Fluid Physiology And Pathology In Chinese Medicine 2nd Edition

JCM Review

The development of Chinese Medicine in the West has entered a new stage in the past few years. There are many good colleges of acupuncture and Chinese herbal medicine throughout the world and several textbooks about the basic theories of Chinese medicine have been published. The next stage of development will require on the one hand the translation of the Chinese medical classics (a process already started), and on the other hand, good-quality textbooks about the clinical experience of practitioners in the West. A book that combines both these aspects, i.e. scholarly translation of Chinese classics together with their application to Western clinical conditions by an experienced practitioner is very rare indeed. Fluid Physiology and Pathology in Traditional Chinese Medicine is such a book. Steve Clavey deals with this important aspect of Chinese medicine by referring to ancient and modern Chinese books and integrating this centuries-old knowledge with modern clinical experience, thus bringing the old classics truly to life. There are other books with scholarly translations of some of the classics but most of them have been written by non-practising sinologists using an idiosyncratic terminology. Steve Clavey, on the contrary, while possessing the same scholarship, brings the old classics to life by demonstrating their application to a modern Western clinical setting and also by adopting a very pragmatic and non-dogmatic approach to terminology. The subject of the book is the physiology and pathology of body fluids in Chinese medicine. The physiology of jin ye is explained in a detail not seen before in English-language texts. He discusses the nature of jin ye, their relationship with qi, blood, essence and, interestingly, shen. There is then a discussion of the pathology of various types of fluids such as tears, saliva, and nasal mucus, again never before discussed in English. The physiology, pathology and treatment of sweating, urination and oedema are considered in depth, for example lack of perspiration, spontaneous perspiration, night sweats, yellow sweat, perspiration partially obstructed, perspiration from the head, sweating on the chest, sweating from hands and feet and underarm sweating. The most important part of the book is bound to be the discussion of thin mucus (yin ), phlegm and dampness. The chapter on phlegm in particular is the deepest discussion of this important pathogenic factor ever to appear in English. Clavey discusses the pathogenesis of phlegm and its differentiation in many different manifestations such as cold phlegm, phlegm-heat, wind-phlegm, qi-phlegm, damp-phlegm, stagnation-phlegm, and parched-phlegm. Apart from discussing in detail the pathogenesis of the usual phlegm symptoms and signs, the author also lists the interesting "constitutional indications of phlegm" again with a detailed explanation of each. These are not usually discussed in other books and include manifestations such as "eye movements are lackadaisical, eye sockets are dark, exudate in the corner of the eyes, heavy-set with thick fingers and hands", etc. He then discusses in great detail the various methods for the treatment of phlegm. An important feature of this chapter is the clear differentiation made between phlegm (tan ), thin mucus (yin ) and water (shui ) as pathogenic factors. The book discusses only the herbal treatment (with a few exceptions) of fluid pathology. The author is eager to stress that this does not represent an "anti-acupuncture bias"; in an interesting note at the end of the introduction he actually asserts that acupuncture is "more difficult" to practise than herbal medicine. Although the book only deals with herbal treatment, however, I would strongly recommend it to acupuncturists as well because it enhances our understanding of the pathogenesis of fluid problems in Chinese medicine. For those who do use Chinese herbs, I would say this book is essential reading as it provides an invaluable discussion of the various methods of treatment for different types of phlegm and dampness. For example, the author discusses six methods of expelling dampness and each of them is examined in great detail with representative formulae and herbs. For those interested in the classics, there is a translation of important sections from various classics at the end of each chapter and a very interesting historical overview of the development of the concept of phlegm in Chinese medicine. The case histories given in the text are interesting and relevant to the subject discussed. Particularly interesting is the case history illustrating the difference between damp-heat arising by itself and the damp-heat arising from the Liver channel. Do not miss the end notes which contain many nuggets of information. For example I was particularly absorbed by the discussion of how to translate the function of bie shi of the triple burner in relation to the yuan qi . Bie shi is normally translated as "special envoy" (i.e. the triple burner is the "envoy" of the yuan qi emerging from in between the kidneys) whereas Clavey proposes that it should be translated as "one who makes separation happen", i.e. the triple burner makes the yuan qi separate into its different uses around the body. Another interesting observation buried in the end notes is the author's stress on the importance of a correct bian bing ( identification of the Chinese disease) in addition to bian zheng ( identification of patterns or differentiation of syndromes). He asserts that even if the bian zheng is correct, without bian bing the focus of treatment will be skewed. The only slight blot on this excellent book is the curious absence of an index. I noticed this as I wanted to look up mingmen and could not do so. Giovanni Maciocia

