Book Review: Identifying and Treating Blockages to Healing by B Strittmatter
Identifying and Treating Blockages to Healing: New approaches to therapy-resistant patients
Thieme Verlag, Stuttgart 2004
Paperback, x + 257 pp
‘Everything that has the smell of a system has to be thought about very carefully. Our bodies do not systematise. Nature is much more chaotic than we believe’
Thomas Ots (2006)
History is not static. Acupuncture has never been monolithic. Many varieties have been developed over the years and in different cultural settings, sometimes exhibiting a rich and exuberant creativity, particularly at times and places where different cultures have met and merged or clashed. Globalisation and the counter-urge to stability, uniformity and controllability may well threaten this diversity.
No-one can pretend to be proficient in all methods of acupuncture, and most of us prefer to use the tools with which we are most familiar. Other approaches may seem strange to us, illogical, outlandish, perhaps even foreign to the true spirit of acupuncture, but we should at least be aware that our way is not the only one. After all, it is our professional duty to be informed about other developments in our chosen field.
As a TCM practitioner who also uses a lot of basic auricular acupuncture, inevitably I have come across many cases that I cannot help in any significant way. Sometimes I think I know why, but often I do not. I was therefore eager to read Identifying and Treating Blockages to Healingby Dr Strittmatter, a key figure in the German Academy for Acupuncture and Auriculomedicine (Munich), a senior editor of the journal Der Akupunkturarzt/Aurikulotherapeut, and chief disciple of Frank Bahr, arguably the major figure in the development of Western auriculotherapy since the death of Paul Nogier. It is mostly Bahr’s ideas that Strittmatter expounds in her book.
In TCM we have ben and biao, root and branch, which may be construed more broadly as constitutional and symptomatic, or underlying and overt. For Strittmatter, the
ben that complements the biao of symptomatic treatment is not rationalised so much in terms of traditional models (wuxing, Five Elements, or bagang, Eight Principles), but is based on the notion of the ‘focus’ or ‘field of disturbance’. A focus is ‘a harmful influence which interferes with the body’s system of self-regulation, especially with the control of stimuli that disturb the body’s order’. Foci may be areas within the body of chronic inflammation (e.g. tonsils, appendix), regions of disturbance in the teeth or jaw, scars, problems with intestinal dysbiosis (e.g. candida albicans), substance intolerance or toxic load (from diet, pollutants, dental amalgam, and so forth). Patients may not be aware of foci, about 50% of which are scars.
According to Bahr and Strittmatter, there are two levels at which these foci or blocks to conventional, symptomatic or regulatory treatment (whether acupuncture, chiropractic or homeopathy) can be diagnosed. ‘Level one’ diagnosis is by means of sensitivity to pressure or using the ‘vascular autonomic reflex’ (VAS), sometimes known simply as ‘Nogier’s reflex’. This is a longitudinal shift in the pulse wave at the radial artery when a pathological point on the ear or body is stimulated in some way. Bahr’s five main ‘focus indicator’ points on and around the ear are investigated in conjunction with the VAS to determine the presence, number and severity of foci, as well as patient laterality. Further points can supposedly be used to check ‘oscillation’ (unstable reflex behaviour) and toxic amalgam load.
Learning how to palpate the VAS and interpret results, like any complex skill, can for some people require considerable determination and practice. I for one have never managed to do so, despite receiving instruction, and this inability (laziness?) on my part has no doubt contributed to my scepticism as to its validity (perhaps an initial unconscious scepticism also led to my difficulties with the method!).
The main ‘level one’ methods of treatment include needling the ear reflex zone corresponding to the focus or stimulating the zone with low intensity laser at specific frequencies, and infiltrating the focus itself with local anaesthetic (Huneke’s ‘neural therapy’). ‘Level two’ treatment is more complex, involving what I call ‘polarity’ methods,2 in particular the use of the ‘3-volt hammer’. Further complexity is introduced with Nogier’s ‘three tissue layers’, ‘inversion’ (reversal of reflexes), use of Bahr’s ‘9-volt rod’, and so on.
