Ephedra: A Historical Perspective
By Cara O. Frank, R. Ac.
Ma Huang, or Herba Ephedrae, is among the oldest documented medicinal herbs in the Chinese Materia Medica. It appears in one the first formulas described in the ancient classic of Chinese medicine, the Shan Han Lun (Treatise on Cold Diseases), and is an herb with broad application in many formulas prescribed for a wide variety of diseases.
Chinese Herbal Medicine – Background
Chinese herbal medicine is an important and fundamental tool in the treatment of disease in Traditional Chinese Medicine. Alone or in tandem with acupuncture and moxibustion, Chinese herbal medicine is used by practitioners the world over to treat every conceivable form of disease. The foundation of Chinese herbal medicine, like that of acupuncture and moxibustion, is thousands of years old, and is an indispensable part of the rich heritage of traditional medicine from China.
One of the first and most important books establishing a rational and empirically based Materia Medica of Chinese herbal medicine is the Shen Nong Ben Cao Jing (The Divine Farmer’s Materia Medica Classic). The Shen Nong Ben Cao Jing is one of the ten pre-modern classics of Chinese Medicine, and along with the Huang Di Nei Jing (The Yellow Emperor’s Inner Classic), comprise the two of the most important of these ancient books. While the Huang Di Nei Jing primarily establishes the theoretical foundation for Chinese medical theory, acupuncture and moxibustion, the Shen Nong Ben Cao Jing lays the foundation for “modern” Chinese herbal medicine based on empirical observation and rationalism (as opposed to earlier supernatural and shamanistic approaches to healing). For example, the concept of classifying herbs by taste and temperature, and identifying the channels and meridians the medicinals enter, first appears in this important text.
While authorship of the Shen Nong Ben Cao Jing is traditionally attributed to the mythical figure Shen Nong (the “Divine Husbandman”); the actual authors are unknown. The mythical Shen Nong is considered one of the great heroes of Chinese history. Dating as far back as 2700 BC, Shen Nong has been revered as a Divine being, hence the translation of “Shen Nong” by some linguists as “the Divine Farmer” or “Divine Husbandman.” (Shen Nong is also accredited with teaching farming and agriculture to ancient Chinese peasants.) Like many historical figures in Chinese history, Shen Nong most likely represents a succession of enlightened scholar-healers whose combined work over several centuries laid the theoretical foundation for the practice of Chinese herbal medicine within the framework of Chinese Medicine. The texts that eventually became what is known today as the Shen Nong Ben Cao Jing were originally compiled from oral traditions (perhaps as early as the first century AD) and later reconstructed, and likely supplemented, by the famous Chinese Taoist Tao Hong-Jing, who lived from 452-536 AD.
Another ancient text of monumental importance to Chinese medicine generally, and Chinese herbal medicine in particular, is the Shang Han Lun (On Cold Diseases), written by Zhong Zhang Ji, who lived circa 150-219 AD. The Shang Han Lun is the oldest surviving and most comprehensive medical text devoted to externally contracted (i.e. infectious) diseases. It provides a systematic method of diagnosis and treatment based on signs and symptoms revealed through oriental diagnosis theory. The theoretical foundation for the Shang Han Lun has its roots in at least three other classic texts, the Huang Di Nei Jing, the Shen Nong Ben Cao Jing, and the Nan Jing (The Classic of Difficult Issues). It is an extremely important work in the field of herbal medicine because it presents a sophisticated and detailed use of herbal formulas to treat a variety of infectious diseases, stemming from the common cold to degenerative disorders. As a clinical manual, the Shang Han Lun is still a relevant and useful resource for today’s herbal practitioner.
Primer on Chinese Herbal Formulas
To understand Ma Huang’s importance as a medicinal in Chinese Herbology, it may be useful to know the basic principles that guide the use of Chinese herbs in herbal prescriptions. In general, Chinese herbs are rarely used individually, but rather are prescribed in formulas usually containing at least four – sometimes significantly more – herbs. Each formula is specifically designed to match the patient’s particular pattern of disharmony -- deduced through careful differential diagnosis-- to restore the body’s state of balance, thereby eliminating the Disease State.
