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Tuesday, March 1, 2022

Countering America's Adversaries Through Sanctions Act

From Wikipedia, the free encyclopedia
 
Countering America's Adversaries Through Sanctions Act
Great Seal of the United States
Long titleAn Act to provide congressional review and to counter aggression by the Governments of Iran, the Russian Federation, and North Korea, and for other purposes.
Acronyms (colloquial)CAATSA
Enacted bythe 115th United States Congress
Citations
Public law115–44
Legislative history

The Countering America's Adversaries Through Sanctions Act (CAATSA) is a United States federal law that imposed sanctions on Iran, North Korea, and Russia. The bill was passed by the Senate on 27 July 2017, 98–2, after it passed the House 419–3. The bill was signed into law on 2 August 2017 by President Donald Trump, who stated that he believed the legislation was "seriously flawed".

Legislative history

On 15 June 2017, the United States Senate voted 98 to 2 for the bill (an amendment to the underlying Iran sanctions bill), which was rooted in a bill introduced in January that year by a bipartisan group of senators over Russia's continued involvement in the wars in Ukraine and Syria and its interference in the 2016 election; with regard to Russia, the bill was designed to expand the punitive measures previously imposed by executive orders and convert them into law. The bill in the Senate incorporated the provisions of the Countering Russian Influence in Europe and Eurasia Act that was introduced in May 2017 by Senator Ben Cardin.

An identical bill was introduced by Democrats in the House of Representatives on 12 July 2017. While the bill's text was unchanged from what had passed the Senate on 15 June, it was titled as House legislation to avoid procedural hurdles. The bill, after being revised to address some of the Trump administration's concerns, passed in the House 419 to 3 on 25 July. On 27 July, the bill was passed overwhelmingly by the Senate.

On 2 August 2017, President Donald Trump signed the bill into law, while stating that he believed the legislation was "seriously flawed".

Provisions

Countering Iran's Destabilizing Activities Act of 2017
  • CAATSA requires the President to impose sanctions against: (1) Iran's ballistic missile or weapons of mass destruction programs, (2) the sale or transfer to Iran of military equipment or the provision of related technical or financial assistance, and (3) Iran's Islamic Revolutionary Guard Corps and affiliated foreign persons.
  • The President may impose sanctions against persons responsible for violations of internationally recognized human rights committed against individuals in Iran.
  • The President may temporarily waive the imposition or continuation of sanctions under specified circumstances.
Countering Russian Influence in Europe and Eurasia Act of 2017
  • The President must submit for congressional review certain proposed actions to terminate or waive sanctions with respect to the Russian Federation.
  • Specified executive order sanctions against Russia shall remain in effect.
  • The President may waive specified cyber- and Ukraine-related sanctions.
  • The bill provides sanctions for activities concerning: (1) cyber security, (2) crude oil projects, (3) financial institutions, (4) corruption, (5) human rights abuses, (6) evasion of sanctions, (7) transactions with Russian defense or intelligence sectors, (8) export pipelines, (9) privatization of state-owned assets by government officials, and (10) arms transfers to Syria.
  • The Department of State shall work with the government of Ukraine to increase Ukraine's energy security.
  • The bill: (1) directs the Department of the Treasury to develop a national strategy for combating the financing of terrorism, and (2) includes the Secretary of the Treasury on the National Security Council.

The Act imposed new sanctions on Russia for interference in the 2016 US elections and its involvement in Ukraine and Syria. The Act converted the punitive measures previously imposed by Executive Orders into law to prevent the President the easing, suspending or ending of sanctions without the approval of Congress.

Section 241 of the Act required that "not later than 180 days after the date of the enactment of this Act, the Secretary of the Treasury, in consultation with the Director of National Intelligence and the Secretary of State" submit to Congress a detailed report — with the option of containing a classified annex — that would include "identification of the most significant senior foreign political figures and oligarchs in the Russian Federation, as determined by their closeness to the Russian regime and their net worth" as well as an assessment of the relationship between such individuals and "President Vladimir Putin or other members of the Russian ruling elite". The section also called for an assessment of the "leadership structures and beneficial ownership" of Russian parastatal entities.

Korean Interdiction and Modernization of Sanctions Act
  • The bill modifies and increases the President's authority to impose sanctions on persons in violation of certain United Nations Security Council resolutions regarding North Korea.
  • U.S. financial institutions shall not establish or maintain correspondent accounts used by foreign financial institutions to provide indirect financial services to North Korea.
  • A foreign government that provides to or receives from North Korea a defense article or service is prohibited from receiving certain types of U.S. foreign assistance.
  • The bill provides sanctions against: (1) North Korean cargo and shipping, (2) goods produced in whole or part by North Korean convict or forced labor, and (3) foreign persons that employ North Korean forced laborers.
  • The State Department shall submit a determination regarding whether North Korea meets the criteria for designation as a state sponsor of terrorism.

