Yan Wu and Warren Fischer
Paradigm Publications 1997
Paperback, 716 pages, £35

(Reviewed by Andrew Flower, EJOM Vol. 2 No. 5)

Practical Therapeutics of TCM is a substantial new text book written with the aim of providing a standard reference work on the treatment of over 100 common diseases following the educational standards set by the top medical texts used at Beijing and Shanghai hospitals of TCM. It provides herbal and acupuncture protocols with additional information on alternative therapeutic methods such as ear acupuncture, plum blossom therapy and lifestyle changes. The diseases covered have been selected as conditions responsive to TCM and are categorised according to traditional differentiations using Chinese medical nomenclature, not the language of biomedicine. Thus, for example, the book describes the treatment of stomach pain (wei tong) not acute gastritis although the book includes the most common biomedical correspondences to this traditional method of classification. The scope of the book is broad and it has sections on internal medicine, dermatology, surgery, gynaecology, obstetrics, paediatrics, ophthalmology, otorhinolaryngology, stomatology and emergentology.

(Congratulations if you made it through the above list). The authors have an interesting range of experience.Yan Wu is a senior Chinese clinician and educator who has also spent three years teaching TCM in New York, and Warren Fischer is a Canadian practitioner who completed the five year training in Chinese at the Beijing University of TCM and practises in Canada. Both authors are highly conscious of the importance of the translation of Chinese terminology into an English equivalent that clarifies the analysis and treatment of the conditions described.

Two comparable texts immediately spring to mind. One is obviously Maciocia's Practice of Chinese Medicine. The other is Zhou's Clinical Manual of CHM and Acupuncture which differentiates diseases according to biomedical categories. In many ways these books cover the same ground by presenting a basic therapeutic text book covering a range of common conditions. Maciocia's book focuses more deeply on 34 conditions whilst Zhou's and this book opt for broader brushstrokes covering a wider clinical terrain. There is obviously room for both of these approaches and I think all Western trained practitioners should welcome Wu and Fischer's effort to make information from the top basic Chinese textbooks available on such a range of diseases.

However, before you stop your Chinese lessons thinking it has all been translated for you the book also has several important shortcomings. Its strengths are often its weaknesses. The book definitely sacrifices depth for breadth. The accounts of the aetiology and pathology of disease are very limited and the book tends to list rather than explain pathology, which is fine as a reminder but frustrating if the information is new. Similarly the complexity of many of the conditions as they appear in practice, not in the text books, is not well addressed. Whilst the standard formulas and acupoints recommended for each differentiation are useful and some of the modifications of these formulas are excellent, there is a real absence of either of these, no doubt, excellent practitioners describing their own experiences in the clinical encounter, either through case histories or through a more involved commentary on the procedures recommended. Also apart from a tantalising glimpse in the introduction there is no reference to any modern research, clinical trials or the empirical experience of an old master. These are the real jewels of information that are lacking in the West and the authors themselves briefly mention the use of, for example, yin yang huo (Herba Epimedii) for autoimmune diseases or tu fu ling (Rhizoma Similacis Glabra) and bi xie (Rhizoma Dioscoreae) to reduce levels of uric acid in the blood in the treatment of gout. Perhaps these are included in the modifications but there is no reference to sources and without being properly highlighted precious details such as these which have the potential to favorably tip the balance in difficult treatments are not given the status they deserve.

Another problem is that the treatment is not adapted to the Western patient. The section on asthma for example makes no mention of the concept of atopy which badly needs to be addressed at the theoretical and clinical levels. Staying with asthma there is also no mention of how to combine Chinese and Western medicines. There is no doubt that inhaled steroids are a relatively safe, life saving treatment. How should a child be weaned off their inhalers? Can Chinese medical treatment be targeted to work with Western drugs to keep them at a minimum for example? This kind of practical information is badly needed to meet the day to day needs of clinical practice.

Similarly in the treatment of consumption or TB, there is no mention of the context of the patient such as the possibility of people with TB being HIV+, or of the public health risks of someone who may have active TB or, even worse, multiple drug resistant TB. And if the authors prefer a Chinese medical approach I, for one, would be very keen to see the clinical trials and the protocol that prove this approach to be the treatment of choice. These are just a few examples but they demonstrate the need for our textbooks to reflect our clinical reality and to take our social, political and medical context into account.

Another criticism is the rather scanty account of acupuncture protocols. Whilst the main points are dutifully listed there is no real explanation of how to work with them and the acupuncture sections are wooden and unsatisfying with no accompanying commentary to bring them to life.

Despite these reservations Practical Therapeutics of TCM is still a useful book that helps to sketch in aspects of the picture of Chinese medicine that have been currently left blank. I think most practitioners would benefit from its presence in the clinic but it is a shame that with the obvious skills and experience of the authors, they did not venture out of the classical textbook mode into a format which addresses the quandaries raised in day to day clinical practice.

Andrew Flower
Andrew Flower practises acupuncture and Chinese herbal medicine and is currently Vice-President of the Register of Chinese Herbal Medicine with responsibility for developing a post graduate training programme.