by Andrew Ellis

Though concentrated granules have been used for almost a half-century in Taiwan and Japan, their use in the West is sill in its infancy. For that reason, this introduction not only discusses the structure and use of Notes from South Mountain, but also contains sections describing the production and clinical application of concentrated granules.

Notes from South Mountain can be accessed differently depending on the goals of the reader. By displaying the formulas in Pinyin alphabetical order, the book makes it easy for the reader to find a desired formula quickly, without stopping at the table of contents. For the practitioner searching for a formula that treats a specific symptom or pattern, the detailed symptom index should be the first stop. For suggestions on treatment of common disorders, the index of common disorders may prove a good starting place. Lastly, the reader may simply stroll through the book at random, taking delight in the discovery of unfamiliar formulas or interesting historical or clinical tidbits found in the discussion of well know combinations.

Formula Name and KPC Number

Because this book was originally intended to be a product handbook for KPC products, it is based on a database of ingredient information, formula names, and so on, provided by KPC. We have left the KPC product numbers in the text because the formulas presented match those products.

The formula name in both Pinyin and common name nomenclature, accompanied by the KPC number.

Ingredients

Ingredients are listed in order according to their percentage in the formula. I have made efforts to insure that the listed herb name corresponds to the herb used in the KPC product.

There is considerable confusion in Chinese medicine about the common names of herbs. I have attempted to correct many mistakes by using the name of the plant that is employed in production and updating antiquated common names. Both the formula common names and the common names in the ingredients lists reflect these changes.

The reader may be unfamiliar with some of the common names that are used in this text. For example, Sha Ren (Amomum villosum) is denoted with the common name "Amomum" and not the frequently seen common name of "Cardamom." "Cardamom" is reserved for Bai Dou Kou (Amomum cardamomum). Mu Xiang, which is often given he common name of "Saussurea," is listed in this text as "Vladimiria" because the botanist at KPC has determined that this is the plant used in production. Saussurea is an endangered species and its trade is restricted under the Convention on International Trade of Endangered Species (CITES). Another example is that of Mu Tong. Since the plant used as a source for Mu Tong is Clematis armandi, we have replaced the common name, "Akebia," with " Clematis armandi." Note that Ba Yue Zha is called "Akebia Fruit" because the fruit of the Akebia plant is used to produce that herb concentrate. While in the West, the plant used to represent Huo Xiang is most often Pogostemon (Guang Huo Xiang), the botanical experts at KPC have determined that KPC uses Agastache. Thus, we have used that name when Huo Xiang is an ingredient in a KPC formula. An example of an updated common name is Fu Ling, for which we have replaced the antiquated name, "Hoelen," in both formula names and ingredient lists with the more accepted name, "Poria." We hope that these changes do not cause undue confusion and that they help to bring attention to the work that remains to be done on the complex issue of herb identification and common name standardization.

The ingredients and their percentages in the formulas KPC produces do not necessarily match absolutely those found in source texts. I have tried to point out any meaningful discrepancies. All formula ingredients and ingredient percentages are dictated by the Taiwan government, so it is difficult to determine the exact reason for ingredient differences. The government seeks control of ingredients in order to provide uniformity of product constituents for products which are reimbursed under Taiwanese national health insurance.

Source

The source text for many formulas is not easy to ascertain. I have done my best to find the earliest mention of the version of each formula that is discussed in this book. The names of the texts are provided in both Pinyin and English. Many of the English renderings come from a list provided by Nigel Wiseman. Several others were taken from the bibliography in Bensky and Barolet's Formulas and Strategies. The remainder were translated by the present author. Whenever I could find reference to the original author's intended meaning for a title, I have done my best to represent this in English.

For a deeper understanding of the clinical applications of a formula and how those applications relate to the formulator's intentions, familiarity with the assumption and theoretical underpinnings of the source text can be very useful. Where clinically relevant, I have included introductory information about the source texts in the discussion section.

Functions

Most of the functions listed are taken from modern Chinese medical books. For formulas for which no functions were available, I have taken the liberty to derive them from the ingredient's functions and the formula's implied goal as expressed by the originator.

