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).

Follow up:

Computers allow easy collection and transfer of data, and it is easy to build databases with tremendous amounts of information. Unfortunately, databases don’t necessarily follow the “bigger is better” model, and it is very common for databases to get loaded with tons of inaccurate, unconfirmed information that ends up diluting the accurate data and compromising the validity of the project as a whole. This problem is not unique to TCM websites- I’ve seen the same thing happen with NIH herb-drug interaction databases and all manners of other applications.

One of my friends from a California school was telling me about a study guide website that is all the rage at his school, he said that many students constantly have it open on their laptop so they can study while in class. This website, called Sacredlotus.com, has a nice design and they seem to have assembled all the information from books like Bensky and Chen into one convenient place (not sure how Bensky and Chen feel about that, but they seem to get away with it). This site has great functionality and they sell a materia medica with nice photos.

Now, I don’t mean to pick on this site in particular, but it is a good example of photos of adulterants and misidentified herbs. Adulterants and misidentified herbs are a systemic problem in Chinese medicine, and it does take a certain degree of expertise to know what to look for. In China, TCM doctors refer to pharmacy specialists for this type of info, and they don’t have the expectation that a doctor will be a jack-of-all-trades expert in both clinical medicine and pharmacy. We have few teachers in our schools that are experts in authentication and relatively little awareness about the scope of issues involved, so it is understandable that many problems in herb identification remain in our community.

Nonetheless, it is important that we make efforts to improve the situation and raise the educational standards. Using the wrong herbs is potentially dangerous and technically illegal, and teaching someone to use the wrong herbs is not really doing the community a service. Since Sacred Lotus specializes in herbal photographs and sells a materia medica based on these photos, it would be better if they had the correct items rather than the adulterants. It is not my intention to single them out- tons of websites, facebook herb groups, school pharmacies and Chinatown shops also stock the wrong herbs. I’ve personally made mistakes in my own earlier work because I didn’t know what I know now back then, and one of my closest early teachers runs a pharmacy that has nearly every adulterant in the book (I’m gradually getting him to switch to the correct items, but he is an old Chinese pharmacist and it is hard for a young white boy like me to get him to change his ways).

The problem of adulterants abounds in China and Taiwan as well. It is a global issue in Chinese medicine, not just something that lags behind in the West. Unfortunately, Chinese herbal medicine isn’t very established in the West, so we will all suffer the consequences if someone harms a patient from the use of the wrong herbs and it generates a lot of bad press. The availability of Chinese herbs in the EU still hasn’t recovered from the fallout from herb mix-ups that caused deaths in Belgium over a decade ago, and even in the USA product liability insurance is limited by those same high-profile cases.

I am just using Sacred Lotus as an example because it is the most widely used free internet resource for this stuff. They also happen to have virtually every mistake that can be made, so their site is a perfect example of how widespread the problems are and why authentication is important. As a bonus, it will be an interesting study in the speed of information exchange on the internet because we can see how long it takes them to learn about this blog, fix the problems and implement changes (if they ever decide to do so).

At any rate, let’s take a look at the identification issues from the sacredlotus.com website:

The Mu Tong entry thankfully has a photo of the safe product Chuan Mu Tong, but Chuan Mu Tong (or its correct English & Latin) is not listed under the alternate names. The item shown is not akebia though it is labeled as akebia. It should be labeled as Chuan Mu Tong, Armand’s clematis (Clematidis Armandii Caulis). The black spots at the center distinguish Chuan Mu Tong. Akebia itself is rarely seen in the USA, most of us have never seen akebia (though it is more common in Japan); we have only seen Armand’s clematis. The incorrect name of Mu Tong is not that big of a deal on the sacredlotus site, but there is one serious problem in their Mu Tong monograph- the toxic AA-containing herb Guan Mu Tong is listed as an alternate name for Mu Tong. Guan Mu Tong is absolutely not an alternate name, acceptable substitute, or synonym for Mu Tong; it is a toxic herb known as Manchurian aristolochia (Aristolochiae Manshurensis Caulis).

Also troubling from the perspective of safety, the Fang Ji photo looks suspiciously like a mixed batch of Han Fang Ji and Guang Fang Ji. See this blog for more info on this

The Ce Bai Ye photo shows a mixed batch. This photo is a good example of the adulterant vs. the genuine item, but unfortunately both items are here treated as genuine. On the left is the adulterant, on the right is the correct medicinal.

