USING THIS BOOK

Chinese Medical Herbology and Pharmacology has been designed 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 practitioner readers to become better clinicians, it offers detailed discussion on traditional applications, dosages and preparation of herbs, cautions and/or contraindications, overdosage and its treatment, and a contemporary expansion of clinician training: potential herb-drug interactions. All of these features simultaneously serve students and faculty in academic settings. Research professionals will find chemical structures and components, in vitro information on pharmacological effects and toxicology, and in vivo information from clinical studies. Some rare or potentially lethal medicinal substances that are not in contemporary use are included and discussed strictly to illustrate important concepts or historical value in traditional Chinese medicine. Among these are endangered species [such as Hu Gu (Os Tigris) and Xi Jiao (Cornu Rhinoceri)] and dangerous heavy metals [such as Shui Yin (Hydrargyrum) and Qian Dan (Minium)]. Their inclusion in no way advocates resumption of use or further destruction of species or resources.

Although pertinent to the history, practice, and research of Chinese herbal medicine, not all herbs discussed herein are commercially available. Some are prohibited as illegal substances [such as Ying Su Ke (Pericarpium Papaveris)], some, as mentioned above, carry excessive potential for toxicity [such as Zhu Sha (Cinnabaris)] or are restricted due to endangered status [such as Xi Jiao (Cornu Rhinoceri)]. 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 substitute substances. The readers are strongly encouraged to know and respect the rules and regulations for use of these substances in their own states and/or countries.

ILLUSTRATIONS

• Black-and-white photographs of substances are displayed in actual size, unless noted otherwise. Because most users of this text will not be gathering herbs direct from nature, we have chosen to provide illustrations of the harvested, processed, manicured substances as our readers would encounter them in realistic purchasing and clinical situations.


• Herb samples available at the time of publication are displayed in a full-color section, in alphabetical order by pinyin name. Matching black-and-white photographs accompany the primary herb entries throughout the text. We encourage the readers to always refer to the color pictures when seeking more complete and life-like illustration of herb samples.

NOMENCLATURE

• Traditional and simplified Chinese Characters lead each herb monograph to provide the most accurate Chinese name and to facilitate understanding of the herb under discussion. Simplified characters serve as the default in cases in which the traditional and simplified are identical.


• Herbs and Formulas: It is our goal to be as comprehensive and precise as possible. Traditional nomenclature of herbs is often vague: one herb may have several alternate names, and may be replaced by substitute plants from varied sources, species or genus. Thus, we have listed in the monographs Chinese characters, pinyin name, alternate pinyin name(s), literal name(s), common English name(s), botanical/zoological name(s) and pharmaceutical name(s). When an herb is commonly obtained from more than one natural source, identification is made of all pinyin, pharmaceutical and botanical names. Because differences in therapeutic effect are often distinguished by names, these distinctions are made clear. For example, Sha Shen (Radix Glehniae seu Adenophorae) is stated as Nan Sha Shen (Radix Adenophorae) or Bei Sha Shen (Radix Glehniae) whenever possible because of the unique clinical applications of each. “Mu Tong” has been separated appropriately into Chuan Mu Tong (Caulis Clematidis Armandii), Guan Mu Tong (Caulis Aristolochiae Manshuriensis), San Ye Mu Tong (Caulis Akebia Trifoliata), Wu Ye Mu Tong (Caulis Akebia Quinata), and Bai Mu Tong (Caulis Akebia Trifoliata Australis), since these plants are not only from different genus and species, but also have different therapeutic effects and safety profiles.
  
  The following are the primary sources the authors relied upon for nomenclature of herbs and formulas:
  
  • Zhong Hua Ren Min Gong He Guo Yao Dian (Chinese Herbal Pharmacopoeia by People's Republic of China), People's Republic of China, 2000. Our standard reference for nomenclature of pinyin and pharmaceutical names, this text offers the most precise, accurate and current information on the identification of Chinese herbs and other medicinal substances.
  
  
  • Xian Dai Zhong Yao Yao Li Xue (Contemporary Pharmacology of Chinese Herbs) by Wang Ben-Yang, Tianjing Science and Technology Press, 1999.
  
  
  • Chinese Herbal Medicine Materia Medica, by Dan Bensky and Andrew Gamble, Eastland Press, 1993.
  
  
  • Chinese Herbal Medicine Formulas & Strategies, by Dan Bensky and Randall Barolet, Eastland Press, 1990.
  
  
  • A Practical Dictionary of Chinese Medicine 2nd Edition, by Nigel Wiseman and Feng Ye, Paradigm Publications, 1998.

