Stephen Birch Published by Thieme, Stuttgart and New York, 2011 Hardback 260 pages with a DVD ISBN: 9783131500618 Price: £65.27
(Reviewed by Sylvia Schroer, EJOM Vol. 7 No. 2)
When I first studied shonishin, those few children that I saw in my practice, which at that time was in central London, tended to be very severely ill and it was a daunting prospect to treat them. I recall one three-year-old girl who had epileptic fits every few minutes. I felt completely out of my depth and I lost my confidence. One happy success was the four-year-old son of friends with whom I was staying for a couple of months – I used a child’s little spoon and fork – and treated the boy and his big sister before bedtime every night with these improvised shonishin tools for a couple of weeks. The kids loved it and the boy got his much wanted action man toy as a reward for sleeping through the night, which he had been struggling to manage. Years later, when the children were much older, they would beg me to do the ‘spoon and fork’ on them – and I was really touched that they had remembered it. I recount this anecdote to show that acupuncture for children can actually be great fun for them – and no needles have to be involved at all. This is a major theme of Stephen’s book. In fact two of its major themes are the treatment of sensitive, very poorly children, and what to do in these circumstances to practise safely, and the importance of making the experience of treatment pleasurable – or at the very least not frightening to the child, as this will disrupt the flow of qi and hamper the treatment process.
Whilst my own experiences give me a different starting point to readers who are completely unfamiliar with shonishin or Japanese acupuncture, Birch is an exceptionally gifted teacher, and the book is well conceived and structured with clear explanations, diagrams and extensive use of case histories, which I think will inspire practitioners, whatever their training and experience, to give shonishin techniques a try. The only potential difficulty I foresee is that practitioners cannot learn what the treatment actually feels like from a book or DVD and may risk making the child uncomfortable. But it is easy enough to try the techniques on yourself first to get a feel for them, which is what Birch recommends.
In the book Birch describes the history and modern development of shonishin; the special requirements of working with children particularly in relation to therapeutic dosage; the tools and instruments of shonishin and how they are used; the core treatment model; special needling techniques and use of dermal needles, moxa and other techniques such as cupping and bloodletting and relevant applications for these. The remainder of the book, from page 93 onwards, discusses how to work with specific conditions, including: respiratory diseases, digestive disturbances, skin conditions, ear and nose problems, behavioural, emotional and sleep problems, urinary conditions, developmental problems, weak constitution, recurrent infection and improving a child’s vitality. The case histories, which are central to the book, bring the shonishin approach to life and suggest this simple treatment can produce dramatic benefits. The chapter on combining treatment methods will be of particular interest to practitioners already working with children using other approaches and demonstrates how easily shonishin can be integrated with other methods.
To my mind one of the most important issues raised in the book is that of optimising therapeutic dose. It is an issue that came up in the clinical research I conducted at the University of York. Practitioners commented on differences in the sensitivities of patients suffering with depression and suggested that some individuals in this patient group were hypersensitive. I have to admit I am not convinced by the argument that the symptom exacerbations, exhaustion and emotional overwhelm that patients described in relation to acupuncture treatment was most likely to be a ‘healing crisis’ or necessary aspect of the recovery process. I think we sometimes just over stimulate our patients, especially those who are very distressed. I tried to find some literature or research on the subject without success. Charles Chace, who writes the book’s foreword suggests: ‘questions of optimal therapeutic dosage are familiar territory for all experienced clinicians. Steve has thought this issue out and articulated it with an unprecedented depth and clarity. The clinical ramifications of his (Birch’s) dosing model extend far beyond pediatrics, and into medical practice as a whole, almost regardless of the modality being used’. In short, reading this book will help practitioners to think about dosage for all their patients, adults as well as children, and provides a model to work with. Dosage is of fundamental import for babies and children, ‘if you do not understand the issues of dosage you are better off not treating babies and children at all’ – page 18. Birch speculates that children’s physiology is accelerated in comparison with adults and suggests they require much lower treatment doses.
The issue of treating sensitive patients is discussed in chapter 4. I am not sure I completely agree with the model proposed by Birch, which feels a bit linear given the complex nature of human beings and dynamics of therapeutic work that can result in both placebo or nocebo effects as consequences of care provision. Birch himself reflects that the model may be a ‘gross oversimplification’ as it cannot account for therapies like homeopathy where the lower the physical dose the more therapeutically potent the treatment is thought to be. Nevertheless the model provides a useful framework for our clinical work and for further exploration of the topic of optimising dosage.
Shonishin is a beautifully simple treatment method that can potentially make a real difference to the lives of families where children are suffering with health problems – be they physical, mental or emotional. Parents will appreciate being able to do something positive for their child and being able to help in such circumstances will be very rewarding for practitioners. Shonishin combines well with other therapeutic approaches and, as the adoptive parent of an older child, I can see great potential for shonishin in supporting children with attachment problems who have experienced difficulties and trauma in early life. Practitioners reading this book may be similarly inspired by the shonishin method and see the potential for it to be of use in new and different situations not covered in the text. However, because of the consideration and guidance on the subject of therapeutic dosage I would recommend this book to all, regardless of whether they intend to work with children or not.
Sylvia Schroer Sylvia Schroer qualified from the College of Traditional Acupuncture in 1991 and trained in Japanese methods with Stephen Birch as well as studying in China (Beijing) and Vietnam. She was the recipient of a personal award from the National Institute of Health Research to increase research capacity in the field of complementary medicine, completing her doctorate in 2009.
