CHINESE HERBAL MEDICINE: MATERIA MEDICA 3RD EDITION
Compiled and translated by Dan Bensky, Steven Clavey, Erich Stoger with Andrew Gamble
Eastland Press, hardback, 1311 pages
This book is available at a reduced price from The Journal of Chinese Medicine bookshop
It is a credit to the pioneering work of the first 1986 edition of this book that ‘Bensky’ is established in the student lexicon as being synonymous with the Chinese herbal materia medica. This 3rd edition is the fruition of 6 years work by Dan Bensky, and his new collaborators Steven Clavey and Erich Stoger, to update, improve and maintain the ‘usefulness’ of the earlier versions.
In the preface the principal changes are introduced as belonging to four categories:
Each herbal entry now has new sections including a commentary, discussion of key combinations and comparison of related herbs. Steven Clavey was primarily responsible for these inclusions and for expanding the familiar sections on contraindications, nomenclature and preparations.
Secondly safety concerns have been highlighted. The comparative innocence of 20 years ago has been shattered by the Aristolochia tragedy and increasing concerns about herbal quality control and herb drug interactions. This new edition now has a cautionary section on toxicity and Erich Stoger has been responsible for new, and especially for the pharmacognostically minded, welcome information on proper herb identification which includes quality criteria, alternate species and adulterants. The information on the chemical constituents of the herbs has also been expanded and updated.
The third change is that herbs which are for the moment considered to be obsolete because of CITES restrictions or unacceptable levels of toxicity have now been given their own chapter. This is a positive way of quarantining herbs such as Chuan Shan Jia ( Mantitis squama) so that, although their use is clearly unacceptable, knowledge of how to use them remains part of the herbal tradition in the West. Unfortunately transatlantic differences mean that noted herbal outlaws such as Mu Tong and the Aconites (surely a fine name for a rock band) are still included in the main text.
Finally many new substances have been included in this edition which now describes 532 herbs in total and 478 in considerable detail.
These are all welcome additions to an old friend. A rather sad loss is the decision to remove the pharmacological and clinical research from the text. The rationale for this (the burgeoning literature within this genre, combined with the ‘limited expertise’ of the authors and their commitment to grounding Chinese herbal medicine in traditional approaches) is understandable. However it is, to my mind at least, a serious shortcoming of this book.
So, does this volume achieve these new objectives and how does it compare with its rivals in the market or on your book shelves?
First of all there is no question that this edition is a considerable improvement on earlier versions. From the point of view of the practitioner the great strength of this book (formerly its great weakness) is the effort that has gone into describing the distinctive nature and activity of each herb. The fabulous commentary provided by Steven Clavey begins with a description of taste, temperature, directionality and channel propensity, which then provides the ‘energetic’ rationale for the precise medicinal actions of each herb. Tao Ren (Persicae Semen), for example is described as:
"Bitter, and thus draining, heavy in weight, and thus sinking and downward directing, and moist in texture, the range of action of Persica Semen (Tao Ren) is determined by the channels it enters: Heart, Liver, Lung and Large Intestine. Its affiliation with the Heart and Liver indicates its action on the blood, but it also moistens the Intestines that are dry to relieve constipation, stops coughs and wheezing, moistens the skin, all of which relate to the Large Intestine and Lung. While it is generally conceded by most material medica texts that it is almost wholly attacking in nature - breaking up blood stasis - its status as a fruit kernel implies some life-giving generative force as well. In Persicae Semen (Tao Ren), this is expressed as the ability to assist in the generation of new blood following the expulsion of old, stagnant blood" (p625).
The transposition of the nature of each herb into a rationale for its medical effects is consistently managed with deceptive ease and fluency. Traditional descriptions, which can so easily be turgid and seemingly unrelated to clinical practice, are brought alive so that their poetry and relevance combine to make a distinctive signature for each herb. References from classical texts are used to develop these understandings, explore contrasting opinions, and to place the use of herbs within a historical and intellectual context.
The definitive quality of a herb and its clinical application is further refined by analysing how the herb synergistically combines or contrasts with a commonly used companion herb. Thus the account of the frequently used combination of Yuan Zhi (Polygale Radix) with Suan Zao Ren (Ziziphi Semen) "illustrates an important but rarely elucidated therapeutic principle: when treating the spirit, there must be a balance between sour-restraining herbs that contract, and acrid-dispersing herbs that free the movement of the spirit. Extroversion and introversion, in modern terms, describes the poles of this movement as the manifestation of the activity of the spirit … Over-expansion of the spirit may be mild as insomnia, or as extreme as psychosis or mania; over-contraction of the spirit may be mild as an inability to ‘open up’ with other people, or as extreme as withdrawal and catatonia" (p932).
