Peter Deadman & Mazin Al-Khafaji with Kevin Baker Journal of Chinese Medicine Publications 1998 Hardback, illustrated, 667 pages, £75. Boxed set of points cards, £35.
(Reviewed by Marian Fixler, EJOM Vol. 2 No. 5)
The Manual of Acupuncture accurately reflects its title - it is a textbook for daily use that is unlikely to have the chance to gather dust on the bookshelves of either students or practitioners. This extensive and comprehensive work is a teacher's dream with its thoughtful layout for students studying acupuncture points. The wealth of knowledge contained in it will enhance every practitioner's understanding of points and will expand all our repertoires. This book has been awaited with eager anticipation, and its evolvement over the years has been mapped by articles in the Journal of Chinese Medicine.
The book emphasises the importance of the classical Chinese tradition, serving as a foundation for further development. The bibliography stands as a testament to the breadth of information integrated into the text by authors who have brought together a wide range of expertise, including direct access to Chinese language texts and considerable clinical experience. The Manual is much broader than an acupuncture points book. Although the main bulk of the text is on acupuncture points, the importance of channel pathways and their connections forms an integral part.
The book begins with an introduction to the significance and historical development of channels and their collaterals, with detailed information about all of the pathways from the cutaneous to the divergents, including diagrams and descriptions of the eight extraordinary vessels. There is an extensive chapter on point categories including the five transporting shu points, yuan source points etc., in addition to the window of heaven points and Sun Si Miao's ghost points. These are discussed within a historical context with reference to relevant cultural significances that inform the theory. The categories are systematically examined through the indications of individual points, illustrating their clinical application. The Manual is bold in its attempt at addressing contradictions and explores many previously unanswered questions, such as reconciling the flow of qi in the twelve channels with the flow of qi along the transporting points.
There are useful sections summarising the cun measurements and methods of locating anatomical landmarks such as vertebra C7. I was disappointed, however, with the detail both for the description and location notes on the points around the sacrum, an area that students often find particularly difficult. There is a section on methods of selecting points, such as using points above to treat disorders below, for example, St 4 di cang as a proximal point for treating atrophy disorder with the inability to walk. In common with other texts, there are useful and detailed lists of regions of the body reached by all of the channels, and a table of the meeting points of channels.
Each chapter on the channels begins with a series of clearly labelled diagrams detailing each of the channel pathways with a written description of the pathways, in bullet point format. Each channel's relationship with its paired yin yang channel and divisional pairing is described and relevant connections are emphasised. This is certainly a welcome improvement to previous points textbooks that have challenged the reader's comprehension with their inconsistencies and omissions. The thoughtfulness in the ordering and clarity of the information reflects the needs of students, who until now have had to tease this out for themselves. Careful consideration of the language used in translation has contributed to its user friendliness.
Each point begins with its name, including Chinese characters, its category and its location. The introduction acknowledges the enormous variation in point location descriptions and the locations have been selected after detailed examination of source texts and current literature available. Additional location notes act as handy tips, including some short cuts and pragmatic advice. Depths for needling are given with cautionary notes regarding underlying anatomical structures; however, there is no further detailed anatomical information. Diagrams of the position of the internal organs at the beginning of the book are a helpful adjunct to this. No further mention is made regarding needle sensation and use of moxa; however, this information is readily available in other texts.
Actions and indications are clear and detailed and are helpfully grouped together by the authors, according to type; these are illustrated through a rich assortment of point combinations, all sourced. The two strongest areas of the Manual superseding all existing texts are the illustrations and the commentaries. Each point has a detailed diagram showing the point in relation to relevant anatomical structures, both surface and structural and adjacent points. The quality of these diagrams is far superior to any I have previously seen and is truly welcomed after the inaccuracies in some previous texts. There are. however, a few surprises, including GB 21 jian jing, drawn much higher than Du 14 da zhui which is described as located on the same level.On further examination, I did find some inconsistencies, such as TH 16 tian you illustrated in two differing locations on two different diagrams in the book. The illustrations are a delight and work as a practical guide to locating points. There are also wonderfully clear diagrams summarising sections of the body, depicting all the points in relation to each other which appear later in the book.
The second main strength of the Manual are the commentaries for each point, which in many instances stretch to several pages. I have not come across such a fully researched and detailed examination in any other text in which the points' actions are discussed in such depth with reference to physiological and pathological processes. Differential diagnoses of patterns are examined in impressive detail and comparisons are made with other points. For example, we learn that although He 5 tong li and He 7 shen men both calm the spirit, He 5, the luo-connecting point, is more appropriate for emotional disorders and is the only heart channel point indicated for gynaelogical disorders, whilst He 7 is more effective for disturbances of sleep and memory. There is also extensive discussion of the point's category and rich use of quotations from classical texts. The names of points explain their use and reference is made to alternative names. Ki 1 yong quan is also known as di chong - earth surge or thoroughfare and is said in Ode to Elucidate Mysteries that 'Kid 1 echoes the Earth'. There are a number of examples where the commentary either omits or refutes the actions attributed to certain points made by other modern day texts, which the authors sometimes regard as interpreting the classics rather loosely. This is always substantiated with classical references. In some cases actions are not included, without explanation, e.g. Ki 23 shen feng, Ki 24 ling xu and Ki 25 shen cang as points with an influence on calming the spirit, in spite of their names. There is, however, interesting reference to the use of many stomach points for treating spirit disorders due to the stomach divergent channel going to the heart. This brings to life the relevance of the channel pathway connections through their points' actions.
The Manual does not assume anything and it was a pleasure to find that intriguing terms, such as 'running piglet qi' , shan disorder and 'steaming bone disease', were fully explained. Less frequently used points, such as Sp 7 lou gu become more accessible when we hear that it is indicated for 'wasting of the muscles and flesh despite normal eating and drinking' due to hidden stomach fire at the qi level. Alongside practical recommendations on clinical use, there are some wonderful anecdotal references to ancient emperors and the treatment of their ailments.
Accompanying the Manual is a box of points index cards. This includes diagrams, point locations and needling information with cautionary notes and actions, all taken from the book. In addition, there is a list of clinical applications, a helpful summary for quick reference. There are also cards listing the point categories presented in table format. The box, like the book, is very elegant though rather tightly packed, making it awkward to withdraw individual cards. This box set will prove a useful study aid or valuable addition to one's clinic.
The Manual is a significant contribution to the continuing development and understanding of acupuncture in the West. It will take its place amongst the most highly regarded works currently available. I have no hesitation in recommending this book to students and practitioners and I am sure that it will become the main textbook in English speaking schools and universities for the study of acupuncture points. Regardless of whether one is a new student or a seasoned practitioner revisiting well known points, the reader can be assured that s/he will become more intimately acquainted with each point in this book and with the complexities of Chinese medicine.
Marian Fixler
Marian Fixler trained at the London School of Acupuncture and Traditional Chinese Medicine and at Nanjing International College. She teaches at the London School of Acupuncture at the University of Westminster, and practises acupuncture and tuina massage in London privately, on the NHS and in HIV services.
