Thursday, April 28, 2011


On 1 May 2011, the European Directive on Traditional Herbal Medicinal Products 2004/24/EC will come into force. This Directive has far-reaching (negative) consequences for acupuncturists, herbalists, the herbal medicine industry and consumers of herbal medicine. Quite simply, this is a draconian Directive that limits our freedom to use herbal medicines as practitioner and consumers. Make no mistake, contrary to what our bureaucrats are telling us, this Directive has nothing to do with the protection of the consumer: it has everything to do with the desire and need of Eurocrats to regulate and control.

In this age of the Internet when high-quality information is readily available, the consumer is perfectly able to satisfy him- or herself about the standard of quality controls and efficacy of a particular herbal remedy. For example, hundreds of clinical studies on herbal medicines are available online.

The main motivation for this draconian European Directive is the European political and administrative class’s pathological need to regulate. In the European mindset, anything that is not “regulated” is assimilated to “illegal”. The European bureaucracy needs to regulate to justify their existence and paradoxically, we, the victims of this legislation, are even paying their salaries through taxation. Have you heard that the European Commission has asked for an increase of 5% in their annual budget? At a time when all over Europe (and especially in Ireland, Greece and Portugal) populations are suffering under a regime of economic “austerity” and drastic cuts!

The second reason for the ban is, sadly the lobbying by the powerful drug companies. Hannan says: “Whenever an apparently absurd law of this kind emanates from the EU, ask yourself cui bono — whose interest does it serve? In this case, there is no mystery: the directive was openly lobbied for by large pharmaceutical companies, which saw an opportunity to put their smaller rivals out of business. Not for the first time, big corporations have used the EU to push through rules which national assemblies would never have countenanced. MPs were left in no doubt about how their constituents viewed the proposal. But Brussels fonctionnaires are invulnerable to the ballot box: the EU was designed, in the aftermath of the second world war, precisely to shield them from public opinion”.1

When asked why we need this Directive, regulators churn out always the same trite things: some Chinese herbal remedies contain undeclared medicinal drugs, some have high levels of heavy metals, etc. This is true (although the percentage of above remedies is a tiny proportion of the total), but there are already existing laws against such practices. Such practices could easily be stamped out using existing legislation without this draconian European legislation. In fact, the result of this legislation will be the exact opposite of what it purports to do. A tiny minority of companies will probably continue selling remedies that are already illegal while many reputable herbal companies who do not, and never have, used such practices will be driven out of business. Moreover, as in usual European style, each country will do what they want, we will have the absurd situation that consumers in one country will be able to buy unlicensed herbal remedies online from another European country: hardly a desirable outcome.

By the way, do you know that the long delay (7 years) in the implementation of this Directive was deliberate? Hannan says: “The ban was voted through the European Parliament seven years ago but, as so often, Eurocrats built in a delay, knowing that national ministers were far more likely to agree to an unpopular measure that would blow up in the laps of their successors”. Indeed, in the UK, the Directive was approved by the Blair Labour Government and it has now blown up in the face of Cameron’s Coalition Government.

Why do we need such Directive?
• Six million people in Britain have visited a herbalist at some point in the past two years
• Two million regularly use alternative treatments as a first resort
• Herbal remedies account for just 0.4% of reported adverse reactions.

In theory, the EU Directive sounds reasonable. It is not “banning” herbal medicines: it is “merely” establishing rules for their “licensing”. In practice however, the licensing requirements are such that no remedy with multiple ingredients (such as Chinese or Ayurvedic medicines) can get a licence because it is impossible to meet the criteria for registration.

Secondly, cost. The licensing of each remedy would cost about between € 50,000 and € 100,000 Euro ($ 74,000-148,000) which is therefore impossible to bear for the overwhelming majority of herbal suppliers. Therefore, the practical effect of this legislation is indeed to ban herbal remedies (and, by the way, increase unemployment).

