The Practical Herbalist #04: Qing Hao in the Clinic By: Andrew Nugent-Head

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The Practical Herbalist is not a list of shortcuts nor a substitution for a classical understanding of prescribing herbs from the Flavor and Nature paradigm that defined our medicine. It expects the reader to have this as a foundation and assumes this knowledge going forward. If the reader is new to the concept of prescribing from the Flavor Nature perspective that was established in the Nei Jing, or would like refreshing on its core principals, they are directed to the four excellent articles by JulieAnn Nugent-Head on classical herbalism published by the Journal of Chinese Medicine. If they wish more information, they can also watch her 3 hour introductory video The Nei Jing as Our Guide to Herbs or her complete online training program, The Classical Herbalist: an In Depth Training Course. Both are available on the Association for Traditional Studies’ online teaching platform: https://association-for-traditional-studies.teachable.com. Simply search for them in the search box to find them among our many online courses.

One of the issues of the current study of herbs is that many people are using formulas without understanding the Shen Nong Ben Cao Upper—Middle—Lower categorization of the herbs within the formula—all the while pontificating about the dangers of using Lower Herbs when they are unintentionally prescribing them for long periods in pill format. Of the more common occurrences of this are Da Huang, Ban Xia, Lian Qiao, Jie Geng, Xing Ren and Qing Hao. Recently the poster child for acceptance of Chinese herbs in modern science due to a recent Nobel Prize for its use in treating malaria, Qing Hao happens to be a lower herb in the Shen Nong Ben Cao and one of the more important ‘treat diseases’ herbs I use in the clinic.

 

There are many writings about the different kinds of Qing Hao and the confusions around it in both old and new texts, as the wormwood family contains a large number of medicinals. For this article we are going to assume we have a working Qing Hao with the correct flavor and nature along with intensity (it is a lower herb, after all) in the clinic. Despite the excitement of following the directions in the old books of soaking in cold water to use, we are also assuming that it works cooked given that is how we prescribe it and obtain results for our patients. We use a thermos cooking method (https://www.thealternativeclinic.org/herb-cooking-instructions/) which means the temperature never reaches nor sustains boiling, but even boiled by patients over the many years of use we have had excellent results. Please remember this: Qing Hao works if used in correct combinations and in correct circumstances at the right dose regardless of cooking method.

 

In our clinic, we tend to draw very sick patients who are often debilitated by their conditions. We do not practice a great deal of Wellness medicine at this phase in our careers, as our focus is on demonstrating how fast and effective Chinese medicine can be for serious illness to gain greater acceptance by the western medical field. Given the dangers of the western medications for auto-immune diseases and their growing prevalence in our population, we are treating Lupus, RA, AS, fibromyalgia, etc on a daily basis. The herb we rely on the most for these patients is Qing Hao. Qing Hao alone will rarely be effective enough for our patients to experience a shift in symptoms within just a few days, but paired correctly it can shift someone from a downward spiral to stable in the first week. It is for this reason that the first two herbs discussed in previous writings were Ma Huang and Gui Zhi. They are two of the most important herbs to be paired with Qing Hao to obtain fast results and work over the long term to put the patient into remission for their condition.

 

Chinese culture believes in similes, metaphors, and teaching fables to shed light on just about everything. From the foundations of the sunny and shady sides of a mountain (the actual pictograph meaning of the characters for Yin and Yang) to the 成語 cheng yu teaching stories, being able to visualize or mentally experience a concept is an important learning tool. For me, I visualize Qing Hao as going in and scouring the deep places, the hidden corners, the forgotten spots where latent pathogens (伏邪) can hide from the Upright Qi (正氣). But those pathogens can only hide in those places in people for whom the Upright Qi is not strong enough to penetrate into those corners or is moving too quickly to work into the crevices and do a thorough cleaning job as it is supposed to. Without a boost or calming of the flow of the Upright Qi, Qing Hao will not be as effective in treating severe or recalcitrant conditions such as Lupus, et al.

 

The dosages I use range from 6g to 30g per formula depending on whether we are at early stage treatment when the symptoms are severe or already mostly in remission. Nicknamed ‘swamp water flavor’ by my patients, it is not a delicious herb to use, so learning to lessen or increase dose based on severity greatly shortens the length of time they need such an unpleasant taste. Too little, and they are drinking it for longer periods with no visible effect to give them the will power to continue their formula; too large of a dose for too long and their stomach simply rebels with nausea despite the progress they are achieving. The Qing Hao is then paired with a clear strategy of strongly heating the patient or cooling the patient along with strong drivers to ensure it can reach every bit of the colonies of latent pathogens nesting in those deep places. The most important drivers are Gui Zhi, Ma Huang (or similar heart stimulator), Fu Zi. The most important warmers are Gui Zhi, Gan Jiang, Fu Zi. The most important cooling herbs are Shi Gao, Zhi Mu, Lu Gen, Hua Shi, and Han Shui Shi.  In Practical Herbalist #02, I wrote about using cooling herbs with Ma Huang. The same principal can be applied to Fu Zi. What is important to note in the cooling herbs is that they are all quite light in nature—not one strongly cold bitter heavy herb in that list; what is important to note in the warming herbs is they are all quite strong and heavy in nature and frequently used in large dosages in the Shang Han Lun.