Indications

The indications are based on the uses mentioned in the source text, amended to include later uses. The list includes the most common uses of the formula, but the symptoms and patterns are explained and expanded upon in the discussion section. Since most formulas have multiple uses, the reader should not take the indication section as a complete list of symptoms or patterns to which the formula can be applied. Note that symptoms listed in this and other sections of the text would be most accurately presented with an "or" between each item. Since this is grammatically awkward, we have used the standard punctuation for lists, which uses a series of commas along with a final "and." Thus, a list such as "headache, runny nose, aversion to cold, and fear of bats" really means that the patient has one or more of these symptoms and not necessarily the entire list.

Discussion

The discussion section expands upon the indications and functions sections; thus the discussion will be more enlightening if the functions and indications are studied first. This section examines the originator's intended use off the formula and then illustrates how other uses have developed from the original reasoning.

Where relevant, we have included comparisons with similar formula to provide insight into the strengths and weaknesses of formulas of similar ilk. These comparisons are generally drawn from modern Chinese sources.

We have provided a translation of those Chinese formulas names that are not a simple statement of the main herb or herbs in the formula. (Formula names such as Bai Tou Weng Tang are self-ex-planatory.) Some cases include an explanation of the name that considers the originator's reason for so naming the formula. The research for this portion of the text was considerable, as the meanings of formula names, like acupuncture point names, are often intentionally esoteric or are obscured by the centuries.

Modifications

The modifications section is based on sources similar to those for the discussion section; that is, they are heavily influenced by classical literature, my experience, and the experience of my teachers. To provide a well-rounded approach, I have included modifications suggested by well-know modern practitioners such as Jiao Shu-De.

The field of Chinese medicine in the West is mired in a translation bog. The multitudes of English translations available for a given term provide entertainment for academics and headaches for students. Choosing a functional approach to this situation, I have used A Practical Dictionary of Chinese Medicine (by Wiseman and Feng, Paradigm Publications) for translations of terminology. This is partly because the present author was involved in the development of the system employed in that reference, and partly because linking to a dictionary obviates the need to explain each term used in the text or add an extensive glossary. If the reader comes upon an unfamiliar term, he or she can consult that dictionary and find not only the original Chinese expression but also a comprehensive definition. This said, I have made some choices that differ from the Practical Dictionary. For example, I do not use the word "panting" for the Chinese "chuan". Rather, I have chosen either "gasping" or "asthmatic breathing", depending on the context. These variations are few, however, and should present no terminological dilemmas for the reader.

In translating the formula names, I have played with two systems and am not convinced that either is preferable. For example, Bu Zhong Yi Qi Tang could be translated as Decoction to Supplement the Center and Boost Qi, or as Center-Supplementing, Qi-Boosting Decoction. You will see both systems used in this text.

Notes from South Mountain is a bit of an oddity. It is not a scholarly work, nor is it a simple handbook. It evolved to fall somewhere between the two. For reasons of practicality, we have not footnoted the text, nor have we provided the other niceties of an academic work. On the other hand, a bibliography is provided for those interested in researching the sources for this book.

The author has visited the KPC production facility in Taiwan several times. The following information was gathered during those visits.

Inspection of Incoming Medicinals

Each lot of incoming herbs is quarantined, inspected, and assigned a source herb number upon arrival. After passing inspection for herb quality, herb identification, heavy metal levels, presence of bugs and other contaminants-and in specific instances, active constituents- the items are removed from quarantine and allowed to enter the storage facility. Agents are then cleaned by hand, and all extraneous material is removed in preparation for further processing. Where needed, herbs are then wine-fried, dry-fried, and so on, according to the tenets of traditional medicine.

Extraction

The ingredients for a formula are gathered together and placed in a large stainless-steel vat filled with water that is treated in an on-site water purification unit. The herbs are soaked for a determined amount of time and then the water is heated to a set temperature. The herbs are cooked for an optimal length of time to extract the most ingredients without overcooking and destroying the constituents. Cooking duration and temperatures are thus unique to each product. At various intervals, the volume and temperature of the solution are recorded in the batch record. In the beginning of the heating process, volatile oils are collected by a volatile oil retrieval system installed on each extraction vat. These oils are reintroduced into the product during the granulation process.

