by Shawn Kirby

Since graduating from acupuncture college and starting my own practice, I’ve done a lot of internal questioning and soul searching, looking for answers to the question that sent me to acupuncture school to begin with – what is healing? More specifically, what is my role, as an acupuncturist, in the healing process?

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By Eric Brand

Long Gu and Long Chi are heavy, settling, spirit-quieting medicinals that are called dragon bone and dragon tooth in English. According to legend, the Chinese people are descended from dragons, and dragons play an important role in Chinese mythology. In ancient times, fossilized mammal bones probably were thought to be remnants of dragons, but let's face it, they probably came from some other creatures.

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By Eric Brand

Learning the names of all the medicinals is a daunting task for students of Chinese medicine. Adding to the confusion, some books use different names for the same substances. Why do some books say Mo Han Lian while others say Han Lian Cao, or Zhi Qiao instead of Zhi Shi? Who sets these standards and how do people know which name is preferred?

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by Bob Flaws

Two weeks ago, Honora and I were having breakfast at our hotel in Delhi prior to flying back to the U.S. The TV was on and everyone was watching a live broadcast of the eclipse. I don't know how much attention this eclipse received in the U.S. since it was not visible here, but in India it was major. It was supposedly a once-in-a-thousand-years kind of event. There were lots of pandits on the TV debating the significance of this eclipse. When we came back for lunch several hours later, the live coverage was still on.

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by Bob Flaws

My read this weekend was Desi Sangye Gyatso's Mirror of Beryl: A Historical Introduction to Tibetan Medicine. Desi Sangye Gyatso was the regent for the Fifth Dalai Lama, a.k.a. the Great Fifth. So this book was written during the seventeenth century, However, it has only recently been translated into English by Gavin Kilty. Of particular interest to readers of this blog, the book devotes quite a bit of space and attention to discussing the impact of Chinese medicine on the development of Tibetan medicine. According to Desi Sangye Gyatso, the three main things taken from Chinese medicine were pulse diagnosis, urine diagnosis, and astrology.

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Here we are in 2010. Perhaps it’s good not to be overly concerned or impressed by such moments, since all moments are precious and juicy no matter when they are. That being said, it is hard to believe we are already so far into this century, that we have a mixed-race Harvard grad in the White House, that we are working our way through the worst economic downturn in many decades. Even with all the problems and divisive politics that our nation has, however, I think we have to count our blessings when we look at the devastation in Haiti, Darfur, and other severely poverty-stricken places around the planet. Then, as business-people, we have to think something like “how much more could I help the suffering of the world if I were more prosperous?” So don’t give up! Work on growing your business not just for the sake of your self and your family, but for how much good you could do in the world if you were more prosperous. Think like Bill Gates and Paul Newman!

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By Eric Brand

Last week I did a blog on the importance of accuracy in study guides and clinical handbooks. Study guides and quick references are very commonly used, so it is essential that these study guides present accurate material. Students are frequently the biggest users of these tools, and students tend to have less experience in gauging issues of accuracy and reliability. It is easy for students to memorize incorrect information if the study guide has mistakes, and the heavy use of quick references in clinic makes these mistakes relatively likely to affect patients seeking care.

In last week’s blog, I discussed pocket handbooks and other sources of information; today I’d like to talk a bit about the internet. The internet is an incredible tool because it offers a tremendous amount of free information. On the downside, it is easy to load content on the internet without going through the traditional expert vetting of information that historically went into book publications (the ease of modern self-publishing has caused this problem to bleed into written books as well, of course).

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By Eric Brand

This is the packaging for authentic Japanese ginseng, known in Chinese as Dong Yang Shen. Dong Yang Shen is processed by par-boiling, which causes it to be white on the outside and red on the inside. Its claim to fame is that it tends not to produce heat.

Dong Yang Shen exists in many grades and qualities. Strictly speaking, Dong Yang Shen should come from Japan, but the same processing method is used in China and Korea to make competing Dong Yang Shen products. For Dong Yang Shen, Japan is the authentic growing region and the Japanese product is superior. That said, ginseng can be smuggled into Japan for processing and export and non-Japanese ginseng can be labeled as Dong Yang Shen to fetch a higher price. Consequently, authenticity is the #1 concern when it comes to Dong Yang Shen.

This photo series shows the packaging of authentic Dong Yang Shen. These samples came from a trusted pharmacy in Taiwan and are representative of the authentic product. This photo is the front of the package. Click here for the photo of the back of the package. Click here for a photo of the contents.

By Eric Brand

This is the back side of the packaging of authentic Dong Yang Shen. It indicates the grade (special grade), the weight (600g, one traditional jin), and the number of roots. The lower the number of roots, the larger their size.

