Guest guest Posted August 10, 2009 Report Share Posted August 10, 2009 A few weeks ago, there was some discussion on CHA about Fu Zi and its processing. I had the chance to ask one of Taiwan's top materia medica experts, Chang Hsien-Che (Zhang Xian-Zhe), about this so I figured that I'd report back to the group. I also asked my teacher Dr. Zhao Zhong-Zhen in Hong Kong about the Fu Zi, he said that his team just wrote a paper on this that has not yet been published, I'll get the details the next time I see him. No doubt it will add some good evidence-based material to the discussion. In the meantime, interested parties might also read the discussion on fu zi, chuan wu, and cao wu in Bensky et al's new materia medica- the pharmacy material by Erich Stoger is really excellent and highly relevant to this discussion. As for the source of today's input, I should introduce Dr. Chang Hsien Che of China Medical College in Taichung. He is a true heavyweight, he did Taiwan's original translation of the Ben Cao Bei Yao (one of the most important materia medica texts in the Qing dynasty, the book still used as the official text on the Taiwan licensing exam). He translated it from classical Chinese (wen yan wen) to modern Chinese (bai hua wen). He produced one of the most incredible herbal pharmacy texts of all time, a 7 volume set of color plates of virtually every substance in the marketplace, hundreds of plates on ginseng or gui ban alone, seriously the most comprehensive work in the Chinese world on the subject of traditional quality discernment. He also wrote one of Taiwan's most important pao zhi books. And just finished doing research that analyzed single medicinal and formula use based on ICD-9 codes for three years of the Taiwan national healthcare system...assessing the prevalence of single medicinals and compound formulas for nearly every major disease in 100 million patient visits by 4000 doctors. What I mean to say is, the guy has some fairly reasonable credentials. I say this because it is always important to know the source of one's information. Lucky Gabriel Fuentes of our own CHA has this guy as his PhD adviser, after following some very good advice to study Chinese from some of our honorable CHA members, Bob Flaws and Bob Damone. Anyway, Dr. Chang provided a mini-dissertation on Fu Zi. As it relates to this discussion, his main take-home points were: 1) Fu zi has many grades and preparation methods, the best of which are not easily duplicated or faked. 2) People that are seriously involved in the herbal medicine trade know how to buy Fu Zi, they know what to look for, they are not easily fooled. 3) Fu Zi processing is very strictly regulated (Bensky's text and other sources support this). 4) Sichuan is the principle growing region of Fu Zi, and inauthentic products are rare on the market. In sum, his opinion is that inadequate processing of Fu Zi is not a major problem in the industry. He acknowledges that practices of adding weight are common with many herbs, even things like Hong Hua can have sugar added for weight, and Xi Hong Hua (saffron) has been found with glycerin added for weight. However, he is highly suspicious of the motives of one who would suggest that most Fu Zi on the market is inadequately processed or is inauthentic. In his experience, this is not a problem. He suggested that the information was more closely linked to marketing rather than science. Basically, he thinks that Heiner's position is largely untenable and based on commercial interest only. That said, Dr. Chang may be wrong. I may write back to CHA in two weeks with the results of Dr. Zhao's study, which will inevitably use sophisticated chemical analysis and assessment of hundreds of samples of Fu Zi from throughout China. Maybe Dr. Zhao's research will confirm that Heiner was correct the whole time. Until then, I'm not sold. So far there has been only one submission, graciously provided by Daniel A. However, it is essentially the translation of an article/anecdote of a Chinese author whose interest, name, and qualifications are unknown. Aconite poisoning is the most common cause of TCM fatalities in the world, it is a big, big deal. Aconite clings on in a very gray area of the law, it is sold as a dietary supplement or food but it doesn't really meet the basic definition of " safe " that is legally required for a substance to be regulated as a food product. Aconite is also one of the most important substances in Chinese medicine. We need to be extremely educated about it, we need to fight vigilantly to preserve our access to it. We should fervently oppose hearsay and rumor that exaggerates its risks, and at the same time we should welcome whatever real evidence is presented, no matter what the results are. We should demand evidence and transparency of sources, and we should always be willing to question our experts and their motives. I respect Heiner and I'm sure he knows more about Fu Zi than I do, but the fact remains that he has nowhere near the expertise that someone like Chang Hsien-Che has, and he has a commercial interest in selling his own Fu Zi. If the evidence supports the idea that the Fu Zi on the market is processed incorrectly, we need to be aware of it and we need to get safer sources immediately. However, if indeed experts like Erich Stoger and Chang Hsien-Che are correct, then Heiner is doing a great disservice to the field by starting the rumor that most Fu Zi is poorly managed and dangerous, especially if this rumor is intended for his own financial gain. It would be a shame if practitioners parroted secondary sources, got Fu Zi banned for all of us, and then later the evidence showed that it was safe all along. Fu Zi is used by millions of patients, so I have a hard time believing that rampant toxicity could survive long without being exposed. When you think about how many tons of Fu Zi get analyzed by granule companies alone each year, you have to think that someone would have caught on to the fact that China's #1 highest risk, most visible and most strictly regulated herbal drug is poorly managed. It appears that only ten or so licensed factories can process Fu Zi and this is their entire specialty, I'd be really surprised if they are totally clueless about their aconite. I don't know, maybe Heiner is right about all this, and I'll get new data from Dr. Zhao that makes me look like an idiot. I don't mind looking like a fool and I am happy to change my mind the second the supporting evidence comes in. I'd gladly lose face if it will provoke someone to contribute evidence instead of " celebrity-says. " Eric Brand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 10, 2009 Report Share Posted August 10, 2009 Thanks Eric, your candor and humility is truly refreshing! Truly honest people are never foolish. They are our salvation. Patrick Edgmon --- On Mon Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2009 Report Share Posted August 11, 2009 Thanks for yet another informative post Eric. Two questions / comments: 1. Is the book still available that has all those color plates of herbs? 2. I would like to mention that there is also a problem with incorrect prescribing of properly-processed fu zi. There are some practitioners who see yang deficiency everywhere, even in cases of extreme excess heat or damp heat. Scarlet tongue with a thick yellow coat? Time for some fu zi! They also tend to prescribe ma huang and xi xin when they aren't indicated. I have had to treat numerous patients for the side effects of these incorrect treatments. The most common side effects have been worsening of the existing condition, extreme mania, acne, and splitting headaches. Don't get me wrong. I use fu zi. When it is indicated, it can have astonishing results. But I'm very concerned that the rampant unnecessary prescribing of fu zi will be more likely to lead to its banning than improperly processed fu zi. - Bill Schoenbart , " Eric Brand " <smilinglotus wrote: > > A few weeks ago, there was some discussion on CHA about Fu Zi and its processing. I had the chance to ask one of Taiwan's top materia medica experts, Chang Hsien-Che (Zhang Xian-Zhe), about this so I figured that I'd report back to the group. I also asked my teacher Dr. Zhao Zhong-Zhen in Hong Kong about the Fu Zi, he said that his team just wrote a paper on this that has not yet been published, I'll get the details the next time I see him. No doubt it will add some good evidence-based material to the discussion. In the meantime, interested parties might also read the discussion on fu zi, chuan wu, and cao wu in Bensky et al's new materia medica- the pharmacy material by Erich Stoger is really excellent and highly relevant to this discussion. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2009 Report Share Posted August 11, 2009 Eric, group, Since Heiner was a topic of discussion in this series of posts, I forwarded him the series so that he could reply on the Fu zi issue, since he lost his password to reply himself. . . I saw Eric's recent post on aconite, and would like to kindly add the following points to the discussion: I find it to be one of the problematic features of our field that during the last 50 years a gradually increasing divide has been opened up between the aspects of TCM theory and practice. It has become quite a common phenomenon, therefore, that TCM authors write about single herbs or formulas without having taken or prescribed any themselves. This may be one of the main elements that needs to be taken into account when reading discussions/opinions about aconite use. I lived in China for more than 5 years, and during this time specifically sought out clinal masters practicing in the Shanghan lun tradition. None of them used aconite, at least not in significant amounts. Seeing my teachers use 3-6g of aconite in Shenqi Wan is about the only regular aconite usage I witnessed during all this time. It was not until 2005, when my colleague Dr. Liu Lihong (contemporary China's most prominent voice on restoring aconite use) connected with living practitioners of Southwest China's Huoshen Pai (Fire School Lineage), that I understood why even the most doggedly determined yang- tonic buffs among my teachers were avoiding aconite. The practitioners (from Sichuan, Yunnan, Hunan, and Guangxi) who intimately know and use this herb all the time (up to 95% in their presciptions, in amounts ranging from 30-200g) summarily concluded that due to the recent realities of the market place the quality of the available aconite has become increasingly problematic, even dangerous. They content (in accordance with Li Shizhen's materia medica) that genuine aconite must come from the small district of Jiangyou in Sichuan, otherwise it does not exhibit the medicinal properties described in the materia medica. When Dr. Liu's Institute for the Clinical Research of Classical undertook a fact finding mission to solve the supply problem for this important herb, he found that more than 90% of the Fuzi exported by that particular district is shipped in from elsewhere, then repackaged into containers labeled " Sichuan, Jiangyou. " Secondarily, they found that chemical shortcuts had replaced traditional processing procedures even for the genuine Fuzi grown within the specified area. As a result, they commissioned the local peasants to grow, harvest, and process aconite according to traditional specifications and, since interpersonal trust has become such an overwhelming issue in the " anything goes " phase of 21st century Chinese business, they established one of their employees to live in this remote district for half of the year during the harvest and processing season (to make sure that everything was done in accordance with their specifications). Since the first harvest of this specially commissioned aconite 2 years ago, it has been the experience of Dr. Liu and Dr. Lu Chonghan (one of the elders of the Fire Spirit School, who prescribes between 15,000 - 20,000 pounds of aconite per year) that the many unexpected and disconcerting reactions to high amounts of aconite decreased dramatically. Dr. Liu is a Buddhist practitioner who