Jane Lyttleton Churchill Livingstone, 2004 Hardback, 422 pages, £34.99
(Reviewed by Felicity Moir, EJOM Vol. 4 No. 6)
What a refreshing book. This is the first of what I hope is the birth of a new era in the long tradition of Chinese medicine, the personal clinical experience of a western practitioner of TCM in one of the areas of speciality - gynaecology. Jane Lyttleton brings us the fruits of her 20 year labour treating western women with problems of fertility in a busy clinic in Sydney, Australia combining herbal medicine and acupuncture and lifestyle advice. She draws on experience gained from studying with Xia Gui-Cheng, one of the top gynaecologists in China, and inter-professional exchanges with some of the best western medical fertility specialists in Australia. Jane’s language is personal and humorous and the book has some classic cartoons that make this a gem in comparison to the dryness of some TCM texts.
The most interesting and possibly controversial aspect of this book is the way that Jane, in response to the well informed demands of our western patients, has married the systems and treatments of infertility from both the Chinese and western medical perspectives. She moves fluidly between the two developing our understanding of the menstrual cycle in preparation for how and why it might go wrong. Her diagnosis and treatment always keeps to a TCM frame of reference, but her understanding of the how and why of infertility is multi-faceted and truly reflects what women seek from us in our western Chinese medicine practices. While other texts refer to western medicine they do not merge the systems into this coherent process.
Early chapters give a most comprehensive description of the menstrual cycle, the movement of yin and yang from the beginning of the period through the ripening of the egg to ovulation and through to pre-menstruation and the bleed. What is so unique is the way Jane has interpreted current understanding of the menstrual cycle from a western perspective, understanding that has come from blood tests, scans and laparoscopies, into TCM.
‘…the Blood and Yin tonics are important in the production of good-quality L mucus (and vaginal lubrication in general) but that small quantities of Yang tonics influence the production of the S mucus and finally, as Yang tonics are taken over a few more days, the P mucus’. ‘Herbs may also be employed at midcycle to help dissolve thick mucousy secretions which have been built up in the follicular phase but now need to be dispelled for free passage (of the egg) from the isthmus of the tube to the uterus.’
The chapter on how the menstrual cycle can be charted through the use of basal body temperature (BBT) charts is covered in much detail. Each different problem such as the follicular phase being too long or the luteal phase being too low is described with clear diagrams and explained again from a TCM and western perspective. ‘Even though the period does not come early, the fact that the temperature has dropped indicates the decline of the Kidney Yang.’
The signs and symptoms of the different patterns of infertility follow normal text book descriptions but with vivid language and again the possible BBT patterns have been added. ‘The process of implantation is a dynamic one which requires vigorous Qi as the embryo binds to the endometrium and then burrows into it’. ‘Shen disturbance usually shows clearly on the BBT chart in the follicular phase as peaks and troughs…’
It is in the treatments that Jane's experience starts to show. Treatments are described in relation to the phases of the cycle e.g. preparing for ovulation or problems in the luteal phase. Modifications and variations of formulae herbal and acupuncture are detailed with emphasis on the timing of treatment. This makes it extremely useful as a practitioner needing to follow a woman's menstrual cycle. This section is well illustrated with interesting case histories and charts showing the woman's BBT recordings throughout the treatment cycles and the different formulae given at the different stages of the cycle and over a series of cycles. The clinical reality emphasises the compassion and understanding of the wider implications of infertility that we need to have as practitioners. To take on the complexity of these cases, with the fine tuning needed as the woman moves through the phases of the cycle, adding some yang tonics here, phlegm resolving at this point, a whole new formula now that ovulation has happened, takes dedication and skill and strength of spirit as another cycle goes by with no pregnancy.
There is a long section on the treatment of different disorders which can cause infertility such as endometriosis, amenorrhoea, pelvic inflammatory disease, blockage of fallopian tubes. The western medical descriptions are very clearly written backed up by current research and treatments. There is a most interesting discussion on the theoretical relationships between different types of endometriosis and their TCM counterpart and a TCM analysis of drugs used for various conditions. So often we find ourselves having to treat women who are also on western medication. Again case histories and the women's BBT chart are used as illustration.
Blockage of the fallopian tubes is covered in a specific chapter and there is a small but succinct section on the treatment of male infertility again with case histories to illustrate how treatments can be modified.
Chapter eight covers miscarriage, both threatened and recurrent, and ectopic pregnancy. Again Jane's perspective includes western medicine and TCM with herbal formulae, acupuncture treatments and clinical illustrations backed up by current practice in China in the gynaecology departments.
The diet and lifestyle section includes some interesting but disturbing research. 'A large study carried out by the Yale Medical School found that the risk of infertility was 55% higher for women drinking just 1 cup of coffee per day.'
But Jane's approach is one of moderation tempered by the specific TCM diagnosis. If there is internal heat alcohol might not be a good idea.
The final chapter is most useful. How do we work with women who are also going through ART? The western medical protocols are well described and Jane's experience of the different needs of women, of couples, provides much food for thought.
The appendices include herbs contraindicated in pregnancy and there is a summary of the formulae used throughout the book and their uses. Herbs that might be proscribed in some countries are clearly asterisked throughout the book but not in the appendix.
Is it a text book? Is it a personal story? It combines both. While other books, notably Maciocia's Obstetrics & Gynaecology in Chinese Medicine and Flaws' A Handbook of Menstrual Diseases in Chinese Medicine have covered infertility in specific sections, Flaws quite extensively on BBT's, this book has gone into much more depth and further illustrates the clinical reality through detailed case histories. It has a similarity to Yu Jin's Obstetrics & Gynaecology in Chinese Medicine in its integrated approach, but while Professor Yu presents her research results we do not get her personal patient experience.
Practitioners treating gynaecology in general, but specifically infertility, either with herbal medicine or acupuncture, will find a lot which is new, interesting and thoughtful. It is easily accessible to final year students and is a welcome addition to the teaching programme. Practitioners of western medicine who might like to gain useful insights into the complexity and beauty of the TCM medical model and how it might help their infertile patients could well gain from this book
(This review is re-published with kind permission of the Register of Chinese Herbal Medicine)
Felicity Moir Felicity Moir is course leader for the BSc (Hons) TCM: Acupuncture and the Diploma and Postgraduate Diploma in Chinese Herbal Medicine in the School of Integrated Health at the University of Westminster. She teaches gynaecology to final year students and is a clinical tutor. Her interest in TCM books therefore is how they can support students learning.
