Decoctions, Dried Decoctions, Powders, Pills, Tablets, and Tinctures

Essay by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Westerners learning about Chinese herbs are often exposed to unusual concepts regarding the form of herbal administration. I have heard some acupuncturists trained in the U.S. say that the Chinese believe that herbs should always be administered as decoctions, as this is the best. Unfortunately, they must never have heard of the numerous traditional herb formularies that described using herbs in the form of powders and pills, nor the 18th century essay by Xu Dachun titled "On the inadequacy of decoctions to completely cure illnesses." Also, they must not have read of successful clinical trials conducted in China using other forms of herbal preparation, nor the admonishment of pharmacists that using certain ingredients in decoction form can be a waste of raw materials.

Others have told me that tinctures are clearly best, as the herbs are more assimilable in that form. Unfortunately, they must never have searched the literature for evidence supporting that claim, as they would not have found such evidence. Even if it were the case for a particular herb or a particular class of chemical compounds, one could hardly expect this to be an established fact for all herbs put in tincture form. They must also not have read the literature about the important category of polysaccharide ingredients in herbs. These components are condensed by alcohol and are generally absent from any alcohol-based preparation.

Still others may purchase pills and tablets for their patients, feeling confident that compliance will be good, without stopping to consider whether this form is suitable for the condition being treated. They may never have heard the idea of using high dosage decoctions to initiate a therapy and then using the pills and tablets as a follow-up to consolidate the effects once a substantial improvement has been attained. Perhaps the practitioner may not have realized that typical dosages of pills or tablets given to patients in China are 10-15 at a time, often repeated three times daily, making this form seem less suitable for compliance and more expensive.

In the introduction to Commonly Used Chinese Herbal Formulas with Illustrations (by Hsu and Hsu), examples of forms of administration are outlined. These include decoctions, powders, pills, unguents, pellets, elixirs, medicated essences, tablets/cakes, rods, threads, washes, fumigants, suppositories, and enemas. Clearly, the Chinese did not limit themselves in the methods of administration and did not focus solely on one type as the best. Today, Chinese herbs are also administered by injection (into acupuncture points or into veins), intravenous drip, nasal spray, and other means.

In this article, I will explore some of the issues surrounding the selection of form of administration for herbs, relying on the methods most often used in the West (orally ingested materials). The subject matter is actually so broad that only a portion can be covered here, but it is hoped that readers will become more aware of the importance of considering the form of an herbal preparation.


We can only speculate on the origins of decoctions, but it is easy enough to imagine that if you wanted to try to consume a food or medicinal herbal material that was tough (perhaps very fibrous), there was little choice but to cook it up in water and drink the resulting liquid (and, possibly, eat the softened material that had been boiled for a long time). Converting the herb (or animal or mineral) to a powder was simply not an option for most individuals: that would require first taking the time to thoroughly dry the substance and then make the effort to reduce it to powder by some simple means (such as was used to make flour from grains; though grains are a lot easier to powder than many other natural materials). Perhaps at an Imperial herbal pharmacy, one would have enough impetus and enough labor to produce some powders and store them up for when they need to be used; making a powder is not a spur of the moment option (though administering the already produced powders is), making a decoction could be done relatively quickly and easily.

Decoctions were the dominant form of therapy in the Shang Han Lun, though other forms were mentioned, including powders and pills. This seems appropriate given the situation and the methodology in the text. The situation was a rapidly progressing disease that could easily cause death if not properly treated and the methodology was to adjust the formulation, often by changing only an herb or two, as the symptoms changed. Often, time was of the essence and one might not wish to use a premade formula. Further, some of the important prescriptions were intended to induce perspiration, and the hot liquid form was helpful in bringing about that result.

By contrast, in the Song Dynasty herb compendium known as the He Ji Ju Fang, many of the formulas were presented as powders or pills. In fact, this highly influential text might be regarded as the starting place of the patent medicine industry that we know of today.

