A SAMPLE SEVEN FORESTS FORMULA:

ASTRAGALUS 10+

by Subhuti Dharmananda, Ph.D., Director, Institute for Traditional Medicine, Portland, Oregon

Astragalus 10+ is the designation of one of the 120 Seven Forests formulations that are provided by prescription, mainly by acupuncturists. The background information about this formula presented here will be instructive towards learning about the Seven Forests formulas and the work of the Institute for Traditional Medicine (ITM).

This formula originated with a 1986 article in the Pacific Journal of Oriental Medicine, published by the San Francisco College of Oriental Medicine, one of the early acupuncture colleges in America. The article outlined research conducted in China and Japan regarding immunological effects of Chinese herbs and their active constituents. Most of this research was conducted in hopes of finding useful therapies for treatment of cancer and the side effects of modern cancer therapies. However, the main reason for interest in this field at the time of the Pacific Journal article was the growing awareness of two syndromes that appeared to involve immune deficiency secondary to viral infections: chronic fatigue syndrome and AIDS. The former had been thought to be associated with one or more of the herpes viruses (the focus of concern was the Epstein-Barr virus that was the known cause of mononucleosis); the latter had just been identified as being caused by the Human Immunodeficiency Virus (HIV). Both of the diseases were frequently reported in the San Francisco area where the college was located, and both had no successful treatment by modern medicine, so people turned to Chinese medicine as an alternative. I was asked to write the article about possible immune system benefits from Chinese herbs. This subject has remained one of great concern, with an emphasis currently on treating side effects of cancer therapies and addressing immune weakness that develops with aging, chronic emotional stress, and poor life style choices.

The central herbs of Astragalus 10+ are three well-known tonics: astragalus, ganoderma (known in Japan as rei-shi), and eleuthero (sometimes called Siberian ginseng). Each of these herbs has been the subject of intensive investigation in the Orient, not only for their potential immunological effects, but also for other possible benefits, such as improving cardiovascular and circulatory conditions. Astragalus 10+ was described in the 1988 ITM book Chinese Herbal Therapies for Immune Disorders (now out of print). It is not the purpose of the current presentation to review this extensive research work on the effects of the herbs, much of which is summarized on numerous internet web sites. The full botanical names and other reference names-useful for searching the internet-are provided in Table 1 for all of the formula's ingredients.

Astragalus 10+ was first produced in 1987 as a bulk powder, to be taken by the tablespoon, but was then made as a convenient tablet with added concentrated extracts of astragalus and eleuthero to compensate for the lower dose of the prescription that is usually consumed in tablet form. The formulation is described in ITM's book for health professionals: A Bag of Pearls (2002). The relevant page from the book is presented here (please note: the sample indications for use are not intended as claims that the formula will be effective for those indications; only that it is consistent with formulas given under such circumstances by Chinese herbalists).

