonder of the World now!

Register at www.cm-db.com -- each of us can contribute a little bit to this project and together we can make it happen. I give you my word, which in my world means that I will make my word happen.

Mu Xiang Liu Qi Yin 木香流气饮

An acupuncturist called me yesterday and wanted to know more about Mu Xiang Liu Qi Yin. I had never heard of the formula, and we had already established that it wasn't in either the Bensky or Chen formula book, so I did a quick google search. A few scattered references to the formula in one of Macioca's books and a few others came up, but no clues as to the ingredients or dosages. Then I did a search in Chinese. Ta-da!

It's from the Song dynasty text Taiping Huimin Heji Jufang, which also gave us such famous formulas as 四物汤 Si Wu Tang and 四君子汤 Si Jun Zi Tang.

There are actually two formulas given, and as far as I can tell the first one is the original as written in the Song dynasty. The second version has modern dosage amounts (grams rather than liang) so I'm guessing this is the version most people use today.

Here is a translation of the ingredients from the first version of the formula:

• 半夏（汤洗七次）二两，Ban Xia 2 liang
  
• 陈皮（去白）二斤，Chen Pi 2 jin
  
• 厚朴（去粗皮.姜制.炒）、青皮（去白）、甘草、香附（炒.去毛）、紫苏叶（去枝.梗），各一斤； Hou Po, Qing Pi, Gan Cao, Xiang Fu, Zi Su Ye, each 1 jin
  
• 人参、赤茯苓（去黑皮）、干木瓜、石菖蒲、白术、白芷、麦门冬，各四两； Ren Shen, Chi Fu Ling, Mu Gua, Shi Chang Pu, Bai Zhu, Bai Zhi, Mai Men Dong, each 4 liang
  
• 草果仁、肉桂（去粗皮.不见火）、蓬莪（煨.切）、大腹皮、丁香皮、槟榔、木香（不见火）、藿香叶，各六两； Cao Guo, Rou Gui, Peng E, Da Fu Pi, Ding Xiang Pi, Bing Lang, Mu Xiang, Huo Xiang, each 6 liang
  
• 木通（去节）八两。 Mu Tong 4 liang

Here's my stab at the actions:
Original: 调顺荣卫，通流血脉，快利三焦，安和五脏。
Translation: Mediate and organize the Ying and Wei, connect and flow the blood vessels, quicken the triple burner, calm and harmonize the five zang organs.

I'm running out of time here, got to get back to work. I'll translate the rest of it later - including indications and directions. Remember folks, there is a huge amount of information on Chinese medicine that hasn't been translated into English, this is just one formula! Heed the words of Bob Flaws and learn your Chinese - you'll have access to so much more information. It advances the profession and helps your patients too!

Fat Turtle Herb Company Profile on Yosan Alumni Page

Nini and I transferred to Yosan University of Traditional Chinese Medicine from another school, and we're glad we did. Take a look!

Pharmacy Term of the Day: 后下 Hou Xia

When you write a Chinese herbal formula and send it to Fat Turtle, it's a little bit like telling the cook exactly how you want your eggs. Over easy? Over hard? Scrambled? Sunny side up? Maybe you want something fancy like benedict?

This is the first in an occasional series highlighting the special instructions you as a Chinese medicine doctor can give to us, the herbal pharmacy, to make sure your patient cooks the formula correctly.

Today we'll be looking at the term "Hou Xia" (hòu xià 后下). "Hou" means behind or at the end. "Xia" means down, lower, underneath. A crude translation would be "throw down at the end", giving you the picture of herbs saved off to the side and then "thrown down" into the pot when the cooking is nearly done.

Some typical herbs that are packaged separately and labeled Hou Xia are:

• Mu Xiang 木香 Aucklandia Radix
  
• Sha Ren 砂仁 Amomi Fructus
  
• Cao Dou Kou 草豆蔻 Alpiniae Katsumadai Semen
  
• Da Huang 大黄 Rhei Rhizoma et Radix (when used as a purgative - when used as a blood mover Da Huang should be cooked together with all other herbs)

The rationale for preparing herbs in this way is that there are volatile oils in these herbs that cook off very quickly. Cooking for 5-7 minutes can release these active ingredients into the formula, while cooking longer than that boils them off into vapor.

The vacuum packing service that Fat Turtle offers necessarily cooks all the herbs together at once, even Mu Xiang and Sha Ren. Does this reduce the efficacy of these herbs? Surprisingly, the answer is no. In fact, the effectiveness may even be increased.

An article published in the Zhejiang Journal of Traditional Chinese Medicine (浙江中医杂志 Zhe Jiang Zhong Yi Za Zhi, Vol‐9. 2005; Weiqing Liang, Junxian Zheng, Jinbao Pu, Kemin Wei) found that extraction of flavonoids and alkaloids from herbs decocted in vacuum cookers is higher than traditional stove top cooking. The extraction of alkaloids from Mu Xiang from traditional cooking was 0.045%, while with vacuum cooking the extraction rate was 0.094% - more than double.

Ginseng Plant

This is a nice picture of a ginseng plant. Note the bright red berries.