Domestic reactions

President Trump

On the day President Trump signed the bill into law, he issued two separate, simultaneous signing statements. In the statement meant for Congress he said: "While I favor tough measures to punish and deter aggressive and destabilizing behavior by Iran, North Korea, and Russia, this legislation is significantly flawed. In its haste to pass this legislation, the Congress included a number of clearly unconstitutional provisions" — such as restrictions on executive branch′s authority that limited its flexibility in foreign policy. Among other things, the statement noted that the legislation ran afoul of the Zivotofsky v. Kerry ruling of the Supreme Court. The president appeared to indicate that he might choose not to enforce certain provisions of the legislation: "My Administration will give careful and respectful consideration to the preferences expressed by the Congress in these various provisions and will implement them in a manner consistent with the President's constitutional authority to conduct foreign relations." It also said: "Finally, my Administration particularly expects the Congress to refrain from using this flawed bill to hinder our important work with European allies to resolve the conflict in Ukraine, and from using it to hinder our efforts to address any unintended consequences it may have for American businesses, our friends, or our allies."

The other statement by Trump noted: "[T]he bill remains seriously flawed – particularly because it encroaches on the executive branch's authority to negotiate. Congress could not even negotiate a healthcare bill after seven years of talking. By limiting the Executive's flexibility, this bill makes it harder for the United States to strike good deals for the American people, and will drive China, Russia, and North Korea much closer together."

State Department

U.S. State Department spokeswoman Heather Nauert stated: "Since the enactment of the CAATSA legislation, we estimate that foreign governments have abandoned planned or announced purchases of several billion dollars in Russian defense acquisitions. Given the long timeframes generally associated with major defense deals, the results of this effort are only beginning to become apparent."

Secretary of State Mike Pompeo warned Egypt against purchasing Russian Sukhoi Su-35, saying "We've made clear that if those systems were to be purchased, the CAATSA statute would require sanctions on the regime."

Defense Department

Assistant Secretary of Defense Randall Schriver stated: "We understand historical India-Russia relationship. ... On CAATSA, Mattis did plea for an exception for India, but I can't guarantee a waiver will be used for future purchases."

International reactions

EU member states

Angela Merkel criticized the draft of new sanctions against Russia that target EU–Russia energy projects.

In mid-June 2017, Germany and Austria issued a joint statement that said the proposed bill heralded a "new and very negative quality in European-American relations" and that certain provisions affecting gas pipeline projects with Russia were an illegal threat to EU energy security.

On July 26, 2017, France's foreign ministry described the new U.S. sanctions as illegal under international law due to their extraterritorial reach.

At the end of July 2017, the proposed law's Russia sanctions caused harsh criticism and threats of retaliatory measures on the part of the European Union President Jean-Claude Juncker. Germany's minister for Economics and Energy Brigitte Zypries described the sanctions as illegal under international law and urged the European Union to take appropriate counter-measures.

India

In October 2018, India inked a US$5.43 billion deal with Russia to procure four S-400 Triumf surface-to-air missile defense systems, while ignoring the CAATSA. The U.S. threatened India with sanctions over India's decision to buy the S-400 missile defense systems from Russia.

According to the President of the U.S.-India Strategic Partnership Forum (USISPF), Mukesh Aghi:

Critics who think that India should avoid the S-400 purchase misread the situation. Simply put, sanctions would have a disastrous effect on U.S.-India relations for decades to come. In India's eyes, the United States would once again be regarded as untrustworthy. Sanctions would push India closer to Russia at a time when India is reeling from the decision to withdraw from the Iran deal—Iran is India's third largest supplier of crude oil.

Two oil companies ordered crude oil from Iran for November ignoring CAATSA. The United States threatened India with sanctions over India's decision to buy oil from Iran.

Indonesia

According to the Australian Strategic Policy Institute, CAATSA has resulted in delays to the Indonesian purchase of Russian Sukhoi Su-35 fighter aircraft and "[the] willingness of the US to impose [CAATSA] sanctions, or whether any waiver might be obtained, has been at the forefront of security diplomacy between Washington and Jakarta in recent months."

Iran

On August 2, 2017, Iranian Deputy Foreign Minister Abbas Araqchi stated in an interview with state TV that, "In our view the nuclear deal has been violated and we will show an appropriate and proportional reaction to this issue,".

North Korea

North Korean foreign ministry officials said that "US bid for imposing sanctions on different countries around the world is entirely outrageous leverage to meet its own interests" and suggesting that the "sanctions bill" against the DPRK, Russia and Iran which recently passed the US Congress is prompting a growing international backlash, citing reactions by Russia, China, Venezuela, Germany, Austria and France.

Russia

After the bill passed the Senate, on 28 July 2017, Russia's foreign ministry announced measures that were cast as a response to the bill passed by Congress, but also referenced the specific measures imposed against the Russian diplomatic mission in the U.S. by the Barack Obama administration at the end of 2016. Russia demanded that the U.S. reduce its diplomatic and technical personnel in the Moscow embassy and its consulates in Saint Petersburg, Yekaterinburg and Vladivostok to 455 persons — the same as the number of Russian diplomats posted in the U.S. — by September 1; Russia's government would also suspend the use of a retreat compound and a storage facility in Moscow used by the US by August 1. Shortly after, Russian president Vladimir Putin said that the decision had been taken by him personally and that 755 employees of the U.S. diplomatic mission must "terminate their activity in the Russian Federation".

After the bill was signed, the Russian Foreign Ministry attributed the sanctions to "Russophobic hysteria" and reserved the right to take action if it decided to. Russian prime minister Dmitry Medvedev wrote on August 2 that the law had ended hope for improving U.S.–Russia relations and meant "an all-out trade war with Russia." His message also said, "The American establishment has won an overwhelming victory over Trump. The president wasn't happy with the new sanctions, but he had to sign the bill."

