Until now, Julian Scott's Acupuncture in the Treatment of Children, based firmly on Chinese texts, has been the undisputed standard work on paediatric acupuncture. Turtle Tail and other Tender Mercies by Bob Flaws, and a pocket book on Chinese paediatrics from the Nanjing College of TCM, have also been available in English for quite a while.
Dr Loo's book, although it covers very similar ground, clearly comes from a different stable. It may well appeal more than these older books to recently trained acupuncturists with a less rigidly TCM or five-element approach.
It is very attractively produced, and well written. The author's knowledge and experience of both western medicine (WM) and TCM paediatrics have resulted in a good 'integrative' approach, suited to today's requirements for evidence and accountability. Throughout, observations and interpretations from both systems are usefully juxtaposed. However, readers familiar with TCM and wishing to brush up their WM will probably benefit more than those acupuncturists who are less familiar with TCM. And sometimes the juxtapositions set each other off and result in fascinating insights, while at others they do not sit so easily together.
So, for example, in chapter 4, on the physiology and pathology of childhood illnesses, May Loo usefully shows how traditional views have to be modified when treating the modern child, overexposed to fast foods, pollutants and technology (electromagnetic fields in particular). Elsewhere in the same chapter, her interpretations of qi dynamics in terms of metabolic acidosis/alkalosis, or enzyme and IgA levels, left me floundering. I frankly winced at her interpretation of the 'triple energiser' and pericardium as parasympathetic and sympathetic nervous systems respectively. The poor old sanjiao has had enough western labels thrust on it already, without needing yet another one!
In her next chapter, May Loo constructs a challenging picture of childhood development in terms of the traditional five-element model and the theories of Piaget and Freud. She argues that trauma during a particular elemental phase of development can render that element vulnerable in later life. This is a cornerstone of the treatment strategies she describes later in the book. Like many clever people struggling to integrate WM and TCM in their daily practice, she has used what she knows in order to create a framework of ideas that feels comfortable for her. Convinced that there are close correlations between the different models she uses, she is even quite dogmatic in how she sets out her views.
Here I think the author has problems. Development is not a fixed succession of events in linear time, but a continuing process. Most five-element trained acupuncturists, for instance, could think of counterexamples to her seven phases of life, from Metal (birth to 2-3 years) through to Fire (the teenage years and early adulthood) and Earth (transition to middle age), and again Metal and Water. Her views of Piaget and Freud are similarly rigid, as well as selective and decidedly dated (she does not even mention the oral and anal 'phases' of development, for example). However, none of us can keep up-to-date with the literature in fields that are not our own, and most of us are quite selective (biased) in the ideas we like to adopt. It is easy to become fixated on the theoretical models we first learn as we train to become practitioners.
In a book more recent than most of those she cites (The Interpersonal World of the Infant, Basic Books 1985), Daniel Stern emphasises that the developmental theories of early psychoanalysis were not based on observation, but inferred retrospectively from the supposed memories of adults: Freud's 'clinical infant' is actually quite different from the actual 'observed infant'. Further, the seeming 'phases' of development are not successive, but remain fully functional, growing, overlapping and coexisting as we ourselves grow. Crucially for May Loo's argument, trauma at a particular age does not lead to predictably specific problems later, and the origin for any of the traditional clinical-developmental issues could lie anywhere in time. As he states, 'Freud’s cognitive sequences … are no longer so widely accepted [as Piaget’s]', and the 'narrative point of origin' is just a metaphor, even if the primary task of therapy remains to find the key metaphor(s) for each person. Simple models that combine aspects of TCM with developmental psychology may be particularly attractive, but in practice they often are (and should be) put aside in favour of what arises, in part intuitively, out of the therapeutic encounter. I suspect this is just as true for Dr Loo as for the rest of us.
In chapter 6 of her book, May Loo very capably describes the diagnostic evaluation of children in both TCM and WM terms. The accompanying tables are clear and useful, and I particularly enjoyed her vivid accounts of the six stages of disease and of family interactions in chronic disorders.