After chapters on the two levels of focus diagnosis and therapy, Strittmatter introduces the use of the laser in detail, covers other applications of the VAS and ear acupuncture, and includes some interesting case histories. A final chapter details focus-relevant reflex locations on the ear, followed by information on training, equipment and practical aids that are available to the practitioner. Strittmatter is very clear that this book, logically constructed and Germanically thorough as it is, and although it covers some 70% of the ear acupuncture training programme of the German Academy for Acupuncture and Auriculomedicine, is no substitute for proper training and hands-on experience (I would certainly have to question, for example, her description of needling at a point that has previously been marked with a non-sterile pen). Training courses are available in Germany, Austria and German-speaking Switzerland, as well as in Canada and the USA.
‘The map is not the territory’
Alfred Korzybsky (1948)
This book is the clearest exposition I have found on some of the more advanced aspects of auriculotherapy. Nevertheless, I have a number of reservations about it and the methods it describes. For starters, the translation, though accurate, is often horribly literal and heavy, not helped by the language of the original, which is unnecessarily complicated at times – particularly when the author attempts to ‘explain’ such phenomena as the VAS or introduce theoretical concepts such as Pischinger’s pathological ‘mesenchyme reaction’. For me, these explanations are unconvincing, partial, and do not help me to a feeling that I have grasped anything more securely, although I realise that they may make a kind of sense to some practitioners who need to know that what they are getting involved in is somehow scientifically acceptable. The trouble is – as with virtually all acupuncture, I have to say – that the methods described in this book cannot be reduced to left-brain science. That is no sin, but what I do find suspect is the implicit assumption that they are all somehow scientific and still have to appear rational, even if lurking beneath their veneer of logic they are in fact not at all scientific, let alone completely rational.
For example, use of a point-finder is described as ‘objective’, although the evidence for this is slim indeed.2 When Strittmatter writes that it is ‘far more convincing’ to use a concentric bipolar electrode than a monopolar one, I wonder who she is trying to convince. She even suggests that VAS results can be verified using the point-finder, or the other way about. To my mind, using one subjective method to verify the results of another may be reassuring, but can lead one further and further away from an acceptably ‘convincing’ and objective shared reality. Strittmatter also seems to imply that the VAS itself is a reliable indicator across different practitioners. The only evidence she presents for this is a reference to a lecture from 1994. On such a key issue, there should be many more studies before a conclusion like this can stand unquestioned.
What I find particularly irritating about this book is that many such statements are made without any supportive evidence at all, or if references are given, they are not completely relevant. For instance, Strittmatter writes (p 43) that ‘the scientific basis for ear acupuncture has been described in numerous publications’, but then includes in the list of 71 references for this statement several that have absolutely no bearing on ear acupuncture, and others that are clinical studies about conditions which she does not mention elsewhere in the book.
All-in-all, this is very much a publication about, and does not provide evidence for, the methods described. For example, we are supposed to accept, without any evidence, that gold needles should be used at points where electrical skin resistance is low, and silver where it is high. Elsewhere we are told that a pathological ‘gold point’ is more negatively charged, a ‘silver point’ more positive. Strittmatter in fact appears undecided as to whether the device she recommends measures electrical resistance or potential at the acupoint: her section heading ‘Measuring the differences in potential’ (p 62) refers to differences between skin resistances, and her minimal aside on the ‘Wheatstone bridge circuit’ clarifies nothing. Muddled presentation like this is unforgivable in a flagship book of this nature.
The differentiation into gold and silver points is an aspect of what I term ‘polarity thinking’ (Mayor 2007). Another is the dependence on the 3-volt hammer in ‘level two’ diagnostics. Here the electrical dipole provided by a 3-volt battery is used in conjunction with the VAS to locate focus indicator and other points, supposedly according to the principle of electrostatic induction. Unfortunately, given the electrical characteristics of skin and underlying tissue, in the configuration used (patient’s ear connected electrically to ground, practitioner holding the nonconductive handle of the hammer with its metal probe tip over – but not in contact with – an ear point, while contacting the patient’s wrist with the other hand to palpate the VAS), there is no conceivable way – scientifically speaking – can I see the polarity of the hammer will have any bearing on changes observed in the VAS. Justifying the procedure by appealing to science I believe to be self-deception on a major scale. Correspondingly with the 9-volt rod: I do not see how a patient holding a cylinder in contact with one pole of a 9-volt battery (the other pole free) can affect the body in any way according to currently accepted science. If science is being invoked to support these procedures, then they should be carefully investigated using scientific methods, not just carried out as ‘thought experiments’. Having said this, I am prepared to admit that the use of polarity does seem to affect the mind, as demonstrated in many nineteenth-century publications on the phenomena of animal magnetism (mesmerism) (Mayor 2007), even if this is difficult to demonstrate ‘objectively’.