In June 2020, USA's Senate Majority Whip, John Thune, R-S.D., proposed an amendment to the 2021 National Defense Authorization Act to allow the US Department of Defense to purchase Turkey’s Russian-made S-400 missile system, using the U.S. Army’s missile procurement account. The reasoning is that this would remove the issue of Turkey having a foreign military system that contravenes the CAATSA. This would then allow the US to re-integrate Turkey into the F-35 Lightning II acquisition and ownership program.

Turkey

Iranian President Hassan Rouhani, Russian President Vladimir Putin and Turkish President Recep Tayyip Erdoğan in Sochi, Russia, November 2017

In late 2017, Turkish President Recep Tayyip Erdoğan and Russian officials signed an agreement worth $2.5 billion for the delivery of the S-400 air defence system units. Secretary of State Mike Pompeo raised concerns over Turkey's S-400 deal with Russia, but President Erdoğan and other Turkish officials rejected the U.S. threat of sanctions under the CAATSA over its purchase of S-400 missile systems citing existing international protocols and agreement forms mutually signed and agreed by Turkey and Russia and that the S-400 offer with Russia was a better deal than the Patriot System offered by US.

Implementation

On 29 September 2017, president Donald Trump issued a presidential memorandum that delegated certain functions and authorities under the Countering America's Adversaries Through Sanctions Act as well as the 2014 Ukraine Freedom Support Act, and the 2014 Support for the Sovereignty, Integrity, Democracy, and Economic Stability of Ukraine Act to the Secretary of State, the Secretary of the Treasury, and the Director of National Intelligence.

Amendment of the relevant directives done by the U.S. Department of the Treasury on 29 September 2017 referred to the Countering Russian Influence in Europe and Eurasia Act of 2017 (CRIEEA) and further toughened the Sectoral Sanctions against Russia.

On 11 October 2017, in a joint statement, Sens. John McCain (R-Ariz.) and Ben Cardin (D-Md.) questioned the Trump administration's commitment to the sanctions bill noting that the White House had "had plenty of time to get their act together" after missing an October 1 deadline to identify Kremlin-linked targets.

President of the World Holocaust Forum Foundation (WHF) Viatcheslav Moshe Kantor is on the list of Russian "oligarchs" named in the CAATSA unclassified report.

At the end of November 2017, Reuters reported that a U.S. government blacklist of persons likely to be sanctioned, albeit not automatically, was to be drawn up by the Treasury Department and sent to Congress by the end of January 2018; the prospect of being included in the list already had the entire Russian business elite concerned, while the Kremlin viewed the U.S. move as an attempt to turn Putin's allies against him weeks before the presidential election. Daniel Fried, Coordinator for Sanctions Policy (January 2013–February 2017), in early December 2017 said that Congress's resolve on the Russia sanctions was sowing fear in Russia, the goal being to "freeze them out of the U.S. system, freeze them out of the dollar and pretty much make them radioactive."

On 29 January 2018, the Trump administration submitted to Congress five reports as mandated by CAATSA, including those on Iran's missile programme, sanctioned persons of North Korea, and two versions (both classified and unclassified) of the report "regarding senior political figures and oligarchs in the Russian Federation and Russian parastatal entities". The unclassified list published the following day by the Treasury Department contained names of 210 people, including 96 Russian tycoons close to president Vladimir Putin with wealth of $1 billion or more, as well as top Russian statespersons and officials, including Russian prime minister Dmitry Medvedev, but excluding Vladimir Putin, all information having been drawn from public sources. The Treasury Department formally explained the legal significance of publishing names of the individuals and entities included in its 29 January 2018 report on Russia: "This report is not a "sanctions list."" Speaking to the Senate Banking Committee on 30 January, the Treasury Secretary Steven Mnuchin said: "The intent was not to have sanctions by the delivery report last night. The intent was to do an extremely thorough analysis — it's hundreds of pages — and there will be sanctions that come out of this report."

Major existing and planned natural gas pipelines supplying Russian gas to Europe. Germany imports 50% to 75% of its natural gas from Russia.

On 15 March 2018, Mnuchin unveiled a series of sanctions, first time under CAATSA as well as Executive Order 13694, against various Russian entities and individuals, including the Russians indicted in Special Counsel investigation, the Main Intelligence Directorate, and the Federal Security Service. Mnuchin issued a statement, saying: "The Administration is confronting and countering malign Russian cyber activity, including their attempted interference in U.S. elections, destructive cyber-attacks, and intrusions targeting critical infrastructure. These targeted sanctions are a part of a broader effort to address the ongoing nefarious attacks emanating from Russia. Treasury intends to impose additional CAATSA sanctions, informed by our intelligence community, to hold Russian government officials and oligarchs accountable for their destabilizing activities by severing their access to the U.S. financial system."

In mid-May 2018, Senators Bob Menendez (D-N.J.), Mark Warner (D-VA), and Sherrod Brown (D-OH), in a letter addressed to the inspectors general of the State Department, Treasury Department and Intelligence Community, alleged that the Trump administration had failed to fully comply with the provisions of the CAATSA and requested investigations into that.

On 20 September 2018, the U.S. government for the first time imposed secondary sanctions under CAATSA by sanctioning China's Equipment Development Department of the Central Military Commission and its director, Li Shangfu, for "engaging in significant transactions with persons" on the List of Specified Persons, namely for transactions that involved "Russia's transfer to China of Su-35 combat aircraft and S-400 surface-to-air missile system-related equipment".