served for many years as the private physician to Kempu Jikpun, the highest Lama of the Ningma sect who still remained in Tibet at that time. I know Dr. Liu very well and trust his personal integrity completely. I know that he would rather drop dead than participate in some entirely profit- driven ploy that disseminates false information among his fellow Chinese medicine practitioners. His entire life work (including his important book, Sikao zhongyi, Rethinking ) has been in service to the goal of preserving the deeper truths of our medicine. As for my own motivation: I was asked by both my teachers and students to make this particular piece of clinically-based information (as well as the actual material to use it) available in the West. At this point, the logistical ramifications of importing powder-filled barrels with single granular extracts from China has put great strain on my clinic staff and stretched my personal comfort zone as a scholar. More than one year later, there have been no financial rewards, just a continuing commitment to help interested practitioners in my community. Heiner Fruehauf On Aug 10, 2009, at 12:31 PM, Eric Brand wrote: > A few weeks ago, there was some discussion on CHA about Fu Zi and > its processing. I had the chance to ask one of Taiwan's top materia > medica experts, Chang Hsien-Che (Zhang Xian-Zhe), about this so I > figured that I'd report back to the group. I also asked my teacher > Dr. Zhao Zhong-Zhen in Hong Kong about the Fu Zi, he said that his > team just wrote a paper on this that has not yet been published, > I'll get the details the next time I see him. No doubt it will add > some good evidence-based material to the discussion. In the > meantime, interested parties might also read the discussion on fu > zi, chuan wu, and cao wu in Bensky et al's new materia medica- the > pharmacy material by Erich Stoger is really excellent and highly > relevant to this discussion. > > As for the source of today's input, I should introduce Dr. Chang > Hsien Che of China Medical College in Taichung. He is a true > heavyweight, he did Taiwan's original translation of the Ben Cao Bei > Yao (one of the most important materia medica texts in the Qing > dynasty, the book still used as the official text on the Taiwan > licensing exam). He translated it from classical Chinese (wen yan > wen) to modern Chinese (bai hua wen). He produced one of the most > incredible herbal pharmacy texts of all time, a 7 volume set of > color plates of virtually every substance in the marketplace, > hundreds of plates on ginseng or gui ban alone, seriously the most > comprehensive work in the Chinese world on the subject of > traditional quality discernment. He also wrote one of Taiwan's most > important pao zhi books. And just finished doing research that > analyzed single medicinal and formula use based on ICD-9 codes for > three years of the Taiwan national healthcare system...assessing the > prevalence of single medicinals and compound formulas for nearly > every major disease in 100 million patient visits by 4000 doctors. > > What I mean to say is, the guy has some fairly reasonable > credentials. I say this because it is always important to know the > source of one's information. Lucky Gabriel Fuentes of our own CHA > has this guy as his PhD adviser, after following some very good > advice to study Chinese from some of our honorable CHA members, Bob > Flaws and Bob Damone. > > Anyway, Dr. Chang provided a mini-dissertation on Fu Zi. As it > relates to this discussion, his main take-home points were: 1) Fu zi > has many grades and preparation methods, the best of which are not > easily duplicated or faked. 2) People that are seriously involved in > the herbal medicine trade know how to buy Fu Zi, they know what to > look for, they are not easily fooled. 3) Fu Zi processing is very > strictly regulated (Bensky's text and other sources support this). > 4) Sichuan is the principle growing region of Fu Zi, and inauthentic > products are rare on the market. > > In sum, his opinion is that inadequate processing of Fu Zi is not a > major problem in the industry. He acknowledges that practices of > adding weight are common with many herbs, even things like Hong Hua > can have sugar added for weight, and Xi Hong Hua (saffron) has been > found with glycerin added for weight. However, he is highly > suspicious of the motives of one who would suggest that most Fu Zi > on the market is inadequately processed or is inauthentic. In his > experience, this is not a problem. He suggested that the information > was more closely linked to marketing rather than science. Basically, > he thinks that Heiner's position is largely untenable and based on > commercial interest only. > > That said, Dr. Chang may be wrong. I may write back to CHA in two > weeks with the results of Dr. Zhao's study, which will inevitably > use sophisticated chemical analysis and assessment of hundreds of > samples of Fu Zi from throughout China. Maybe Dr. Zhao's research > will confirm that Heiner was correct the whole time. > > Until then, I'm not sold. So far there has been only one submission, > graciously provided by Daniel A. However, it is essentially the > translation of an article/anecdote of a Chinese author whose > interest, name, and qualifications are unknown. Aconite poisoning is > the most common cause of TCM fatalities in the world, it is a big, > big deal. Aconite clings on in a very gray area of the law, it is > sold as a dietary supplement or food but it doesn't really meet the > basic definition of " safe " that is legally required for a substance > to be regulated as a food product. > > Aconite is also one of the most important substances in Chinese > medicine. We need to be extremely educated about it, we need to > fight vigilantly to preserve our access to it. We should fervently > oppose hearsay and rumor that exaggerates its risks, and at the same > time we should welcome whatever real evidence is presented, no > matter what the results are. We should demand evidence and > transparency of sources, and we should always be willing to question > our experts and their motives. I respect Heiner and I'm sure he > knows more about Fu Zi than I do, but the fact remains that he has > nowhere near the expertise that someone like Chang Hsien-Che has, > and he has a commercial interest in selling his own Fu Zi. > > If the evidence supports the idea that the Fu Zi on the market is > processed incorrectly, we need to be aware of it and we need to get > safer sources immediately. However, if indeed experts like Erich > Stoger and Chang Hsien-Che are correct, then Heiner is doing a great > disservice to the field by starting the rumor that most Fu Zi is > poorly managed and dangerous, especially if this rumor is intended > for his own financial gain. It would be a shame if practitioners > parroted secondary sources, got Fu Zi banned for all of us, and then > later the evidence showed that it was safe all along. > > Fu Zi is used by millions of patients, so I have a hard time > believing that rampant toxicity could survive long without being > exposed. When you think about how many tons of Fu Zi get analyzed by > granule companies alone each year, you have to think that someone > would have caught on to the fact that China's #1 highest risk, most > visible and most strictly regulated herbal drug is poorly managed. > It appears that only ten or so licensed factories can process Fu Zi > and this is their entire specialty, I'd be really surprised if they > are totally clueless about their aconite. > > I don't know, maybe Heiner is right about all this, and I'll get new > data from Dr. Zhao that makes me look like an idiot. I don't mind > looking like a fool and I am happy to change my mind the second the > supporting evidence comes in. I'd gladly lose face if it will > provoke someone to contribute evidence instead of " celebrity-says. " > > Eric Brand > > > Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2009 Report Share Posted August 11, 2009 Thanks Eric for the further opinions on this fuzi issue. As stated before, I have no real opinion either way and only have discussed this with a handful of people. Clearly there are differing opinions in regard to its toxicity. However, without peering through a microscope one can notice its effect in the clinic which can give us it quite a bit of information. One thing that is evident is that Spring Wind's new fuzi has a different clinical effect than their previous version. I was fortunate enough to have quite a few patients on various fuzi formulas containing Spring Wind's older fuzi. When the new black steamed fuzi arrived I started using this version. I also personally was experimenting with fuzi myself and similarly switched. Here is what I noticed. The older fuzi has a much more stimulating effect, even to the point of causing insomnia. When I personally took the older fuzi (1.5-3g a day) I felt like I drank a pot of coffee and felt like Superman, but could not sleep. Others have reported a similar action. The new (supposedly less toxic) fuzi did not have this effect. However, my energy was much more sustained and " normal " even at a higher dose, 5g a day. For one patient, I had to include strong spirit calming medicinals to counteract the stimulating effect of the older fuzi. This formula actually still caused some insomnia. When I switched to the new fuzi she actually became drowsy during the day (due to the spirit calming medicinals)- this did not happen with the older fuzi formulas. Now the question is, is this stimulating effect a positive normal action of fuzi or a undesired " toxic " result that is not present in the more processed versions (such as Spring Wind's new black fu zi or Heiner's). I have no idea if this stimulating effect is due to the toxic ingredients, diester diterpene alkaloids (DDAs). However, from the experience in my own body, I feel that the overstimulation effect is somewhat depleting and not really about warming the fire and assisting the yang. On the flipside, maybe this new fuzi just doesn't have the proper 'punch' that fuzi should have. But I kind of prefer the new one, but we shall see. Since my sample size is relatively small, I am curious what others have experienced or have to think. -Regards, - On Behalf Of Eric Brand Monday, August 10, 2009 1:31 PM Fu Zi authenticity and safety A few weeks ago, there was some discussion on CHA about Fu Zi and its processing. I had the chance to ask one of Taiwan's top materia medica experts, Chang Hsien-Che (Zhang Xian-Zhe), about this so I figured that I'd report back to the group. I also asked my teacher Dr. Zhao Zhong-Zhen in Hong Kong about the Fu Zi, he said that his team just wrote a paper on this that has not yet been published, I'll get the details the next time I see him. No doubt it will add some good evidence-based material to the discussion. In the meantime, interested parties might also read the discussion on fu zi, chuan wu, and cao wu in Bensky et al's new materia medica- the pharmacy material by Erich Stoger is really excellent and highly relevant to this discussion. As for the source of today's input, I should introduce Dr. Chang Hsien Che of China Medical College in Taichung. He is a true heavyweight, he did Taiwan's original translation of the Ben Cao Bei Yao (one of the most important materia medica texts in the Qing dynasty, the book still used as the official text on the Taiwan licensing exam). He translated it from classical Chinese (wen yan wen) to modern Chinese (bai hua wen). He produced one of the most incredible herbal pharmacy texts of all time, a 7 volume set of color plates of virtually every substance in the marketplace, hundreds of plates on ginseng or gui ban alone, seriously the most comprehensive work in the Chinese world on the subject of traditional quality discernment. He also wrote one of Taiwan's most important pao zhi books. And just finished doing research that analyzed single medicinal and formula use based on ICD-9 codes for three years of the Taiwan national healthcare system...assessing the prevalence of single medicinals and compound formulas for nearly every major disease in 100 million patient visits by 4000 doctors. What I mean to say is, the guy has some fairly reasonable credentials. I say this because it is always important to know the source of one's information. Lucky Gabriel Fuentes of our own CHA has this guy as his PhD adviser, after following some very good advice to study Chinese from some of our honorable CHA members, Bob Flaws and Bob Damone. Anyway, Dr. Chang provided a mini-dissertation on Fu Zi. As it relates to this discussion, his main take-home points were: 1) Fu zi has many grades and preparation methods, the best of which are not easily duplicated or faked. 