Contents

Preface Foreword Introduction 1 Fluid physiology in traditional Chinese medicine Basic concepts Jin-ye Qi transformation Normal fluid metabolism Fluid metabolism processes The interwoven process Role of zang and fu organs Spleen and Stomach Mutual tonification of Spleen and Kidneys San Jiao Lungs Small Intestine and Large Intestine Kidneys Urinary Bladder Definition of Jin-ye Ye fluids Jin fluids Role of jin and ye fluids Qi and jin and ye fluids Qi and fluid production Qi and fluid movement and transformation Blood and jin and ye fluids Jin and ye fluids and breast milk Jing-essence and jin and ye fluids Shen (spirit) and jin and ye fluids Classical essay 2 Fluids of the Five Zang organs Physiology Physiology of the Five Fluids Sweat is the fluid of the Heart Tears are the fluid of the Liver Watery saliva (xian) is the fluid of the Spleen Mucoid saliva (tug) is the fluid of the Kidneys Nasal mucus is the fluid of the Lungs Summary Clinical differentiation and treatment Differentiation and pathological lacrimation Common symptom patterns Differentiation and treatment Formulas Summary Excessive mucoid saliva Common symptom patterns Differentiation Formulas Summary Differentiation of drooling Common symptom patterns Differentiation Formulas Excessive nasal mucus Common symptom patterns Differentiation Formulas Summary 3 Sweat Physiology Pathology Lack of sweating Sweating Treatment Principle of treatment Differentiation and treatment of abnormal sweating Lack of perspiration Common symptom patterns Differentiation and treatment Formulas Summary Spontaneous perspiration Common symptom patterns Differentiation of patterns Formulas Summary Nightsweats Common symptom patterns Differentiation Formulas Summary Yellow sweat Common symptom patterns Differentiation Formulas Summary Perspiration partially obstructed Common symptom patterns Differentiation Formulas Summary Perspiration from the head Common symptom patterns Differentiation Formulas Summary Sweating on the chest Common symptom patterns Differentiation Formulas Classical comments Sweating from the hands and feet Common symptom patterns Differentiation Formulas Summary Classical comments Underarm sweating Common symptom patterns Differentiation Formulas Classical comments Sweat and acupuncture Classical essays 4 Urination Physiology Mingmen Kidney qi consolidation Pathology Abnormalities in the amount of urine Abnormalities in frequency Abnormalities in the sensations of urination Differentiation of urinary symptoms Darkish urine Common symptom patterns Differentiation Formulas Summary Cloudy urine Common symptom patterns Differentiation Formulas Summary Clear profuse urination Common symptom patterns Differentiation Formulas Difficult urination Common symptom patterns Differentiation Formulas Summary Obstructed urination Common symptom patterns Differentiation Formulas Classical comments Frequent urination Common symptom patterns Summary Terminal dribbling Common symptom patterns Differentiation Formulas Summary Urinary incontinence Common symptom patterns Differentiation Formulas Case history Nocturia Common symptom patterns Differentiation Formulas Enuresis Common symptom patterns Differentiation Formulas Summary Painful urination Common symptom patterns Differentiation Formulas Summary Blood in the urine Common symptom patterns Differentiation Formulas Summary Spermaturia Common symptom patterns Differentiation Formulas Classical essay 5 Edema Pathology Pathological mechanisms Exogenous (external) pathogens Endogenous (internal) pathogens Pathogenic excess Functional deficiencies Interaction of qi, blood and fluids Differentiation and treatment Common symptom patterns Differentiation Formulas Differentiations of edema in classical literature Differentiation of yin edema and yang edema Differentiation of the 'five edemas' Special categories Classical treatments Zhang Zhong-Jing: diaphoresis and diuresis Zhu Dan-Xi: tonify Spleen and Lung, harmonize Liver Zhang Jing-Yue: Kidney yang is the basis Specific treatments and formulas Acupuncture treatment Yang edema Explanation Yin edema Explanation Treatment of the 'Five Edemas' (wu shui) Wind-edema (fen" shui) Skin-edema (pi shui) Righteous-edema (zheng shui) Stone-edema (shi shui) Yellow sweat (huang hen) Treatment of qi edema Treatment of xue fen (blood separation) Treatment of shui fen (water separation) Historical overview Classical essays 6 Thin mucus syndromes Pathology Categories of thin mucus syndromes History Types of thin mucus syndrome and treatment Thin mucus in the Stomach and Intestines Formulas Thin mucus in the hypochondrium Formulas Thin mucus in the limbs Formulas Thin mucus above the diaphragm Formulas Case history 7 Phlegm: etiology and symptomatology Concept of phlegm in TCM Scope of phlegm influence Summary Role of zang organs Brief review of fluid metabolism Introduction to phlegm pathology Individual zany organ activity Lungs Spleen Kidneys San Jiao L.iver The Heart Summary Constitutional indications Case history ypical phlegm symptoms Explanation of the special characteristics Vertigo, headache and heavy head