 

The classic 溫病 Wen Bing formula from which our Qing Hao treatment strategy comes from is Qing Hao Bie Jia Tang. 青蒿三钱,知母二钱,细生地四钱,鳖甲五钱,丹皮二钱. Qing Hao 3 qian, Zhi Mu 2 qian, Sheng Di Huang 4 qian, Bie Jia 5 qian, Mu Dan Pi 2 qian. From the formula, it is obvious it is being used to treat the hot version I described which has been around long enough to damage the Yin and set off a sequelae of additional symptoms. It is also obvious as to the importance of Qing Hao not just in it being the main name of the formula, but that every other herb in the formula is either an upper or middle herb in the Shen Nong Ben Cao. We then immediately modify accordingly based on a few realities of our clinic: the first is we do not use animal products in which the animal is killed, which means we do not ever prescribe Bie Jia; the second is no one actually has Sheng Di Huang, as what is marketed as Sheng Di Huang is actually Gan Di Huang (please see JulieAnn’s excellent and free video on Di Huang in her Single Herb tasting series https://association-for-traditional-studies.teachable.com/p/single-herb-tasting). Frequent substitutes for those two herbs are Lu Gen, Mai Men Dong/Tian Men Dong and Xuan/Yuan Shen. Note that this classic formula is missing what I am calling a Driver as it is assumed the heat is already driving the Qi too intensely.

 However, while we certainly have pure heat auto-immune patients, they are rarely compared to the more common presentation we have for auto-immune disorders coming into our clinic. We see straight on cold/poor or weak circulation auto-immune patients and, more commonly, cold patients who suffer from hot spots or hot symptoms which can lead a practitioner astray in choosing herbs. For those patients who have pain, difficulty moving, exhaustion, brain fog and have no clear signs of true heat, a straight on strategy of large doses of warm acrid to move the Qing Hao through the system is our most frequent choice. Gui Zhi, Gan Jiang, Jiang Huang at doses of 30g or higher when severe paired with Qing Hao and then herbs to protect or stimulate the Middle Palace depending on their digestion will be our base formula.

 For patients who describe hot painful spots but wear lots of clothes or run cold while presenting herpes type outbreaks, the above strategy balanced with cool sweet herbs such as Lu Gen, Bai Mao Gen, Zhi Mu or Mai Men Dong and Qin Jiu/Jiao if there is joint pain at up to 30g can relieve the immediacy of the heat signs while not damaging the Qi or Yin needed to get the Qing Hao through the body. As a side note, many Chinese herbs have a secondary or different name used by the old doctors who were trained prior to 1949. I have mentioned two in this article: Xuan/Yuan Shen and Qin Jiu/Jiao. The former changed its original name from 玄Xuan to 元Yuan in the north as after an Emperor adopted the玄  Xuan character in his name, it was no longer used in common words. This was a very common thing in China as a sign of respect throughout the ages, such as the habit of never using Confucious’ first name丘 Qiu when talking about him. The second reason is more practical. Qin Jiao 秦艽 can easily be confused with the Jiao, or pepper family, if said with a strong accent or listened to by someone with little to no education. To avoid patients thinking they should put green peppers in their formulas, northern doctors pronounced the Jiao as Jiu.

 

For patients who do show straight heat conditions, the strategy of Ma Yi Shi Gan Tang and its substitutions apply (see Practical Herbalist #02). These days, it is often easier to obtain Fu Zi than it is to obtain Ma Huang, so it can be used as a first choice if it is on hand. Otherwise, while caffeine or large dosages of other stimulating herbs can help push the Qing Hao through, we tend to rely on Gui Zhi balanced heavily with cooling herbs, particularly Shi Gao in Shang Han Lun sized doses.

 

Of course, the building of formulas around Qing Hao can be used for any latent pathogen. Malaria is a classic example of this—the illness comes and goes, can disappear then return and, left untreated, does slow but fatal damage to the kidneys and liver. Another brief aside: spending time talking about diseases while in Kenya and then Botswana, the guides there do not favor the use of anti-malarial pills. They prefer to get the disease and identify it quickly, as it is very treatable. It is ignoring it or being unable to treat it for a length of time that makes it fatal. However, with anti-malarials on board, one can still get the disease but have its core symptoms masked. The person thinks they caught a cold or flu, but never gets too sick until irreparable damage is done to the organs.

 

Other examples in which we build formulas around Qing Hao are for Lyme, Mono, HIV/AIDS and just about every other disease in which the patient is run down and worn down by an illness until their system is so weak that they are consumed by their disease. It can also be a secondary herb to assist in treating gastro-intestinal opportunistic conditions in which bacteria colonies like candida have become established, or any other bacterial colonies such as chlamydia elsewhere in our patients—however, it is more common to see us turn to Yin Chen Hao as its fluffier nature also makes it more drying for damp heat bacterial conditions. Understanding and learning to use Shen Nong Ben Cao Lower herbs effectively can help shift those interested in moving beyond wellness/chronic conditions and into treating more acute conditions. Qing Hao is one of the best herbs to start with and used flexibly can make a huge difference in any disease focused practice. 

 

Andrew Nugent-Head

© Andrew Nugent-Head 2019, reprinted with permission only