The Treatment of Disease with Traditional Chinese Medicine [Vol. 1: Lung, Kidney, Liver, Heart]
Will Maclean & Jane Lyttleton University of Western Sydney Macarthur Hardback, 967 pages, £45
(Reviewed by Nicholas Haines, EJOM Vol. 3 No. 2)
I remember so clearly in 1988 reading in the Journal of Chinese Medicine Jane Lyttleton's article about cervical neoplasia. I was impressed and relieved with the way she combined western medical theory, TCM differentiation and her own clinical experience. The main reason for this sense of relief was that here was the chance to a) value our own clinical experience and b) recognise the difference between patients treated in China and those who actually arrived at our doors.
Although I have not read anything written by Will Maclean, I certainly recognised this style of Jane Lyttleton in the Clinical Handbook of Internal Medicine. Reading the short piece about the authors, I can see that Will Maclean follows a similar desire to translate Chinese medicine in this way. This book is the first of two volumes which aims to provide comprehensive coverage of traditional Chinese internal medicine. In this volume, disorders of the lung, kidney, liver and heart are covered and in volume II, disorders of the spleen, the jingluo and qi, and blood and fluids.
The book itself is a rather good-looking 967-page volume. I say good looking because so many of my patients remarked about it while I had it sitting on my desk. It feels like a good handbook, sturdy and useable with a robustness that should stand up to frequent use, which inevitably it will be put to.
Internally, the text font is relatively small but easy to read, with a full but not crammed-in feel. This gives an overall impression that the authors have an abundance of information to impart, but remain aware that the book must continue to be useable.
The book consists of four parts - diseases of the lung, kidney, liver and heart. Divided within them are 33 chapters and each of these explores a traditional disease category, such as insomnia and lower back pain. This is not really a major criticism but I could not really see the advantage of grouping the disease category under the major heading of a zang. Although certain diseases may have predominance in a particular zang, they are often by no means exclusive to that zang. I must say that this way of organising the disease does not detract from the usability of the book or the authors' achievement and may have some advantage in structuring an educational programme, which I understand was one of Will Maclean's motivating forces.
Initially, in each of the chapters a disease is discussed from both a TCM point of view and the biomedical perspective. This discussion provides a useful overview of that disease. In some chapters this discussion is quite brief and in others more substantial. Chapter 25 on epilepsy is a good example of the author's thoroughness. Their biomedical discussion is informative from both a physiological and pathological perspective. There is a highlighted box outlining in some depth the biomedical classification of seizure types, looking at the description, recovery time and frequency. Although this information could be found from other sources, having it presented in such a clear, precise manner within a single format makes this book a really useful tool.
The disease is then differentiated into the relevant syndromes, and the aetiology of each is discussed to a good standard.
Following on from this there is often a useful section called 'treatment'. In this section the authors draw on their obvious clinical experience, providing a helpful overview of clinical management, offering lifestyle advice, giving guidance into what to prioritise within the development and the treatment of the disease. This section also gives recommendation as to when to refer for western biomedical assessment. This advice is useful for both the experienced practitioner and novice alike. As practitioners I am sure we can often become engrossed within our diagnosis, especially when a TCM pattern is so obvious, forgetting sometimes the other possibilities.
The 'clinical features' of each differentiation are then listed. At this point, making a direct comparison with Maciocia's Practice of Chinese Medicine, the authors' description of the clinical features are less in-depth at times than Maciocia's (at other times slightly better), which has some implications when one looks at the suggested treatment methods. In the main the two authors are advocating a herbal approach. The problem seems to be that the section on differentiation really needs to be as comprehensive as possible in order to assist in the making of an accurate diagnosis, which is so essential to herbal prescribing.
In the usual manner, the authors start with a classical or modified formula with appropriate additions or variations to suit the clinical situations encountered. A number of patent medicines are also put forward. I noticed that there is an absence of any discussion about the formulas or patents (unlike in Maciocia's Practice of Chinese Medicine). This decision may have been based on the knowledge that this information is now well covered elsewhere (Formulas and Strategies Bensky/Barolet) and to include it would have made the book too unwieldy.
The most serious weakness with this excellent book is in the lack of a systematic approach to the acupuncture. What is given is no more than a list of suggested points. I am not saying that the book will not be greatly appreciated by an acupuncture audience but there may be, quite rightly, a sense of disappointment in this lack of a systematic approach.
At the end of each section there are 'clinical notes'. These are again an example of the authors sharing their clinical experience in correlating the TCM patterns to bio-medical disease categories, developing ideas on clinical management and giving some idea of the likely prognosis. I am not usually fond of writing in books or even sure if this is a conscious design feature, but the book at this point has a space which is asking to be written into, a space to put down one's own clinical notes or ideas. I know from the introduction the authors ask for dialogue and feedback about both the book and practitioners' own clinical experience. Together with this space in which to write it makes the book seem even more alive.
With all the current issues about herbal safety, toxicity and endangered species, it was good to see a number of appendices devoted to these issues.Perhaps due to the speed of change within the herbal world, these sections were already lacking certain important key points which I hope will be addressed in future editions.
In conclusion, Will Maclean and Jane Lyttleton have provided through their hard work and expertise, a book which superbly adapts the TCM perspective to a western audience. I look forward to volume II.
Nicholas Haines Nicholas Haines has studied Chinese Medicine in America, China and the UK since the early 1980s. He has lectured at the Northern College of Acupuncture in the UK and at local hospitals for 13 years.