JCM Review
"A Handbook of Modern Chinese Hematology is an invaluable contribution to the field of Chinese medicine. The discussion of diseases is comprehensive, user-friendly and clinically relevant in today's TCM practice".
Dagmar Ehling, DOM, author of The Chinese Herbalist's Handbook
"An invaluable and inspiring reference source; highly recommended for both practitioners of Chinese medicine and Western medicine".
Yali Fan, OMD, author of Chinese Pediatric Massage Therapy
"Simon Becker offers the first comprehensive discussion of Western blood pathology through TCM theory, demonstrating that Chinese medicine provides an effective method of reducing side effects and enhancing Western treatments. A must for primary care practitioners."
Leah Martino, OMD, Past Editor in Chief, California Journal of Oriental Medicine.
Chinese medical hematology is a specialised field within Chinese medicine ' at least as much so as paediatrics, geriatrics and gynaecology. Simon Beckers' interest was first stimulated when he was lucky enough to intern with Dr. Sun Wei-zheng, the head of the hematology department at the Heilongjiang University of Chinese Medicine. Enthused by the successful treatments he observed in Dr. Sun's clinic, the author began to systematically research and collect material derived from Dr. Sun's teaching, his own clinical experience, many recent articles from Chinese medical journals and various Chinese language books. A Handbok of Chinese Hematology is the fruit of this work and opens up an entirely new specialised field of Chinese medicine practice to the many practitioners who are only able to access this material through the English language. Even in China, Chinese medical hematology is a relatively new area of specialisation which is undergoing continuous intensive research and whilst this book will likely require updating in the future, it encapsulates the most current information available on the subject.
This is a book for herbalists, with only a very short section devoted to acupuncture treatments since acupuncture is not normally used in China for hematological diseases. As it is also primarily for practitioners of Chinese medicine, the western medicine content ' although reasonably substantial ' is not comprehensive and relatively simplified compared to western medical textbooks on the subject (a bibliography of which is included). Introductory chapters cover the basic western medicine theory of hematological diseases, a discussion of the principle Chinese medicinals used in their treatment and a discussion of the ways Chinese medicine can be integrated with western medicine, whether as supplementary or primary treatment. The bulk of the book is devoted to a discussion of various hematological disorders, with a western and Chinese medicine discussion of the disease, and treatment based on pattern differentiation. The disorders themselves are divided into red blood cell disorders (e.g. nine kinds of anaemia), white blood cell disorders (including infectious mononucleosis, leukopenia, the leukemias and lymphomas) and hemostatic disorders. A total of 20 diseases are covered. The final portion gives case histories and clinical audits for eighteen diseases. One thing is immediately striking about the herbal prescriptions ' the absence of dosages. This is discussed by the author in the preface "The reason for this seeming omission is that I believe practitioners should never prescribe medicinals they have not studied and for which they do not already know the standard dosage parameters".
Personally I believe this is a great shame. One of the observations we can make in studying the specialised treatment of different diseases in Chinese medicine is that standard dosage parameters are often not the norm, and it is precisely the unusual (usually unusually high) dosages of particular ingredients that are a key clinical factor.
This criticism however should not deflect from praising what is an extremely valuable piece of work. It is of inestimable service to the maturing profession that specialised books of this kind are now appearing in English, and we owe a debt of gratitude to Simon Becker for his work. Whilst some of the diseases covered here might be encountered only rarely in daily practice, what is essential is to have the reference material available for when we are called on to treat them. For this reason, no serious practitioner can afford to be without this book.