Visitors to modern Chinese hospitals will usually observe the strong reliance on decoctions there. In fact many hospitals, and several independent pharmacies, will cook up the herbs on the premises, so as to save the patient the effort. This situation reflects a number of factors:

  1. When Chinese medicine was revived during the 1950's, there were not many patent medicine factories, not much herb manufacturing equipment, and transportation of premade formulas from one region of China to another was difficult. Therefore, the cruder method of boiling up large slices of herbs was relied upon, and this method has simply continued for some time afterward.
  2. The recommended dosages of herbs has become quite high in recent years: higher than in the past. Some pharmacists claim that this is because of poor quality of herb materials and use of lots of substitute herbal materials. Whatever the cause, these high dosages can only be given at reasonable cost in the form of decoctions.
  3. There is considerable emphasis on differential diagnosis in the hospitals. This means that premade formulations, such as powders and pills, are inappropriate.

Yet, the situation is already changing as China's economy improves. There are now factories associated with many hospitals, turning out tablets that are used by patients (Western visitors may not see this aspect of medical practice unless they stay for some time).

Decoctions were used by U.S. practitioners when Chinese herbal training was first available in the late 1970's and throughout the 1980's, but reliance on this method has declined somewhat for several reasons, including the widespread availability of other forms deemed more convenient by practitioners and patients. Most often, herb decoctions are prescribed by Chinese immigrants who have prior training and experience in using this form and who are comfortable with designing herb formulas for each patient.

Among the difficulties in using decoctions in the West today are the space requirements for storing herbs, the absence of pharmacists to take on the timely task of stocking the pharmacy and filling prescriptions, and the lack of adequate training at Western colleges of Oriental medicine (some of which do not emphasize herbal prescribing in any form). Further, there are techniques for making a highly effective decoction that have been ignored even in modern China, such as adjusting the cooking time for different ingredients. This issue will be explored here in some detail as a representative example of considerations that enter into making a good decoction.


The varying cooking times recommended for different Chinese herbs represent a balance between two major considerations: the time it takes for extraction of active components from the crude herbs and the rate of loss of active components by heat, oxidation, decomposition, and evaporation. When fresh vegetables are steamed or boiled, after just a few minutes the color of the vegetables becomes brighter, but a few moments later, they discolor and lose both taste and nutritional value. In the same way, herbs can be over-cooked, with destruction of medicinal value.

Minerals, and materials that have minerals as the main component, require the longest cooking time. They often have a low solubility and thus take longer to extract, but they are not damaged by prolonged cooking. In order to extract minerals, they must first be powdered, since the boiling water cannot penetrate to any significant depth; this is usually done by a device called a "cracker." Traditionally, it is recommended that minerals be cooked before other ingredients for about an hour. Dragon bone, oyster shell, haliotis, gypsum, talc, fluorite, and hematite are such examples.

Prolonged cooking is also recommended when the destruction of active components is deemed desirable. For example, raw aconite is cooked for several hours to render it essentially non-toxic. Processed aconite need not be cooked as long since it has already been detoxified, but some herbalists still recommend extra cooking time compared to other herbs.

An intermediate cooking time is recommended for herbs with non-volatile active components as their primary ingredients. For example, ginseng, astragalus, licorice, philodendron, coptis, and scute include components such as glycosides, flavonoids, and alkaloids that are not boiled away by prolonged cooking. Some components are not especially water soluble, that is, their chemical structure is such that it is "repelled" by water, but with long-term cooking, some of those components are forced out of the herb and into the water. These herbs are typically cooked for about 40-60 minutes (if these are added to a mineral brew after an hour of cooking, that means the minerals will have about two hours cooking time).

In order for several herbs belonging to a complex formula to be effectively cooked in about the same amount of time, they must be cut to the appropriate thickness. The thickness of the herbs influences the time it takes for the active components to migrate from the middle of the herb material to the water medium. The slicing that is usually done before Chinese herbs are sold renders most herbs relatively thin, and thus able to be cooked for about the same amount of time (and a much shorter time than if they were uncut). Thick roots such as ginseng and tang-kuei are sometimes sold in whole form, but are best used after being sliced so that their thickness is comparable with other ingredients. Hard roots (e.g., tienchi) and barks (e.g., phellodendron) need to be thinner than soft fruits (e.g., lycium and chaenomeles).