CHINESE THERAPEUTIC ACTIONS

• Traditional Chinese Medicine (TCM) terminology. Because traditional Chinese medicine and western medicine have distinct cultural and philosophical influences, it is challenging 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 nor 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).
  
  
  • Nouns distinct to herbal medicine are italicized, capitalized and translated, such as Ren Shen (Radix 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, herbs other than the principle herb under consideration in a given monograph will be listed with their full pinyin and pharmaceutical names at each use, unless mentioned multiple times within a given paragraph.
  
  
  • 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 traditional Chinese medicine but not when referring exclusively to anatomical function. For example, Huang Qin (Radix Scutellariae) is commonly used to clear Lung heat because the herb has shown antibiotic effectiveness to treat infection of the lungs.
  
  
  • In some few instances, the authors 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 Ye is also listed.
  
  
• Formulas and Compositions: Examples of Chinese herbal formulas are mentioned throughout this text, to enhance understanding of the qualities of an individual herb, and its applications. Herbal formula names are cross-referenced in Appendix 5, Cross-Reference of Herbal Formula Names. Further discussion, including the full composition of each formula in a thorough monograph, will be available in our next book.


• Note: A keen reader may notice that the ingredients listed in some exemplar formulas here may differ slightly from standard classic formulas. We name the classic formula to demonstrate the intent and basic strategy of the formulation in clinical application, but not to list the exact composition of the ingredients. Thus, in any given exemplar formula, additional herbs may be listed (as modifications) to optimize treatment in the particular contextual situation.

DOSAGE

• Standard dosage: Listed in this text is the standard dosage of dried herb to be used in decoction for an average adult, unless otherwise specified. Adjustments are needed if the herbs are to be used in other forms: higher dosage (generally double) for the fresh herb, and lower dosage for herbs ingested in powder or pill forms. The average adult is defined as being between 18 and 60 years of age, weighing approximately 150 pounds. Thus, dosage must be adjusted more precisely depending on individual attributes. Additional information and guidelines for dosage adjustment can be found in Appendix 8, Dosing Guidelines.


• Weights and Measurement: Units of measurement have been converted from the traditional Chinese system to the metric system. Additional information on comparison and conversions can be found in Appendix 9, Weights and Measures: Chinese, British and Metric Systems.


• Herb status: Herbs in many forms are mentioned, accurately reflecting the marketplace and the clinic.
  
  
  • Fresh herbs are those that are recently harvested. Fresh herbs are the most potent because the active components are completely or largely intact and available. Paradoxically, the dosage for fresh herbs is generally higher, as they still naturally contain a large amount of water.
  
  
  • Dried herbs are those from which the water has been removed, usually by drying under the sun. Drying is an essential process that makes it possible to store herbs for longer periods of time without their becoming spoiled. Dried herbs are nonetheless frequently referred to as “raw herbs,” not to be confused with fresh herbs. Most herbs sold in herb stores are dried.
  
  
  • Unprocessed herbs have not been treated to alter their properties. Herbs are assumed to be unprocessed unless stated otherwise. “Unprocessed” is used in this text specifically to contrast differences in function and property with those of “processed” herbs.
  
  
  • Processed herbs have been treated to alter or enhance certain properties and functions. There are numerous ways to “process” an herb, including dry-frying, charring to ash, calcining, roasting, boiling, steaming, quenching, and simmering, among others.
  
  
  • The most common way in which herbs are stored and sold is dried and unprocessed. Therefore, most herbs in this text are assumed for purposes of discussion to be dried and unprocessed unless stated otherwise. Fresh herbs must be indicated specifically in contrast with dried herbs. If processed, the exact mechanism of processing must be indicated to differentiate the product from unprocessed substances.
  
  
• Preparation and Processing of Herbs: Processing enhances or alters therapeutic actions of herbs, and reduces side effects and/or toxicity. A general description of preparation and processing strategies and modalities is offered in Part I of this text, Chapter 5, Preparation and Processing of Chinese Herbs. The purposes and final effects of preparation and processing for each herb are listed in the Dosage section of the individual herb monographs.

CAUTIONS / CONTRAINDICATIONS

While it may be self-evident to experienced practitioners, new students and researchers or healthcare professionals from other fields will want to particularly note the cautions or contraindications mentioned for use of each substance under consideration. (If there are none reported, none will be mentioned.) In some cases these follow from observations made by practitioners hundreds or even thousands of years in the past, and the careful and accurate transmission of these key pieces of information from one generation of herbal practitioners to the next is one of the factors contributing to the long tradition of safe and effective practice of Chinese herbal medicine with a minimum of unwanted side effects.

