Professor Xu Yihou Translated by Yi Sumei Donica Press, 2004 Hardback, 770 pages, £61.75
(Reviewed by Mazin Al-Khafaji, EJOM Vol. 4 No. 6)
Skin diseases are amongst the most common conditions that afflict man, and yet many practising Chinese medicine in the West have only the most rudimentary understanding of how to treat them. This is a great shame, because with the correct training and knowledge, many of these frequently encountered diseases are in fact eminently treatable. This state of affairs exists for a number of reasons, not least the dearth of good books on dermatology in the English language. With the publication of this textbook by Professor Xu this reason at least becomes all but obsolete. Running to almost 800 pages it is bound to establish itself as one of the indispensable books on dermatology for the serious student and practitioner. A word of warning for acupuncturists though; even though the book’s back cover boasts acupuncture as one of the modalities of treatment, in actual fact it accounts for a very small percentage of the text. This, coupled with the fact that the pre-eminent form of treatment for dermatological disease has always been herbal medicine, will make this book of limited interest to those not practising Chinese herbal medicine.
The first chapter in the book entitled, ‘The skin and skin disorders in Chinese medicine’ gives a brief introduction to the anatomy of the skin followed by an overview of the physiology and aetiology of skin disorders according to Chinese medicine. Although in diagnosing and treating the skin the same principles that are used for internal medicine apply, the emphasis is somewhat different. Gaining insight of the disease by studying the morphology of the skin has pride of place in this process. This is reflected in this initial chapter by a rather good description of primary and secondary lesions, how to recognise them and what their significance is.
‘Main treatment methods for skin disorders’ is the second chapter. It describes the principles of internal and external treatment with herbal medicine, treatment with acupuncture and moxibustion, ear acupuncture, as well as a brief discussion of the role of diet in the treatment of the skin. Whereas the section on the role of acupuncture and moxibustion is cursory, reflecting the relative insignificance of this method of therapy in treating dermatological disease, there is a brief but good account of external method of treatments with herbal poultices, powders, ointments and washes.
After these preliminary chapters, the main body of work commences, namely the classification of skin disease and their treatments. In all, 120 skin diseases are presented in seventeen chapters and are classified according to disease type, which is the standard method of classification in western dermatological books. As such, chapter headings such as eczema and dermatitis, papulosquamous disorders, sebaceous and sweat gland disorders, viral disease of the skin etc are found. This is not the common method used in traditional Chinese works on dermatology, including Professor Xu’s original work in Chinese, where conditions are organised according to areas of the body the skin disease is likely to be manifested (e.g. disorders of the face, disorders of the limbs etc). I was happy to see that the translation of Professor Xu’s work uses the modern system of classification, because personally I find the traditional method a far more cumbersome and unwieldy method of organisation. Readers who are unfamiliar with skin disease will also find it much easier to look up conditions they have only heard about but not seen.
Each of the diseases presented in this book are discussed under the following headings:
‘Clinical Manifestation’; a rather good and concise description of the condition is given in bullet point format. The common way the condition manifests is outlined in a precise and useful way.
‘Differential Diagnosis’: differentiating one disease from another is a crucial first step in understanding how to go about treating any condition, but never more so than in treating disease of the skin. To the uninitiated, different skin diseases may appear very similar; eczema may at first sight look identical to a fungal infection, psoriasis may mimic seborrhoeic dermatitis in almost every respect. Failure to differentiate the disease at the outset, and for example treat a case of rosacea as if it were acne, despite their morphological similarities, will almost certainly lead to disappointment for both the patient and the practitioner. Clear, concise and relevant information is presented outlining how to recognise the disease and how it differs from other similar conditions. There are some colour pictures with examples of some of the commoner conditions, but it has to be said that the quality of many is not very good. The keen reader can get around this problem by using it in conjunction with an atlas of dermatological disease.
