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JCM Review This is an immense book. It is immense in size (750 action packed pages), immense in scope (a detailed discussion on managing autoimmune conditions in general & then an in-depth account of 16 common conditions), & immense in learning
- which the author shares with great clarity & generosity. If your life is busy & you are in a hurry you can stop reading this review now & just buy this book. For those of you with more time or tighter purses here is a more considered review. The author of the book, Professor Shen, a fifth generation Chinese medicine practitioner, graduated in 1962 from the Shanghai College of TCM. Four years later China descended into the turmoil of the Cultural Revolution, which removed the senior echelon of experienced doctors & left junior interns treating hundreds of inpatients & outpatients every day. This crisis forced Professor Shen back to the classical texts of Chinese medicine to identify treatment strategies, which he then applied & revised in order to achieve effective results. Once the Cultural Revolution ended Professor Shen became Director of the Rheumatology & Immunology department & combined a busy clinical practice with basic scientific research into immune, autoimmune & rheumatic disease. Since then he has lectured internationally, written prolifically, & seen a number of his empirical formulae granted patent medicine licenses in China. The Management of Autoimmune Diseases with Chinese Medicine reflects the key elements of its authors biography. It is rooted in a deep & detailed understanding & appreciation of traditional Chinese medicine. This theory informs & is in turn tested by extensive clinical experience that makes this book a highly practical treatment manual that uses the full panoply of Chinese medicinal arts to address autoimmune disease. Traditional theory is also supplemented by more recent pharmacological insights into the actions of Chinese herbs that will satisfy the reader with more modern medical tastes. The basic tenet of the book is that although autoimmune diseases are essentially a modern categorisation, Chinese medicine has encountered these diseases throughout its history & has developed a sophisticated understanding & an array of tools to help manage these conditions. Indeed, the correspondences & associations that emerge from Chinese medicine pattern diagnosis can introduce a greater coherence into the understanding & treatment of autoimmune diseases compared to Western medicine, which tends to identify basic mechanisms brilliantly but often fails to apply a whole systems approach to these conditions. One of the major contributions that Chinese medicine can make in this area is an appreciation of the underlying root pathologies that need to be addressed once the branch symptoms have been brought under control. Whilst the use of steroids, non-steroidal anti-inflammatory drug (NSAIDs), disease-modifying anti-rheumatic drugs (DMARDs) & immunosuppressive drugs may be effective in managing acute presentations, they are sadly lacking when it comes to effecting a deeper & more lasting change. The first five chapters of this book present an overview of immune function from the perspective of both Western & Chinese medicine. They introduce the main elements of aetiology, pathology & treatment that are then developed in the subsequent discussion of 16 common autoimmune conditions (which include rheumatoid arthritis, Sjögrens syndrome, ulcerative colitis, Crohns disease, thyroid disease & multiple sclerosis). These introductory chapters are detailed & well-written & considerable credit is due to the publisher, Donica, for the excellent English language editing & the careful attention given to biomedical information throughout this book. Professor Shen explores autoimmunity as a complex process that frequently combines an underlying Kidney deficiency (usually Kidney yin with empty heat) with invasion of external pathogens. These pathogens disturb the harmony of the ying & wei systems & damage the jingluo, before penetrating more deeply into the body to affect the zangfu. Secondary complications of blood & phlegm stasis may then develop, which contribute to the complexity of these diseases & their resistance to treatment. The discussion of the main treatment methods for autoimmune diseases in Chapter 4 is another detailed & informative section that will appeal to both novice & experienced practitioners. Professor Shen introduces the importance of adapting treatment according to the phase of the disease (acute or chronic, root or branch) & the individual nature of each patient. He discusses straight treatment (countering heat with cold herbs) & paradoxical treatment (treating cold with cold & heat with heat) for instances where false signs can lead to confusing presentations. There is a wonderful section on when to keep to a formula & when to modify treatment that captures the practical orientation of the text & will be greatly appreciated by those beginning their herbal careers. He then proceeds to identify the main treatment principles (nourishing yin, clearing heat, invigorating blood etc.) & discusses the key herbs from the point of view of their traditional use & then from a biomedical perspective. Professor Shen maintains a respectful balance between these two approaches. The treatment principle of clearing heat, for example, is differentiated into six categories that include nourishing yin, thrusting pathogenic factors outward, cooling ying, cooling blood, relieving toxicity & transforming blood stasis. This exemplifies the Chinese approach of compiling relatively simple building blocks into complex, targeted formulae, which optimises clinical effectiveness. Biomedical details
- such as the ability of Sheng Di Huang (Radix Rehmanniae Glutinosae) to inhibit humoral immunity, enhance the production of adrenal corticosteroids & increase the secretion of saliva
