JCM Review
The publication of the first volume of Will Maclean and Jane Lyttleton's Clinical Handbook of Internal Medicine is a substantial addition to the rapidly expanding literature on the practice of Chinese Medicine which I have no doubt will become an essential reference guide to students and existing practitioners alike.
This is the first of two volumes which aim to provide a comprehensive coverage of Internal Medicine ('Nei Ke'). Volume 1 covers disorders of the Lung, Kidney, Liver and Heart whilst Volume 2, to be published shortly, will complete the picture with disorders of the Spleen, the jingluo, and of qi, blood and fluids. The body of the text has been organised according to the traditional groups of TCM diseases ( 'bian bing') each of which is differentiated into syndromes ('bian zheng') and allocated to one of the zangfu. So, for example, under the broad rubric of Lung Disorders we have acute exterior diseases (including sections on 'shang han' and 'wen bing'), cough (including lung abscess ), wheezing ( including asthma), epistaxis, haemoptysis, loss of voice, sinusitis and nasal congestion, rhinitis, sore throat (including throat abscess) and tuberculosis. This format allows due respect to be given to the differentiations and insights of Western bio-medicine whilst structurally emphasising the value and comprehensive facility of traditional Chinese medicine. It also provides an excellent template for anyone aspiring to organise a truly high level undergraduate training programme. Whilst there may be quibbles about the allocation of specific diseases to certain organs, such as when epilepsy is described as a predominantly Liver disorder when some might include it as a dysfunction of the Heart, I think these are minor debates and don't really detract from the achievements of this work.
This book not only offers an extensive account of the traditional field of internal medicine but also makes its most significant contribution by moving from a deep and well referenced study of Chinese texts into an analysis which incorporates the clinical realities of the practice of TCM in the West. In the introduction the authors write of the importance of addressing the cultural, dietary and climatic milieu that practitioners in the West find themselves working within. The differences between clinical experiences within China and the kind of experience that most of us have in our own clinics is often noted, but this is the first clinical textbook in my experience that systematically takes this into account when discussing the treatment of a broad range of disease processes. Thus for example when discussing the treatment of tuberculosis ('fei lao') the authors acknowledge the primacy of Western antibiotics in the elimination of the tuberculosis bacilli and as a consequence orientate the text to Chinese medical nterventions which provide appropriate constitutional support to complement the use of antibiotics and also to provide symptomatic relief of some of the distressing symptoms of TB, such as night sweats, which are responsive to TCM treatment. This is a mature, practical and effective approach which accurately reflects my own experience in treating people with TB and is consistently applied throughout the book.
Each of the 33 chapters in Volume 1 explores a traditional disease category such as painful urination or hypochondriac pain and begins with a useful revision of the aetiological and pathological processes underlying the condition, supplemented by boxes of additional information, and summarised by usefully pithy diagrams. There is a short section on treatment approaches which provides a helpful overview of clinical management including prioritising certain interventions in the course of the disease, offering lifestyle advice and making recommendations as to when particular patients need to be referred for western bio-medical assessment. The text then highlights the clinical features of each disease and makes detailed recommendations for treatment. These follow the standard pattern of starting with a classical (but frequently modified) herbal formula and proceeds to an excellent section covering additional modifications addressing a variety of possible clinical developments. There is a section on patent medicines, and last is a section on acupuncture treatment. Finally there are 'clinical notes' which broadly correlate the TCM patterns to bio-medical disease categories, and also develop some ideas of clinical management mentioned earlier with a particular and much welcomed emphasis on the likely prognosis with TCM intervention.
I found the format very practical, easy to reference and full of interesting and clinically relevant information. The herbal treatments suggested are excellent and I particularly liked the guidelines given on dosages which vary from the modest to the massive according to the nature of the herb and the presenting condition. This is one of the thorniest issues in Chinese herbal practice in the West at the moment, revolving around questions of safety and efficacy, but whilst we must aim to use the minimum necessary dosage there are times when a heavy dosage is absolutely essential to achieve a therapeutic effect. In addition the text highlights herbs with potentially toxic side effects and those which may belong to endangered species and summarises this information in two appendices at the back of the book.
