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Chinese Herbal Medicine: The Formulas of Dr. John H. F. Shen

Chinese Herbal Medicine: The Formulas of Dr. John H. F. Shen by Leon I. Hammer and Hamilton Rotte. Stuttgart, Germany: Thieme; 2012. Hardcover, 312 pages. $99.99.

Chinese Herbal Medicine: The Formulas of Dr. John H. F. Shen was written for practitioners of Traditional Chinese Medicine (TCM); the reader is expected to be conversant in Chinese medicine terminology and familiar with the names and properties of TCM herbs. Unlike most texts that present herbal formulas with the same intended audience, this book does not focus on well-known ancient preparations of famous scholar physicians, as does the frequently used text of a similar name, Chinese Herbal Medicine: Formulas and Strategies (Scheid et al., Eastland Press, 2009), for example. Rather, the formulas presented here are from Dr. John Shen (1914-2000), a contemporary physician with a colorful past, described in the introductory text. He practiced Chinese medicine from about 1936 until 1971 in Hong Kong, Chongqing, Shanghai, and Taiwan; he then immigrated to the United States where he practiced until the late 1990s. As recounted in the preface by Efrem Korngold, Dr. Shen had been initiated into the Menghe lineage of Chinese physicians. The Menghe lineage is a tradition that began in the early 17th century and flourished at the beginning of the 20th century, influencing the development of modern TCM in the 1950s and 60s, the version that since has been studied worldwide. Dr. Shen, however, was maintaining and developing that tradition along a different path, which is an important aspect of this compilation of his formulas.

The book is subdivided into two parts, the first covering disease categories (with major sections on cardiovascular, gynecologic, musculoskeletal, and neurological conditions), and the latter following the stages of the life cycle, beginning with adults with intentions to conceive, and following through to pregnancy and childbirth, disorders in children, adolescents, young adults, and finally old-age disorders. The text also is divided into segments by two authors, the foremost being Leon Hammer, MD, who studied at Cornell Medical College and received further training in psychoanalysis and psychiatry, and was drawn to Chinese medicine in the early 1970s. When he encountered Dr. Shen, Dr. Hammer began an intensive apprenticeship that lasted more than 27 years and was the source of much of this books material. In the text, Dr. Hammer focuses primarily on the diagnostic category for each formulation and provides an explanation of various syndromes that could be classified under a single heading (e.g., different types of insomnia). In addition, he conveys Dr. Shens general ideas about disease causation and the steps a person must take in adjusting his or her lifestyle. Hamilton Rotte, a TCM herb specialist who works at Dr. Hammers Dragon Rises College of Oriental Medicine in Gainesville, Florida, had the primary task of providing explanations of the role of each of the formulas ingredients intended effects and depicting the overall therapeutic strategy of the formula from the modern TCM perspective (his writing is available in only the first part of the book).

Because the prescriptions are from an individual practitioner, this authors first goal was to determine if they would be understandable for practitioners who received their training, as is standard practice today, by learning the collection of well-known historic formulas. I found that the formulas were comprised of commonly used ingredients that would be known to practitioners and that the formulations, though they have some distinctive characteristics, would make sense as well. As is expected from the work of any individual physician, the formulas contained certain herbs that the author clearly favored. I also checked whether these formulas could be imitated by practitioners working today, and found that most of them could be: Some ingredients are no longer readily available due to sourcing from endangered species or toxicity issues, but substitutes could be found in those cases. I noted, for example, that there were a number of prescriptions with chenxiang (Aquilaria spp., Thymelaeaceae), which comes from the seriously endangered Aquilaria tree, but other aromatic woods, such as tanxiang (Santalum album, Santalaceae), would serve a similar function. Also, several formulas included ingredients that require special processing, most often frying, which usually would require an ingredient accessible only by those who provide crude herbs to their patients. However, as long as the practitioner who might be using dried decoctions (granules, extract powders) in place of crude herb decoctions is aware of the changes in properties that frying causes for some of these herbs, substitution may be possible. For example, the surface-relieving herb jingjie (Schizonepeta tenuifolia, Lamiaceae) is fried to become an astringent, so using ordinary jingjie would not do; another astringent would have to be chosen.

For ease of identity, the formulas ingredient lists include the pinyin designation of the herbs, as well as the pharmacopeial names and various common names. Additionally, the dosage for herbs used in decoctions is given, typically in the range of three-to-12 grams per day for each ingredient. While some of the formulas followed relatively closely a well-known traditional prescription such as Wendan Tang or Longdan Xiegan Tang, most of them were unique combinations that could inspire trained practitioners to consider these alternative formulation patterns. For example, Dr. Shen described a formula for maladjustment of cardiac nerves (small heart) that Dr. Hammer indicates likely would be used to treat a person with spasm of the coronary arteries and temporary blood stagnation. [E]motionally this person will experience deep unexplained fear with unexpressed anger. In my view, this is an excellent prescription that could warrant discussion about the basis for including the chosen ingredients and the way their actions contribute to the formulas effect.