In January 2019, U.S. Ambassador to Germany Richard Grenell told Handelsblatt that European companies participating in the construction of Nord Stream 2 gas pipeline are "always in danger", because sanctions under the CAATSA are "always possible". The Trump administration has long opposed the Russian-backed Nord Stream 2 — a pipeline for delivering natural gas from Russia to Germany. Within that context Grenell also sent letters to German companies involved in the construction of said Nord Stream 2, threatening sanctions.

Businesses involved in Nord Stream 2 natural gas pipeline have been sanctioned by the United States, which has been seeking to sell more of its own liquefied natural gas (LNG) to European states, with the passing of the National Defense Authorization Act for Fiscal Year 2020 on December 20, 2019. German Finance Minister Olaf Scholz called the sanctions "a severe intervention in German and European internal affairs", while the European Union spokesman criticized "the imposition of sanctions against EU companies conducting legitimate business." Russian Foreign Minister Sergey Lavrov also criticized sanctions, saying that U.S. Congress "is literally overwhelmed with the desire to do everything to destroy" the U.S.–Russia relations.

On 8 December 2020, the House of Representatives adopted sanctions against NATO member Turkey due to its purchase of S-400 missile system from Russia. Trump administration said that the president will veto the bill. Trump had earlier worked to delay passing sanctions against Turkey, but he lost the 2020 United States presidential election. On 14 December, 2020, the United States imposed the sanctions on Turkey, and the sanctions included a ban on all U.S. export licenses and authorizations to Turkey's Presidency of Defense Industries (SSB) and an asset freeze and visa restrictions on Dr. Ismail Demir, SSB’s president, and other SSB officers. The United States also excluded Turkey from the joint F-35 project, as well as barred Turkey from approaching new NATO technological development.

In January 2021, the Trump administration imposed sanctions on the Russian pipe-laying ship “Fortuna” and its owner, KVT-RUS.

List of Russian nationals named in the CAATSA unclassified report

The list of "oligarchs" and businessmen submitted as part of one of the five reports delivered to Congress on 29 January 2018 included 96 names.

Although it was widely, and incorrectly, reported in the media that those on the list "may be subject to sanctions", the CAATSA Report itself made clear that it "in no way should be interpreted to impose sanctions on those individuals or entities". It also specified that inclusion in the report "does not constitute the determination by any agency that any of those individuals or entities meet the criteria for designation under any sanctions program", and in no way indicates that "the U.S. Government has information about the individual's involvement in malign activities".

Shortly after the list was released, it was reported that the Trump administration's Treasury Department had simply copied it from the Forbes' 2017 "World Billionaires" list: people, including those with non-Russian citizenship on the Forbes list who had Russian heritage and a net worth of $1 billion or more, had been indiscriminately included in the CAATSA Report. In its response to a lawsuit asserting that the compilation of the list was "arbitrary, capricious, and contrary to law", the Treasury Department has confirmed that it is "not challenging" the allegation that it had "simply republished" the Forbes billionaires list.

Criticism

The senior fellow at Singapore's ISEAS–Yusof Ishak Institute wrote that "Washington's efforts to curb Moscow's global arms sales may have the unintended effect of obstructing some Southeast Asian countries' attempts to resist Beijing's relentless advances; they may even enhance China's influence."

According to the Stratfor, "the CAATSA process could discourage Vietnam from further building its defense relationship with the United States, if only to avoid future compromises to its strategic autonomy. ... In today's world, middle powers are increasingly assertive and refuse to tie themselves to any single great power. The United States' reliance on the blunt tool of extraterritoriality could eventually backfire if it's not careful."

On 8 December 2020, the House of Representatives approved a sanctions package against Turkey due to its purchase of S-400 missile system from Russia. Subsequently doubts were raised by a number of international policy analysts that military sanctions on the NATO ally would weaken the alliance, effectively reducing Turkey's ability to obtain American technology for regional defense.

Secretary of Defence James Mattis has argued that the Congress should amend CAATSA and give the administration wide authority to grant waivers. Senators John Cornyn and Mark Warner urged President Joe Biden to waive sanctions against India as it could adversely affect U.S.-India cooperation against China.

Chinese herbology

From Wikipedia, the free encyclopedia

Dried herbs and plant portions for Chinese herbology at a Xi'an market

Chinese herbology (simplified Chinese: 中药学; traditional Chinese: 中藥學; pinyin: zhōngyào xué) is the theory of traditional Chinese herbal therapy, which accounts for the majority of treatments in traditional Chinese medicine (TCM). A Nature editorial described TCM as "fraught with pseudoscience", and said that the most obvious reason why it has not delivered many cures is that the majority of its treatments have no logical mechanism of action.

The term herbology is misleading in the sense that, while plant elements are by far the most commonly used substances, animal, human, and mineral products are also utilized, among which some are poisonous. In the Huangdi Neijing they are referred to as 毒藥 (pinyin: dúyào) which means toxin, poison, or medicine. Unschuld points out that this is similar etymology to the Greek pharmakon and so he uses the term "pharmaceutic". Thus, the term "medicinal" (instead of herb) is usually preferred as a translation for (pinyin: yào).

Research into the effectiveness of traditional Chinese herbal therapy is of poor quality and often tainted by bias, with little or no rigorous evidence of efficacy. There are concerns over a number of potentially toxic Chinese herbs.

