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Clinical introduction to medical acupuncture

Article  in  Acupuncture in Medicine · December 2007

DOI: 10.1136/aim.25.4.204-a

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Media reviews
The Journey to Pain Relief
A Hands-On Guide to Breakthroughs in Pain
Treatment
Phyllis Berger
Paperback, 264 pages, price $18.95
Published by Hunter House; 2007
ISBN 0-89793-469-5
How do you treat patients with pain? With difficulty?
With acupuncture? Or perhaps a combination of
techniques. This book abounds with enthusiastic ideas
and combinations. It is compiled by a physiotherapist
and an acupuncturist practitioner who has suffered
considerable spinal pain first hand, and who is
eminently qualified to appraise critically the many
treatments she has personally received and uses in
professional practice. The book will appeal to patients
who wish to know more about the multi-disciplinary
approach and become empowered and knowledgeable
participants. As a doctor I was fascinated by the
explanations of several electrical therapies such as
the Action Potential Stimulation Current device (APS)
that produces a modified direct current (MDC).
Berger has produced a well-balanced book which
briefly covers the neuroanatomy and physiology of
Clinical Introduction to Medical Acupuncture
Steven KJ Aung, William PD Chen
Hardback, 324 pages
Price: 89.95
Thieme, New York (2007)
ISBN 1-58890-221-8 (3-13-138271-6)
Dr Steven Aung is a respected clinician and teacher
of what he calls ‘medical acupuncture’ at the
University of Alberta in Canada. This book, co-
authored with a former pupil, is intended as a ‘self-
instructional primer’ for doctors, presumably
designed in particular for those who attend his
courses. In the words of its three (sic) forewords, it is
‘comprehensive’, ‘intensive’ and ‘reveals the links
between TCM and Western or biophysical medicine’.
ACUPUNCTURE IN MEDICINE 2007;25(4):204-206.
204
pain in non-rocket-science detail. Three appendices
cover more detail: Acupuncture looks at broad
categories such as stress, inflammation, the
autonomic system, neuralgia, headache and pain in
the major joints; TENS (transcutaneous electrical
nerve stimulation) covers general and specific
electrode placement together with useful hints and
tips; MDC looks at electrode placement and I note
that it can be used when attached to acupuncture
needles. Other described treatments include
everything electrical (‘Electricity can heal’), magnets,
laser, prayer, self-hypnosis and touch. The book is
well illustrated with line diagrams, numerous case
examples and advice on practical application.
The importance of posture, exercise, breathing,
relaxation and laughter all add to that multi-
disciplinary approach and added value when used
with specific therapies.
So who will derive most benefit from this book?
Clearly the patient and the doctor, but I suggest you
buy a copy for your patients’ library and enjoy a
quiet read yourself. I guarantee that it will add to
your treatment expertise in both manual and
electroacupuncture.
Colin Lewis
The book, large in size and ambitious in scope, is
divided into seven sections. The first four introduce
Traditional Chinese Medicine (TCM), the channels
and acupoints, and TCM syndrome diagnosis and
differentiation, including very brief accounts of tui na
(TCM massage therapy), electroacupuncture (EA)
and Aung’s own ‘vital energetic (Qi) alignment
procedures’. Next come sections on the acupuncture
‘microsystems’ (auricular, hand, nose, foot and scalp
acupuncture), treatment of selected syndromes and
diseases, and other TCM therapeutic approaches
(‘complementary modalities of wellness’), including
food therapy, herbal supplements and qi gong. The
book closes with three appendices – a glossary,
suggested reading and answers to the quiz questions
at the end of every chapter.
Several readable books are now available that
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introduce TCM to those who have been trained in
Western medicine (WM). Steven Aung’s will no
doubt be useful for those who want to follow this
path, but I would hardly call it an ‘introduction’. His
presentation is dense and often he uses terms prior to
or even without defining them or including them in
the index (‘water cupping’, for example, is mentioned
on page 157 but not described at all, the all important
cun is first used on page 24 but not defined until
page 102), even framing quiz questions on topics
that have not yet been covered. Because of lack of
space, he ends up making dogmatic and over
simplistic interpretations of traditional ideas in
Western terms, as when he states baldly (page 111)
that ‘acupuncture points are motor points’, or claims
(page 21) that disease in a channel results in
symptoms of weakness, with ‘pain and swelling of
the affected [associated] organ’. The relationship
between WM and TCM is rarely as cut-and-dried as
this! (Similar comments could be made about
William Chen’s PDA downloadable software
‘AcuNotes®’, recommended several times in the
book as an aid to mastering the information it
contains.)
Aung can also go into what I would consider
irrelevant detail (‘In the south, the weather is often
damp, foggy, or dewy. This can produce a preference
for sour taste and preserved food’, page 119; is this
in Canada, or in the classical Chinese literature of
correspondences?), and is at times unreasonably
dogmatic about TCM itself, as in ‘It is necessary that
the Qi sensation reaches the diseased area’ (page
114). On the other hand, sometimes his language is
obfuscatory, as in his unnecessarily lengthy definition
of an acupoint (page 101), vague, as when he states
they are ‘points of electrical response of the skin’
(page 112), or muddled, as in his description of
acupuncture needle diameter in millimetres and gauge
in successive sentences, without explaining the
relationship between them (page 116); to compound
this North American muddle, he retains the inch as
the unit of needle length.
Aung makes many statements without stating
his sources or evidence. For instance, he claims (page
