Skin diseases are amongst the most common conditions that afflict man, and yet many practising Chinese medicine in the West have only the most rudimentary understanding of how to treat them. This is a great shame because with the correct training and knowledge, many of these frequently encountered diseases are in fact eminently treatable. This state of affairs exist for a number of reasons, not least the dearth of good books on dermatology in the English language. With the publication of the textbook, Dermatology in Traditional Chinese Medicine by Professor Xu this reason becomes all but obsolete. Running to almost 800 pages it is bound to establish itself as one of the indispensable books on dermatology for the serious student and practitioner.
The first chapter, ‘The skin and skin disorders in Chinese medicine’ gives a brief introduction to the anatomy of the skin followed by an overview of the physiology and aetiology of skin disorders according to Chinese medicine. Although the same principles that are used for internal medicine apply to diagnosing and treating the skin, the emphasis is somewhat different. Gaining insight into the disease by studying the morphology of the skin takes pride of place in this process. This is reflected in this initial chapter by a rather good description of primary and secondary lesions, how to recognise them and what their significance is.
Chapter two, ‘Main treatment methods for skin disorder’ describes the principles of internal and external treatment with herbal medicine, acupuncture, ear acupuncture and moxibustion, as well as a brief discussion of the role of diet in the treatment of the skin. Whereas the section on the role of acupuncture and moxibustion is cursory, reflecting the relative insignificance of this method of therapy in treating dermatological disease, there is a brief but good account of external methods of treatments.
After these preliminary chapters, the main body of work commences, namely the classification of skin diseases and their treatment. In all, 120 skin diseases are presented in 17 chapters and are classified according to disease type, which is the standard method of classification in Western dermatology books. This chapter is therefore organised under headings such as eczema and dermatitis, papulosquamous disorders, sebaceous and sweat gland disorders, viral diseases of the skin etc. This is not the common method used in traditional Chinese works on dermatology, where conditions are organised according to areas of the body in which the skin disease is likely to manifest (e.g. disorders of the face, disorders of the limbs etc). I was happy to see that Professor Xu uses the modern system of classification, because I personally find the traditional Chinese method a far more cumbersome and unwieldy method of organisation. Readers who are unfamiliar with skin disease will also find it much easier to look up conditions they have only heard about but not seen.
Each of the diseases presented in this book is discussed under the following headings:
Clinical manifestation: A rather good and concise description of the condition is given in bullet point format and thus the common way the condition manifests is outlined in a precise and useful way.
Differential diagnosis: Differentiating one disease from another is a crucial first step in understanding how to go about treating any condition, but never more so than in treating disease of the skin. To the uninitiated, different skin diseases may appear very similar; eczema may at first sight look identical to a fungal infection; psoriasis may mimic seborrhoeic dermatitis in almost every respect. Failure to differentiate the disease at the onset, and for example treat a case of rosacea as if it were acne, will almost certainly lead to disappointment for both the patient and the practitioner. Clear, concise and relevant information is presented on how to recognise the disease and how it differs from other similar conditions. There are a number of colour pictures with examples of some of the commoner conditions, but it has to be said that the quality of many is not very good. The keen reader can get around this problem by using this book in conjunction with an atlas of dermatological disease.
Aetiology and pathology: Presented in bullet point format, the primary factors that predispose to developing the condition are discussed, as are trigger factors and the pathological process of the disease according to Chinese medicine.
Pattern identification and treatment: This constitutes the major portion of the text; a breakdown according to Chinese medicine of the sub-varieties of each condition and their treatment. A brief description of each pattern is followed by a formula, with a short explanation of the ingredients used and a list of modifications that are suggested according to the individual manifestation. I felt this section was adequate, but a little disappointing. A professor of over forty years of experience must have a wealth of knowledge to impart, identifying the salient characteristics and critical features that separate one pattern from another and make success in the clinic more likely. Though this aspect was addressed to some degree in the following section, clinical notes, I couldn’t help feeling that the standard differential diagnosis presented would need to be modified substantially to make it effective in practice. It is of course notoriously difficult to identify and pass on what is in effect the distilled and refined knowledge of tens of thousands of hours of experience, but nevertheless the requirement for this crucial aspect is what is now in most demand and increasingly acts as the benchmark by which works are judged. Treatment with body and ear acupuncture is also presented, but it is clear that these techniques of treatment are relegated to adjunctive methods.
