Susanna Dowie Published by Churchill Livingstone Elsevier Edinburgh, 2009 www.elsevierhealth.com Hardback, 134 pages with illustrations, RRP £31.99
(Reviewed by David O'Keeffe, EJOM Vol. 6 No. 2)
Most students or newly qualified practitioners begin their clinical practice with excitement, enthusiasm and no small dose of trepidation. Long consultations with patients followed by late night homework ensure every possible differentiation of any condition presented has been revised.
And then the patient arrives to upset your well thought out treatment plans, announcing that they have just been diagnosed with a rare illness you’ve never heard of! Like the patient I inherited from another student practitioner whose thick file I pored over for ages, whose numerous conditions I studiously revised in my ‘Giovanni’ only to find that he was attending for treatment because his gall bladder had just been removed two days previously!
Susanna Dowie’s new pocket reference book might not have rescued me directly from that scenario but nervous new practitioners and anxious students facing exams may well welcome it. Clearly labelled a ‘portable reference’, the book does not aim to provide the kind of comprehensive background covered by authors such as Giovanni Maciocia in their classic textbooks. Maciocia himself provides the preface to this guide, suggesting Dowie has compiled the book ‘in a masterly way’. Many students and practitioners will, of course, know her as the principal of LCTA in north London.
The portable concept is good. It will save some student practitioners hawking around Maciocia’s heavy tomes in backpacks as comfort blankets and emergency resources to have to hand just in case! Lightweight in its presentation but not its information, Dowie’s book is handy for the student wanting to do some last minute exam revision on the train or the new practitioner looking for a reasonably discreet reference guide to have available during treatments. Nicely bound in a hard cover, it should not get too dog-eared with heavy use. Wire binding enables a ‘look-no-hands’ reading of the book when open flat on a desk. Pages are of an attractive wipe-clean glossy paper that one expects is long-lasting, although it inhibits writing personal notes or memory cues.
The format is unusual, initially confusing, but workable once you get to grips with it. Basically presented as two books within one, it has a separate upper and lower part (imagine a book cut horizontally in two but within the same cover). The ‘upper book’ mainly covers a range of common conditions presented with their western and Chinese medicine differentiations. The ‘lower book’ provides a range of information on patterns and appropriate points for treatment. One reads across the first 26 pages and latter seven pages of the ‘upper’ and ‘lower’ books as a combined volume for the contents pages, index, and bibliography as well as an overview of the fundamentals of Chinese medicine diagnosis.
The 26 page overview of the ‘building blocks’ of Chinese medicine is ‘just enough to serve as a rapid reminder’, Dowie suggests. Useful it is as revision material – with some good diagrams on fundamentals such as the production of qi and blood. However, the student might occasionally benefit from knowing the origin of the material (eg, the diagram of the ear which does not refer to shen men or Sympathetic), given that different teaching colleges may base their teaching on slightly different texts or differing interpretations thereof. The author generously acknowledges in her introduction that she has drawn on a wide range of sources, making no apologies ‘for plagiarising, paraphrasing and précising liberally’, so I guess this is her explanation for the absence of any referencing. A bibliography is provided.
One of the most important aspects of a reference book is the indexing and cross-referencing. Being able to find one’s way around quickly and easily is surely the imperative. Here Elsevier’s editors have missed a trick.
Having found the Chinese medicine differentiations in the ‘upper book’, one then has to look up each syndrome in the index to identify where its detailed description is located in the ‘lower book’. Furthermore, the index itself crosses the ‘upper’ and ‘lower’ books so you have to keep closing the page you are on (ie, the differentiations) to look up the index. How much easier it would be to use if the patterns listed under the Chinese medicine differentiations had the relevant pages of the ‘lower book’ annotated beside each one. No need then to keep referring back to the index to find the information required. And if the contents page was in the lower quadrant of the book only, one could have the ‘upper book’ open flat all the time on the relevant page while looking up each pattern in turn in the ‘lower book’.
For the most part, information is presented in a concise, easily understood way. However, on occasions, the cross-referencing doesn’t work so well for the new student in their early days at college. One finds ‘Lungs not descending and diffusing’ listed as one of the patterns under ‘Depression’. However, the reader cannot then find this listed in the patterns index – so a degree of knowledge is required to know where to go next. Not dissimilarly, ‘Heart Yang Deficiency, water overflowing’ is listed as a differentiation under ‘Oedema’ but does not appear in the index of syndromes although ‘Kidney Yang Deficiency, water overflowing’ naturally does.
A description of some of the main combined syndromes would have been useful and their absence might again confuse the new student.
Young graduates in the bloom of their second decade might find the small typeface easy enough to read, but those mature students among us who aren’t spring chickens might find themselves straining, as I did, to read the small print. Unnecessarily small page numbers almost necessitated the magnifying glass!
One guesses that the small typeface was in part driven by pressure on space to fit a lot in. And a lot of useful information there is. A list of western and Chinese differentiations across a variety of conditions (eg, abdominal pain, headaches, insomnia) sitting on opposing pages is really beneficial to the student or new graduate.
Likewise, a description of syndromes with pulse/tongue signs, treatment principles and suggested points is useful to have to hand in a compact volume, although some colleges have already published this information in small filofax or other formats. Classic herbal formulae are also included.
As a learning tool, the western differentiations of a range of common conditions are useful. However, one learning opportunity has been missed. Much emphasis is now rightly placed on the new practitioner being aware of ‘red flags’ ie, those signs or symptoms which might warrant a referral to a GP. An indicator of such a warning sign in the relevant parts of this book would be a highly useful extra layer of information for the student or new practitioner and one which could easily be annotated. However, the author could be excused for maintaining her primary focus on Chinese medicine differentiations and patterns.
This publication does not set out to be a resource book for comprehensive background research on specific conditions. As a useful pocket guide it does what it says on the tin. And for once, at £31.99 (or less from some sources), it’s an acupuncture reference book that won’t require an overdraft to be added to the poverty stricken student’s library.
David O’Keeffe David is a recent graduate of the College of Integrated Chinese Medicine in Reading.
