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“Acupuncture has been proved to be safe; now would be a very good time to add further clinical evidence of its value in neurological conditions” (p 199)
This is a book in three parts, with five background chapters on traditional Chinese medicine (TCM) and Western medical approaches followed by a core of chapters focused on clinical treatment in six different areas (acquired brain injury, Parkinson's disease, multiple sclerosis, spinal cord injury and disease, peripheral nervous system disorders and motor neuron disease), and concluding with a chapter on ‘pulling it together’. There is also a single brief appendix on outcome measures used in neurological rehabilitation, and an index.
The authors, both experienced and knowledgeable in the field of neurological rehabilitation, have open-mindedly set themselves the admirable, if unenviable, task of demonstrating how TCM and Western medical acupuncture (WMA) may both be appropriate, and even integrated, in the treatment of central and peripheral nervous system conditions (many of the former being notoriously refractory to most interventions).
They have managed to do so quite successfully, using methods of clinical reasoning based on categorising the conditions in different ways. For example, they make the interesting suggestion that the three groups of TCM syndromes usually invoked to describe neurological disorders (Bi, Wei and Feng) can be combined together in a single ‘neurological syndrome’, with different manifestations in the six different areas covered. This is a powerful insight, particularly for those who are not at ease with the complexities of TCM. Within the WMA framework, they consider the effects of acupuncture under four headings: sensory, motor and visceral functions, as well as generalised symptoms (insomnia, fatigue, mood disturbance). Acupoint selection guidelines are based on these two models (using points with traditional functions and/or segmental associations), taken together with the symptom pictures for the different conditions, and of course should be used thoughtfully, in the context of the practitioner's own knowledge and experience.
Hopwood and Donnellan manage to make the whole process of clinical reasoning sound easy, although the many case studies presented vary from levels 1 (single symptom) and 2 (complex or chronic), both treatable using either WMA or TCM, to level 3 (again complex or chronic, but now requiring a mix of WMA and TCM). However, their presentation is realistic and rightly cautious, by no means giving the false impression that acupuncture is 100% successful in this field.
Some minor reservations
It is difficult to write about TCM for non-TCM practitioners without it sounding like mumbo-jumbo or rigidly systematic. Sometimes in this book the writing on TCM is indeed a little fuzzy, at others too cut and dried, but although I have tried hard to pick holes in it, I have not really been able to locate any major problems. Nevertheless, for those unfamiliar with the TCM jargon, a glossary would have been useful (do we all know that the Wei in Wei Qi is not the same as in Wei syndrome, for example?), while on the other hand some explanation of the Hmax/Mmax ratio and the ‘surface projection zone of the decussation of the pyramid’ (pyramids?) would be welcome. The index is disappointing (no mention of neuralgia, for instance, let alone trigeminal neuralgia, although this is touched on at various points), and referencing is sometimes omitted, as in the appendix, and also for a number of statements based on what ‘some teachers’ or ‘some scholars’ say. There are also some obvious typos, as when the hun is associated with the Lung rather than the Liver (p 8).
In 2002 I wrote a comparative review of two books on acupuncture for neurological disorders.1 Since then, one of those books has been republished, now enlarged to over 600 pages and incorporating musculoskeletal disorders as well.2 The author, Lü Shaojie, has thus covered many more conditions than have Hopwood and Donnellan, including headaches of different types, some 14 types of cranial nerve disorders other than Bell's palsy and trigeminal neuralgia, and many individual peripheral nervous system disorders. However, although his book is quite accessible to those not trained in TCM, that is his background, and he does not cover the WMA approach at all. Furthermore, the many conditions he does cover are not considered under one unifying ‘neurological syndrome’, which will make his book less satisfying to those who prefer the portable simplicity of Hopwood and Donnellan. In some ways the books are complementary, and both have their place.
This is a good and useful book, primarily intended for physiotherapists already using acupuncture, but also for others working with neurological conditions, in particular professional acupuncturists. The authors clearly state their aim “to see the two professions better able to work together with this important group of patients,” and this book should contribute to that.
Competing interests DM is the editor of Acupuncture in the Treatment of Musculoskeletal and Nervous System Conditions (2nd edition) by Lü Shaojie.
Provenance and peer review Not commissioned; not externally peer reviewed.
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