Chinese Herbal Patent Medicines: The Clinical Desk Reference, by Jake Paul Fratkin OMD, L.Ac. Shya Publications: Boulder, Colorado, <www.shyapublications.com>. 2001. 1198 pp. hardcover including 16 appendices, plus extensive tables of contents, 80 pages of color product photographs. ISBN 0-9626078-4-3.

In the world of Chinese herbal medicine there are a few "must have" books. These include Bensky and Gamble's Materia Medica, and the companion book, Formulas and Strategies. Then there is Him-Che Yeung's two volume Handbook of Chinese Herbs and Handbook of Chinese Formulas, Hong-yen Hsu's Commonly Used Herb Formulas with illustrations, a Japanese-Chinese or "Kanpo" herbal formulary with a slightly different slant than usually found in Traditional Chinese Medicine (TCM). Now, at the top along with these has to be Jake Fratkin's latest edition of Chinese Herbal Patent Medicines.

Chinese patent medicines are ready-made preparations used by Traditional Chinese herbalists and freely accessible to the general public. There are literally thousands of Chinese patent medicines, most of which are produced under exemplary Good Manufacturing Practice (GMP) standards regulated with stringent requirements as to their quality and safety by government agencies not dissimilar to the U.S. Food and Drug Administration.

The classical sources for many of the patent formulas demonstrate that most of these products have a history of clinical efficacy extending well over 2,000 years. Each herb is listed by Chinese pinyin, pharmaceutical name, botanical name, common name, and by the various traditional therapeutic categories such as AA (tonify qi), AB (tonify blood), J (stop bleeding). This important classification is readily available on the back cover of the book.

The products are classified according to their traditional and modern pathological use with commentary and differentiation of each, so that if one wants to find a product for the common cold, flu or nasal disorders, 82 products are listed under eight subcategories. The second section includes infections, fevers and internal heat, which refer to viral and bacterial infections with 84 products described in seven categories of influenza, sore throat, genito-urinary infections, gastrointestinal infections, infections and fevers in infants and children, and the important underestimated condition of infections described as "deficiency fire." These are only two of a total of 12 broad categories. It leads one to think that if you can't find a patent for a particular condition in this book, it simply does not exist. Given the foundational principle that is described in Chinese Tong bing yi zhi, Yi bing tong zhi meaning "The same disease, different treatments; Different diseases, the same treatment," one can, with a minimum of understanding of herbal medicine, learn how to apply practically any of these patent formulas for a much wider scope of conditions than those listed.

This new volume is vastly enlarged from the 1987 edition, which was only 335 pages long, listing 225 patents. Now more than 1,200 pages describe 1,140 herbal patents. The first edition utterly obsolete, the second is a must. It is a thorough reference work and is in itself a text on TCM based on the author's 25-plus years of clinical experience.

Modeled after the Physician's PDR, it includes 78 pages of product photographs making identification more reliable (and the justifiable cost of the book which in the United States is a well-spent $75.00). The patent descriptions are clearly stated so that one can avoid products containing endangered animal parts, heavy metals, chemical or pharmaceutical drug contamination and adulteration, or those containing aristolochic acid from Aristolochia spp., which are banned by the U.S. Food and Drug Administration (FDA).

There are contributions by a number of respected colleagues and authors in the appendices such as Subhuti Dharmananda, Ph.D., on The Value of Chinese Patents; by Andrew Ellis on Herb Substitution and Label Accuracy in Patent Medicines from the People's Republic of China; Lorenzo Puertas on Quality and Safety in Good Manufacturing Practice (GMP) Factories in China; and Richard Ko, Pharm.D., Ph.D. (food and drug scientist with the California Department of Health Services, Food and Drug Branch), on Laboratory Analysis of Heavy Metals Chemicals and Pharmaceuticals in Chinese Herbal Products.

In Fratkin's own evaluation, entitled Facts Concerning Toxic Contamination of Chinese Patent Medicines, he has clearly done his homework. He claims that of the 1,140 patents described in the book, 460 have met Australian GMP standards (this is listed under each product described), meaning that these products do not contain pharmaceuticals and are in compliance with heavy metals and chemical contaminant standards. He then evaluates the products that have not, for various reasons, earned the Australian GMP standard (many simply because they were not examined). His conclusion is that about 30 percent of patent medicines from China that are not from a GMP-based factory may have some heavy metal contamination, qualifying this by writing that any possible heavy metals should be compared with the length of time and amount ingested of the patent medicines.

Herbal "medicinals" have become legally tolerated in the United States because the sale of Chinese patent medicines are protected by a powerful Chinese lobby with sufficient financial and political clout to convince authorities that the availability of Chinese herbs and mainland products is an integral part of their cultural identity and, therefore, beyond the sanctions of the law. Since the late 1960s with the new herbal renaissance and the acceptance of acupuncture as a legal profession in the United States and most of the Western world, Chinese herbal patents have gradually insinuated themselves into mainstream use, creating what at best could only be described as an annoyance for such regulatory agencies as the FDA.

The revelation that many of these products contain restricted drugs, animal parts, chemicals and heavy metals, causes the FDA, the media and, consequently, the general public to question the safety of these products. With the publication of this new edition of Chinese Herbal Patent Medicines, general public, healthcare professionals, and many herbalists have as reliable a resource as is presently possible for evaluating these products by Western standards. Jake Fratkin's definitive book lifts this cloud of suspicion so that the approximately two-thirds of the safe and effective products can be better known and safely incorporated into international health care.

— Michael Tierra, OMD, AHG Herbalist and Author Ben Lomond, California