A typical Chinese Medical clinic employs between 300 and 500 herbs on a regular basis. In order to understand the functions of the individual herbs and herbal combinations it is necessary for the practitioner of Traditional Chinese Medicine (TCM) to study Chinese herbology. In order to be able to differentiate between the various herbal substances, they are often grouped and classified in herbal categories, such as herbs that clear heat (antipyretics), herbs with anticoagulant effect, herbs that arrest bleeding, laxative herbs, antitussives, substances that calm the spirit, to give a few examples. 

It then becomes essential for the student to become very familiar with the effect of the herbal category as a whole. As an example we can choose the category of “substances that release exterior conditions”.

What are exterior conditions, what is exterior or exogenous pathogen and how do they affect the body?

Western medicine is chiefly a medicine dealing with chemistry. Diagnosis is done via a chemistry panel, disease is thought to be caused by viruses, bacteria, hormonal imbalances, and medication consists in certain chemicals or molecules. 

Chinese medicine is more a medicine of physics. It distinguishes electric currents, ionic flow, pathways of electric or ionic currents, and the pathogens include elements of physics as well such as wind, cold, heat, moisture (dampness) or dryness. What most people don’t know is that these two, the chemical view and the view of physics can describe the same phenomena, but with a completely different angle. They actually represent the two sides of the same coin.

The question for someone that is used to think within the chemistry framework of medicine, obviously is, what exactly is wind, cold, or damp and how can it affect the body?

Mitochondria, the power plants of the body

I always ask my patients, how many cells are there in a human body? The answer is between 50 and 100 trillion. Among the parts of the cell, one is of a particular interest for this discussion. The power plant of the cell, the mitochondrion. An average cell contains about 1000 mitochondria but certain muscle cells such as the heart muscle, contain up to 3000 mitochondria. The mitochondria may take up 10 – 15 % of the volume of the cell, which is an indication of the primary importance of this organelle in the human body. Mitochondria absorb the ingested food, liquids and oxygen and via a complicated process, crank out hydrogen ions, also known as positive ions H+ and electrons. The mitochondria often form long chains at the inside of the cell, and it is this scaffolding that can either lead to a transport of current or if interrupted act as a storage battery. Mitochondria also produce heat.

Energy never flows randomly, but rather in a vector, with other words it flows in a specific direction. The energy of the whole body flows in a specific network of energy conduits, which are called meridians. If the energy flow is normal, then there is health and all the functions of the body perform normally. If energy flow is abnormal, then the function of the body becomes abnormal as well.

Abnormal energy flow and exopathogens

Many factors can lead to abnormal energy flow, and energy is particularly sensitive to other forms of energies, such as heat, cold, wind or dryness. The interaction of these energies may lead to disease. These forms of energy invade the body from the exterior, hence they are termed exogenous pathogens. The wind is the spearhead that easily drives in other pathogens such as heat, cold or damp. The term wind chill factor describes how the wind can cause the organism to feel a lower temperature than the one that the thermometer describes. 

After sweating, when the pores are open, after taking a shower, when going outside with wet hair or when exposed to the outside weather without proper clothing can most easily lead to an overtaxing of the body’s defenses, the wind and cold can invade the skin and muscles where they begin to affect the energy flow and disrupt the normal physiological functions. 

The first reaction of the body is tightness, muscle spasm and pain. Depending on which factor is predominant a slightly different symptomatology may present. 

If the influx is more severe, then the person might come down with an upper respiratory tract infection or a flu. 

If the condition lingers on the body will try to get rid of the pathogen by heating up and producing sweat. If the defenses aren’t strong enough, then the pathogen might get stuck in the skin leading to various dermatological conditions such as urticaria, acne, rashes, eczema and so on.

A pathogen consisting of a mixture of wind, cold and damp may lead to arthritic changes in the bones and joints.

Because the lung and the skin are closely related, and their function energetically interdependent, when exogenous pathogen invades the skin, then the flow of energy through the skin is disrupted, and the pathogen may progress along the meridian to affect the function of the lung, leading to cough, allergies and asthma.

Substances that release exterior conditions

The herbs and other medicinal substances that are able to release exterior conditions are classified either into warm substances or cool substances. Generally speaking, for people living in the northern hemisphere, such as in the state of Washington, Idaho, Canada or Alaska, the chief exogenous pathogen is cold. The body’s natural response to a cold invasion is to generate heat, so as to create sweat and drive out the cold. In some instances the heat goes up high, and we then call it fever. In terms of the herbal effects, substances that release cold exopathogen are spicy in flavor and warming in nature, with other words, they warm up the body and by the actions of certain spicy volatile ingredients, induce sweating. To bring out their full potential, they must be ingested in the form of a hot tea, or sometimes in conjunction with a hot rice gruel. Everybody has experienced the sweating and heating that occurs, when a spicy dish is eaten. The two most common warm diaphoretic herbs are Ephedra and Cinnamon Twig.

Cool external releasing herbs are used more commonly in the south, where the invasion of the body is more often by wind and heat, or by damp heat. Those substances are cool and mildly spicy in nature, they induce a mild sweat, but at the same time they cool down the body. Two typical examples are Mint (sometimes named peppermint) and Honeysuckle.

Since exopathogenic invasion may create a whole host of conditions, the herbs within this category have the propensity to address very specific conditions. Some herbs are preferred for headaches, others for the cold or flu, yet others for dermatological conditions. 

The following herbs are generally classified in the warm exterior releasing category:

Ephedra, Cinnamon Twig, Perilla Leaf, Schizonepeta, Ledebouriella, Notoptergium, Angelica Root, Ligusticum Rhizhome, Xanthium, Magnolia Flower, Fresh Ginger, Scallion, Asarum, Cilantro

All these substances are spicy or slightly spicy in nature, and they all have a warming, thermogenic effect on the metabolism.

