Book Review: Chinese Medical Herbology and Pharmacology

[Guest guest]

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

 

Reviewed by

 

INTRODUCTION

 

Chinese Medical Herbology and Pharmacology’s (henceforth “CMHP”)

appears to be an amalgamation of author John Chen's background as an

instructor of both TCM herbology and Western pharmacology. CMHP’s

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.

 

The third category of pharmacodynamic interactions is what most

patients actually ask about. This particular category isn’t really

described as “idiopathic” in so many words, but when there is

documentation that describes unforeseen interactions, it is included in

the portion of the CMHP that deals with individual herbs. One example

of this action would be the relationship of Chai Hu (Rx. Bupleurum) and

interferon therapy as was observed among hepatitis patients in Japan

who were concurrently taking the herbal formula Xiao Chai Hu Tang

(Minor Bupleurum Decoction). There were a number of deaths that arose

from that particular interaction. Still, the debate as to whether it

was the Chai Hu or some other ingredient in this formula that was

responsible for the interaction has not yet been settled.

 

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’s 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’d be well ahead of the learning curve

for the first three years of their master’s 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 “Author’s 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’s really a lot of fun to read.

 

IMAGES

 

The color images in the CMHP are actually very good. I found a few that

were inexplicably out of focus, three out of 533 to be exact. However

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’s about time.

 

Unfortunately, it would have 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 suia which is Ma Lan Gen, a secondary

species for this particular medicine. The Ban Xia is not Peniellia

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.

 

Cross reference of herbs listed by Western indications (whooping cough)

and pharmacological effects (i.e. analgesic)

 

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 variety of translational systems. 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

pamphletssuch as using the now cliché 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 an admirable depth, its

strengths are in its new information that hasn’t really been covered by

other books. These strengths include: 1) Good 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 talk about such variations as the different

plants that are also called " Mu Tong " , or the various other flavors of

Fu Ling (Poria) such as Chi Fu Ling, Bai Fu Ling, Fu Ling Pi, and Fu

Shen.

 

In CMHP, John Chen has found his voice. Unfortunately, there isn’t a

lot to say about herb/drug interactions yet. 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.

 

All in all, this book is a joy to read, an awesome educational tool,

and a welcome addition to my library. I hope that in future additions,

the herb/drug interactions will be backed up with more referenced

examples of real-life issues as well as more accuracy in the herb

images. Until then, it’s a very good start.

 

_______________________

 

For the record: Al Stone has no stake, economic or otherwise, in the

sales or perceptions of this book.

_______________________

 

--

 

Pain is inevitable, suffering is optional.

-Adlai Stevenson

[Guest guest]

Dear Al,

 

Thank you for your good review of Chen & Chen's new materia medica. I agree

with almost all your statements, especially your criticism of the " papyrus "

font style. I would add that the " ombre-like " shading at the top of each

page contributes to this rather unprofessional graphic look. Your suggestion

that the black and white pictures of each herb should be different views to

what is shown in the color images would have made the book much more

expensive than it already is.

 

On the plus side, I would mention the high-quality glossy paper, which gives

the book an overall heavy and substantial feel.

 

Of course, the content is the most important aspect, and you have covered

that well. But graphics, paper quality, quality of indices, etc. are such

important points that are often not addressed very well in many of the books

our profession is offered.

 

I'm constantly amazed that topics that are given entire chapter headings do

not show up in the index. The Blue Poppy books are sometimes guilty of this

offense.

 

Julie Chambers

 

 

-

" Al Stone " <alstone

" Chinese Herbal Medicine "

Cc: " herb students list " <herb-students

Saturday, May 01, 2004 6:10 PM

Book Review: Chinese Medical Herbology and Pharmacology

[Guest guest]

Al,

 

thanks for your thorough review.

 

On Saturday, May 1, 2004, at 05:10 PM, Al Stone wrote:

 

>  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 variety of translational systems. 

 

I think this is an excellent book and while some have voiced concerns

that Chen did not use Wiseman terminology, including myself, the fact

is that this translation terminology is not widely accepted despite its

comprehensive nature. I think chen has largely addressed the concerns

of those who demand a translation standard by providing a cross

reference glossary between his terms, wiseman's and chinese characters.

I believe this satisfies the COMP standard for denotative translation.

He has chosen to use what he considers to be more common or

transparent terms in many cases. While some may complain about the

accuracy of a term like hernial disorder, it is glossed and cross

referenced, so quit yer whinin' :-). John actually spent a lot of

extra time doing this cross referencing after receiving feedback from a

number of sources. It is notable that he only cross references with

wiseman, thus recognizing the need to cross reference with the only

comprehensive english language glossary available.

 

 

 

 

Chinese Herbs

 

 

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