I reviewed the previous edition of this book, published in 1993, as
His early books on acupuncture were based on the traditional
ideas, being written before he revised his opinions. This one
reflects his present position and is therefore non-traditional,
not to say iconoclastic. Acupuncture points in the traditional
sense, he says, do not exist, and nor do 'meridians' (channels).
Also, Mann has introduced some ideas that do not form part of
the traditional system, such as the use of periosteal needling
and the concept of 'strong reactors'—people who are
particularly sensitive to the effects of acupuncture.
As he acknowledges, many acupuncturists disagree with his ideas, but
he is unrepentant. Generally, he insists, effective needling sites are
not 'points' but rather areas varying in size. In certain patients it
makes little difference where the needle is placed, so that anywhere in
the body will do; in others anywhere in a particular limb works, or else
segmental treatment will be the answer (dermatome, myotome, sclerotome).
Some modern acupuncturists regard acupuncture points as identical with
trigger points. Mann does use trigger points but he does not regard them
as the whole basis of acupuncture. He points out that some areas, such
as his favourite Liver 3 in the foot, are seldom tender (which trigger
points are, by definition), yet they are extremely effective.
Mann attaches great importance to the idea of 'dosification' in
acupuncture. In recent years he has increasingly tended to
favour the use of what he terms 'micro-acupuncture'. The needle
(usually only one is used) is inserted on one side of the body,
to a depth of about 3 mm, and withdrawn without stimulation
after a few seconds. He now uses this technique in about 70 per
cent of his patients.
The book describes Mann's approach in detail and then goes on to
apply it to different body areas. The techniques used are
described clearly and are illustrated with good line drawings.
Mann's wish to avoid classic acupuncture terminology has led him
to devise his own nomenclature for needling sites, so that his
favourite Liver 3, for instance, becomes dorsalis pedis/dorsal
interosseus area (abbreviated to DPDI). One can understand his
motive for constructing this terminology but I
find it cumbersome in practice, and I doubt if it will become
This is a very readable book, written in a colloquial style. It
presents an idiosyncratic view of acupuncture but one that I
am in sympathy with. I find that what Mann says makes
sense to me and corresponds well with what I see in clinical
practice. On one or two topics my experience is different. Mann
says that he has seen some 30 patients with chronic fatigue
syndrome (myalgic encephalomyelitis, ME), all of whom responded
as strong reactors. I think his experience has been unusual
here; most people, including me, have found that acupuncture
seldom works in this disorder. He is also more impressed by the
importance of diet ('rich food') than I am. But these are minor
points. I should say that this is one of the best books on
acupuncture to have appeared in English.
The new edition contains two new chapters, including a useful discussion of
the best intervals to leave between treatments and when to re-treat. The
biggest innovation, however, is the description of what Mann calls
Hyper-Strong Reactors. Mann originally introduced the idea of Strong
Reactors (patients who respond unusually strongly to acupuncture and who
generally do well), and this is now widely accepted among practitioners of
modern acupuncture, but now he has taken the notion further by identifying a
subgroup who respond even more strongly. Such patients, he holds, need to be
treated correspondingly gently; indeed, they may require what he calls
Hyper-Micro-Acupuncture, in which the surface of the skin is just touched or
pricked very lightly with the tip of the needle. This may sound like
absurdly minimalist treatment, but in fact a number of modern acupuncturists
have been independently moving in the direction of doing less and less.
There are undoubtedly some patients who will respond only to very gentle
needling. At the same time, one does wonder how far the trend can be taken
before it ceases to be a treatment at all.
This book remains one of the best textbooks of acupuncture for
acupuncturists who follow the modern (non-traditional) approach.