The result of this Directive is that:
• A third-party dispensary service (Product Supplier) can no longer make up individualised raw and powdered prescriptions, batches of pills or capsules
• Patent herbs will no longer be available to any practitioners, whether state regulated or not and will disappear from the UK/ European market. Over-the-counter herbal remedies also will not be available to consumers
• Only health professionals who are statutorily regulated can prescribe or sell “finished” unlicensed medicines and even that is up in the air in the UK

It is ironic that such restrictions on the use of herbal medicines are being introduced at the same time as more and more powerful and dangerous previously prescription medicinal drugs are being de-regulated and sold over the counter without prescription. Such drugs cause a 100 times more side effects and adverse reaction than herbal remedies. This proves that the European Directive has nothing to do with protection of the consumer.

In my opinion, we should fight this European Directive tooth and nail on political rather than medical grounds because that is what this Directive is inspired by. We can argue for the next 10 years that herbal remedies are intrinsically safe but the regulatory authorities will always come back with the same old excuses: undeclared drug ingredients, heavy metals, the one patient who got liver failure years ago, St John's Wort induces cytochrome P450, etc.

It is also a losing battle to argue the medical case with regulatory authorities (although necessary and we should continue doing that) because they are not elected and have a vested interest in “regulating” and “licensing”. By contrast, politicians are elected and all they are interested in is being re-elected. They are therefore more sensitive to the political case: we should tell them en mass that we are not going to vote for them if they do not scrap this Directive.

Why should Eurocrats decide what I can and cannot take for my health? It is a fundamental issue of freedom and we should demand our freedom!

It is ironic that this freedom-killing European Directive is coming into force on 1 May, the day when traditionally the peoples of Europe celebrate freedom and workers’ rights…

1. Daniel Hannan: Allergic to Freedom Why is Europe taking up arms against herbal remedies? (12.03.2011)

2. Daniel Hannan: Allergic to Freedom Why is Europe taking up arms against herbal remedies? (12.03.2011)

Tuesday, April 19, 2011


Giovanni has a new Twitter account which will be dedicated to short messages on all aspects of Chinese medicine, some with links. @gmaciocia.

Sunday, April 17, 2011


Since the previous Clinical Tip was about guilt as an emotional cause of disease, it makes sense to discuss now shame as an emotional cause of disease. I think that shame is as common as guilt in Western patients while it could be argued that Eastern societies are more prone to shame than guilt.

Shame may be caused by a feeling of shame about one's behaviour in breaking society’s rules or customs; more commonly, it is an in-born feeling of shame due to one's upbringing. It is a feeling of blame which often makes one feels “dirty”; with shame, one feels that one has to hide from the frowning look of society. One feels observed all the time.

According to Solomon, in small doses, shame is an affirmation of one's autonomy, a confirmation that one will live by one's standards and accept responsibility. In small doses, shame is conducive to self-esteem. However, in larger doses, shame is overwhelming and it is self-demeaning, making one extremely defensive and impotent.

As a cause of disease, we consider the shame that is overwhelming, that is due to one's upbringing and that is not related to one's actions or to have done anything wrong. A person suffering from this shame will always feel as if they had done something wrong and will want to hide.

It is often said that Western societies are “guilt-based” and Eastern ones “shame-based”, so it is useful to explore the differences between shame and guilt. Shame is related more to one's place in society, what people think of us, the feeling that one has to hide because one has done something wrong, something that society frowns upon, something “dirty”.

In other words, as long as we do not do anything that society disapproves of or, most importantly, we are not seen, not found out to be doing something “wrong”, we do not feel shame. By contrast, in such situations we would feel guilty even if nobody sees us doing something “wrong”.

It is certainly true that Eastern societies are shame-based probably due to the strong Confucian influence. As the Confucian ethics is all about social relationships, and about one's “place” in society and conforming to strict rules of conduct and social hierarchy, it is natural that shame ensues from contravening the established rules of society. Thus, people are worried about not being seen to be doing anything that society would frown upon.

What is paramount in shame, is how one appears to the other members of the community, not how one feels inside. Guilt, is a “darker” emotion, more inner-directed, an emotion from which there is no escape, the judgement is there, whether anyone sees us or not. The big difference between guilt and shame is that guilt has no redemption, it “eats” one inside for ever; shame has redemption and repair.

With shame, we have a feeling of being seen doing something wrong (by implication, if we are not seen, we do not feel shame). With guilt, we hear an inner voice condemning us and we cannot escape it.

Wollheim explores the differences between shame and guilt and I have summrized them in this Table.

