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Chinese Medical Herbology and Pharmacology

By John K. Chen, Tina T. Chen, with Laraine Crampton

Art of Medicine Press, Inc. City of Industry, CA USA. 1327 pp

ISBN: 0-9740635-0-9

http://aompress.com

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INTRODUCTION

Chinese Medical Herbology and Pharmacology? (henceforth ?MHP?) appears to be an amalgamation of author John Chen's background as an instructor of both TCM herbology and Western pharmacology. CMHP? greatest strength in real terms is likely its educational value. As a teaching text, its organization, introductions and summaries make this is a wonderful book for both teachers and students, but what makes CMHP unique is its focus on herb/drug interactions and biomedical mechanisms for the actions of the TCM herbs.

HERB/DRUG INTERACTIONS

When it comes to herb/drug interactions, CMHP has done an admirable job of introducing the subject and giving TCM practitioners plenty to think about, however hard evidence is lacking. This lack is not the fault of the CMHP authors, but it needs to be understood at the outset that although herb/drug interactions are a hot topic, there is scanty hard data. What we have here is an author who straddles both the world of TCM herbology and western pharmacology pointing us toward the most likely interaction issues and in some cases documented observations of adverse events.

Information presented in this book is worth reviewing here at least to present the two different types of herb/drug interactions. The first being pharmacokinetic interactions in which drugs will have an affect on the absorption, distribution, metabolism, or elimination of herbal medicines. For example, drugs that slow gastrointestinal motility such as those that address diarrhea will increase the time in which herbs are in the intestines being absorbed. As a result, a smaller dosage of herbs may need to be used to avoid an overdose.

The second type of herb/drug interaction is the pharmacodynamic. Pharmacodynamic interactions are more about the effects of drugs and herbs having a synergistic effect, antagonizing effect, or idiopathic interaction.

An example of the synergistic type of interaction would be found in a patient who is taking warfarin (Coumadin). This is a blood thinner used in the treatment of any problem where excessive clotting of the blood could be life-threatening such as deep vein thrombosis or transient ischemic attacks. These pathologies might look like Blood stagnation from the TCM perspective and so Blood activating herbs might be used to address these conditions. Thinning the blood with herbs can potentiate the effect of the warfarin giving rise to excessive bleeding or bruising.

Antagonistic effects of herbs might include the stomach acid stimulating effects of herbs that dry damp aromatically. If the patient is taking drugs to limit the production of stomach acid in the treatment of ulcers, herbs that dry damp aromatically might counteract the effects of these drugs giving rise to an exasperation of acid-induced pain.

One area that will eventually need to be addressed is that many drugs that are metabolized in the (biomedical) liver or kidneys will weaken these organs, and herbs that also stress these organs should be monitored carefully while a patient is taking these types of drugs.

While many of the herb/drug interactions that the CMHP presents are guesses based solely on theoretical possibilities, it is a good start, but obviously not an end.

TEACHING TEXT

As a teaching text, this book is an excellent choice. Each herb category chapter begins with an extensive introduction explaining the pathology and treatment for each category of herb. Following the chapter is a wrap-up of the herbs' functions and properties with well-presented charts. Best of all, it describes the generalities that each of the herb category? share.

This, I find extremely beneficial for students who want to limit the minutia necessary to memorize. These intros and summaries allow for a minimum of memorization while maximizing understanding of how herbs do what they do in each unique category.

These chapter introductions include clear differentiations of subcategories within each chapter that helps clarify the usages of the herbs within that category. In this regard this textbook offers the same information as the existing industry standards, but it goes a bit further, describing in more detail differential diagnosis, cautions/contraindications, processing, and of course pharmacological effects beyond simply a single word description that I find in competing books.

The summaries too add a level of generalization that really helps the student get a handle on the commonalities to most of the herbs in any given chapter. This is how I personally studied my herbs and am happy to see such information so clearly organized at the end of each chapter. If students mastered only the introductions and summaries to each chapter in this book they? be well ahead of the learning curve for the first three years of their master? degree program.

