Types of Herbal Medicine and How They Differ

Types of Herbal Medicine and How They Differ

Traditional East Asian medicine, including Chinese medicine, is already a deep part of daily life. Yet many people still aren't sure when East Asian medical care is needed, or how to use it so it truly helps their health. This is a space where you and I, Mira, look at how to get the full benefit of East Asian medicine.

When we fall ill, we are diagnosed and given medicine. That medicine comes in many forms: injections, IV drips, tablets, powders, patches, ointments and more. Each form is developed and prescribed so the medicine can work as well as possible for the patient's illness and condition.

Herbal medicine, one of the main treatments in East Asian medicine, is no different. Depending on the herbs and their properties, it is made as liquid decoctions, round pills, powders, concentrated granules, lozenges you let melt like candy, and more. There are even medicinal wines made with alcohol. Let me walk you through the forms of herbal medicine, shaped by the herbs, the prescription and the needs of modern life, and what makes each one special.

1. Decoctions (tang): fast-acting liquid medicine

The decoction is the form most people picture when they hear "herbal medicine." Have you ever seen a TV drama scene where hand-picked herbs are carefully simmered over a fire? The herbs are soaked in water, alcohol, or a mix of the two, then boiled over a suitable heat for a set time. The residue is strained off, and only the liquid is taken by mouth or used on the skin.

Because the herbs are simmered in water, a decoction draws out a high share of their active compounds, and the body absorbs them quickly. Herbs are also easy to add or remove, so the prescription can be adjusted fast to the patient's condition for the best result.

A decoction can be finely tailored to each person, but it is fiddly to brew and hard to make in large batches. These days, for convenience, herbal pharmacies often brew it for you and pack it in pouches or spouted packs, though this adds to the cost.

2. Powders (san): dried herbs ground fine

A powder is made by drying herbs in the sun or over low heat and grinding them. There are powders to take by mouth and powders for the skin.

Oral powders are swallowed as they are, or stirred into water or another medicine. Some, depending on the prescription, are boiled briefly in water or steeped for about 8 hours, and only the liquid is drunk. External powders are blown into the throat or nose, or sprinkled on wounds to stop bleeding and help them heal.

Today most powders are taken by mouth, but in the past cuttlefish bone powder was used to stop bleeding. When tonsils were badly swollen, powdered herbs were even put in a bamboo tube and blown onto them.

Powders are easy to mass-produce and quick to make, and simple to take and carry. On the downside, some people find powders hard to swallow, and the compounds you only get by heating herbs in water or alcohol are hard to capture this way.

3. Concentrated granules

Granules make up for the weak points of powders. Instead of grinding the raw herbs, the herbs are extracted, a base (excipient) is added, and the moisture is dried off to form granules. They work well, and because they dissolve easily in warm water, they are easy to take. They can also be filled into capsules. They are easy to carry and keep for a long time, so they suit long-term use.

4. Pastes (go)

Pastes are made by boiling herbs in water or oil and concentrating them. They have a texture like Greek yogurt or honey, both so popular these days.

To make a paste, a decoction is simmered for a long time over low heat until the water evaporates and it thickens. Or powdered herbs are kneaded and cooked in a double boiler.

The best-known paste is Korea's Gyeongokgo. Ginseng and poria are ground fine, mixed with fresh rehmannia juice and honey, and heated in a double boiler for 72 hours (three days and nights). The sealed jar is then soaked in a well for a day and night, and heated again for another 24 hours.

A well-known paste for the skin is Jaungo. Ointments like this are made by steeping herbs in oil, boiling them to draw out their properties, and adding beeswax until the paste is firm enough to spread on skin.

In the past, herbal plasters (goyak) were widely used for skin problems and boils. When I was a child, you could easily find them at any pharmacy. They are hard at room temperature, but on the skin body heat softens them, and the medicine is absorbed locally through the wound or skin.

5. Pills (hwan): small round solids

Pills are made by grinding the combined herbs into powder and shaping it into round solids with honey, water, rice paste, flour paste or herbal juice. A pill is absorbed slowly, so its effect lasts longer, and pills are easy to take and carry. Aromatic herbs, whose compounds change or weaken when boiled or heated, are made into pills. Musk in Gongjindan is a typical example; many modern versions use agarwood or costus root in its place.

Pills meant to melt slowly in the mouth, like Woohwang Cheongsimwon and Gongjindan, are called tanjadae ("slingshot-pellet size") and today usually weigh about 3.75 g. Pills swallowed with water are made smaller: ojadae, the size of a paulownia seed, and smaller still, nokdudae, the size of a mung bean. Here's a fun fact: the original Gongjindan recipe was rolled to ojadae, the size of a paulownia seed, while today it is usually made as a larger tanjadae pill.

6. Medicinal wine (herbal liquor): alcohol as the solvent

Medicinal wine uses alcohol as its solvent. Herbs are steeped in baijiu (clear grain liquor) or huangjiu (yellow rice wine), and after a set time the residue is discarded and the liquor is used.

If herbs are boiled in alcohol until the alcohol evaporates, the result counts as a decoction; medicinal wine still contains its alcohol. Medicinal wines are also used on the skin to disinfect and speed recovery from pain and bruises. Medicinal wine is absorbed quickly, but its alcohol can do harm. One option is to set it in hot water to let the alcohol evaporate before taking it.

7. Distilled herbal water (yangno)

Distilled herbal medicine is called yangno, meaning "dew of medicine." It is made by distilling the steam that rises as a decoction boils.

It is as clear as water, so even children can take it easily. But it captures only compounds that dissolve in water and evaporate, so it is much weaker than a decoction.

8. Soft extracts (yeonjo extract)

Soft extracts arrived recently, thanks to advances in formulation technology. In English it is called a liquid extract: a softened extract. Herbs are steeped in a solvent to draw out their compounds, and the liquid is then adjusted to a set concentration. By consistency, extracts are grouped into liquid, thick and dry extracts. A familiar example is red ginseng extract (hongsam extract), the thick, dark paste sold in jars and sticks. Many formulas contain fructooligosaccharides, corn syrup or high-fructose syrup, so people with severe diabetes should take care.

9. Lozenges (troches): let them melt

Troches are candy-like lozenges that you let dissolve slowly in your mouth. They are mainly used when the mouth or throat is sore. Chewing or swallowing them whole stops them working fully, so always let them melt.

A well-known herbal troche is the watermelon frost lozenge, often taken for a scratchy throat, a cold that won't go away, or asthma.

Troches act directly on the uncomfortable area, so they work fast, and they are easy to store and take. If you have diabetes or obesity, I recommend looking for troches made with sugar substitutes rather than sugar.

At a glance

The right form depends on your condition and the herbs in your prescription, so ask your practitioner which suits you. This post is for general information.