Contents
Preface
Introduction
Book 1: Theories & Principles of Modern Chinese Hematology
Basic Western Medical Theory of Hematological Diseases
Chinese Medicinals in the Treatment of Blood Diseases
Acupuncture in the Treatment of Blood Diseases
The Role of Chinese Medicine in the Treatment of Blood Diseases
Book 11: The Treatment of Hematological Diseases in Chinese Medicine
Section 1: Red Blood Cell Disorders
Anemias
Aplastic anemia
Myelodysplastic syndrome
Paroxysmal noctumal hemoglobinuria
Pure red cell aplasia
Megaloblastic anemia
Iron deficiency anemia
Thalassemia
Anemia due to chronic renal failure
Hemolytic anemia
Addendum: Sickle cell anemia
Polycythemia Vera (PV)
Section II: White Blood Cell Disorders
Infectious Mononucleosis
Eosinophilia
Leukopenia
The Leukemias
Lymphomas
Section III: Hemostatic Disorders
Idiopathic Thrombocytopenic Purpura
Primary Thrombocythemia
Allergic Purpura
Hemophilia
Purpura Simplex
Book III: Case Histories & Clinical Audits
Allergic Purpura
Aplastic Anemia
Eosinophila
Hemolytic Anemia
Hemophilia
Hereditary Spherocytosis
Idiopathic Thrombocytopenic Purpura
Iron Deficiency Anemia
Leukemia
Leukopenia
Lymphoma
Megaloblastic Anemia
Paroxysmal Nocturnal Hemoglobinuria
Polycythemia Vera
Pure Red Cell Aplasia
Sickle Cell Anemia
Thalassemia
Thrombocythemia
Bibliography
General Index
Pinyin Formula Index
Sample
An excerpt from Acupuncture in the Treatment of Blood Diseases
In China today, acupuncture is not considered the standard of care for the treatment of Western hematological diseases. Patients with blood diseases are treated in the nei ke (internal medicine) department. In other words, patients with Western hematological diseases are treated by Chinese medical doctors prescribing orally administered, polypharmacy Chinese medicinal formulas. It is telling that, in the preparation of this book, I could only find three articles on the treatment of hematological diseases with acupuncture in the modern Chinese medical literature.
In the West in general and North America in particular, the practice of acupuncture became established before Chinese herbal medicine did, and thus acupuncture still represents Chinese medicine to a lot of Western patients seeking Chinese medical treatment. Because of this, many, if not most, Western patients routinely expect acupuncture treatment from Chinese medical practitioners who are most commonly legally defined as "acupuncturists," and they are often not satisfied receiving orally administered Chinese medicines alone. It is partly for this reason and partly due to the fact that acupuncture can be beneficial to most Western patients regardless of disease, that I have included this short and albeit limited discussion of the ways in which acupuncture may benefit patients who are also taking Chinese medicinals or modern Western drugs for the treatment of hematological diseases. Because Book II, the treatment section of this book, is based entirely on Chinese sources, it does not include any acupuncture references. However, based on the functions of acupuncture points as described below, one can formulate acupuncture treatment plans for any patient with any hematological disease simply by following the treatment principles listed for the different patterns of the respective diseases discussed in Book II.
Acupuncture principles & protocols
As Bob Flaws is fond of pointing out, the liver becomes depressed and the qi becomes stagnant if either one does not get what one wants or, conversely, gets what one does not want. Since sufferers of chronic diseases are limited as to what they can and cannot do, virtually all chronic diseases are complicated by liver depression qi stagnation. In addition, living in modern Western society and having to cope with its many socio-economic stressors, severe liver qi depression first transforming into heat and then giving rise to heart fire is not uncommon. When fire harasses the heart spirit, this spirit becomes disquieted, resulting in various psycho-emotional complaints. In addition, most blood diseases tend to be enduring, and many of them are also relatively severe. Thus patients with these kinds of diseases are often depressed, anxious, and fearful. Therefore, one can expect to find liver depression and disquietude of the spirit complicating most cases of blood disease. Based on my experience, one of the ways acupuncture can benefit patients suffering from blood diseases is to course the liver and resolve depression, clear heat and quiet the spirit. Although Chinese medicinals may also effectively relieve symptoms of liver depression qi stagnation, when trying to deal with the sometimes very complicated pathological mechanisms underlying some of the blood diseases discussed in this book, acupuncture treatments for the psychological imbalances arising from depressed liver qi and consequent heart fire may be a very useful and immediately acting adjunct. It is my experience that acupuncture is a very effective and relatively quick way of dealing with such problems.
