Morphine. Oxycodone. Hydrocodone. Codeine. We’re all familiar with the addictive drugs that make up the opioid crisis. It’s a deadly problem, with no easy solution.
Traditional Chinese medicine (TCM) practitioners bring a unique skillset to the epidemic. Acupuncture offers a non-addictive pain management alternative, and a therapeutic intervention that works concurrently with both physical and emotional challenges. What’s more, opium and opioids have existed in our herbal pharmacopeia, for centuries, not just decades. As such, practitioners have greater insight into the effects of these drugs on patients.
A good place to start in laying the foundation for understanding opiates from a TCM perspective is to look to the herbal texts – both historical and modern.
First, let’s understand the herbal derivation of opium and opiates. Opium is a substance extracted from Papaver somniferum, commonly known as the poppy. It is harvested from the plant latex – the resin released by the plant when its surface is cut or injured. The term “opiates” refers to the drugs that are developed from this substance (side note: The term “opioid” more broadly refers to any substance that binds to the opioid receptors in the brain).
Modern TCM herbal texts don’t include opium as an herb, but they do include ying su ke, which is the dried husk of the same plant – although it is classified as “obsolete” because of the addiction and toxicity issues. Let’s look at what Bensky et al.’s Materia Medica tells us about this herb:
Ying Su Ke
Properties: Sour, astringent, neutral, toxic
Meridians entered: Kidney, Large Intestine, Lung
Actions & indications:
If you’re confused about what this all means, don’t worry, I’ll translate. Primarily, the herb is used for the problem of things “leaking” out of the body – from the Lung (cough), from the Large Intestine (diarrhea), or from the Kidney (sperm, urine, vaginal discharge; from a TCM perspective, Kidney energy controls these substances). The herb is considered “astringent”, in that it resolves the symptom by binding up the faulty system so that the leakage stops.
Of note here is that the alleviation of pain is considered a less important function for this herb. The mention of pain as the last bullet point emphasizes this fact.
Similar to the current crisis, opium transitioned from medicinal use to popular use in China in the 1400s – although, at that time, it was because of its function as an aphrodisiac, rather than as pain medication. This popular use spun into similar widespread addiction problems to those we see today.
Li Shizhen, a prominent Chinese herbalist, lists in his book Compendium of Materia Medica (published in 1578), the use of opium for diarrhea, cough, and pain. He emphasizes its aphrodisiac function – it “retains the essence of men,” which refers to its ability to slow ejaculation – and the popularity that it had gained because of this property. In TCM, loss of sperm leads to a deficiency in “Kidney essence,” which can eventually lead to an inability to function sexually (as well as early aging and numerous other problems). This property and function made opium a popular drug for virility.
Once again, from this historical look at opium, we see an emphasis on the astringent nature of the plant, rather than on its pain management function. However, such strong astringency, especially when used improperly, can lead to problems.
Bensky et al.’s historical commentary on ying su ke includes reference to Miao Xiyong’s Commentary on the Divine Husbandman’s Classic of Materia Medica (published in 1625), which discusses the importance of only using these astringent herbs in the case of deficiency – in chronic cases, rather than in cases of acute illness. You don’t want to, for example, stop diarrhea caused by food poisoning with this herb, because your body will fail to flush the pathogen from your body. The symptom and discomfort of the diarrhea will be briefly under control, but the underlying pathogen will have the opportunity to thrive and grow, because it’s not being ejected quickly.
This is an important point: Opium is useful for addressing deficiency syndromes, specifically. However, an equally important point is that, while it treats leakage symptoms that result from a deficient constitution, it does nothing itself to tonify and nourish the underlying deficiency. So, it powerfully treats the symptom, but not the root issue. As you can imagine, this can lead to problems.
Overuse of opiates because of their addictive quality is what shifts the herbs or drugs from medicinal to problematic. When the use of an astringent substance escalates in an unbalanced manner, problems arise. In the case of opiates, the more common symptoms of abuse include:
From a TCM perspective, the pattern that stands out is the excessive Yin energy at play: inward, slowing, stopping, holding. This is the end point of an astringent, or binding, property gone awry – especially when it’s not being balanced by addressing any underlying deficiency. When Yin energy becomes excessive, and increasingly out of balance with Yang energy, the patient is at risk of the separation of Yin and Yang, which results in death.
While the drugs today are markedly different from the herbal substances of the past, it’s helpful to consider historical knowledge in order to move forward with modern issues. Understanding these substances from a TCM perspective gives us a more familiar angle to address the issue of opioid addiction when it presents in our clinics.
Research & Writing by Dr. Stephanie Albert
Dr. Stephanie Albert holds a Doctorate of Acupuncture and Chinese Medicine from the American College of Traditional Chinese Medicine in San Francisco, CA. She runs a private practice out of the Lotus Center in the Mission district of San Francisco, where she works with patients to address stress, insomnia, pain, women’s health issues, and other health complaints through acupuncture, herbal medicine and lifestyle modification. www.stephalbert.com