The term “guilt” (zui) occurs very infrequently in the Analects of Confucius. By contrast, shame (chi) is mentioned in many passages. It is always used with reference to a lapse of responsibility, often accompanied by insult, estrangement and humiliation at the hands of others.

Shame is very ingrained in Confucianist ethics. It is even something that is considered a beneficial “tool” to keep people in line. Consider this passage from the Analects of Confucius:

“The Master said: ‘Lead the people with administrative injunctions and keep them orderly with penal law, and they will avoid punishments but will be without a sense of shame. Lead them with morality (de) and keep them orderly through observing ritual propriety (li) and they will develop a sense of shame; and, moreover, will order themselves”.

This passage is an attack on the Legalists who advocated keeping people in order with strict laws and harsh punishments. In other words, Confucius is saying that laws and punishments may keep social order, but even better is to lead by example so that people will regulate themselves due to the sense of shame from not following the social order.

The importance of shame in Chinese society is also apparent from a study of the penal system and amnesties in ancient China: there is evidence that the ancient courts acted harshly in cases of serious crimes but relied on shame entailed in the process of litigation to discipline the more minor offenders and restore their commitment to social responsibility.

In terms of the effects on Qi by shame, I think that this emotion makes Qi stagnate but also possibly in some cases, sink. Indeed, sinking of Qi is, in my experience, a common result of shame; Dampness also frequently accompanies shame.

When one feels shame, one feels “dirty” and “dirty” is characteristic of Dampness. Thus, shame often manifests with sinking of Qi and Dampness: for example, prolapses, very chronic and stubborn vaginal discharge, excessive menstrual bleeding from sinking of Spleen- and Kidney-Qi, slight urinary incontinence.

1. Solomon R The Passions, Hackett Publishing Company, Indianapolis, 1993, p. 245. 2. R Wollheim, On the Emotions, Yale University Press, 1999, pp. 155-6.

Tuesday, April 12, 2011


The draconian European Directive on herbal medicines is coming into force very soon (at the end of April). This will stop the sale of herbal remedies. We must all make our voice heard to stop this infringement of our freedoms that is being pushed by the European Union under the influence of pharmaceutical multinationals. Please support the Alliance for Natural Health, the Benefyt Foundation and the European Herbal Practitioners Alliance. Please watch the video and sign the petition.

