Collections of Traditional Chinese Medical Literature as Resources for Systematic Searches

Abstract

Objectives:

This review evaluates and compares published collections of the traditional literature on Traditional Chinese Medicine in terms of their scope and utility as resources for systematic searches for information of relevance to traditional evidence, clinical research, and drug discovery.

Methods:

Published collections of books and compilation works that contain substantial samples of traditional literature on Chinese herbal medicine were located via internet, library, and bookshop searches. These sources were compared in terms of scope, size, content, and ease of searching.

Results:

The fourteen included collections varied considerably in scope, format, probity of included material, and accessibility. The largest was Zhong Guo Ben Cao Quan Shu (The Complete Collection of Traditional Texts on Chinese Materia Medica), with 2027 titles; followed by Zhong Hua Yi Dian (Encyclopaedia of Traditional Chinese Medicine), a compact disc (CD) of 1000 full books; and Zhong Yi Fang Ji Da Ci Dian (Great Compendium of Chinese Medical Formulas), which includes extracts derived from 680 books. Zhong Yi Fang Ji Da Ci Dian is an edited collection that is highly accessible because it is well-indexed with respect to herbal formulas and disorders. The most accessible of the large full-text collections is the Zhong Hua Yi Dian CD, which allows electronic searches. However, neither collection provides detailed bibliographic information on their included books. A collection that combines convenient search options with high quality bibliographic data is Si Ku Yi Xue Cong Shu (The Four Treasuries of Medical Works), but having only 104 titles, this is one of the smaller collections.

Conclusions:

A two-stage process for systematic searches is suggested. Large indexed compendia such as Zhong Yi Fang Ji Da Ci Dian or electronic resources such as Zhong Hua Yi Dian can be used to locate citations, and this can be followed by crossreferencing to authenticated editions of the books to verify the retrieved information.

Introduction

T he fundamental approach of evidence-based medicine is to adopt the best available evidence into clinical practice.¹ With the development of electronic databases for modern Traditional Chinese Medicine (TCM) literature,² systematic reviews of clinical trial evidence have become a feature of TCM research.^3
–5 As TCM moves progressively to an evidence-based approach, such evidence is being integrated into the TCM literature and clinical practice.^6

–9 However, considering the diversity of the clinical interventions in current use, it will take many years before all of these interventions can be evaluated by clinical trials. In the case of certain TCM interventions, the only available evidence may be documents relating to traditional practices. These include treatment recommendations in clinical manuals and textbooks published in recent decades as well as records of long-term use found in the traditional literature.

The traditional literature on TCM is large and diverse, comprising thousands of books written over a span of more than 2000 years. This literature remains a source of information on TCM materia medica, herbal formulas, and acupuncture applications with modern TCM clinical manuals still referencing their therapeutic information to sources from the traditional literature.

From the viewpoint of the researcher, the TCM literature is a repository of potentially useful data. This literature can be used to determine which substances or methods have been used for treating specific disorders, for example, to investigate which plants are used to address tremor¹⁰ or to investigate how uses of specific herbs have changed over time.¹¹ However, the systematic evaluation of this literature presents a number of difficulties.

First, there is no single complete collection that can be used as a definitive sample of the TCM literature. Consequently, researchers wishing to undertake systematic searches must select from among a range of resources. Second, most of the TCM literature remains in print form; is not indexed; and is diverse in genres, formats, and structures. This presents barriers to systematic searching and to the application of conventional text-mining methods.¹² Finally, the scale of this literature is formidable. For example, the largest and best-known of the premodern materia medica, the Ben Cao Gang Mu (Materia Medica Classified by Section and Sub-Section, c. 1593)¹³ contains 1892 monographs on items of materia medica with references to 952 previous authors.^14

–17 In the formulary genre, Pu Ji Fang (Formulas for Universal Benefit), which was compiled by a team of scholars under Zhu Xiao and completed in 1406, contains 61,739 formulas divided into 2175 categories with references to the source texts.¹⁸ A number of large collections of full books were also produced. An example is the imperial encyclopaedia Si Ku Quan Shu (The Four Literary Treasuries),¹⁹ which was commissioned in 1772 and completed in 1792. It comprised 3457 separate works arranged in four main divisions with a subdivision on medicine.²⁰ These, and hundreds of other traditional works, remain in print.