Nausea, vomiting, borborygmus; sticky greasy feeling Intermittent plum-stone throat Difficulty swallowing; vomiting of thin phlegm Chronic chest tightness and stuffiness Palpitations, anxiety, easily startled; insomnia Heavy body, low grade fever; or subjective fever only Sores and ulcers, or tissue necrosis with weeping Stuffy chest, distended or cool feeling in the back Masses or nodes Raw pain in the mouth Subcostal swelling and fullness Variable pulse manifestations Summary Combination of phlegm and other pathogens Other common phlegm combinations Case history Different treatment methods in phlegm conditions 8 Phlegm treatment: principles and methods Approaches to phlegm treatment Root treatments Restoring normal transformation and transportation Formulas Tonifying Spleen and Kidney yang Formulas Warming Kidney yang to support Urinary Bladder Formulas Tonifying yin fluids Formulas Cooling heat, restoring qi flow and transforming phlegm Formulas Branch treatments Warm transformation of thin mucus Formulas Attack to expel thin mucus Formulas Unblocking the surface to transform thin mucus Formulas Transforming phlegm to settle dyspnea Formulas Transforming phlegm to stop cough Formulas Transforming phlegm to disperse nodular masses Formulas Removing food stagnation to eliminate phlegm Formulas Transforming phlegm and extinguishing wind Formulas Transforming phlegm to calm the Heart Formulas Transforming phlegm to open painful chest obstruction Formulas Expelling phlegm to settle epilepsy Formula Scouring phlegm to relieve depression Formulas Draining fire to eradicate phlegm Formulas Transforming phlegm to open the orifice of the Spirit Formulas Scouring phlegm to calm the shen Formula Breaking up phlegm to restore consciousness Formula Cutting phlegm to open the collaterals Formulas Summary of phlegm treatment methods Knowledge of the mechanism is essential Formulas Herbs used in phlegm treatments Xuan Fu Hua (Inulae, Flos) Hou Po (Magnoliae Officianalis, Cortex) Zhi Shi (Citri seu Ponciri Immaturis, Fructus) Bing Lang (Arecae Catechu, Semen) Du Huang (Rhei, Rhizoma) Zi Su Zi (Perillae Fructescentis, Fructus) Lai Fu Zi (Raphani Sativi, Semen) Zao Jiao (Gleditsiae Sinensis, Fructus) Wei I.ing Xian (Clemetidis Chinensis, Radix) Xuan Shen (Scrophulariae Ningpoensis, Radix) Yu Jin (Curcumae, Tuber) Bai Jie Zi (Sinapsis Albae, Semen) Mai Ya (Hordei Vulgaris Germinantus, Fructus) Classical essays Case history 9 Damp Etiology of pathogenic damp Nature of damp Damp is 'heavy' and 'turbid' Illnesses caused by damp tend to be chronic The pathological development of damp disease Damp harms yang Damp can cause a wide range of problems Damp tends to combine with other pathogens Exogenous damp is a seasonal pathogen Basic principles for expelling endogenous damp Transformation Parching Diuresis Six methods for the expulsion of damp Discussion of damp treatment methods Expulsion of damp with sweet and bland flavors Formulas Summary Cooling diuresis Fragrant transformation of damp Formulas Bitter-warm parching of damp Formulas The use of wind-dispersing herbs to expel damp Formulas Strengthening yang to transform damp Formulas Herbs to expel damp Herbs to expel surface damp Herbs to expel wind damp Diuretic herbs Bland diuretics Bitter-cold diuretics Herbs for fragrant transformation of damp Parching herbs Herbs for pungent-warm parching of damp Herbs for bitter-cold parching of damp 10 Damp-heat Pathology Special points in damp-heat diseases Strong seasonal character Relatively prolonged course of disease Combination of damp and heat symptoms Obvious obstruction of Spleen and Stomach function Damp-heat etiology and pathological mechanisms Etiology of damp-heat disease Origins of damp-heat Exogenous damp-heat Case history Endogenous damp-heat Endogenous and exogenous factors combined Damp and heat produce each other Pathology of damp-heat disease Entry of damp-heat pathogens Pathogenic damp-heat is frequently toxic Damp-heat easily damages the Spleen and Stomach Damp-heat easily blocks the qi mechanism Damp-heat easily influences fluid metabolism Damp-heat entering the blood Damp-heat easily creates phlegm Symptoms of damp-heat Low grade fever Afternoon fever Chest obstruction Thirst without desire to drink Lack of appetite and ability to eat Heaviness of head and body Scanty, dark, difficult urination Loose but difficult passage of stool Nausea and vomiting Abdominal distention Signs of damp-heat Thick greasy tongue coat No specific pulse Miliaria crystalline Principles of damp-heat treatment Differentiate which pathogen is mild and which is serious Distinguish the location of the problem Open San Jiao qi movement To treat the root, seek the source Fundamental methods of herbs used in damp-heat treatment Promoting Lung qi flow to transform damp Combining pungent flavors to open Using bland flavors to promote urination and leach out damp Using fragrance to transform damp Strengthening Spleen to parch damp Opening the flow of yang qi to transform damp Using bitter-cold flavors to clear heat and dry damp Clearing heat and relieving toxi"city" Cooling and moving the blood Contraindications in the treatment of damp-heat disease Pungent-warm diaphoresis Bitter-cold purging Moist greasy tonics Sweet-warm obstructing tonics Dietary contraindications Appendices 1 Origin and development of phlegm theory 2 Major contributors to phlegm theory 3 Clinical manifestations of phlegm 4 Clinical manifestations of damp 5 Major writers 6 Bibliography