Concentration

When the optimal extraction strength is reached, the herbs are removed from the extraction vat and the liquid is piped directly into the condensing vat. Here it is condensed through evaporation in a relative vacuum under low temperature.

Flow Coating

After vacuum evaporation, the thickened liquid is piped into a vacuum dryer and flow-coating chamber. At this time, a base powder of either potato starch (non-GMO) or a powder of the raw herbs is sprayed into the chamber. This material mixes with the liquid spray (along with the addition of methylcellulose) to form granules. Toward the end of this process, the volatile oils collected in the extraction phase are introduced into the chamber and are absorbed into the granules.

Packaging

The granules are then packaged and sealed in plastic (recyclable) bottles by modern machinery. The labels for each lot are accounted for and printed with the expiration date and lot number. All of the procedures that take place after extraction are done in a clean-room atmosphere where all employees adhere to clean-room requirements and the air is filtered and conditioned to approved standards.

Tracking

Each step of production is tracked through meticulous bookkeeping. For example, bath numbers of the source herbs are recorded in the batch record so each final product can be traced back to its source material. Because of these strict operating and tracking measures, one can quickly see the details of each procedure applied to a product during the production process.

Testing

The goal of testing is to insure the quality, purity, and consistency of each product. Samples from each lot are kept on site so that any lot can be checked at a later time. Each lot is checked to insure that it meets the manufacturer's acceptable levels for heavy metals and plate count. Thin-layer chromatography and HPLC are performed on products for which those tests are appropriate and meaningful. Further, each lot is tested to make certain it contains no E. coli or salmonella. KPC sends products intended for export to an independent laboratory in Europe to be tested for pesticides, aflatoxins, and certain heavy metals.

1. What is the concentration ratio of herb concentrates?

   There are several ways to answer this question. The simplest is to reply that 250-500 grams of raw herbs are used to produce 100 grams of concentrate. This yields a concentration ratio of 2.5:1 to 5:1, depending on the specific formula or single herb. Most formulas are in the range of 3:1 to 4:1. Formulas of a very glutinous nature require more starch in order to be prepared into a dry form and thus tend to lower concentration. These figures are misleading, however, because the highly controlled environment in which the concentrates are produced and reintroduction of captured volatile oils result in a product superior to what would be produced on one's kitchen stove. Thus, the 250-500 grams of herbs produce a more potent product than they would if cooked in a less efficient method. For this reason, it is not accurate to think that 10 grams of a raw herb equals 2-4 grams of a concentrate. See the section "How to Use Herb Concentrates" for more information on dosing herb concentrates.

2. Are all single-herb products concentrates?

   No, it is not possible to concentrate minerals, saps, or most animal products, since their constituents are not very soluble in water. These items are sold as ground powders when in singles-herb form. In formulas, they are generally cooked with the rest of the herbs and are part of the base onto which the concentrate is sprayed in the flow-coating process.

3. Do herb concentrates contain corn products?

   KPC stopped using corn starch as carrier several years ago. Currently, KPC uses only potato starch (non-GMO) or raw herb powder as a carrier for the herb concentrate. We have not inquired with other manufacturers about their choice of carrier.

4. What dose of concentrated granule should I give a patient per day?

   Most practitioners in Taiwan, where concentrated granules have been in use for over forty years, give between 10 and 12 grams per day. Naturally, children get considerably less (about half) and infants and toddlers are usually given about one-half gram or less per dose, four to five times a day.

5. What is the best way to take the granules?

   Most patients mix the granules with warm water and drink this between meals. For children, it is sometimes best to mix the granules with a food such as apple sauce.

6. Is it better to use a pre-made formula or to mix single ingredients oneself?

   The advantages to a pre-made formula are that the herbs are cooked together and that some non-soluble item such as saps and minerals are included in both the carrier and the concentrate. Also, most formulas are made with raw herb powder as a base, and many single herbs are made with starch as a base. On the hand, making a formula from scratch allows one to tailor it to the exact needs of the patient.