Book Review: Acupuncture: An Aid To Differential Diagnosis. Susanna Dowie
Price: £29.99 (€43.99)
Churchill Livingstone, Edinburgh (2008)
‘There has long been a need for a concise handbook of Chinese medicine that would help the student and recently qualified practitioner to memorise the huge amount of information needed to practise. … Susanna Dowie has compiled such a handbook in a masterly way’
Giovanni Maciocia (Foreword)
This is a very clever ‘little’ book. Each page is split horizontally into two, so that there are in effect twice as many pages as stated above. After a thorough Table of Contents and an initial overview of the building blocks of Chinese medicine, the upper pages (coloured white) cover the differential diagnoses of 50 common conditions in alphabetical order, with the Western differentiation of each on the left hand page and the Chinese on the right. The lower pages (green, after the initial overview) list 100 patterns (syndromes), grouped by Zangfu (again alphabetically). The book closes with a brief Bibliography and a good Index.
Fifty conditions and 100 patterns may not sound very impressive to the modern practitioner continually battered by statistics and incomprehensibly large numbers, but when compared with the 34 conditions listed in Maciocia’s weighty tome The Practice of Chinese Medicine (over 900 pages!), or the fewer than 80 syndromes I was taught fifteen years ago, that a book of this size contains so much is really quite remarkable.
Susanna Dowie has practised as an acupuncturist for over twenty years in the UK and Australia. For the last sixteen of these she has lectured at the London College of Traditional Acupuncture and Oriental Medicine (LCTA), of which she has been Principal since 1995. She was also the first Chair of the Council of Heads of Acupuncture Colleges in the UK. She is therefore well placed to understand the needs of students and ‘practitioners still finding their feet’ (as most of us always are, in one way or another). She started work on this book in 2004, and makes no apology for plundering many sources, consulting many authorities, and sifting and re-writing several times to arrive at the essential nectar that she feels will be most useful in general acupuncture practice in the West, without being exhaustive or cumbersome.
Given the space restrictions (only 200 words on each half-page), the differentiations are necessarily succinct, but sufficient. The Chinese ones usually include the Aetiology and a list of the associated Zangfu patterns, and the Western differentiations (written in conjunction with a conventional medical doctor who also trained in acupuncture) are well structured to be comprehensible to those who think more easily in Chinese medical rather than biomedical language. The patterns follow a standard outline: aetiology, underlying or accompanying pathology, signs and symptoms, pulse, tongue and treatment principle, with suggestions on acupuncture and herbal treatment. In general, the language is clear, and if her sources have disagreed on translation, the author has resorted to Wiseman’s terminology. She has also included a brief Glossary (including both Pinyin and Chinese characters).
It takes a little while to get used to the format of four pages to a spread rather than the usual two, but once this becomes familiar, it certainly makes cross-referencing between differentiations and syndromes relatively simple. It is a shame, however, that the publishers were not able to keep the preliminary and closing pages uncut as the author originally intended. This does make for some confusion, as in these pages the text runs from the top to the bottom of the left hand pages and then correspondingly for the right ones, rather than from left to right in each pair of upper and lower pages. Nevertheless, using both the Contents and the Index should enable the reader to locate most topics.
The book is sturdily bound, printed on plastic-coated paper. No doubt this will ensure it survives the frequent use to which students and newly fledged (and other!) practitioners will subject it – as well as the spills of herbal tea imbibed to reduce anxiety when unable to locate concise descriptions of patterns such as ‘Heart Blood and Spleen Qi deficiency’. However, although the paper used may conform to the publisher’s avowed policy to ‘use paper manufactured from sustainable forests’, the use of plastic coating means that recycling – if it ever comes to that – will be a problem (if the plastic comes from recycled teacups, this is not stated). Incidentally, readers can allay their anxiety by looking up ‘Heart Blood deficiency’ and ‘Spleen Qi deficiency’ separately.
Unusually for me, I only have one or two problems with the actual content of this book. (1) The functions of the Fu are listed only perfunctorily. (2) I would have liked a brief description of each of the pulse qualities (after all, the book was designed for acupuncturists with ‘less than perfect memories’, as the author states in her Introduction). (3) The print is a little small for old fogies like myself who refuse to put on their reading glasses (if they can find them). (4) Confusingly, the diagram of ear points (p. xxi) attempts to cram in both the Chinese and European points (following the rather larger illustrations in Terry Oleson’s Auriculotherapy Manual), with the result that Shenmen has been inadvertently omitted (there is also a minor typo in the diagram – Jan Jiao for San Jiao). I very much doubt that students or novice practitioners will ever need so much auricular information, particularly when many experienced European teachers and practitioners prefer a simple unified system rather than attempting to dabble in two. This is the case in the popular Praxishandbuch Akpunktur by Kubiena and Sommer (soon to be published in English by Elsevier). There the main points used are very clearly illustrated, with the Chinese rather than the European ‘Spleen’ point indicated, for instance, despite inclusion of several of Nogier’s points as well.
Such quibbles aside, I think that Acupuncture: An aid to differential diagnosis will be a very useful book, not only for LCTA students and graduates, but for all those who require a handy aide-mémoire in the treatment room. When I trained, I created my own (now very battered) notebooks as learning aids to read on trains and buses and to remind myself what I was supposed to be doing in the clinic. Susanna Dowie has distilled a wealth of information to provide an off-the-shelf version of this. It is arguable whether we remember more if we create our own resources rather than reading what others have written. Perhaps in their next edition the publishers could include some blank pages for readers to include their own memos. Plastic-coated, these would of course be wipeable, so notes could be erased and altered at will.
[This review includes information from an interview with Susanna Dowie in October 2008]
David Mayor is an acupuncturist in Hertfordshire, England, and an undergraduate and Masters research supervisor at the London College of Traditional Acupuncture and Oriental Medicine. He is also editor of the textbooks Electroacupuncture: A Practical Manual and Resource (Churchill Livingstone, 2007), Clinical Application of Commonly Used Acupuncture Points by Li Shizhen (Donica, 2007), and Acupuncture in the Treatment of Musculoskeletal and Nervous System Disorders by Lu Shaojie (Donica, forthcoming, 2009). See www.welwynacupuncture.co.uk for more information.