Clinical notes: This brief section could easily have been expanded into a platform for Professor Xu to impart his undoubted wealth of clinical experience. There are few things as useful to a clinician faced with a patient and attempting to construct an effective formula, than to have certain critical points identified, be it the dosage of certain ingredients or the relative frequency of occurrence of certain patterns. Even though this is provided to some degree, I would have liked to see a significant expansion of this very useful section.
Case histories: Some very interesting case histories are presented with a discussion of their diagnosis and treatment. Many principles of treatment can be gleaned by detailed study of this section. It is of course the case example that constitutes the decisive link between theory and practice, so close attention can be rewarded by insights into how a doctor actually composes a formula and how it is modified in the face of the evolution of the condition with treatment. On several occasions I was surprised by how different the formula was in the case examples when compared to the theory that had preceded it, until I realised that the majority, if not all, of the cases presented were by other dermatologists, rather than by Professor Xu. As a consequence we do not get an insight into the professor’s more detailed approach to diagnosis and treatment, although we do get the opportunity of looking at the clinical practice of famous doctors such as Zhu Renkang, Zhao Bingnan and Zhang Zhili.
Literature excerpts: Whole passages of text from classical and modern dermatological works are reproduced here, and serve to give the reader a good impression of how varied different physicians’ approaches can be.
Modern clinical experience: This very useful section presents in a succinct way various clinical studies by modern dermatologists. Even though Professor Xu himself acknowledges that in many instances these studies do not meet research criteria in western medicine, their inclusion none the less gives the reader a very valuable taste of how different doctors approach treating the same skin disease.
The final section of the book is devoted to appendices, with a supplementary materia medica of ingredients along with combinations that are commonly used in dermatology, a list of acupuncture points, and the formulas for the external therapies that are mentioned in the book.
In summary, I felt that Dermatology in Traditional Chinese Medicine is a good, well laid out and easy to use textbook that is brimming with useful information just waiting to be discovered and put into practice. Professor Xu should be wholeheartedly congratulated for sharing with us his long experience and insights in such a modest and unassuming way, and in the process helping transmit the treasures of Chinese medicine to a wider audience. If you have any interest in dermatology at all, and you should, considering how common skin disease are, don’t hesitate for a moment to add this admirable book to your collection.
1. Physiology of the skin in traditional Chinese medicine
2. Etiology of skin disorders in traditional Chinese medicine
3. Pattern identification and treatment of skin disorders
Basic principles of pattern identification for skin disorders
Main methods for determining treatment
Disease patterns and determination of treatment
Main treatment methods
4. Eczema and dermatitis
Common patterns of eczema
Seborrheic eczema of the scalp and face
TCM treatment of eczema at particular body sites
5. Psoriasis and other papulosquamous disorders
Pityriasis rubra pilaris
6. Allergic disorders
7. Erythema and blood vessel disorders
Small vessel vasculitis
8. Bullous skin diseases
Epidermolysis bullosa acquisita
9. Viral infections of the skin
Common warts (verruca vulgaris)
Plane warts (verruca plana)
Plantar warts (verruca plantaris)
Herpes zoster (shingles)
10. Bacterial infections of the skin
Pyogenic paronchyia (whitlow)
Venous leg ulcers
Erythema induratum (Bazin's disease)
11. Fungal infections of the skin
Tinea capitis (ringworm of the scalp)
Tinea manuum (ringworm of the hands)
Tinea pedis (athlete's foot)
Tinea unguium (ringworm of the nail)
Tinea corporis (ringworm of the body)
Tinea cruris (jock itch)
Pityriasis versicolor (tinea versicolor)
12. Disorders of the sebaceous and sweat glands
13. Regional dermatology
Recurrent aphthous stomatitis
14. Neuro-functional deficient skin diseases
Pruritus in pregnancy
15. Pigment-deficiency skin diseases
16. Hereditary skin diseases
Keratosis follicularis (Darier's disease)
Keratosis palmaris and plantaris
17. Drug eruptions
18. Skin disorders due to physical agents
Chapped and fissured hands and feet
Miliaria rubra (prickly heat)
Erythema ab igne
Polymorphic light eruption
Decubitus sore (bedsore)
19. Infestations and bites
Insect bites and stings
Pediculosis (lice infestation)
20. Benign skin tumors
Nevus flammeus (birth mark)
Benign melanocytic nevi (moles)
External formulae with detailed ingredients, preparation and usage
Commonly used herbs for skin disorders
Commonly used acupoints for skin disorders
Glossary of TCM terminology
Occurrence of skin diseases by body region