My next concern was whether or not the information meant to introduce and explain the formulations to readers could be adequately informative. While I would have liked to see a presentation of Dr. Shens approach to herbal prescribing, there is not an overview included, and it does not seem to have been part of Dr. Hammers education from Dr. Shen. Rather, for several of the formulas (in the first part of the book only), there is first a brief description attributed to Dr. Shen about the disorder being treated. Certain characteristic thoughts of Dr. Shen came through clearly from the commentaries: It is evident that he was very concerned about overworked people or overused body parts (e.g., the digestive system), and he frequently recommended rest as part of the therapy. As an example, under the heading of uterine bleeding, which he perceived as a disorder caused by failure of the uterus to close, he offered, among some other explanations, working too much, and he recommended for 1 week before [the] period, during, and 1 week after [the] period dont work too hard, no cold drinks, no sex. He continued: Because the uterus is already working hard during the period, sex puts too much pressure on it and keeps it from closing properly and that [t]oo much work drains energy from the body that is already tired from the period.

Similar concerns are raised for several other types of disorders. Thus, Rotte, in his description of a formula for pain due to lifting too much, explained that Dr. Shen frequently mentioned the adverse effects of physical overwork, particularly in young people. Overwork and overuse of the body in general can be viewed as a form of trauma. Also, Dr. Shen considered that cold was a primary factor in fatigue, such as chronic fatigue, and that coldness was a frequent cause of other chronic illnesses, including asthma and allergies; coldness as a pathological factor could have been introduced earlier in life, he explained, by having fondness for cold drinks as a child, which manifests later as disease.

In the absence of an explanation of how the formulas were constructed, Rotte explains each formula by relying primarily on lists of ingredients that fall into different therapeutic categories (these herbs regulate qi, these herbs dry damp, etc.). He sometimes cites the actions of one of the ingredients according to what was conveyed by Ding Ganren (1865-1926), another key figure in the Menghe tradition; this information is not readily available elsewhere. Thus, he observes that, According to Ding Ganren, yuanzhi (root of Polygala tenuifolia or P. sibirica, Polygalaceae) tonifies the kidneys and benefits the essence. These, however, are not indications for yuanzhi taught in modern TCM training.

I believe most readers already familiar with TCM would recognize the type of TCM information Rotte provides, as I frequently sensed that he had missed key elements of the formula design, relying on a different perspective of herbal formulation than the one preserved by Dr. Shen. To get the most from studying Dr. Shens formulations, I think it is better to not use this approach; Rottes descriptions of herb therapeutic categories are correct, but unreflective of Dr. Shens insights, so they detract from learning a different and potentially valuable herbal perspective.

Dr. Hammer provides an extended explanation of the formulas uses, and how Dr. Shen described various disease processes or diagnostic interpretations. Dr. Hammer frequently points out that the categories that Dr. Shen used had no TCM equivalent; further, the pulse descriptions fit a Shen-Hammer style (explained in detail in Dr. Hammers book Chinese Pulse Diagnosis: A Contemporary Approach; Eastland Press, 2003) rather than the pulse-taking method and categories usually studied today, and Dr. Shen was keenly interested in facial diagnosis, so there are whole patterns based on subtle coloration in the face (e.g., blue-green color around the mouth, vertical discoloration below the eye, appearance of vessels in the inner part of the lower eyelid). I did not sense that one had to learn these diagnostic procedures to use the book and get some value from these explanations. Dr. Hammer was cognizant of the value of allowing other practitioners to remain in the realm of their TCM training and to be able to pick up the gist of Dr. Shens teaching as evidenced by his explanations.

While this book is ideal for students of Dr. Hammers diagnostic approach who want to learn about the herbal aspects of his mentors work, I also consider it of value to any TCM practitioner who feels ready to go beyond the standard TCM formula set. I liked the formulas, which were the central part of the book, and the explanations by Dr. Hammer put them in a proper perspective. I am thankful to Dr. Hammer for undertaking the huge amount of work involved in preserving these formulas for the Chinese medical profession. The publisher, Thieme, which always provides very well-organized books, has again attained a format that is easy to work with.

As with other formularies, this book is not one intended to be read through cover-to-cover; on the other hand, because of the unique diagnostic and therapeutic groupings and unusual formulations, it is not quite a ready-to-use reference book where one would simply look up a treatment and follow the pattern presented. Rather, I see this as a book best grasped by reading several formula sections and gradually absorbing the system of herb-prescribing it contains; a few weeks of reviewing the text will be sufficient, and the readings need not be in any special order. After that is accomplished, the text becomes a useful reference book, because when looking up disease conditions that one may encounter in the clinic, the formulas and explanations will be readily understandable.

Subhuti Dharmananda, PhD

Institute for Traditional Medicine

      Portland, Oregon