Book Review: Schizophrenia, Sleep, and Acupuncture. Edited by Peggy Bosch and Maurits van den Noort
Hardback, Size: 15.9 x 23.5 cm, Pages: xii + 347, Price: €39.95 (US$54.00)
Hogrefe & Huber, Göttingen (2008)
This is a groundbreaking publication. To my knowledge, it is the first multi-author book of any substance in English that focuses on the acupuncture treatment of a particular condition. It is also the first publication on any form of complementary and alternative medicine by Hogrefe, a distinguished European publishing house better known for its psychology textbooks and journals. The only previous book in English on zhenjiu (acupuncture and moxibustion) for schizophrenia is a 1999 translation by Thomas Dey of a Chinese text originally published in 1987, compiled by an unstated number of unnamed authors. A work with a broader perspective is long overdue.
The book divides into three parts. The first five chapters provide a very informative introduction to schizophrenia, its neuroimaging, pharmacology and conventional treatment, with a thought-provoking chapter on a cross-cultural approach to its diagnosis and management. Then follow two chapters on sleep (often disordered in schizophrenia), and finally nine chapters on traditional Chinese medicine (TCM). Three of these introduce TCM, its philosophy and the modalities of acupuncture, with a subsequent discussion of the problems encountered in attempting acupuncture research with Western scientific methods. Then comes a fascinating overview of neuroimaging research on acupuncture, followed by a useful synopsis of the effects of acupuncture on the dopaminergic system, whose dysfunction is usually accepted as being a key to schizophrenia. The final chapters focus on the treatment of schizophrenia and insomnia with acupuncture and moxibustion.
The first section will be very useful to acupuncture practitioners wishing to understand current biomedical thinking on schizophrenia. Some of the chapters are written in quite technical language, but provide essential information if you are considering working with schizophrenic patients under orthodox medical care.
The chapter on sleep and what can go wrong with it provides a comprehensive yet very readable survey, in contrast to the one on sleep, schizophrenia and melatonin that follows, which is over-complex and more limited in scope.
The first two chapters in the third section of the book offer an introduction to TCM, covering material that will be familiar to most acupuncturists, although Stan Switala’s short account of the history of ‘TCM’ may be an eye-opener for some (and I would question LiPing Han’s dating of the Yi Jing to ‘around 1000 B.C.’). The contribution by the Dutch editors (together with Swiss doctor and acupuncturist Brigitte Ausfeld) on the modalities of acupuncture and research methodology is not very satisfactory – short, not very fully referenced, and again written as an introduction for those unfamiliar with acupuncture rather than those already in the field. However, the review of neuroimaging studies on acupuncture that follows, again by the editors should be useful to all, as will be the next chapter, by three Korean authors, on acupuncture and dopamine. Although their conclusions are minimal, they usefully provide a synopsis of the acupuncture points in the dopamine studies that are among those most frequently used in treating insomnia and schizophrenia. The next chapters, on acupuncture for insomnia and for psychological disorders in general, will be helpful as background reading, the former for its integration of biomedispeak and TCM language, and the latter for its summaries of diagnosis, treatment and symptom analysis. Once more they are written at a level that will be fairly non-challenging for most acupuncturists. For the hands-on practitioner, the last two chapters will be the most useful.
The first of these, by Qinzhang Ding and two colleagues from Hebei Medical Sciences University, provides a thoroughly practical account of their integration of Western medicine and TCM in the treatment of schizophrenia. They point out that this combination reduces the side effects from antipsychotic medication, so permitting the use of larger, more effective dosages. Interestingly, they state that electroacupuncture (EA) is more effective than standard acupuncture for mental diseases, and appear to use this quite frequently for schizophrenia (although not for sleep disorders). Their EA protocol is based on well-known studies by Hechun Luo, focusing on stimulation of baihi (DU-20) and yintang (M-HN-3), but with adjunctive points such as shuigou (DU-26), tounie (N-HN-31), neiguan (P-6), yongquan (KI-1) and suliao (DU-25) in addition. Unfortunately, there are some editorial problems with this section. The sole reference on electroacupuncture (Leonhardt’s book on ‘electroacupuncture according to Voll’) is misleading, as it has nothing whatsoever to do with the form of EA advocated. Terms such as ‘sound wave current’ are not explained, and there appears to be some confusion on the part of the translators as to differences between electrical frequency, intensity and charge. Furthermore, the explanation of how EA works is woolly, unreferenced, and completely unrelated to the huge amount of high-quality Chinese research carried out on the neurochemistry of acupuncture (in particular, its effects on dopamine, which is not mentioned at all in this chapter).
The last chapter in the book – and for me one of the most successful – is a very well presented and thoughtful case study, by Neil Quinton and Dominic Harbinson (acupuncturists trained at the College of Integrated Chinese Medicine in the UK) and Patricia Ronan, a mental health lecturer currently completing her PhD on acupuncture in the treatment of psychosis. Here the discussion section in particular is a rewarding read.
The book closes with a good index, although regrettably it lacks a glossary and list of abbreviations, quite a drawback in a work that uses many technical terms.
Other areas where I would have appreciated further input include the use of nutritional strategies that may be useful as adjuncts to TCM treatment (Switala’s throw-away mentions of diet, qigong and taiji are insufficient and could well irritate conventional medics), some suggestions on how to cope with potentially violent patients (only touched on in the final chapter), and the inclusion of more detail on the electrical parameters used (and at which points) in the many EA studies listed in the chapter on acupuncture and the dopaminergic system, where such information is really essential. The electrical parameters are also poorly described in the chapter by Ding et al. As I have stated repeatedly, it is unfortunate that there is as yet no universally accepted standard on how such data should be presented in works on acupuncture, which makes replication difficult (in clinical practice as well as research).
The content of a number of the chapters in this book may not be particularly original, and for some is quite basic, sometimes the English language is a little quirky, in some chapters referencing is quite minimal, and in a number of them there are few take-home messages for practitioners. However, as a whole the book offers something unique. It is certainly a breath of fresh air to find a book not published by the usual gang of four (Elsevier, Thieme, Blue Poppy, Paradigm), and with high-calibre contributors from a range of different countries who have not suffered from over-exposure in the acupuncture press.
This is a milestone book. Bringing together specialist authors for the benefit of the majority of us who are generalists in our practice, it provides a model for the acupuncture textbooks of the future, and hopefully will do much to encourage further good research in the West on a topic that, until now, has really only been investigated in China.
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, 2009). See www.welwynacupuncture.co.uk for more information.