Collaborations between RMIT University (in Bundoora, Victoria, Australia) and Guangdong Provincial Academy of Chinese Medical Sciences (in Guangzhou, China) have been developing methods for systematically searching and evaluating information found in both modern scientific literature and TCM literature. The aim is to combine the results derived from the traditional literature with those derived from research literature to:

(1) Identify the best available clinical evidence, both traditional and scientific

(2) Select treatment methods for evaluation in clinical trials

(3) Identify natural products for drug discovery endeavors.

Part of this project involved the evaluation of a range of collections of the TCM literature as resources for systematic searches.

Aims of This Study

This study aimed to investigate published collections of the TCM literature, and evaluate their utility as resources for systematic searching. The specific objectives were to:

(1) Locate published collections of books and extracts that provide large samples of TCM literature

(2) Evaluate these sources in terms of their scope, size, and ease of searching.

Methods

Collections of TCM literature are not typically listed in medical databases, and their titles are diverse, so the approach to locating collections was to undertake searches of: the internet in Chinese and English, with a focus on publishers and booksellers specializing in Chinese medicine (searches by Suyueh Chang, Brian May PhD, Daniel Rechter BHSc, Iris Zhou PhD 2008–2011); bookshops specializing in Chinese medicine in Sydney (B May and S Chang, 2009–2010), Melbourne (B May, Michael Owens BAppSc, D Rechter, 2006–2011), Hong Kong, Shenzhen, Guangzhou, Hangzhou (B May, M Owens, Anthony Zhang PhD, Shujun Sheng PhD, 2006–2010), and Taipei (B May, S Chang, David Lu MAppSc, 2009–2010); and libraries with collections of books on TCM, including the Chinese Medicine Library at the Hong Kong Baptist University, the Guangzhou University of Chinese Medicine, the Guangdong Provincial Hospital of Traditional Chinese Medicine, and RMIT University (B May, M Owens, A Zhang, Angela Yang PhD, 2006–2010, with help from library staff). Searches were “snowballed” by examining reference lists, dictionaries, and bibliographies.^21

–25

The inclusion criteria for each item were that the collection:

(1) Has been commercially published, republished, or reprinted in the previous 25 years; is still available; and can be purchased or accessed by the general academic researcher;

(2) Is mainly composed of, or based on, premodern works on TCM, broadly defined as encompassing the period up until the modernization of TCM after 1949;

(3) Contains a list of all the titles included in the collection; and

(4) Is substantial in size and, when possible, is one of the largest available.

Private collections and collections held in research institutions were not considered. General dictionaries of Chinese medicine, compendia of materia medica and collections of modern TCM books were excluded. Collections that included both modern and traditional works were not excluded as long as the majority of the collection was derived from pre-1950 works.

Utility of collections was assessed from the viewpoint of undertaking systematic searches of herbal medicines (single herbs or herbal formulas). The following criteria were used: number of books included or extracted (based on tables of contents); scope (historical periods, genres of books); accessibility of information (via tables of contents, indices, and/or electronic search facilities); and bibliographic information on the included books (authorship, edition, etc).

Results and Discussion

The characteristics of the 14 included collections and compilations are summarized in Table 1.^{21,26