Another example of polarity thinking is the use of the 9-volt rod to stimulate the ‘sympathetic’ or ‘parasympathetic’ nervous system on one or other side of the body. Accounts of body polarity occur throughout complementary medicine, whether in mesmerism, Count Maffei's system of ‘electro-homeopathy’ or Leon Eeman’s ‘biocircuits’ (Mayor 2007). However, considerations of polarity develop into systems all too easily (in acupuncture itself, the simplicity of yin and yang rapidly expanded to become bagang, the Eight Principles, for example).
The mentally held intention of the practitoner seems to be involved in other techniques using the 3-volt hammer described by Strittmatter. In one of these, if the hammer is positioned over the skin near an inserted needle, it is used with the VAS to determine withether a needle is precisely located (if the VAS becomes stronger, the needle is not correctly inserted). In another, the hammer probe is positioned near (or even contacting) the other end of an inserted needle to check whether the needle is still ‘working’ or should be removed. As the needle is a conductor, whether the hammer is positioned near the inserted needle tip or near its handle should not, I would have thought, make any difference to the VAS. Indeed, in these two techniques we are being asked to believe that an identical VAS response can give diametrically opposite indications – that the treatment is not working, or that it is working. It is the mind of the practitioner that decides the interpretation to adopt, and for this to be so the practitioner has to believe in what s/he is doing while suspending rational judgement (not necessarily a bad thing when it comes to healing, I should add!).
‘Unlike our animal cousins, humankind seems pitifully ill-constructed for simplicity’
Salley Vickers (2006)
Starting from the premise that non-responses to regulatory therapy must involve a focus, the inevitable consequence when the indicated test methods and intervention are also not effective is that the focus theory has to be extended in some way to cover this outcome. We all do this kind of thing of course, and it is often a fertile way of developing new treatment strategies, but in the case of Nogier and Bahr the result as I perceive it is a piling up of ever more elaborate ideas and methods in a process that I think of as ‘complexification’. I know from my own experiments in dowsing and radionics thirty years ago how easy it is to fall into this trap – believing what you do is the way, you build your own universe in which you can remain in control of what, ultimately, is not controllable, even if you would like it to be. Thus, after he had found the first focus indicator point, Bahr ‘searched for, and found, four other focus indicator points’. My housemate, watching me dowsing, would say that I hid things in order to find them again. If you look hard enough for something when you are dealing with energetic phenomena, you are all too likely to find it/them. And having found them once, you are very likely to deepen the groove and find them again, and again – until you think they are really there – although if we know anything about energy it is that it changes all the time, and that stasis is akin to death.
The need to control is very evident in this book. The approach is not patient-centred, but very much revolves around the practitioner. Especially with the ‘level two’ methods, for instance, ‘the practitioner no longer has to rely so much on the patient’s memory (patient’s history), because the method also permits the detection of foci which are either unknown to the patient (e.g. in the dental region) or can no longer be recalled’ (p 47). Patient narrative is secondary to practitioner expertise. Emotional problems are ‘treated’ using psychotropic points. The burden of stress ‘is literally taken away by eliminating the focal activity’. Emphasis repeatedly is on saving time, rather than for example allowing the patient to work through their emotional issues. Psychotherapy is reserved for ‘severe cases’. Such a cavalier attitude to the subtlety of psychological process is, I think, potentially quite harmful. As practitioners, we all have to beware of hubris.