- can then rest on a solid foundation of traditional practice. This manual takes a broad view of possible Chinese medical interventions. In addition to herbal medicines there is extensive information on the use of acupuncture, moxibustion, cupping, external treatments (many different herbal compresses & medicinal plasters are described), tuina, remedial exercise & diet. These are given both a generic introduction in Chapter 4 & then considered more specifically within the subsequent chapters on particular diseases. The dietary information in particular looks interesting, & the acupuncture adopts a fairly standard TCM approach with some added extras including, for example, various bleeding techniques. Chapter 5 discusses the integration of Chinese & Western medicine in the treatment of autoimmune diseases. There is a clear & practical appreciation of the value of drug intervention in controlling acute, disabling & life-threatening symptoms of autoimmune conditions. This is balanced by a recognition of their side effects, the potential for rebound reactions on withdrawal, & the limited ability of these interventions to address underlying causes to restore normal physiological function & prevent reoccurrence of disease. Once again, Professor Shens approach is practical & clinically based. Most of the patients he sees with active disease will already be taking some form of pharmaceutical drug. For those taking long-term steroids Chinese medicine can be used to enhance their therapeutic effect (thereby allowing a lower dose to be used), reduce side effects of these powerful but frequently damaging drugs, & in the long term (in many cases requiring over three years of treatment) replacing steroids with Chinese medical treatments. This account is thorough & pragmatic. The main adverse effects of steroids are considered & the role of Chinese medicine in alleviating them discussed. There are formulae to help heal gastrointestinal inflammation & ulceration arising from steroid & NSAID use, & to address drug-induced problems of osteoporosis, diabetes mellitus, reduced immunity to infection, adrenal insufficiency, mood changes & insomnia. This valuable information extends beyond the field of autoimmunity & is applicable to other common presentations in our clinics. The sections on individual diseases show the same care & attention to detail in the introduction to the Western medical approach & in the account of the aetiology, pathophysiology & pattern differentiation according to Chinese medicine. The treatment that is recommended to address these various patterns

Includes:: a guiding formula, modifications & acupuncture treatment. Other treatment methods such as the use of patent remedies, external treatments, dietary advice & rehabilitation exercises are then discussed. One of my few criticisms of this book is the lack of diagrams to clarify the application of these remedial exercises; perhaps this can be added in subsequent editions. There is an additional & very useful section on clinical notes, which provides a helpful commentary on the management of each disease according to Professor Shens clinical experience. In the chapter on rheumatoid arthritis, for example, there is an important discussion on differentiating between cold & heat & excess & deficiency. The account of cold-heat complex, where hot swollen joints are aggravated by exposure to cold requires a complex formula that combines warming herbs such as Gui Zhi (Ramulus Cinnamomi Cassiae) & a few of the herbal unmentionables, with cooling herbs such as Zhi Mu (Rhizoma Anemarrhenae) & Shi Gao (Gypsum Fibrosum Crudum). This is an established treatment principle within Chinese medicine, but it is good to see it explained so clearly with reference to clinical practice. The known biomedical characteristics of the herbs are also described. Ren Dong Teng (Caulis Lonicerae Japonicae), for example, is described as a herb that regulates immunity, controls vasculitis & inhibits fibrositis; it reduces the level of immunoglobulins, is analgesic & anti-inflammatory (p.224). This is a controversial area that I will return to briefly in this review but my personal view is that this information can make an important contribution to how we use herbal medicines & to the effectiveness of our treatment. The final sections of each chapter describe in-depth case studies & summaries of modern clinical research. The case studies are detailed, with good accounts of the rationale for the formula & how it was modified over time. Several less common herbs are used that will help to extend practitioners therapeutic repertoire. Dosages are substantial &, to my eyes, ring true as potent forms of clinical intervention. Interestingly, despite the chapter on integrated medicine, most of the cases presented in the rheumatoid arthritis chapter use Chinese rather than Western medicine as the primary form of treatment. I wonder how much the prevailing zeitgeist of integrated medicine has influenced the theoretical sections of this book, & whether this is indeed an accurate reflection of most clinical practice? In China this integration may be easier than in the West & it is good to see Chinese medicine on its own exerting a powerful & sustained effect on this disease. In my own limited experience of the treatment of autoimmune disease this is a therapeutic outcome that is indeed possible to achieve. Some practitioners will question the dominance of biomedical thinking in the organisation of this book. Personally I have little time for this argument & believe we have to accept that biomedicine is the dominant paradigm that currently defines disease categories. Chinese medicine practitioners have to learn how to apply Chinese medical principles to these conditions or we will become even more marginalised & anachronistic. Of course problems can arise when we apply current biomedical understanding to herbal medicines. Biomedical understanding in this regard is frequently incomplete & unreliable. Whilst I appreciate its value, I am wary of using it as a primary determinant for when or when not to use a particular herb. In Professor Shens text for example there is an injunction to use Huang Qi (Radix Astragali seu Hedysari) or Ling Zhi (Ganoderma) with great care & in low dosages in autoimmune disease (p.53). This is because these herbs can enhance humoral immunity & may thereby exacerbate an autoimmune condition. However, in another section of the text it is acknowledged that Huang Qi has the potential to have a two-way immunoregulatory function