Each formula has four principal components: a Monarch (Principle); Deputy; Assistant; and Envoy. Each plays a fundamental role in the action of the formula as a whole. The Monarch produces the primary effects in treating the cause or main symptoms of a disease. Its action dominates the whole formula. The Deputy herb has the primary function of helping to strengthen the effect of the Monarch herb and secondarily to treat symptoms that accompany the disease that the Monarch herb is treating. The Assistant herb has three purposes: (1) to assist the Monarch and Deputy in strengthening their therapeutic effect or to treat less important symptoms by its own action; (2) to reduce or clear away the toxicity and undesired side effects of the Monarch and/or Deputy; and (3) to reduce the potential for vomiting in serious cases due to the potent effects of the other herbs. The Envoy herb acts as either a "medicinal guide," leading the other herbs in the prescription to the affected site in the body, and/or a "mediating herb," helping to coordinate the effects of the other herbs in the prescription. Each component may consist of one or more herbs.
Ma Huang
The simplest and most elegant formula appearing in Chapter One of the Shang Han Lun is Ma Huang Tang (Ephedra Decoction). As the name implies, Ma Huang is the Monarch, or Principle, herb. Ma Huang Tang is used to treat the initial stages of the common cold or flu, such as chills, slight fever, headache, stiff neck, aversion to cold and an absence of sweating. This formula promotes sweating, diffuses the lungs and eases the shortness of breath often associated with this stage of a cold. In Chinese medical terms, this pattern of disease is known as the Tai Yang (Greater Yang) stage of disease.
Ma Huang is also the Monarch herb in a number of formulas that treat other respiratory tract disorders, including asthma, pneumonia, bronchitis, influenza, bronchial asthma and pulmonary emphysema. For instance, Ma Xing Shi Gan Tang (Ephedra, Apricot Kernel, Gypsum and Licorice Decoction) is a formula that has diaphoretic and anti-asthmatic actions, and is used to treat upper respiratory tract infections, pneumonia, asthma and measles. Ding Chuan Tang (Stop Wheezing Decoction) is used for phlegm and heat in the Lungs and treats asthma and bronchitis. For excess fluid in the Lungs presenting with coughing, fever, aversion to cold with chills, fullness in the chest, lack of sweating and edema, Xiao Qing Long Tang (Minor Blue Green Dragon Decoction) is prescribed. This formula, which features Ma Huang, is used for the Western medical disorders such as the common cold, influenza, chronic asthmatic bronchitis, bronchial asthma and pulmonary emphysema. In Chinese Medical terms, it corresponds to a pattern of exterior wind-cold with stagnation of water or body fluids.
Ma Huang also appears in formulas not usually associated with respiratory problems. An example is Yang He Tang (Yang-Heartening Decoction). This formula treats deep-rooted boils, rheumatoid arthritis and bone tuberculosis which, in Chinese diagnosis, results from cold phlegm stagnation. Ma Huang acts to resolve the phlegm, remove stagnation and relieve nodules and boils by driving out cold from the deeper regions of the body. Another arthritis formula containing Ma Huang is Gui Zhi Shao Yao Zhi Mu Tang (Cinnamon Twig, Peony and Anemarrhena Decoction). This is used for rheumatoid arthritis, gout and connective tissue disorders resulting in swollen and painful joints. Ma Huang is used in this formula to warm the channels and relieve pain. Chronic arthritis with intense pain and severely limited movement of the joints can be treated with Wu Tou Tang (Wild Aconite Decoction) or Yi Ren Tang (Coix Decoction), both of which help disperse wind-dampness, warm the channels and relieve pain.
Finally, Ma Huang appears in Xiao Xu Ming Tang (Minor Prolong Life Decoction), a formula for hemiplegia, non-hemmorrhagic cardiovascular accidents, urticaria and rheumatoid arthritis. In this formula, Ma Huang helps conduct deep-seated pathogenic influences out of the body. The formula is based on the archaic notion that Zheng Feng- or Succumbing to Wind is caused by exposure to external wind. We now think of stroke as being caused by internal wind that is generated by the Liver. The formula has some serious errors that not only prevent it from being useful for any stroke, but has the potential for iatrogenesis: Ma huang is hypertensive, as is Fu Zi – (rx aconite). Since hypertension is one of the usual causative factors in stroke, these herbs should strictly be avoided. Additionally, this formula is potentially toxic, owing to the presence of another herb, Guang Fang Ji, Rx Aristolochia which has the potential to be nephrotoxic.
In summary, Ma Huang deserves our respect. It is a hugely useful herb. One that is often immediately gratifying owing to its dramatic impact on the body. When used carefully we can employ it for chronic conditions in attenuated dosages. Fear Not Ephedra!