Another difficulty I have with this kind of work concerns the correspondences that are erected and then supposed (by some) to be valid for all time (even if others develop alternative tables of correspondence that they cling to just as tenaciously!). I am thinking particularly of Kramer and Voll’s thirty-year old energetic correlations between the teeth/odontons and the body (pp 248-51) (e.g. top right front tooth = Kidney/Bladder), or Schmid and Bahr’s more recent ‘tooth points on the body’ (p 188) (e.g. top right front tooth = LU-7). It would be helpful to have more evidence for these correspondences than just the bland statement that ‘evidence has shown’ them to be correct – or not even that! Similarly, how did Bahr develop his system of the five focus indicator points? They seem completely arbitrary to me. Would another charismatic innovator have created a completely different system?!
As another example, Bahr has used ampoules of substances such as histamine, prostaglandin E1 and vitamin C to locate his five focus indicator points, with cortisone ‘corresponding’ to the acupoint yintang. Why does cortisone ‘resonate’ with yintang? Why is this supposedly the control point of the reticular formation within the brain. Trying to link so many different systems of healing together can, to my mind, only be subjective and subject to change.
When it comes to frequency of pulsed laser application, for instance, Nogier and Bahr created very different schemes. Bahr’s ‘thymus-specific frequency’ is supposedly 94.9375 Hz. Is this meaningful in practice? How was this determined? Would 94.9 Hz or even 95 Hz be as effective? Similarly for Bahr’s ‘frequency 7’, 299.75 Hz. How was this determined to be the frequency for detecting hidden dental foci? How on earth did Nogier justify that 4.56 Hz is the ‘nutritional frequency’, or that 36.50 Hz resonates with the spinal cord?
‘When you believe something, I mean really believe it, it becomes real or, rather, it calls what is real into being. It’s entertaining the belief which makes it real’
Salley Vickers (2006)
Often in this field it seems that once the teacher has decided, then the students follow. Even setting aside issues of scientific respectability, I feel most uncomfortable with Strittmatter’s assumption that the ideas of her teachers have to be correct and that methods taught by other ‘medical “fringe groups” ‘ are not. For a healing system to work, it requires belief – or at any rate a suspension of disbelief – not only by its originator but also by those who s/he teaches. I have no problem with that. Without beliefs and systems of some sort, where would we be? But to create a system that is clearly not altogether rational, and present it dressed up as rational/scientific, or as the one true way, is dangerously close to fundamentalism.
As acupuncturists, I strongly believe that we must do all we can to remain open to our patients, to what they teach us, to other realities than those we have created in our particular traditions and practices. We need to take the models of reality we are taught as just that, as models, ‘as if’ they are real, understanding sometimes with at least some part of ourselves that they are not reality. Doubt is part of life.
I am certainly not saying that TCM is better or worse than the Nogier-Bahr-Strittmatter approach. Nor am I saying that such approaches should be abandoned for a purely rational medicine (the body is not rational). They are both systems of ideas that are applied in practice with the intention of healing. We may use them, but not do violence to the interaction between practitioner and patient that is at the heart of healing, nor to our feelings of what is right.
‘If you can make a rule, this is not Chinese medicine’
John Shen (2001)
David Mayor is a practising acupuncturist experienced in the use of auricular stimulation methods. He is also editor of the textbooks Electroacupuncture: A Practical Manual and Resource (Churchill Livingstone) and Clinical Application of Commonly Used Acupuncture Points by Li Shizhen (Donica), both due out early in 2007. See www.welwynacupuncture.co.uk for more information.
Korzybski, A (1948). Science and Sanity: An introduction to non-Aristotelian systems and general semantics. Lakeville: International Non-Aristotelian Library.
Mayor, D. (2007) Electroacupuncture: A Practical Manual and Resource. Edinburgh: Churchill Livingstone.
Ots, T. (2006). ‘The segmental structure of the body – appraisal of classical Chinese phenomenology and destruction of its theoretical framework’. British Medical Acupuncture Society Spring Meeting, University of Warwick. March 26.
Papier, A. (2001). ‘In memoriam Dr John Shen’. Journal of Chinese Medicine. Oct; (67): 22-3
Vickers, S. (2006). The Other Side of You. London: Fourth Estate.