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Astringent Complex

CLINICAL APPLICATIONS

* Swelling and inflammation: acute or chronic, may present with or without redness, heat sensation, and/or pain

* All excess heat (acute) and deficiency heat (chronic) conditions presenting with fire, heat, damp-heat, or toxic heat

* Any swelling, exudate, fluids, pus, abscess from water or damp accumulation as a result of inflammation

 

WESTERN THERAPEUTIC ACTIONS

* Anti-inflammatory effect to reduce swelling and inflammation

* Suppressant effect on the pro-inflammatory cytokines, such as tumor necrosis factor-α (TNF-α) and interleukin-1 beta (IL-1β)

* Antioxidant effect to fix free-radical-mediated peroxidation of membrane lipids and oxidative damage of DNA and proteins

 

CHINESE THERAPEUTIC ACTIONS

* Clears fire, damp-heat, toxic heat, and deficiency heat

* Reduces swelling and redness

* Cools the blood

 

DOSAGE

Take 2 to 4 capsules three times daily on an empty stomach with warm water. Dosage may be increased to 6 to 8 capsules three times daily, if necessary. The herbs should be taken with meals for those with sensitive digestive system.

 

INGREDIENTS


Bai Wei (Radix et Rhizoma Cynanchi Atrati)

Ce Bai Ye (Cacumen Platycladi)

He Zi (Fructus Chebulae)

Ma Chi Xian (Herba Portulacae)

Tian Hua Fen (Radix Trichosanthis)

Wu Bei Zi (Galla Chinensis)


 

BACKGROUND

Inflammation is a complex biological response that protects the host organism from harmful stimuli, such as infections or irritations. Inflammation may be classified as either acute or chronic. Acute inflammation is the initial response of the body to harmful stimuli. Chronic inflammation, on the other hand, is a disease.

        Acute inflammation begins with increased blood perfusion to the affected areas, leading to localized redness and heat. In cases of infection, the blood vessels become more permeable and allow various immune cells to leave the blood vessels and enter the affected areas. Some cells, such as macrophages and neutrophils, engulf and digest micro-organisms. Other cells release hydrogen peroxide (and other oxidative chemicals) to kill micro-organisms so they can be consumed and cleaned up by phagocytes. In cases of irritation, such as an allergy, there is an inappropriate immune response that triggers inflammation. When exposed to an allergen (an irritation factor), pre-sensitized mast cells respond by degranulating and releasing histamines, which in turn propagate an excessive inflammatory response. This is characterized by blood vessel dilation, production of pro-inflammatory molecules, and recruitment of leukocytes.[1] In both cases, the initial inflammatory response is a healthy and natural response against infections and irritants, and without it, the body would not be able to properly defend and heal itself.

        Once the threat of infection has passed or the presence of the irritant has been removed, the body returns to its normal condition. In cases of chronic inflammatory disease, the immune system develops an inappropriate response to something it has been exposed to in the past, and becomes confused. Instead of protecting the body, the immune system begins to attack the healthy cells. The immune system can attack various tissues and organs, and cause a wide range of problems to the external and internal parts of the body. Examples of chronic inflammatory diseases include arthritis, rheumatoid arthritis, tendonitis, bursitis, gouty arthritis, polymyalgia rheumatica, systemic lupus erythematosus, osteoarthritis, celiac disease, vasculitis, bronchiolitis, irritable bowel disease, atherosclerosis, psoriasis, myocarditis, nephritis, colitis, iritis, hay fever, and many more. In fact, Dr. Andrew Weil has stated that chronic inflammation may be “the root of all degenerative disease,” and the “cause of the two greatest killers in America: cancer and heart disease.”[2]

 

FORMULA EXPLANATION

Inflammation is a part of the body’s natural defense system against injury and disease. It is mostly recognized with symptoms of pain, redness, and swelling that is the result of injury or infection. However, inflammation can also be chronic, present throughout the body, and contribute to various diseases. Astringent Complex is an herbal formula designed specifically with anti-inflammatory effects to address both acute and chronic inflammation, targeting the chief signs and symptoms of swelling, redness, heat, and pain.

