Chen Song Yu and Li Fei
Translated by Jin Hui De
Churchill Livingstone, 1993
Hardback, 294 pages with illustrations, £32.50

(Reviewed by Hla Myat Saw, EJOM Vol. 1 No. 4)

On first glance at this extremely clearly presented book, I was immediately impressed. The enormous amount of information is structured in such a logical step-by-step way, and the reader feels promised to be taken by the hand with ease and clarity from the simpler foundations of understanding individual herbs to the more complex formulation of prescriptions and their modifications. It is clearly a reference book with a difference - it also sets out to be a guide book in adapting prescriptions.

Whether this is achieved on more detailed examination of the book can only be answered by describing it in its sections. The book is divided into five sections, with each part designed to take the reader a step further towards the creation of the herbal prescription and its modifications.

In Part 1 individual herbs are compared mostly in couples, in the order that they are usually listed in the Materia Medica, and occasionally illustrated with clear diagrams to clarify the comparisons. In terms of content of information, there is not a lot of additional information on the herbs than is already in the Materia Medica. However, as an adjunct to the Materia Medica this is excellent because of the way the information is organised in terms of similarities and differences between herbs.

Part 2 titled 'Combinations of common Chinese herbs' is unfortunately less easy to reference. While the contents are informative, there does not seem to be any particular order in which the information is indexed other than the headings used in the Materia Medica for individual herbs. This form of indexing is fine in Part 1 where the reference point is the herb. However, in this section the reference point for most readers would be the particular symptom for which the herb combinations are best used, in which case, it would have been appropriate to have had an additional index according to symptoms. For example, in the subheading 'Herbs that release the exterior and stop cough and wheeze' combinations of herbs that serve this function are listed such as ma huang and gui zhi 'disperse cold, induce diaphoresis and relieve pain'. Later other symptoms under the combination of jing jie and fang feng 'disperse wind cold, relieve pain and itching, and express skin rashes' and so on. If this section is used as a reference in its present design, a whole chapter may have to be read to arrive at the combination that treats the symptom one is looking for. This is a design failure which makes the information less accessible.

Part 3 deals with the 'Application of herbs on the basis of the differentiation of patterns of the zang fu'. Each zang fu section is in turn categorised under subheadings of their different functions. For example, 'lungs' is sub-headed with sections on 'herbs that moisten the lungs', 'herbs that purge the lungs', 'herbs that tonify the lung qi' etc, with a list of herbs that serve these functions.

This section really does work extremely well as a reference for modifying formulas. The layout and use of diagrams makes the information accessible and the information will be a great aid for students and practitioners.

Part 4 titled 'Combinations and comparisons of commonly used formulae' is also a well presented section and gives guidance from treatment principles to descriptions of formulas. The reader is led step-by-step towards creating the formula. Examples of representative formulas are given and they are later compared. In addition the 'Points to remember...' section at the end of each chapter is insightful and adds depth to the TCM explanations. For me, this section was a delight. Although it does not give the full range of formulas available nor cover as broad a spectrum as Bensky's Formulas and Strategies, it is not setting out to be a reference on available formulas. It aims to help the reader along in understanding certain basic principles in the creation of formulas, and this it does, clearly and practically.

Part 5, sub-headed within different names of common diseases is useful for its compilation of case histories. However, the way the cases could be described to make the section more useful will be discussed later.

This book is meant for the second and third year student or practitioner of Chinese herbs. On the whole it is excellent as a manual for students because it structures and gives clarity to the vast array of basic factual information that they are inundated with, and will make the learning process far easier.

Within the context of how TCM is approached in China today, it is a book that will be considered as a classical reference book. In relation to how the book appears, set against a wider field of different approaches to herbal prescriptions and modifications, I felt there were certain omissions in the book essential to the proper understanding of creating formulas. For example, although mentioned in the foreword, not once was the direction (floating, sinking, ascending or descending) of herbs taken up in the text. Perhaps my opinion on its importance is reflective of my own training in herbalism. In the Vietnamese approach, creating a prescription or modification without some emphasis on the sense of direction of a herb would be as important an omission as not knowing whether a herb was hot or cold. Not only does the information allow a herbalist to predict certain outcomes from the use of a herb, but also allows us to understand the herb. For example, xuan shen which 'cools heat in the blood' is also listed amongst 'herbs that tonify kidney yin' on page 108. Xuan shen is also categorised under 'herbs to cool heat in the blood' in the Materia Medica. However, mu dan pi which is also in the 'cooling heat in the blood' category, is not included in the list of herbs to tonify kidney yin. The reason lies purely in the direction of the herb which is not alluded to in the book. Xuan shen has a descending action, is cooling, has a salty taste and, therefore, 'drags empty heat back to its roots' and thus indirectly tonifies kidney yin. Mu dan pi has a floating and sinking direction which together with its pungent taste, has a more dispersing action, especially the red variety, associated with entering the blood level, and is used to move blood.

Although the application of herbs are mentioned in detail and the direction is mentioned indirectly in terms of whether they effect the upper, middle or lower jiaos, the reasoning behind their effects in terms of using the directional aspects together with taste, colour, temperature and natural habitat, are not used as part of the essential explanation for understanding the specific qi of a herb, so that it can be precisely adapted to the qi of the patient.

Another important omission, from my perspective, was the use of toasting methods. This is used as part of a common practice to modify the individual herbs to enter certain channels or to affect their directions. For example, toasting with alcohol has the effect of raising the qi upwards and concentrating the action of the herbs on the upper jiao. Toasting with fresh ginger juice has the effect of eliminating phlegm, opening the pores to induce sweat, or warm the cold qi of the herbs and descend rebellious qi. Toasting with salt water can disperse lumps or fibroids in the womb and lower abdomen, and concentrate and direct the qi downwards to the lower jiao, leading the herbs to the kidney meridians and so on.

This kind of information is not exclusive to the Vietnamese approach but is not mentioned in a reference book on herbal formulas. These omissions highlight some of the differences in the present approaches to formulas and their modifications and is important to be aware of when one refers to a book as a reference.

As far as its sensitivity to some of the current questions on adapting formulas is concerned, one important aspect which I feel would have been useful to mention is guidance on dosages. This was mentioned sporadically (e.g. 'xi xin stops coughing in small doses but large doses can cause respiratory failure') but not as part of a specific guidance.

Part 5, devoted to treatment of common diseases with case histories could have been enlightening if case histories had follow-up procedures with changes in dosages etc as the qi of the patient changed with treatment. Dosage is a particularly important aspect in terms of using prescriptions from China in the West. Western patients tend to have weaker qi in general and most prescriptions need to be adapted.

In summary however, I feel the book deserves a warm welcome. It is one which will clarify and structure the vast amount of information given on herbal courses and will give practitioners some additional insight into the creation of formulas.

Chen Song Yu is Director of the Teaching and Research Section of Chinese Materia Medica and Li Fei is Director of the Teaching and Research Section of Prescription, both at Nanjing College of Traditional Chinese Medicine.

Hla Myat Saw
Hla Myat Saw is an acupuncturist and herbalist. She lectures at the London Academy of Oriental Medicine, and is Secretary of the Register of Chinese Herbal Medicine.