Bonica

doi: 10.1136/aim.20.4.207-a 2002 20: 207-208Acupunct Med

Adam Ward Bonica's Management of Pain

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Reviews

Acupuncture in the treatment of depression: A

manual for practice and research.

Rosa N Schnyer & John JB Allen

Hardback, Pages: 240, Price: £30.99

Churchill Livingstone, 2001

ISBN 0-443-07131-4

Depressive disorder is a common chronic

condition. It results in a greater burden than cancer,

diabetes or heart disease in terms of disability

adjusted life years according to a pivotal study by

the World Health Organisation and World Bank.

Conventional treatments for depressive disorder

can be broadly categorised into pharmacological

and psychological. Antidepressant treatment is the

mainstay of treatment. Although the response to

antidepressants is good, there is a significant

number of patients who either do not respond to

treatment or do not develop full remission with

treatment. Psychological treatments range from

counselling using problem solving to cognitive

therapy and interpersonal therapy. All have been

shown to be efficacious. The outcome of combined

pharmacological and psychological treatments is

better than either alone. Electroconvulsive therapy

remains an important treatment for severe

depressive disorder. Novel treatments showing

promise include transcranial magnetic stimulation.

Professor Thase from University of Pittsburgh

School of Medicine has written an excellent

chapter on depression, its symptoms, epidemiology,

aetiology and treatment. Schnyer & Allen state

that the book is based on their pilot randomised

controlled study evaluating acupuncture as a

treatment for depression. The authors’ perspective

of acupuncture is that of traditional Chinese

medicine. Clearly, the target audience are

acupuncturists of the traditional Chinese medicine

paradigm.

In chapter 7, the authors take the reader through

research methodology and problems unique to

investigation of acupuncture. They go onto present

their findings from their study. The authors also

present some interesting case reports from their

study.

In the assessment of depressive disorder,

general practitioners will screen for organic

causes of depression, such as anaemia. It is not

clear whether the authors’ intake protocol takes

this into account. The authors have covered

suicide assessment thoroughly. They have also

included a caution about acupuncture in treating

depressive disorder in pregnancy. One important

omission from this book is the risk benefit

assessment of acupuncture. There is no mention of

any of the adverse effects of acupuncture. The

safety concerns of acupuncture should be

mentioned. Most adverse effects can be avoided

by proper training of the practitioner.

Any attempt to scientifically evaluate a

treatment for depressive disorder is important. I

think that the authors must be congratulated on

their work in this field. Hopefully others will be

stimulated to embark on further research to

evaluate the role of acupuncture in mild to

moderate depressive disorder.

Hagen Rampes

206ACUPUNCTURE IN MEDICINE 2002;20(4):206-210.

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Book Reviews

Color Atlas of Acupuncture

Body Points, Ear Points, Trigger Points

H-U Hecker, A Steveling, E Peuker, J Kastner,

K Liebchen

Paperback, Pages: 268, Price: £22

Thieme, Stuttgart 2001

ISBN 3 13 125221 9

This small paperback measures just seven and a

half inches by four and three quarter inches. It is

therefore extremely portable and will fit into any

large pocket. Nevertheless, contained within its

covers is an immense amount of information of

clinical and practical significance, all the authors

being physicians with a special interest in

acupuncture.

After a brief introduction describing the

generalities of point location the book is divided

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Book Reviews

207ACUPUNCTURE IN MEDICINE 2002;20(4):206-210.www.medical-acupuncture.co.uk/aimintro.htm

into three sections. Part one includes body

acupuncture points encompassing the 12 paired

meridians together with the Conception vessel,

Governor vessel and Extra Points. Each meridian

is traced on a photograph of a model with all the

points indicated, however, only selected points are

described in the text. All the most important

points are included and broadly conform to the

selection of points used in the foundation courses

of the BMAS. Each selected point is compre-

hensively described together with its location,

depth of needling, indications and action in TCM

terms. In addition, highlighted paragraphs include

immensely useful comments relating to safety and

anatomical location. There are also clear anatomical

drawings as well as illustrations of the practitioner’s

hand placements used to locate selected points.