        Acute inflammation is characterized by marked changes in the vascular system, noticeably increased blood flow, increased heat, and increased exudation of plasma proteins and fluids into tissues, causing swelling. In traditional Chinese medicine (TCM), acute inflammation from trauma is diagnosed as qi and blood stagnation with heat and dampness. Qi and blood stagnation results in the pain associated with trauma or poor blood flow. Heat is the redness and/or hot sensation while dampness is the edema or excess accumulation of fluid. Dampness may also be the acute inflammatory exudates causing swelling, which can also manifest as pus, sores, abscesses, and boils.

        Infection and inflammation have two different pathologies. While infections and inflammations are both treated with heat-clearing herbs in Chinese medicine, the biggest difference is that heat-clearing, detoxifying herbs are mostly used for their antibiotic or antiviral effects against infections, while heat-clearing herbs with sour taste and astringent/binding property are employed to address inflammation, as the symptoms involve heat sensation, redness, and swelling.

        Tian Hua Fen (Radix Trichosanthis) reduces acute inflammation by clearing heat and purging fire. Ce Bai Ye (Cacumen Platycladi) cools blood and stops bleeding that may be associated with acute inflammation. Wu Bei Zi (Galla Chinensis) and He Zi (Fructus Chebulae) are two key herbs that address swelling, as they have sour taste and astringent/binding property, which function to shrink the inflamed and expanded tissue. Ma Chi Xian (Herba Portulacae) and Tian Hua Fen (Radix Trichosanthis) treat acute inflammatory exudates by clearing heat, draining pus, and dispelling abscesses and sores through urination. Acute inflammation coupled with infection is diagnosed as toxic heat accumulation with damp accumulation. Two herbs in this formula have heat-clearing and detoxifying effects, namely Ma Chi Xian (Herba Portulacae) and Bai Wei (Radix et Rhizoma Cynanchi Atrati). For noticeably clear signs of bacterial or viral infection, Herbal ABX or Herbal AVR should be used concurrently.

        Chronic systemic inflammation represents yin-deficient heat or heat in the blood. As the body’s resources are taxed from chronic inflammation, yin becomes deficient, and deficiency heat or heat in the blood can manifest. Bai Wei (Radix et Rhizoma Cynanchi Atrati) and Ma Chi Xian (Herba Portulacae) cool blood and clear deficiency heat in the ying (nutritive) level; they are two key herbs to address chronic inflammation. Tian Hua Fen (Radix Trichosanthis) helps to generate body fluids, which is a yin substance that is essential for tissue growth. Wu Bei Zi (Galla Chinensis) and He Zi (Fructus Chebulae) are two important herbs that address swelling as both herbs have sour taste and astringent/binding property to prevent the drying of yin from heat in cases of chronic inflammation.

        Together, these six herbs clear excess heat, deficiency heat, damp-heat, and toxic heat; they also cool the blood, and drain and reduce swelling.

 

CAUTIONS & CONTRAINDICATIONS

* This formula should be used with caution if infection is involved. Due to the sour and binding properties of the herbs in this formula, it may cause retention of pathogenic factors if used alone. Other formulas to address the cause of the infection should be added, such as Herbal ABX or Herbal AVR.

* This formula is contraindicated during pregnancy and nursing.

 

CLINICAL NOTES

* Astringent Complex is designed by Dr. Jimmy Wei-Yen Chang to reduce signs and symptoms of acute and chronic inflammation.

* Astringent Complex is a formula that treats the symptoms of inflammation, and is most effective if taken with another formula to treat the cause of inflammation. If Astringent Complex is taken with another formula, keep the dosage ratio at 1:2 or 1:1, respectively.

