USING THIS BOOK

Chinese Herbal Formulas and Applications is a compendium designed to be used with Chinese Medical Herbology and Pharmacology. Both texts have been created for use in the clinic, in the classroom, in research, and to preserve and convey valuable historical information that may yet prove crucial in our future. Written to empower practitioners to become better clinicians, it offers detailed discussion of traditional applications, Chinese therapeutic actions, clinical manifestations, clinical applications, modifications, cautions and/or contraindications, suggested concurrent acupuncture treatments, and a contemporary expansion of clinician training: potential herb-drug interactions. All of these features also serve students and faculty in academic settings. Research professionals and clinicians will find invaluable in vitro information on pharmacological effects and toxicology, and practical in vivo information from clinical and research studies.

Proper translation and use of Traditional Chinese Medicine (TCM) terminology is a challenging issue. Because Traditional Chinese Medicine and Western medicine have distinct cultural and philosophical influences, it is sometimes difficult to accurately convey some TCM terms and concepts by using English or allopathic clinical language. We have made sincere efforts to provide consistent standards for terms and concepts to bridge the gap, as follows:

• Terms that have become an accepted part of English language discourse and are well understood by the general public, such as qi, yin, and yang, are not italicized or capitalized.


• Terms unique to the profession, understood primarily by TCM practitioners, are given in pinyin, italicized and translated but not capitalized; such as bi zheng (painful obstruction syndrome), xiao ke (wasting and thirsting syndrome), and lin zheng (dysuria syndrome).


• It is important to note that anatomical organ names in TCM imply functions distinct from their common understanding in Western medicine. Therefore, organ names are capitalized when discussed within the context of TCM, but not when referring exclusively to anatomical function. For example, Qing Fei Tang (Clear the Lung Decoction) is commonly used to clear Lung heat, a disorder of the lungs with such biomedical diagnoses as bronchitis, pneumonia, or bronchiectasis.


• Nouns distinct to herbal medicine are italicized, capitalized and translated, such as Ren Shen (Radix et Rhizoma Ginseng) and Bu Zhong Yi Qi Tang (Tonify the Middle and Augment the Qi Decoction).


• Translations are omitted after the first full use of the term in one monograph or segment of a monograph, unless repetition is necessary to insure clarity and safety in discriminating between substances or concepts.


• To avoid confusion, formulas other than the principal formula under consideration in a given monograph will be listed with their full pinyin and common names at each use, unless mentioned multiple times within a given paragraph.



• The glossary at the end of this text provides definitions, as well as a cross-reference to Chinese characters, pinyin names, and the terminology used by Wiseman and Ye.

  In some instances, we felt that rendering a highly precise translation of a Chinese word misses the common professional meaning/usage of the term. In these cases, the common usage has been chosen for the body of the text, while precise translation is offered in the glossary.


• The glossary provides additional information on individual terms and definitions. A cross-reference with the terminology chosen by Wiseman and Feng is also offered.

Although pertinent to the history, practice, and research of Chinese herbal medicine, not all herbs and formulas discussed herein are commercially available. Some rare or potentially-lethal medicinal substances that are not in contemporary use are included and discussed only to illustrate important concepts or historical value in traditional Chinese medicine. The discussion of these herbs and formulas in no way advocates resumption of use, or, in the case of endangered or at-risk species, further destruction of species or resources. These substances are included only to offer the accurate history of their critically important usage in traditional herbal medicine, and to serve as models for appropriate usage of effective herbal substitutes.

Readers are strongly encouraged to know and respect the rules and regulations for use of these substances in their own states and/or countries. Among these are:

• Endangered species, such as Hu Gu (Os Tigris) in Hu Qian Wan (Hidden Tiger Pill), and Xi Jiao (Cornu Rhinoceri) in Xi Jiao Di Huang Tang (Rhinoceros Horn and Rehmannia Decoction).


• Heavy metals, such as Zhu Sha (Cinnabaris) in Zhu Sha An Shen Wan (Cinnabar Pill to Tranquilize the Spirit), and Hei Xi (Lead) in Hei Xi Dan (Lead Special Pill).


• Illegal substances, such as Ying Su Ke (Pericarpium Papaveris) in Jiu Xian San (Nine-Immortal Powder).