Saturday, April 2, 2011


For all have sinned and fall short of the glory of God 1 Romans 3.23 In the previous Clinical Tip I discussed sadness and grief deriving from loss as a pervasive emotion in Western patients. In this Clinical Tip, I discuss another common emotional cause of disease in Western patients, i.e. guilt. Guilt is a pervasive emotion in Western patients. It is completely missing from Chinese medicine books and one could say that it simply does not exist in the Chinese psyche. It could be argued that guilt is intrinsically related to the Judeo-Christian religions and especially the Christian religion with its concept of “original sin.” I have never seen expressions referring to “feeling of guilt” as an emotional cause of disease in modern or old Chinese books. It could be argued that this is due to the fact that a feeling of guilt is more or less absent in Eastern societies. In fact, the concept of guilt is totally absent in all three major Chinese religions/philosophies of Confucianism, Daoism and Buddhism. Indeed, Confucius did not even believe in the value of punishment for crimes. Fingarette concurs that the concept of guilt is absent in the Analects of Confucius. The Analects do mention the word chi 耻 in several passages but this is shame rather than guilt. Fingarette says: “If we are unaware of the crucial differences in perspective, these texts on chi lend themselves easily to the assimilation of Confucian shame with Western guilt. Although chi is definitely a moral concept, the moral relation to which it corresponds is that of the person to his status and role as defined by li (rituals). Chi looks outward, not inward. It is not, as is guilt, a matter of the inward state, of repugnance at inner corruption, of self-denigration, of the sense that one is as a person, and independently of one’s public status and repute, mean or reprehensible. The Confucian concept of shame is a genuinely moral concept, but it is oriented to morality as centering in li, traditionally ceremonially defined social comportament [behaviour], rather than to an inner core of one’s being.”2 It should be stressed that what concerns us here in dealing with emotions, is not guilt but the feeling of guilt which is totally unrelated to an actual crime or transgression. For example, a person may have committed a crime but feel no guilt at all; conversely, a person may have committed no crime or transgression but feel guilty (which is usually the case in our patients). Guilt (and shame) are considered by some to be “moral” emotions as they bear upon morality. Wollheim says: “The role of the moral emotions is to provide the person with an attitude, or orientation. What is distinctive of the moral emotions is that the attitude is reflexive. It is an attitude that the person has towards himself/herself as a person.”3 Guilt is strongly linked to a sense of self and specifically to a negative sense of self: this is probably an important reason for the absence of guilt in Chinese culture as the self in Chinese culture is not the individualized, inward-looking, psychological self of Western culture, but a socially-constructed self. This may also account for the presence of shame in Chinese culture (related to a social sense of self) and the absence of guilt (related to an individual self). Guilt can manifest in many different ways, e.g.: – Feeling of responsibility for negative circumstances that have befallen oneself or others – Feeling of regret for real or imagined misdeeds, both past and present – Feeling responsible (and guilty) for any negative thing that occurs to members of one’s family or one’s partner – Taking responsibility for someone else’s misfortune or problem. The above are only a few examples of the sort of behaviour induced by feelings of guilt. A feeling of guilt may be due to the transgression of social or religious taboos or from having done something “wrong” which is later regretted. However, a feeling of guilt may also be innate and not related to any specific action. This innate feeling of guilt derives often from upbringing. This latter feeling is indeed the most destructive one. Guilt is self-reproach for some actual misdeeds or an in-born feeling of guilt totally disconnected from any misdeeds. Guilt includes a sense of inadequacy and despair not found in shame. Guilt does not require any particular offence and the doctrine of Original Sin is an example of this. When assailed by a feeling of guilt, a person is one’s own judge and a more ruthless and less reasonable judge than any real judge. Guilt is inwardly-directed and its object is the self; in this sense, it is almost the “opposite” emotion to that of anger as this latter emotion is usually directed at another person. Guilt is based on a moral criteria of having broken a law of morality (real or imagined). The “mythology” of guilt is the doctrine of the Original Sin. The “authority” providing the criteria is absolute and unquestionable. Guilt is a “dark” emotion with no redemption; it is a much “darker” emotion than shame and in my experience, more difficult to “treat” (if that is the right word). As for disharmonies induced by guilt, this emotion can have different effects in different people. First of all, it may lead to Qi stagnation: it affects any organ and especially the Lungs, Heart, Liver and Kidneys. Due to its “dark”, “stagnating” character, the Qi stagnation may cause Blood stasis easily. This Blood stasis may be in any part of the body and any organ but particularly in the Lungs, Heart, Liver and Kidneys. The pulse is Wiry or Firm. Under certain conditions, guilt may also cause sinking of Qi and affects the Kidneys causing some urinary problems or menstrual problems from sinking of Qi. The tongue has a red tip and possibly purple body. When guilt is the emotional cause of disease, the pulse is Wiry or Firm if there is Qi and Blood stagnation. If there is sinking of Qi of the Kidneys, the pulse is Deep and Weak on the Kidney positions, possibly slightly Overflowing on the Heart position and Choppy in general without wave. How does one “treat” guilt? It is possibly the most difficult to “treat”: it is a ‘dark” and deep-seated emotion and that is probably why it easily gives rise to Blood stasis. I generally choose the points depending on the patterns induced by guilt. I generally treat the Heart, Lungs, Liver and Kidneys. Some examples of points used would be HE-7 Shenmen, P-7 Daling, LU-7 Lieque, LU-3 Tianfu, LIV-3 Taichong, KI-4 Dazhong, KI-9 Zhubin, G.B.-13 Benshen, Du-24 Shenting. Of course, possibly with guilt more than any other emotion, a true healing cannot take place without a conscious effort of introspection from the patient with the help of psychotherapy. 1. Holy Bible, New International Version ®. 1984 International Bible Society. Online version [Accessed 2007]. 2. Fingarette H 1972 Confucius - The Secular as Sacred, Waveland Press, Prospect Heights, Illinois, p. 28. 3. Wollheim R 1999 On the Emotions, Yale University Press, New Haven, p. 148.