‘Aetiology & pathology’: presented in bullet point format, the primary factors that predispose to developing the condition are discussed, as are trigger factors and the pathological process of the disease according to Chinese medicine.
‘Pattern identification and treatment’: this constitutes the major portion of the text; a breakdown according to Chinese medicine of the sub-varieties of each condition and its treatment. A brief description of each pattern is followed by a formula, a short explanation of the ingredients used as well as a list of modifications that are suggested according to the individual manifestation. I felt this section was adequate, but a little disappointing. A professor of over forty years of experience must have a wealth of knowledge to impart, identifying the salient characteristics and critical features that separate one pattern from another, and make success in the clinic more likely. Though this aspect was addressed to some degree in the next section entitled ‘Clinical notes’, I could not help feeling that a standard differential diagnosis was presented that would need to be modified substantially to make it effective in practice. It is of course notoriously difficult to identify and pass on what is in effect the distilled and refined knowledge of tens of thousands of hours of experience, but none the less the requirement for this crucial aspect is what is now in most demand and increasingly acts as the bench mark by which works are judged. Treatment with body and ear acupuncture is also presented, but it is clear that these techniques of treatment are relegated to adjunctive methods.
‘Clinical notes’: this brief section could easily have been expanded and acted as a platform for Professor Xu to impart of his undoubted wealth of clinical experience. There are few things as useful to a clinician faced with a patient and attempting to construct an effective formula, than to have certain critical points identified, be it in the dosage of certain ingredients or the relative frequency of occurrence of certain patterns. Even though this is done to some degree, I would have liked to see much more of this very useful section.
‘Case Histories’: some very interesting case histories are presented with a discussion of the diagnosis and treatment. Many principles of treatment can be gleaned by detailed study of this section. It is of course the case example that constitutes the decisive link between theory and practice, so close attention can be rewarded by insights into how a doctor actually composes a formula and how it is modified in the face of the evolution of the condition with treatment. On several occasions I was surprised by how different the herbal formula was in the case examples when compared to the theory that had proceeded it, until I realised that the majority, if not all the cases presented were by other dermatologists rather than by Professor Xu. As a consequence we do not get an insight into the professor’s more detailed approach to diagnoses and treatment, although we do get the opportunity of looking at how some famous doctors such as Zhu Renkang, Zhao Bingnan, and Zhang Zhili do.
‘Literature excerpts’: another very interesting section where excerpts from classical as well as modern texts are presented. Whole tracts of text from other dermatologist works are reproduced and serve to give the reader a good impression of how varied different physicians’ approaches can be.
‘Modern clinical experience’: this very useful section presents in a succinct way some clinical studies by modern dermatologists. Even though Professor Xu himself acknowledges that in many instances these studies do not meet research criteria in western medicine, their inclusion none the less gives the reader a very valuable flavour of how different doctors approach treating the same skin disease.
The final section of the book is devoted to appendices, where a supplementary materia medica of ingredients along with combinations that are commonly used in dermatology, a list of acupuncture points, and the formulas for the external therapies that are mentioned in the book.
In summary, I felt that Dermatology in Traditional Chinese Medicine is a good, well laid out and easy to use textbook that is brimming with useful information just waiting to be discovered and put into practice. Professor Xu should be wholeheartedly congratulated for sharing with us his long experience and insights in such a modest and unassuming way, and in the process helping transmit the treasures of Chinese medicine to a wider audience. If you are a herbalist and have any interest in dermatology at all, and you should do considering how common skin diseases are, do not hesitate for a moment in adding this admirable book to your collection.
Mazin Al-Khafaji Mazin Al-Khafaji studied Internal Medicine alongside Chinese students at the Shanghai College of Traditional Chinese Medicine where he graduated as Doctor of Chinese Medicine in 1987. Since his return he has been in practice in Brighton & Hove where he specialises in the treatment of allergic, autoimmune and skin diseases. He lectures widely to postgraduates in the UK and abroad.