History

Chinese pharmacopoeia

Chinese herbs have been used for centuries. Among the earliest literature are lists of prescriptions for specific ailments, exemplified by the manuscript "Recipes for 52 Ailments", found in the Mawangdui which were sealed in 168 BC.

The first traditionally recognized herbalist is Shénnóng (神农, lit. "Divine Farmer"), a mythical god-like figure, who is said to have lived around 2800 BC. He allegedly tasted hundreds of herbs and imparted his knowledge of medicinal and poisonous plants to farmers. His Shénnóng Běn Cǎo Jīng (神农本草经, Shennong's Materia Medica) is considered as the oldest book on Chinese herbal medicine. It classifies 365 species of roots, grass, woods, furs, animals and stones into three categories of herbal medicine:

  1. The "superior" category, which includes herbs effective for multiple diseases and are mostly responsible for maintaining and restoring the body balance. They have almost no unfavorable side-effects.
  2. A category comprising tonics and boosters, whose consumption must not be prolonged.
  3. A category of substances which must usually be taken in small doses, and for the treatment of specific diseases only.

The original text of Shennong's Materia Medica has been lost; however, there are extant translations. The true date of origin is believed to fall into the late Western Han dynasty (i.e., the first century BC).

The Treatise on Cold Damage Disorders and Miscellaneous Illnesses was collated by Zhang Zhongjing, also sometime at the end of the Han dynasty, between 196 and 220 CE. Focusing on drug prescriptions, it was the first medical work to combine Yinyang and the Five Phases with drug therapy. This formulary was also the earliest Chinese medical text to group symptoms into clinically useful "patterns" (zheng ) that could serve as targets for therapy. Having gone through numerous changes over time, it now circulates as two distinct books: the Treatise on Cold Damage Disorders and the Essential Prescriptions of the Golden Casket, which were edited separately in the eleventh century, under the Song dynasty.

Succeeding generations augmented these works, as in the Yaoxing Lun (药性论; 藥性論; 'Treatise on the Nature of Medicinal Herbs'), a 7th-century Tang dynasty Chinese treatise on herbal medicine.

There was a shift in emphasis in treatment over several centuries. A section of the Neijing Suwen including Chapter 74 was added by Wang Bing [王冰 Wáng Bīng] in his 765 edition. In which it says: 主病之謂君,佐君之謂臣,應臣之謂使,非上下三品之謂也。 "Ruler of disease it called Sovereign, aid to Sovereign it called Minister, comply with Minister it called Envoy (Assistant), not upper lower three classes (qualities) it called." The last part is interpreted as stating that these three rulers are not the three classes of Shénnóng mentioned previously. This chapter in particular outlines a more forceful approach. Later on Zhang Zihe [張子和 Zhāng Zĭ-hé, aka Zhang Cong-zhen] (1156–1228) is credited with founding the 'Attacking School' which criticized the overuse of tonics.

Arguably the most important of these later works is the Compendium of Materia Medica (Bencao Gangmu:本草綱目) compiled during the Ming dynasty by Li Shizhen, which is still used today for consultation and reference.

The use of Chinese herbs was popular during the medieval age in western Asian and Islamic countries. They were traded through the Silk Road from the East to the West. Cinnamon, ginger, rhubarb, nutmeg and cubeb are mentioned as Chinese herbs by medieval Islamic medical scholars Such as Rhazes (854– 925 CE), Haly Abbas (930–994 CE) and Avicenna (980–1037 CE). There were also multiple similarities between the clinical uses of these herbs in Chinese and Islamic medicine.

Raw materials

There are roughly 13,000 medicinals used in China and over 100,000 medicinal recipes recorded in the ancient literature. Plant elements and extracts are by far the most common elements used. In the classic Handbook of Traditional Drugs from 1941, 517 drugs were listed – out of these, only 45 were animal parts, and 30 were minerals. For many plants used as medicinals, detailed instructions have been handed down not only regarding the locations and areas where they grow best, but also regarding the best timing of planting and harvesting them.

Some animal parts used as medicinals can be considered rather strange such as cows' gallstones.

Furthermore, the classic materia medica Bencao Gangmu describes the use of 35 traditional Chinese medicines derived from the human body, including bones, fingernail, hairs, dandruff, earwax, impurities on the teeth, feces, urine, sweat, and organs, but most are no longer in use.

Preparation

Decoction

Typically, one batch of medicinals is prepared as a decoction of about 9 to 18 substances. Some of these are considered as main herbs, some as ancillary herbs; within the ancillary herbs, up to three categories can be distinguished. Some ingredients are added in order to cancel out toxicity or side-effects of the main ingredients; on top of that, some medicinals require the use of other substances as catalysts.

Chinese patent medicine

Chinese patent medicine (中成药; 中成藥; zhōngchéng yào) is a kind of traditional Chinese medicine. They are standardized herbal formulas. From ancient times, pills were formed by combining several herbs and other ingredients, which were dried and ground into a powder. They were then mixed with a binder and formed into pills by hand. The binder was traditionally honey. Modern teapills, however, are extracted in stainless steel extractors to create either a water decoction or water-alcohol decoction, depending on the herbs used. They are extracted at a low temperature (below 100 degrees Celsius) to preserve essential ingredients. The extracted liquid is then further condensed, and some raw herb powder from one of the herbal ingredients is mixed in to form an herbal dough. This dough is then machine cut into tiny pieces, a small amount of excipients are added for a smooth and consistent exterior, and they are spun into pills.

