I want to share this great article by one of my favorite Chinese Herbalists, Dr. Fratkin.

HEY YOU! GET YOUR HEAD OUT OF THE CLASSICS!
Jake Paul Fratkin, OMD, L.Ac.

Good, I caught your attention. Too many students and graduates of TCM herbal
programs in the US are married to the classical formulas, and are completely ignoring
clinical applications and developments that have been going on in China since the
founding of the People’s Republic in 1949.

Case in point. An acupuncture student in my city, not a patient, recently told me
that she had been battling a cold for the last 5 days. I asked her what formula she was
on, and she told me Xiao Chai Hu Tang (i), given to her by an herbal teacher at her college. I
was mortified. This approach may have offered a great amount of comfort 1800 years
ago, but herbal medicine has developed by leaps and bounds since then, especially in the
last 50 years. I recently had the opportunity to read a private document produced in
China that detailed the top 50 best-selling Chinese patent medicines in China. The
number one best-seller was Gan Mao Ling. If our acupuncture student is typical of TCM
students in the United States, this would mean that hundreds of millions of average
Chinese people have a much better grasp on how to treat the common cold than herbal
teachers in this country.ii

Historical Developments Since 1949. Chinese medicine has been evolving
tremendously since the founding of the People’s Republic of China, and many TCM
students and practitioners have not kept up with the developments. Let’s look at the
history. Chinese herbal medicine was in a complete institutional limbo between 1911 and
1949, when the country vacillated between periods of stagnation and instability, and
outright war and chaos. During the rule of the guomindang (Kuomintang), the Chinese
Nationalist Party under Chiang Kai-shek (Jiang Jie-shi) completely suppressed TCM in
1927 in favor of Western medicine.

With the founding of the People’s Republic, equality was given to TCM alongside of
biomedicine, with the creation of separate (but equal) hospitals and medical schools.
Some say this was due to the influence of Deng Ying-chao, the wife of the first Premier, 2
Zhou En-lai. Deng’s mother was a TCM doctor, and she aspired to be a doctor herself,
but was unable to do so due to the civil war. With the support and influence of Zhou Enlai, she was able to promote the development of TCM hospitals and universities
throughout the country, starting in 1955. Of course, many of the revolutionary leaders
were steeped in Chinese medicine, relying on herbs and acupuncture for medical
treatment during the Long March, for example.

In the 1950s, mass campaigns were organized that involved people into large social
movements. These were manufactured in part to expand and consolidate the rule of the
Communist Party of China (CPC) on the local level, but significant health campaigns were
enacted. Health campaigns included eradication of the four pests (rats, flies, mosquitoes
and sparrows), sanitation of the water supplies including the building of dams and
reservoirs (and eradication of snails that carried schistosomiasis), and the creation of
medical clinics and hospitals throughout the country.

One part of the mass-movement health campaign was to go into smaller
communities and ask questions like, “What unusual herbs do you have in your region that
are unknown around the country?” or “Do you have any effective herbal formulas that
might benefit people in distant parts of the country?” In the spirit of the founding of the
new country, many people contributed this information voluntarily. Doctors who had
previously been reticent to share their secrets were now encouraged by being valued for
their seniority and expertise, and by being placed in positions of authority, such as head
of departments at the regional TCM hospitals and medical universities.
The CPC made all of this information available in free or inexpensive publications,
which were circulated thought the country. Now doctors in Lanzhou might hear of an
unusual herb being used in Guangxi, and they would make their own efforts to obtain it.
Similarly, herbal formulas were published that used these newer herbs, or used herbs in
unusual combinations based on an respected local doctor’s experience. Quickly, the
information spread throughout China and started a trend that greatly increased the
amount of knowledge of herbs and herbal formulas.