- inhibiting an overactive humoral immune response or enhancing it when it is weak. A similar regulatory effect has been noted for Ganoderma, which is commonly used in allergic asthma & for autoimmune related infertility (see Li & Browns article Efficacy & mechanisms of action of traditional Chinese medicines for treating asthma & allergy in the February 2009 Journal of Allergy & Clinical Immunology). This leaves us on rather unstable ground. Professor Shen has noted from his own clinical experience that use of these herbs in the acute phase of an inflammatory autoimmune illness can exacerbate the problem. Maybe in such cases we should rely more on traditional Chinese medicine theory that would generally prohibit the use of qi & blood tonics during acute phases of inflammatory illness, but retain their role in the longer term treatment of underlying deficiencies, or within formulae that are strongly clearing & draining. In reality this is the line generally recommended by Professor Shen but, in this instance, the biomedical explanation is more tenuous, rigid & less helpful than the traditional understanding of the application of these herbs. Another potential shortcoming of this work arises from the geographical, cultural & genetic differences that may exist between Chinese & Western populations. This may lead to variations in the aetiology & presentation of disease, & in the response to Chinese medicine treatment. This may mean we need to adapt approaches recommended by Professor Shen according to our own experience (although this is true for any transfer of knowledge & practice between cultures & should not deter us from using this text). Professor Shen has written an excellent book that combines a deep theoretical understanding with hard-earned clinical experience. He has generously shared this knowledge in a detailed & comprehensive text that will enrich the practice of Chinese medicine for many years to come. I am confident that this text will be a classic of our time & the author, editors & publisher deserve our support & gratitude for this venture. So, for those of you who made it thus far, you are led back to my initial recommendation many paragraphs ago buy this book! Andrew Flower RCHM Journal Review For much of our day-to-day practice we can get by quite well with our basic standard model approach to diagnosis & prescription-writing. Indeed, as beginners we imagine that the basic TCM package is going to be sufficient for our whole careers without having to delve too much into the intricacies of western pathology & pharmacology. Sooner or later it dawns on most of us that we are, in fact, woefully under-equipped to deliver reliable care to some patients especially those unfortunate people coping with cancer or serious autoimmune disorders. We feel compelled to give the best care we possibly can but are frustrated by the realisation that access to better information would improve outcomes. Information such as clinical & pharmacological research combined with the extensive experience of authorities working in specialist departments of Chinese hospitals. We can take some consolation in the fact that doctors in mainland China seem to have had similar sentiments in the decades after the Mao era when it was realised that, in the light of modern pathology, the historical tradition was deficient in some areas. This realisation led to significant scientific resources being allocated to areas such as cancer & autoimmune disease. The interest in cancer followed in the wake of President Nixons historic visit to China in 1971, perhaps because a little earlier Nixons presidential mission statement had publically proclaimed that America declares war on Cancer. Many other illnesses that are quite poorly addressed by modern biomedicine were also singled out for research SLE being a notable example. Faced with numerous cancer patients seeking my help in my first years of practice I managed to find the resources to develop sufficient competence to make a real difference for some. It proved much harder to gain competence with autoimmune immune disorders like most, my basic standard model was supplemented with a few half-remembered truisms from the research literature along the lines of sheng di often good in autoimmune problems, lei gong teng inhibits immune autoimmune processes but be careful. For some lucky patients muddling through in this way some sometimes gave good results but the hit rate was sub-optimal. I began to dread these difficult cases. When I employed Ying Luo as my assistant I was able to saddle her with the worry. A bright practitioner with research experience in nephritis in autoimmune patients, she gave me the chance to observe a higher level of skill at work as she successfully tackled our autoimmune patients woes. To give the best chance to our patients we desperately need the insights that have come from the marriage of high-level TCM scholarship with modern pharmacology, pathology & medicine. Insights that have long been tricky to acquire in the west. Which brings me to my great joy at getting a copy of Shens Management of