2) People that are seriously involved in the herbal medicine trade know how to buy Fu Zi, they know what to look for, they are not easily fooled. 3) Fu Zi processing is very strictly regulated (Bensky's text and other sources support this). 4) Sichuan is the principle growing region of Fu Zi, and inauthentic products are rare on the market. In sum, his opinion is that inadequate processing of Fu Zi is not a major problem in the industry. He acknowledges that practices of adding weight are common with many herbs, even things like Hong Hua can have sugar added for weight, and Xi Hong Hua (saffron) has been found with glycerin added for weight. However, he is highly suspicious of the motives of one who would suggest that most Fu Zi on the market is inadequately processed or is inauthentic. In his experience, this is not a problem. He suggested that the information was more closely linked to marketing rather than science. Basically, he thinks that Heiner's position is largely untenable and based on commercial interest only. That said, Dr. Chang may be wrong. I may write back to CHA in two weeks with the results of Dr. Zhao's study, which will inevitably use sophisticated chemical analysis and assessment of hundreds of samples of Fu Zi from throughout China. Maybe Dr. Zhao's research will confirm that Heiner was correct the whole time. Until then, I'm not sold. So far there has been only one submission, graciously provided by Daniel A. However, it is essentially the translation of an article/anecdote of a Chinese author whose interest, name, and qualifications are unknown. Aconite poisoning is the most common cause of TCM fatalities in the world, it is a big, big deal. Aconite clings on in a very gray area of the law, it is sold as a dietary supplement or food but it doesn't really meet the basic definition of " safe " that is legally required for a substance to be regulated as a food product. Aconite is also one of the most important substances in Chinese medicine. We need to be extremely educated about it, we need to fight vigilantly to preserve our access to it. We should fervently oppose hearsay and rumor that exaggerates its risks, and at the same time we should welcome whatever real evidence is presented, no matter what the results are. We should demand evidence and transparency of sources, and we should always be willing to question our experts and their motives. I respect Heiner and I'm sure he knows more about Fu Zi than I do, but the fact remains that he has nowhere near the expertise that someone like Chang Hsien-Che has, and he has a commercial interest in selling his own Fu Zi. If the evidence supports the idea that the Fu Zi on the market is processed incorrectly, we need to be aware of it and we need to get safer sources immediately. However, if indeed experts like Erich Stoger and Chang Hsien-Che are correct, then Heiner is doing a great disservice to the field by starting the rumor that most Fu Zi is poorly managed and dangerous, especially if this rumor is intended for his own financial gain. It would be a shame if practitioners parroted secondary sources, got Fu Zi banned for all of us, and then later the evidence showed that it was safe all along. Fu Zi is used by millions of patients, so I have a hard time believing that rampant toxicity could survive long without being exposed. When you think about how many tons of Fu Zi get analyzed by granule companies alone each year, you have to think that someone would have caught on to the fact that China's #1 highest risk, most visible and most strictly regulated herbal drug is poorly managed. It appears that only ten or so licensed factories can process Fu Zi and this is their entire specialty, I'd be really surprised if they are totally clueless about their aconite. I don't know, maybe Heiner is right about all this, and I'll get new data from Dr. Zhao that makes me look like an idiot. I don't mind looking like a fool and I am happy to change my mind the second the supporting evidence comes in. I'd gladly lose face if it will provoke someone to contribute evidence instead of " celebrity-says. " Eric Brand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2009 Report Share Posted August 11, 2009 Bill, 1) Which properly-processed is fuzi are you referring to? I think that the side effects that you mention are potentially from improperly processed fuzi (see my previous post). 2) I of course I agree with your contention that one should not use fuzi incorrectly. However I think your argument cuts both ways. There are of course " hot " conditions that do not respond to typical cooling treatments and reverse when using fuzi. I have had three such patients in my clinic in the last month. For example, they may have a deep red tongue, core body heat (experienced by the patient), or yellow phlegm. Such symptoms can easily normalize if given fuzi when there is a yang deficiency. For example an asthma patient with yellow phlegm and deep red tongue dramatically improved and the tongue actually turned pink fairly quickly with fuzi. Of course all this comes down to proper diagnosis, but we should not rule out the possibility that tonifying yang with fuzi cannot eliminate heat signs, even sometimes with " extreme " heat signs. However, I do agree with you that such situations are the exception and not the rule, and we need to be careful no matter what method we use. Regards, - On Behalf Of bill_schoenbart Tuesday, August 11, 2009 9:59 AM Re: Fu Zi authenticity and safety Thanks for yet another informative post Eric. Two questions / comments: 1. Is the book still available that has all those color plates of herbs? 2. I would like to mention that there is also a problem with incorrect prescribing of properly-processed fu zi. There are some practitioners who see yang deficiency everywhere, even in cases of extreme excess heat or damp heat. Scarlet tongue with a thick yellow coat? Time for some fu zi! They also tend to prescribe ma huang and xi xin when they aren't indicated. I have had to treat numerous patients for the side effects of these incorrect treatments. The most common side effects have been worsening of the existing condition, extreme mania, acne, and splitting headaches. Don't get me wrong. I use fu zi. When it is indicated, it can have astonishing results. But I'm very concerned that the rampant unnecessary prescribing of fu zi will be more likely to lead to its banning than improperly processed fu zi. - Bill Schoenbart <%40> , " Eric Brand " <smilinglotus wrote: > > A few weeks ago, there was some discussion on CHA about Fu Zi and its processing. I had the chance to ask one of Taiwan's top materia medica experts, Chang Hsien-Che (Zhang Xian-Zhe), about this so I figured that I'd report back to the group. I also asked my teacher Dr. Zhao Zhong-Zhen in Hong Kong about the Fu Zi, he said that his team just wrote a paper on this that has not yet been published, I'll get the details the next time I see him. No doubt it will add some good evidence-based material to the discussion. In the meantime, interested parties might also read the discussion on fu zi, chuan wu, and cao wu in Bensky et al's new materia medica- the pharmacy material by Erich Stoger is really excellent and highly relevant to this discussion. > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2009 Report Share Posted August 11, 2009 On Tue, Aug 11, 2009 at 5:28 PM, < > wrote: > > > For example an asthma patient with yellow phlegm and deep red tongue > dramatically improved and the tongue actually turned pink fairly quickly > with fuzi. > Jason, were there any other signs or symptoms that suggested to you that there was a yang deficiency in this patient? I can't see diagnosing a yang deficiency with this presentation alone. -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2009 Report Share Posted August 11, 2009 Eric, As a friend of mine in China just pointed out, there are plenty of old very respected doctors that underestimate risks of more modern developments, for example, heavy metals. Times do change, and our ability to assess risk has dramatically improved in recent years. " Traditional quality discernment " is much different than modern toxicity issues. At least one major supplier in China that I know of says that it is standard practice for fuzi's skin to be removed with toxic chemicals. Furthermore, it is my experience with China/Chinese that they tend to underestimate the impact of environmental toxins/chemicals. I could easily see the majority of the fuzi industry not even considering its impact on health. This is precisely why Spring Wind's fuzi boasts a non-chemical removal of the skin. Clearly, Dr. Chang Hsien Che is knowledgeable. Does he have any comments about the chemicals used for removing the skin? I think that Heiner has some valid points and I agree that he probably is not making any money at all selling his fuzi. This is not a high-priced item and clearly a large hassle to deal with. Although far from definitive, Daniel's translated paper, as well as at least two other sources are reporting issues. This is enough for us to take this seriously and further investigate. There is no question that fuzi can cause problems. We can easily try to blame this on misdiagnosis, or we can look at potential toxicity as well as investigate more modern processing methods (pressure-steaming) to help ameliorate unwanted side effects / potential toxicity. As stated in my previous post, this steemed version is much smoother. Furthermore, sometimes it takes other countries such as the US or Japan to request a higher/safer grade products. It should be noted that Spring-Wind's supplier almost exclusively sells to Japan. Many experts say that Japan has some of this most stringent herbal regulations in regard to safety. In addition, the majority of the highest grade herbs are sold to Japan and Korea (not the West). Although I love mainland China very much, I think that the laws involving toxins etc. can sometimes be a bit lax. Regards, - On Behalf Of Eric Brand Monday, August 10, 2009 1:31 PM Fu Zi authenticity and safety A few weeks ago, there was some discussion on CHA about Fu Zi and its processing. I had the chance to ask one of Taiwan's top materia medica experts, Chang Hsien-Che (Zhang Xian-Zhe), about this so I figured that I'd report back to the group. I also asked my teacher Dr. Zhao Zhong-Zhen in Hong Kong about the Fu Zi, he said that his team just wrote a paper on this that has not yet been published, I'll get the details the next time I see him. No doubt it will add some good evidence-based material to the discussion. In the meantime, interested parties might also read the discussion on fu zi, chuan wu, and cao wu in Bensky et al's new materia medica- the pharmacy material by Erich Stoger is really excellent and highly relevant to this discussion. As for the source of today's input, I should introduce Dr. Chang Hsien Che of China Medical College in Taichung. He is a true heavyweight, he did Taiwan's original translation of the Ben Cao Bei Yao (one of the most important materia medica texts in the Qing dynasty, the book still used as the official text on the Taiwan licensing exam). He translated it from classical Chinese (wen yan wen) to modern Chinese (bai hua wen). He produced one of the most incredible herbal pharmacy texts of all time, a 7 volume set of color plates of virtually every substance in the marketplace, hundreds of plates on ginseng or gui ban alone, seriously the most comprehensive work in the Chinese world on the subject of traditional quality discernment. He also wrote one of Taiwan's most important pao zhi books. And just finished doing research that analyzed single medicinal and formula use based on ICD-9 codes for three years of the Taiwan national healthcare system...assessing the prevalence of single medicinals and compound formulas for nearly every major disease in 100 million patient visits by 4000 doctors. What I mean to say is, the guy has some fairly reasonable credentials. I say this because it is always important to know the source of one's information. Lucky Gabriel Fuentes of our own CHA has this guy as his PhD adviser, after following some very good advice to study Chinese from some of our honorable CHA members, Bob Flaws and Bob Damone. Anyway, Dr. Chang provided a mini-dissertation on Fu Zi. As it relates to this discussion, his main take-home points were: 1) Fu zi has many grades and preparation methods, the best of which are not easily duplicated or faked. 