A significantly short cooking time is recommended for herbs that have volatile oils as major active components. As was recently demonstrated for cinnamon twigs, during the first ten minutes of cooking, the volatile oils appear in the liquid in increasing amounts as the water extracts them, but after ten minutes, the rate of loss into the air exceeds the rate of extraction, so the amount of active component decreases. Thus, a ten minute cooking time is about right. Herbs with volatile oils are especially found in the pharmacopoeia categories of Fragrant Herbs for Resolving Wetness, Spicy Herbs for Relieving the Surface, Herbs for Regulating Qi, Fragrant Herbs for Opening Orifices, and Herbs for Dispelling Chill (see: The use of aromatic agents for regulating qi, vitalizing blood, and relieving pain).

To determine whether or not an herb has volatile oils, one can consider the fragrance of the herb when it is cooked (strong fragrance means more volatile oil) and one can also examine the list of ingredients in the herb, such as indicated in Oriental Materia Medica and in Chemical Constituents of Oriental Herbs by Hong-yen Hsu and his colleagues. The list of herbs relying on volatile components for their activity is very long; typical examples are cinnamon twig, cyperus, cardamon, clove, lindera, saussurea, and aquilaria.

Some herbs are reputed to be damaged by prolonged cooking even though the volatile component is not the main ingredient. For example, uncaria and cnidium are recommended to be cooked for only ten minutes though the main ingredients recognized today are non-volatile. The problem that arises in relation to such herbs is that some chemical structures unfold under the influence of hot water, and become inactivated.

Light flowery herbs usually require very little cooking because they are so thin. In some cases, it is recommended that the herb be wrapped in cloth (e.g., inula flower) so that it won't break up and float around in the tea, being difficult to strain out. Since flowers usually contain some volatile oil components, they can be cooked for a very short time with good effect, though it may not be required. Commonly used flowers include carthamus, chrysanthemum, buddleia, and lonicera.

Gelatin is usually added to the hot tea after it has been strained because it will readily dissolve and by adding it last, it will not be lost to the pot (i.e., the sticky material will not attach to herb dregs and the cooking vessel). There are some items that ought not be cooked at all. For example, borneol is a highly volatile herb extract that is rapidly lost in decocting. It is intended to be used in the form of pills; one can obtain some borneol in a decoction by briefly cooking herbs such as cardamon. Many animal agents can be cooked but are not included in decoctions because they are very expensive. The extracted substances from animals tend to be a bit sticky and, as with gelatin, they can cling to the "dregs" that are tossed out. This may be acceptable for inexpensive items, such as earthworm, but is quite a problem when using products that cost several hundred dollars per pound. Musk is an example of a substance that is both extremely volatile and extremely expensive and thus would not be cooked (actually, today, musk is no longer available; muscone, a chemical component like borneol, is used, always in pill form). In modern Chinese practice, notoginseng (sanqi) and succinum are not included in decoctions, but given along with decoctions as a powder to be swallowed down with water or tea.

Despite the wide range of cooking times that can be recommended for optimal results, it is not at all uncommon for Chinese doctors to blend all items together to be cooked for the same period of time. The various losses that might occur from using a single cooking time (which may be too short for some items and too long for others) can be partly compensated for by using a larger dosage of those ingredients. This is not an exact compensation, since easily extractable and non-volatile ingredients will then be present in excessive amounts compared to other components, but it provides a reasonable approximation of the desired product. Fortunately for the herbalist, a majority of herbs are reasonably extracted by the intermediate cooking time. This includes virtually all components of the following Materia Medica categories (note exceptions for minerals): tonics, fire-purging, phlegm-resolving, blood-regulating, astringents, anti-rheumatics, and diuretics.

There are certain rules to follow in making teas that can assist in getting the best quality product. Plant materials should be soaked in cold water for at least 20-30 minutes before cooking. This allows the plant cells to expand and thus to release their ingredients when boiled. If the herbs are boiled before they are fully moistened, the boiling water can seal in the active components by toughening the cell walls. To preserve volatile components, one can use a covered pot, but this will only help if the lid is several inches above the boiling surface (and thus at a lower temperature) and if the rate of boiling is low. Otherwise, the oils will just escape with steam around the edges of the lid (and the pot is likely to boil over). If this method is followed, a traditional technique of using a large volume of water and then boiling it down to a small volume of water cannot be followed. Since a reasonably large volume of water is needed to cover the herbs, this means that a larger volume of liquid must be consumed.