* This herbal formula is rarely used alone. It is designed to be used as a supplementary formula for treatment of various inflammatory condition. In TCM, inflammation can be characterized by excess heat in the qi level, toxic heat, heat in the blood, deficiency heat, qi and blood stagnation, and/or damp accumulation. The cause of inflammation should be determined and a primary formula used to address the condition. Causes of inflammation range widely, including inflammation/infection of various organs, arthritis, rheumatoid arthritis, gout, bursitis, tendonitis, trauma, chronic inflammation, cough, Crohn’s disease, inflammatory bowel diseases, hemorrhoids, pelvic inflammatory disease, hypertension, prostatitis, asthma, autoimmune diseases, sinus conditions, and vasculitis.

 

Pulse Diagnosis by Dr. Jimmy Wei-Yen Chang:

* Acute inflammation: big pulse, a thick, straight pulse that is expanding and forceful on all levels. The thicker and more forceful the pulse, the more acute or severe the inflammation in the body.

* Chronic inflammation: dispersing pulse, a soft, borderless pulse.

 

SUPPLEMENTARY FORMULAS

* With bacterial infection, add Herbal ABX.

* With viral infection, add Herbal AVR.

* With severe heat conditions, add Gardenia Complex.

* With dampness, add Pinellia Complex.

* With severe pain, add Herbal ANG.

* For inflammation due to trauma, add Flex (TMX).

* For fibrous tissue, add Circulation (SJ).

* For edema, add Herbal DRX.

* With abscess, nodule, or hard swelling, add Resolve (AI).

* With arthritis, add Flex (Heat), Flex (CD), or Flex (GT).

* With pain in the arms, add Arm Support.

* With acute neck and/or shoulder pain, add Neck & Shoulder (AC).

* With acute back pain, add Back Support (AC).

* With acute knee and/or ankle pain, add Knee & Ankle (AC).

* With asthma or respiratory conditions, add Respitrol (Heat), Respitrol (Deficient), or Respitrol (Cold).

* With sinusitis or rhinitis, add Magnolia Clear Sinus or Pueraria Clear Sinus.

* For inflammatory condition of the gums or gastrointestinal track, add GI Care.

* With inflammatory bowel disease, such as irritable bowel syndrome or Crohn’s disease, add GI Harmony or GI Care (UC).

* For inflammatory conditions of the heart, add Circulation.

* With lupus, add LPS Support.

* With liver disease, add Liver DTX.

* With kidney disease, add Kidney DTX.

* With chemical poisoning or hypersensitivity, add Herbal DTX.

* With genito-urinary inflammation or pelvic inflammatory diseases, add V-Support.

 

ACUPUNCTURE TREATMENT

Traditional Points:

* Please refer to other formulas for acupuncture points depending on each specific condition.

 

Master Tung’s Points by Dr. Chuan-Min Wang:

* Inflammation: Bleed Ear Apex or Wuling (T DT.04) area. Needle Muliu (T 66.06), Mudou (T 66.07).

 

Balance Method by Dr. Richard Tan:

* Left side: Houxi (SI 3), Xiaohai (SI 8), Taichong (LR 3), Ququan (LR 8)

* Right side: Shaohai (HT 3), Shenmen (HT 7), Yanglingquan (GB 34), Zulinqi (GB 41)

* Left and right sides can be alternated from treatment to treatment.

* The above acupuncture prescription is for general inflammation. Please refer to other formulas for acupuncture points depending on each specific condition.

 

Ear Acupuncture:

* Please refer to other formulas for acupuncture points depending on each specific condition.

 

Auricular Medicine by Dr. Li-Chun Huang:

* General anti-inflammatory points: Allergic Area, Endocrine, Adrenal Gland, Spleen, corresponding points (to the area affected). Bleed Ear Apex.

* Please refer to other formulas for acupuncture points depending on each specific condition.

 

NUTRITION

* Increase the consumption of the following foods: fresh fruits and vegetables, mushrooms, whole grains such as brown rice and bulgur wheat. Choose organic produce if possible.

