Felix Mann

Reinventing Acupuncture (2nd Edition)

A new concept of ancient medicine

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 The needle (usually only one is used) is inserted on one side of the body, to a depth of about 3 mm, and withdrawn without stimulation after a few seconds.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 widely used.

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.