Liver-coursing & spirit-quieting points
The four basic points for freeing the orderly reaching of the liver qi are the so-called four bars (si guan). The four bars are made up of the two points, He Gu (LI 4) and Tai Chong (Liv 3), which are needled bilaterally (thus totaling four insertions). Inserting needles at these four points typically quickly leads to very deep relaxation, with patients often falling asleep within minutes of obtaining the qi.
Another effective four needle combination which not only courses the liver and rectifies the qi but also nourishes yin and quiets the spirit is the contralateral insertion of Nei Guan (Per 6) and Zhu Bin (Ki 9) and Shen Men (Ht 7) and Tai Xi (Ki 3). I like to use this combination in patients suffering from liver depression qi stagnation complicated by kidney yin vacuity with upward flaming of internal heat. Such internal heat is usually transformative heat from liver depression as well as heat from yin vacuity.
Nei Guan is the meeting point of the yin linking vessel (yin wei mai). It nourishes the blood and enriches yin, and loosens the chest and calms the mind. It is located on the hand jue yin pericardium channel and is, therefore, connected to the foot jue yin liver channel. Thus, Nei Guan also has a function of coursing the liver and moving the qi. This point is combined, contralaterally, with Zhu Bin. Zhu Bin is the beginning and cleft (xi) point of the yin linking vessel. As such, it is connected to Nei Guan and functions more strongly when combined with that point. Zhu Bin further has the function of enriching yin and quieting the spirit. When the yin linking vessel is accessed through this combination, it powerfully nourishes yin and quiets the spirit, loosens the chest and relieves anxiety.
Shen Men is a point on the hand shao yin heart channel. It is a main point for quieting the spirit and nourishing heart blood. Tai Xi enriches yin and clears vacuity heat. It also lies on the lesser yin channel - the foot shao yin kidney channel-and is thus connected to the heart channel. When these four points are used together, they course the liver and rectify the qi, enrich yin, clear vacuity heat, and quiet the spirit.
Points for patterns As far as the treatment of specific blood diseases with acupuncture is concerned and based on my own clinical experience with Western patients, I believe the following approach is a rational one. Once the patient's pattern(s) and, therefore, the treatment principles for these patterns are established, a point prescription can be composed in a similar fashion to composing a Chinese medicinal formula. This approach to the creation of acupuncture protocols is standard in the People's Republic of China today. One of the modern proponents of this approach was Wang Le-ting, past director of the Acupuncture Department of the Beijing Chinese Medical Hospital.
For instance, if a particular patient's pattern is a liver-spleen disharmony with qi and blood dual vacuity and damp accumulation, then the treatment principles necessary to rebalance these patterns are to course the liver and fortify the spleen, supplement the qi and nourish the blood, and also to eliminate dampness. Tai Chong (Liv 3) courses the liver and rectifies the qi. Because it is the earth point on the wood channel, it also harmonizes liver wood and spleen earth. Because the spleen is the latter heaven root of qi and blood engenderment, supplementing the spleen and supplementing the qi and blood are largely synonymous. To supplement the qi, one can choose Zu San Li (St 36), the earth point on the yang earth channel. To supplement the blood, one can combine Zu San Li with San Yin Jiao (Sp 6). This is the spleen network point which connects the spleen, liver, and kidneys, all three of which are closely connected to the blood. In addition, San Yin Jiao helps harmonize the liver. Since the spleen is in charge of moving and transforming water within the body, another spleen channel point may be added - Shang Qiu (Sp 5). Dampness is associated with the earth phase and Shang Qiu is the child or draining point on the yin earth channel. Or, depending on where the dampness is located and the nature of its pathological manifestations, one might choose the water point on the yin earth channel-Yin Ling Quan (Sp 9).
Thus it is easy to see that acupuncture can be chosen for each of the elements in a statement of treatment principles which, in turn, is based on the patient's pattern discrimination. Depending on the relative proportions of patterns, more than a single point might be selected to accomplish a single function, while sometimes a single point may accomplish two or more functions. In addition, it is also possible and typically standard practice to add one or more points depending on the patient's symptomatology or major complaints. Certain points are known to have pronounced empirical effects on certain symptoms or areas of the body. Therefore, one or more points may be added for their symptomatic actions.