Autoimmune Disorders with Chinese Medicine, the result of a collaboration of a renowned Shanghai doctor & his peers who have researched & specialised in this field for more than 40 years. My task is, as succinctly as I can manage, to offer you a glimpse of its scope, depth & style. Five introductory chapters examine immune function from the biomedical & CM perspectives, discuss the CM aetiology & treatment methods of AI disease & the way that western & Chinese methods can work side-by-side. These hundred pages lead us with authority to an overview of Chinas current state-of-the-art understanding from the (sorry for this..) inadequate state-of-the-ark undergraduate deal we tend to get on this at college. This is followed by extensive individual chapters on: RA, SLE, Discoid Lupus, Sjögrens, systemic sclerosis, polymyositis/dermatomyositis, mixed connective tissue disease, Raynauds, ulcerative colitis, Crohns, thrombocytopenic purpura, autoimmune-haemolytic anaemia, autoimmune-hepatitis, Graves disease, Hashimotos thyroiditis, MG & MS. Each chapter opens with an up-to-date summary of the biomedical pathology, clinical features, Chinese medicine aetiology (referenced to both the classic & modern CM literature), detailed differentiation & treatment together with case histories, some of the clinical & laboratory research literature plus appropriate acu-moxa treatment. All this delivered in exemplary style, error-free & in good English. Wonderful! Focussing on the chapter on rheumatoid arthritis (RA) gives us an idea of the comprehensive & practically-orientated qualities of this work. Biomedical background: The biomedical story presented here is spot-on. It is clear, up to date with just the right amount of depth &

Includes:: discussions on usual investigations, complications & differential diagnosis in biomedicine. This is good stuff, it feels fresh, much more than just a perfunctory rehash of a decades-old medical textbook, it draws on current US & EU definitions of, & research on, RA. CM aetiology: This is a detailed & illuminating account of RA aetiology that brings together the classical viewpoint & marries it to the distilled experience of modern authorities such as Jiao Shu-de who, we find, introduced some new classifications of Bi zheng. Pattern identification & treatment: Twelve patterns are described. A closer look, though, reveals that some are either simply late stage complications or are subcategories such as wind-cold-damp bi: wind predominant, so things do not get too out of hand complexity-wise. Clarity is helped, too, by clear tabulated summaries of the patterns. A single formula is given for each pattern mostly straightforward unfussy jiajian versions of known formulae & which incorporate modern pharmacology knowledge without abandoning traditional structure. Standard herbs are used so we dont have the frustration of long lists of banned or unobtainable medicinals. OK, Wu tou & shi gao are included simply because these are crucial substances, there are also discussions here & there on animal-derived substances their power & possible substitutions. Everything is clearly explained &, in the usual way, guidance is offered on modifications to the base formulas & suitable acu-moxa protocols are discussed. Exemplary. Other treatment methods: This section gives extra detail on special acupuncture approaches, on prepared chengyao medicines, on external herb treatments, rehabilitation techniques, appropriate Chinese dietary therapies most of which are herb-based congees. Clinical Notes: This section deals with some of the finer points of diagnosis such as distinguishing hot & cold, shi & xu, as well as examining the treatment principles ; using pungency, understanding disease depth & stage & treating according to the location affected. In the next sections we get a summary of the main herbs that have been researched for use in RA, a discussion on WM-CM integration in RA treatment that

Includes:: a brief critical appraisal of the role of drugs such as NSAIDs, methotrexate, etc. Patient advice is provided & then ten detailed case histories are presented. A selection of clinical trials of CHM & acupuncture for RA taken from the Chinese literature are summarised with extra sections on electro-acupuncture & moxabustion. As if this was not quite comprehensive enough, the RA chapter continues with a detailed appendix on RA in the elderly that incorporates various mini essays on subjects such as the importance of capillary circulation. Multiply all this by the other fifteen AI illness chapters covered & you begin to get an idea of just what a truly remarkable resource this text is. Truly wonderful. The only other way you could conceivably get your AI treatment skills up to this level would be to learn good Mandarin, identify some brilliant AI specialists in China & beg them to let you study with them for ten years. A good approach but one that is going to cost you rather more than £60-70! So, if patients with hard-to-treat disorders are your nightmare, this Donica title is a dream. For the sake of all those stricken by rheumatoid, ulcerative colitis, Crohns, MS, Graves & the like
- please, please get this book. Charles Buck










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Professor Shen Pi'an graduated in 1962 from Shanghai College of Traditional Chinese Medicine & since then has been working as a doctor in the Shanghai Traditional Chinese Medicine Hospital. He has been Professor & Director of the Rheumatology & Immunology Department at the hospital since the early 1980s. He is currently honorary consultant at the Diakonissen Hospital in Austria & has also lectured in Japan & Taiwan. A prolific author, Professor Shen has written more than 10 books related to immunology, rheumatology & materia medica pharmacology. This is the first of his books to be translated into English. ...