Ginseng is often graded by size based on how many roots are required to make one jin (600g, also called a catty). Sizes under 20 are the best, 30 roots per jin is a bit small, 60-80 indicates very small roots. This same grading scale is used for Chinese and Korean ginseng as well. The very largest roots tend to be about 8 or 10 roots per jin. 15 is the most common size for large roots.

By Eric Brand

These are the Japanese ginseng roots that were in the bag shown above. Notice how they are yellowish-white on the outside and red on the inside. Dong Yang Shen is said to get better as it ages. Properly stored, it can be aged for years. The longer it ages, the more harmonious and fragrant it is said to become.

Authentic Dong Yang Shen is slightly expensive, this grade costs about $200 for 600 grams on the U.S. market. I only started eating Dong Yang Shen relatively recently, but I've become a big fan. The flavor is very clear and clean, and the therapeutic effect is excellent.

Given the fact that many American patients have heat, one would think that Dong Yang Shen would be a very popular ginseng here. However, it seems that few people have even heard of it. It is worth learning about.

By Eric Brand

Above is a rather nice photo of Ling Zhi that I took at an herbal marketplace in Guangzhou. When Ling Zhi is cultivated, it naturally gets a very glossy, shiny appearance that almost looks like lacquer. It can also be cultivated to grow in an “antler” shape; this form is called Ling Zhi Rong. The antler form looks like deer antlers rather than a mushroom; it is long and thin with branches at the tip.

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By Eric Brand

When we study Chinese medicine, we cannot help but notice that many of our teachers have a deep appreciation for the classics in Chinese medicine. Most Western students that read books like the Shang Han Lun (On Cold Damage) find them difficult to understand and difficult to incorporate into the modern clinic, yet invariably many of our teachers emphasize that these classical texts are of vital importance. Why is there such a reverence for these ancient classics?

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Or perhaps the 4th world? Hard to say what world it was after 14 days in Bodhgaya, India. At night it reminded me of the dark, wet, noisy, dirty world of the director`s cut of Blade Runner. Though I had been to India before, I did not remember it to be this harsh, dirty, polluted, and difficult for the people who live there...totally in your face. And this is the international epicenter and pilgrimage site of Buddhism, which is in some ways absolutely perfect, but that`s a longer discussion.

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By Eric Brand

These three groups of Chuan Bei Mu all came from the same batch. This Chuan Bei Mu is not sulfured; it cost about $200/kg from a wholesale supplier that sells to many Chinese hospitals (I bought it in Nanjing). It is fairly typical and remarkably similar products can be found from TCM wholesalers in the USA.

I sorted the product into three grades by hand for the purposes of illustration. The two piles on top are true Chuan Bei Mu, the pile on the bottom is Ping Bei Mu. See the previous blog for more information on the difference between these.

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By Eric Brand

Chuan Bei Mu (Fritillariae Cirrhosae Bulbus) is a very prized Chinese herb. It is common in Cantonese culture to consume Chuan Bei Mu as a general tonic for the lungs, and it is often integrated into Chinese herbal teas, desserts, and syrups sold in Hong Kong and Guangzhou. Shops selling Chuan Bei products abound, and even the 7-11s there carry beverages that contain Chuan Bei Mu (some are even made by Coca-Cola- see this blog).

Most practitioners use Chuan Bei Mu for treating cough with dryness and phlegm. Its range of use in clinical medicine is relatively specific compared to its folk medicine use, and most Western practitioners do not realize that a whole complex culture has developed around Chuan Bei Mu in places like Hong Kong. I suspect that any plant that can capture the attention and appreciation of an entire region of people must be an exceptional medicine, and I’ve always liked Chuan Bei Mu.

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by Shawn Kirby

This technique was taught to me by one of the finest men I know, a gentleman, scholar and raconteur, Ted Hall. A veteran of over 25 years in practice Ted is, simply put, the finest acupuncturist I know. As a SWAC student, I fell severely ill in my second year. After quite a bit of TCM acupuncture and herbs, to little or no effect, I went to Ted as a last resort. Ted, a practitioner of Japanese meridian therapy, had me back on my feet and raising hell in three treatments. Previous to those treatments I had viewed Japanese techniques with a jaundiced eye. However, when it comes to my own health (as is the case, I would assume, with most people) it’s put up or shut up, and Ted was the person who helped me. Seeing is believing, and I took every clinic and elective I could with Ted before I left school. One of the hallmarks of Ted’s practice is his extensive use of, and love for, moxa. This little blog, based on his moxa rolling technique, is dedicated to Ted.

