'… looking for parallels of process is a trap for the unwary' (p. 61)
This is an innovative, thoughtful and thoroughly useful guide to conventional medicine (ConM) from the perspective of Chinese medicine (CM), by a GP who has trained and practised in both worlds. Based on the course developed by the author for the College of Integrated Chinese Medicine in the UK, it is very obviously an education tool. Each chapter includes a list of learning points, information boxes and self-tests. After introductory chapters on the medical sciences, conventional clinical practice and concepts of health and disease, the main part of the book takes the reader through the physiology, investigation and diseases of the major systems of the body. There is also good coverage of pregnancy and childbirth, children's health and mental health. A final chapter reviews 'red flags', withdrawing from pharmaceutical drugs, communicating with ConM practitioners and ethical issues. The book rounds off with 11 rather sparse pages of references and an excellent 35-page index (although occasionally technical terms are inadvertently omitted). The book is well illustrated, and comes with a CD-ROM.
The author's main premise is that constellations of symptoms and signs are common to both CM and ConM and provide the bridge between them, even if CM is more concerned with the underlying causes of imbalance and ConM more with the consequence comparisons made in the numerous summary boxes throughout the book are therefore between CM approaches that support underlying deficiency or otherwise rectify imbalance and ConM treatments that ignore these and are therefore 'suppressive'. Although the CM-based interpretations of ConM treatments are useful, after a while the litany of balance versus suppression becomes somewhat repetitive. For many conditions the only information given is a rather basic parsing based on the usual catechism of syndromes, while others are viewed as just a result of deficient Kidney jing (knowledge that may not be particularly useful in the clinic). The overall impression is that the CM perspective the author adopts is quite narrow, a Procrustean attempt to squeeze everything possible into the syndrome model. In addition, some of the attempts to find parallels between CM and ConM appear more than a little forced, such as the use of embryology in the discussion of how the deep pathway of the Kidney channel ending at the root of the tongue 'fits' with the relationship between the Kidney and thyroid function. In my view, embryology, like quantum theory in discussions of qi, can be invoked to justify almost anything.
Another minor criticism is that in the interests of completeness many conditions are included that most CM practitioners are very unlikely to meet (haemolytic uraemic syndrome, for instance). On the other hand, some are not covered in any great depth (e.g. TMJ, male infertility), and some well-known CM approaches are even omitted altogether (such as the use of moxa for breech presentation). In addition, there is often insufficient referencing to enable the reader to pursue particular topics further. In other instances there is overdependence on a very few source books, which are repeatedly and uncritically cited (particularly Scott and Barlow's Acupuncture in the Treatment of Children and Stephen Gascoigne's work on drugs). Furthermore, comments on the limitations of CM (e.g. in the treatment of psoriasis) are all too infrequent.
For a book that purports to appeal to all complementary therapists, the coverage of alternative treatments other than CM is in the main surprisingly patchy. Thus, despite its title, I suspect that practitioners of other complementary therapies who are unfamiliar with the language of CM may find coming to grips with this text rather a struggle (even if well worth the effort in the end). One major omission for such readers is a comprehensive glossary. Coverage of some ConM treatments is of course partial, for example the emphasis on cognitive behavioural therapy as the 'ideal' method for post traumatic stress disorder without mentioning other approaches such as mindfulness meditation for which there is now also good evidence. As this example shows, parts of this book will inevitably become outdated relatively rapidly as current ConM knowledge and treatments become superseded. However, for most of us -and for some years to come -the content will be more than adequate, providing sufficient knowledge to enable us to practise with greater assurance that we understand the ConM model of what we are treating and its implications for our own CM approach.
The CD-ROM that accompanies the book includes a useful 'image collection', some 'case studies' (which are not really case studies at all, but further self-tests with answers) and five appendices on CM organ correspondences, how to interpret the energetic action of drugs, 'red flags', tables of categories of drugs (in rather poky small print) and a detailed summary of all the topics in the book. This is all useful, but the publishers have missed a trick by not including the text of the book itself on the CD, which would then become a very handy and readily searchable aide-mémoire for clinical use (or revision). It would also make the whole thing easily updateable. Something else that could usefully be included would be easy-reference differential diagnostic tables – the material is all there in the book already, so it would not take much to put these together. Also although the CD-ROM is easy to install, if you are already running other software that uses the 'Java 2 runtime environment' – such as the CD-ROM that comes with Elsevier's Electroacupuncture textbook – you will not be able to access it. However, the most frustrating aspect of the CD-ROM is the cumbersome search method that is used (the same procedure as on the CD-ROM of Elsevier's Electroacupuncture). It is slow, clunky and will put off a lot of readers. Hopefully this will be changed in future editions.
This book is a major work, meticulous and methodical, and filled with an extraordinary amount of detail (it took me seven weeks of breakfast reading to get through it). Comprehensive and thorough, it will be useful to both students and practitioners of CM-related therapies.