huangqi Astragalus 15% ciwujia Eleuthero 15% lingzhi Ganoderma 10% maimendong Ophiopogon 10% nüzhenzi Ligustrum 10% heshouwu Ho-shou-wu 7% roucongrong Cistanche 6% baizhu Atractylodes 6% gancao Licorice 6% renshen Ginseng 5% wuweizi Schizandra 5% sangshen Morus fruit 5%       GENERAL ACTIVITIES tonify qi, nourish blood and essence SAMPLE INDICATIONS FOR USE chronic immune deficiency, frequent infections, general weakness TO PERSONALIZE, ADD Ganoderma 18 or Eucommia 18 for general deficiency syndrome Antler 8 or Tang-kuei Tablets for anemia Shou Wu Tablets or Restorative Tablets for yin deficiency Ginseng 18 for digestive weakness Astragalus 16 for chronic lung disease Ginseng 6 to boost the qi This formula is intended for long-term use, usually for several weeks or months. MANUFACTURING SPECIFICATIONS Powdered herbs combined according to the prescription indicated here are mixed with astragalus and eleuthero extracts, then made into 750 mg tablets. Bottling of 100, 250, and 420 tablets.   EXPLANATORY NOTES Astragalus 10+ is a tonic prescription that has the principal aim of enhancing the immune system functions, though it can be used as a general tonic for qi, blood, and essence. Deficiencies of the immune function may be caused by chemotherapy, radiation, or surgery, by infectious agents (especially viruses), and by various stresses (e.g., environmental exposure to extremes of temperature, emotional disturbance, irregular habits of sleep, exercise, and eating). The particular herbs selected for this formula are ones that have been demonstrated by modern research to enhance immune functions. A key to successfully promoting immune functions is getting an adequate dosage of the active constituents, which include polysaccharides, saponin glycosides, and fatty acids. This formula should be taken in substantial amounts (often 5 or more tablets at a time) for the initial therapy; this can be followed up-after immune regulation is improved-with a lower dosage maintenance. Quite a few Western practitioners rely on a form of administration that is not used by Chinese practitioners: alcohol-based liquid extracts. Alcohol condenses the active polysaccharides and renders them unavailable in the finished product. Therefore, many times this method of therapy is found ineffective, but it is because the active constituents have not been delivered. A similar problem can arise from using suboptimal doses of the herbs in decoctions or tablets. Concentrated extracts of astragalus and eleuthero have been added to the basic formula to boost the amounts of these ingredients which are often included in high dosages in Chinese clinical practice. Coricepium (White Tiger) may be used additionally to increase the amount of polysaccharides provided.

ITM has produced, on average, nearly 700 kg (1,500 pounds) of Astragalus 10+ each year during the past 15 years, for a total of 10,000 kg (5 metric tons). It has an excellent record of safety and lack of adverse effects; a few people may experience gas and bloating when taking large amounts due to the polysaccharides. No claims can be made for its effectiveness, however, as it has not been subjected to rigorous testing that would be essential to making any such claim.

The reason that the formula is available by prescription-and not through general sales-is that immune deficiencies are potentially serious health problems for which a comprehensive therapeutic approach should be used. It is the role of the practitioner to help an individual understand their health problems and the steps that need to be taken to manage them; it is also the practitioner's duty to explain the possible contribution of an herb formula like Astragalus 10+. Most people are unfamiliar with the Chinese herb ingredients and will have some difficulty understanding their actions without the aid of their health professional. Further, many people have questions about the herbs-duration of use, changing formulas, possible interactions with medications or overlap with other supplements-that should be asked of their health professional. ITM provides advanced educational materials to practitioners that may aid them in this task, but has limited information suitable for the consumer of the formula.

The name of the formula reflects its history of development. The original journal article describing the immune enhancing herbs presented an Astragalus Eight Herb Formula, which was then manufactured in tablet form by Health Concerns, under their Chinese Classics label. Astragalus Ten Formula was originally produced by ITM for a research project involving people with HIV infection. It was later modified to become Astragalus 10+ (12 ingredients) based on further investigations and intended for broader applications.

A Chinese description of this formula is a broad-based tonic that supplements qi, blood, yin, and yang. In the current classification system, astragalus, atractylodes, eleuthero, ginseng, and licorice are qi tonics; they improve digestive functions and help overcome fatigue. Morus fruit and ho-shou-wu are blood tonics; they enrich the blood and may slow the development of signs of premature aging such as dry skin, dry and graying hair, and loss of visual and auditory acuity. Ophiopogon and ligustrum are yin tonics; they moisten dryness and prevent overheating, such as occurs with menopausal hot flashes, afternoon flushing, or night sweating. Cistanche is a yang tonic that, together with ginseng and eleuthero, is invigorating. Schizandra and ganoderma serve as general tonics with mild sedative nature that aid getting a good night's sleep.

Table 1. Herbs in Astragalus 10+.

Notes to table: Do not confuse astragalus root, as used here, with the leaves of other Astragalus species which are eaten by animals and can be toxic due to high levels of the nutrient selenium (which is a beneficial nutrient, but can be consumed in excess when animals feed heavily on the leaves). Do not confuse Cistanche salsa with Cistanche deserticola, the latter being an endangered species in China that had been one source of roucongrong. Ginseng refers to the standard red ginseng of China, a processed root that has a mild nature.