JOURNAL OF CHINESE MEDICINE NUMBER 64 OCTOBER 2000

Questions Concerning
Chinese Herbal Medicine: Materia Medica
by Jiang Yong-Ping

verall Chinese Herbal Medicine: Materia Medica by Bensky and Gamble1 is one of the best texts on Materia Medica in the English language. Its breadth of coverage, depth of information and attention to translation are all impressive. In teaching from this text over the past two years, however, I have found some mistakes and some important missing information. This article intends to address these mistakes and fill in the missing information.

intestinal wind and Spleen/vLiver imbalance, but it is important to understand that these are two different patterns. 2. Xiang Ru (Herb Elsholtziae seu Moslae) Releases the exterior, expels summerheat, and transforms dampness: ... This herb simultaneously expels summerheat from the exterior and transforms turbid dampness in the interior.3 Here we find a discrepancy. Summerheat is a fire evil, yet Xiang Ru is an acrid, warm herb, which expels wind-cold, not summerheat. We use this herb in summer because it also transforms internal damp. Internal damp in the summer may result from the natural environments humidity and from partaking of cold foods and drink. External wind-cold invasion is common in summer due to improper or excessive use of methods of cooling down, so it is common to have coexisting patterns of external pathogenic wind- cold with internal damp. This is precisely Xiang Rus primary indication because its actions are to expel summer season wind-cold (not summerheat), and transform internal damp. 3. Niu Bang Zi (Fructus Arctii Lappae) Moistens intestines: for wind-heat constipation.4 There is no such pattern as wind-heat constipation; external wind-heat invasion does not directly cause constipation. If a patient diagnosis is external pathogenic wind-heat and this patient also has constipation, there must be another pattern to explain the aetiology of the constipation. We need the correct diagnosis to prescribe the correct treatment, and whilst this herb does treat wind-heat by releasing the exterior and also treats constipation by moistening the intestines, it is diagnostically imperative to maintain the distinction between the two. 4. Zhi Zi (Fructus Gardeniae Jasminoidis) With Semen Sojae Praeparatum (dan dou chi) for insomnia and irritability from deficiency, resulting from lingering heat in the chest.5

Mistakes
1. Fang Feng (Radix Ledebouriella Divaricatae) Expels wind: also for intestinal wind due to imbalance between the Spleen and Liver manifested in recurrent, painful diarrhea with bright blood in the stool.2 Intestinal wind is not produced by a Spleen/Liver imbalance. Intestinal wind has two main causes: external wind-heat directly invades the intestines, or damp-heat obstructs the intestines. Both patterns cause intestinal dysfunction and also damage intestinal blood vessels causing bleeding. Bloody stool with diarrhoea and abdominal pain are the major symptoms, with bloody stool especially being the hallmark of intestinal wind. The basic treatment principles are to expel wind, clear damp-heat, and stop bleeding and diarrhoea. Fang Feng is used to expel wind, clear damp, and stop diarrhoea. A Spleen/Liver imbalance is an entirely separate problem, and this patient will usually have an emotional disturbance in her/his history to cause the Liver to initially invade the Spleen. This is evidenced by abdominal pain and diarrhoea, but there is no blood in the stool. If a patients diagnosis is Spleen/Liver imbalance, but there is also blood in the stool, there must be another diagnosis to explain the blood. For Spleen/Liver imbalance, the treatment principles are to balance the Spleen and Liver, and here we use Fang Feng to disperse Liver qi, expel dampness, and stop diarrhoea, for example, the formula Tong Xie Yao Fang (Important Formula for Painful Diarrhea) uses Fang Feng in exactly this manner. To conclude, in the clinic we use Fang Feng to treat both

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JOURNAL OF CHINESE MEDICINE NUMBER 64 OCTOBER 2000

Zhi Zi with Dan Dou Chi (ie: Zhi Zi Chi Tang) does treat insomnia and irritability caused by heat disturbing the chest, but this is absolutely an excess condition, not a deficient one. This is a confusion in translation. The Shang Han Lun says this combination treats Xu Fan. Fan means irritability, whilst xu in this instance means there is no accumulation of water-heat or phlegm-heat (ie: jie xiong), in other words, this is not the xu that means deficiency but the one that means formless or no accumulation. Here, accumulation and no accumulation (formlessness) are both excess patterns. Furthermore Zhi Zi and Dan Dou Chi are not tonifying herbs, and to say that Zhi Zi combined with Dan Dou Chi treats deficient insomnia and irritability is incorrect.

is actually the function for Xiao Mai. These are the most problematic or elusive statements of function and indications in the text, and I hope instructors and students integrate these distinctions and ever strive to refine their TCM herbal knowledge.

References
1 2 3 4 5 6 Bensky, Dan and Gamble, Andrew. Chinese Herbal Medicine: Materia Medica, Eastland Press, Inc., Seattle. WA: l993. ibid page 32. ibid page 39 ibid page 41 ibid page 58 ibid page 391

Missinq or unclear information

1. Gui Zhi(Ramulus Cinnamomi Cassiae) Many students using this text fall to the misconception that Ma Huang (Herba Ephedrae) treats wind-cold excess pattern, while Gui Zhi treats only the deficiency pattern, because in Actions and Indications, the text only says that Gui Zhi treats wind-cold deficiency pattern. Actually, Gui Zhi is also very important for wind-cold excess pattern, for example Ma Huang Tang, Da Qing Long Tang, Xiao Qing Long Tang and Ge Gen Tang are all formulas which treat wind-cold excess pattern, and all use Gui Zhi with Ma Huang. Ma Huang is acrid and warm, and thus is strong in expelling wind-cold, whilst Gui Zhi is acrid, warm and sweet, and as well as expelling wind-cold, moves the channels and aids the wei (defensive) yang. In wind-cold excess pattern, the cold obstructs both the ying and the wei, so the treatment must include removal of obstructions from the ying and wei. This makes Ma Huang with Gui Zhi the best combination in treating wind-cold excess pattern. In the Shang Han Lun, regardless of what other patterns are extant, this combination of Ma Huang and Gui Zhi is always used to treat wind-cold excess pattern. 2. Sheng Jiang (Rhizoma Zingiberis Officinalis Recens) This herb is noted for alleviating sea-food poisoning, but the text does not mention this function. This is an important function which should not be overlooked. 3. Fu Xiao Mai (Semen Tritici Aestivi Levis) The text lists the actions and indications of both Fu Xiao Mai and Xiao Mai as if they all pertain only to Fu Xiao Mai. Fu Xiao Mai is unripened wheat and Xiao Mai is ripened wheat, each having its own functions and indications. Fu Xiao Mais major functions are to stabilise and bind sweat, tonify qi and clear heat, and it is usually used for deficient day or night sweats or steaming bone disorder. Xiao Mais major functions are to nourish the Heart and calm the spirit, and it is usually used for restless organ disorder, for example in Gan Mai Da Zao Tang (Licorice, Wheat and Jujube Decoction). So the texts second function for Fu Xiao Mai (Nourishes the heart and calms the spirit6)

Thanks to Melissa Cathcart for help in translating. Jiang, Yong-Ping, Ph.D., Dipl.Ac., Dipl.Herb., L.Ac., Assoc.Professor, Clinical Faculty, Head of Herbal Department, Minnesota Institute of Acupuncture & Herbal Studies, 2501 West 84th Street, Bloomington, MN 55431, U.S.A.

The Journal of Chinese Medicine

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