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Part I
Basics
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Chapter 1
Introduction
Species feed on one another for growth, survival and prosper. The environment is where the interactions take place. We and the rest of the world constitute an integral whole called ecosystem. Sustention and/or evolution of the whole exert commensurate pressure on the parts. Human use of plants for medicine has ancient roots as animal use of plants for healing has been widely documented. The first and second industrial revolutions since the eighteen century have liberated us from repetitive brawny works, with the inventions of steam engines and electricity. The third industrial revolution, or digital revolution, since late twentieth century, has freed us from brainy chores, with the introduction of computers and the internet. Since the twenty first century, we are entering the fourth industrial revolution which is expected to further augment our brain power, with artificial intelligence technologies. Our life style and environment are affected by industrialization and urbanization, so are human ailments. While biotechnologies have progressed hand-in-hand with industrial revolutions, herbology should not fall behind. We have to think about the future of herbology. In doing so, we begin by reviewing state-of-the-art technologies that are relevant to and readily available for herbology advances. We then try to glue these technologies together. The result can be coined AI herbology, whose goals are to increase not only life spans but also quality of life. Although we make use of herbal prescription usage data from traditional Chinese medicine, no prior knowledge of any systems of traditional herbal medicines is assumed.
1.1Concentrated Herbal Extract Granules (CHEG)
Animals have evolved to self-medicate using medicinal materials in the wild. For example, primates and ruminants consume bitter-tasting leaves of specific plants to purge parasites in their intestines. Cats and dogs also eat grass, and it is believed that the feline and canine grazing behaviors aid in their digestion. It is therefore not surprising that humans have learned to treat their own ailments using natural sources, including plants, minerals, and animals, found in their surroundings since the dawn of mankind. Examples of ancient civilizations that have developed systems of knowledge about herbal preparation and usage for the purpose of medication are many. Notable ones include Egypt, Greek, India, and China. However, after the discovery of vaccines and antibiotics in Western Europe in 1800, medicine entered a modern era. Industrialization and commercialization, first taking place in Great Britain in the same period, have further propelled the spread of modern medicine across the globe.
Besides manufacturing and marketing advances, great success of modern western medicine is attributed to the scientific methodology developed to identify effective treatments. The method consists of a series of clinical trials which compare effects of treatment between two groups of patients: one undergoing real treatment with active components, the other fake treatment with inert components. Patients usually do not know which treatment they receive. Only the treatment that brings about statistically significant difference (in the favorable direction) between the two groups of patients would pass the trials, gaining scientific evidence for the effectiveness of the treatment. The scientific method provides confidence and evidence that the treatment effects are repeatable in the population of patients under investigation.
It is clear that if ancient herbal medicine is to compete with modern western medicine, herbal medicine has to adopt scientific methodology to demonstrate their effectiveness. Although clinical trials are known to be costly in terms of money and time, trials of this kind have started, one notable example being PHY906—a four-herb formula that has been used for the treatment of nausea, vomiting, abdominal cramps, and diarrhea in traditional Chinese medicine (TCM) for 1800 years [Chu, 2018].
At the heart of scientific evidence-based medicine lies repeatability. A basic premise for reproducible outcome is that properties of the herbal product are the same from batch to batch. To assure the quality standard, the United States Food and Drug Administration (US FDA) requires pharmaceutical manufacturers to adhere to a system of manufacturing processes called current good manufacturing practice (cGMP). Pharmaceutical companies have thus spent resources to minimize product variations through chemical and biological profiling techniques. Safety is the other major concern for pharmaceuticals, in particular, for herbal products. Heavy metals, pesticide residues and microbes in herbal products are nowadays routinely screened for to meet cGMP regulations. Another consideration of herbal medicine improvement is preparation. People nowadays travel a lot. People go across states by planes, trains, and cars. The form of herbal medicine delivery has to be convenient for people on the move. Herbal products in the form of powdered extracts, called concentrated herbal extract granules (CHEG), by cGMP-complying pharmaceutical facilities, can simultaneously meet the three requirements. Production of CHEG takes basically five steps: 1) acquisition of raw herbal materials; 2) preprocessing of the raw materials according to classical herbal texts; 3) mixing the preprocessed herbs at specific dry weight ratios according to classical medical texts; 4) concentration of the mixture by hot-water extraction; and 5) granulation by spray-drying of the aqueous extract. Step three is missing if the CHEG is made up of a single herb. We call them CHEG herbs. If CHEG contains multiple herbs, we call them CHEG formulas throughout the book.
CHEGs were first developed in Japan in the 1920s. Since then, use of CHEGs has steadily gained popularity. They are now the major form of herbal medicine in Japan, Korea, Taiwan, and Hong Kong. In particular, CHEGs have been reimbursed by the health insurance in Japan since 1967 and in Taiwan since 1995. Many of them are available without prescriptions over the counter. In China, decoctions are the major form of herbal prescriptions with CHEG as supplements to decoctions. Although manufacturing and use of CHEGs lag in China, China Food and Drug Administration (CFDA) just finished, in March 2016, collecting opinions regarding CHEG standards, a move that is interpreted to de-franchise CHEG production. CHEG market is expected to boom in China soon. In addition, CHEGs are regulated as dietary supplements by the US FDA. They are thus also available in the American market. Because of the advantages of CHEG in terms of manufacturing, marketing, and accessibility, the book is concerned with TCM derived CHEGs, rather than the herbal preparations from Unani, Ayurveda, or other ...