* Eat whole foods, and minimize the consumption of processed foods and fast foods. Avoid processed meats such as lunch meats, hot dogs, and sausages as they contain nitrites, which are associated with inflammation and chronic diseases.

* Drink green or oolong tea, and avoid coffee whenever possible.

* Increase intake of berries, especially blueberries and strawberries. They are an excellent source for anti-inflammatory phytochemicals and antioxidants.

* Increase intake of nourishing, cooling foods/roots such as Mexican yams, yams, radishes, potatoes, carrots, melons, cucumbers, beets, turnips, malanga, celeriac, taro, and rutabaga.

* Avoid spicy, deep-fried, or greasy foods. Avoid sugar as it contributes to production of damp and phlegm. Also avoid cold or raw foods that may compromise the Spleen and as a result produce more dampness.

* Avoid alcohol, coffee, energy drinks or other stimulants.

* Avoid spicy, pungent, aromatic vegetables such as pepper, garlic, onions, basil, rosemary, cumin, fennel, anise, leeks, chives, scallions, thyme, saffron, wormwood, mustard, chili pepper, and wasabi.

 

LIFESTYLE INSTRUCTIONS

* Avoid drinking, smoking, staying up late, and stress, which all contribute to heat.

 

CASE STUDIES

* A 59-year-old male was stung by a sea urchin while diving in Hawaii four months prior to coming in for treatment. The spines of the sea urchin went into his hand. The black markings of the sting are all gone, but he has difficulty moving his fingers with limited movement of his fingers and hand. His tongue is dusky and swollen with a sticky coat. His pulses are wiry and slippery. After taking Flex (NP) and Astringent Complex for 15 days, in conjunction with acupuncture, the patient is completely healed. Submitted by K.M., Albany, California.

* A 50-year-old female presented with persistent proctitis, which she had suffered from for two years. Her right and left pulse were superficial and wiry, and her left cun position was convex and forceful at both the middle and superficial positions. She was prescribed GI Care and Astringent Complex, 50:50. After three 100 gram bottles of the mixed formula, her symptoms disappeared. It has been four months since she finished the herbs and her symptoms never returned, and her medical tests came back negative as well. Submitted by S.B., Berkeley, California.

 

PHARMACOLOGICAL AND CLINICAL RESEARCH

To effectively and properly treat chronic inflammatory disease, Astringent Complex uses many anti-inflammatory herbs to control unnecessary and unchecked inflammatory reactions. Traditionally, these anti-inflammatory herbs are described as “heat-clearing” or “astringent” herbs. Today, their pharmacological effects have been discovered through laboratory reports and their indications are validated through clinical studies.

        Ce Bai Ye (Cacumen Platycladi) exerts a potent anti-inflammatory effect by suppressing the expressions of tumor necrosis factor (TNF)-α, interleukin (IL)-6, and cyclo-oxygenase (COX)-2.[3] Ma Chi Xian (Herba Portulacae) has comparable analgesic and anti-inflammatory effects to diclofenac sodium (Voltaren), one of the most frequently used non-steroidal-anti-inflammatory drugs in the world.[4] According to one study, topical application of an herbal paste made from equal portions of Ma Chi Xian (Herba Portulacae) and Mang Xiao (Natrii Sulfas) showed 93% rate of effectiveness among 128 patients to reduce swelling and inflammation from external or trauma injuries within 3 to 7 days.[5] Lastly, many herbs in this formula play significant roles in treatment of chronic inflammatory diseases. Ce Bai Ye (Cacumen Platycladi) and Ma Chi Xian (Herba Portulacae) have been used to treat various inflammatory conditions associated with infection.[6]

