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ABuchbesprechungen | Book and Media Reviews

Val Hopwood, Clare Donnellan

Acupuncture in Neurological Conditions.

Churchill Livingstone, Edinburgh, 2010. Hardbound, 232 pages. £ 39.99, ISBN 13: 978-0-7020-3020-8

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‘Acupuncture has been proved to be safe; now would be a very good time to add further clinical evidence of its value in neurological conditions’ (p. 199)

Contents

This is a book in three parts, with fi ve background chapters on Chinese (‘TCM’, traditional Chinese medi-cine) and Western medical (WM) approaches followed by a core of chapters focused on clinical treatment in six diff erent areas (acquired brain injury, Parkinson’s disease, multiple sclerosis, spinal cord injury and di-sease, peripheral nervous system disorders and motor neurone disease), and ending with a chapter on ‘pulling it together’. There is also a single brief appendix, on outcome measures used in neurological rehabilitation, and an index.

Readability

Hopwood and Donnellan manage to make the whole pro-cess of clinical reasoning sound easy – although the many case studies presented vary from levels 1 (single sym-ptom) and 2 (complex or chronic), both treatable using either WMA or TCM, to level 3 (again complex or chronic, but now requiring a mix of WMA and TCM). However, their presentation is realistic and rightly cautious, by no means giving the false impression that acupuncture is 100 % successful in this fi eld. It is diffi cult to write about TCM for non-TCM practitioners without it sounding like mumbo- jumbo or rigidly systematic. Sometimes in this book the writing on TCM is indeed a little fuzzy, at others too cut and dried, but although I have tried hard to pick holes in it, I have not really been able to locate any ma-jor problems. Having said that, for those unfamiliar with the TCM jargon, a glossary would have been useful (do we all know that the ‘wei’ in wei qi is not the same as in wei syndrome, for example?), while on the other hand some explanation of the Hmax/Mmax ratio and the ‘surface projection zone of the decussation of the pyramid’ (pyra-mids?) would be welcome. The index is disappointing (no mention of neuralgia, for instance, let alone trigeminal neuralgia, although this is touched on at various points), and referencing is sometimes avoided, as in the appendix, and also for a number of statements based on what ‘some teachers’ or ‘some scholars’ say. And there are some ob-vious typos, as when the hun is associated with the Lung rather than the Liver (p 8).

Innovation

The authors, both very experienced and knowledgeable in the fi eld of neurological rehabilitation, have open-mindedly set themselves the admirable if unenviable task of demon-strating how TCM and Western medical acupuncture (WMA) may both be appropriate, and even integrated, in the treat-ment of central and peripheral nervous system conditions (many of the former being notoriously refractory to most interventions). They have managed to do so quite successful-ly, using methods of clinical reasoning based on categorising the conditions in diff erent ways. For example, they make the interesting suggestion that the three groups of TCM syn-dromes usually invoked to describe neurological disorders (Bi, Wei and Feng) can be combined together in a single ‘neurological syndrome’, with diff erent manifestations in the six diff erent areas covered. This is a powerful insight, parti-cularly for those who are not at ease with the complexities of TCM. Within the WMA framework, they consider the eff ects of acupuncture under four headings: sensory, motor and vis-ceral functions, as well as generalised symptoms (insomnia, fatigue, mood disturbance). Acupoint selection guidelines are based on these two models (using points with traditio-nal functions and/or segmental associations), taken together with the symptom pictures for the diff erent conditions.

Readership and relevance

This is a good and useful book, primarily intended for phy-siotherapists already using acupuncture, but also for others working with neurological conditions, in particular profes-sional acupuncturists. The authors clearly state their aim ‘to see the two professions better able to work together with this important group of patients’, and this book should con-tribute to that. In 2002 I wrote a comparative review of two books on acupuncture for neurological disorders [1]. Since then, one of those books has been republished, now enlarged to over 600 pages and incorporating musculoskeletal disor-ders as well [2]. The author, Lü Shaojie, has thus covered many more conditions than have Hopwood and Donnellan, including headaches of diff erent types, some 14 types of cra-nial nerve disorders other than Bell’s palsy and trigeminal neuralgia, and many individual peripheral nervous system disorders. However, although his book is quite accessible to those not trained in TCM, that is his background, and he does not cover the WMA approach at all. Furthermore, the many conditions he does cover are not considered under one unifying ‘neurological syndrome’, which will make his

Buchbesprechungen | Book and Media Reviews

book less satisfying to those who prefer the portable simpli-city of Hopwood and Donnellan. In some ways the books are complementary, and both have their place.