–38} All are written in Chinese, thirteen are printed books, one is in electronic format only (on CD),²⁶ and two have print and electronic versions.^33,37,39,40 Six were selected for more detailed discussion, based on size, and searches for specific information were undertaken. The largest is Zhong Guo Ben Cao Quan Shu (The Complete Collection of Traditional Texts on Chinese Materia Medica; 2027 complete or partial books),²¹ followed by Zhong Hua Yi Dian (Encyclopaedia of Traditional Chinese Medicine, 4^th Edition; 1000 complete books on CD),²⁶ and Zhong Yi Fang Ji Da Ci Dian (Great Compendium of Chinese Medical Formulas, 1st Edition; a collection of extracts from 680 books).²⁷ Two collections were issued by the same publisher in similar formats and could be considered to be parts of the same collection of 302 titles: Ming Qing Ming Yi Quan Shu Da Cheng (Complete Collection of the Works of Famous Doctors from the Ming and Qing Dynasties; 230 titles)²⁸ and Tang Song Jin Yuan Ming Yi Quan Shu Da Cheng (Complete Collection of the Works of Famous Doctors from the Tang, Song, Jin and Yuan Dynasties; 72 titles).²⁹ Although it is relatively small, Si Ku Yi Xue Cong Shu (The Four Treasuries of Medical Works; 104 books)³³ is also discussed because it is the only collection accessible via an online version. The following sections provide additional details on these six selections.

Table 1.

Characteristics of the Fourteen Included Collections

Title	Format	Year ^a	Genre	Description	Information access
1. Zhong Guo Ben Cao Quan Shu (The Complete Collection of Traditional Texts on Chinese Materia Medica)²¹	Print F, T	1999	Materia medica	2027 complete or partial books as multivolume set	Table of contents (full collection)
2. Zhong Hua Yi Dian (Encyclopaedia of Traditional Chinese Medicine, 4th ed.)²⁶	CD T/S	2000	Diverse	1000 books on one CD	Table of contents (full collection; CD only); digital search
3. Zhong Yi Fang Ji Da Ci Dian (Great Compendium of Chinese Medical Formulae, 1st ed.)²⁷	Print S	1994	Formulary	Extracts from 680 books as multivolume set	Indices of formula names and disease names
4. Ming Qing Ming Yi Quan Shu Da Cheng (Complete Collection of the Works of Famous Doctors from the Ming and Qing Dynasties)²⁸	Print S	1999	Complete works of famous doctors	230 books as multivolume set	Tables of contents (in separate books)
5. Tang Song Jin Yuan Ming Yi Quan Shu Da Cheng (Complete Collection of the Works of Famous Doctors from the Tang, Song, Jin and Yuan Dynasties)²⁹	Print S	1999	Complete works of famous doctors	71 books as multivolume set	Tables of contents (in separate books)
6. Li Dai Zhong Yi Ming Zhu Wen Ku (Library of Famous Books on Chinese Medicine Through the Ages)³⁰	Print S	1996–1998	Diverse	170 books as series	Tables of contents (in separate books)
7. Zhong Guo Yi Xue Da Cheng (Great Collection of Chinese Medicine)³¹	Print T	1936 & 1990	Diverse	136 books as multivolume set	Tables of contents (in separate books)
8. Zhong Yi Lin Chuang Bi Du Cong Shu (Essential Collection of Clinical Chinese Medicine)³²	Print S	2005–2007	Diverse	105 books as series	Tables of contents (in separate books)
9. Si Ku Yi Xue Cong Shu (The Four Treasuries of Medical Works)^33,40	Print & online^b F, T	1792 & 1991	Diverse	104 books as multivolume set	Tables of contents (in separate books) Online search^b
10. Zhong Yi Bi Du Bai Bu Ming Zhu (The 100 Essential Famous Books on Chinese Medicine)³⁴	Print T	2007–2008	Diverse	100 books as series	Tables of contents (in separate books)
11. San San Yi Shu (Medical Books in Three Categories of 33)³⁵	Print S	1924 & 1998	Diverse	99 books as multivolume set	Tables of contents (in separate books)
12. Zhong Yi Jing Dian Wen Ku (Library of Chinese Medical Classics)³⁶	Print S	1993–2010	Diverse	97 books as series	Tables of contents (in separate books)
13. Huang Han Yi Xue Cong Shu (Collection of Imperial Han Medical Books)^37,39	Print & CD^b S	1936 & 1993	Diverse	72 books as multivolume set or one CD	Tables of contents (in separate books); digital search^b
14. Shi Yong Zhong Yi Gu Ji Cong Shu (Practical Collection of Ancient Chinese Medical Books)³⁸	Print S	1999–2004	Diverse	60 books as series	Tables of contents (in separate books)

Notes: All publications are in Chinese only; superscript numbers represent references in the text of this article. Number of included books is based on the lists of titles for each collection.