NEW AND IMPROVED HERB FUNCTIONS

As you read through individual herb uses you may notice that there are a few twists on the same-old same-old. Ma Huang (Hb. Ephedrae) being the first herb that many learn will serve as the example. Ma Huang is generally given three functions: 1) diaphoretic to release the exterior, 2) anti-asthmatic to relieve wheezing and coughing, 3) diuretic to address edema. The CMHP adds additional functions such as dispersing cold for Bi Zheng (painful obstruction syndrome), cold damp, or wind-damp in the channels. Ma Huang is also used for Yin type sores that are due to blood deficiency with stagnation of cold and phlegm.

Another reason that this book rocks for students is when an herb function can be explained by the herb's properties, this is presented in the first sentence of the herb's actions. For instance: "Acrid and warm, Ma Huang (Hb. Ephedrae) ventilates the Lung..." and "Ma Huang enters the Lung and Urinary Bladder channels to regulate water circulation and eliminate edema..." and "Warm and dispersing in nature, Ma Huang disperses and eliminates cold and damp from the exterior parts of the body."

One thing that should be kept in mind is that the properties given to herbs in this book don't always agree with the properties presented in other books. I spoke with co-author John Chen regarding this discrepancy. While anybody who has more than one TCM herb book can testify, herb books simply don't always agree on properties such as taste, temperature, and channel tropism. Chen's desire was to present other viewpoints to remind the student of TCM that while many properties are agreed on across the board, many properties are not found in all source texts. This is one more reason that making peace with ambiguity is a skill that every TCM student needs to master early on. This choice to describe different properties however may prove to be an unnecessary hurdle in making this book a state board exam text.

One item that I especially like about the CMHP is that most cautionary statements are answered. In other words, while many herbs are described as toxic, the CMHP goes on to describe these toxic side effects in terms of signs and symptoms. Best of all, it includes solutions to these reactions with herbal and sometimes biomedical interventions. This has been a glaring omission in most herb books that end up in the English language.

AUTHOR'S COMMENTS

This is probably the most entertaining section of each herb. This is the area where long-standing assumptions are questioned such as the efficacy of Ge Jie (Gecko) being found mostly in the tail. Recent studies have found the body and tail to have similar active constituents and produced similar effects.

Other ?uthor? Comments? represent the idiosyncratic opinions and uses of each herb based on the teachings of the Chens' various teachers. Little things such as "To arrest cough, use Hu Tao Ren (Sm. Juglandis) with intact skin. To lubricate the intestines, peel and discard the skin.?

This section is really all over the place, but represents the herbal equivalent of "fun facts and useful information" that no other herb book really has. It? really a lot of fun to read.

../images

The color ../images in the CMHP are actually very good. However I found a few that were inexplicably out of focus, three out of 533 to be exact. Still, the lighting and photographic work on most of these ../images is excellent. They were done in a studio, for the most part on the same white background, and they were all exposed for their particular color quality. In other words, the bright white herbs such as Shi Gao (Gypsum Fibrosum) are not washed out to the point where you can't see whether the herb is a powder or a rock. The dark black herbs such as Sheng Di Huang (Rx. Rehmanniae) are not featureless shadows either. These are really fine ../images. These plates were obviously shot by a professional familiar with product and studio photography, and it? about time.

The quality of paper on which this book is published is a nice heavy glossy feel that adds to its perceived quality. However I don? however think that I can say the same thing about some of the color plates of this text. There are entire pages where the color seems to be off and so all the herbs have a yellow/brown cast. I? not sure how widespread this apparition is among the books that have been printed, but in the two copies to which I had access, they both suffered from a color balance problem on certain pages.

It would have also been nice to have someone in that studio who was more familiar with the actual herbs being photographed. My go-to guy for herb identification (Robert Newman, L.Ac.) describes some discrepancies: The Wang Bu Liu Xing photo does have Vaccariae segetalis in it (the dark seeds), but it also shows the outer part of the fruit of Ficus pumila which is a false material that is often the adulterant we receive in the USA. The Ban Lan Gen photo is not of Isatis indgotica, but Baphiacanthus cusia which is Ma Lan Gen, a secondary species for this particular medicine. The Ban Xia is not Pinellia ternata, but Shui Ban Xia (Typhonium flagelliforme) and is not considered equivalent to the true Ban Xia. The Jin Qian Cao photo is of Desmodium, not Lysimachia. There is a little more wackiness there, but for the most part, the ../images are at least well shot.