xii) that acupuncture has been effectively utilised
for 4000 years in China. That may be a slight
exaggeration, although according to other sources,1
stone and bone needles dating back to 3000 BCE
have indeed been excavated in Korea. As another
ACUPUNCTURE IN MEDICINE 2007;25(4):204-206.
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Media reviews
example, he states (page 20) that in 1989 the Chinese
Academy of Sciences ‘finally and definitively
verified the existence of all 14 channels using three
biophysical methods’. Such a bold assertion requires
some further explanation, and a reference to support
it. Again, it is a real pity that in one of the more
detailed chapters of the book, on the evidence for
the existence of channel systems, the text is not
supported by proper referencing.
Like any busy practitioner who is trying to find
time to write, Aung also occasionally makes mistakes,
as in Table 2.2, where he states that yang controls
the solid organs (zang) and yin the hollow organs
(fu) – rather than the other way round. There are a
number of other errors that have not been properly
checked by the publisher’s editorial staff, such as
the statement (page 21) that ‘pain in the posterolateral
aspect of the upper extremities indicates the small
intestine channel, whereas pain in the posteromedial
aspect … indicates the heart channel’. There are also
errors in spelling (eg ‘temporomandibular’, page
113, or ‘Todschidjakin’ for Podsibiakin, page 199), in
references to Figures (eg on page 11), and, more
importantly, in the Figures themselves (for example,
the location of SI11 in Fig 12-5, or the illustrations of
BL17 at two different locations in Figs 13-4 and 13-
5, positioned right next to each other on the page,
or of GV-14 in Figs 19-10 and 19-11, again next to
each other, and in Fig 20-4 a few pages later).
Aung’s account of electrical methods of
measurement is also misleading, as when he implies
(page 149) that electrical resistance is measured only
at the jing Well points on the fingers and toes, stating
categorically that ‘high figures indicate repletion;
low figures indicate vacuity’. The opposite is held
to be true in most electrical acupoint measurement
systems. Similarly, his description of the electro plum
blossom needle is partial, and reads as if there is only
one such device on the market. His account of the
origins of EA is incorrect: Louis Berlioz did not use
it himself, but only suggested its use, a suggestion that
was later taken up by Jean-Baptiste Sarlandière,2 (not
‘Sarlaan Diere’, as here). Aung states that Osler also
used EA. My understanding is that he used local
needling without electrical stimulation.
However, it is unfair to cavil too much about the
shortcomings of this book. With his wealth of
experience and access to the huge Chinese literature
on acupuncture, Aung also offers many fascinating
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Media reviews
and useful insights, as in his description (page 46) of
the variant locations and uses for point SI-6 on the
forearm, or his accounts of palpatory techniques
(page 148) or treatment methods for sanjiao
dysfunction (pages 295-6). His own unique ‘vital
alignment energetic procedures’, in which the
practitioner holds needles inserted in yintang and
other major ‘chakra’ points, are a particularly
intriguing innovation (pages 201-3). In the variant
he terms ‘conjoint sexual alignment therapy’,
reminiscent of the work of Leon Eeman, the points
are linked in a circuit between the two partners in a
couple using low frequency EA, rather than between
patient and practitioner.
Some of the point location illustrations in this
book are excellent, such as those of CV-24 and
jiachengjiang on page 83, or of GV-28 on page 90.
Aung’s charts summarising the ‘six exogenous
factors’ (Wind, Cold, Summer Heat, Dampness,
Dryness and Fire) are particularly useful (pages 136-
8), while his tables of ‘root’, ‘end’, ‘origin’ and
‘superior’ points (page 190) are unusual and thought
provoking.
Also thought provoking are his comments that in
EA ‘regular frequencies drain repletion, whereas
irregular frequencies strengthen vacuity’ and ‘a high
frequency has a sedating effect, whereas using a low
frequency results in a tonifying effect’ (page 200). His
comparison of traditional needling techniques in
tonification (bu) and sedation (xie) is intriguing too:
using counterclockwise rotation of the needle in the
ACUPUNCTURE IN MEDICINE 2007;25(4):204-206.
206
former, with long retention, but clockwise rotation
and short retention for the latter. I was taught the
opposite, which I have always found effective. So
is this yet another misprint, or does this mean that
the concepts of bu and xie are themselves
meaningless, that TCM is full of contradictions and
can therefore be dismissed out of hand, or that it is a
field in which many different methods may be used,
each with their own validity, and that the intention of
the practitioner is involved at some fundamental
level?
In conclusion, it is refreshing to find an English-
language book aimed at medical practitioners that
does not rubbish TCM altogether. I can recommend
it as an aide-mémoire for those wishing to brush up
their TCM and an interesting account of one man’s
interpretation of acupuncture in modern terms.
However, it is not an introductory text on TCM, and
those who want something a little deeper may also
find it unsatisfactory. Moreover, it may well
disappoint those seeking a clearer understanding of
what ‘medical acupuncture’ is or can become, other
than acupuncture as practised by the medically
qualified.
David F Mayor
Reference list
1. Eckman P. In the Footsteps of the Yellow Emperor: Tracing
the history of traditional acupuncture. San Francisco, CA:
Cypress Book Co; 1996.
2. Mayor DF editor. Electroacupuncture: A practical manual
and resource. Edinburgh: Churchill Livingstone; 2007.
www.acupunctureinmedicine.org.uk/volindex.php
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Clinical introduction to medical acupuncture

David F Mayor

Acupunct Med 2007 25: 204-206

doi: 10.1136/aim.25.4.204-a

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