Segment-Anatomie: Der Schlssel zu Akupunktur, Neuraltherapie und Manualtherapie

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 Media reviews

MEDIA REVIEWS                                                of her own knowledge on the subject, a                     evolution and the role of the sympathetic
                                                             comprehensive if not all-inclusive review of               nervous system in muscle extension, arousal
Segment-Anatomie: Der Schlussel zu
                                                             the extensive literature published in German               and behaviour (by no means just the usual
Akupunktur, Neuraltherapie und
                                                             (around 240 references), in comparison to                  account of the ‘‘fight or flight’’ response).
                                                             which that available in English looks very                 For the first time, I was also able to
By Ingrid Wancura-Kampik. Published by Urban & Fischer       minimal indeed! In fact, only 10 English                   appreciate the part the phrenic nerve may
(Elsevier), Munich (2008). 421 pages, J79.95 (hardback).     language publications are listed here,                     play in referred pain (and treatment — as in
ISBN 978-3-437-57970-7.                                      although much of the author’s base material                the use of ST38 or GB39 for shoulder pain),
   This is a book of fundamental importance                  derives from works by Henry Head and James                 and the importance of the ‘‘hiatus lines’’
for the acupuncture profession. Most medical                 Mackenzie translated into German. (In all,                 where (because of the way the limbs develop
acupuncturists will be aware of the concepts                 nearly 7% of the references are translations               in the embryo) the dermatomes do not
of ‘‘segmental acupuncture’’ outlined by                     from English. The proportion of papers                     follow one another in numerical order
Bekkering and van Bussel.1 However, phy-                     translated from German in a comparable                     (metamerically), resulting in a lack of
siotherapists who practise acupuncture may                   English textbook would be far less.)                       organ-referred pain in the extremities.
be more familiar with trigger point therapy,                    The book is richly illustrated (116 illustra-           Wancura considers that the points of inter-
and the majority of traditional acupuncturists               tions, many in two or more parts) and                      section of the limb channels (PC6, TE5, SP6,
will have little knowledge of either approach.               divided into 10 chapters: (1) an introduction              GB39) lie along these lines, which act, as she
All will benefit from reading this textbook                  to the segments and metamerism; (2 and 3)                  says, in a way like erogenous zones, where a
which, as the subtitle claims, may well be a                 on the role of the peripheral spinal and                   small stimulus can elicit a large response, so
key to understanding many aspects of acu-                    autonomic nervous systems in the segments;                 that needling them may well have effects
puncture, neural therapy (a method of treat-                 (4–7) on the dermatomes, myotomes, scler-                  equivalent to infiltrating the associated
ment using local anaesthetic injections) and                 otomes and enterotomes (viscerotomes); (8)                 prevertebral plexi in neural therapy. She
indeed manual therapy, in terms of Western                   on the connections within and between the                  does not, however, provide evidence for this
anatomy. It will also be useful to other health              segments (the latter frequently via the                    statement, other than it being ‘‘according to
professionals as an aid to diagnosis.                        paraspinal sympathetic trunk); (9) on                      experience’’, while her connection between
   Dr Wancura is a highly experienced                        referred pain; and (10) on the areas of                    the ‘‘guan’’ of PC6 and TE5 with the
acupuncture practitioner, the co-author of                   referred pain and autonomic reflex symp-                   ‘‘frontier’’ implicit in the hiatus lines does
several works on acupuncture since 1974,                     toms associated with the internal organs.                  stretch credibility somewhat.
and involved in the study of the ‘‘forgotten                    Each chapter will repay careful study. I                   Wancura’s coverage and illustrations of
knowledge’’ of segmental anatomy since                       particular enjoyed the author’s many seg-                  Head’s ‘‘maxima’’ (as well as her account of
1965. The present book is the summation                      mental insights into psychosomatics and                    the Head zones on the cranium) are also

  Some shortcomings of this book
  The author’s style is quite didactic. As a skilled teacher, she knows the value of repetition, but the book could have been much shorter if certain general propositions
  (for instance, on the autonomic effects of internal organ dysfunction) were clearly stated once and then referred to, rather than being reiterated in full, in each
  section of each chapter. Dr Wancura is also somewhat dogmatic in her statements about the ‘‘ground rules of acupuncture’’ (for instance, ‘‘always use SI3 or TE5 for
  back pains’’, p. 62) and categorical (and not always consistent) in her correlations, as when (p. 34) she states that the SI, GB, ST and TE channels correspond to the
  areas innervated by the lateral spinal nerve branches, or (p. 73) that in general, the channels on the extremities can be defined as borderlines between the ventral
  and lateral metameric spinal nerve branches. Sometimes I have the impression that such correlations are rather forced, particularly when she equates Head’s dorsal
  maxima with points on the BL channel (p. 158), directly contradicted by the illustration (based on Head) that follows. I am also unconvinced by her explanation of the
  directions of ‘‘energy flow’’ in the limbs in terms of dermatome sequences. This needs to be much more carefully argued. There is usually more than one way to
  explain one model (that of Chinese medicine) in terms of another (Western anatomy and/or physiology), and it is symptomatic of our Western scientific arrogance
  that she writes, for instance, that she can only accept with difficulty the generally accepted view that the ancient Chinese did not undertake anatomical dissection
  (p. 17), or that the scientific explanation of the empirical findings of acupuncture lies in European segmental anatomy (p. 301). Sometimes a model can be unduly
  persuasive, particularly for those who have immersed themselves in it for many years. Whether it is the model of Western anatomy or that of Chinese medicine, it is
  easy to get carried away, ‘‘playing trains’’ 
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