Even so, I think safety considerations are still slightly lacking and the section on toxic herbs excluded some herbs such as Wu Zhu Yu (Fructus Evodia) and Guang Fang Ji (Radix Aristolochiae) which are worthy of mention and more worryingly Zhu Sha (Cinnabaris) which despite possibly accumulating in the body to cause mercury poisoning, is still recommended for short term use in the text. In addition I could find no mention of the possibility of idiosyncratic reactions to Chinese herbs which can lead to rare but potentially fatal reactions.
A more serious weakness of the book which I think will be difficult to remedy is the relative poverty of information on acupuncture treatment. Whilst the authors explain their reasons for this in the introduction it is a shame that the section on acupuncture is little more than a list of indicated points with no real attempt made to describe the dynamic use of acupuncture in the resolution of diseases. Although acupuncturists will benefit from the excellent analysis and differentiation of diseases into syndromes they will probably not learn too much from the treatment protocols offered.
This book has to be compared with the two other leading lights in the comprehensive textbook field, Maciocia's Practice of Chinese Medicine and Wu and Fischer's Practical Therapeutics of Traditional Chinese Medicine. In many ways it combines the best of both of them having the same depth of analysis as Maciocia but also having the greater breadth that is available in Wu and Fischer. Maciocia gives more space to explaining the function of individual herbs and herbal formulas and is definitely more forthcoming in his sections on acupuncture and as such is probably better for the student of Chinese medicine but personally I have found the clinical pragmatism and the treatment guidelines for managing diseases to be more relevant in the Clinical Handbook under review.
Similarly whilst Wu and Fischer cover broader territory than both the other books, their work is seriously limited by staying firmly within the confines of TCM as practised in China without any reference to the changing circumstances of TCM in the West. One area in which I find all three books frustratingly limited is in the almost complete absence of any details of contemporary research information into TCM treatments. There is a wealth of such material which, despite some methodological flaws, could provide really useful information to guide and develop our clinical practice and should surely be included in these basic textbooks.
Despite these reservations, I think this is an excellent book and I am sure it will become an essential text for the practice of Chinese medicine, particularly in its herbal guise, throughout the Western world. It combines a thoroughness and depth of study with clinically focused material and a maturity of approach that is both welcome and inspiring. In the introduction the authors actively invite feedback both on the text and also from practitioners' own experience in the treatment of disease with the intention of developing the book to 'represent the collective voice of TCM practitioners in the West'. I hope this process of active revision and inclusion does occur as I think the benefits are potentially huge. This is a small step in the history of Chinese medicine but a great leap forward for its practice in the Western context.