Original publication year and reprint/republication year of the version(s) examined.

Separate publication.

F, facsimile: T, traditional characters; S, simplified characters in available edition; CD, compact disc.

The Complete Collection of Traditional Texts on Chinese Materia Medica

In 401 large volumes published in 1999, this collection includes 2027 titles arranged under ten genre categories (see Table 2). The editors stated that the included works were selected from ∼ 6000 books that the editors had examined.²¹ The collection mainly contains facsimile copies of printed books and manuscripts. The included texts range from manuscripts uncovered from the early Han dynasty tombs at Ma Wang Dui and other sites, to works published as recently as 1959. In some cases, the original books are in poor condition with numerous lacunae, and some are fragments. In other cases, the text is complete and of high quality. The collection also includes many editions of the same book. For example, there are three editions of Ben Cao Gang Mu. In many cases, the whole book is not included, just the sections on materia medica, so, although there are 2027 titles listed, only ∼ 740 are complete books. For each book or extract, there is an introduction that provides bibliographic information on the original work and on the edition.

Table 2.

Genres of Books in The Complete Collection of Traditional Texts on Chinese Materia Medica ²¹

Genre	# of vols. ^a	# of titles ^a	Description
1. Primary materia medica	161	318	Complete or fragmentary works
2. Formula books	76	16	Complete works on formulary and general medicine
3. Materia medica sections in medical books	14	277	Mostly sections relating to materia medica extracted from clinical works.
4. Agricultural books	21	118	Mostly complete works
5. Buddhist & Daoist	13	210	Complete medical works and extracts from the Buddhist & Daoist Canons
6. Local/regional	22	843	Mostly short extracts from local gazetteers
7. Foreign	49	142	Mostly complete works published in Japan & Korea
8. Reference	38	43	Mostly extracts
9. Minority medicine	4	27	Mostly extracts with some complete works, includes works written in Tibetan script
10. Miscellaneous	3	33	Mostly complete works on diverse subjects
Total	401	2027	—

Numbers are based on table of contents.

The introductory volumes include a list of book titles, tables of contents, and bibliographies for the included titles. Also, there are additional volumes on holdings in foreign libraries, lists of titles in other book collections, a chronology of works on Chinese materia medica and related topics, and a materia medica of 1000 different herbs and their properties. Although the overview of the collection states that there are two volumes of indices on CD-ROM, these are not yet available.

The books are authentic editions without modern editorial alterations and are valuable for reference. However, undertaking systematic searches (e.g., based on disease names) is a formidable task. The main way to locate specific information is via the tables of contents. These vary in detail and may be missing. When available, they mostly provide the name of the individual item of materia medica but some include sections on disease and symptom names.

Encyclopaedia of Traditional Chinese Medicine

Both the third edition (689 titles)⁴¹ and the fourth edition (1000 titles)²⁶ were examined, but only Zhong Hua Yi Dian, 4^th Edition,²⁶ is discussed in this article. The CD is divided into two parts. The main part contains the full texts of 1000 premodern books (with illustrations) organized into sections and subsections according to genre (see Table 3). The books are divided further into chapters and/or sections according to the layout of each particular book. This approach provides a comprehensive table of contents for the CD, but there is no system of indexing.

Table 3.

