Practical Diagnosis In Traditional Chinese Medicine

This text is distinguished by its authority, authenticity, and completeness. Most diagnostic information in English is abstracted rather than translated from Chinese sources and is typically abbreviated to fit the limits of general survey texts for beginners. Practical Diagnosis differs from these presentations as it is an English presentation of the entire Chinese language work compiled by one of China's most respected living physicians. The English edition is a complete translation of the text used in China with neither abstraction nor simplification.
The book is in six major sections with information presented from the general to the specific allowing the reader to understand the many details in context. The first section describes the four examinations. The second covers eight principle; disease cause; six channel; four aspect; qi, blood and fluid; viscera and bowel, and channel and network vessel patterns. The third section concentrates on the application of these patterns in practice, including a small but unique chapters giving a step-by-step approach to determining treatment from the pattern and the differentiation of various conditions that are treated as fixed-entity diseases. The fourth section describes the application of traditional diagnostic principles in the gynecology, pediatrics, external medicine, traumatology, opthamology, and EENT clinics. This is followed in section five with an explanation of 25 commonly-seen clinical symptoms and, in section six, an explanation of the standard in- and out-patient medical record and how to prepare one. Several pages are devoted to clinical observations in external medicine, and there are chapter-ending tables that review differentiations in useful detail. In each chapter there are differentiations of what may and what must be clinically observed before a pattern can be identified with confidence. Throughout, the book is distinguished by the both the extent and depth of its detail.

From The Journal of Chinese Medicine 61, October 1999

"In order to know the inside, [one] must observe the outside, examining the outside, [one] knows the inside. That which is inside, must appear outside". Dan Xi Xin Fa

This is the most comprehensive and detailed textbook on traditional Chinese diagnosis yet to appear in English. It is a translation of a Chinese text, primarily authored by Prof. Tietao Deng (a famous physician from southern China) in 1988. It thoroughly discusses the four examination methods (inspection, listening and smelling, enquiring and palpation), pattern identification (according to the eight principles; disease causes; six channels; four levels and triple burner; qi, blood and body fluids; zangfu; and twelve channels), the detailed application of pattern differentiation, general diagnostic principles (in gynaecology, paediatrics, external medicine, traumatology, ophthalmology and ear, nose and throat diseases), and finally diagnosis of commonly seen clinical symptoms (fever, fear of cold, headache, cough etc.).

The strength of the book mainly lies in the detail with which each subject is covered. For example, the chapter on pulse diagnosis is impressive. The introduction includes a discussion of the various historical methods of relating the zangfu to pulse positions: "Modern physicians disagree about the location of the viscera and bowels of the inch, bar and cubit positions; some agree with traditional descriptions and others disagree ' We believe that the attribution of the six pulse positions to the viscera and bowels is based upon the traditional experience of Chinese medicine over many years and that it ought not to be easily agreed with nor disagreed with, but that a further step should be taken in deeper research of the topic". Each pulse quality is dealt with at length, with discussion of its manifestation, variations, distinction from different but similar pulses, and of course its clinical significance. There is also lengthy consideration given to what to do if the pulse and pattern do not tally ("it is necessary to decide whether to enter treatment by abandoning the pulse for the pattern or abandoning the pattern for the pulse"), and a wonderful section on 10 unusual pulses including the 'seething cauldron', the 'waving fish', the 'leaking roof' etc. Each pulse is illustrated and there are useful charts that summarise the textual information (as there are throughout the book). There is occasionally apparent confusion, for example when discussing the scallion stalk pulse where it is described as empty in the centre and replete at the sides, whilst the next sentence quotes the Si Yan Mai Jue "It has both the floating and deep positions, only the center is empty". As for the rough pulse, the explanation of the image of running a knife along bamboo ("the knife is light and short, making it difficult") is not as illuminating as the one given to me in a beautiful Sussex gardens by Dr. Shen Canruo of Nanjing (approaching a stand of giant bamboo, he whipped out his penknife and demonstrated that as he drew his knife down the whole length of the stem, the varied length of the sections between the nodules gave rise to an uneven clicking rhythm). The comprehensive detail of the pulse chapter is mirrored throughout every section, whether discussing colour of the complexion, how to diagnose worms in children or snakebites, or mapping all the various patterns and sub-patterns of the progression of external disease, and it is fair to say that this book represents probably the most thorough exposition of standard written diagnosis theory in modern Chinese medicine.