2) People that are seriously involved in the herbal medicine trade know how to buy Fu Zi, they know what to look for, they are not easily fooled. 3) Fu Zi processing is very strictly regulated (Bensky's text and other sources support this). 4) Sichuan is the principle growing region of Fu Zi, and inauthentic products are rare on the market. In sum, his opinion is that inadequate processing of Fu Zi is not a major problem in the industry. He acknowledges that practices of adding weight are common with many herbs, even things like Hong Hua can have sugar added for weight, and Xi Hong Hua (saffron) has been found with glycerin added for weight. However, he is highly suspicious of the motives of one who would suggest that most Fu Zi on the market is inadequately processed or is inauthentic. In his experience, this is not a problem. He suggested that the information was more closely linked to marketing rather than science. Basically, he thinks that Heiner's position is largely untenable and based on commercial interest only. That said, Dr. Chang may be wrong. I may write back to CHA in two weeks with the results of Dr. Zhao's study, which will inevitably use sophisticated chemical analysis and assessment of hundreds of samples of Fu Zi from throughout China. Maybe Dr. Zhao's research will confirm that Heiner was correct the whole time. Until then, I'm not sold. So far there has been only one submission, graciously provided by Daniel A. However, it is essentially the translation of an article/anecdote of a Chinese author whose interest, name, and qualifications are unknown. Aconite poisoning is the most common cause of TCM fatalities in the world, it is a big, big deal. Aconite clings on in a very gray area of the law, it is sold as a dietary supplement or food but it doesn't really meet the basic definition of " safe " that is legally required for a substance to be regulated as a food product. Aconite is also one of the most important substances in Chinese medicine. We need to be extremely educated about it, we need to fight vigilantly to preserve our access to it. We should fervently oppose hearsay and rumor that exaggerates its risks, and at the same time we should welcome whatever real evidence is presented, no matter what the results are. We should demand evidence and transparency of sources, and we should always be willing to question our experts and their motives. I respect Heiner and I'm sure he knows more about Fu Zi than I do, but the fact remains that he has nowhere near the expertise that someone like Chang Hsien-Che has, and he has a commercial interest in selling his own Fu Zi. If the evidence supports the idea that the Fu Zi on the market is processed incorrectly, we need to be aware of it and we need to get safer sources immediately. However, if indeed experts like Erich Stoger and Chang Hsien-Che are correct, then Heiner is doing a great disservice to the field by starting the rumor that most Fu Zi is poorly managed and dangerous, especially if this rumor is intended for his own financial gain. It would be a shame if practitioners parroted secondary sources, got Fu Zi banned for all of us, and then later the evidence showed that it was safe all along. Fu Zi is used by millions of patients, so I have a hard time believing that rampant toxicity could survive long without being exposed. When you think about how many tons of Fu Zi get analyzed by granule companies alone each year, you have to think that someone would have caught on to the fact that China's #1 highest risk, most visible and most strictly regulated herbal drug is poorly managed. It appears that only ten or so licensed factories can process Fu Zi and this is their entire specialty, I'd be really surprised if they are totally clueless about their aconite. I don't know, maybe Heiner is right about all this, and I'll get new data from Dr. Zhao that makes me look like an idiot. I don't mind looking like a fool and I am happy to change my mind the second the supporting evidence comes in. I'd gladly lose face if it will provoke someone to contribute evidence instead of " celebrity-says. " Eric Brand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 11, 2009 Report Share Posted August 11, 2009 There was, I was just pointing out the obvious heat signs. But they were enough to throw me off for the first round of treatments. -Jason On Behalf Of Al Stone Tuesday, August 11, 2009 6:34 PM Re: Re: Fu Zi authenticity and safety On Tue, Aug 11, 2009 at 5:28 PM, < <%40Chinese Medicine> > wrote: > > > For example an asthma patient with yellow phlegm and deep red tongue > dramatically improved and the tongue actually turned pink fairly quickly > with fuzi. > Jason, were there any other signs or symptoms that suggested to you that there was a yang deficiency in this patient? I can't see diagnosing a yang deficiency with this presentation alone. -- , DAOM Pain is inevitable, suffering is optional. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 , " " wrote: > Eric, > As a friend of mine in China just pointed out, there are plenty of old very > respected doctors that underestimate risks of more modern developments, for > example, heavy metals. Times do change, and our ability to assess risk has > dramatically improved in recent years. " Traditional quality discernment " is > much different than modern toxicity issues. Yes, of course. The reason I mentioned Dr. Chang's background is because I wanted to point out that he is a scientist as well as an expert in traditional quality discernment. He is fairly old, yes, but he stays abreast of the latest scientific developments. It is true that Dr. Chang's specialty lies in traditional quality discernment rather than analytic chemistry, therefore I posed the question to my teacher Dr. Zhao Zhong-Zhen as well. Each is a top expert, but with a slightly different angle (Dr. Zhao more botany, chemistry, and contaminants, Dr. Chang more about grading and pao zhi, but there is a lot of overlap between their knowledge). However, the hard thing about asking a real expert about these issues is this: What literature do I have to show them as the basis for my inquiry? It is a loss of face for me to ask them a scientific question if the only sources of information that I have are: 1) An article that is essentially just a commercial advertisement, and 2) A translated abstract of a paper with no citation, no author, no publication data, etc. I would be embarrassed to ask someone like Dr. Zhao a question based on such sources alone- he would just look at me and think " since when do you use ads as the basis for your academic information? " Hao diulian! (what a loss of face that would be) One of the more annoying things about Chinese medicine in America is clearly illustrated by the thread on Worsley and his sources. It is easy to spread unsubstantiated information, but it is much harder to actually track down facts and evidence. Unfortunately, it is always the myth-busters that actually have to do the hard work of producing the evidence. Sometimes the people trying to correct misconceptions are busy with their other work, and it is annoying to waste time tracking down facts just to constantly dispel rumors by other people that spread information without any care in the world for evidence or reliable sources. I will share my thoughts on the Worsley topic soon, but I might not get to it today. I am grateful for the fact that our discussion of Fu Zi has now been enriched by Heiner, the discussion is far more rich and meaningful now. > At least one major supplier in China that I know of says that it is standard > practice for fuzi's skin to be removed with toxic chemicals. I wouldn't doubt that. However, I have almost never seen Fu Zi with the skin removed in the marketplace. I don't know what stores you shop in, but virtually every batch of Fu Zi that I have seen has the skin intact. The main form of Fu Zi on the US market is Hei Fu Pian, called Hei because the black skin covers the outside. Eric Brand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 The fu zi that I see over-prescribed is dark, with black skin. I can't confirm for sure that it is processed properly, but I have seen it work just fine in cases of actual yang deficiency. > Bill, > > 1) Which properly-processed is fuzi are you referring to? I think that the > side effects that you mention are potentially from improperly processed fuzi> Yes, of course a well-trained SHL practitioner will detect underlying yang deficiency in heat conditions. What I am referring to is the type of practitioner who sees it in ALL cases and prescribes fu zi, ma huang, and xi xin all the time. This shotgun approach will certainly have success stories, but the often untold story is the dozens of extreme adverse events that other people are forced to clean up. Prescribing according to dogma is no replacement for a proper differential diagnosis. - Bill Schoenbart > > 2) I of course I agree with your contention that one should not use fuzi > incorrectly. However I think your argument cuts both ways. There are of > course " hot " conditions that do not respond to typical cooling treatments > and reverse when using fuzi. I have had three such patients in my clinic in > the last month. For example, they may have a deep red tongue, core body heat > (experienced by the patient), or yellow phlegm. Such symptoms can easily > normalize if given fuzi when there is a yang deficiency. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 Bill, I could not agree more. It clearly incorrect to prescribe these hot medicinals for ALL cases. Do you find practitioners in your area doing this? I have been reading some huoshenpai stuff lately, and there are doctors that claim to use fuzi in 98% of formulas. This is a bit hard for me to wrap my head around and is counterintuitive in regard to true CM diagnosis. Although my experience with fuzi is very small compared to these guys, my percentage of patients that get these type of treatments is quite small. Also, who else is distributing this black fuzi besides Spring Wind. Is it also the steamed version (for 5 hours)? I know Spring Wind just recently started carrying this. I wouldn't mind experimenting with a few versions. Regards, -Jason On Behalf Of bill_schoenbart Wednesday, August 12, 2009 9:50 AM Re: Fu Zi authenticity and safety The fu zi that I see over-prescribed is dark, with black skin. I can't confirm for sure that it is processed properly, but I have seen it work just fine in cases of actual yang deficiency. > Bill, > > 1) Which properly-processed is fuzi are you referring to? I think that the > side effects that you mention are potentially from improperly processed fuzi> Yes, of course a well-trained SHL practitioner will detect underlying yang deficiency in heat conditions. What I am referring to is the type of practitioner who sees it in ALL cases and prescribes fu zi, ma huang, and xi xin all the time. This shotgun approach will certainly have success stories, but the often untold story is the dozens of extreme adverse events that other people are forced to clean up. Prescribing according to dogma is no replacement for a proper differential diagnosis. - Bill Schoenbart > > 2) I of course I agree with your contention that one should not use fuzi > incorrectly. However I think your argument cuts both ways. There are of > course " hot " conditions that do not respond to typical cooling treatments > and reverse when using fuzi. I have had three such patients in my clinic in > the last month. For example, they may have a deep red tongue, core body heat > (experienced by the patient), or yellow phlegm. Such symptoms can easily > normalize if given fuzi when there is a yang deficiency. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 Jason, The fu zi shotgun approach is not a widespread practice here, but it is practiced regularly a local practitioner who is not a member of this group. I'll just leave it at that, since my purpose is to discuss the issue and not publicly put down this person by name. One of my Chinese teachers commented on this issue in a very simple way: " Don't be a fuziholic " . I'm not sure of the source of that fu zi, since I now get my herbs elsewhere. I want to repeat that I think fu zi is great when it is needed. Some of the most amazing responses to herbs that I have seen have come from prescribing Jin Gui Shen Qi San, Wu Mei San, and Fu Zi Li Zhong Wan. I am just very concerned about its indiscriminate use, based on the numerous adverse events I have seen. - Bill , " " wrote: > > Bill, > > > > I could not agree more. It clearly incorrect to prescribe these hot > medicinals for ALL cases. Do you find practitioners in your area doing this? > I have been reading some huoshenpai stuff lately, and there are doctors that > claim to use fuzi in 98% of formulas. This is a bit hard for me to wrap my > head around and is counterintuitive in regard to true CM diagnosis. Although > my experience with fuzi is very small compared to these guys, my percentage > of patients that get these type of treatments is quite small. > > > > Also, who else is distributing this black fuzi besides Spring Wind. Is it > also the steamed version (for 5 hours)? I know Spring Wind just recently > started carrying this. I wouldn't mind experimenting with a few versions. > > > > Regards, > > > > -Jason > > > > > On Behalf Of bill_schoenbart > Wednesday, August 12, 2009 9:50 AM > > Re: Fu Zi authenticity and safety > > > > > > The fu zi that I see over-prescribed is dark, with black skin. I can't > confirm for sure that it is processed properly, but I have seen it work just > fine in cases of actual yang deficiency. > > > Bill, > > > > 1) Which properly-processed is fuzi are you referring to? I think that the > > side effects that you mention are potentially from improperly processed > fuzi> > > Yes, of course a well-trained SHL practitioner will detect underlying yang > deficiency in heat conditions. What I am referring to is the type of > practitioner who sees it in ALL cases and prescribes fu zi, ma huang, and xi > xin all the time. This shotgun approach will certainly have success stories, > but the often untold story is the dozens of extreme adverse events that > other people are forced to clean up. Prescribing according to dogma is no > replacement for a proper differential diagnosis. > > - Bill Schoenbart > > > > > 2) I of course I agree with your contention that one should not use fuzi > > incorrectly. However I think your argument cuts both ways. There are of > > course " hot " conditions that do not respond to typical cooling treatments > > and reverse when using fuzi. I have had three such patients in my clinic > in > > the last month. For example, they may have a deep red tongue, core body > heat > > (experienced by the patient), or yellow phlegm. Such symptoms can easily > > normalize if given fuzi when there is a yang deficiency. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 Eric et al, I imagine that Daniel would be happy to supply you with the full text of the article he is translating, or at least the Chinese title. Yes you are right, it would be much better if we had some more details. We may just be at the beginning of this journey. As far as the skin, I have also wondered this same question, however, I assume that there is an outer skin / peel that is removed and what we see is an inner skin, but I cannot verify this. But, if one reads the preparation methods for fuzi we find some information. For example, pao fu zi says (paraphrased from Chinese), wash the fuzi, soak in clean water for one night, eliminate the skin, and slice, again add water and soak., dan fu zi has a much more involved processing method including of course soaking in salt water for a few days, and then boiling with gan cao, heidou etc. but it also mentions " scraping off " the skin. Those are the only two entries I can find at the moment. Does anyone else have any additional information? - On Behalf Of Eric Brand Wednesday, August 12, 2009 9:38 AM Re: Fu Zi authenticity and safety <%40> , " " wrote: > Eric, > As a friend of mine in China just pointed out, there are plenty of old very > respected doctors that underestimate risks of more modern developments, for > example, heavy metals. Times do change, and our ability to assess risk has > dramatically improved in recent years. " Traditional quality discernment " is > much different than modern toxicity issues. Yes, of course. The reason I mentioned Dr. Chang's background is because I wanted to point out that he is a scientist as well as an expert in traditional quality discernment. He is fairly old, yes, but he stays abreast of the latest scientific developments. It is true that Dr. Chang's specialty lies in traditional quality discernment rather than analytic chemistry, therefore I posed the question to my teacher Dr. Zhao Zhong-Zhen as well. Each is a top expert, but with a slightly different angle (Dr. Zhao more botany, chemistry, and contaminants, Dr. Chang more about grading and pao zhi, but there is a lot of overlap between their knowledge). However, the hard thing about asking a real expert about these issues is this: What literature do I have to show them as the basis for my inquiry? It is a loss of face for me to ask them a scientific question if the only sources of information that I have are: 1) An article that is essentially just a commercial advertisement, and 2) A translated abstract of a paper with no citation, no author, no publication data, etc. I would be embarrassed to ask someone like Dr. Zhao a question based on such sources alone- he would just look at me and think " since when do you use ads as the basis for your academic information? " Hao diulian! (what a loss of face that would be) One of the more annoying things about Chinese medicine in America is clearly illustrated by the thread on Worsley and his sources. It is easy to spread unsubstantiated information, but it is much harder to actually track down facts and evidence. Unfortunately, it is always the myth-busters that actually have to do the hard work of producing the evidence. Sometimes the people trying to correct misconceptions are busy with their other work, and it is annoying to waste time tracking down facts just to constantly dispel rumors by other people that spread information without any care in the world for evidence or reliable sources. I will share my thoughts on the Worsley topic soon, but I might not get to it today. I am grateful for the fact that our discussion of Fu Zi has now been enriched by Heiner, the discussion is far more rich and meaningful now. > At least one major supplier in China that I know of says that it is standard > practice for fuzi's skin to be removed with toxic chemicals. I wouldn't doubt that. However, I have almost never seen Fu Zi with the skin removed in the marketplace. I don't know what stores you shop in, but virtually every batch of Fu Zi that I have seen has the skin intact. The main form of Fu Zi on the US market is Hei Fu Pian, called Hei because the black skin covers the outside. Eric Brand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 , <zrosenbe wrote: > > Eric, group, > Since Heiner was a topic of discussion in this series of posts, I > forwarded him the series so that he could reply on the Fu zi issue, Hi Z'ev, Thanks for forwarding the post, Heiner's response really raised the bar of the discussion. Just the type of meaningful content that I was hoping for. I always appreciate your pursuit of knowledge and your resourcefulness when it comes to getting in touch with the right experts at the right time. To Heiner, I really appreciate your response. You've made a major contribution to the field by bringing awareness of the Huo Shen Pai (Fire God School) to the West. As I know you can appreciate, China is a place with great diversity in Chinese medical practice, and all too often people in the West have a skewed view of " TCM " simply because they haven't had adequate exposure to the great variety of thoughts and approaches that we find in China. The Huo Shen Pai is a perfect example of the rich medical diversity in China, and I truly commend you for bringing it to the attention of Western practitioners. You've done a great thing with your website as well as your personal quest to learn more about Chinese medicine- by learning to speak Chinese and sharing your experiences with your colleagues in the West, you've really opened people's minds. The website's concept of interviews with famous Chinese doctors is awesome, it really allows Westerns to gain access to the thoughts of top doctors in China, and I really respect how you've made the site into a great information resource. So, on to Fu Zi, please see my responses below. > It was not until 2005, when my colleague Dr. Liu Lihong (contemporary > China's most prominent voice on restoring aconite use) connected with > living practitioners of Southwest China's Huoshen Pai (Fire School > Lineage), that I understood why even the most doggedly determined yang- > tonic buffs among my teachers were avoiding aconite. The practitioners > (from Sichuan, Yunnan, Hunan, and Guangxi) who intimately know and use > this herb all the time (up to 95% in their presciptions, in amounts > ranging from 30-200g) summarily concluded that due to the recent > realities of the market place the quality of the available aconite has > become increasingly problematic, even dangerous. They content (in > accordance with Li Shizhen's materia medica) that genuine aconite must > come from the small district of Jiangyou in Sichuan, otherwise it does > not exhibit the medicinal properties described in the materia medica. Thanks very much for sharing the background information on the great experts that stimulated this discussion. In many ways, it seems to me that your core product and concept is really premium Fu Zi. Gourmet, boutique, didao, the best stuff that you can get your hands on. I really respect that. I'm really into that kind of thing. For example, I get the best of the best Ren Shen in China. I spent years over there, and I have sought out the most knowledgeable people that I can find to learn about ginseng. I hit all the markets throughout the country, go to the growing region, the conferences, I read all I can and I do everything possible to really understand ginseng. I've managed to build connections for the best stuff, straight from the first wholesaler in China. Authentic Chang Bai Shan mountain-grown ginseng, basically the exact equivalent of what you've done with Fu Zi. So I really respect where you're coming from. In Li Shi-Zhen's time, the best Ren Shen came from Chang Bai Shan. Chang Bai Shan is a mountain on the border of China and North Korea, it is the original didao (authentic region) spot for ginseng according to traditional Chinese medicine. It is the ginseng equivalent of Jiangyou, the district where you source your premium Fu Zi. But back in Li Shi-Zhen's day, ginseng was mostly obtained from wild sources, and the ginseng market today is different from what it was back then. Nowadays, ginseng is grown in Korea, Russia, and Northeastern China. Only three states in China produce it, Jilin, Liaoning, and Heilongjiang. Liaoning-grown is said