JCM Review
As Giovanni Maciocia says in the preface to this vast and comprehensive textbook "The longer I practise, the more I appreciate the importance of diagnosis to Chinese medicine in particular and to medicine in general. Indeed, one could say that the value of Chinese medicine lies not in its theories of Yin-Yang, Five Elements, Eight Principles, etc., but in diagnosis itself".
Whilst this may seem self-evident, what he is referring to is the extraordinary focus on, and expertise in, the arts of observation and examination that form one of the richest parts of Chinese medicine, and which have so declined in modern western medicine. A traditional medicine, the major part of whose history predates modern biomedical diagnostics, has only the human senses to rely on, and the science and art of Chinese medicine diagnosis concerns itself with everything that can be seen, smelt, palpated, heard and asked about. How comprehensive this knowledge is, is illustrated by the breadth of this monumental work that goes so much further than anything yet published in English on this subject.
The book is divided into 5 major parts: diagnosis by observation, diagnosis by interrogation, diagnosis by palpation, diagnosis by hearing and smelling, and symptoms and signs. Several of these parts are subdivided into sections, and then each section is further subdivided into chapters (there are 111 chapters in the whole book). Thus section one (diagnosis by observation) is subdivided into i. observation of the body, mind and complexion, ii. observation of parts of the body, and iii. tongue diagnosis. The first of these (observation of the body etc.) has chapters on observing body shape (according to yin and yang, according to the five elements, according to prenatal and postnatal influences, according to body build, according to pain and drug tolerance), observing the mind, spirit and emotion (the three aspects of the spirit, the three conditions of the spirit, the spirit and constitution, the spirit and the emotions), observing the complexion and so on.
Section 5, Symptoms and signs, is the largest, and the previous sections frequently refer to it. For example, diagnosis by observation of the neck illustrates and gives brief differentiations of variations in neck length and width, neck rigidity, soft neck, deviated neck etc. Similarly, diagnosis by interrogation covers goitre and pain and stiffness of the neck. In both cases, however, for each disorder or pattern the reader is referred to a chapter in section 5 where a full discussion of the presentation is given (pattern, symptoms and signs, pulse etc.). For a book of this size, it would have been more helpful here to refer readers to the relevant page number in section 5, as it can take a bit of time to track down the right passage in the text.
It is hard in a review to convey the immensity of this book. It can really only be repeated that nothing as ambitious has been attempted in English before, and that it is inconceivable that anyone studying or practising Chinese medicine can afford to be without it.
Peter Deadman