One of the goals of this text is to bridge understanding between Traditional Chinese Medicine and Western medicine. To accomplish this goal, tremendous efforts have been made to research and discuss the Western scientific information available on herbal medicines, such as pharmacological effects, clinical studies and research, toxicology, and herb-drug interactions. Information is presented using the following parameters and general understandings:

• References: It has been our intention to cite from original and credible sources whenever possible. Selection of references was based on relevance, strong study design, English language, and use of human subjects whenever and wherever possible, with preference given to randomized, blinded, controlled studies over observational reports. However, not all references met our selection criteria, mostly because studies on Chinese herbs have been done predominately in China, and in Chinese. Therefore, instead of restricting ourselves and the readers to the limited amount of information that fit these strict criteria, we decided to use our best judgment in including relevant information from credible sources. Another limitation we encountered during the compilation of this text is the inaccessibility of some original articles, texts, and references—some are out of press and others simply cannot be located. Although some literature was not always as complete, detailed or current as we would prefer, we have made our best effort in all cases to convey as much information on the original source as possible, and occasionally have judged even limited information to be of some value.


• Scientific and Medical Terminology: For the occasional allopathic term that readers might find puzzling, we recommend accessing any standard allopathic medical dictionary. Since there is no need for translation or interpretation of these terms, we concluded that it was unnecessary and cumbersome to include such terms in the glossary of this text.



• Chinese herbal medicine has developed over two thousand years, across many dynasties, and by physicians separated by both time and geography. Therefore, it is not uncommon for one or more herbal formulas to have identical names, with similar or completely different compositions and functions.

  Medical Abbreviations and Symbols are used in accordance with Dorland’s Illustrated Medical Dictionary, 28th edition, published by Saunders.


• Drug Names are designated in this text by generic (proprietary) names only, or a combination of generic names. The generic names are referenced according to Drug Facts and Comparisons, which is updated monthly by Facts and Comparisons, a Wolters Kluwer company.

In addition to the general concepts described above, a brief explanation of headings found in each formula monograph is provided below.

IDENTIFICATION

Each formula is identified by four traits at the beginning of each formula monograph. Chinese Characters in both traditional and simplified forms are listed first. In cases where the traditional and simplified characters are identical, only one will be listed. Pinyin Name with Mandarin tone markings is provided to identify and pronounce the names as accurately as possible. The Literal Name is the name translated directly from its pinyin name. Original Source refers to the traditional text or reference in which the formula was first documented. This is an important aspect of identification because the original source then allows one to learn when, where, and by whom this formula was first developed. Lastly, when applicable, alternate names are given for formulas that have different pinyin, literal, or commercial names.

Accurate identification of herbal formulas is reasonably straightforward in most cases. Most formulas discussed in this text have distinct Chinese characters, pinyin names, and common names, and can be accurately identified. However, it is important to remember that Chinese herbal medicine has developed over two thousand years, across many dynasties, and by physicians separated by both time and geography. Therefore, it is not uncommon for one or more herbal formulas to have identical names, with similar or completely different compositions and functions. Under such circumstances, the original source text must be stated to accurately differentiate the identities of the herbal formulas. We have listed two examples to illustrate this potential confusion:

• Example One: There are two formulas called Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Release the Muscle Layer). Both have similar actions and compositions.
  
  
  • Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Release the Muscle Layer) from Shang Han Liu Shu (Six Texts on Cold-Induced Disorders) focuses more on relieving the muscles, and consists mainly of exterior-releasing and muscle-relieving herbs.
  
  
  • Chai Ge Jie Ji Tang (Bupleurum and Kudzu Decoction to Release the Muscle Layer) from Yi Xue Xin Wu (Medical Revelations) is better at clearing heat, and consequently contains more heat-clearing herbs.
  
  
• Example Two: Two formulas sharing the name of Yi Yi Ren Tang (Coicis Decoction) have distinctly different compositions and functions.
  
  
  • Yi Yi Ren Tang (Coicis Decoction), from Ming Yi Zhi Zhang (Displays of Enlightened Physicians) by Huang Fu-Zhong in the 16th century, is a formula that dispels wind-dampness from the exterior to treat bi zheng (painful obstruction syndrome).
  