All of the color ../images appear together toward the front of the book organized alphabetically by their pinyin names. Then there are black and white versions of these same ../images that show up as graphic elements in the individual herb portion of the book. The quality of the black and white is somewhat reduced in that the ../images lack contrast. Because there are already excellent color ../images of each herb, I would have preferred to see the black and white versions zoom in on one particular aspect of the image to really bring out its texture or other unique physical property. The way things are now, these ../images are redundant to the color ../images and don't really add anything new to the visual experience of the herb. Zooming in to the holes of Mu Tong (Caulis Mutong) or the spines of Zhi Zi (Fr. Gardeniae) would have provided a unique visual insight into the physical nature of these herbs that couldn't otherwise be achieved with the naked eye.

APPENDICES

There are numerous appendices that provide cross-references on which herbs are used for symptoms by TCM diagnosis, Western medical diagnosis, and pharmacological effects. As an example, "thirst" is treated by herbs that address wind-heat, stomach heat, intestinal heat, heat-toxins, damaged yin, water accumulation, thirst with bitter taste in the mouth, and thirst with a sweet taste in the mouth. Each of these categories had at least two herbs listed. This is a nice means by which, with proper TCM differentiation, you can begin to modify formulas to extend their efficacy in addressing these other symptoms.

The cross-reference based on Western medical diagnosis and another based on pharmacological effects provides some insight into the herbs' Western differentiations and actions. Again, the warning of proper TCM differentiation is encouraged by the authors to maximize efficacy and safety.

LOOK AND READABILITY

Terminology chosen in this book is familiar and flows very nicely for me as a reader. I'm not sent to another dictionary a few times in each paragraph, I don't trip over words I don't know, and what is being expressed is absolutely clear. The Wiseman & Feng terminology is not used extensively so terms such as gao lin or cloudy dysuria can be read without tripping over "unctuous strangury". If however you are more accustomed to the Wiseman & Feng terminology, I'm sure that the shoe will be on the other foot and you may need to use the ample glossary more frequently which features a cross reference with Wiseman terms. For me, this book is replete in clarity and vacuous in ambiguity thanks to plainly stated terms such as excess and deficiency.

This book was authored by the brother/sister team of Tina and John Chen, but on the title page, editor Laraine Crampton is given some authorship credit as well. Her contribution to the book was to make it readable. I want to give her some credit for the clarity and flow of this text. It really is easy to read and much of that is due to her work. Having myself translated more than a few Chinglish works into English, I take my hat off to Ms. Crampton for a job well done.

The information in this text is well laid out making it easy for the eye to locate specific information on any page. There are also chapter tabs on the side of the book that provide a visual cue as to where one chapter ends and another begins without even opening the book.

My only criticism of the visual presentation of the book is that some of the graphic choices make the CMHP look like a consumer targeted pamphlets such as using the now clich? papyrus type-face that is so common in TCM literature. This and a few other choices take this remarkably intelligent and well-written work and give it a consumer targeted health magazine spirit that I doubt was the intent of the authors. If they want to speak to students and practitioners of both TCM and western sciences, they should really attempt to emulate the graphic choices of books that aim higher in terms of the educational standards of their readership.

SUMMARY

While this book covers old ground with admirable depth, its strengths are in its new information that hasn? been covered by other books. These strengths include: 1) Comprehensive color photographs of the raw herbs. 2) Herb/drug interaction predictions. 3) Over dosage signs, symptoms, and treatment. 4) New and improved functions of old reliable herbs.

The number of herbs described is more than most other English reference books. There are a few more herbs presented in this book than the Bensky/Gamble text, probably less than 100 in all. Plus, there are many subsections that help to differentiate different parts of the same plant or similar varieties.

In CMHP, John Chen has found his voice. Unfortunately, there isn? yet much to say about herb/drug interactions. As individuals such as Dr. Chen continue to research and publish these findings our industry can continue to use our herbal tools in a safe and effective manner.

I think that the most telling critique I can give this book is, after using it for a few months to write this review, I find that I am still using it. I like it. It works for me. It is worth your purchase dolla