They could be used for all the above mentioned conditions that are induced by exopathogenic invasion, but they have their own individuality and strong points, making them preferable for specific conditions.

For example, Perilla Leaf is effective for conditions where the cold invasion affects the lungs and digestive system, such as a stomach flu, or bronchitis. Angelica Root is more specific for headaches and sinus problems. Notoptergium is famous for its treatment of arthritis and neck or upper back pain, while Cilantro is more specific for skin conditions and acne.

Personality of Ephedra

The herb of interest today is Ephedra. Below is the monogram of Ephedra, taken from my textbook on Chinese herbs. In order to truly understand herbs, they have to become personalities in a student’s mind. 

When I first heard about Ephedra, my friend said: “If you are in a desert, such as the Mojave desert and you are not sure you are going to make it out, you should cook up some tea made from Ephedra. Then you will feel full of energy and just straight walk out of the desert.” Even though this sounds amusing there is some truth to this statement. Ephedra has the effect to stimulate our brain, take away fatigue, and increase endurance. It is for these functions that many athletes have taken Ephedra or some of its components to enhance athletic performance. It is now on the anti-doping list of all sports organizations such as the NBA, MLB, AFL and the Olympic committee. As a matter of fact, if the outside temperature is too high, or if the person is dehydrated, or if the ingested dosage is too high, Ephedra may have tragic consequences. 

Steve Bechler, a pitcher for the Baltimore Orioles died from an Ephedra overdose, as a complication of a heat stroke, following a spring training workout. Ephedra is very spicy and has a very strong diaphoretic effect, inducing profuse sweating. At the same time due to certain alkaloids, it also has a bitter flavor, which excites the heart and spirit (a Chinese way of saying it stimulates the mind and keeps a person awake). Its warm energy is used for a person that is afflicted by cold weather, and helps to warm and restore a normal temperature. If Ephedra is taken on a hot summer day in Fort Lauderdale (the Orioles spring training camp), the person overheats, gets dehydrated, his heart beat gets hyperstimulated and consequently death may occur.

Ephedra has been used for thousands of years by medical practitioners throughout the world. Its recorded history dates back at least 3 thousand years, but it may have been known by herbalists during much earlier dates. Ephedra was used as medicine in Europe, the Middle East, India, China and Russia for millennia. Its primary use is for the treatment of common cold, cough, and specifically asthma.

With the advent of chemistry and modern medicine, herbal substances were chemically studied and the individual components were isolated. The idea obviously was to find out which component of Ephedra was producing the sought after effect, in relieving asthma, or acting as a decongestant.

The chemical components of the three varieties of Ephedra used in TCM are described in detail at the end of the monograph. For our purpose here, two ingredients stand out, ephedrine and pseudoephedrine. 

Ephedrine was isolated for the first time from Ephedra Ma Huang in 1887, then in the 1930’s Ephedrine’s medicinal effects were discovered by Western Medicine, finally in 1954 Ephedrine was first available as an oral therapy for asthma. According to Wikipedia Ephedrine is “commonly used as a stimulant, appetite depressant, concentration aid, decongestant, and to treat hypotension associated with anaesthesia …. both Ephedrine and Pseudoephedrine act as a bronchodilator, but pseudoephedrine has considerably less effect”.

Ephedrine also promotes fat loss and was used in conjunction with caffeine and aspirin which also have an appetite supressant effect, in what is known as ECA by body builders, who want to reduce body fat.

Pseudoephedrine is used as a nasal decongestant, stimulant or as a substance that promotes wakefullness. It is found individually or in combination with antihistamines, acetaminophen or other NSAIDs in many over the counter drugs. I am in possession of a list of over eight hundred of the most common medications sold in grocery stores or drugstores. Here are a few exerts:

Acetaminophen & pseudoephedrine hydrochloride, actifed 12 hour, actifed cold 7 allergy, advil flu and body ache, afrin, aleve sinus and headache, alka seltzer plus cold & cough capsules, bayer select flu relief, benadryl allergy and sinus, cenaphed plus, children’s cough and cold etc. etc. I am only at the letter c but I left out at least 100 medications. It is almost impossible not to find ephedrine or pseudoephedrine in any cold or flu remedies, sinus or allergy remedies, cough supressants, expectorants or pain relievers. For a full list search here: www.in.gov/cji/files/Product_List.pdf  

It can now be said as a matter of fact, that billions of dollars are being made of the herb Ephedra and that as a result the companies that manufacture these products, want to control the market. This is one of the reasons that the FDA has given in to these pressures and controlled the use of Ephedra and its constituents:

 “August 17, 2006, the U.S. Court of Appeals for the Tenth Circuit in Denver upheld the FDA's final rule declaring all dietary supplements containing ephedrine alkaloids adulterated, and therefore illegal for marketing in the United States. [3] Furthermore, ephedrine is banned by NCAA, MLB, NFL, and PGA TOUR [25] Ephedrine is, however, still legal in many applications outside of dietary supplements.” Source: Wikipedia.

There is a dark side to Ephedra. With very small resources Ephedrine or Pseudoephedrine can be converted into psychoactive drugs, most notably metamphetamines and ecstasy. These drugs are much more addictive than heroin or cocaine and have an enormous negative effect on the human brain. Meth labs as they are called have been creeping up all over the United States and they are primarily driven by the Mexican drug cartel.

From my point of view, it is best if Ephedra is used in a way that is commensurate with the long history and practice of Chinese medicine and its safeguards. TCM never used Ephedra as a performance enhancing drug, psychoactive substance or for weight loss. Below the monograph on Ephedra.