To minimize leaving behind active components in the "dregs" (the strained out herb material), a second cooking can be done (with less water), and the two liquids (first cooking and second) can be combined. Some practitioners use the first cook as a one day supply and then have the dregs cooked again for a second day dosage. Unfortunately, this makes the two treatments markedly different. Dividing up materials according to cooking time is a major effort that helps explain why pre-made formulas that can just be swallowed down are so popular. However, one must be fully aware of all the major requirements for proper herb preparation to judge effectively when convenience may take precedence over other qualities.


Dried decoctions were developed in Japan in the 1950's and have become a major method of providing herbs in Japan, Taiwan, the U.S., and Europe. This new process appears to have been generated by the convergence of two virtually opposite trends. On the one hand, Japan began a major industrialization during this period, which led to the application of modern technologies to herbal medicine. On the other hand, there was a strong interest developed in relying on ancient Chinese herbal formulas, especially those from the Shang Han Lun and He Ji Ju Fang, with the belief that there was something inherently valuable in the ancient formulas that could not otherwise be matched by modern efforts. These two trends led to the production of convenient dried decoctions (a powder or, with additional processing, a granule) of the traditional formulas. In Japan forty years later, there are over 200 traditional combinations prepared by this method that are deemed standard pharmaceutical products covered by the national health insurance. In Taiwan, which adopted the technology and ideas from Japan, the dried decoctions are utilized in dozens of hospitals and clinics. The preparations were first imported into the U.S. around 1976 and into Europe around 1980, where they eventually superseded the use of home-prepared decoctions; due to various factors, the products imported from the Orient come from Taiwan rather than Japan. More recently, China has adopted this technology and now exports to the U.S. and at least one company in the U.S. manufactures the granules.

The dried decoctions are produced by making very large batches of the herb formulas as decoctions (in large tanks), and then draining the liquid from the dregs. The liquid is then evaporated (using heat and vacuum) to form a syrup. The syrup is then put into a spray-drier along with a powder carrier (usually starch or the dried, powdered, herb dregs), and the remaining water is evaporated, leaving a dry powder.

The amount of extractable materials varies considerably from one herb to another and from one formula to another. The finished product, on average, is about a 4.5:1 concentration of the ingredients of the crude herbs. Put another way, it takes about 450 grams (about one pound) of raw materials to yield about 100 grams of finished product (a typical amount dispensed at one time). Put another way, if you would prescribe to a patient a formula made with 90 grams of crude herbs (for a decoction), then you would prescribe about 20 grams per day of the dried extract. Actually, you may get by with a little less (say 12-18 grams/day) because some of the common errors of home preparation are eliminated by the factory processing.

In the U.S. there are nearly 400 traditional formulas available in this form, and there are also about 400 single herbs made as dried extracts. One can prescribe the traditional formulas as is, or modify them by adding single herb extracts, or one can make up an entirely new formula using the single herb extracts.

As with the decoctions there are a number of issues to be faced in using these materials. One has to rely on the factories to make decisions about the cooking time, and one is often unclear about the concentration factors of individual herbs and formulas, making dosing quite difficult to estimate. The cost of the materials is clearly higher than that for crude herbs used in making a decoction, but there are some cost-saving advantages in storage space, reduced losses (crude herbs are subject to damage by insects, for example), and better patient compliance (the patient need not spend time preparing the tea and need not consume the granules in tea form). In the U.S., the average cost per pound of crude herbs, from a Chinese shop, for making a decoction is about $10, while the average practitioner cost for 100 grams of granules is about $16.

There are three ways to consume the materials. One is to put a measured quantity in the mouth and swallow down with a glass of water, just as one would do with a capsule or tablet. In fact, in Japan the granules are sometimes packaged in small foil tubes so that one simply tears the end off the tube and dumps the measured quantity of granules in the mouth, to be swallowed down with water. A second way is to encapsulate the granules and take them: some companies provide the traditional formulas already in capsules (or, in a few cases, in tablets). While this enhances compliance for some patients, it also tends to reduce the dosage consumed: a 15 gram daily dose generally requires 30 capsules (500 mg typical fill), which is both costly (compared to loose granules) and a lot of units to take. A third way is to put the dried decoction in a cup, add boiled water, and produce a tea. The products made in fine powder or tiny granule form can simply be stirred up and consumed immediately. Those made with larger granules (a specialty of Sun Ten Pharmaceuticals) are intended for the method of swallowing down rather than making a tea, but if left to soak in the boiled water for a few minutes, it can also be used as a tea. When a tea is made from the powders or granules, after sitting for a while there will be some powder at the bottom of the cup. This is the carrier substance, and it need not be consumed.

