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1. What are the four flavors of Chinese herbs? What are their applications in clinical practice

The four flavors are called ‘Si Qi’ in Chinese. ‘Si’ means ‘four’, and ‘Qi’ means ‘the special quality of the herb’. In this context it indicates the temperature of the herbs, namely hot, warm, cold and cool.Hot and cold herbs are opposite in nature, and correspond to the Yang and Yin. Cool and warm herbs have the same nature as cold and hot, but to a lesser degree.

Each herb possesses one of these four temperatures. However, there are also herbs that are neither hot nor cold, and are not included in the four flavors. They are classified as ‘Ping’, meaning ‘neutral’. In clinical practice, hot or warm herbs are used to warm the body and to treat Cold syndromes. For example, Gan Jiang (Zingiberis rhizoma) is able to warm the Middle Jiao and treat abdominal cramp and diarrhea; Dang Gui (Angelicae sinensis radix) can warm the Blood and alleviate pain due to Cold in the Blood.

A cold or cool herb is used to clear Heat and to treat Heat syndromes. For instance, ShiGao (Gypsum) can clear Heat in the Lung and Stomach and therefore it can reduce fever, wheezing and thirst; Sheng Di Huang (Rehmanniae radix) can reduce Heart-Fire in order to treat restlessness and insomnia. A neutral herb can be used when the syndrome is not characterized by Heat or Cold. For instance, Fu Ling (Poria) can promote urination and reduce edema.

A neutral herb can also be used in either a Cold or Heat syndrome in combination with other hot or cold herbs. For instance, Fu Ling (Poria) can be used with Fu Zi (Aconiti radix lateralis preparata) to warm the Kidney-Yang and reduce edema; it can also be used with Xiao Ji (Cirsii herba) to treat painful urinary dysfunction due to Heat in the Bladder. These are the basic applications of the four flavors. The four flavors are amongst the primary properties of herbs but, in fact, the number is not confined to four. Like many other theories in Traditional Chinese Medicine (TCM), the four flavors primarily indicate the temperature quality of the herbs.

The theory also suggests that these temperatures can be subdivided into different degrees, but does not indicate the details of these degrees. The terms ‘very hot’, ‘hot’, ‘warm’ and ‘slightly warm’ are sometimes used. In practice, differences in temperature between herbs are usually found out from the explanations of the function, from applications given in books and from personal experience.

Moreover, hot herbs can be divided into thin-hot and thick-hot. A thin-hot herb possesses a lighter hot nature, which leads to a quicker action; it is often used to expel exterior pathogenic Cold - examples are Ma Huang (Ephedrae herba), Gui Zhi (Cinnamomi cassiae ramulus) and Xin Yi (Magnoliaeflos). A thick-hot herb possesses a strong hot nature that leads to a strong and steady action; it isused to warm the Interior and treat interior Cold syndrome - examples include Fu Zi (Aconiti radixlateralis preparata)*, Rou Gui (Cinnamomi cassiae cortex) and Gan Jiang (Zingiberis rhizoma). Cold herbs can likewise be divided into thin-cold and thick-cold. A thin-cold herb can gently but quickly disperse and clear Heat in the Upper Jiao or in the superficial level of the body- examples are Bo He(Menthae herba), Chai Hu (Bupleuri radix), Sang Ye (Mori folium) and Ju Hua (Chrysanthemi flos).A thick-cold herb can strongly clear Heat and reduce Fire - examples include Huang Lian (Coptidisrhizoma), Huang Qin (Scutellariae radix), Huang Bai (Phellodendri cortex) and Long Dan Cao (Gentianae radix).

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