These medicines are not patented in the traditional sense of the word. No one has exclusive rights to the formula. Instead, "patent" refers to the standardization of the formula. In China, all Chinese patent medicines of the same name will have the same proportions of ingredients, and manufactured in accordance with the PRC Pharmacopoeia, which is mandated by law. However, in western countries there may be variations in the proportions of ingredients in patent medicines of the same name, and even different ingredients altogether.

Several producers of Chinese herbal medicines are pursuing FDA clinical trials to market their products as drugs in U.S. and European markets.

Chinese herbal extracts

Chinese herbal extracts are herbal decoctions that have been condensed into a granular or powdered form. Herbal extracts, similar to patent medicines, are easier and more convenient for patients to take. The industry extraction standard is 5:1, meaning for every five pounds of raw materials, one pound of herbal extract is derived.

Categorization

There are several different methods to classify traditional Chinese medicinals:

  • The Four Natures (四气; 四氣; sìqì)
  • The Five Flavors (五味; wǔwèi)
  • The meridians (经络; 經絡; jīngluò)
  • The specific function.

Four Natures

The Four Natures are: hot (; ), warm (; ), cool (), cold () or neutral (). Hot and warm herbs are used to treat cold diseases, while cool and cold herbs are used to treat hot diseases.

Five Flavors

The Five Phases, which correspond to the Five Flavors

The Five Flavors, sometimes also translated as Five Tastes, are: acrid/pungent (), sweet (), bitter (), sour (), and salty (; ). Substances may also have more than one flavor, or none (i.e., a bland () flavor). Each of the Five Flavors corresponds to one of the zàng organs, which in turn corresponds to one of the Five Phases: A flavor implies certain properties and presumed therapeutic "actions" of a substance: saltiness "drains downward and softens hard masses"; sweetness is "supplementing, harmonizing, and moistening"; pungent substances are thought to induce sweat and act on qi and blood; sourness tends to be astringent (; ) in nature; bitterness "drains heat, purges the bowels, and eliminates dampness".

Specific function

These categories mainly include:

  • exterior-releasing or exterior-resolving
  • heat-clearing
  • downward-draining or precipitating
  • wind-damp-dispelling
  • dampness-transforming
  • promoting the movement of water and percolating dampness or dampness-percolating
  • interior-warming
  • qi-regulating or qi-rectifying
  • dispersing food accumulation or food-dispersing
  • worm-expelling
  • stopping bleeding or blood-stanching
  • quickening the Blood and dispelling stasis or blood-quickening or Blood-moving.
  • transforming phlegm, stopping coughing and calming wheezing or phlegm-transforming and cough- and panting-suppressing
  • Spirit-quieting or Shen-calming.
  • calming the Liver and expelling wind or Liver-calming and wind-extinguishing
  • orifice-opening
  • supplementing or tonifying: this includes qi-supplementing, blood-nourishing, yin-enriching, and yang-fortifying.
  • astriction-promoting or securing and astringing
  • vomiting-inducing
  • substances for external application

Nomenclature

Many herbs earn their names from their unique physical appearance. Examples of such names include Niu Xi (Radix cyathulae seu achyranthis), "cow's knees," which has big joints that might look like cow knees; Bai Mu Er (Fructificatio tremellae fuciformis), white wood ear,' which is white and resembles an ear; Gou Ji (Rhizoma cibotii), 'dog spine,' which resembles the spine of a dog.

Color

Color is not only a valuable means of identifying herbs, but in many cases also provides information about the therapeutic attributes of the herb. For example, yellow herbs are referred to as huang (yellow) or jin (gold). Huang Bai (Cortex Phellodendri) means 'yellow fir," and Jin Yin Hua (Flos Lonicerae) has the label 'golden silver flower."

Smell and taste

Unique flavors define specific names for some substances. Gan means 'sweet,' so Gan Cao (Radix glycyrrhizae) is 'sweet herb," an adequate description for the licorice root. "Ku" means bitter, thus Ku Shen (Sophorae flavescentis) translates as 'bitter herb.'

Geographic location

The locations or provinces in which herbs are grown often figure into herb names. For example, Bei Sha Shen (Radix glehniae) is grown and harvested in northern China, whereas Nan Sha Shen (Radix adenophorae) originated in southern China. And the Chinese words for north and south are respectively bei and nan.

Chuan Bei Mu (Bulbus fritillariae cirrhosae) and Chuan Niu Xi (Radix cyathulae) are both found in Sichuan province, as the character "chuan" indicates in their names.

Function

Some herbs, like Fang Feng (Radix Saposhnikoviae), literally 'prevent wind," prevents or treats wind-related illnesses. Xu Duan (Radix Dipsaci), literally 'restore the broken,' effectively treats torn soft tissues and broken bones.

Country of origin

Many herbs indigenous to other countries have been incorporated into the Chinese materia medica. Xi Yang Shen (Radix panacis quinquefolii), imported from North American crops, translates as 'western ginseng," while Dong Yang Shen (Radix ginseng Japonica), grown in and imported from North Asian countries, is 'eastern ginseng.'

