Zang Fu Syndromes: Differential Diagnosis and Treatment
John McDonald and Joel Penner Lone Wolf Press, California, 1994 Hardback, £69
(Reviewed by Susanna Dowie and Shai Golan, EJOM Vol. 3 No. 6)
When we invited John McDonald to do two guest lectures at the London College of Traditional Chinese Medicine it was before we even knew of the existence of this book. As a lecturer he is fascinating, informative and very funny. The only disappointing part to those of us who attended his seminars, is that John hails from 12,000 miles away in Australia. So unless he is planning to relocate we shall have to wait for a return trip to hear him again. In the meantime, there is this gem of a book.
John McDonald is billed as ‘one of Australia’s foremost acupuncture educators and writers’ with an impressive 25-year history of practising and teaching in many of the best-known Australian oriental medicine colleges. Joel Penner, John’s partner in authorship, is well-known as a practitioner, teacher and professor of oriental medicine in California. Their experience as teachers is evident throughout this book, which represents years if not decades of research into how best to present their subject. They have done a superb job of producing a down-to-earth, no-frills text book which is specifically designed for second year students of oriental medicine: although, to limit its use to this group would be a shame. As a reference book on the zang fu syndromes it is just excellent and would quickly prove a backbone text in the library of any practitioner who works with them.
As a potential second-year text book it is very focused. It makes no concession to the teaching of the building blocks of Chinese medicine theory - it presumes these are already known. There is no description of Five Elements, Eight Extras, Four Levels, Six Divisions, etc. The book is just what it claims to be: a book on the zang fu syndromes: if the building blocks are mentioned, it is in context, and prior understanding is presumed. In this sense it is interesting to stand the book next to other comparable textbooks almost all have a much wider scope. Many include a description of the theoretical underpinnings of Chinese medicine. Many texts include point locations and/or actions listed separately. In leaving these things aside and yet including Chinese herbal formulae, this book fills a very particular niche.
The book is arranged in two parts, the first being devoted to the zang fu syndromes, their differential diagnosis and their treatment with acupuncture, and the second being a review of herbal formulae. One of the main strengths of this book is its practicality. It is written in such a way that it is a joy to use. In a world where text books normally range from poorly to grossly inadequately indexed and referenced, this book is a breath of fresh air. The syndromes are divided into the Five Elements initially, and then subdivided according to organ and syndrome. Each elemental section begins with a table allocating the syndromes in the section according to hot/cold/neither, xu/shi, and finishes with a map showing the complexity of their aetiological interactions.
Syndromes are given their aetiology, both from a western and Chinese medicine perspective. Clinical manifestations are separated from associated western conditions. A particularly useful section discusses relevant differential diagnosis, enabling the reader at a glance to make the appropriate distinctions between syndromes, without cross referencing. For instance, under the section on Wind Heat Attacks Lung, there are brief notes of the differential diagnosis between Wind Cold and Wind Heat, Wind Heat and Phlegm Heat, Wind Heat and Lung Yin Xu. The section on Phlegm-Fire disturbs the Heart differentiates Kuang and Dian, Heart Fire Flaring Up and Heart Yin Xu. This is ideal for students who are learning to prioritise and to explore the ben/biao relationships in syndromes. Acupuncture point prescriptions are described using the numbering system and the pin yin, together with their major actions, primary points and further points for specific symptoms. Common herbal formulae are listed here and referenced to the second part of the book.
Perhaps the most startling section in the book is at the end, where there are no less than eight separate indices. Three deal with the herbal formulae, referencing them in pin yin, in English and in Latin: a fourth looks at individual herbs in pin yin. In addition, there is an index of tongues, of pulses, of points and finally of symptoms. The delightful part is that none of these is skimpy or a mere gesture. We decided to test it out by looking up glomerulonephritis in the symptoms index (sic). We found references to two herbal formulae and several syndromes. Had we not already been familiar with the differential diagnosis of this disease, we could easily and rapidly have worked it out from this information, and what is more we could have differentiated between the background condition and its acute manifestations.
The herbal formula section is very user friendly and would be particularly interesting and useful to advanced students of Chinese herbal medicine (for revision) and practitioners, as a good source of reference. The action of individual herbs is discussed briefly, but more importantly, herb combinations that have significant functions in the context of the formula are also discussed. Each formula has a list of signs and symptoms associated with it, which gives a pretty good clinical picture of a patient who might benefit from it.
As with the zang fu syndrome section, this section also lists the associated western conditions a formula is likely to treat. This is enormously useful for cross-referencing or researching a particular condition. In the zang fu syndromes section, common herbal formulae are listed under each syndrome; in the formulae section, the zang fu (and non zang fu) syndromes are listed under each formula. This symmetry is another strength of the book - you can look up formulae in the zang fu section or look up syndromes in the formula section.
The job of a reviewer in part is to be nitpicky. So: on one or two occasions the section of associated western conditions seemed a little obscure, such as the reference to diptheria beside Lung Yin Xu. On the other hand, the section on Wind Heat made no mention of tonsillitis. The layout of the book is in general very good, but where some syndromes spread over two or more pages, it would have helped to have had some means of identifying the start of a new syndrome by the layout alone. Visually it is easy to get lost.
Whilst we digest this book, John told us that he is working on a points book which has been 22 years in the making so far. If it turns out to be anywhere near as good as Zang Fu Syndromes we shall be delighted with it. The only disappointing thing? This kind of book cannot possibly reflect John’s sense of humour.
Susanna Dowie Susanna Dowie has been the Principal of the London College of Traditional Acupuncture and Oriental Medicine for the last six years and also runs a private acupuncture practice. She has a Masters Degree in Complementary Health Studies from Exeter University.
Shai Golan Shai Golan was educated in Israel and runs a private practice in acupuncture, Chinese herbal medicine and tui na massage. He also practises acupuncture alongside an NHS GP surgery. He works as a Clinical Supervisor at the University of Westminster and holds the post of Co-ordinator of the Acupuncture Clinical Module at the London College of Traditional Acupuncture and Oriental Medicine.