Barbara Kirschbaum
First English edition; Eastland Press, Seattle, 2000
Hardback, 260 pages, including colour illustrations, £54

(Reviewed by Simon Fielding, EJOM Vol. 3 No. 5)

This work was first published in German in 1998. Since no translation details are given I presume that the author, who qualified as an acupuncturist at the International College of Oriental Medicine in 1980, wrote this English edition herself. The emphasis of the work is on clinical interpretation rather than theory. Kirschbaum acknowledges the debt she owes to Giovanni Maciocia, with whose Tongue Diagnosis in Chinese Medicine (Eastland Press, 1987) her book invites obvious comparison. Maciocia's work, Kirschbaum says in her introduction, 'was crucial to the in-depth study' of tongue diagnosis in the West. It is not her purpose 'to cover the basics' already covered by him. Accordingly, the book begins with just a short chapter on 'The Foundations of Tongue Diagnosis'. The ensuing eleven chapters deal with different types of tongue presentation: Chapter 2 deals with 'Pale Tongue Signs'; Chapter 3 to 7 with tongue signs associated with the Kidney, Stomach, Lung, Heart and Liver respectively; Chapters 8 and 9 with Blood Stasis and Heat Disorders. Chapter 10 deals with Tongue Coatings and Chapter 11 with 'The Completely Cracked Tongue'. The final chapter looks at 'Changes in the Tongue Following Treatment'. There is an interesting little foreword to the book by Dominique Herzer, looking briefly at the history of tongue diagnosis in Chinese Medical literature.

The great strength of this book is its clarity both in the text and in the many colour photographs. The sensible and logical organisation of the chapters also contributes significantly to its success. The first chapter, as well as explaining theoretical considerations and the method of tongue observation, describes and illustrates normal tongues, thereby giving a valuable yardstick before delving into the realms of pathology. Each of the ensuing chapters dealing with tongue signs associated with various disharmonies is divided into sub-sections. The chapter on 'Pale Tongue Signs', for example, has sections on pale and swollen tongues, pale tongues with a depression at their root, pale and thin tongues etc. Each sub-section begins with a discussion of the aetiology and pathology involved, and how the pathology reflects in the tongue. There then follows a series of photographs of the tongue type dealt with in the sub-section, showing a progression from mild to severe signs. Alongside each photograph are tabular details describing the main features of the tongue and the Chinese diagnosis pertaining to each feature; the patient's presenting symptoms; the western diagnosis pertaining to that particular patient, and the background to the disease. Many of the sub-sections conclude with a case history or two. The final chapter, 'Changes in the Tongue Following Treatment', is composed entirely of cases. There is a comprehensive index of pathologies, symptoms and tongue types.

The result is a well-written, succinct and very readable reference work of high quality; a quality which is well reflected by the publishers in the durable and attractive production of the book and its clear presentation. The quality of the photographs is obviously crucial here; one's perception of colour, particularly, is to an extent subjective: it is difficult to be certain that the shade you refer to as pink is not what someone else would call pale red, for example. Such subtleties are obviously important in diagnosis. I was surprised by the depth of pinkness exemplified by Barbara Kirschbaum as a normal tongue and, following from that, the amount of colour in tongues which she describes as slightly pale. I am inclined to believe that the reason for this is not inaccuracy on the author's part nor unfaithful colour reproduction of the photographs, so much as a tendency on our part as practitioners in a country where a pale tongue is so prevalent not to realise that what we describe as a pink tongue is often pale by more universal standards.

Atlas of Chinese Tongue Diagnosis provides, in my opinion, the kind of logical step by step approach to its subject that Bob Flaws provides for pulse diagnosis in The Secret of Chinese Pulse Diagnosis, (Blue Poppy Press, 1995). It is, however, a much more approachable and clinically useful reference; but then tongues are a great deal easier to illustrate and compare than pulses. A student approaching tongue diagnosis for the first time would, I think, find this book a tremendous help, useful and easy to use. As a reasonably experienced practitioner, I also find it an invaluable and inspiring way to focus on this essential aspect of our perceptual skills as diagnosticians. Although not a cheap book, its quality makes it well worth its cost in my opinion; as a reference work, its usefulness should be long-term.

Simon Fielding
Simon Fielding has worked as an acupuncturist in Leicester for ten years; he also practises Chinese herbal medicine. He lectures at the London College of Traditional Acupuncture and Oriental Medicine in London and works on the editorial board of EJOM.