Abstract
Stuttgart: Georg Thieme Verlag, 2011, 260 pages, ISBN: 978-3-13-150061-8, $79.95.
Ephemeralization provides the ideal backdrop for understanding the surprising efficacy of the Japanese pediatric system, shonishin. I say surprising because shonishin is a medical embodiment of ephemeralization. The level of stimulation employed in a shonishin treatment is upon first glance—quite literally—unbelievable. The techniques of shonishin emphasize gently tapping, stroking, rubbing, and scratching the surface of the skin, rather than inserting needles through the skin as in most styles of acupuncture. That remarkable results are often obtained from such minute levels of stimulation is, or should be, if properly appreciated, worldview-altering.
Stephen Birch was mentored earlier in his career by Dr. Yoshio Manaka, a researcher, acupuncture clinician, classical scholar, surgeon, and artist. Indeed, Birch coauthored with Manaka Chasing the Dragon's Tail, a brilliant exposition of Manaka's treatment ideas. In Manaka's writings, he explains how he drew ideas and inspiration from Buckminster Fuller's work in synergetic geometry. It is no surprise then that in this book Stephen Birch gives such eloquent voice to the shonishin system and its expression of Fuller's ephemeralization. After all, if science and industry are “morewithlessing,” why not traditional medicine as well?
After practicing an ephemeralized acupuncture on infants and children and seeing its results, one is left with the question of dosing in adult treatment as well. Dosing is an issue that has never received the level of attention in Traditional East Asian Medicine (TEAM) that it deserves, but in shonishin it is all-important. Consequently, Birch devotes considerable space to it in the book and DVD. He makes the case that this is a matter of crucial importance, not just in children, but in adult treatment as well. He presents Dr. Manaka's dose model in which we see two thresholds: the therapeutic threshold and the overdosing threshold. If too much stimulation is given (e.g., a deep needle with strong de qi sensation), then the treatment runs the danger of moving quickly over the therapeutic threshold (where we want to go) and on past the overdose threshold (where we do not want to go) before the acupuncturist can do anything to alter it. Dr. Birch makes clear that this model is not exclusive to shonishin treatment; adult treatment as well operates under the same rules, but in the case of adult treatment, the distance between therapeutic and overdose thresholds is much wider and thus not so fraught with the danger of unintentionally overdosing a patient.
For the shonishin practitioner, this core question of appropriate dosing is ever present, even given that shonishin treatments will always be quite gentle when measured against the type of needle stimulation typical of TCM treatment. The need to make a dosing decision is always there: Just how gentle does this particular technique need to be? How many times do I stroke this meridian before it will be too much? Do I tape a press sphere on one point or two or none at all, and then how long should it be left on? With how many grams of pressure should I be tapping or stroking? As the saying goes in herbal medicine, the only difference between a medicine and a poison is in the dose administered. In shonishin, the difference between a helpful treatment and one that crosses the line into overtreatment is a fine line not easily drawn.
Birch's book arrives on the scene at a propitious moment. If Portland, Oregon can be taken as a measure of the country, then interest in shonishin is growing rapidly. Shonishin seminars here the last 2 years have been sold out. However, there has been a dearth of quality resources available to support the learning of interested students and practitioners—only Miki Shima's earlier DVD. Now we have Birch's book and his DVD, and together they will advance the learning and technique of many. This is a blessing to the many children who can benefit from this style of treatment.
Shonishin: Japanese Pediatric Acupuncture, as Charles Chace explains in his foreword, is a cross-hybridization of different writing approaches: It is a personal clinical insights memoir, a textbook, and a collection of case records. That these very different styles of writing are blended so seamlessly attests to Birch's writing and synthesizing skills. The book begins with history and theory to set the context for all that follows. In the ensuing chapters, Birch covers what he calls “core” treatment, pattern-based treatment, home treatment that can be taught to parents, how to needle children when this becomes necessary, moxa, cupping, bloodletting, and other associated techniques and therapies. It is as complete an examination of shonishin as any practitioner is likely to need. Birch does not presuppose in his writing that the reader has had previous exposure to any Japanese modalities, so that even those practicing a standard Traditional Chinese Medicine approach can use this book to get started in shonishin. In the section on treatment, Birch covers a wide range of conditions: urinary, digestive, behavioral, ear–nose, developmental problems, recurring infections, weak constitution, insomnia, skin problems, asthma, and also includes a chapter on less commonly encountered problems.
The DVD also is well conceived and executed. It begins with a brief lecture on the history of shonishin and its distinguishing characteristics, most notably that it is not an overly theory-driven practice, as so much of TEAM is. The filming is professional in quality and allows a good view of Birch's hands as he demonstrates the various techniques on actual patients. There is a good age range of the patients as well, from infant to toddler to older children. A fuller discussion after each treatment would have been beneficial, so that the viewer new to shonishin would have some better idea of what went on in his clinical thinking as he moved through the treatment. Because there are so many techniques and tools that might be used in shonishin, it was not possible for Birch to demonstrate all of them. He gives as good a brief history and scientific rationale for moxa on the DVD as I have heard anywhere, and, although he demonstrates the technique for the camera on an adult, I would have loved to see him do direct moxibustion on a child. I would also have benefited from hearing him explain moxa therapy to parents, most of whom will not be eager to let an acupuncturist burn plant material on the skin of their child.
I heartily recommend Stephen Birch's Shonishin: Japanese Pediatric Acupuncture. It is highly accessible for readers and holds the promise of significantly advancing their skills. It is a worthy addition to anyone's professional library.