OVERDOSAGE & TREATMENT

When used properly by trained practitioners, herbal medicines are generally considered safe and effective. Many examples of overdosage listed in this text are based on accidental ingestion, and not the intentional use of herbs by practitioners. Nonetheless, dosage is often the critical dividing line between a “medicine” and a “poison.” The information on overdosage and its treatment is cited from numerous references. It is important to keep in mind that, while most cases of overdosage can be treated with the traditional methods listed, acute and life-threatening situations may require emergency medical intervention, as traditional methods may be inadequate in some contemporary clinics, because of the time and/or methods required for processing or preparation of remedies.

CHEMICAL COMPOSITION

• The chemical composition of herbs is extremely complex. The authors have accessed many resources for the compilation of this section in each monograph. For herbs in common use, the main active constituents have been studied extensively and are well understood. However, for herbs that have not been used as frequently, much research is still needed for complete understanding.


• The chemical structures of the main constituents are diagramed in the herb monographs, whenever relevant and available. The diagrams of chemical structures are provided with permission from The Merck Index 12th edition by Chapman & Hall/CRCnetBASE/Merck, and from Traditional Chinese Medicines Molecular Structures, Natural Sources and Applications by Yan X, Zhou J, and Xie G.

WESTERN SCIENCES

• 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, use of human subjects whenever and wherever possible, with preference given to randomized, blinded, controlled studies over observational reports. However, not all references meet our selection criteria, mostly because studies on Chinese herbs were done predominately in China, 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, others simply cannot be located. Although it is not always as complete, detailed or current as the authors would prefer, we have made our best effort in all cases to convey as much information on the original source as possible, judging 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 (see next entry for example). 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 for this text.


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


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


• Pharmacological Effects: Most pharmacological studies focus on the anatomical and physiological influences of the herbs 1) on the body or 2) against pathogens. For example, many herbs are described as having antihypertensive effects, as the administration of the herbs leads directly to a decrease in blood pressure. Others are said to have antibacterial effects, as the introduction of the herb leads to the inhibition or death of bacteria. However, the exact mechanisms of action for many herbs are still not well understood at this time.


• Clinical Studies and Research. Chinese herbs are used in multiple-herb formulas to treat patients. Thus, most clinical studies and research cited include use of many herbs, not solely a single substance under consideration. Though this increases the number of variables influencing outcome, this 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 little extensively definitive information available. Basic understandings of this topic are detailed in Part I, Chapter 8, Concurrent Use of Herbal Medicines and Pharmaceuticals. Documented and potential interactions (based on our best understanding of herbs and drugs) are discussed in each herb monograph when relevant. Herb monographs that do not contain herb-drug interaction information imply that there was no known or documented interaction at the time of publication. However, readers are strongly encouraged to stay updated, as new information on herb-drug complementarities and conflicts is regularly being published.

TOXICOLOGY

The toxicology of individual herbs or of their constituents is reported based on in vitro studies. Readers are urged to examine and understand these reports with the same attention to context, proportion and clinical application as would be the case in reviewing toxicology and/or in vitro studies for any medicine or supplement.

SUPPLEMENT

Frequently, additional herbs have names and/or functions similar to the primary substance under discussion in a particular monograph. These are brought for consideration in the Supplement section, particularly when they might serve as substitutes or be inappropriate substitutes. Many herbs included in this section are derived from the same botanical sources as the main herb in the monograph, and are mentioned for quick comparison purposes.

AUTHORS’ COMMENTS

When there is relevant clinical information that does not sensibly fall under other categories, or when the authors wish to provide additional insights on a particular herb or its uses or a related topic, or to offer clinical experience volunteered by their teachers, this information is discussed in this closing segment of the monographs.

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 for 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 Medical Herbology and Pharmacology, 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 both to provide as much information as possible and to avoid overwhelming students and practitioners with excessive repetition and complexity that obscures key concepts and bogs down progress through the general text.

For this reason, the reader will find in Part III that there are no less than ten specialty appendices to 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 have brought to bear on behalf of Chinese Medical Herbology and Pharmacology, as listed in the section titled “About the Authors and Contributors.”

There is, last but not least, 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 Medical Herbology and Pharmacology. 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 nor the publisher nor any other 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 Medical Herbology and Pharmacology is intended as an educational guide for healthcare practitioners, as professional training and expertise are essential to the safe practice of herbal medicine in recommendation of and effective guidance for 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 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 other 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.