Andrew Flower
Contents
Acknowledgements xvii
Foreword xviii
Translation and Terminology xx
Introduction xxi
Part 1. Lung Disorders
1. Acute Exterior Disorders (gan mao) 2
1.1 Wind Cold 6
1.2 Wind Heat 9
1.3 Summer Heat and Dampness 11
1.4 Wind Dryness 14
1.5 Exterior Wind Cold with Interior Heat 16
1.6 Exterior Disorders with deficiency 18
1.6.1 Qi deficiency (and external Wind) 18
1.6.2 Yang deficiency (and external Wind Cold) 21
1.6.3 Blood deficiency (and external Wind) 23
1.6.4 Yin Deficiency (and external Wind) 25
Summary of guiding formulae for acute exterior disorders 27
Appendix :Warm Diseases (wen bing) 28
1. Wei level 28
2. Qi level 28
2.1 Heat in the Lungs 28
2.2 Heat accumulating in the Stomach and Intestines
(yang ming) 30
2.2a Heat in the yang ming channels 30
2.2b Heat and Phlegm in the chest and yang ming 31
2.2c Strong Heat in yang ming with constipation 32
2.2d Damp Heat in yang ming 33
2.3 Heat lingering in the chest and diaphragm 35
3. Ying level 36
3.1 Heat entering the Pericardium 36
3.2 Heat obstructing the Pericardium 37
4. Blood level 39
4.1 Heat causing the Blood to move recklessly 39
4.2 Hot Blood and Blood stasis 40
Appendix :Febrile diseases caused by Cold (shang han) 43
1. Tai yang syndromes 45
1.1 Tai yang channel syndrome 45
1.2 Tai yang organ syndrome 46
1.3 Wind Cold with retention of Phlegm Dampness 47
1.4 Wind Cold with pre-existing internal Heat 48
2. Shao yang syndrome 50
3. Yang ming syndrome 51
4. Tai yin syndrome 52
5. Shao yin syndromes 54
5.1 Heart and Kidney yin deficiency 54
5.2 Heart and Kidney yang deficiency 55
6. Jue yin syndromes 58
6.1 Classical presentation 58
6.2 Jue yin channel syndrome 59
2. COUGH (ke sou) 64
2.1 Wind Cold 70
2.2 Wind Heat 73
2.3 Wind and Dryness 76
2.4 Lung Heat 80
2.5 Phlegm Damp 82
2.6 Phlegm Heat 85
27 Liver Fire Invading the Lungs 88
2.8 Lung yin Deficiency 91
2.9 Lung qi Deficiency 95
2.10 Kidney (and Spleen) yang deficiency 97
2.11 Blood stagnation 99
Summary of guiding formulae for cough 101
Appendix :Lung Abscess (fei yong) 102
1. Early Stage 103
2. Middle Stage (suppuration, rupture stage) 105
3. Convalescent Stage 107
3. WHEEZING (xiao chuan) 110
3.1 Wind Cold 114
3.2 Wind Cold with Phlegm Fluids 116
3.3 Wind Cold with Internal Heat 118
3.4 Wind Heat 120
3.5 Phlegm Damp 123
3.6 Phlegm Heat 127
3.7 Qi Stagnation damaging the Lungs 130
3.8 Lung qi and yin deficiency 133
3.9 Lung and Spleen qi deficiency 135
3.10 Lung and Kidney yin deficiency 138
3.11 Kidney yang deficiency 141
Summary of guiding formulae for wheezing 145
Appendix :Asthma 146
Appendix :Paediatric Asthma 148
4. EPISTAXIS (bi n') 156
4.1 Wind Heat, Lung Heat 160
4.2 Toxic Heat 162
4.3 Stomach Heat 164
4.4 Liver Fire 166
4.5 Liver and Kidney yin deficiency 169
4.6 Spleen qi deficiency 171
Summary of guiding formulae for epistaxis 173
5. haemoptysis (ke xue) 176
5.1 Wind Heat 179
5.2 Dryness affecting the Lungs 181
5.3 Wind Cold 183
5.4 Lung Heat 185
5.5 Phlegm Heat 187
5.6 Liver Fire 189
5.7 Lung and Kidney yin deficiency with Heat 193
5.8 Spleen qi deficiency 196
Summary of guiding formulae for haemoptysis 198
6. loss of voice (hoarse voice) (shi yin) 200
6.1 Wind Cold 204
6.2 Wind Heat 206
6.3 Lung Dryness 210
6.4 Phlegm Heat 212
