Medical Acupuncture: A Western Scientific Approach 2nd Edition Edited by Jacqueline Filshie Adrian White Mike Cummings Publishers: Elsevier, 2016 Hardback: 734 pages RRP: £79.99
(Reviewed by Jane Wilson, EJOM Vol.8 No.6)
This second edition of Medical Acupuncture: A Western Scientific Approach is a large book separated into seven sections and thirty-nine chapters. This is an evidence-based text-book for a new branch of medicine. This branch of medicine is closely aligned to acupuncture; however, this style of medicine aims to provide an alternative pathophysiology for the action of inserting filiform needles. Consequently, although this book has been on my shelf for some months now it has not yet been directly supportive of my own clinical practice. This text-book is outlining something that the editors have called Medical acupuncture, which is a new body of knowledge based around the insertion of filiform needles. However, this is about findings based on positivist sciences and evidencedbased medicine which many would question in this post-positivist era (Goldenberg, 2005). Furthermore, this text-book is primarily about pain management. Despite this, there is a huge body of information compiled here, by people with an obvious passion for what they do and a desire to communicate.
This book contains multiple references regarding findings from randomised controlled trials (RCTs) but very little on how points might be selected. In fact the issue of points has conflicting approaches between the editors and the various authors throughout: whilst some contributors think that all points are irrelevant, many say that traditionally recognised points are at the very least safe and for this reason alone might be better than non-recognised points on the body. Using points not traditionally recognised is described in this book as being just as good or nearly as good, never better though. So if not better, why not do as Schnorrenberger (2017) suggests and use acupuncture foramina as described by Wang Wei-Yi (987-1067) with centuries of use which have demonstrated themselves to be safe and effective? Something that does come across in this book is that filiform needling is safe if practised well, with a good knowledge of anatomy.
Overall this book is very supportive of filiform needling practice. To see trials here demonstrating that ‘substantial evidence shows that neural pathways are responsible for the action’ (p.395); or that ‘it has actions on sympathetic and parasympathetic pathways’ (p.399); or that it ‘reduces cortisol levels’ (p.443) is very pleasing. However, these are simply some found effects and still a long way from giving any definitive explanations for action; for example see Langevin (2010) for a discussion on the possible multiple and connective tissue pathophysiological mechanisms. References in the book to the limbic system as primary do not really help much more, as Koppleman et al. (2016) remind us in their editorial: ‘the appraisal and synthesis of research is purely a human endeavour and with that comes interpretation consistent with a particular, subjective world-view’. But, for anyone who still thinks that acupuncture is simply a placebo, this book is an essential read.
One of the most difficult areas here is the definition of what is described as acupuncture. The editors give a strong argument that they do not wish to be seen as performing dry needling, as they suggest this implies that the evidence is not attended to, but is it acupuncture? Many people today would argue that the word acupuncture has come to be the word that is the common translation of zhēn jiŭ - 針灸, which describes a practice of acupuncture and moxibustion that includes not only the insertion of filiform needles but also the use of moxibustion, and furthermore, that this is associated with a whole system of practice. This practice would include dietary and lifestyle advice (from a very specific context), as well as an approach which includes diagnostic methods, differentiation theory and pattern recognition, treatment principles, strategies, and treatment plans, as well as reasoned point composition. Point composition means choosing points which work in synergy in respect of their classifications and actions. In addition, this approach deems qi as part of this practice and that qi has a wider meaning than energy and relates to a shared representation of cosmic order and a system of correspondences and correlations that extend the evidence-based theory which originates from statistics. Far greater progress could result not only from a simple recognition and acknowledgement of these differences but also the value of both. These are different ontological points of view but they could perhaps work better with each other if they were more clearly defined (Zhu and Most, 2016; Zhou et al., 2015). Moreover, Wen- Yue Jiang (2005) discusses how traditional medicine aims to correct maladjustments and restore the body’s self-regulatory functions. The approach here is more directed to specific pathogenic targets rather than the overall functional state of the patient. This is despite the early part of the book focussing on the limbic system and suggesting that acupuncture regulates the body’s responses.
This covers most of that discussed in Sections 1, 2, 3 and 4; with the addition in Chapters 9, 10 and 11 of information covering superficial acupuncture, auricular acupuncture and electroacupuncture respectively. There are also sections of some different styles of practice e.g. self-needling by patients, periosteal needling, transcutaneous electrical nerve stimulation and laser treatments.
Section 5 on research is important as rigorous research is essential; this section covers topics such as blinding, bias, sham, etc. However, it would have been good to have seen more reference to STRICTA (MacPherson et al., 2015) and critique of the intervention in randomised controlled trials.
Section 6 is titled ‘Clinical Use’ and includes 21 chapters by different authors on topics such as mental health, urogenital conditions, skin conditions, rheumatology, etc. All topics have been approached in this new evidenced-based method, with each chapter having extensive references, mostly from randomised controlled trials (some of which have been reviewed by the authors). There may be valuable information here that can inform more traditional practice, as whilst traditional medicine does relate back through time, it is not stuck in time and still has the ability to absorb new ideas (Scheid, 2007).
The writers clearly set out to see how they might deliver effective acupuncture within a limited health budget and for it to be more widely available. There is also a desire to deliver this style of treatment in a safe way. The book explains how this provision is driven by patients, yet there is not much of a patient voice here; although there are some incredibly touching acknowledgements regarding acupuncture usage by medical personnel. Chapter 37 is a fascinating chapter on primary care where Jen Foell describes how bringing acupuncture into a consultation enriches this by bringing in ‘a direct healing element’ (p.619) and how this brings to the consultation elements of caring and touch.
The diagrams and photographs at the beginning of the book seem out of context and do not sit well with the rest of the text. The diagrams at the end are very simple and not really adapted to add to this text-book. Both of these sections are poorly labelled and referenced.
Overall I agree with the reviewer of the first edition of this book (Mayor, 1998); it is important and also far more conciliatory than previous writings from this group. We can all learn from each other and this book clearly supports acupuncture as a safe and effective intervention that can be used both in acute and chronic situations in many different specialities. It is good to look forward to making positive steps towards effective communication and collaboration in the future between all groups who are amazed by the effects of filiform needling in all its guises and working on ways that this can be delivered to as many people as possible. To achieve these goals it is important to reflect on: firstly, delivery in both individualised and standard ways; secondly, on how to get effectiveness in the real world and thirdly, possible ways to integrate with different forms of medicine. But knowledge must be open ended and as Raphals (2015) emphasises, philosophy must be part of medical care. Furthermore, there is a need to embrace foundational concepts and respect is fundamental to this process.
(Reviewed by Jane Wilson, EJOM Vol.8 No.6)
Jane Wilson MCSP, SRP, CertEd, DipTP, DipShi, CAc (Nanjing), MSc, MBAcC, MAACP, FHEA divides work between private practice in London and being a senior lecturer at Westminster University, teaching both undergraduate and postgraduate programmes. Jane has been a physiotherapist since 1977, training at the Royal London Hospital, and an acupuncturist since 1989, training at Nanjing College in China. Jane gained her MSc from King’s College in 1994.