  
  • Yi Yi Ren Tang (Coicis Decoction) from Zheng Zhi Zhun Sheng (Standards of Patterns and Treatments) by Wang Ken-Tang in 1602 is a formula that dispels dampness from the Intestines, to treat intestinal abscess.

COMPOSITION

This section details the composition of the herbal formula, listing the ingredients and doses. The names of the herbs are given in pinyin and pharmaceutical names, following the same standards as the terminology listed in Chinese Medical Herbology and Pharmacology. Herbs that require special preparation are stated accordingly, with preparation methods defined in detail in the glossary. The doses of the herbs are given using standard metric weights and measurements. In cases in which the doses are unavailable from the source text, or if the contemporary doses are different, the suggested doses are provided in brackets.

While the authors hope that reading this section is easy and straightforward, writing it at times was quite difficult and challenging because of the wide variety of substance names. To streamline the writing and learning processes, we chose to use standardized names. The standardized pinyin names of herbs refer to the ones established by Zhong Hua Ren Min Gong He Guo Yao Dian (Chinese Herbal Pharmacopoeia by the People's Republic of China), published by the People's Republic of China, 2000. We used this reference as the standard for nomenclature of pinyin and pharmaceutical names because this text offers the most precise, accurate, and current information on the identification of Chinese herbs and other medicinal substances.

This decision obviously has its advantages and disadvantages. The main advantage in standardizing the nomenclature is to facilitate learning and minimize confusion and avoid errors. However, a true disadvantage is that the reader loses an historical sense of how an herb was originally used in the formula. We tried to compensate for this disadvantage with a brief explanation in Authors’ Comments when appropriate. We believe this approach has more advantages than disadvantages, and hope the reader will understand and forgive us for taking such liberty. Listed below are two examples of how the herb names were standardized, along with short illustrations of their advantages and disadvantages.

• Example One: Bing Pian (Borneolum Syntheticum) is used as the standard nomenclature whereas in the past it may have been named as Long Nao or Mei Pian, and cited in such formulas as Zhi Bao Dan (Greatest Treasure Special Pill) and An Gong Niu Huang Wan (Calm the Palace Pill with Cattle Gallstone). Long Nao and Mei Pian are alternate pinyin names of Bing Pian (Borneolum Syntheticum), neither of which are used frequently today. This gradual historical drift in names may require some additional time to cross-reference in order to correctly identify these alternate names elsewhere.


• Example Two: Shao Yao (Radix Paeoniae) is a general name that may refer to either Bai Shao (Radix Paeoniae Alba) or Chi Shao (Radix Paeoniae Rubra). While keeping the general name will retain its historical context, providing the specific name will be more clinically relevant and helpful. Since the main emphasis of this text is on herbal formulas and their clinical applications, we kindly ask your pardon when we recommend Bai Shao (Radix Paeoniae Alba) in Shao Yao Gan Cao Tang (Peony and Licorice Decoction), and Chi Shao (Radix Paeoniae Rubra) in Gui Zhi Fu Ling Wan (Cinnamon Twig and Poria Pill). Please see these two formulas for additional explanation.

Historically, the doses of herbs are stated using units from the Chinese system (such as liang, qian, and fen) or general descriptive terms, such as a certain number of pieces of Ku Xing Ren (Semen Armeniacae Amarum) or pills the size of egg yolks. While the general market place may still use such units and terms, academic and healthcare institutions have converted doses of herbal medicine to the metric system. Therefore, when necessary, we have also chosen to convert and present doses in metric weights and measurements. For additional background information on this conversion, see Part 1, Chapter 7: Weights and Measures.

DOSAGE / PREPARATION / ADMINISTRATION

This section describes the traditional methods for preparation and administration of the formula. Contemporary methods of preparation and administration are also discussed when applicable. The dosage here refers to that of the formula as a whole, not the dose of each ingredient.

Some formulas given as decoction do not have additional instructions on preparation or administration. In these cases, simply follow the generic method to prepare and administer the decoction, as described in Part 1, Chapter 6: Preparation and Administration of Decoction.

Some formulas commonly given as pills have lengthy, detailed descriptions of how to manufacture these products in large quantities. While this information may be interesting to some, it is not useful or practical to most. In these cases, readers may use their professional judgment and switch the dosage forms (e.g., from pills to decoction) and convert the doses of the ingredients accordingly.