The Dang Gui in the photo is made by splicing multiple roots together. This is not a big deal, it is still an acceptable product. However, it is made by pressing sulfured roots together so that it gains the appearance of one large root.

The Shi Hu photograph is not dendrobium but rather a substitute plant called You Gua Shi Hu derived from Ephemerantha fimbriata (Bl.) P.E. Hunt et Summ. This is a tolerated substitute. It is not as effective but it is much cheaper and is considered acceptable.

The Ban Xia photo is not Ban Xia, but rather Shui Ban Xia (typhonium). This is a toxic substitute that has different TCM properties.

The Wu Wei Zi photo is Nan Wu Wei Zi (Schisandrae Sphenantherae Fructus), not Bei Wu Wei Zi (Schisandrae Chinensis Fructus). Both items are medicinal and share similar properties, but Bei Wu Wei Zi is preferred and has much higher levels of active constituents. See this blog

Hong Teng & Ji Xue Teng are mixed up. The photo for Hong Teng is not correct, and the photo for Ji Xue Teng is actually a photo of Da Xue Teng, misidentified and sold as Ji Xue Teng. This is a very common problem. These herbs are commonly confused because their Chinese names allude to the red veins visible in the cross section of the vines.

It is hard to be sure on the cordyceps photo, but it looks like it is an adulterated product. The unattached black fungus in the photo is irregularly shaped, overly large, and somewhat suspicious.

The Chuan Bei Mu photo contains a lot of Ping Bei Mu, but this is not a very big deal. See this blog for more information about Chuan Bei vs. Ping Bei.

The Wu Jia Pi is not a “Pi.” The product should be root bark but the photo shows whole roots. This is a very common problem.

Bai Jiang Cao is not the correct Bai Jiang Cao (Patriniae Herba). Rather, it is the common substitute Herba Thlaspi.

The He Huan Hua photo shows a Cantonese substitute, a magnolia flower. This has a similar TCM action to quiet the spirit, but lacks the qi-coursing action of the true product.

The Ban Lan Gen in the photo is the Southern variant Radix Baphicacanthi. This isn’t the official medicinal but it is an acceptable substitute

The wrong Fu Ping is pictured. See this blog and this blog

The wrong Chuan Niu Xi is pictured, the item shown is Wei Niu Xi. See this blog

Bai Wei is also incorrect.

Zi Cao photo is wrong, this item is Wei Ling Cai, not Zi Cao. Wei Ling Cai is a common adulterant for Bai Tou Weng as well.

The Bai Tou Weng photo is also wrong. The item in the photo is the whole herb from the plant Polycarpaea corymbosa (L.) Lam. The Latin name of Bai Tou Weng is Pulsatillae Radix but people never notice that the product in their herb jar is often not a root. The correct item is a root.

Sheng Ma photo is also wrong, it is Guangdong Sheng Ma. See this blog

Wang Bu Liu Xing photo is wrong, shows Bi Li Guo instead of Wang Bu Liu Xing. See this blog, this blog, and this blog

I know that I’ve blogged about authentication so much by this point that readers are probably ready for me to switch gears and write about some acupuncture topics. Nonetheless, this website illustrates the scale of the problem that I’ve been writing about when it comes to authentication. This website is close to #1 in terms of its popularity among students, but it has errors on about 20 out of the 22 main herbs that I’ve raised in my authentication blogs here at Blue Poppy. Out of all the commonly misidentified herbs in the West, this site has over 90% of them wrong. Worse still, I’ve seen the same rate of errors at large, well-known TCM schools.

Until we slowly turn this ship around and raise awareness of the importance of using the correct herbs, we are at risk every day that some lawsuit will hit the media and damage our professional image. The best way to change the status quo is to get the correct items into our study guides and school clinics. We need 100% of all new graduates to know the difference between dangerous substances like Guang vs. Han Fang Ji and Guan vs. Chuan Mu Tong. We need to have herbal pharmacy education in our schools before some patient dies and the whole field of herbal pharmacy gets taken away from us.

At Blue Poppy, raising the educational standards in the field is our #1 mission. Blue Poppy is making generous donations to non-profit research projects to improve the standards of authentication in the West, and we work tirelessly to raise awareness and create solutions. We are exploring ways to make more and more material available in valuable disciplines like herbal pharmacy, and we invest heavily in issues of herbal medicine quality control. Our job is to make sure that practitioners have the best educational resources and the safest herbs available, and we hope that our efforts advance the field of herbal medicine in the West in every way possible. Thanks for reading our blog!