Lou Hsing Chuang et al, Translated by Thomas Dey Paradigm Publications, Brookline, Massachusetts, USA, 2000 (Translation), 1987 (Chinese original) Paperback, 140 pages, £9.95
(Reviewed by Dr Kevin Baker, EJOM Vol. 3 No. 6)
This welcome book aims to communicate the perception, experience and treatment of schizophrenia within contemporary Chinese culture. It proposes that Chinese medicine as a whole and acupuncture in particular make a valid contribution to the future of a psychiatric medicine that is informed by both western and Chinese models of mental health.
It is intended for English speaking practitioners of traditional acupuncture as well as psychologists trained in western medicine and the individuals and associated family members who suffer with this most prevalent of the major psychiatric disorders. Cross cultural and historical studies indicate that schizophrenia is present in all modern day societies and has probably been present throughout recorded history.
Thomas Dey, the translator, spent several years in the People’s Republic of China before studying Chinese medicine in Nanjing. As a result of his experience he was left with ‘the strong belief that there is much suffering by people with mental diseases that could be alleviated by TCM, were it better understood’. No information is given about the authors of the original Chinese edition of the book (1987), save that they have practised acupuncture for many years and are based in Hangzhou.
I trained in TCM in the 1980s and was sufficiently impressed by the importance of mental emotional factors in disease causation to embark upon psychotherapy training in the 1990s, and this is the first text I have come across that seriously addresses the question of the role of the TCM perspective and acupuncture treatment for mental health disorders. Though the title specifies schizophrenia as the main focus, in effect all mental health disorders, whether major (psychosis) or minor (neurosis), are considered under the broad TCM category of Dian-Kuang (mania-withdrawal). This book thus serves as a valuable introduction to our subject and in a significantly more modest format than Chinese Medical Psychiatry (Flaws & Lake, published by the Blue Poppy Press 2001), currently available for the practitioner who wishes to read further around this subject.
One of the features of this book that I particularly like is the eight page forward by Dr Richard Warner, psychotherapist and author of Recovery from Schizophrenia: Psychiatry and Political Economy. Dr Warner provides very useful basic introductory information about schizophrenia, its symptoms, diagnosis, prevalence, causation and factors in effective treatment. This forward is followed by the translator’s preface in which he enthuses about the book as a resource for TCM practitioners, psychotherapists and the general reader. He sets the context with a consideration of the language of medicine and the patterning of disease from western and Chinese perspectives. He also considers the ideological perspectives, informing TCM practitioners in mainland China in the 80s. He explicitly acknowledges his use of the Wiseman et al translation protocol for this work and is appreciative of this. As a non-Chinese reader myself I am unable to make any comments on translation issues.
The main text is set out as six chapters commencing with an introduction, which has an integrated holistic perspective. The abnormal intellectual, emotional and volitional behavioural responses to the schizophrenic subject’s environment are acknowledged. Whilst from a western medical perspective the debate in relation to aetiology (i.e. nature/hereditary versus nurture/environment) continues, from the TCM perspective, as with all diseases, ‘a thousand forms of suffering do not exceed three types’ (i.e. climatic, mental-emotional and miscellaneous causative factors). Numerous quotations from the Ling Shu and later texts from the dynasties are made. A useful research review on aetiological factors concludes with five main aspects listed viz poor intrapersonal relations during childhood; hereditary factors; tense family atmosphere during childhood; evident introversion tendencies before onset; and unpleasant occurrences during gestation or parturition. This introductory chapter does provide a useful consideration of the complexities of the aetiology in schizophrenia and includes several historical references to the use of acupuncture in treatment.
The second chapter covers clinical symptomatolgy considering the abnormal thought patterns, the emotional and volitional disturbances and the disordered perceptual features of hallucination and delusion. The complexity in the varieties of clinical presentation is evident. A standard classification of types of schizophrenia is listed (simple, hebephrenic, catatonic and paranoid) together with a useful description of the main features of each type.
The third chapter covers the diagnosis (medical history and psychological examination) and the essential differential diagnosis. In terms of the latter a full spectrum from neurotic to psychotic is considered including for example, symptomatic psychosis in which psychotic presentations manifest as a result of somatic, infectious or toxic disorders, thus emphasising the complexity of differential diagnosis and the necessity of using an holistic mind body perspective for accurate western medical diagnosis. The ostensibly much simpler TCM diagnosis of Dian Kuang from Qi and Blood disharmony with Phlegm and Fire harassing the Heart had already been considered in Chapter One.
The following chapter on prevention provides ample material for reflection for us all as practitioners and as human beings. Good home-cooked wisdom here I thought. First create your healthy mental lifestyle, ‘avoiding anger, reducing thinking, eliminating worry, speaking conservatively and severing selfish thoughts are all practical measures for nourishing the heart’. Secondly maintaining the central nervous system through a balanced lifestyle, adequate deep sleep, the avoidance of fatigue and promoting ‘active rest’ is recommended. Essentially from the TCM the Qi and Blood wants movement and the Essences and Spirit want tranquillity. Finally the importance of early diagnosis and treatment is emphasised whilst recognising that the schizophrenic is usually the last to present after his/her family, friends, work colleagues etc. have noticed significant change.
The last substantial chapter covers treatments under a number of categories. Firstly, the authors’ own experience in clinical practice over many years. They cover Dian (mania) and Kuang (withdrawal) as well as symptomatic treatment for insomnia, anorexia, hallucinations and delusions. There is a useful consideration of improving effectiveness through correct point location, direction and depth of needling together with a review of the major needling techniques. The experience of the ancients is next considered using classical acupuncture as well as psychotherapy and sleep therapy using herbs. A number of case histories are given. Modern measures in the form of ECT, insulin therapy, drug therapy, body acupuncture and various other acupuncture techniques (e.g. electroacupuncture, auricular acupuncture and bleeding) are next considered. No substantial details are offered but our cultural differences are underlined as we are advised that use of large needle at GV 16 can result in death which ‘should elicit great concern’. There next follows a useful and interesting section on psychotherapy before completing with a consideration of acupuncture and Chinese herbs used in conjunction with drug therapy.
A concluding chapter rightly acknowledges the importance of more extensive research into the mechanisms by which acupuncture does treat schizophrenia as well as hopefully eliciting further information about its causes and development. Thomas Dey hopes that this book helps ‘to clear a path towards transcultural adoption of Chinese medicine within a Western medical system’. I certainly found this book a good start for that task. As with several modern Chinese medical texts I do have substantial reservations about the success rates claimed for acupuncture treatment in such a major psychiatric disorder as schizophrenia. However, overall I found the content both engaging and inspirational as a text from mainland China in the mid 1980s. I did enjoy the forward from a western medical psychiatrist, which helped to contextualise acupuncture treatment from an holistic western medical perspective. Hence I shall conclude with Dr Warner’s appreciative final words ‘acupuncture can certainly play a role in the treatment of schizophrenia, insofar as it meets the following criteria: - It is a less stigmatising treatment approach than alternative forms of treatment; - It is non-alienating, non-coercive, non-intrusive, and respects the individual and his/her personal integrity; - It mobilises an optimistic social consensus, is part of a vigorous effort to achieve a cure, and encourages involvement of the broader social group to aid the integration of the ill person. It enhances family support.
There may well be levels beyond these in which acupuncture has a place to play in the treatment of schizophrenia.’
Dr Kevin Baker Dr Kevin Baker is an holistic physician who runs a private practice in Sussex in both traditional acupuncture and psychotherapy. He is a contributing author with Peter Deadman and Mazin Al Khafaji of the widely acclaimed Manual of Acupuncture (JCM Publications 1998).