Toxicity

From the earliest records regarding the use of medicinals to today, the toxicity of certain substances has been described in all Chinese materia medica. Since TCM has become more popular in the Western world, there are increasing concerns about the potential toxicity of many traditional Chinese medicinals including plants, animal parts and minerals. For most medicinals, efficacy and toxicity testing are based on traditional knowledge rather than laboratory analysis. The toxicity in some cases could be confirmed by modern research (i.e., in scorpion); in some cases it could not (i.e., in Curculigo). Further, ingredients may have different names in different locales or in historical texts, and different preparations may have similar names for the same reason, which can create inconsistencies and confusion in the creation of medicinals, with the possible danger of poisoning. Edzard Ernst "concluded that adverse effects of herbal medicines are an important albeit neglected subject in dermatology, which deserves further systematic investigation." Research suggests that the toxic heavy metals and undeclared drugs found in Chinese herbal medicines might be a serious health issue.

Substances known to be potentially dangerous include aconite, secretions from the Asiatic toad, powdered centipede, the Chinese beetle (Mylabris phalerata, Ban mao), and certain fungi. There are health problems associated with Aristolochia. Toxic effects are also frequent with Aconitum. To avoid its toxic adverse effects Xanthium sibiricum must be processed. Hepatotoxicity has been reported with products containing Reynoutria multiflora (synonym Polygonum multiflorum), glycyrrhizin, Senecio and Symphytum. The evidence suggests that hepatotoxic herbs also include Dictamnus dasycarpus, Astragalus membranaceous, and Paeonia lactiflora; although there is no evidence that they cause liver damage. Contrary to popular belief, Ganoderma lucidum mushroom extract, as an adjuvant for cancer immunotherapy, appears to have the potential for toxicity.

Also, adulteration of some herbal medicine preparations with conventional drugs which may cause serious adverse effects, such as corticosteroids, phenylbutazone, phenytoin, and glibenclamide, has been reported.

However, many adverse reactions are due to misuse or abuse of Chinese medicine. For example, the misuse of the dietary supplement Ephedra (containing ephedrine) can lead to adverse events including gastrointestinal problems as well as sudden death from cardiomyopathy. Products adulterated with pharmaceuticals for weight loss or erectile dysfunction are one of the main concerns. Chinese herbal medicine has been a major cause of acute liver failure in China.

Most Chinese herbs are safe but some have shown not to be. Reports have shown products being contaminated with drugs, toxins, or false reporting of ingredients. Some herbs used in TCM may also react with drugs, have side effects, or be dangerous to people with certain medical conditions.

Efficacy

Only a few trials exist that are considered to have adequate methodology by scientific standards. Proof of effectiveness is poorly documented or absent. A 2016 Cochrane review found "insufficient evidence that Chinese Herbal Medicines were any more or less effective than placebo or Hormonal Therapy" for the relief of menopause related symptoms. A 2012 Cochrane review found no difference in decreased mortality for SARS patients when Chinese herbs were used alongside Western medicine versus Western medicine exclusively. A 2010 Cochrane review found there is not enough robust evidence to support the effectiveness of traditional Chinese medicine herbs to stop the bleeding from haemorrhoids. A 2008 Cochrane review found promising evidence for the use of Chinese herbal medicine in relieving painful menstruation, compared to conventional medicine such as NSAIDs and the oral contraceptive pill, but the findings are of low methodological quality. A 2012 Cochrane review found weak evidence suggesting that some Chinese medicinal herbs have a similar effect at preventing and treating influenza as antiviral medication. Due to the poor quality of these medical studies, there is insufficient evidence to support or dismiss the use of Chinese medicinal herbs for the treatment of influenza. There is a need for larger and higher quality randomized clinical trials to determine how effective Chinese herbal medicine is for treating people with influenza. A 2005 Cochrane review found that although the evidence was weak for the use of any single herb, there was low quality evidence that some Chinese medicinal herbs may be effective for the treatment of acute pancreatitis.

Successful results have been scarce: artemisinin is one of few examples. An effective treatment for malaria, it was derived from Artemisia annua which is traditionally used to treat fever. Chinese herbology is largely pseudoscience, with no valid mechanism of action for the majority of its treatments.

Ecological impacts

Dried seahorses like these are extensively used in traditional medicine in China and elsewhere.

The traditional practice of using (by now) endangered species is controversial within TCM. Modern Materia Medicas such as Bensky, Clavey and Stoger's comprehensive Chinese herbal text discuss substances derived from endangered species in an appendix, emphasizing alternatives.

Parts of endangered species used as TCM drugs include tiger bones and rhinoceros horn. Poachers supply the black market with such substances, and the black market in rhinoceros horn, for example, has reduced the world's rhino population by more than 90 percent over the past 40 years. Concerns have also arisen over the use of turtle plastron and seahorses.

TCM recognizes bear bile as a medicinal. In 1988, the Chinese Ministry of Health started controlling bile production, which previously used bears killed before winter. Now bears are fitted with a sort of permanent catheter, which is more profitable than killing the bears. More than 12,000 asiatic black bears are held in "bear farms", where they suffer cruel conditions while being held in tiny cages. The catheter leads through a permanent hole in the abdomen directly to the gall bladder, which can cause severe pain. Increased international attention has mostly stopped the use of bile outside of China; gallbladders from butchered cattle (牛胆; 牛膽; niú dǎn) are recommended as a substitute for this ingredient.

Collecting American ginseng to assist the Asian traditional medicine trade has made ginseng the most harvested wild plant in North America for the last two centuries, which eventually led to a listing on CITES Appendix II.

