East Asian Arch Psychiatry 2010;20:92-3

BOOK REVIEW

Editors: Peggy M.P.C. Bosch, Maurits W.M.L. van den Noort
Hogrefe & Huber Publishers
USD54.00; pp348; ISBN: 978-0-88937-355-6

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From time to time we come across patients who say they have not taken the medicine we prescribed but have instead sought treatment from Chinese medicine practitioners. Being trained in the schema of western medicine, we sometimes feel sceptical about traditional Chinese medicine as a means of treating psychiatric disorders.

But does traditional Chinese medicine deserve such scepticism? The book Schizophrenia, Sleep, & Acupuncture by Peggy M.P.C. Bosch and Maurits W.M.L. van den Noort aims to show readers the size of the misunderstanding between Chinese and western medicine in psychiatry. They achieve this by providing background information and discussing important theories involving schizophrenia and sleep in both fields.

This book starts with a discussion by the editors of how schizophrenia is understood in western medicine, as a disease manifested by symptoms such as hallucinations, delusions, thought disorder, impairment of volition, and blunted emotional responses. It is well established that a neurochemical imbalance is responsible for the condition, but what triggers such an imbalance is not yet known despite the discovery of several strongly associated factors. Treatments, mostly antipsychotics, therefore aim to restore the neurochemical balance. Such treatments have side-effects however, for example, extrapyramidal effects.

A discussion of sleep problems from the western medical perspective then follows. The causes of sleep disorders are diverse — ranging from almost all psychiatric disorders to neurological disorders and other medical conditions. Problems with all stages of sleep can contribute to such disorders, but rapid eye movement (REM) sleep and the deep stages of non-REM sleep are the most vulnerable.

The editors spend two-thirds of the book explaining the theories underpinning traditional Chinese medicine. In contrast to the western focus on specific pathological change in an organ, traditional Chinese medicine sees the body as an integrated system. Although each body organ has a unique function in the system, they never function in isolation. Parts of the body are assigned to one of the five elements (wood, fire, earth, metal and water), which consume or nourish each other. Consequently, disease in any organ may have a wider impact on the entire system through these secondary effects on pathological processes. Traditional Chinese medicine also pays attention to the interaction between man and his environment. All phenomena in both the world and the human body are categorised as yin or yang, and these have to be well balanced to avoid disease developing. There are no specific chemical concepts such as neurotransmitters, but Chinese medicine does emphasise vital substances: qi, blood, essence and body fluid. These need to be in constant movement to maintain well-being.

Applying the above concepts, psychiatric illness and sleep disorders are viewed very differently in traditional Chinese medicine. Instead of focusing on a specific disorder of the mind, it considers pathological changes in the body and the mind as a whole. So the disorders are actually a manifestation of overshooting or weakening of one element, an imbalance of yin and yang, or stagnation or deficiency of the vital substances.

The book ends with a discussion on acupuncture. Acupuncture is a common treatment modality in traditional Chinese medicine. Needles are used to stimulate the acupuncture points in various meridians to restore balance and promote movement. A diversity of patterns of acupuncture points and a number of different methods of manipulating the needle are applied to manage different diagnoses. Schizophrenic patients are given acupuncture courses tailored to their specific disease patterns; 2 patients with schizophrenia will have different acupuncture points used, even though they both have been diagnosed with schizophrenia.

The authors of the articles on acupuncture have cited extensive research into the efficacy of acupuncture as a means of treating schizophrenia and sleep disorders. It is evident that acupuncture helps with insomnia but the results for treating schizophrenia are inconclusive. Some researchers have observed changes in the dopaminergic systems in schizophrenic patients after acupuncture, but the structure of these studies could not rule out the placebo effect. More research using better methodology is needed. It is clear, however, that acupuncture can support people receiving antipsychotics by lessening the side-effects and improving sleep in schizophrenic patients.

This book provides a vast range of information from both western and Chinese medicine about schizophrenia, sleep and acupuncture. Apart from providing factual information, it also tries to bridge the gap between the 2 by finding common brain changes brought on by the treatments used in both fields. The book opens a new perspective for psychiatrists trained in the western medical system. It is interesting to read, though there are problems when Chinese medical jargon, which we sometimes hear in our daily life in Hong Kong, is translated into English. Readers who have some basic understanding of Chinese philosophy will find it easier to digest. Having said this, it is still worth reading especially when we practise in Hong Kong — a place where a significant proportion of people consult both doctors practising modern western medicine and those practising traditional Chinese medicine.

Joyce SY Chow, MBChB, MRCPsych
Department of Psychiatry
Tai Po Hospital
Hong Kong SAR
China