Content: *** Readability: ** Originality: **** Readership and relevance: *** Cost/benefi t ratio: ****

Inhalt

Nach einer Standortbestimmung zum Thema mit diff eren-zierter Ätiologie und Diff erenzialdiagnostik teilt sich das Buch in drei Teile: 1. Übersicht zu psychotherapeutischen und naturheilkundlichen Verfahren, 2. Anleitung zur Arzt-Patienten-Interaktion, 3. Beschreibung von ca. 30 somato-formen Störungen und somatoformen Schmerzstörungen (vom chronischen Müdigkeitssyndrom bis zur Cranioman-dibulären Dysfunktion).

Lesbarkeit

Das Buch ist übersichtlich gegliedert, enthält viele Querver-weise, die durch diff erenzierte Nummerierung leicht aufge-funden werden können. Im 3. Teil erfolgen leider zu viele ste-reotype Wiederholungen bei den Unterpunkten Diagnostik.

Innovation

Dies ist das erste Buch dieser Art.

Umsetzbarkeit

Es werden reichlich klare Hinweise und Anweisungen ge-geben, wie Patienten naturheilkundlich und/oder psycho-therapeutisch behandelt werden können.

Meine Meinung

Eine Verhaltenstherapeutin und ein Naturheilkundler setz-ten sich zum Ziel, ein integratives Buch zu somatoformen und funktionellen Störungen zu schreiben.

Rose Shaw, Axel Eustachi

Somatoforme und funktionelle S– Gesprächsführung und naturheilkund

Urban & Fischer (Elsevier), München 2010, 21

References

Mayor DF. Wong JY 2001 A Manual of Neuro-Anatomical Acupuncture. 1. II. Neurological Disorders and Lü SJ 2002 Handbook of Acupuncture in the Treatment of Nervous System Disorders. A comparative review. Journal of Chinese Medicine. 2002 Oct; (70):55–7 LüSJ Acupuncture in the Treatment of Musculoskeletal and Nervous System 2. Conditions (2nd edition). St Albans: Donica, 2009 David Mayor, Welwyn

David Mayor86 Handside LaneWelwyn Garden City, Herts AL8 6SJTel.: +44 (0) 17 07 / 32 07 82 davidmayor@welwynacupuncture.co.uk

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Was das Buch istEine sehr ausführliche Beschreibung einzelner Störungs-bilder sowie der möglichen psychotherapeutischen und naturheilkundlichen Interventionsmöglichkeiten inkl. chi-nesischer Medizin. Der Teil zur Arzt-Patienten-Interaktion darf ebenfalls als gelungen bezeichnet werden.

Was das Buch nicht istEs ist nicht integrativ. In jedem Kapitel stehen der psy-chotherapeutische und der naturheilkundliche Teil relativ unverbunden nebeneinander. Man könnte diesen Ansatz als komplementär bezeichnen. A. Eustachi beschreibt die breite Palette naturheilkundlicher Therapieansätze, was aber weitgehend fehlt (trotz des sehr interessanten Kapi-tels zur Standortbestimmung), ist eine inhaltliche Ausein-andersetzung über das Konstrukt der somatoformen Stö-rungen, die über den Status quo hinausgeht. Die westliche Psychologie und Psychiatrie verstehen im Grunde soma-toforme Störungen als eine Fehlentwicklung. Eigentlich psychologische Defi zite würden somatisiert, da der Pa-tient sich die psychische Störung nicht eingestehen will/kann. Folgerichtig sieht die westliche Psychologie in der Symptomatik keine biologische Gesetzmäßigkeit, sondern ein individuelles Ausdrucksverhalten. Sicherlich existiert dieses individuelle und symbolische Verhalten, bspw. bei hypochondrischen Patienten. Aber das in diesem Buch nicht aufgedeckte „Geheimnis“ eines großen Teils der „somatoformen“ Störungen besteht darin, dass die beim Patienten vorliegenden Symptome ein in sich schlüssiges Muster, einen Syndromkomplex bilden können, der einer bestimmten emotionellen Veränderung – zumeist Hem-mung derselben – zugeordnet werden kann: psychoso-matische Störungen als emotio-somatische Störungen, so wie es in der Syndromlehre der Chinesischen Medizin zu

törungen liche Konzepte

6 S., € 35,95, ISBN 978-3-437-57670-6