        He Zi (Fructus Chebulae) has both antihistamine and anti-anaphylactic effects. In a dose-dependent manner, administration of water extract of He Zi (Fructus Chebulae) significantly inhibited histamine release from mast cells, and effectively prevented and/or treated systemic and local anaphylaxis.[7] He Zi (Fructus Chebulae) also has anti-inflammatory effects and disease-modifying activity for the treatment of rheumatoid arthritis. According to one study in subjects with artificially-induced arthritis, it significantly inhibited joint swelling by modulating the pro-inflammatory cytokine expression in the synovium, reducing serum levels of TNF-α, TNF-R1, IL-6 and IL-1β.[8] According to another study, chebulagic acid isolated from the immature seeds of He Zi (Fructus Chebulae) significantly suppressed the onset and progression of collagen-induced arthritis.[9] Chebulagic acid also showed potent activity to inhibit both cyclo-oxygenase and 5-lipoxygenase, the key enzymes involved in inflammation and carcinogenesis.[10]

        Finally, Tian Hua Fen (Radix Trichosanthis) has a marked anti-inflammatory effect and has been used to treat various chronic inflammatory conditions.[11],[12] Tian Hua Fen (Radix Trichosanthis) also has immunoregulatory functions. Trichosanthin, an active component extracted from this herb, has illustrated a beneficial immunoregulatory effect in subjects who received skin transplantation by significantly delaying allograft rejection and minimizing other inflammatory conditions. The mechanism of this action is attributed to the reduced levels of interleukin (IL)-2 and interferon-gamma, and increased levels of IL-4 and IL-10 in splenic T cells.[13]

        In summary, Astringent Complex contains many herbs with excellent binding and retaining effects to reduce swelling and inflammation and treat various types of inflammatory disorders.

 

COMPARATIVE ANALYSIS

Western medicine is very effective in treating acute inflammatory conditions. Non-steroidal anti-inflammatory drugs (NSAIDs) effectively relieve pain and reduce swelling to treat various joint diseases. These drugs, however, are not safe or effective for treating chronic inflammatory disease. NSAIDs, such as Motrin (ibuprofen), Naprosyn (naproxen) and Voltaren (diclofenac), cause serious side effects such as gastric ulcer, duodenal ulcer, gastrointestinal bleeding, tinnitus, blurred vision, dizziness, and headache. Furthermore, the newer NSAIDs, also known as Cox-2 inhibitors [such as Celebrex (celecoxib)], are associated with significantly higher risk of cardiovascular events, including heart attack and stroke. In fact, these side effects are so serious that two Cox-2 inhibitors have already been withdrawn from the market [Vioxx (rofecoxib) and Bextra (valdecoxib)].

        Severe or systemic inflammation is often treated with corticosteroids, such as prednisone, to quickly and effectively suppress inflammation. Though effective for short-term use, long-term use of corticosteroids causes numerous side effects: increased appetite and weight gain, deposits of fatty tissues, water and salt retention leading to swelling and edema, high blood pressure, diabetes, black and blue marks, slow healing of wounds, osteoporosis, cataracts, acne, muscle weakness, thinning of the skin, increased susceptibility to infection, stomach ulcers, increased sweating, mood swings, psychological problems such as depression, and adrenal suppression and crisis. Therefore, corticosteroids should be used cautiously and only for acute and severe inflammatory disorders.

        Chinese herbs work well to treat both acute and chronic inflammatory conditions. In cases of acute inflammation, it is important to identify the cause and characteristics of the inflammation. For example, treatment for acute infection and inflammation of the lungs is very different from the treatment for acute injury and inflammation of the knees. When the acute inflammation subsides, and is transformed into a chronic inflammatory disease, careful observation must be made to differentiate constitutional imbalance. By using herbs that correct the underlying imbalance, the deterioration of chronic inflammatory disease will be reversed and healing can finally begin.

        Drugs are more powerful and should be used in cases of serious and acute inflammatory disease. However, they should only be used when absolutely necessary as they cause significant side effects. On the other hand, herbs are more effective to gradually alter the underlying constitution of the body to positively affect the long-term course of chronic inflammatory disease. Herbs are also much gentler, and will not cause significant side effects even with long-term use.