Increasingly in mainland China, herb formulas are prepared in factories by making a dried decoction and then pressing the material into a tablet (sometimes with small sugar coated tablets that are easy to swallow). These tablets are sometimes sold as patent medicines on the general market, but many are produced by factories associated with TCM colleges and hospitals and used locally only. Numerous Chinese medical journal reports mention this type of preparation in clinical trials.

POWDERS (other than dried decoctions), PILLS, CAPSULES, TABLETS

Powdering of crude herbs to make medicines has a long history, having been mentioned in the Huangdi Neijing and even the pre-Neijing scroll "Wushier Bing Fang" (about 168 B.C.). The use of powdered herbs reached two peaks in Chinese medical history, the first marked by the publication of the He Ji Ju Fang (1080 A.D.) which mainly dealt with premade formulas in powder and pill form, and the other being the current era in which powdering machinery and the desire for convenient forms of herbs combined with ecological concerns to focus attention on this method.

Powders may be ingested directly (swallowed with some water or tea) and are then called sanji ("powder form"), or made into a tea by boiling in hot water, and called zhusan ("pouring powders"). Powders that are rolled into sticky pills comprise a separate category because the binder used traditionally (e.g., honey or malt syrup) is believed to slow down absorption of the herb materials, and this is an intentional effect, or, at least, an effect that is taken into account in describing the action of the finished product. However, pills will be mentioned here because they are used, like powders, as substitutes for decoctions and other liquid preparations. Modern tableted or encapsulated powders correspond to the traditional powders that are ingested directly, since they are produced with the intention of promptly returning to powder form in the stomach, as the capsule or tablet quickly breaks down in the hot stomach juices.

A Song Dynasty physician commented that the use of decoctions was declining in his time and that "When there is a situation where the use of decoctions is indicated, doctors usually prescribe boiling powders." Today, especially in the West, decoctions are largely being replaced by tableted powders instead.

Producing powders is a difficult process: the herbs must be cut into very small pieces, dried sufficiently to make them brittle, and then crushed intensively enough to reduce them to a reasonably fine powder. This last step was accomplished, until this century, by grinding between stones by human or animal power (in some cases, small amounts were prepared in a mortar). In modern patent medicine factories in China, powders produced by machinery are expected to pass through very fine 80-100 mesh screens (such powders nearly dissolve in the stomach, not just break up into minute pieces). Many of the ancient powders could probably not pass through a 30 mesh screen.

Powders sometimes have advantages over liquid preparations. To avoid wasting precious materials, it is usually recommended that items which yield poor extraction, which lose potency with heat and/or evaporation, or which are lost to the dregs and the pot, be powdered and ingested directly, even if other ingredients are to be taken in decoction form at the same time. In many modern Chinese herb factories, essential oils are sometimes separated from herbs and then added to the powders of the other formula ingredients. This is done, for example, to make Yin Qiao Jie Du Pian (Tablet of Forsythia and Lonicera Formula).

Fragrant materials, such as borneol, aquilaria, dalbergia, and musk are often provided as powders or in pills. In modern times, many physicians are prescribing myrrh, frankincense, and other aromatics in powder form, though they had previously been used in decoctions. Toxic substances of medicinal value, such as realgar, centipede, scorpion, cinnabar, strychnos, and toad secretion are usually prescribed as powders or in pills in order to better control the dosage. When making an extract, the amount of toxic component available in the liquid can vary from a very large number of factors, while one can have much better control over the amount of a powder.

Some ingredients, such as succinum, are poorly solubilized in hot water (or alcohol), while others are damaged by the extraction process, such as the heat denaturation of the anthelmintic proteins of omphalia: such materials are preferred in powder form. Even for some unexpected ingredients, such as alkaloids that are quite soluble and stable in water, there are instances where there are advantages to using powders. For example, in the 1988 Chinese Journal of Integrated Traditional and Western Medicine, a comparative study of Shedan Chuanbei (snake gallbladder and fritillaria) powder and liquid showed that the relative content of fritillaria alkaloids in the powder was much higher than in the liquid preparation (by more than 2:1). Further, the expectorant action, as measured in laboratory mice, was better with the powder than the liquid.