Main Genres of Books the Encyclopaedia of Traditional Chinese Medicine ²⁶

Main genres	# of titles ^a	Description
1. Medical classics	49	Focuses on the Han dynasty classics Nei Jing & Nan Jing and commentaries on these
2. Diagnostic methods	43	Mainly on pulse diagnosis with a few titles on tongue diagnosis
3. Materia medica (ben cao)	67	Books on individual herbs; in subsections arranged by dynasty
4. Formulary (fang shu)	117	Books on multiherb formulas; in subsections arranged by dynasty plus other subcategories
5. Acupuncture & tui na	50	Mostly on acupuncture with 2 on tui na/an mo (Chinese massage)
6. Shanghan & Jingui	71	The two Han dynasty classics Shang Han Lun & Jin Gui Yao Lue & associated commentaries
7. Warm disease (wen bing)	38	Books on Warm (i.e., febrile) Disease theory and therapeutics
8. Comprehensive medical works	87	A diverse selection of works on theory, diagnosis & therapeutics
9. Clinical & specialty works	277	Books on the treatment of diseases arranged by clinical specialty: internal medicine; gynecology, paediatrics; and others
10. Health preservation, diet & exercise	40	Lifestyle, food & exercise with 5 titles in the exercise subcategory
11. Medical records & cases	155	A diversity of works, including collections of case studies.
12. Other	6	Includes medical history, forensics & other topics
Total	1000	—

Numbers are based on table of contents.

The first page of each book contains its title, the author's name, and the dynasty, but, in some cases, the last two items of information are missing. Some books contain prefaces that may include information pertinent to their authorship, editions, or publication dates, but there is no consistent format for these, and they are frequently absent. There are no references to the print edition(s) that formed the basis for the CD version, nor are there any editorial footnotes. This is a major drawback because the origin of the text included in the CD cannot be assessed without undertaking comparison with editions in other collections.

The second part of the CD comprises sections on famous medicines, doctors, books, formulas, quotations, and terminology arranged in dictionary format. Unfortunately, the two sections are independent and the second section is not a listing of the information contained in the main part.

There are two main approaches to searching the main part. One is to locate a book in the table of contents, then use the book's table of contents (when available) to locate the information sought. This approach is fast and effective for finding information in a particular book, as long as the information is located under the subsections identified in the CD. Another approach is to use the search function. This is limited to a single word or phrase and will find all instances in the section selected. Boolean operators cannot be used, so electronic searches can yield many irrelevant hits, which can be laborious to sort through.

There are other issues with the functionality of the CD as follows:

(1) The headings and main text cannot both be searched at the same time. So, when conducting a comprehensive search, the section headings and the main text have to be searched separately. Consequently, duplicate citations may be obtained.

(3) Sections of text can be selected and copied into word processing software, but section headings cannot be copied as text, only as screen shots.

(3) Because the books are premodern, a number of the characters used are not typically included in the character sets of modern word processing programs. Therefore, when an extract is copied as text, these characters can blank out, change, or be omitted.

(4) The CD is protected by a code that only allows its installation on a single computer. Also, we found that the CD would only work with certain operating systems. The text can be viewed in simplified or traditional characters but this is not provided as an option—it depends on how the searchers' computer is configured.

Despite these issues, Zhong Hua Yi Dian ²⁶ combines the positive features of having a broad scope across the various genres of TCM literature, full text (rather than selected extracts), and a searchable digital format.

Great Compendium of Chinese Medical Formulas

Published in 1994 in 11 volumes, this compendium²⁷ contains 96,592 individual formula entries, most of which have been extracted from traditional books including Pu Ji Fang.¹⁸ The entries generally include the following information: source text(s); ingredients; methods of preparation; actions; and indications. An index of 680 book titles provides the authors' names and publication years of the source books, but this index was found to be incomplete, and there is no information regarding the editions of the books that were used. Given that the extracts are referenced to the book section, it was possible to locate passages for verification. In cases where an entry was crossreferenced to an edition of the source book, the texts were found to correspond closely, but, in a few cases, when a number of books were referenced within the same formula entry, it was initially unclear which book the different parts of the entry were derived from. This compendium is well-indexed to formula names, and includes an index of disease and symptom names with the page numbers of all the relevant entries. However, it is an edited compilation, and there are no explanations for why certain formulas were included whereas others were not.