Part Two covers the ear acupuncture points

(Chinese and Nogier) located on very clear close-

up colour photographs with amplification in the

text, which includes specific indications and

general comments.

Part three includes 19 muscles and their

commonly occurring trigger points illustrated by

simple and very clear, coloured anatomical

drawings. The Trigger Points are shown together

with their referral patterns and, most interestingly,

important acupuncture points occurring close to

trigger points are also shown. The text includes a

description of each muscle, and includes its

origin, insertion, innovation and action, as well as

preliminary background, examination techniques

and therapeutic comments. The book is well

referenced and indexed.

The Seirin Pictorial Atlas of Acupuncture

An illustrated manual of acupuncture points

Yu-Lin Lian, Chun-Yang Chen, Michael Hammes,

Bernard C Kolster

Edited by Hanhs P Ogal & Wolfram Stor

Hardback, Pages 351, Price: £25

Konemann, Cologne 2000

ISBN 3 8290 2996 9

The Seirin atlas is a large A4 sized book devoted

to 409 selected Chinese acupuncture body points.

Each is clearly indicated with three different

illustrations (two photographs and one anatomical

3D colour drawing). The text includes brief

descriptions of the location, needle insertion,

action, indications and special comments that

include safety aspects. The 12 paired principal

channels are included together with the pathways

of the Du Mai and the Ren Mai, and there is a

comprehensive selection of extra points. The

introduction includes basic principles of

measurement, needling techniques and a brief

summary of channels and points. All points are

located numerically as well as being named in

Chinese together with the English translation.

There is also an index and list of reference texts.

This is obviously not a book that can be easily

be carried in a pocket but the quality and clarity of

the illustrations more than compensate.

Each of these Acupuncture atlases are quite

exceptional in their own way and I would

thoroughly recommend obtaining a copy of each.

I only wish they had been available when I first

started studying acupuncture. Any student of

acupuncture, at any level, will find them of

immense value.

Adam Ward

Bonica’s Management of Pain

Editor: John D Loeser

Associate Editors: Stephen H Butler, C Richard

Chapman, Dennis C Turk

Hardback, Pages: 2178, Price: £181

Lippincott Williams & Wilkins, Philadelphia 2001

ISBN 0 683 30462 3

Anyone involved in acupuncture / dry needling

becomes something of a pain expert if only

through the day-to-day experience of treating

patients. This was exemplified by a recent survey

of NHS hospital pain clinics in the UK that

revealed that it is now unusual for acupuncture /

dry needling not to be offered as part of the

therapeutic repertoire.

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Book Reviews



Bonica’s Management of Pain has become

something of a classic in pain management texts

and provides a comprehensive and practical

approach to all areas of pain control. The late John

J Bonica’s first edition was published in 1953 and

rapidly established itself as a leader in the field.

This third edition is now very much a multi-author

textbook and has grown into standard reference

work with no less than 132 contributors.

The book is made up of five parts. These are

devoted to a general introduction, patient evaluation,

generalised pain syndromes, regional pains and

methods of symptom control. This comprehensive

approach covers all areas of pain management and

includes a contribution from Chan Gunn as well as

a brief chapter giving an overview of acupuncture.

But this book’s strength is in its broad coverage and

practical approach. It discusses psychology, ways of

measuring disability, physiology, specific diseases

and a wide range of therapeutic interventions.

Those of us who regularly use acupuncture /

dry needling know that helping patients who come

to us with pain and disability is much more than

inserting needles in a technically proficient way.

I thoroughly commend this book as a first class

reference source for developing a rounded,

knowledgeable and, in the end, more satisfying

and effective approach to the care and treatment of

pain and suffering.

Adam Ward

Pediatric Acupuncture

May Loo

Hardback, Pages: 372, Price £45

Churchill Livingstone, Edinburgh 2002

ISBN 0 443 07032 6

A handsome new textbook written by an Assistant

Clinical Professor in paediatrics at Stanford

University should be a good setting for a

comprehensive account of paediatric acupuncture.