6.5 Liver qi stagnation 214
6.6 Lung and Kidney yin Deficiency 216
6.7 Lung and Spleen qi Deficiency 218
6.8 Qi, Blood and Phlegm Stagnation 220
Summary of guiding formulae for loss of voice and hoarse voice 222
7. SINUSitis and nasal CONGESTION (bi yuan) 224
7.1 Wind Cold 228
7.2 Wind Heat 230
7.3 Liver qi Stagnation With Stagnant Heat 232
7.4 Liver and Gall Bladder Fire 234
7.5 Phlegm Heat 236
7.6 Lung qi deficiency 239
7.7 Spleen qi deficiency 242
7.8 Kidney deficiency 245
7.9 Blood stagnation 248
Summary of guiding formulae for sinusitis and nasal congestion 250
8. rhinitis (bi qiu) 252
8.1 Wind Cold 255
8.2 Lung qi deficiency 258
8.3 Lung and Spleen qi deficiency (with Phlegm) 261
8.4 Kidney deficiency 264
Summary of guiding formulae for rhinitis 268
9. sore throat (hou bi) 270
9.1 Wind Heat 272
9.2 Lung and Stomach Heat 276
9.3 Lung and Kidney yin deficiency 279
9.4 Spleen qi deficiency 283
Summary of guiding formulae for sore throat 286
Appendix :Throat abscess (hou yong) 287
10. tuberculosis (fei lao) 292
10.1 Lung yin Deficiency with Heat 296
10.2 Lung and Kidney yin deficiency 298
10.3 Qi and yin Deficiency 300
10.4 Yin and yang both deficient 302
10.5 Symptomatic treatment 304
10.5.1 Nightsweats, spontaneous sweating 304
10.5.2 Bone steaming, tidal fever 305
10.5 3 Haemoptysis 305
10.5.4 Cough 306
10.5.5 Chest pain 306
Part 2. Kidney Disorders
11. LOWer BACK PAIN (yao tong) 308
11.1 Cold Damp 314
11.2 Damp Heat 317
11.3 Wind (Damp, Cold or Heat) 319
11.4 Blood stagnation 323
11.5 Liver qi stagnation 325
11.6 Spleen Damp 327
11.7 Kidney deficiency 330
Summary of guiding formulae for lower back pain guiding formulae 333
12. Painful urination SYNDROME (lin zheng) 336
12.1 Heat Painful Urination Syndrome 342
12.1.1 Damp Heat 342
12.1.2 Heart Fire 346
12.1.3 Liver Fire 348
12.2 Stone Painful Urination Syndrome 350
12.2.1 asymptomatic stones 350
12.2.2 stones with Damp Heat 353
12.2.3 stones with Blood stagnation 355
12.2.4 stones with Kidney Deficiency 356
12.3 Qi Painful Urination Syndrome 360
12.3.1 Liver qi stagnation 360
12.4. Blood Painful Urination Syndrome 362
12.4.1 Heat, Damp Heat 362
12.4.2 Blood stagnation 365
12.4.3 Kidney yin deficiency 367
12.5 Cloudy Painful Urination Syndrome 369
12.5.1 Damp Heat 369
12.5.2 Kidney qi deficiency 371
12.6 Exhaustion painful urination syndrome 373
12.6.1 Kidney deficiency 373
12.6.2 Spleen Qi deficiency 377
12.6.3 Heart and Kidney qi and yin deficiency 379
Summary of guiding formulae for painful urination guiding formulae 381
13. cloudy Urination (niao zhuo) 384
13.1 Damp Heat 386
13.2 Spleen qi deficiency with sinking qi 388
13.3 Kidney yin deficiency 390
13.4 Kidney yang deficiency 392
Summary of guiding formulae for cloudy urination guiding formulae 395
14. difficult urination and urinary retention
(long bi) 398
14.1 Damp Heat 402
14.2 Obstruction of Lung qi 405
14.3 Liver qi stagnation 408
14.4 Blood stagnation 411
14.5 Spleen yang deficiency 413
14.6 Kidney yang deficiency 416
14.7 Kidney yin deficiency 419
Summary of guiding formulae for difficult urination and
urinary retention 421
15. Frequent urination and incontinence
(yi niao) 412
15.1 Damp Heat 428
15.2 Liver qi stagnation 430
15.3 Kidney (qi) yang deficiency 433
15.4 Kidney yin deficiency 436
15.5 Spleen (and Lung) qi deficiency 438