to be slightly inferior, but in truth all the ginseng is graded based on quality. Even the same field will produce some roots that are better than others, and the traditional grading is quite sophisticated. Ultimately, the precise region is less important that the quality grade. If you really know how to look at the product, you can tell exactly what quality it is. The stuff from Chang Bai Shan is fantastic, for the half-wild grade Chang Bai Shan is pretty much the only source that exists. But even though I sell the real Chang Bai Shan goods and Chang Bai Shan was the most famous small region in Li Shi-Zhen's era, I still would never say that the Korean, premium Chinese red, or Russian woods-grown ginseng products are necessarily inferior. Each region produces a slightly different product and the quality can be quite excellent if you know how to buy it. The cultivation techniques and pao zhi methods used now are different than they were in Li Shi-Zhen's time. Now we have Hong Shen (red ginseng) and different growing regions than they had back in the Ming dynasty. Both Fu Zi and Ren Shen are ancient products with extreme sophistication. Just learning how to moderate and harness the power of Fu Zi took an incredible amount of human experience. Fu Zi and Ren Shen can be found in many varying grades and processing forms, and their world is much more complex than a single district of cultivation area. To say that only one district produces good stuff is a fairly significant statement. It requires evidence to back it up, and for items like Fu Zi and Ren Shen, there is an incredible amount of literature available on aconitine or ginsenoside content, the effects of different processing methods, the variance based on growing environments, etc. We both read Chinese, you know this literature exists for Fu Zi, I know it exists for Ren Shen. In the case of Ren Shen, it is basically safe. Ren Shen has lots of quality problems, lots of poor product on the market, overuse of fungicides, overuse of sulfur, etc. I bring a product that is a solution to all of this, I bring the real authentic woods-grown, chemical free Chang Bai Shan didao Ren Shen to the market, just like you do with the Fu Zi. For me it doesn't matter too much- I don't talk much about the poor quality, poorly-processed low grade stuff on the market and its dangers, I just talk about the good stuff, the stuff that you can get if you really know how to buy good ginseng. I don't fear that ginseng will be banned because I know it is generally well-established and ultimately quite safe. But Fu Zi is different. Fu Zi is one of the world's most famous poisonous plants. It has great medicinal power that we all respect. But even though the FDA doesn't specifically exclude it, it isn't really completely established in our law. Some companies cannot import Fu Zi because it is not really all that legal as a food or dietary supplement in the US, and the enforcement of the law is very inconsistent. Food products, by law, must be safe. Fu Zi is poisonous and it survives in a very gray area of the law here in the US. It is vital to preserve our access to Fu Zi, for the good of the Huo Shen Pai as well as the average person that uses 3 grams in Shen Qi Wan. If you want to say that your Fu Zi is the best, by all means, I'll stand behind you. I can see that you are getting the best stuff that you can and you care about it. But if you are suggesting that the entire industry of Fu Zi beyond your company is unsafe, I ask that you please provide evidence for this. Fu Zi must be tested for its aconitine content, all granule producers and ethical suppliers do this. There is an incredible amount of literature available on this, an incredible amount lab reports abound. To state that most Fu Zi is dangerous is a big deal. It needs to be substantiated. If we can't produce the evidence and responsibly police ourselves, someday the FDA might step in and deny us all access because acupuncturists say it is poorly regulated and dangerous even if they've never looked at a single scientific paper. I know that you read Chinese so you know the literature and you understand the academic standards in the Chinese world. In these uncertain times, please preserve the academic standards and do not say that most Fu Zi is dangerous unless you can show this with solid data. > When Dr. Liu's Institute for the Clinical Research of Classical > undertook a fact finding mission to solve the supply > problem for this important herb, he found that more than 90% of the > Fuzi exported by that particular district is shipped in from > elsewhere, then repackaged into containers labeled " Sichuan, > Jiangyou. " Of course, authenticity is always a problem when buying herbs in China. That is why the people that do it spend years learning the art of buying a certain product. I understand that Jiangyou is the best region and that inferior goods are smuggled in to be sold under the Jiangyou stamp. We see the same thing with ginseng, smuggling Jilin ginseng into Korea so that it fetches a higher price is common. The same is true for wine. Wine is Europe is strictly regulated, but still cases surface where French growers get caught smuggling grapes from Spain, etc. Grapes also have their authentic growing regions and many different grades, just like Ren Shen or Fu Zi. Just like Ren Shen, wine is best from certain counties. For example, wine from Napa is better than wine from Colorado. But to say that Napa is the only good place to grow wine? That is a bold statement. Sonoma is quite close, and both Napa and Sonoma grow many different grades of product. I think a grower in Sonoma might call foul if a grower in Napa said that only Napa product is worth its salt. I suspect that the same is true of Fu Zi. Someone that knows what they are doing, knows how to buy it, is willing to pay the price...that person can probably get good Fu Zi. But to narrow an entire tradition down to one district is really quite extreme. It doesn't matter if you are talking about grapes or ginseng or aconite, it matters how the season is, how the general environment is, how the soil is, and now that we have HPLC, it is more complex that Li Shi-Zhen ever dreamed of. It doesn't matter what plant you are talking about, there are very few plants in the world that can only be effectively grown in one village or county. Many books state that the best Fu Zi comes from the state of Sichuan, but I'd never heard of Jiangyou county before. Good Fu Zi is said to come from the state of Sichuan, just like good sweet corn is said to come from Colorado. But honestly, the sweet corn in New Mexico is about the same as in Colorado (both are much better than California corn). Likewise, the ginseng in Jilin province is good, but let's face it, Heilongjiang province has the exact same environment and the Korean product is even better. Plants don't read books, they don't know where the county line is. > As for my own motivation: I was asked by both my teachers and students > to make this particular piece of clinically-based information (as well > as the actual material to use it) available in the West. At this > point, the logistical ramifications of importing powder-filled barrels > with single granular extracts from China has put great strain on my > clinic staff and stretched my personal comfort zone as a scholar. More > than one year later, there have been no financial rewards, just a > continuing commitment to help interested practitioners in my community. I fully understand that this isn't about profit for you. The same is true with the ginseng for me. I bet we both make very little profit, but we still do it because we are nerds that love this stuff. I realize that you are concerned with getting good stuff and I'll send people that want premium Fu Zi your way. I also understand that the clinical experience of your teachers suggests that the Jiangyou product is the best. But please don't say that everything else is dangerous unless you have data to support it. I sell good ginseng and many people tell me it is the best they've ever tried- but I would never rag on inferior ginseng and risk getting it banned. Fu Zi is a high risk product, so we need to make sure that our advertisements don't exaggerate the risks. It would be a great shame to lose this powerful ally. The only way to preserve our access is to build an evidence base that has data behind it. Sincerely, Eric Brand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 In response to the case that Bill is talking about, what is unfortunate is that this individual is an educator who is encouraging somewhat of a blind leap into this specific method of Fu Zi use. I've also seen many of the same adverse effects and potentially dangerous applications including in cases of hypertension. What is fortunate is that this teacher is also really inspiring a lot of students to investigate SHL and JGYL. Does anyone have a succinct explanation of the different schools of practice that are contributing to some of the faddish overapplication of Fu Zi? Where are these methods being disseminated and how? I heard from Roy Upton that Fu Zi is responsible for not only the most T.C.M. fatalities, but for the most adverse effects attributed to any one herb world wide. I'm curious as to the level of documented adverse effects in Japan based on lower doses being administered in the Kanpo system. Anyone have data on this? I always cringe when I see Xiao Huo Luo Dan patents on health food store shelves. I think that this type of lack of commercial discrimination puts herbs such as FuZi at risk of being taken from us. Remember it wasn't trained T.C.M. practitioners that abused the relatively more safe MaHuang to the point of its current regulation. Ben plantmed2 Wed, 12 Aug 2009 16:51:23 +0000 Re: Fu Zi authenticity and safety Jason, The fu zi shotgun approach is not a widespread practice here, but it is practiced regularly a local practitioner who is not a member of this group. I'll just leave it at that, since my purpose is to discuss the issue and not publicly put down this person by name. One of my Chinese teachers commented on this issue in a very simple way: " Don't be a fuziholic " . I'm not sure of the source of that fu zi, since I now get my herbs elsewhere. I want to repeat that I think fu zi is great when it is needed. Some of the most amazing responses to herbs that I have seen have come from prescribing Jin Gui Shen Qi San, Wu Mei San, and Fu Zi Li Zhong Wan. I am just very concerned about its indiscriminate use, based on the numerous adverse events I have seen. - Bill , " " wrote: > > Bill, > > > > I could not agree more. It clearly incorrect to prescribe these hot > medicinals for ALL cases. Do you find practitioners in your area doing this? > I have been reading some huoshenpai stuff lately, and there are doctors that > claim to use fuzi in 98% of formulas. This is a bit hard for me to wrap my > head around and is counterintuitive in regard to true CM diagnosis. Although > my experience with fuzi is very small compared to these guys, my percentage > of patients that get these type of treatments is quite small. > > > > Also, who else is distributing this black fuzi besides Spring Wind. Is it > also the steamed version (for 5 hours)? I know Spring Wind just recently > started carrying this. I wouldn't mind experimenting with a few versions. > > > > Regards, > > > > -Jason > > > > > On Behalf Of bill_schoenbart > Wednesday, August 12, 2009 9:50 AM > > Re: Fu Zi authenticity and safety > > > > > > The fu zi that I see over-prescribed is dark, with black skin. I can't > confirm for sure that it is processed properly, but I have seen it work just > fine in cases of actual yang deficiency. > > > Bill, > > > > 1) Which properly-processed is fuzi are you referring to? I think that the > > side effects that you mention are potentially from improperly processed > fuzi> > > Yes, of course a well-trained SHL practitioner will detect underlying yang > deficiency in heat conditions. What I am referring to is the type of > practitioner who sees it in ALL cases and prescribes fu zi, ma huang, and xi > xin all the time. This shotgun approach will certainly have success stories, > but the often untold story is the dozens of extreme adverse events that > other people are forced to clean up. Prescribing according to dogma is no > replacement for a proper differential diagnosis. > > - Bill Schoenbart > > > > > 2) I of course I agree with your contention that one should not use fuzi > > incorrectly. However I think your argument cuts both ways. There are of > > course " hot " conditions that do not respond to typical cooling treatments > > and reverse when using fuzi. I have had three such patients in my clinic > in > > the last month. For example, they may have a deep red tongue, core body > heat > > (experienced by the patient), or yellow phlegm. Such symptoms can easily > > normalize if given fuzi when there is a yang deficiency. > > > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 , " bill_schoenbart " <plantmed2 wrote: > > Thanks for yet another informative post Eric. Two questions / comments: > > 1. Is the book still available that has all those color plates of herbs? Yes, Dr. Chang is going to start sending his book set to the US in bulk, so it will soon be on the US market. It is a seven volume set, I think 5 or 6 of the volumes are just pictures of color plates. All the text is in Chinese, which obviously is a limiting factor. There is no standard English terminology to describe all the technical terms of traditional quality discernment, so it would be really hard to translate and it would be too specialized for any English language publisher to invest in. But the Chinese version and the all-important photographs will be around, and the book will be very reasonably priced considering its scale. If you email me, I can send you a sample of the photographs (in an advertisement that describes the book, also in Chinese at the moment). Ericbrand at gmail.com (no spaces). Bill, I will be lending my set of Dr. Chang's books to Roy Upton in Santa Cruz until the shipment of books comes in. I would presume that you know Roy, so you could stop by and check them out sometime. For those that don't know Roy Upton, he is doing great work on a project called the American Herbal Pharmacopoeia. Check it out at http://www.herbal-ahp.org/ Really the best stuff I've ever seen from the perspective of scientific Western literature on herbs. On par with the best stuff coming out of Asia. > 2. I would like to mention that there is also a problem with incorrect prescribing of properly-processed fu zi... But I'm very concerned that the rampant unnecessary prescribing of fu zi will be more likely to lead to its banning than improperly processed fu zi. Agreed. There is no substitute for pattern differentiation and flexible thinking. The beauty of Chinese medicine is that we have many different perspectives to draw from, we can use Shang Han Lun theory, Wen Bing theory, Zang Fu Pattern Identification, etc. It doesn't make sense to limit oneself based on dogma, though dogma surely sells like hotcakes. But yes, I can accept that there are a few top doctors in China that use Fu Zi in 95% of the cases they see, and I think this illustrates theory in a very interesting fashion and adds to the diversity of Chinese medicine. Nonetheless, I think that their viewpoint is slightly extreme. Even though Chinese medicine has always had extreme (and often pioneering) viewpoints, the vast majority of doctors tend to return to the basic principles of balance and flexibility. I would like to see the Huo Shen Pai in action and I am humble and intrigued... but to be honest I would take any statements about Fu Zi with a grain of salt if the statement came from someone who used Fu Zi in 95% of all the cases they saw. Eric Brand Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 Eric, I think we need to remember that before the modern era, Chinese physicians catered to more local populations with specific trends in health colored by the constitution of local people, climate, diet and other factors. Just as there are local strains of herbs, wines, and foods, there are local 'strains' of patient populations as well. Volker Scheid discusses this in his " Currents of Tradition " text, which is about the late Qing dynasty Suzhou current of physicians. In our 'global' society, where people move all over the world, cultures intermingle, and one can get macdonalds in Beijing, people have changed and we need a more 'eclectic' approach to practice. At the same time, I think we can appreciate those practitioners who have 'limited' themselves to a particular style of medicine, such as Arnaud's Shang Han Lun/Jin Gui based practice. We need to keep these lineages alive, and having people devoted to these currents keeps them so. However, I see that one of the 'trends' in our patient populations is an exhaustion of yang qi and a need for fu zi. I never understood all the fu zi formulas in the Shang Han Lun or the nature of yin channel diseases until I was exposed to the 'fire school' approach, and it filled in a major gap in my knowledge base. On Aug 12, 2009, at 11:34 AM, Eric Brand wrote: > Nonetheless, I think that their viewpoint is slightly extreme. Even > though Chinese medicine has always had extreme (and often > pioneering) viewpoints, the vast majority of doctors tend to return > to the basic principles of balance and flexibility. I would like to > see the Huo Shen Pai in action and I am humble and intrigued... but > to be honest I would take any statements about Fu Zi with a grain of > salt if the statement came from someone who used Fu Zi in 95% of all > the cases they saw. > > Eric Brand Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 , <zrosenbe wrote: > > Eric, At > the same time, I think we can appreciate those practitioners who have > 'limited' themselves to a particular style of medicine, such as > Arnaud's Shang Han Lun/Jin Gui based practice. We need to keep these > lineages alive, and having people devoted to these currents keeps them > so. I absolutely agree. I'm glad to see different schools of thought alive and thriving! Eric Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 Ben, Jiao Shu-De teaches that mastering the use of fu zi and da huang, as powerful as they may be, is necessary to practice Chinese herbal medicine. While I agree that indiscriminate use of fu zi is, of course, wrong, and that xiao huo luo dan should not be on health food store shelves, that doesn't mean that use of fu zi isn't essential in the right place and time. Some of my more serious patients with kidney failure, lupus or rheumatoid arthritis rely on a reliable source of this herb. It is even more critical with patients who have been given a lot of prednisone, which turns the body very cold over time by dispersing yang qi and essence. .. On Aug 12, 2009, at 11:17 AM, ben zappin wrote: > In response to the case that Bill is talking about, what is > unfortunate is that this individual is an educator who is > encouraging somewhat of a blind leap into this specific method of Fu > Zi use. I've also seen many of the same adverse effects and > potentially dangerous applications including in cases of > hypertension. What is fortunate is that this teacher is also really > inspiring a lot of students to investigate SHL and JGYL. > > Does anyone have a succinct explanation of the different schools of > practice that are contributing to some of the faddish > overapplication of Fu Zi? Where are these methods being disseminated > and how? > > I heard from Roy Upton that Fu Zi is responsible for not only the > most T.C.M. fatalities, but for the most adverse effects attributed > to any one herb world wide. I'm curious as to the level of > documented adverse effects in Japan based on lower doses being > administered in the Kanpo system. Anyone have data on this? > > I always cringe when I see Xiao Huo Luo Dan patents on health food > store shelves. I think that this type of lack of commercial > discrimination puts herbs such as FuZi at risk of being taken from > us. Remember it wasn't trained T.C.M. practitioners that abused the > relatively more safe MaHuang to the point of its current regulation. > > Ben Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 12, 2009 Report Share Posted August 12, 2009 I have used fu zi for over 25 years often in the range of 30g per day. For the last 18 yr or so in powder form. I have never has any problems with side effects and that has been using TCM. A patient may develop constipation which usually can be prevented with other herbs. I have had patients develop excessive sweating, dry mouth, but now after studying with arnaud i think these patients did not have fusi pulse. I have heard of patients getting hurt by firegod dr but never seen one myself so i cant really comment. At this point i would say that professionally processes fuzi is quite safe when used within differential diagnosis and or when balanced by other herbs when used for properties such as analgesic effects. I know the Taiwanese company i use process their own herbs and have their buyers accompany the herbs all the way to Taiwan. I am sure they know what they are doing. I just got the 10:1 fuzi from classical pearls and it tastes and smells very similar to my Taiwanese company, although a bit stronger, and starchy. I guess they use sanyao. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 13, 2009 Report Share Posted August 13, 2009 Again, Heiner responds (forwarded by Z'ev): Eric, thank you much for your detailed and informed response to my comments! I am sorry to hear that something I said or wrote conveyed the impression that the Fuzi I am importing via Classical Pearls is the only safe choice on the market. It maybe the only one that I trust using in my own clinic, and one that my teachers and colleagues from the Fire Spirit School have specifically sought out due to a wave of sustained quality problems of Fuzi sold in Southern and South-West China. However, I am very well aware that my own knowledge on the subject of Fuzi is anecdotal and viewed through the lens of my own experience. In this matter, I primarily rely on the opinion of my teachers and colleagues from Sichuan and Guangxi, who prescribe more Fuzi than anyone else I know worldwide. I find that there are many strong personalities (and associated viewpoints) in our profession, and for the sake of mutual respect I am always trying to acknowledge that my own passions and opinions are subjective, patterned and limited by my individual life path. I always warn my students on the first day of class that they will hear my own understanding of yin/ yang and other foundational concepts of Chinese medicine, and tell them that this is by no means the best and only way of looking at them. You mention chemical ingredient testing as a reliable way of establishing an efficacy rating of herbs. I personally have a deep- seated distrust of using laboratory data as an objective and exclusive claim about the quality of herbal materials. I remember a lecture by the sole surviving external alchemy veteran at Chengdu University of TCM in 1991, when she told the story of how certain traditional skin remedies were rendered completely ineffective, even harmful, when the materialist agenda of the post-cultural revolution era demanded to ditch cumbersome and time-consuming alchemical traditions (for the production of metal containing remedies) as " superstitious " and replaced them with chemical shortcuts. The claim was that the chemical composition of the end product was the same, yet the clinical results were horrifying: all of a sudden, slow-healing flesh would grow up and out in the form of giant tumorous welts, rather than pull together neatly and quickly as it would when the traditionally produced product was applied. In my opinion, clinical experience still has an important place in Chinese medicine education. The (subjective) experience of master practitioners (as well as all the other crafts people involved in the production and trading and processing of herbs) needs to be acknowledged and respected. For me, personal transmission still represents the most significant entry-way for a deeper level of initiation into this medicine. No institutionalized guidelines and tables and data sheets can replace that. The devices of modern science have not yet progressed to a level where the dao, the shen, and the qi contained in an herb can be adequately measured and represented in numerical form. Until then, we need to rely on the more messy (yet in my opinion also infinitely more interesting) ways of human transmission... This is the sacred work we all do. Let's respect each other as fellow " sage acolytes " in this process. And finally--I would love to get some of your Changbai Shan ginseng for my clinic. How do I order some? Heiner I also understand that the clinical experience of your teachers suggests that the Jiangyou product is the best. But please don't say that everything else is dangerous unless you have data to support it. I sell good ginseng and many people tell me it is the best they've ever tried- but I would never rag on inferior ginseng and risk getting it banned. Fu Zi is a high risk product, so we need to make sure that our advertisements don't exaggerate the risks. It would be a great shame to lose this powerful ally. The only way to preserve our access is to build an evidence base that has data behind it. Sincerely, Eric Brand Chair, Department of Herbal Medicine Pacific College of Oriental Medicine San Diego, Ca. 92122 Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 15, 2009 Report Share Posted August 15, 2009 I'll attest that Eric has the best ginseng anywhere. Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2009 Report Share Posted August 17, 2009 Dear all fuzi enthusiasts I apologize for not responding earlier. It was finals week here at SIOM. I am very heartened by the passionate interest I have seen recently on CHA regarding fuzi. My teacher in Taiwan used fuzi quite a bit and was not afraid to use it even while under the critical opinion of the majority of the other experienced doctors on island (which is dominated by Wen-Bing style). But he used it appropriately following consistent diagnostic, dosaging and herb pairing criteria. As many of you have aptly mentioned, this is a very powerful herb and produces excellent results when used correctly. Needless to say, it is potentially disastrous as well. The problems we face as practitioners with regard to safety and public (and govt) opinion includes a wide range of factors, some of which we can and should control (our in-clinic actions) and some we can't control (patient behavior and response) and some which we hope have been controlled for us (integrity of equipment and supplies). Assuming we use fuzi with the highest skills and experience possible, we still are forced to rely on an assumption of product quality. In Taiwan where I treated cancer patients in a western hospital, I gave out prescriptions (it was a free clinic) and told patients to fill them out at their local herbal shops. Several came back the next week reporting strange symptoms after taking the herbs but which should not have occured with any reasonable predictability. After suggesting they fill out their prescription at another herbal shop the symptoms dissappeared. Following this, I rarely gave out a prescription instead prefering to offer the herbs from my own supplier at cost price. With regard to fuzi, my teacher had an incident a few years back where suddently several patients reported fuzi toxicity (numbness in tongue and mouth). Following that experience, he no longer trusts quality control of paozhi fuzi from mainland and always adds a relatively large® amount of raw ginger to fuzi prescriptions. Quality control problems exist in China. That is widely known. As practitioners, we cannot afford to wait for problems to occur in our patients before showing due diligence. The authors of the articles I have translated and presented spent months in the field. The main author reports widespread problems which mirror those mentioned by Heiner. Nobody stands for lead in toys or tainted Tylenol. Why should we accept such potential problems with fuzi? In the last week, in addition to what has been posted on CHA, I have privately received a several other emails which support one side of the argument or the other. It is my intention to continue to follow up with this issue. However, at this point I simply aim to present the information detailed in these articles which report potentially serious levels of industrial toxicity issues and obviously has implications to our daily clinic. Thank you all for your comments. Daniel L. Altschuler Quote Link to comment Share on other sites More sharing options...
Guest guest Posted August 17, 2009 Report Share Posted August 17, 2009 Heiner and all, Sorry for the slow reply, I had to go to Hong Kong and haven't had much time to catch up on email. > You mention chemical ingredient testing as a reliable way of > establishing an efficacy rating of herbs. I personally have a deep- > seated distrust of using laboratory data as an objective and exclusive > claim about the quality of herbal materials. I would never suggest that laboratory analysis would suffice as an exclusive source of information regarding medicinal quality. Traditional quality discernment is also important, and clinical application is an essential aspect of quality assessment. Going back to the topic of ginseng as an example, chemical analysis, traditional quality assessment, and clinical application are all equally important. A lab can measure the potency and spectrum of ginsenosides. Not all ginseng has the same distribution of the different active ginsenosides, so the chemical fingerprint informs us of many subtle nuances. Our current understanding of the science of ginseng is still not adequate to explain all of the pharmacological effects of the whole product, much less its Chinese medical applications. The high sensitivity of the human organism still surpasses the high sensitivity of chromatography, and the current state of the science does not yet give us the " whole picture understanding " that actually eating the product can provide. Nonetheless, a simple chemical test can determine whether ginseng is improperly processed or full of toxic additives. Chemistry can even tell us if ginseng is genetically contaminated by hybridization. (Xi Yang Shen has a distinct marker ginsenoside that only occurs in Panax quinquefolium. If this compound is found in a sample of Ren Shen, it indicates that the genetic purity of the strain has been compromised by cross-pollination.) I would never suggest that chemical analysis alone would be an adequate guide for purchasing ginseng. One also needs to assess quality with the traditional specifications, appearance, growing region, flavor, aroma, etc. The most important assessment is to eat and use the product clinically. Our body and our patients can report subtle differences that are highly relevant. Heiner, I highly value your opinion of Fu Zi because it comes from the clinical experience of yourself and your teachers. I consider this to be an authentic and essential source of information. In no way am I suggesting that chemical analysis is superior to the assessment of a clinical expert. Nonetheless, chemistry is important for determining safety and risk, and chemistry is a valid manifestation of nature, complete with parallels for all the dynamics of qi and everything else that Chinese philosophy holds dear. Going back to ginseng, chemistry alone cannot show us everything about what makes good ginseng great, at least not with our current understanding. Two different batches could be equally excellent even though they have significant chemical differences. Likewise, two batches could have what appears to be similar chemistry but different quality. Nonetheless, chemical testing can identify problems that pose a safety risk. With ginseng, these risks are fungicides, pesticides, mold, and other contaminants. Chemical testing is beneficial to exclude such risks. With Fu Zi, the main cause of toxicity is improper processing, which is directly related to the effects of aconitine. A lab test is the perfect way to confirm or deny whether the processing is adequate. Once again, I have no problem with you saying that your Fu Zi is the best. I'm sure it is. But to say that other Fu Zi is dangerous requires evidence. Expert opinion is enough to say that your stuff is the best. But to say that everything else is dangerous, well, that requires some investigation. We know exactly why Fu Zi is dangerous and it is easy to chemically assess whether or not it actually is more dangerous than it should be. If we deny the validity of chemical testing when it comes to Fu Zi, we have to make a decision based on faith in the teacher's opinion instead of objective evidence. Consider something like wine. A very old and sophisticated product, like Fu Zi. Like Fu Zi, it thrives in specific soil conditions, and we differentiate it based on its county of production as well as its grade. We use a lab assessment to determine its alcohol content and to screen it for pesticide residues. But we use taste and traditional assessment to determine its quality. Any true wine expert actually drinks the wine. They don't just look at it in a lab; just like the clinical Fu Zi experts, they actually use it. But let's face it, many of the world's greatest wine experts are alcoholics, and many of them have a developed palate and usage trends that differ from the average wine drinker. Similarly, the people that are the greatest experts on Fu Zi are people from the Fire God School (Huo Shen Pai) in Sichuan. These people use it all the time, often in massive doses. They know it inside and out, but many people that are drawn to giving massive doses of Fu Zi to 95% of their patients may be prone to extreme opinions about many subjects, especially Fu Zi. I'm sure that we would find many true wine experts that are a bit extreme in their opinions. Without a doubt, they know wine better than most of us, but many of us may not choose to emulate the lifestyle that gave them such an intimate knowledge of the drug. Many of us may not even share their same taste and draw the same conclusions. Please understand that I highly value traditional knowledge and I think your teachers' opinions are at least as important as HPLC assessment. But when you write that most other Fu Zi products on the market are dangerous, I think many readers may interpret that statement as something that is based on objective evidence rather than your teachers' opinion. Many of us do not use Fu Zi in massive doses in 95% of our patients, but retaining access to Fu Zi is critical for all of us. Given that many practitioners do not research issues at great depth, I could easily foresee people reading these articles and assuming that Fu Zi processing is often inadequate and dangerous. These ideas could be repeated without looking at additional evidence, and then we could all lose access to this valuable substance. We all agree that this would be a great tragedy. As writers and translators, we bear tremendous responsibility. Many people cannot read the primary Chinese literature, so the few people that can access this material owe it to the profession to make our work transparent. Opinions should be differentiated from material that can be verified in primary sources. This is not to say that the old master's knowledge is less valuable than the material found in the literature, but people have a right to know which material comes from the old master and which material comes from the literature. With an issue like Fu Zi, the stakes are higher because misinformation could easily cause all of us to lose our right to prescribe one of our most important allies. And finally--I would > love to get some of your Changbai Shan ginseng for my clinic. How do I > order some? You can check it out at my website www.legendaryherbs.com I also have some photographs and articles on ginseng up on the excellent Blue Poppy Blog, located at BluePoppy.com Thanks for the vibrant discussion. Our group here at CHA is fantastic. 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