For me, the book had two main difficulties. The first relates to the Chinese method of presenting textbook information. There is a traditional way of presenting such material that is rarely deviated from, and this can often fail to answer difficult clinical questions or reflect the true range of clinical variations. For example the rapid pulses are explained as deriving from heat, and yet I frequently encounter rapid pulses in the clinic that clearly have some other cause, whether nervousness, excitement, having rushed to the clinic or other, often impenetrable reasons. To take another example, the discussions of 'Anger damage pattern' as well as 'Binding Depression of Liver Qi' are typical of the simplified 'snapshot' approach to what is surely one of the most common, complex and incredibly varied emotional patterns seen in the clinic. The second difficulty concerns the translation which adheres to the terminology of Nigel Wiseman's English-Chinese Chinese-English Dictionary of Chinese Medicine. We all know that the translation of classical Chinese terminology into English is a complicated, fraught and potentially controversial subject, and it would be churlish not to acknowledge the considerable labour that Wiseman has put into his work. It also appears that this terminology is becoming more and more widespread in the USA, whilst there seems to be much more resistance to it in Europe. My difficulty mainly concerns how it appears to mangle the English language. I simply have problems with a sentence like "Swelling without transparency that is sometimes small and sometimes large is a foxy mounting pattern of the small intestine falling into the scrotum" and one of those difficulties is not laughing.

These reservations apart, this is an important book and one that will join the growing ranks of essential Chinese medicine textbooks.

Foreword vii
Introductions ix

SECTION ONE
EXAMINATION METHODS 1

1. Inspection examination 3

2. Listening and smelling examination 56

3. Inquiry examination 63

4. Palpation examination 83

SECTION TWO
PATTERN IDENTIFICATION 163

5. Eight principle pattern identification 165

6. Disease cause patternidentification 185

7. Six channel pattern identification 211

8. Defense, qi, construction and blood pattern identification and triple burner pattem identification 230

9. Qi, blood and body fluid pattern
identification 253

10. Viscera and bowel pattern identification
268

11. Twelve channels and networks pattern
identification 305

SECTION THREE COMPREHENSIVE APPLICATION OF PATTERN IDENTIFICATION METHODS 325

12. Essentials of pattern identification of
extemal diseases 327

13. Essentials of pattern identification of
miscellaneous diseases 333

14. Steps in the identification of patterns and
determination of treatment 337

15. Identification of patterns and
identification of disease 341

SECTION FOUR OUTLINE OF DIAGNOSTIC PRINCIPLES OF CLINICAL DEPARTMENTS 351

16. Outline of diagnosis in gynecology 352

17. Outline of diagnosis in pediatrics 365

18. Outline of diagnosis in external medicine
373

19. Outline of diagnosis in traumatology
382

20. Outline of diagnosis in ophthalmology
390

21. Outline of diagnosis in ears, nose and
throat 396

SECTION FIVE
DIAGNOSIS OF COMMONLY SEEN CLINICAL SYMPTOMS 401

22. Fever (heat effusion) 403
23. Fear of cold 410
24. Abnormal sweating 414
25. Headache 418
26. Cough 422
27. Panting 427
28. Chest pain 431
29. Heart palpitations 434
30. Insomnia 437
31. Spiritmind abnormalities 441
32. Bleeding 449
33. Thirst 454
34. Torpid intake 457
35. Stomach ducipain 460
36. Abdominal pain 463
37. Vomiting and retching 468
38. Constipation 472
39. Diarrhea 474
40. Dizziness 478
41. Yellowing 482
42. Convulsions 486
43. Lumbar pain 489
44. Inhibited urination 492
45. Excessive urination 495
46. Water swelling 498

SECTION SIX WRITING A MEDICAL RECORD 501

47. Overview 502

48. The content and format of the medical
record 507

49. Examples of inpatient medical records
513

REFERENCES 521

INDEX 529