To put this in context, when we look at the education of TCM students in this
country, we find 300 formulas that are commonly taught. These represent the classical
formulas, whose origins date back to Zhong Zhong-jing (circa 220 CE) and conclude
around 1911. Since 1955, however, hundreds of new formulas came to be known, and 3
have become famous in their own right. I would include here er xian tang (“Two
Immortals”), developed in a Shanghai hospital in 1975 to address menopausal fatigue
and heating up in a completely new way; gan mao ling, a Taiwan formula that made its
way to the mainland in 1988, which is unrivaled for control and treatment of the
common cold; geng nian wan, for menopausal sweating; ping chuan wan for asthma; tong
jing wan for menstrual cramps; li dan pai shi wan for gallstones; bu nao wan for insomnia
and anxiety; pai shi wan for kidney stone; ming mu shang qing wan for red eye and eye
infection; or zhong zi wan for infertility.iii

Applying Formulas to Medical Conditions versus Pattern Differentiation.
I have been accused of applying Chinese herbal formulas, especially the newer ones,
in a Western medical fashion, instead of relying on traditional pattern differentiation. This
is not exactly the case. Certainly, a number of new formula/products are meant to
address a focused diagnosis, such as hemorrhoid, sinus congestion, menstrual cramps,
uterine fibroid, goitre, prostate swelling etc. This satisfies the need of consumers in an
over-the-counter purchase at a herbal pharmacy, and in most of these cases, pattern
differentiation is not particularly diverse. When qualified herbalists prescribe a prepared
formula, however, it is incumbent that they analyze the ingredients and dosages
carefully.

A formula may indicate menstrual hot flashing, but as the herbalist studies the
formula, she/he can tell if it addresses various differentiations such as kidney yin
deficiency, kidney yang deficiency, blood deficiency or liver stagnation. Conversely, when
a practitioner diagnoses his/her patient, he/she should know what kind of formula they
are looking for, and seek out the formula that best product that addresses the need. Of
course, this is not necessary for the practitioner who custom-prescribes. But with
manufactured products, one must apply the formula/product correctly, by analyzing its
content and deciding if it is appropriate or not.iv The key for the practitioner is to know
well the materia medica. Ony then can she/he know what rhe product is actually doing.
The Newer Textbooks from China.

Since 1987 or so, TCM textbooks began to appear that addressed illnesses by the
Western names (endometriosis, lupus, duodenal ulcer, diabetes, etc.) References would 4
be given to the traditional TCM diagnosis (Skin Bi Syndrome for scleroderma, for
example), but organization of the chapters, at least, was around the medical diagnosis.
More and more, a summation of the medical etiology of the disease would be included,
along with modern laboratory diagnostic parameters. What remained truly TCM would be
various pattern differentiations applied within the medical diagnosis, and of course,
herbal formulas and adjustments based on pattern differentiation.
This reflects the direction of TCM in China today. Herbal practitioners are accepting
medical parameters to a disease process based on anatomy, physiology, and diagnosis,
and they have an understanding of the pharmaceutical therapies that are offered. This is
important to them because many patients coming to TCM hospitals will have had medical
evaluations and diagnosis, and the doctors need to be clear on prognosis and effects of
pharmacological intervention. To them, knowledge of both orientations serves them and
the patient best. But let’s be clear. When they come to a TCM doctor, the therapies
change. Now it is herbal medicine, prescribed and monitored by TCM doctors, using
traditional pattern differentiation.

There is a new generation of bilingual textbooks that are coming out of China. These
publishers include People’s Medical Publishing House, Shanghai University of TCM, Higher
Education Press, Academy Press, etc.v
Most of these books address diseases by their
medical names: pediatric books will have chapters of chicken pox and eczema;
gynecology texts will talk about uterine fibroid and endometriosis.
Are they betraying the great classical tradition of TCM for a bastardized modern
amalgam? Certainly not. They represent the past, present and future of Chinese
medicine. The doctors and teachers who write these books are all thoroughly steeped in
the classical literature relevant to their specialty, and in the original language! But they
have also studied advancements in biomedicine as well, and understand how to
communicate with their medical colleagues, as well as to know the limitations of, or
complications due to, pharmaceutical treatment.

More importantly, these textbooks should be the guiding light for Chinese herbal
practitioners outside of China, like us. We still need to know how the best and brightest
minds in China are dealing with complicated illness. Here, I am addressing those who do
individual herb prescribing (raw or powder), the benchmark of the higher-level herbalist.
To ignore what has been coming out of China over the last 50 years, and by dwelling 5
only in the world of classical formulas, is to limit your ability and effectiveness. And
because 45% of Chinese people continue to rely on herbal medicine as their first choice
in healing,vi China will remain the guiding beacon for the rest of your professional lives.