Herbs in use

Chinese herbology is a pseudoscientific practice with potentially unreliable product quality, safety hazards or misleading health advice. There are regulatory bodies, such as China GMP (Good Manufacturing Process) of herbal products. However, there have been notable cases of an absence of quality control during herbal product preparation. There is a lack of high-quality scientific research on herbology practices and product effectiveness for anti-disease activity. In the herbal sources listed below, there is little or no evidence for efficacy or proof of safety across consumer age groups and disease conditions for which they are intended.

There are over 300 herbs in common use. Some of the most commonly used herbs are Ginseng (人参; 人參; rénshēn), wolfberry (枸杞子; gǒuqǐzǐ), dong quai (Angelica sinensis, 当归; 當歸; dāngguī), astragalus (黄耆; 黃耆; huángqí), atractylodes (白术; 白朮; báizhú), bupleurum (柴胡; cháihú), cinnamon (cinnamon twigs (桂枝; guìzhī) and cinnamon bark (肉桂; ròuguì)), coptis (黄连; 黃連; huánglián), ginger (; ; jiāng), hoelen (茯苓; fúlíng), licorice (甘草; gāncǎo), ephedra sinica (麻黄; 麻黃; máhuáng), peony (white: 白芍; báisháo and reddish: 赤芍; chìsháo), rehmannia (地黄; 地黃; dìhuáng), rhubarb (大黄; 大黃; dàhuáng), and salvia (丹参; 丹參; dānshēn).

50 fundamental herbs

In Chinese herbology, there are 50 "fundamental" herbs, as given in the reference text, although these herbs are not universally recognized as such in other texts. The herbs are:

Binomial nomenclature Chinese name English common name (when available)
Agastache rugosa, Pogostemon cablin huò xiāng () Korean mint, Patchouli
Alangium chinense bā jiǎo fēng () Chinese Alangium root
Anemone chinensis (syn. Pulsatilla chinensis) bái tóu weng () Chinese anemone
Anisodus tanguticus shān làng dàng ()
Ardisia japonica zǐ jīn niú () Marlberry
Aster tataricus zǐ wǎn () Tatar aster, Tartar aster
Astragalus propinquus (syn. Astragalus membranaceus) huáng qí () or běi qí () Mongolian milkvetch
Camellia sinensis chá shù () or chá yè () Tea plant
Cannabis sativa dà má () Cannabis
Carthamus tinctorius hóng huā () Safflower
Cinnamomum cassia ròu gùi () Cassia, Chinese cinnamon
Cissampelos pareira xí shēng téng () or () Velvet leaf
Coptis chinensis duǎn è huáng lián () Chinese goldthread
Corydalis yanhusuo yán hú suǒ () Chinese poppy of Yan Hu Sou
Croton tiglium bā dòu () Purging croton
Daphne genkwa yuán huā () Lilac daphne
Datura metel yáng jīn huā () Devil's trumpet
Datura stramonium zǐ huā màn tuó luó () Jimson weed
Dendrobium nobile shí hú () or shí hú lán () Noble dendrobium
Dichroa febrifuga cháng shān (常山) Blue evergreen hydrangea, Chinese quinine
Ephedra sinica cǎo má huáng () Chinese ephedra
Eucommia ulmoides dù zhòng () Hardy rubber tree
Euphorbia pekinensis dà jǐ () Peking spurge
Flueggea suffruticosa (formerly Securinega suffruticosa) yī yè qiū ()
Forsythia suspensa liánqiáo[83] () Weeping forsythia
Gentiana loureiroi dì dīng ()
Gleditsia sinensis zào jiá () Chinese honeylocust
Glycyrrhiza uralensis gān cǎo () Licorice
Hydnocarpus anthelminticus (syn. H. anthelminthica) dà fēng zǐ () Chaulmoogra tree
Ilex purpurea dōngqīng () Purple holly
Leonurus japonicus yì mǔ cǎo () Chinese motherwort
Ligusticum wallichii chuān xiōng () Szechwan lovage
Lobelia chinensis bàn biān lián () Creeping lobelia
Phellodendron amurense huáng bǎi () Amur cork tree
Platycladus orientalis (formerly Thuja orientalis) cè bǎi () Chinese arborvitae
Pseudolarix amabilis jīn qián sōng () Golden larch
Psilopeganum sinense shān má huáng () Naked rue
Pueraria lobata gé gēn () Kudzu
Rauvolfia serpentina shégēnmù (), cóng shégēnmù () or yìndù shé mù () Sarpagandha, Indian snakeroot
Rehmannia glutinosa dìhuáng () Chinese foxglove
Rheum officinale yào yòng dà huáng () Chinese or Eastern rhubarb
Rhododendron qinghaiense Qīng hǎi dù juān ()
Saussurea costus yún mù xiāng () Costus root
Schisandra chinensis wǔ wèi zi () Chinese magnolia vine
Scutellaria baicalensis huáng qín () Baikal skullcap
Stemona tuberosa bǎi bù ()
Stephania tetrandra fáng jǐ () Stephania root
Styphnolobium japonicum (formerly Sophora japonica) huái (), huái shù (), or huái huā () Pagoda tree
Trichosanthes kirilowii guā lóu () Chinese cucumber
Wikstroemia indica liāo gē wáng () Indian stringbush

Other Chinese herbs

In addition to the above, many other Chinese herbs and other substances are in common use, and these include:

Atomic bombings of Hiroshima and Nagasaki

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