These are more than nuggets of herbal application or traditional wisdom. This is a reminder of the philosophical alphabet which forms the basis of Chinese herbal medicine which this book admirably succeeds in bringing to life and clinical relevance.
There are, however several important shortcomings to this work. The sections on herbal toxicity are rather alarming. There is not enough distinction made between mild and usually transient common side effects, and rare cases of serious adverse reactions which are usually due to allergic reactions or overdoses of the herb. The current climate in the West, where, in the absence of ‘proven’ benefits, any incidence of serious abreaction to a herb is an unacceptable risk and may be sufficient to generate calls for a voluntary or even statutory ban, will not be calmed by the litany of vomitings, respiratory failures, convulsions, anaphylactic reactions and even deaths attributed to (usually massive overdoses) of commonly used herbs. Such cases are described but no source references are given which is an unwelcome and uncharacteristic lack of rigour from this book. In considering the toxicity of Huang Qi (Astragali Radix) for example: "Allegic (sic) reactions have also been reported, including skin eruptions, pruritis, and anaphylactic shock. For this reason, the herb should be used with caution in treating patients with allergies (p721)." Given that Huang Qi is one of the most commonly used herbs to treat and prevent allergic asthma and rhinitis this statement requires both a reference and a greater degree of clarification.
Another limitation within this section has been the decision to omit references to herb-drug interactions. Whilst it is true that the data in this field is in its infancy, nevertheless including evidence of adverse interactions between warfarin and Dan Shen (Salviae miltiorrhizae Radix) and Dang Gui (Angelica sinensis Radix), or the potentially fatal consequences of combining Ma Huang (Ephedrae Herba) with MAOI anti-depressants and so on, would surely significantly contribute to the safe practice of herbal medicine.
Other shortcomings are best revealed by a comparison with the other lead player in the materia medica field which, in my opinion, is the recently published Chinese Herbology and Pharmacology by JK and TT Chen (Art of Medicine Press). Both books contain similar accounts of the actions and indications of each herb which, I suspect, reflects a commonality of Chinese language source material. However the presentation in the Chen book is clearer and more accessible. The use of emboldened headings and subheadings and placing the symptom rather than the herb combination at the beginning of the sentence means that Chen is easier on the eye and better suited to quick referencing than the Bensky. Whilst Chen manages to group pharmaceutical, common and pinyin herbal names and conditions treated all together in one index, Bensky has retained the inconvenient and time wasting separate indexes for these items.
Less cosmetically Chen combines traditional descriptions of the herbs with an account of related pharmacological and clinical research. Whilst some of this research is questionable (90%+ rates of success), of undetermined relevance (herbal injections and animal studies) and frankly weird (a daily dose of 60g of Fu Ling to treat 53 cases of chronic schizophrenia) some of it provides a vital insight into the application of herbs in the treatment of commonly presenting clinical conditions. Thus, taking Huang Qi (Astragali Radix) again as an example, Bensky is impoverished by the self-imposed rejection of research data supporting the use of this herb as an adjuvant treatment for nephritis, chronic hepatitis or chemotherapy induced leukopenia. Whilst many practitioners will welcome the poetry of the traditional understandings they may also hanker for the more prosaic but often incredibly practical insights acquired from the modern application and evaluation of these herbs.
So, the moment of truth. Should you rush out and purchase the latest Bensky? I think there is no question that it is a vastly improved edition. The commentary, comparisons, and new data on nomenclature and quality control all add considerably to previous editions and other versions of the Materia Medica. In particular the descriptions of herbal individuality and applications which are rooted in traditional energetics and classical references are the great strength of this book. However, despite the firm foundations laid in this text, in my opinion, only half the story has been told. The reasons for this are understandable but regrettable. The 3rd edition of Bensky may still be synonymous with the materia medica but, as befits our age, I suspect the trend for double barrelled names will soon be adopted by Chinese herbal students and practitioners lugging their ‘Bensky-Chen’s’ from pillar to post.
Andrew Flower