Author’s announcement: I have recently organized all of the herbal products available
in America into a convenient 80-page PDF document. Take a look:
www.drjakefratkin.com/products/whos-got-what
________________________________________________________________

i Xiao chai hu tang. “Minor Bupleurum Decoction”; Shang han lun, “Injury (by) Cold
Discussion”; Zhang Zhong-jing, 220.
ii I have previously written on the subject of modern treatment of viral illness in Acupuncture
Today. See: “The Potential Avian Flu Epidemic”, Acupuncture Today, April, 2006 (Vol. 07, Issue
04), and “Modern Applications for Antiviral Therapy”, Acupuncture Today, March, 2005 (Vol. 06,
Issue 03).
iii All of these can be found in Jake Fratkin, Chinese Herbal Patent Medicines, The Clinical Desk
Reference, Shya Publications, 2001. This book lists 850 herbal formulas, which include most of the
classical 300 formulas. The others are modern hospital-generated formulas that have made their
way into the mainstream.
iv Custom prescribers actually benefit from studying the modern formulas. Many are unavailable as
herbal products, and need to be made. Many of the formulas can be found in my book. See
Endnote 3, above.
v Most are available from Redwing Books (www.redwingbooks.com).
vi 45% of Chinese use herbal medicine as either their first or second recourse in an illness. This
number was mentioned in a lecture given by a senior member of the China Academy of Traditional
Chinese Medicine in 2009.

Scleroderma and TCM

Scleroderma is a kind of skin disease of connective tissue caused by sclerosis of the skin. It is divided into two types: localized and systemic types. Generally, it undergoes through three stages, red swelling, sclerosis and atrophy. At the  advanced stage, the affected skin will be adhered to the deep tissue and produce functional disturbance of corresponding organs. This disease is called (scleroderma).  

Main Points of Diagnosis
Localized Scleroderma
1. Skin Lesion: Part of the skin has a sensation of burning heat and itching, then slightly elevated patches in red or purple color. The lesion may be tenoid or elliptical in shape, and its border is clear with purple halos around them. The central part is sunken and then the color of patches will become yellow, brown and pale. The skin will be indurated and adhesive to the subcutaneous tissue, then the cleavage lines will disappear. Its surface is smooth and then will become atrophied and thin, and will lose elasticity. There are branny desquamations and pigmentations on the skin lesion.
2. Symptoms and Signs: At first the patient may have an unusual feeling or a sense of itch, then the skin becomes blunt and insensitive.
3. It often occurs on the head, face, neck and limbs, especially among the young and middle-aged women. Scleroderma which occurs at the terminal end of limbs of the young women, is known as "acrosclerosis." The course of this disease is chronic.
Systemic Scleroderma
1. Skin Symptoms and Signs
1) The skin lesion begins in the face or the skin of the distant end of limbs, symmetrical in distribution, then gradually spreads throughout the whole body. Or the skin lesion is generalized from the beginning. It often attacks the face, limbs, neck and trunk, mostly among middle-aged women.
2) At first the skin becomes thick and swollen, its surface is smooth and cleavage lines disappear. The skin shows parenchy-matous edema (at edema stage), then gradually becomes adhered to the subcutaneous tissue and it becomes hard, sallow in color and its border is clear (at sclerosis stage). Finally, the skin becomes atrophied and thin, and the hair may fall off. And sweat obstacle may appear. The skin and muscle will be stick to the bone and become stiff (at atrophy stage).
3) At the beginning, there are unusual, tense and itching sensations locally, and then the sensations become blunt gradually or entirely lost.
2. General Constitutional Symptoms
1) At the beginning, there are such symptoms as general malaise, arthralgia, loss of weight, stiff fingers and spasm of terminal arteries of limbs. The features at the advanced stage are emaciation, weakness with low fever.
2) The face may be involved and looks awkward. The nose will be sharp and the ears thin. The movement of the mouth and eyes and chewing will be restricted. In case thoracic wall is involved, respiration may be limited. In case four limbs are invaded, the joints will become stiff and motions limited. In case the digestive tract is involved, there will be difficulty in swallowing, accompanied with vomiting, nausea, abdominal distention and diarrhea. In case the lung is invaded, vital capacity will be reduced. If the heart is involved, heart failure will occur. If the heart is involved, heart failure will occur. If the kidney is involved, renal hypertension and uraemia may appear.

