FIVE ELEMENT CONSTITUTIONAL ACUPUNCTURE  
by Angela Hicks, John Hicks & Peter Mole    
Churchill Livingstone, hardback, 300 pages, £34.99

While interviewing a number of different colleagues at the recent annual international conference for Chinese medicine in Rothenburg, Germany, it became clear quickly that this is a book that many have been waiting for. Students, practitioners and teachers of Chinese medicine alike expressed enthusiasm and appreciation for the book and gratitude to the three authors for writing this thoroughly researched, well-documented and skilfully organised book. It is the first comprehensive textbook that makes Five Element Constitutional Acupuncture accessible to both those familiar and those unfamiliar with this particular style. At the same time the authors make a great effort to embrace the idea of diversity within the practice of acupuncture. The book reflects the successful integration of their studies and clinical work with J. R. Worsley with their own long-term clinical experience.

A glance at the table of contents reveals the clear structure and easy accessibility of the book, with larger sections and smaller chapters making it easy for the reader to identify specific subjects. The summary at the end of each chapter will be particularly appealing to students.

A long and impressive stream of quotes from the classics runs through the entire book documenting the authenticity of this style of acupuncture.  In the first section, the reader is introduced to the foundations of the Five Element approach. The authors take us back to the origins of Five Element Constitutional Acupuncture during the Han dynasty, introducing Naturalism, Daoism and the ‘Three Treasures’ as well as basic ‘Five Element Theory’ outlining the ‘Sheng’ and ‘Ke’ cycles. The idea of ‘Spirit’ is introduced as well as a brief discussion of the ‘Five Shen’, which is revisited in greater detail in the description of the individual Elements in Section Two. In this section, the concept of the ‘Constitutional Factor’, central to this particular style of acupuncture, is discussed in great detail, anticipating (perhaps critical) questions that the reader might have. This is followed by a discussion of the causes of disease emphasising the internal causes, specifically the five emotions associated with each Element, as is the tradition in this style.
Few books put so much emphasis on the relationship between practitioner and patient and recognise that rapport is essential in the development of this relationship. The final chapter of the first section is dedicated to ‘the inner development of the practitioner’. The authors’ deep commitment to assist the practitioner/student in cultivating virtuosity (‘linghuo’) shines through in this part of the book. It goes way beyond the abstract idea of the “supreme physician” and gives practical guidelines about the interaction with a patient and the development of true presence, awareness and compassion. In later chapters, the issue of self-development is revisited and the authors give a series of practical exercises in order to facilitate greater rapport.

Section 2 gives an introduction to the Five Elements and does so in a clearly differentiated way: Each Element is described in a series of three chapters. The first of the three chapters discusses the Chinese character for the Element and the element’s ‘resonances’. This is a new, very elegantly chosen term replacing the idea of ‘correspondences’ or ‘associations’ in order to imply an energetic link between the Element, the ‘primary resonances’ (colour, sound, odour and emotion) and the ‘secondary resonances’ (season, stage of development, climate, sensory orifice or organ, tissue, residue and taste). The second of the three chapters associated with each Element describes the functions of the related Organs, emphasising the classical descriptions given in Su Wen Chapter 8. Great emphasis is placed on the spiritual aspect of the associated Organ (e.g. Liver – Hun). The third chapter explains several aspects of the behaviour typical of the Constitutional Factor associated with each Element. The authors clearly state that these associations do not derive directly from classical texts but are mostly based on observations from modern clinical practice.
The descriptions are meticulous and spiced with small case examples in order to illustrate particular behavioural patterns.
The third section of the book is dedicated entirely to diagnosis: how to record a case history and make a diagnosis, more on “developing rapport”, and then great detail on the four pillars of diagnosis (observation of colour, odour, sound and emotion) all the while making helpful suggestions and introducing exercises in order to learn the “tricks of the trade”.

This is a particularly playful part of the book. One chapter in this section on diagnosis has the beautiful title  ‘Golden Keys’ educating the practitioner to pay close attention to significant expressions or behavioural patterns of a patient that are often indicative of a particular imbalance in one of the Elements.

A rather fascinating section of the book is the one dedicated to so called ‘Blocks to Treatment’ which are described as factors that potentially ‘can have a profoundly negative effect on the person’s psychological or physical health unless they are cleared’. The four specific blocks are explained (‘Aggressive Energy’, ‘Possession’, ‘Husband-Wife Imbalance’ and ‘Entry-Exit Blocks’) in great detail. Each ‘Block’ is described in light of its historical context as well as its contemporary significance; how to detect and treat such an imbalance, with a number of case examples.  With their accessible writing style, the authors have effectively demystified such a delicate subject as ‘possession’ that undoubtedly has the potential to lead to much confusion and misunderstanding, especially among those not familiar with this particular style of acupuncture.

The section of the book covering different types of points discusses those that treat the spirit quite extensively but limits discussion of specific points organised by channels to those frequently used by Five Element Constitutional acupuncturists and refers readers to other publications for information on the actions and indications of other points.

The section on treatment guides the reader gracefully through three stages of treatment planning. Following this, eight case examples are given to ‘pull it all together’ and demonstrate the application of this style of treatment, all the while reminding the practitioner of the importance of minimal intervention based on a correct diagnosis on one hand and the fact that the diagnosis remains ‘a working hypothesis’ demanding flexibility on the other.

The final section of the book is dedicated to discussing the integration of traditional Chinese medicine and Five Element Constitutional Acupuncture, illustrated by a number of carefully outlined case histories. At the heart of this approach is the long-standing clinical experience of the three authors and their profound commitment to place the patient centre-stage: ‘All medicine has to adapt to the environment, culture and needs of the people it serves.’ The reader is invited to explore the differences and similarities between the different styles of treatment, emphasising the fact that the strengths of each system superbly compliment each other and therefore give the practitioner a wider range of treatment possibilities.

A fair reviewer should mention a few aspects of a book that could be improved. Admittedly, this has been challenging. If there is anything that could have been added to the book it should be in this section. Understandably and perhaps to avoid controversy, the authors chose to focus on the strengths of traditional Chinese medicine and Five Element Acupuncture. It would have been helpful to mention that there are some limitations inherent to each style of acupuncture; and that in fact, the weakness of one system is complemented by the strength of the other.

The authors deserve sincere approval for collaborating to write this book. They are making a tremendous contribution to the possibility of increasing dialogue within the acupuncture community far beyond the integration of Five Element Constitutional Acupuncture and TCM.

Sybill M.B. Huessen, M.S. TCM, Winterswijk, The Netherlands