CHINESE THERAPEUTIC ACTIONS

These are the treatment strategies that link the disease diagnosis with the therapeutic effects of the formulas.

CLINICAL MANIFESTATIONS

This section focuses on diagnosis of the disorder, and associated signs and symptoms. Tongue and pulse diagnoses are essential parts of TCM diagnosis and are listed here when applicable. The information presented in this section is drawn primarily from the original source texts and sometimes from the standard herbal formula textbooks used in mainland China. The diagnosis of the disorder and associated signs and symptoms are further elaborated upon and explained in the Explanation section.

CLINICAL APPLICATIONS

This section summarizes the primary clinical applications of the formula in terms of allopathic (biomedical) disease. Additional information justifying the formula’s use for such conditions is found under Pharmacological Effects and Clinical Studies and Research.

Please note that this is not a comprehensive inclusive/exclusive list, but only a partial account of the most commonly used clinical applications. Inclusion of a biomedical disease in this list of applications does not imply that a given formula can be used indiscriminately for that particular disease. Similarly, the lack of mention of a biomedical disease here does not mean a given formula is ineffective for this condition. Listing of allopathic disease is designed to serve as a guide to assist practitioners in selecting the best possible formula. It is extremely important that the practitioner has a complete and thorough understanding of the formula, and that he or she uses it to treat appropriate Chinese medical presentations, whether of specific allopathic conditions or not.

EXPLANATION

This section is divided into two main sections: explanation of the etiology of the disease, and the strategy underlying the herbal treatment. A chart is also provided to summarize the relationship of the formula to its diagnosis, signs and symptoms, treatment strategies, and functions of the herbs within the formula.

MODIFICATIONS

This section details how to modify the principal formula to treat complications and variations of the target condition.

CAUTIONS / CONTRAINDICATIONS

While it may be self-evident to experienced practitioners, new students and researchers or healthcare professionals from other fields will want to note in particular the cautions and/or contraindications mentioned for use of each formula. However, if there are none reported in the literature or known within the tradition, none will be mentioned. Careful observation of these cautions and/or contraindications ensures the safe and effective practice of Chinese herbal medicine with a minimum of unwanted side effects.

Information cited in this section is derived primarily from classic source texts, current textbooks, and research journals and articles. Cautions and contraindications are associated directly with the formulas as a whole, and not based on “cut and paste” information from individual ingredients. It is important to note that the cautions and contraindications of the formula as a whole are not the same as the sum of all cautions and contraindications of its individual ingredients. These formulas are carefully crafted with appropriate herbal checks and balances to ensure safety and efficacy. Thus, a particular herb that might individually be cautioned for use in a disease presentation may appear safely within a well-crafted formula to treat that disease pattern.

PHARMACOLOGICAL EFFECTS

Most pharmacological studies focus on the anatomical and physiological influences of the herbs on the body or against pathogens. For example, many formulas are described as having antihypertensive effects, as their administration leads directly to a decrease in blood pressure. Others are said to have antibacterial effects, for introduction of the formula leads to the inhibition or death of bacteria. However, it is extremely difficult to understand the exact mechanisms of action of the herbal formulas; each formula contains many herbs and each herb has many chemical constituents. As a result, most research information on individual herbs focuses on pharmacological effects, while research information on herbal formulas focuses on clinical studies.

CLINICAL STUDIES AND RESEARCH

This section briefly outlines the use of Chinese herbal formulas to treat allopathic (biomedical) diseases. The research methodologies vary from formula to formula and from disease to disease. While the use of the formula without modification may be appropriate in certain disorders, more complicated diseases will often require modifications in order for the formula to be effective. Although the traditional goal of research is to limit the number of variables and identify the causal relationships, this is often not possible with Chinese herbal medicine. Chinese herbs are used in multiple herb formulas to treat patients. Thus, most clinical studies and research cited include the use of many herbs, not simply a single substance under consideration. Although this increases the number of variables influencing the outcome, it nonetheless reflects the actual practice of Chinese herbal medicine and the basis on which centuries of refinement have been effectively carried forward.