Differentiation and Treatment of Common Syndromes     
Internal Treatment
1) Blood Stasis Type
Main Symptoms and Signs: The skin becomes hypertrophic and elevated or sunken and hard. It may be bright red, purplish red or yellowish red or brown is color. The tongue is light purple with ecchymosis on it. The pulse is rapid.

Therapeutic Principle: Promoting blood circulation and expelling stasis.
Recipe: Decoction of Four Herbs plus Safflower and Peach Kernel and other ingredients
astragalus root
red peony root
red sage root
spatholobus stem
dried rehmannia root
Chinese angelica root
chuanxiong rhizome
honeysuckle flower
peach kernel
safflower
pangolin scale
earth worm
dried body of ground beetle
licorice root
All the above herbs are to be decocted in water for oral administration.

2) Type of Kidney Deficiency and Blood Stasis
Main Symptoms and Signs: The skin becomes thick, sclerotic, or atrophied and thin, accompanied with pain in the knees and waist, tinnitus, vertigo, impotence, premature ejaculation, low fever, spontaneous perspiration, ecchymosis on the tongue and deep and fine pulse.
Therapeutic Principle: Nourishing the kidney and warming, promoting blood circulation and removing blood stasis.
Recipe: Kidney Reinforcing Bolus and Decoction of Four Herbs plus Safflower and Peach Kernel
prepared rehmannia root
multiflower knotweed root
dogwood fruit
eucommia bark
epimedium
morinda root
peach kernel
safflower
red peony root
red sage root
Chinese angelica root
ligusticum rhizome
All the above herbs are to be decocted in water for oral administration.

3) Type of Splenic Asthenia and Blood Stasis
Main Symptoms and Signs: The skin is sclerotic and atrophied, accompanied with fatigue, loss of appetite, abdominal pain and distension, loose stool, ecchymosis on the tongue, thready and moderate pulse.
Therapeutic Principle: Strengthening the spleen and replenishing qi, promoting blood circulation and removing blood stasis.
Recipe: Decoction for Invigorating the Spleen and Nourishing the Heart with additional ingredients
astragalus root
red peony root
red sage root
codonopsis root
big-head atractylodes rhizome
spatholobus stem
poria
Chinese angelica root
aucklandia root
tangerine peel
amomum fruit
longan aril
fresh ginger
Chinese date
All the above herbs are decocted in water for oral use.

4. Other Therapies
1) 10 ml of salvia miltiorrhiza injection with 500 ml of 5% glucose is used for intravenous drip, once a day, The whole course of treatment will be 10 days running and then stop dripping for 7 days. Curative effects can be seen after a month's treatment.
2) Four Worms Pill
Ingredients:
dried body of scorpion
dried body of centipede
dried body of ground beetle
dried earthworm
All the above drugs are made into pills in equal amount each. The size of the pill is the same as that of a mung bean. Take 3-5g each time,  three times a day.
3) Pill of Rhubarb and Ground Beetle
Ingredients:
rhubarb
dried body of ground beetle
licorice root
lactiflora peony root
dried ginger rhizome
rehmannia root
scutellaria root
peach kernel
apricot kernel
gradfly
dried leech
dried grub
All the above herbs are to be ground into fine powder to make pills. 10 grams for each pill. Take one pill each morning and evening.


Note: The following text is selected from A  Practical English-Chinese Library of Traditional Chinese Medicine by Prof.Dr. Enqin Zhang(Engin CAN), he was the chief editor&author of the books, now lecturing and practising Chinese medicine at The Asante Academy of Chinese Medicine in the  Middlesex University Archway Campus, 2-10 Highgate Hill, N19   5LW, London, U.K