The six pathogenic energies of Chinese medical theory represent environmental conditions that favor the growth of common microbial disease vectors: bacteria, virus, fungi, and parasites. The Chinese character for wind includes the radical meaning “insect” or “worm”, suggesting that the traditional concept of wind includes infectious diseases caused by bacterial and viral pathogens. Damp and cold syndromes correspond to fungal and parasitic diseases. Effective treatment must clear pathogens and improve the function of the immune system. Laboratory research on pharmacology allows new applications of herbal medicines for diseases absent from the historical record. The integration of modern pharmacology into herbal prescribing can achieve results in complex cases that resist treatment by traditional methods.

The classical therapeutic categories of expelling wind cold, wind heat, cooling blood, clearing heat and toxins, and clearing damp heat contain herbs with antiviral, antibacterial, and antifungal effects. Herbal medicines have broad-spectrum antipathogenic effects, so an herbal formula for bacterial infection will never cause fungal overgrowth. The lack of side effects and the broad-spectrum nature of herbs make them ideal for long term treatment of chronic diseases.

In clinical practice, one may discover the limits of tradition and the necessity of accuracy in both diagnosis and choice of herbs. The author abandoned traditional formulas after several years of clinical practice with less than optimal results. Creating prescriptions one herb at a time eliminates nonessential ingredients that reduce effectiveness by interfering with the action of other essential constituents.

Clinical responses to classical formulas are often disappointing. Classical formulas may have only one or two herbs with the principle therapeutic value. As an example, the Tai Yang stage formulas Ma Huang Tang (ephedra), Kuei Chih Tang (cinnamon twig) and Ge Gen Tang (pueraria), may be combined to alleviate headache and sinus infection, but one must include cooling heat and clearing toxin herbs like lonicera, chrysanthemum, forsythia, and morus leaf to achieve more than minimal symptomatic relief.

A transient reduction in symptoms may be achieved with classical prescriptions because the syndrome matches the formula, however the antibacterial or antiviral effect is usually insufficient to treat contemporary illnesses. Zhang Yuan-su, the 12th century teacher of two of the four great Jin-Yuan masters noted that “No two movements of qi are identical; ancient and modern times differ; ancient formulas are helpless for modern diseases”.

This statement carries even more weight in 21st century practice when every patient walking into an acupuncturist’s office has antibiotic resistant infections. The entire clientele is overdosed on antibiotics from medical care to the dairy products they consume so that there is little chance to get an excellent clinical response with classical prescriptions.

From the perspective of pharmacology, in sinus infection, cinnamon twig and ephedra act as antihistamine, pueraria and paeony alleviate vascular spasm and headache, and xanthium, angelica, lonicera and chrysanthemum will address the bacterial root of the symptoms. The final prescription is comprised of the most pharmacologically active parts of four to six different classical formulas. If you mix these formulas together in their complete classical form without deletions, the results will be poor because the nonessential ingredients dilute or negate the effect.

In pneumonia, Bai Hu Tang, White Tiger Tea, fails to lower fevers until houttuynia, gardenia, scutellaria, and bupleurum are added to provide a more powerful antibiotic effect. If you give tonics in these situations, patients worsen because the immune system is already overwhelmed. Because the bug is already replicating beyond immune system control, you must attack the bug and assist the immune system simultaneously. I discussed this issue with a doctor from Beijing. He said in China, prescriptions are half tonic and half clearing agents, but this approach often fails in American patients. My experience is that 80% of the prescription must be for clearing pathogens with 10-20% tonics and then you get a result.

Another important modern clinical observation is that frequent dosages are essential to a good clinical response. The classical twice a day dosing does not give an optimal result. Because herbs are plant foods, the duration of action is not much longer than the time between two meals. I found very little impact on acute febrile disease or serious infections unless dosage is repeated every one to two hours for at least 24 to 72 hours.

Wind/Cold - ephedra, cinnamon, perilla, schizonepeta, siler, asarum, angelica dahurica, ginger, magnolia flower. Wind cold represents the early stages of bacterial or viral infection, and allergic syndromes.
Wind/Heat - mentha, arctium, morus leaf, chrysanthemum, vitex, eriocaulon, pueraria, bupleurum, cimicifuga. Wind heat represents later stages of bacterial or viral infection. Herbs used have antiviral and antibacterial properties, with antiinflammatory effects.

Drain Fire - anemarrhena, gardenia, prunella, phragmites, cassia, celosia, buddleia. These herbs are powerfully antibacterial as well as antifebrile.
Cool Blood - rehmannia raw, scrophularia, moutan, lithospermum, lycium bark, cynanchum. These herbs are powerfully antibacterial as well as antifebrile, and hemostatic.
Clear Heat Toxin - lonicera, forsythia, isatis leaf/root, dandelion, viola, thlaspi, houttuynia, oldenlandia, anemone, fraxinella, smilax, blechnum, sophora subprostrata, belamcanda.

These herbs have broad spectrum antibacterial, antiviral, antifungal, and anticancer effects.

Clear Heat Dry Damp - scute, coptis, phellodendron, gentiana, sophora root, fraxinus, picrorhiza. Damp heat represents bacterial and fungal pathogens, supported by the fact that all of these herbs have strong antibacterial and antifungal effects. They are used to treat vaginal discharges, diarrhea, and dermatitis. Reproductive system illnesses are often related to the digestive tract, where fungal overgrowth creates toxic effects on hormonal balance. Irritable Bowel Syndrome is due to toxic bacterial and fungal overgrowth causing inflammation, not because of emotional upset or stress. These patients are emotionally upset because they have a toxic gut that is alters their brain chemistry. Many psychiatric problems, shen disturbances, stem from a toxic gut as well.

