Chinese Herbal Medicine: Materia Medica

Chinese Herbal Medicine: Materia Medica (CHMMM, ) is a popular and encyclopedic reference book on materials used in traditional Chinese medicine (TCM). As of 2020, it is in its 3rd edition.Chinese Herbal Medicine: Materia Medica by Dan Bensky, Steven Clavey and Erich Stöger (2004) Eastland Press. 3rd edition. ISBN 0939616424. The title is a bit of a misnomer because while the book mainly includes herbal substances, it also includes animal, mineral and fungal substances.
Entries have sections on:
Notably lacking are references giving any evidence of claims. The only bibliographic entries are those used for translation. A significant failing of the 3rd edition is that it removed the "Pharmacological & Clinical Research" section from each entry that previously appeared in the 2nd edition.Chinese Herbal Medicine: Materia Medica by Dan Bensky, Andrew Gamble and Ted J. Kaptchuk (2004) Eastland Press. 2nd edition. ISBN 0939616157."Chinese Herbal Medicine: Materia Medica, 3rd edition" book review by Andrew Flower, The Journal of Chinese Medicine. The authors' explanation for removing these sections is that:
While the authors do cite other other publications that cover these areas of knowledge (The Pharmacology of Chinese Herbs,The Pharmacology of Chinese Herbs by Kee Chang Huang (1999) CRC Press. 2nd edition. ISBN 0849316650. Pharmacology and Applications of Chinese Materia Medica,Pharmacology and Applications of Chinese Materia Medica by Hson-Mou Chang & Paul P. H. But (2001) World Scientific. ISBN 9810236921. and Chinese Materia Medica: Chemistry, Pharmacology and ApplicationsChinese Materia Medica: Chemistry, Pharmacology and Applications by You-Ping Zhu (1998) CRC Press ISBN 9057022850.), the absence indicates that CHMMM is not evidence-based medicine. While safety issues are generally covered, efficacy is not — rather, the alleged efficacy of a given substance is based on largely pre-scientific Chinese herbal texts (appeal to ancient wisdom and argument from authority).
With regard to Actions & Indications sections, the authors consulted three primary sources (Chinese Herbal Medicine中药学 Zhongyaoxue by 颜正华 Yan Zhenghua et al. (1991) 人民卫生出版社 Ren min wei sheng chu ban she. ISBN 711701489X, Clinical Traditional Chinese Herbal Medicine,中华临床中药学 Zhong hua lin chuang zhong yao xue by 雷载权 Lei Zaiquan et al. (1998) 人民卫生出版社 Ren min wei sheng chu ban she. ISBN 7117028785. and Chinese Herbal Medicine中药学 Zhong yao xue by 高学敏 Gao Xuemin et al. (2000) 人民卫生出版社 Ren min wei sheng chu ban she. ISBN 7117164123.), stating:
What the authors did not explain is the reason for this consistency was due to the Chinese Communist Party's (CCP) doctrine on Western and Chinese medicine during the mid-1950s to mid-1960s, in which Chinese medicine became standardized, resolving or glossing over the contradictory elements of the four ancient texts.Chinese Medicine in Early Communist China, 1945-1963: A Medicine of Revolution by Kim Taylor (2005). Routledge. ISBN 041534512X. The authors likely did not know this because a history of TCM in communist China was not published until a year after the 3rd edition of CHMMM.
The authors' wholesale acceptance of "basic actions of the herbs in modern materia medica texts" is not a trivial issue because:
#It completely disregards evidence-based medicine ("Western medicine" in TCM parlance) with regard to efficacy.
#It is an arbitrary agreement imposed by CCP doctrine, which does not comport with with either the contradictions of ancient Chinese medicine or the current practice of Chinese medicine in non-CCP influenced areas, such as Singapore, Hong Kong and Taiwan.
#The authors have been forced to recognize in some cases and sometimes inconsistently (see below) that the "traditional contraindications" sections are at least at times inadequate in the face of modern science.
=="Obsolete" substances==
A significant change to the 3rd edition was the inclusion of an "Obsolete Substances" chapter, which segregated two types of substances from the main body of the book, those substances with unacceptable toxicity, and those that are derived from endangered species (based on CITES Appendices I and II). CITES Appendix I lists the most endangered species, banned from international trade, and CITES Appendix II lists species that are less threatened and still allowed in trade. The CITES Appendices Convention on International Trade in Endangered Species of Wild Fauna and Flora. Unfortunately, the alleged actions and indications are still described for each substance as well as methods of preparation; this could be tempting for the unscrupulous or inattentive practitioner. Also unfortunate is that because of the authors' admitted lack of expertise in pharmacology, and the removal of the pharmacology and clinical research sections, one is left wondering whether the authors had insufficient knowledge to judge whether more substances should have been added to this chapter. The unacceptably toxic substances listed in the 3rd edition are:
The products from endangered species are:
Rhinoceros horn is listed separately as a substance that should no longer be used due to its endangered status. Also, several substances were under consideration for listing in CITES Appendix II at the time of publication of the 3rd edition:
For some listings in the substances with unacceptable toxicity, substances are not treated uniformly. The authors clearly state that some should not be used, e.g., by stating "…should be regarded as an obsolete drug" or "…it is the editors' view that it should no longer be used" (Aristolochia manshuriensis, calomel, lithargyrum, and borax), though preparation information is still given in some cases.