Summary of guiding formulae for frequent urination and
incontinence of urine 440
16. Haematuria (niao xue) 442
16.1 Damp Heat 446
16.2 Heart Fire 449
16.3 Liver Fire 451
16.4 Blood stagnation 453
16.5 Kidney yin deficiency with Heat (Fire) 456
16.6 Spleen and Kidney yang (qi) Deficiency 458
Summary of guiding formulae for haematuria 460
17. IMPOTENCE (yang wei) 462
17.1 Liver qi stagnation 465
17.2 Damp Heat 467
17.3 Kidney yang Deficiency 470
17.4 Kidney yin deficiency 472
17.5 Heart Blood and Spleen qi deficiency 475
17.6 Heart and Gall Bladder qi deficiency 477
Appendix :Nocturnal Seminal Emission (yi jing) 479
Summary of guiding formulae for impotence and nocturnal seminal emission 486
18. Tinnitus and Deafness (er ming, er long) 488
18.1 Wind Heat 492
18.2 Liver qi stagnation 495
18.3 Liver Fire 497
18.4 Phlegm Heat (Fire) 500
18.5 Blood Stagnation 503
18.6 Kidney deficiency 505
18.7 Spleen qi deficiency (with Phlegm Damp) 508
18.8 Qi and Blood deficiency 511
Summary of guiding formulae for tinnitus and deafness 513
Part 3. Liver Disorders
19. Dizziness, vertigo (xuan yun) 516
19.1 Liver qi stagnation 522
19.2 Liver yang rising, Liver Fire 524
19.3 Liver and Kidney yin deficiency with yang rising 527
19.4 Phlegm Damp 530
19.5 Blood stagnation 534
19.6 Qi and Blood deficiency 536
19.7 Kidney deficiency 539
Summary of guiding formulae for dizziness 543
20. hypochondriac pain (xie tong) 546
20.1 Liver qi stagnation 548
20.2 Damp Heat in the Liver and Gall Bladder 553
20.3 Liver yin (Blood) deficiency 555
20.4 Blood stagnation 558
Summary of guiding formulae for hypochondriac pain 561
Appendix :Gallstones (dan shi bing) 562
21. Jaundice (huang dan) 570
21.1 Damp Heat (Heat greater than Dampness) 574
21.2 Damp Heat (Dampness greater than Heat) 577
21.3 Damp Heat with exterior symptoms
(early stage external Damp Heat) 579
21.4 Liver and Gall Bladder stagnant Heat
(Bile duct obstruction with Heat) 581
21.5 Toxic Heat 583
21.6 Cold Damp 586
21.7 Spleen qi and Blood deficiency 588
21.8 Blood stagnation 590
Summary of guiding formulae for jaundice 592
22. shan qi (shan qi) 594
22.1 Cold shan qi 596
22.2 Watery shan qi 598
22.3 Liver qi stagnation shan qi 601
22.4 Qi deficiency shan qi 603
22.5 Foxy shan qi 605
24.6 Phlegm and Blood stagnation shan qi 607
Summary of guiding formulae for shan qi 609
23. tremors (chan zheng) 612
23.1 Liver and Kidney yin deficiency 614
23.2 Qi and Blood deficiency 617
23.3 Phlegm Heat generating Wind 620
Summary of guiding formulae for tremor 622
24. wind stroke (zhong feng) 624
Channel syndromes 630
24.1 Emptiness of the channels with Wind invasion 630
24.2 Liver and Kidney yin deficiency with rising Liver yang and Wind 633
24.3 Phlegm Heat with Wind Phlegm 636
Organ syndromes 638
24.4 Closed syndrome 638
24.4.1 Yang closed syndrome 638
24.4.2 Yin closed syndrome 640
24.5 Flaccid collapse syndrome 643
Sequelae of Wind stroke 645
24.6 Hemiplegia 645
24.6.1 Qi deficiency with Blood stagnation 645
24.6.1 Liver yang rising with Blood stagnation 646
24.7 Dysphasia 649
24.7.1 Wind Phlegm 649
24.7.2 Liver and Kidney yin and yang deficiency 650
24.8 Facial paralysis 652
Summary of guiding formulae for Wind stroke 654
25. Epilepsy (dian xian) 656
25.1 Yang seizures 661
25.2 Yin seizures 664
25.3 Spleen deficiency with Phlegm 666
25.4 Liver Fire with Phlegm Heat 669