HERB-DRUG INTERACTION

Herb-drug interaction is a critically important subject, yet there is, at this point in time, little definitive information available. A basic understanding of this topic can be found in Part I of Chinese Medical Herbology and Pharmacology, Chapter 8: “Concurrent Use of Herbal Medicines and Pharmaceuticals.” Documented interactions between formulas and drugs are discussed in each formula monograph when relevant. Theoretical or hypothetical interactions are not included because they involve too much assumption and speculation. Where formula monographs do not contain any herb-drug interaction information, there was no known or documented interaction available to include in timely fashion at the time of publication. However, readers are strongly encouraged to stay updated, as new information on herb-drug complementarities and conflicts is published regularly.

TOXICOLOGY

In most cases, the toxicology of herbal formulas is reported based on in vitro studies. Readers are advised to examine and understand these reports with the same attention to context, proportion, and clinical application as they would in reviewing toxicology and/or in vitro studies for any medicine or supplement.

RELATED FORMULA(S)

These formulas have similar compositions and/or functions to the principal formula, or have grown out of the broader application of the principal formula. This section highlights the contrasting differences between the principal and related formula(s) without restating overlapping similarities.

AUTHORS’ COMMENTS

This closing segment provides additional insights, clinical experience, and relevant information that do not clearly fall under the other categories. This section also offers detailed comparison and contrast of formulas when appropriate.

This section occasionally offers clinical insights on the formulas from contemporary practitioners. It should be noted that these insights were originally presented in the context of educational seminars, and not in published works; hence, there is often or usually no cited reference in these instances.

REFERENCES

Reference material is embedded in the text for ease of access via endnotes in each monograph. The key information from all of these notes has been carefully consolidated into two thorough bibliographic resources.

• The complete names of historical books (given in Chinese characters, pinyin names, and English names) are listed in the Bibliography of Historical Texts.


• The complete names of recent journals, articles and books are listed in the Bibliography of Contemporary References.

ADDITIONAL RESOURCES

In a text involving so many hundreds of pieces of information as Chinese Herbal Formulas and Applications, it is inevitable that on any given page a reader might find information that inspires curiosity about specific details that are not included in that particular monograph. The authors want to provide as much information as possible and to avoid overwhelming students and practitioners with excessive repetition and complexity that obscure key concepts and bog down progress through the general text.

For this reason, the reader will find in Part III, ten specialty appendices that provide intensive bodies of information at the close of the text, followed by a thorough glossary and the two bibliographies mentioned above. Each of these is self-contained and self-explanatory.

The authors are proud and grateful to have had an excellent gathering of committed and experienced professionals contributing to, and evaluating, the content of this textbook. We invite the reader to appreciate the wealth of training and experience these contributors, who are listed in the beginning of the text, have brought to bear on behalf of Chinese Herbal Formulas and Applications.

Last but not least, there is an extensive index at the close of Part III, linking terminology and topics throughout the text for the convenience of students, practitioners and researchers.

It is our hope that these features will contribute to the greatest accessibility and convenience in your use of this volume.

DISCLAIMER

Great care has been taken by the authors, editors, and other contributors to maintain the accuracy of the information contained in Chinese Herbal Formulas and Applications. All information has been evaluated, double-checked and cross-verified. However, in view of the potential for human, electronic, or mechanical error, neither the authors, the publisher, nor any contributors involved in the preparation or publication of this text warrant that the information contained herein is in every aspect accurate, and they are not responsible for any errors or omissions, nor for the results obtained from the use of said information.

Chinese Herbal Formulas and Applications is intended as an educational guide for healthcare practitioners, as professional training and expertise are essential to the safe practice of herbal medicine, in both recommendation of, and effective guidance of, the use of herbs. We cannot anticipate all conditions under which this information may be used. In view of ongoing research, changes in governmental regulation, and the constant flow of information relating to Chinese and Western medicine, the reader is urged to check with other sources for all up-to-date information. In recognition of that fact that practitioners accessing information in this text will have varying levels of training and expertise, we accept no responsibility for the results obtained by the application of the information within this text. Neither the publisher, authors, editors, nor contributors can be held responsible for errors of fact or omission, or for any consequences arising from the use or misuse of the information herein.

It is our intention to continually update and improve this text to maintain and enhance its usefulness. We welcome and encourage your comments and suggestions.