Saturday, December 15, 2018

Gao Fang - Take a tonic in winter, kill a tiger in spring…

As I've been spending more time in Hangzhou for my phd program, I've come across some interesting formulas and Chinese medicine practices. This time last year I spent a few months in a Hangzhou clinic where I learned about a method of prescribing formulas called gāo fāng (膏方). During the transition from autumn to winter, a traditional Chinese tonic formula is written with large quantities of herbs, and made into a sort of paste. This paste is taken home, mixed with hot water, and consumed over a period of at least 15 days, but usually 30-45 days. The purpose of gāo fāng is to strengthen the qì (), and nourish the body for the coming winter so that one emerges in spring free from illness, and ready for the new year. 

In the cold of winter, our appetite increases as the body is driven to consume higher levels of calories to stay warm. Chinese medicine doctors believe this is the perfect time to consume tonic herbs, and rest as much as possible. No “detoxing” or fasting in the winter!!!!

The practice is at least as old as the Huang Di Nei Jing (about the 1st century BCE), but my mentors in China suggest that in those early times the formulas were very simple, and probably used topically. Also, these formulas were only used by royalty and the aristocracy due to the high cost. As social welfare improved in the Ming and Qing dynasties (starting about 700 years ago), the general population became more concerned with health and longevity, and the practice became more widespread. Zhejiang, where I study every year, and Jiangsu province, were the most wealthy regions at that time, and the formulas and clinics that wrote them flourished.

There is a famous story of Li Hongzhang whose family member had a severe cough each winter. It is believed that a gāo fāng containing renshen (ginseng) and ge jie (gecko) relieved this cough, and the herbalist who wrote the formula, Cai Tong De Tang, was immortalized on a plaque in his pharmacy. 

Some pharmacies have ready-made pastes, but it is best to have an evaluation by a trained herbalist. If there are underlying issues, such as poor digestion, an intensive 2 week regulation formula is written so the body is able to absorb the potent tonic herbs. In addition to poor digestion, the gāo fāng is contraindicated in those with tumors or masses, as it is believed this strong tonic formula may increase those tumors. 

The formula is completely pattern based, geared towards one’s underlying constitution, and history of medical issues; however, the general idea is to nourish yin and tonify yang. A typical gāo fāng may contain as many as 40 herbs, cost as much as $400 - $1500, and will contain e jiao (donkey hide gelatin), lu jiao jiao (deer antler gelatin), gui ban jiao (turtle shell gelatin), ren shen (renshen), and other tonic herbs. In addition to these tonics, the formula usually contains honey and sugar for flavor, and sesame or walnut may be added for additional flavor. About 1-2 tablespoons is consumed each day, morning and evening, with hot water or in huang jiu (yellow rice wine). It is also recommended that the tea or soup be consumed from a porcelain bowl. Throughout history metal pots and serving ware were often made of reactive metals. I believe that is why formulas were only cooked in clay pots, and consumed from bowls made of porcelain. Today we have more options…

This is a typical gāo fāng formula we wrote for a female patient of 35 years old, with 2 children in generally good health:

Tai zi shen 150g, Zhi huang qi 120g, Shu di huang 150g.
Yang chu sha 15g, Gou qi zi 150g, Xin xian tie pi 150g,
Zhi he shou wu 120g, Sang shen 120g, Mai dong 60g,
Wu wei zi 15g, Chao bai shao 120g, Zhi gan cao 30g,
Zhi xiang fu 60g, Fa Ban xia 60g, Fu ling 60g,
Fo shou gan 60g, Lian zi 120g, Pu gong ying 120g,
Huai Xiao Mai 120g, Sang ji sheng 120g, Mu gua 60g,
Lian xu 50g, Qian shi 120g, Hei zhi ma 125g,
He tao ren 125g, Da zao 120g, E jiao 250g,
Yi tang 250g, Huang jiu 250g, Wen shan yao 30g  

Even if you can’t get a custom gāo fāng written for you, I always tell my patients to loosen up in the winter, reduce your stress, sleep more, and gain a few pounds. It’s time for family, good food, and inner reflection.  

Have a happy holiday season!!!!

References: › Health › TCM