Complete Collection of the Works of Famous Doctors from the Ming and Qing Dynasties

Published in 1999, this is a modern collection of medical literature from the Ming (1368–1644) and Qing (1644–1911) dynasties.²⁸ It comprises 230 complete titles that are published in 30 volumes as collections of the works of 30 famous doctors. Each volume has an introductory essay on the doctor and the doctor's writings. The collection is not indexed, so information must be located via the tables of contents in each book.

Complete Collection of the Works of Famous Doctors from the Tang, Song, Jin and Yuan Dynasties

Published in 1999 by the same publisher as the previously mentioned collection,²⁸ this collection²⁹ complements the former collection and is similar in format. This collection²⁹ comprises 72 titles, excluding research essays, which are published in 20 volumes as collections of the works of 21 famous doctors from the Tang (618–907) to the Yuan dynasties (1271–1368). The collection is not indexed, but there are tables of contents and introductory essays regarding the editions used.

The Four Treasuries of Medical Works

This edition of the medical section of the Qing dynasty encyclopedia Si Ku Quan Shu was republished in 1991 in 53 volumes.³³ It is printed as facsimiles in traditional format reduced in size so each page shows four pages of the original material. The edition provides a collection of ∼ 104 important works that had been selected by the experts of the time. Most titles have tables of contents in traditional format, but there is no overarching indexing system. There is, however, an online edition of the whole Si Ku Quan Shu, which is accessible by subscription and has a search function.⁴⁰ This availability makes this important collection much more accessible.

Other collections

Five of the remaining collections are book series published in recent decades,^{30,32,34,36,38} and three are reissues of collections that were first published in the 1920s³⁵ or 1930s.^31,37 These print editions can only be accessed via the tables of contents for individual books, but one of the smaller collections is also available as a searchable CD similar in format to Zhong Hua Yi Dian. ³⁹

Zhong Yi Fang Ji Da Ci Dian,²⁷ via its indices, is the most convenient of the above resources for locating information on herbal formulas and their use for specific conditions. For searches on other topics and when a systematic search of full texts is required, Zhong Hua Yi Dian ³⁹ is the most accessible resource, because it has an electronic search facility. A drawback of these two collections that is they provide insufficient information on the origins, editions, and authorship of the included books. The only collection that combines ease of searching with good probity for its included books is Si Ku Yi Xue Cong Shu ³³ (print and online versions), but having ∼ 104 titles, it provides a relatively small sample of the literature. The three other collections discussed above provide good bibliographic data but systematic handsearching is excessively time-consuming. A practical approach is to conduct searches using Zhong Yi Fang Ji Da Ci Dian ²⁷ or Zhong Hua Yi Dian ²⁶ to locate citations and then validate these by crossreference to authenticated editions of the books.

Conclusions

Eleven of the fourteen collections identified are in print form only and are difficult to search. Of the four collections that provide convenient search options, the largest two lack bibliographic detail on the included books. Therefore, we suggest a two-stage process—of search followed by verification as outlined in this article.

Footnotes

Acknowledgments

The authors thank the Preventive Health Flagship Program, Commonwealth Scientific and Industrial Research Organization (CSIRO), for providing partial funding support. The project is also partially supported by an international grant from the Guangdong Provincial Academy of Chinese Medical Sciences, Guangdong Province, China. We thank Suyueh Chang, Angela Yang PhD, David Lu MAppSc, Iris Zhou PhD, Michael Owens, BAppSc, Anthony Zhang PhD, Shujun Sheng PhD, Johannah Shergis BAppSc and Daniel Rechter BHSc for assistance in searches, data extraction, compilation and/or resolving numerous questions. We also wish to thank the library staffs at Hong Kong Baptist University and at the Guangzhou University of Chinese Medicine for their kind assistance with the literature-search process.

Authors' Contributions

B.H.M. designed the study, performed the analyses, and drafted the manuscript for this article. C.C.L.X. conceived of and coordinated the project, and revised manuscript drafts. C.J.L. provided a review and critical contributions to the article.

Disclosure Statement

No financial conflicts exist for any of the authors.

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