In ancient times it was said that "The qi of raw materials is most poignant and works first." This suggests an appreciation for the properties of uncooked herbs. In the standard textbook Zhongyao Xue (1990), 80 medicinal materials are suggested to be prescribed in powder or pill form, either because they should never be boiled, are best if not boiled, or are more efficiently used if they are not extracted first. Among items commonly used in the West (and not already mentioned above) that are recommended in powder form are: the antiparasitic herbs torreya, quisqualis, and brucea (a tea of this herb is too bitter to consume); the purgatives mirabilitum and aloe; the animal substances gecko, wasp nest, arca shell, eupolyphaga, pangolin, leech, earthworm, tabanus, and clam shell; the minerals actinolite, magnetite, and lapis; the blood-vitalizing herbs cnidium, corydalis, and san-chi; the saps styrax, calamus gum, and bamboo sap; and miscellaneous items such as zizyphus, bletilla, indigo, cardamon, schizandra, and gleditsia.

Convenience (of ingestion) is a major reason why powders are recommended by Chinese doctors. For example, if one has an acute symptom (e.g., an injury or influenza), it can defeat the value of an herbal remedy if one must first go to a doctor, get a script, go to the herb shop to fill the prescription, and then return home and spend an hour or more cooking the herbs prior to ingesting them. It is much more appropriate to have a prepared powder (at home or at a public pharmacy) which can be consumed by boiling in water for just a few minutes, or swallowing it down directly (even more convenient in pill, capsule, or tablet). These forms are also more convenient for those who are debilitated and don't have easy access to assistance in preparing decoctions, and for materials used repeatedly, for which the preparation and drinking of a decoction becomes tiresome. Prepared medicinal wines have similar advantages.

As the population of China has soared, and the adoption of Chinese medicine by other cultures has grown, the demands on natural resources have dramatically increased while the land available for their cultivation has declined. One of the methods for dealing with this situation is to rely more heavily on powders, which are used at lower dosages, to replace the higher dosage decoctions. For "boiling powders," the dosage of crude herbs is usually reduced by about two-thirds. As reported in the Handbook of Chinese Herb Preparation (1989), a comparison of making teas (by boiling) with licorice either from regular pharmacy pieces or from coarsely powdered licorice revealed that 28% more glycyrrhizin could be obtained from half as much licorice powder as cooked licorice slices. When ingesting powders directly, one-fifth to one-tenth the weight of herb materials utilized for decoction can sometimes be used in order to obtain similar effects. A 180 gram herb decoction might be replaced by two 9-gram boluses or by two dozen tablets.

However, there are some limitations when the amount of crude materials is reduced in this way, such as getting reasonable amounts of trace minerals from the herbs. This must be taken into account when deciding which formulas to use in a lower dosage powder form and what disorders are to be treated by them. When herbs are powdered, their shelf-life is quite limited. The powdering process leaves much more surface area exposed to air, moisture, and light. Therefore, powdered herbs must be stored in tightly sealed, opaque containers, preferably in temperature-controlled environments if they are to be retained for an extended period. Making a tablet or pill alleviates this problem by again removing the exposed surface; encapsulation partly resolves the problem, depending on how tightly the powder has been packed into the capsules. Modern packaging (e.g., glass and plastic bottles) extends the shelf life of the materials. Directly swallowing loose powders has met with some resistance among Western patients (true also of the dried decoctions in powder or granule form). Making a tea from powdered herbs may be more acceptable for some, as long as the taste of the prescription is not too strong. Tableted powders have solved the majority of compliance problems encountered, but the number of tablets to be consumed still surprises many patients and there are some individuals with throat problems that have considerable difficulty swallowing tablets. Large tablets intended for treatment of adults may prove unacceptable to children who might otherwise benefit from the same formula.

There are also some potential clinical disadvantages to prepared formulas presented as powders, capsules, pills, or tablets. One does not have control over the formulation (as would be the case with combining crude herbs for a decoction or combining dried decoctions of individual herbs), so one who relies solely on these forms is stuck trying to find a formulation that is compatible with the patient needs. Sometimes, it is necessary to combine two different formulas, with the result that a few herbs from each formula are included in the treatment even though they are unnecessary for the patient. Also, many Westerners are used to taking capsules or tablets made with Western drugs, at a dosage of one or two units at a time. With Chinese herbs, to get similar therapeutic activity, one may need to take 8-15 units at a time; this may deter patients and make them particularly concerned about any bodily changes that could be deemed an adverse effect of the herbs since they would certainly expect an adverse effect of that much of a drug product.


