Giovanni Maciocia
Churchill Livingstone, New York and London, 1998
Hardback, 959 pages, illustrated, £75

(Reviewed by Felicity Moir, EJOM Vol. 2 No. 5)

Obstetrics and Gynecology in Chinese Medicine is a continuation of Giovanni Maciocia's series on the theory of disease patterns. In The Practice of Chinese Medicine, published in 1994, Maciocia provided a comprehensive analysis of a wide range of diseases from many systems, including three from the area of gynaecology namely dysmenorrhoea, menorrhagia and metrorrhagia and pre-menstrual tension. In his new book, the red cover denoting the colour of xue, he systematically discusses all the main patterns that come under the internal medicine gynaecology and obstetric department, fu ke.

Maciocia has a wealth of experience both in his reading of the Chinese classics and in the knowledge he has gained from lecturing internationally. Translations of Chinese sources on this subject have been done before, particularly by Bob Flaws, but what Maciocia has done for the profession is to compile much disparate information into a single volume, make it comprehensive and readable and annotate it with his own case histories.

The first section of the book on history, physiology and general pathology should be essential reading for all students of Chinese medicine. Without this understanding one could say it would be impossible to treat any woman, presenting with any condition, gynaecological or otherwise. Maciocia presents again (originally in The Foundations of Chinese Medicine, 1989) his detailed understanding of the nature and function of the extraordinary channels and their pathological manifestations, but enhances it with a discussion on treatment. Particularly useful is his differentiation of the uses of the points on the Kidney channel on the lower abdomen. The differentiation of excess (shi) and deficient (xu) patterns of the Girdle Vessel (Dai Mai) is illuminating although primarily theoretical. The concept has not been incorporated into the treatment of miscarriage, for example.

There is an excellent discussion of the reason why, and the possible presentations of, that most difficult but all too common phenomenon of patients presenting with simultaneous kidney yin and kidney yang patterns and mixtures of hot and cold patterns. For example, '44; hot flushes, night sweating, Pale tongue' or '44; Pale tongue, feeling cold, very hot feet at night'.

The section on aetiology is steeped primarily in Chinese tradition; the quotes, therefore, while interesting, are not particularly relevant to modern Western women. From a Qing dynasty text, 'Women from rich families are arrogant and often hide their feelings. They cannot stop eating cold fruits if these are delicious..' Quote from The Golden Mirror of Medicine, 'Women cannot control themselves and are frequently affected by worry, pensiveness, anger or depression...' The author lacks input on the issues affecting women in the modern world; the 'super mum' looking after career and family and the impact on the qi and blood; the use of tampons and their affect on the downward movement of blood. I am disappointed that he does not discuss the impact of the contraceptive pill on women's gynaecological health, possibly the most important aetiological factor today in fu ke.

The diseases sections are divided into menstrual irregularities, problems at period time, diseases of pregnancy, diseases after childbirth, and miscellaneous diseases (including a section on breast lumps and how the difference between benign and malignant might have been differentiated in TCM). However, readers of The Practice of Chinese Medicine will be pleased to know that Churchill Livingstone has improved the layout of this book, making it much easier to find your way through the headings and sub-headings.

I found the acupuncture treatments lacking depth, although there are some excellent classical prescriptions especially in the section on infertility. The herbal formulae are comprehensive, though I am concerned about the author's inclusion of some banned or 'grey area' substances such as fu zi (Aconiti Carmichaeli Praeparata), gui ban (Plastrum Testudinis) and zi he che (human placenta). Maciocia justifies his position in the introduction, but I feel this is not the way to deal with the legal controls and controversy surrounding herbal medicine.

My main criticism is that the forward by Ted Kaptchuk is misleading, in that it implies a modification of the ancient approach to TCM by modern clinical experience. The bulk of the book is theoretical. The author has not applied to any of the diseases within fu ke the kind of reanalysis he applied to asthma or ME in The Practice of Chinese Medicine. The case histories go some way in bringing to life the reality of the clinical experience for gynaecology. However, the whole section on obstetrics, except for morning sickness and the section on 'Acupuncture and Herbal Treatment in Midwifery' written by Budd and Yelland, has no clinical experience incorporated.

As a teacher of gynaecology, I am grateful to Maciocia for compiling this text and would expect to find it on all academic reading lists. The cost, however, may be prohibitive for many students. As a practitioner of gynaecology, I look forward to hearing more from the author and other practitioners on how we modify the traditional Chinese approach to meet the needs of modern women.

Felicity Moir
Felicity Moir is the Principal of the London School of Acupuncture and TCM and course leader of the BSc (Hons) in Traditional Chinese Medicine: Acupuncture at the University of Westminster.