Others do not state this — though they should because no clear evidence of efficacy and no risk-benefit analysis is given — and even give conditions for use: cinnabar, opium, nux-vomica, T. wilfordii, Aristolochia debilis, A. fangchi, A. mollissimae, and arsenic sulfide.
==Issues with specific substances==
===Aristolochia species===
The authors treat several species of Aristolochia differently with regard to toxicity even though the primary issue of toxicity for all species of Aristolochia is that it causes acute kidney cancer and rapid-onset cancer. This was reported conclusively by the International Agency for Research on Cancer in 2002,Some Traditional Herbal Medicines, Some Mycotoxins, Naphthalene and Styrene IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 82 (2002) World Health Organization, International Agency for Research on Cancer. two years before the 3rd edition of CHMMM was published, with the first report of toxicity in 1994."Urothelial malignancy in nephropathy due to Chinese herbs" by J.-P. Cosyns et al. (1994) Lancet 16;344(8916):188. doi:10.1016/s0140-6736(94)92786-3.
For mǎ dōu líng (A. debilis or A. contorta), the authors did not state that these plants contains aristolochic acid (AA) or that the plants are carcinogenic.
For guān mù tōng (A. manshuriensis), the authors did not state that the plant is carcinogenic.
For guǎng fáng jí (A. fangchi), the authors adequately described the nature of its toxicity, but as noted above, did not definitively say that the plant should not be used.
For xún gǚ fēng (A. mollissima), the authors state, "This substance is toxic, due in part to its AA content, which is nephrotoxic and possibly carcinogenic." The authors should have instead stated that the plant is a carcinogen, not that it is possibly a carcinogen.
===Aristolochia substituents===
Due to the nature of TCM, plants with similar Chinese names are allowed to be substituted for each other. Thus all plants with mù tōng, mù xiāng fáng jí in their name may be substituted for each other, whether or not they are Aristolochia species. It is therefore rather risky to consume such plants without there having been a chemical analysis on them to test for AA. These plants are: Stephania tetandra, Cocculus trilobus, C. orbiculatus, Clematis armandii, C. montana, Akebia quinata, A. trifoliata, Aucklandia lappa, Inula helenium, I. racemosa, and Vladimiria souliei.
For Akebia, Stephania tetandra, Cocculus, the authors warn of the substitution issue, but understate the danger of Aristolochia. Clematis is listed as an addendum to Akebia and has no separate mention of toxicity. For Aucklandia lappa, Inula, and Vladimiria souliei, no mention of the substitution Aristolochia issue is given.
The authors do discuss the substituent problem, both specifically with regard to Aristolochia and more generally:
The two problems with this statement:
#Evidence for herbal safety is poor because most herbs have not been adequately tested for safety or efficacy. How does one know that the pharmacologically 'correct' herb is safe or whether the substituent is?
#The author's approach to substituents is incongruous with their own statement regarding their approach to Chinese herbal medicine ("…that the practice of Chinese herbal medicine must be grounded on traditional approaches…").
===Xì xīn===
Asarum heterotropoides and A. sieboldii (xì xīn) are in the Aristolochiaceae family, as is the Aristolochia genus. Asarum species only contain trace levels of AA, but cases of aristolochic acid nephropathy due to Asarum consumption have been reported in a few incidences.Medicinally Used Asarum Species: High-Resolution LC-MS Analysis of Aristolochic Acid Analogs and In vitro Toxicity Screening in HK-2 Cells by Johanna Michl et al. (2017) Front. Pharmacol. 8:1-9. The authors did not report on AA, and the report on AA nephropathy was published after the 3rd edition of CHMMM.
===Bīng láng===
The authors did not give any toxicity information for betelnut (bīng láng). Betelnut causes a variety of toxic effects and is a human carcinogen.Betel-quid and Areca-nut Chewing and Some Areca-nut-derived Nitrosamines (2004) IARC Monographs on the Evaluation of Carcinogenic Risks to Humans, Volume 85 (2002) World Health Organization, International Agency for Research on Cancer.
==References==
Category:Alternative medicine
Category:Chinese medicine