Why Roll Your Own?

Considering the number of prefabricated moxa rolls available on the market, the question on your mind is probably, “why bother?” Simply put because you can choose your own brand of moxa, upgrading the quality of moxa in your roll by a factor of ten. Just as you save money by cutting up your own chickens rather than going to the butcher, you can save a lot of money by making your own moxa rolls. With prefab moxa rolls, your hard earned dollar goes to processing and manufacturing costs instead of the moxa itself, which is typically garbage. “So,” you ask, “what determines moxa quality and why should I care?”

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By Eric Brand

I’m working on a blog regarding classical texts in Chinese medicine, so I thought it would be fun to first start with a review on some interesting highlights related to the development of Chinese herbal formulas. Chinese medicine is characterized by polypharmacy, with literally over a hundred thousand recorded formulas that can still be accessed in the modern day. From a few simple combinations to incredibly complex formulas, the sheer effort that has gone into collecting formulas for the past 2000 years is stunning. Let's look at the numbers.

The earliest accurately dated manuscript (168 B.C.E) to include formulas in Chinese medicine came from a nobleman’s burial chamber at Ma Wang Dui. At this time, there was not yet any influence of visceral manifestation or five-phase theory, and the channels and pulses were not interconnected. In the Ma Wang Dui manuscripts, there is a strong influence of sympathetic magic and a far less cohesive picture of the Chinese medicine that we know today.

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by Honora Lee Wolfe

Our general manager, Bruce, asked me to write up part #4 of this series on marketing prior to my departure for India. So while I’m continent-hopping, you can read my thoughts on this very sensitive subject…how to price your services.

I have stated in print that I am, fundamentally, in support of the Community Acupuncture movement in the US, mostly because it brings the benefits acupuncture to a larger group of patients who might otherwise not try it because of financial constraints. That is a worthy goal. (I have heard rumors about something of which I don’t approve if it is true; paying practitioners shamefully low wages to work at such clinics. I hope this is the rare exception to the rule!)

All that being said, some practitioners in the same towns where these clinics exist are saying to me, “We’re getting killed on price by new, young practitioners who are offering lower priced services at community acupuncture clinics. How do we attract patients to our clinics when we charge, in some cases, twice as much per treatment?”

I don’t believe that you necessarily need to lower treatment prices to compete. Consider that not everyone is purchasing the least expensive cars or houses or anything else…even in this economic climate. Most important to remember is that people don’t always or even usually choose health care based on price. These choices are based on trust, results, reputation, and referral. If you look at long-established practitioners, they will tell you that they don’t necessarily lose patients by raising their rates…often just the opposite. Still, it remains tough times for many and almost everyone is looking for ways to save money. Thus, this post is a discussion of pricing, discounts, packages, and all that jazz.

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By Eric Brand

Obviously I’ve been having fun with my new camera the past few days. This photo shows a mixed sample of Fang Ji. Can you differentiate the safe herb Han Fang Ji (Stephaniae Tetrandrae Radix) from the dangerous herb Guang Fang Ji (Aristolochiae Fangchi Radix) in this photograph? It isn’t easy unless you know what to look for!

Guang Fang Ji is a common adulterant of Han Fang Ji. In the past, the two were regarded as interchangeable medicinals, two regional variants of Fang Ji. Their TCM actions were traditionally regarded as the same, but they differ significantly in their chemical constituents. Han Fang Ji (also called Fen Fang Ji or simply Fang Ji) contains an important active constituent called tetrandrin, while Guang Fang Ji contains the nephrotoxic and carcinogenic chemical aristolochic acid (AA).

AA is a major concern for Chinese medical practitioners because it is associated with serious adverse events. AA has been implicated in some high-profile cases of adverse events with Chinese herbs, and as a whole our community remains undereducated on this important issue. Like the aerial portions of Xi Xin, Guang Fang Ji is no longer considered safe for use (for example, it was banned from use in Hong Kong in 2004, and is not allowed in the USA as well). Therefore, practitioners should learn how to differentiate Han Fang Ji from Guang Fang Ji so that the latter can be avoided.

The similar appearance, similar Chinese names, and traditionally interchangeable use of these two items cause them to be easily confused. In fact, they are sometimes mixed together, as in the sample shown here (taken from a clinic in the USA). For this reason, many regions have very strict regulations when it comes to manufacturing products that contain Fang Ji; for example, Taiwanese granule companies are required to use microscopy and TLC testing from several different parts of each batch of raw herbs before the product can be made. This allows the batch to be definitively identified as Han Fang Ji and verifies that it lacks contamination from Guang Fang Ji.