25.5 Liver and Kidney yin deficiency 672
25.6 Blood stagnation 674
Summary of guiding formulae for epilepsy 677
26. spasms, convulsions (jing bing) 680
26.1 Febrile convulsions 683
26.1.1 Acute phase 683
26.1.2 Post acute phase (yin and Blood deficiency) 688
26.1.3 Post acute phase (Chronic childhood convulsions due to Spleen yang deficiency) 691
26.2 Wind Toxin tetany (Muscular tetany) 693
26.3 External Cold Damp (Damp Heat) 695
26.4 Phlegm obstruction 697
26.5 Blood stagnation 699
26.6 Qi and Blood deficiency 701
Summary of guiding formulae for convulsions and spasms 703
27. ascites (drum like abdominal distension) (gu zhang) 706
27.1 Qi and Damp stagnation 709
27.2 Cold Damp 711
27.3 Damp Heat 713
27.4 Blood stagnation 716
27.5 Spleen and Kidney yang deficiency 718
27.6 Liver and Kidney yin deficiency 720
Summary of guiding formulae for ascites 722
Part 4. Heart Disorders
28. chest Pain (xiong bi) 724
28.1 Heat scorching and knotting the chest 737
28.2 Phlegm obstruction 740
28.3 Liver qi stagnation 746
28.4 Cold congealing Heart Blood circulation 750
28.5 Heart yang deficiency 753
28.6 Blood stagnation 756
28.7 Heart (Lung and Spleen) qi deficiency 759
28.8 Heart (and Kidney) yin deficiency 761
Summary of guiding formulae for chest pain 767
29. Palpitations (jing ji 智', zheng chong) 770
29.1 Heart qi deficiency 775
29.2 Heart yang deficiency 777
29.3 Heart yin deficiency 780
29.4 Heart Blood and Spleen qi deficiency 784
29.5 Heart and Gall Bladder qi deficiency 787
29.6 Phlegm Heat 789
29.7 Spleen and Kidney yang deficiency 792
29.8 Blood Stagnation 795
Summary of guiding formulae for palpitations 798
30. Insomnia (bu mei) 800
30.1 Liver qi stagnation, stagnant Heat, Fire 808
30.2 Heart Fire 812
30.3 Stomach disharmony 815
30.4 Phlegm Heat 817
30.5 Blood stagnation 820
30.6 Heart Blood and Spleen qi deficiency 823
30.7 Heart and Kidney yin deficiency 826
30.8 Heart and Gall Bladder qi deficiency 829
30.9 Liver yin (Blood) deficiency 831
Summary of guiding formulae for insomnia 833
31. somnolence (duo mei) 836
31.1 Dampness wrapping the Spleen 838
31.2 Phlegm obstruction 840
31.3 Blood stagnation 842
31.4 Spleen qi (and Blood) deficiency 844
31.5 Spleen and Kidney yang deficiency 846
Summary of guiding formulae for somnolence 848
32. forgetfulness (jian wang) 850
32.1 Heart Blood and Spleen qi deficiency 853
32.2 Heart and Kidney yin deficiency 856
32.3 Kidney jing deficiency 859
32.4 Blood and Phlegm stagnation 861
Summary of guiding formulae for forgetfulness 864
33. anxiety (you l') 866
33.1 Heart qi deficiency 871
33.2 Heart and Kidney yin deficiency 873
33.3 Heart Blood and Spleen qi Deficiency 876
33.4 Heart qi and yin deficiency 879
33.5 Heart and Gall Bladder qi deficiency 881
33.6 Phlegm Heat 883
Summary of guiding formulae for anxiety 885
Appendix A Original unmodified formulae 886
Appendix B Processing methods for herbs; modifications to prescription; herbs that require special treatment 906
Appendix C Delivery methods for herbal medicine 910
Appendic D Herbs contraindicated during pregnancy 914
Appendix E Incompatible and Antagonistic herbs 916
Appendix F Toxic herbs 917
Appendix G Medical substances derived from endangered species 920
Appendix H Medical substances derived from animals 922
Index 925
Source texts and references 966