Dr Loo then goes on to describe some of the techniques she uses in addition to traditional methods, such as Manaka's ion pumping cords (although Manaka's work is not acknowledged), electrical acupoint stimulation (what I call 'pTENS', or point/probe TENS), magnetic and laser stimulation. Most of this chapter is clear and useful, although her account of laser stimulation is superficial and somewhat confusing. I suspect this is because she does not use it often herself. However (as in the previous chapter), I do sometimes find her didactic approach dogmatic and occasionally even mechanical. I would take issue, for example, with directly teaching very young children breathing methods derived from qi gong. Children are very malleable, and if we ourselves are not extremely clear about our own state and what we are doing, we can easily cause unintended harm. It might be better to teach their parents, and then let children learn their breathing style through unconscious attunement with them, rather than being too directive ourselves. I was also puzzled by some of the more idiosyncratic functions she attributes to certain acupoints without justification, and surprised at the emphasis she places on the Japanese four-point (four-needle) technique (although, of course, every teacher and every school has its own traditions in such matters).
After this very practical chapter, the author continues with a succinct and useful account of dietary management (as before, with very clear tables), and then a chapter on childhood infections and immunisation. There is a lot of information here that will be useful for parents and practitioners struggling with the controversies surrounding immunisation, but surprisingly little about acupuncture treatment of childhood illnesses, given her earlier statement that infections and rashes are the ‘bread and butter’ of paediatric practice (infections are better covered in the 1990 Nanjing pocket book).
In her final and probably most useful chapter, over 120 pages long, May Loo covers the usual paediatric conditions very capably, from both WM and TCM perspectives. While she omits some of the conditions mentioned by Julian Scott, such as teething, vomiting, myopia and 'glandular congestion', she includes accounts of others, like headache, diaper (nappy) rash, conjunctivitis and acne that many practitioners will find helpful. Her coverage of ADHD (attention deficit hyperactivity disorder) and migraine are excellent examples of how WM and TCM can be integrated. I also enjoy the way she can happily combine acupuncture methods from different traditions. Sometimes though, as in her account of immunology (too complex?) and obesity (simplistic?), her attempts at integrating WM and TCM are not so successful. It would also have been helpful if she could have included some illustrative case reports, maybe fleshed out the information derived from published clinical studies more fully (there are over 800 publications referenced in this chapter), and included a few more definitions of some of the unindexed medical terms and abbreviations she uses.
The book ends with clear illustrations of the acupoints (although a number of these are miscaptioned), together with a good index. Incidentally, there are a few other errors in the book which could be corrected in a future edition, such as repeated use of luo gong/He 8 instead of lao gong/P 8, and some incorrectly numbered references in the section on treating obesity.
In conclusion, I would definitely recommend Pediatric Acupuncture. I do not think it will completely replace Julian Scott's more strictly TCM-based book, but it does provide a more rounded and contemporary approach to treating children's conditions. However, I feel that Dr Loo's five-element model of development has considerable weaknesses. It may reveal new therapeutic vistas, but should not be taken too literally.
Acknowledgements: I would like to thank Helen Thomas for the loan of Acupuncture in the Treatment of Children, by Julian Scott (Eastland Press/Chinese Medical Publications 1991) and Essentials of Chinese Pediatrics, by Cao Jiming, Su Xinming and Cao Junqi (Foreign Languages Press, Beijing, 1990). I would also like to thank my wife, Susan Harrison Mayor, for drawing my attention to the book The Interpersonal World of the Infant, by Daniel N Stern (Basic Books, 1985).
David F Mayor David F Mayor originally trained in biodynamic psychology before studying five-element acupuncture at the College of Traditional Acupuncture, and is married to a Jungian analyst. He is currently preparing a textbook on Electroacupuncture (EA) for the publishers Churchill Livingstone.
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