 



[1] Cotran; Kumar, Collins (1998). Robbins Pathologic Basis of Disease. Philadelphia: W.B Saunders Company.

[2] Andrew Weil — www.drweil.com.

[3] Choi Y, Moon A, Kim YC. A pinusolide derivative, 15-methoxypinusolidic acid from Biota orientalis inhibits inducible nitric oxide synthase in microglial cells: implication for a potential anti-inflammatory effect. College of Pharmacy, Seoul National University, 599 Gwanangno, Gwanak-gu, Seoul 151-742, Republic of Korea. Int Immunopharmacol. 2008 Apr;8(4):548-55.

[4] Chan K, Islam MW, Kamil M, Radhakrishnan R, Zakaria MN, Habibullah M, Attas A. The analgesic and anti-inflammatory effects of Portulaca oleracea L. subsp. Sativa (Haw.) Celak. Department of Biomedical Sciences, Zayed Complex for Herbal Research and Traditional Medicine, Ministry of Health, PO Box 29300, Abu Dhabi, United Arab Emirates. J Ethnopharmacol. 2000 Dec;73(3):445-51.

[5] Shan Dong Zhong Yi Za Zhi (Shandong Journal of Chinese Medicine), 1996; 15(6):282.

[6] Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press, 2004.

[7] Shin TY, Jeong HJ, Kim DK, Kim SH, Lee JK, Kim DK, Chae BS, Kim JH, Kang HW, Lee CM, Lee KC, Park ST, Lee EJ, Lim JP, Kim HM, Lee YM. Inhibitory action of water soluble fraction of Terminalia chebula on systemic and local anaphylaxis. College of Pharmacy, Woosuk University, Chonju, 565-701, Chonbuk, South Korea. J Ethnopharmacol. 2001 Feb;74(2):133-40.

[8] Nair V, Singh S, Gupta YK. Antiarthritic and disease modifying activity of Terminalia chebula Retz. in experimental models. Department of Pharmacology, All India Institute of Medical Sciences, New Delhi, India. J Pharm Pharmacol. 2010 Dec;62(12):1801-6. doi: 10.1111/j.2042-7158.2010.01193.x.

[9] Lee S.I., Hyun P.M., Kim S.H., Kim K.S., Lee S.K., Kim B.S., Maeng P.J. & Lim J.S. Suppression of the onset and progression of collagen-induced arthritis by chebulagic acid screened from a natural product library. Arthritis Rheum. 2005, 52(1): 345-353.

[10] Reddy DB, Reddy TC, Jyotsna G, Sharan S, Priya N, Lakshmipathi V, Reddanna P. Chebulagic acid, a COX-LOX dual inhibitor isolated from the fruits of Terminalia chebula Retz., induces apoptosis in COLO-205 cell line. Department of Animal Sciences, School of Life Sciences, University of Hyderabad, Hyderabad 500046, India. J Ethnopharmacol. 2009 Jul 30;124(3):506-12.

[11] Akihisa T, Yasukawa K, Kimura Y, Takido M, Kokke WC, Tamura T. Five D:C-friedo-oleanane triterpenes from the seeds of Trichosanthes kirilowii Maxim. and their anti-inflammatory effects. College of Science and Technology, Nihon University, Tokyo, Japan. Chem Pharm Bull (Tokyo). 1994 May;42(5):1101-5.

[12] Chen J, Chen T. Chinese Medical Herbology and Pharmacology. City of Industry, CA: Art of Medicine Press, 2004.

[13] Gong Q, Deng D, Ding J, Wang C, Bian Z, Ye Z, Xu J. Trichosanthin, an extract of Trichosanthes kirilowii, effectively prevents acute rejection of major histocompatibility complex-mismatched mouse skin allograft. Transplant Proc. 2008 Dec;40(10):3714-8.