Below is a selection of the most commonly used points for the most common Chinese patterns. Using this list, one should be able to craft the core of acupuncture prescriptions for all of the patterns of all of the hematological diseases discussed in Book II.
Common points for common treatment principles:
Boosting the qi: Zu San Li (St 36), Qi Hai (CV 6), San Yin Jiao (Sp 6), Pi Shu (Bl 20)
Lifting & upbearing the qi: Bai Hui (GV 20), Dan Zhong (CV 17)
Nourishing the blood: San Yin Jiao (Sp 6), Qi Hai (CV 6), Guan Yuan (CV 4), Nei Guan (Per 6), Qu Quan (Liv 8), Tai Chong (Liv 3), Ge Shu (Bl 17)
Enriching yin: Tai Xi (Ki 3), Zhao Hai (Ki 6), San Yin Jiao (Sp 6), Guan Yuan (CV 4), Shen Shu (Bl 23), Zhu Bin (Ki 9)
Invigorating yang: Ming Men (GV 4), Guan Yuan (CV 4), Shen Shu (Bl 23), Fu Liu (Ki 7)
Fortifying the spleen: Zhong Wan (CV 12), Zu San Li (St 36), San Yin Jiao (Sp 6), Tai Bai (Sp 3)
Warming the center: Moxibustion at Zu San Li (St 36), moxibustion at Zhong Wan (CV 12)
Coursing the liver: Tai Chong (Liv 3), He Gu (LI 4), Zhang Men (Liv 13), Yang Ling Quan (GB 34), Nei Guan (Per 6), Zhi Gou (TB 6)
Quieting the spirit: Shen Men (Ht 7), Nei Guan (Per 6), Da Ling (Per 7), Yin Tang (M-HN-3), Tai Xi (Ki 3), San Yin Jiao (Sp 6), Xin Shu (Bl 15), Shen Tang (Bl 44)
Quickening the blood: Xue Hai (Sp 10), Tai Chong (Liv 3), He Gu (LI 4), Ge Shu (Bl 17)
Resolving the exterior: Fei Shu (Bl 13), Lie Que (Lu 7), He Gu (LI 4)
Clearing heat: Chi Ze (Lu 5), Qu Chi (LI 11), Wei Zhong (Bl 40), Shao Hai (Ht 3), Yin Xi (Ht 6), Lao Gong (Per 8), Shao Fu (Ht 8), Qu Ze (Per 3), Jie Xi (St 41), Xing Jian (Liv 2), Da Zhui (GV 14)
Although acupuncture is not commonly used in China for the treatment of hematological diseases per se, that does not mean that one cannot or should not seek to redress the patient's pathological imbalance through the use of acupuncture based on the patient's pattern discrimination. All that is required in order to use this kind of acupuncture is to do a pattern discrimination, state the logically necessary treatment principles, and compose an acupuncture protocol based on those principles. In addition, acupuncture points may also be selected on the basis of their known empirical efficacy in eliminating or mitigating the patient's major clinical symptoms or complaints.
However, one should not use too many needles in any given treatment. It is my experience as a teacher and clinical preceptor that many Western practitioners, when not able to decide between two similar points, use both of them. This often leads to the use of an excessive number of needles. The use of too many needles can disperse a patient's qi and, if their qi is already vacuous, produce very exhausting treatments. Therefore, attention should be paid to keeping the number of needles to a minimum. Correct point selection and effective point combination is of much greater importance than using every applicable point.
Having said all this, I believe it needs to be pointed out once again in an unequivocal fashion that Chinese herbal medicine should be the predominant method of treatment of hematological diseases. This is the standard of care for the diseases discussed in this book in the People's Republic of China where Chinese medicine originated and has been the most extensively documented. If one also chooses to do acupuncture as well as prescribe Chinese medicinals for the diseases discussed in this book, the practitioner should keep in mind that this is nonstandard, experimental treatment which is primarily being used as an adjunctive modality.
