Skya Gardner-Abbate
Southwest Acupuncture College Press, Sante Fe, New Mexico,1996
Hardback, first edition. 62 illustrations, photographs and tables, 237 pages, £45

(Reviewed by Susanna Dowie, EJOM Vol. 2 No. 6)

Holding the Tiger's Tail is primarily a book on technique, but its particular charm lies in the ability of the author to make crystal clear subjects whose complexity can often perplex and mystify students and newly qualified practitioners. It is eminently readable, and an excellent technical and practical reference book for both the clinical student and novice to mid-range practitioner. It makes no attempt to be a comprehensive textbook - more, it is a collection of ideas which clearly interest the author and are well worth taking on board as part of the elaborate tool kit of a skilled practitioner. The book covers much of the practical groundwork of an acupuncture clinician. It is not as basic, for instance, as Acupuncture and Moxibustion- A guide to Clinical Practice by Auteroche, Gervais, Auteroche, Navailh, Toui-Kan, and yet produces a strong sense of the real-life energetics of qi. The evolution of oriental acupuncture into a system suitable for use in the West on western patients is demonstrated through the very human yet eclectic style of this book. Her sources are wide and varied and, where understanding is not readily available from outside sources, Ms Gardner-Abbate is not at all averse to presenting her own hypotheses based on sound clinical experience. A strong point of this book is in the author's ability to convince us that her well developed ideas arise from long-term and varied clinical experience: experiences on which she has reflected at length and constructively, which encompass the entirety of the therapeutic encounter rather than stopping at the level of technical expertise. It is unusual to read a good practical book and, at the same time, get a sense of the author as a rounded, highly evolved practitioner - Ms Gardner Abbate's patients 'live' and so does she.

The book is written in two parts. Part 1, General Treatment Approaches, contains 14 chapters on various techniques.

The first chapter looks at protocols for making a diagnosis and treatment strategies and the second looks at different needling techniques. Here there is a very interesting section on point pathology; using inspection, auscultation, olfaction, palpation and inquiry to determine pathological conditions from points alone. In this section of the book is also a brief but interesting overview of different interpretations of what a point actually is.

There is a simple, straightforward and clear explanation of point classification including luo points, xi (cleft) points, influential points, coalescent points, confluent points etc. Later on in the book, a chapter is exclusively devoted to these points with a stress on the gynaecological implications. This is particularly helpful in view of the proportion of female patients one sees, and the large amount of gynaecological conditions presenting.

Skya very satisfactorily puts into context the consideration of five elements and TCM, appropriately presenting these two systems as two of many different systems for interpretation, diagnosis and treatment.

She also makes an interesting comparison of the Chinese and English methods of using luo points for excess and deficient conditions and talks about how to needle differently to access tranverse luos or longitudinal luos. Skya states that, although quite different clinically, nevertheless, each strategy works.

There is a chapter on bloodletting techniques, such as plum blossom needling, shoni-shin needling and the technique of gwa sha and an entire chapter devoted to the action of P 6, including an interesting section on the value and technique for palpation of this point.

Skya gives a very good explanation of how to make point selections and combinations which cuts through the complexity nicely. She speaks of the six divisions treatment with paired xi cleft and supplementary points, and briefly mentions the Shang Han Lun description showing how symptoms change as a cold disorder progresses through energetic layers.

Alongside very useful tables and aesthetic and dynamic paper cuts, Skya has used case histories to illustrate her points. Many of her case histories address the nature of the relationship between the patient, the practitioner and the healing process as well as the actual techniques employed. The very first one is typical, and describes a case where acupuncture and herbal treatment were an effective strategy to combat disease, and yet the noncompliance of the patient was such that to proceed with effective treatment in a positive healing atmosphere was almost impossible.

Part II covers in depth four diseases with their appropriate treatment protocols: Periodontal Gum Disease, Cellulite, Facial Rejuvenescence and the Menopause. Uncomfortable as I was seeing the menopause listed under a category labelled disease, nevertheless, the fascinating thing about this section is not so much the diseases and treatment protocols themselves, although these are clearly thought through and well rounded taking into account patient compliance and the broader health implications of the disease: rather, what I found particularly stimulating was the way in which the whole treatment strategy was thought out as an entire lifestyle process. I had a degree of healthy scepticism about the reference to herbal and vitamin formulae in the section on menopause, because it seemed simplistic and contrary to the differentiation necessary to make a satisfactory detailed diagnosis. As she states, menopausal symptomatology varies hugely from one individual to another and is unlikely to be satisfactorily dealt with by any universal cure-all - having tried Chinese patent formulas with minimal success Ms Gardner Abbate has alighted on these three formulas and pronounced that 'these products were so effective that many patients did not require any acupuncture'. I await to see the formulae in action.

I look forward to her next book The Magic Hand Returns Spring, The Art of Palpatory Diagnosis - palpation has become almost a lost art.

Susanna Dowie
Susanna Dowie has been in practice since 1982 and is widely experienced in many aspects of the complementary medicine field, including homoeopathy and massage. She is now studying for an MA in Complementary Health Studies and since 1995 has been Principal of London College of Traditional Acupuncture. She currently holds a seat on the British Acupuncture Accreditation Board.