The term "alcohol" comes from the Arabic, meaning "finely divided spirit" and this makes reference to the idea that all substances have a spirit; the spirit of wine is so finely divided that it becomes invisible as it is driven from the liquid by heat, reappearing only upon condensation. The Chinese term for medicine, "yi", includes the pictogram for wine. It is meant to distinguish the "true" medical practitioners from the shamans, who were of questionable repute and relied on rituals, amulets, and things other than medicines. The best way to understand the uses of wine in medicine is to realize that, unlike water used to make tea or to swallow a pill, the wine or other alcohol preparation also serves a role as an herb. Alcohol contributes its own properties which are deemed rather potent and therefore must be taken into consideration.

In the historical encyclopedia of the Han Dynasty, wine is classified as being hot, and is said to reach every part of the body, harmonize the blood and qi, open the meridians, foster yang, and expel cold. These properties are important to consider today because, in the West, a growing number of practitioners of Chinese medicine are using a wide variety of herb formulas in the form of tinctures (alcohol extracts). These same practitioners are often very cautious about using "hot" herbs, such as aconite, cinnamon bark, deer antler, and curculigo, or highly dispersive herbs, such as bupleurum, but may not give the same level of consideration to the role of the alcohol because it has not been discussed by most authors.

If one were to visit China, Taiwan, or Japan, the use of herbal tinctures as substitutes for teas, powders, or pills would not be seen as common practice. There are medicinal wines, but these are to be consumed in substantial quantity and for specific ailments, not just any ailment. The utilization of all sorts of Chinese herbal formulas and single herbs in tincture form is a Western development, based on a practice of making tinctures of Western herbs, a practice that had rapidly expanded at about the same time that Chinese herbs were introduced to the West. The dosing of Chinese herbal formula tinctures was set at the same level as that for Western single-herb tinctures, resulting in consistent underdosing of the complex formulas.

Henry C. Lu, a well-known Chinese doctor and teacher has said "Herbs may be taken with Chinese or Japanese wine or whisky or brandy in case of arthritis, rheumatism, and other symptoms of weakness, such as sexual impotence and recuperating from prolonged illness...when herbs are taken for hot diseases, liquor should not be taken at all." In the earliest known book about Chinese herbal therapies, the Wushier Bingfang, there are 30 alcohol prescriptions mentioned (about 11% of the total). Wine remedies mentioned in the Neijing are for treatment of meridian blockage, sudden fainting, and ear problems. Shang Han Lun formulas that are made with alcohol are exclusively for warming and blood-vitalizing effects; among them are two that are still widely used today: Carthamus Wine, for gynecological disorders, and Trichosanthes Fruit Wine, for cardiac disorders.

Sun Simiao (6th century) described 80 formulas made with alcohol, also for warming and blood-vitalizing therapy. It is indicated in the Shengji Zonglu (1122 A.D.) that because of the penetrating action of alcohol, wine formulas are better than decoctions for treating meridian obstruction. The author also mentions the use of alcohol-based formulas for a syndrome of blood deficiency combined with qi stagnation, for cold syndrome, paralysis, cramping, and sudden fainting.

Wine has been known in China for about 4,000 years. Originally, low-alcohol wines were produced from rice; specific herbs, such as curcuma (yujin), were included during the fermenting process to produce the finished product. Since about 500 A.D. it has become common to produce medicines by steeping the herbs in a distilled liquor. During the Qing Dynasty period, the practice of boiling herbs in wine instead of water was introduced as an alternative technique. Modern Chinese researchers have investigated the use of the "wine formulas." For example, two books have been published recently, A Great Compendium of Chinese Medicinal Wines (1991) and Treating 100 Diseases with Medicinal Wines (1990). The uses of the alcohol-based formulas are mainly in the following categories:

Blood stasis, meridian obstruction, and/or cold syndrome: arthritis, paralysis, amenorrhea, dysmenorrhea, infertility, post-partum disorders, impotence, phlebitis, arteritis, chronic skin diseases (especially if associated with a cold syndrome), injuries, and fractures.