In the absence of chemical testing, the two can be assessed based on their gross appearance if one knows what to look for. Han Fang Ji is powdery to the touch (its alternate name Fen Fang Ji literally means “powdery fang ji”). Guang Fang Ji is less powdery, it feels coarser to the touch. This is particularly noticeable if you break the slice and touch the broken area. Additionally, Guang Fang Ji has more defined and numerous striations, which look like spokes on a bicycle wheel. By contrast, Han Fang Ji has sparse radial striations and its broken surfaces are more even and less rough.

In this photograph, the two pieces at the center of the bottom row are characteristic of the appearance of Han Fang Ji, while most of the other slices are more characteristic of Guang Fang Ji.

By Eric Brand

This is the fruiting body of cultivated cordyceps (this is Cordyceps militaris). It has a similar constituent profile to wild Cordyceps sinensis. In fact, the lab-grown product is often even higher in active constituents than wild cordyceps. However, a glass jar in a lab cannot replicate the high mountain environment of Tibet, Qinghai, and Sichuan, so we cannot assume that its effects are identical to the wild product.

That said, it costs about 100 times less than the true wild product so it is far more practical for clinical use. Nonetheless, most experts believe that it should be considered as a distinct, new medicinal in Chinese medicine. It nearly certainly has medicinal effects, but few would suggest that it is identical to the true wild product.

For a photo of wild cordyceps, click here

For a photo of fake (counterfeit) cordyceps, click here

By Eric Brand

This is the whole herb of Xi Xin. It is the medicinal that most of us are familiar with, but it is no longer considered safe for use. The aerial portions of the plant contain significant quantities of aristolochic acid and should not be used internally.

To learn more, click here, here, and here

By Eric Brand

This is the Xi Xin that should be in all of our clinics. Many Chinese materia medica scholars believe that only the roots of Xi Xin were used in Shang Han Lun times. In fact, the name Xi Xin means "thin acrid," which is thought to be a reference to the thin shape of the roots and their strong acrid taste. Over the centuries, the entire plant became commonly used as Xi Xin, and the whole plant is still widely seen in TCM pharmacies in China and abroad. However, the aerial portions of the plant have significant amounts of aristolochic acid (AA) and are associated with a high incidence of adverse events. The root is largely lacking in AA and is thus considered the safe product for internal use.

In the official pharmacopoeias of Hong Kong, mainland China, and Taiwan, only the root is now listed as the correct item for Xi Xin. If we look at older editions of the PRC Pharmacopoeia, we can see that the whole herb is listed in the 1995 edition, but in the 2005 edition only the root and rhizome are listed. This reflects the discovery of the harmful effects of AA and the trend to eliminate the clinical use of the aerial portion of the plant. Of course, it takes time for the message to get out, so it is not uncommon to still see the whole herb used in both China and the West.

At present, few practitioners understand the issues involved with Xi Xin. It is essential for us all to understand that the root is the product that should be used, not the whole herb.

This is true wild cordyceps. Not to be confused with the fakes from today's earlier blog. This sample came from the pharmacy DXD in San Diego, it was about $112 per liang (37.5 grams) a few years ago. The price has gone up dramatically since then.

This is a closeup shot of the fake cordyceps from today's earlier blog. I think the store in Chicago was selling this stuff for $5 or so for a box of 3 oz. That price is a dead giveaway, and of course the appearance and the flavor of the fake is pretty easy to spot if one knows what the real stuff looks like.

By Eric Brand

Here is a nice specimen of counterfeit cordyceps. This specimen came from a Chinese herbal pharmacy in Chicago. Actually, I found it at the home of several TCM students, who had already eaten most of the box. Fortunately, this is not a toxic adulterant but rather a simple fake- it is made from flour. Needless to say, it has no medicinal value. At least it wasn't priced as high as the real deal!

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By Eric Brand

A few weeks ago, my blog discussing examination texts raised the topic of “study guides,” which all-too-often seem to be more popular with students than actual primary source texts. While it is natural for people to use quick reference materials for fast lookups in the clinic, many of these study guides fail to maintain consistent quality in terms of their information. Regardless of whether one is using a study guide to prepare for exams or to jog one’s memory when treating a patient in clinic, it is essential that practitioners rely on high quality information.

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By Eric Brand

2010 will be an exciting year at Blue Poppy. We will be expanding into new territory, with new product lines and all manners of educational innovations. Originally only a small publishing company, Blue Poppy is now also a major herbal manufacturer and an educational leader. As 2010 unfolds, Blue Poppy will enter a new phase, with huge expansions in our product lines and educational opportunities.

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