Wind Damp - acanthopanax, clematis, chaenomeles, gentiana chin chiu, xanthium, morus branch, siegesbeckia. These herbs have antiinflammatory effects, and are clinically used in trauma and arthritis.

Aromatic Transform Damp - agastache, magnolia bark, atractylodes lancea, cardamon. These have antibacterial and antifungal effects, and are primarily used for diarrhea and poor digestion.

Qi Regulating - citrus, cyperus, saussurea, lindera, aquilaria, santalum, melia. These herbs are principally
antispasmodics but they also have antibacterial, antifungal, and antiallergy effects.

Qi Tonics - ginseng, codonopsis, astragalus, dioscorea, atractylodes macrocephala, jujube, licorice, polygonum root. These herbs benefit immune system function and have hormonal effects.

Regulate Blood - agrimonia, bletilla, sanguisorba, sophora flower, pseudoginseng. These herbs are hemostatics for bleeding disorders, including ulcers and hemorrhoids.

Blood Stagnation - cnidium, salvia, milletia, corydalis, curcuma aromatica, curcuma longa, leonurus, lycopus, luffa, paeony red, carthamus, scirpus, achyranthes, liquidamber. These herbs have pain relieving effects, anticancer effects, and immunoregulatory effects meaning that they are appropriate for the treatment of autoimmune diseases. Many of these herbs have a profound effect on the cardiovascular system, effecting blood coagulation, cardiac function, and increasing haematopoesis in anemia.

Blood Tonics - rehmannia cooked, ho shou wu, tang kuei, paeony, lycium fruit, longan. These herbs effect the endocrine system, and may be used in hyperlipidemia and diabetes. Blood deficiency disorders are often described in Western medicine as hormonal problems.

Diuretics - hoelen, polyporus, alisma, capillaris, stephania, coix, benincasa, akebia, dianthus, plantago, desmodium. Diuretics are useful in urinary tract infections and water retention from intestinal toxicity.

Many of these herbs strengthen immunity and provide antiinflammatory effects in arthritis and autoimmune kidney disease.

Warm Interior - ginger dried, cinnamon bark, clove, fennel. These herbs have strong antibacterial effects, and are cardiotonic. They have a pain relieving effect for intestinal disorders.

Astringents - schizandra, mume, terminalia, gingko. Primarily for chronic diarrhea and cough, these herbs have antibacterial effects.

Purgatives- rhubarb, senna, aloe, cannabis/linum, pharbitis. These are powerful laxatives with antibacterial effects intended for short term use only. Prolonged administration of these herbs can cause intestinal damage and dependency.

Stop cough transform phlegm heat - fritillaria, trichosanthes, sterculia, sargassum, laminaria. These herbs have antibacterial and expectorant effects.

Stop cough calm asthma - aster, stemona, eriobotrya, perilla seed, morus bark. Antibacterial, antitussive, antiasthma and expectorant properties characterize these herbs.

Transform cold phlegm - pinellia, cynanchum, platycodon. These herbs have antibacterial and expectorant effects, alleviating nausea.

Tonify Yin - glehnia, asparagus, ophiopogon, dendrobium, polygonatum officinale, lily, loranthus, eclipta,
ligustrum. Yin tonics increase production and persistence of antibodies, improving the function of the immune system.

Tonify Yang - cistanche, cynomorium, epimedium, walnut, eucommia, dipsacus, drynaria, ciboteum. Yang
tonics benefit hormonal functions and have positive effects on the nervous system. TCM terminology for impotence is yang deficiency, a reflection of the correspondence between theory and pharmacology of the materia medica. These herbs also have important applications in neurodegenerative disorders like multiple sclerosis, ALS, and Parkinson’s disease.

Calm Spirit - zizyphus spinosa, biota seed, polygala, albizzia, polygonum multiflorum stem, ganoderma. These herbs regulate neurotransmitter functions in the brain, having sedative and antiseizure effects.

Extinguish Internal Wind - gastrodia, tribulus, gambir. These herbs are hypotensive and have antiseizure effects. Internal wind symptoms in Western medicine are related to hypertension or seizure disorders. The origins of cardiovascular disease can be related to liver function, as overproduction of cholesterol causes atherosclerosis resulting in high blood pressure. Toxic intestinal flora may cause the liver to overproduce cholesterol even in vegans.

Digestant - crataegus, shen qu. The classical TCM use of crataegus is for
gastrointestinal complaints from overeating. Pharmacological research shows crataegus to be an important herb for cardiovascular disease.

Kill worms - areca seed, quisquisalis, torreya, omphalia. These herbs are antiparasitics, effective for taenia, giardia, etc.

The most important source texts for information on clinical applications and pharmacology are Pharmacology and Clinical Applications of Traditional Chinese Medicine, by Chang and But, published by World Scientific Press, and The Pharmacology of Chinese Herbs, second edition, Kee Chang Huang, CRC Press. At the Pacific Symposium workshop, we will review these major categories of pharmacological action and their individual herbs in detail from the perspective of clinical work with patients.