Miscellaneous disorders: cough/asthma, epilepsy in children, growth disorders due to malnutrition, tinnitus, and loss of voice.

In Japan, a study of a medicinal wine, Youmeishu, first described in China during the Ming Dynasty, showed it to be an effective agent for post-surgical recovery for gynecological patients; consistent with use of wines in treating blood stasis. Because blood stasis and meridian obstruction are characteristic problems of aging, there is growing use of medicinal wines for that purpose. However, these materials can be problematic for some, since alcohol interacts with a wide range of modern drugs, and because of direct problems with alcohol ingestion for those with liver disease or alcohol hypersensitivity.

The influence of alcohol on herb formulas is illustrated by the instructions for use of one of China's most famous remedies, Yunnan Pai Yao. When the product is to be used for stopping bleeding, it is to be taken with water. When, on the other hand, it is to be used to vitalize blood circulation, it is to be taken with wine for best effects. The amount of alcohol to be consumed with herbs was addressed by Sun Simiao. He indicated that to obtain the desired action, it was essential to consume a quantity which was sufficient to feel the effect of the alcohol (more than momentarily as a response to tasting it). He cautioned about the adverse effects of consuming too much.

For the average American, the amount of alcohol in a single glass of wine is usually sufficient to meet Sun Simiao's criteria; this corresponds to about a "shot glass" of distilled alcohol (at 40% alcohol by volume); women have a lower tolerance in general. Recent Western findings that regular ingestion of wines made with red grapes may have health benefits, such as preventing heart disease, and that wines in general seem to promote longevity (perhaps by relaxation response) when consumed in the amount of about two to four glasses daily, tend to support the Chinese experience with wine ingredients that are even more medicinally potent than grapes.

In many instances, Western manufacturers of Chinese herb tinctures do not select the tincturing process for any specific medicinal purpose, but rather to serve as a medium for extraction and preservation and to enhance compliance (especially among children). The dosage of herbs used in making the preparation is usually quite small, about 7-10 grams of dried crude herbs per one ounce of fluid extract. While alcohol/water mixtures (typically 20-40% alcohol) are generally superior to water in extracting active constituents of herbs, the effectiveness of boiling water is often comparable to cold alcohol used in tincturing. In some cases, such as the immune-enhancing polysaccharides of astragalus, lonicera, medicinal mushrooms, and other herbs, alcohol is actually a poor medium because it causes the components to condense out of the liquid (thus they stick to the herb dregs that are tossed out or to the surfaces of the processing equipment).

The dosages usually recommended for tinctures, a few drops, may provide the extract of less than a gram of crude herbs and usually does not provide the "alcohol action" that Sun Simiao deemed important if the alcohol is indeed to count as part of the treatment (which may be of benefit in cases where alcohol provides a non-desired action, such as warming). Some practitioners advise adding the tincture to boiling hot water to drive off the alcohol, but this further condenses active components and drives off some of the important essential oils (for which alcohol/water is a good medium to aid evaporation).

The thousands of years experience gained by Chinese herbalists and doctors in the use of alcohol in relation to herbal treatments should not be set aside lightly. Pretreatment of herbs with wine (e.g., the processing of rehmannia to produce shoudihuang), extraction of herbs with liquor (e.g., for Hu Gu Jiu for rheumatism), and consumption of alcohol along with an herbal pill (as is done with Yunnan Pai Yao), are part of the rich cultural heritage of China's medical tradition.

In the West, tincturing was originally developed as a means of dealing with fresh plant materials; by soaking them in alcohol and straining out the plant mass, one could preserve herbs for future use. A large proportion of Western herbs are flowers and leaves, which have a very poor shelf-life if simply dried, as opposed to the Chinese tendency to rely on roots, rhizomes, and barks that have a longer shelf-life. The vast majority of early American patent medicines in liquid form relied on alcohol as the principal effective ingredient, containing very little of herb extracts. Most recently, tinctures have become common in part because of ready availability of alcohol for commercial use and the willingness of consumers and practitioners to accept the idea that minuscule amounts of such preparations have a substantial therapeutic potential. By pursuing a fuller understanding of the role of alcohol in the various stages of herb processing and in the general field of herbal therapeutics, the value of this method could be much better realized.

May 1997