With 25 years experience of working with children,

as a western paediatrician and then in combination

with traditional Chinese acupuncture (TCA), the

author has a wealth of experience in paediatrics.

22 common conditions are detailed, both as

western description and treatment, and then using

traditional Chinese concepts; this is very

comprehensive and has 804 references. The author

explains the pros and cons of immunisation for the

western and Chinese approaches, and I am glad to

observe that she broadly supports vaccination. In

practice she allows the parents to make an informed

decision about whether to vaccinate or not.

Disappointingly, there are no scientific or

medical acupuncture principles, and nothing about

segmental innervation, or neuro-hormones. It is all

heavy TCA – but very well described. The only

common ground is in some of the methods of

acupuncture technique, and the fact that electro-

acupuncture, laser, and non-invasive techniques

may have a part to play in treatment.

The book is full of interesting ideas. Attention

deficit hyperactivity disorder (ADHD) is a

challenging condition to treat in the West. The

author claims to have had success in treating 7-9

year olds incorporating five-element developmental

theory. A number of recipes for this condition are

given, for example, Sishencong and Yintang for

general treatment.

The author manages to ‘integrate western

knowledge and technology with ancient Chinese

medicine’ and a good example is seen in treating

acute otitis media where ‘Acupuncture treatment can

be given concomitantly with antibiotics, as Chinese

medicine’s goal in expelling the pathogen and

tonifying the immune system complements the

western regimen’. However, the author gives very

little guidance on when not to use acupuncture, and

alarmingly suggests that most western diagnoses

can by treated by traditional Chinese acupuncture,

which may give the wrong impression to lay

acupuncturists. This approach is not medical

acupuncture, but simply western medical education

for those practitioners without medical training,

and not always informative for doctors.

There are pictures of happy children having

acupuncture and clear graphics showing

acupuncture points and meridians. The book is

the most comprehensive text on paediatric

acupuncture that I have come across, but I do hope

that the author will incorporate scientific and

medical acupuncture principles in the next edition.

Colin Lewis

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Software Review

209ACUPUNCTURE IN MEDICINE 2002;20(4):206-210.www.medical-acupuncture.co.uk/aimintro.htm

Anatomy of the locomotor apparatus

Francesco Bettinzoli, Bio Media

On 3 CD-ROMs – Upper extremity,

Lower extremity, and Trunk and Head

Price: ^47 per CD

Bio Media, Switzerland 2002

www.biomedia.ch

Content:

One of my fond memories as a medical student

was getting to grips with anatomy. Many an evening

was spent with Gray’s in one hand and the bones

of my half skeleton in the other. Reams of notes

were made describing the origin and insertion of

each muscle, with annotations showing the muscle

in action.

How easy anatomy would have been using this

software! Set up installs the QuickTime playback

program, and inserts information into the computer

registry, but the program runs directly from the

CD-ROM. The first CD of the series shows the

bones, joints and muscles of the upper extremity

in glorious multimedia. A series of menus allows

you to focus down on the particular aspect of

anatomy that you wish to study. So, I chose bones,

selected scapula, and the screen showed a virtual

scapula bone in fine detail, with a written

description. By allowing the mouse pointer to

hover over an anatomical term, the scapula picture

revolves round and zooms in, to show me the

highlighted detail. In virtual reality mode I am

able to rotate the scapula about a vertical axis.

Well, now I know all the anatomical landmarks,

written my own notes with the inbuilt notemaker,

I can now proceed to discover how the shoulder

joint works. I choose the glenohumeral articulation,

and a short movie accompanied by the narration

of an Italian, speaking very good English, shows

me just how mobile the joint is. The muscle menus

take me down to the individual muscles where

their origin, insertion, innervation and function

are described as text. The movie option again gives

a narrated action sequence of the muscle in action.

I found that moving the mouse too quickly

over the action ‘hot spots’ would cause the program

to freeze, requiring a Ctrl-Alt-Del sequence to end

the program task. In fact, the same technique was

useful to close the program rather than go through

an endless scroll of credits. I would like to see a

facility to be able to minimise the program screen,

so that I could return to the program easily rather

than closing it down, and then waiting for the

entire opening credits before using it again. The

anatomical content is reasonably comprehensive,

but what happened to the missing quadratus

lumborum muscle?

The software is written using Macromedia

Director (the Rolls Royce of interactive multimedia)

and uses QuickTime movie control. There is a

choice of four languages, and the package gives a

good feel of professionalism to the presentation,

and no doubt forthcoming medical students may

well learn their basic anatomy from a package like

this. For medical acupuncturists, it is a painless

way to become re-acquainted with the knowledge

of anatomy that may have slipped away during the

clinical years. At about £30 per CD, it represents

good value for medical software. Don’t throw

away your Gray’s anatomy just yet, as the extra

detail in the book makes anatomy come alive in a

way that no animation by itself can possibly achieve.

The Biomedia website (address above) gives a

very useful hands-on feel for the program, and is

well worth a visit.

Rating:

Presentation 10/10

Medical content 9/10

Ease of use 9/10

System requirements:

PC: 486, 66MHz, 16mB RAM, Win 95, 640x480

graphics resolution, CD-ROM x 4 speed, SB

compatible sound card.

MAC: OS 7,8, or 9

Reviewed:

29th September 2002

Colin Lewis

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Software Review



The Journal of Chinese Medicine (1979-2002)

4th Edition

CD-ROM (279MB), Price: £120 + VAT

Increasingly, I find it very convenient to have

resource material stored as digital media – just

look at the success of Microsoft’s Encarta. The

CD-ROM takes up so little room compared to a

book, and the search facility should better any

index.

However, the CD-ROM must obey some basic

rules. First, it must not install files on my

computer without my knowledge. Secondly it

must be fast and intuitive to use, and thirdly, the

search facility must be able to find a keyword,

title, or author for the whole content. This CD

scores well on the first two rules, but the third

could be better.

The JCM CD-ROM contains a varied mix of

articles and reviews from its paper journal – 454

full articles, 527 abstracts and 157 book reviews

and plenty of news features, spanning the last 23

years. Acupuncture is the main topic, but there is

some reference to herbal medicine and massage.

Under the heading contents by subject, the

submenu lists Acupuncture points (very

descriptive – not an anatomical catalogue),

Techniques (from cupping to propagated needle

sensations), Case histories, Diseases, General

discussion and General theory. The emphasis is

very much on Traditional Chinese Medicine, but I

was pleased to see in the News sections, that there

was reference to the BMJ and Acupuncture in

Medicine. The abstracts are taken from the Journal

of Traditional Chinese Medicine, and the book

reviews are very thorough – even including

medical acupuncture books.

You will need to have Internet Explorer and

Adobe Acrobat reader installed on the computer

before you can use the disc. Copies of this

software are provided (albeit old editions).

Navigation will be familiar to anyone who uses a

web browser, and allows the reader to zoom in on

a final article, which is in a Portable Document

Format (.pdf) file, and read using Acrobat reader.

The search facility configuration is complicated

and instructions are given for version 4 of Acrobat

reader. I use a more up-to-date version of the

software, and I was unable to configure it so that I

could search the whole CD rather than just the

article I was looking at. This deficiency needs to

be sorted out before the next release.

There was a fascinating selection of

acupuncture topics on this CD-ROM despite the

heavy emphasis on TCM. It is time that a CD of

Acupuncture in Medicine articles is put together!

Rating:

Presentation 8/10

Content (Traditional Chinese Acupuncture) 10/10

Content (Medical acupuncture) 4/10

Ease of use 8/10

System requirements:

CD-ROM drive, Internet Explorer, Adobe Acrobat

reader

For more details:

Contact Journal of Chinese Medicine

Internet: www.jcm.co.uk

Email: [email protected]

Reviewed:

10th November 2002

Colin Lewis

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Bonica