Not by Rote: A Dynamic Approach to Applying Acupuncture

In medical school, much of our training centered around the memorization of acu-points and point protocols.  The challenge that became obvious was differentiating between many of the overlapping point functions and indications in a clinically meaningful way. 

Even before practicing in the clinic, it seemed to me that rote reliance upon protocols was often not likely to produce a response that most Western patients were seeking.  This is not to say that such approaches were not useful, but that there were more efficient means by which to approach certain conditions.  In China, it is not uncommon for patients to receive treatments everyday and sometimes twice a day.  In the States, due to time and expense, a weekly model is the norm, which puts greater demands upon high performance through quick results.   Furthermore, it seemed unlikely that protocols were intended to  act as a script to be followed to the point and more as a framework for understanding body dynamics.  The example of Bach's compositions come to mind, where many scholars have proposed that some pieces have been written to allow for improvisation.  Similarly, it is likely that many point protocols are merely guidelines for developing an appropriate approach given the circumstances of the patient at hand.  Below are three factors that inform a dynamic approach to applying acupuncture  for dramatically benefitial results.

1) Numerous points perform the same function differing only by etiology.  Theoretically some points and point combinations bear more or less upon the root cause of a condition.  Determining what the root problem is and how to address it in relation to the patient's presentation or range of presentations is key.  A thorough health history consequently becomes critical because it allows for the practitioner to tie seemingly disparate maladies into a cohesive approach.  As an illustration, osteoarthritis and asthma may seem to have no bearing upon one another, but should these two conditions present in one person, there is a strong possibility that there are food allergies affecting the digestive system, which in turn is affecting the circulatory system (arthritis) and respiratory system (asthma).  Though Chinese medicine stresses holism, either by lack of linking related conditions or due to the demands of an insurance industry which has only a facile understanding of the interrelated nature of the body's systems, the probability of a rote approach that disregards the fulcrum upon which a range  of conditions rest is high.

2) The efficacy of a point is not just in its selection but also its angle, depth, and stimulation. These factors will be evident to neither practitioner nor patient unless certain palpation techniques are applied.  Palpation in this context is a kind of call-and-response, where points that are likely to release a distressed area are tested before a needle is ever inserted.  The "call" in this context is the selected point and the "response" is change at the distressed location.  If there is no change, then either the diagnosis is incorrect or the point on the diagnosed channel is incorrect.  It is also possible that the point is correct, but that it resides on the opposite limb.  When a selected point reduces discomfort in the distressed area, then a needle is inserted.  If a needle is inserted but the patient does not respond as she did when the point was simply massaged, then the needle angle and/or depth needs to be repositioned.   An illustration would probably make matters even more confusing, but suffice it to say that although St-36 (Zu San-li) （足三里） is regarded as a universally applicable point for abdominal distress, my own experience suggests that there is no such universal point and that careful consideration of the overall picture in the context of Five Element, Ten Heavenly Stems or some other functional Chinese medical systems theory must be applied.  A palpatory approach is a definitive way for responding to the body's current condition, in contrast to a rote projection about what the therapist "thinks" might be at play.  It also means that diagnosis is an integral part of the treatment, whereby a protocol is developed only as the body responds, as opposed to expecting the body to respond to a predetermined protocol.

3) Points that release in previous session may not respond in subsequent sessions.  This means that each session is approached as a discrete moment in the course of treating the condition.  Certain acupuncture masters vary their protocol by alternating from one limb to the other from one session to the next.  This is a common way to send the same message to the body, while still providing variation.  Consider, for example, instances where a particular food or medication provides a great boost for the first month, but then gradually tails off in efficacy.  The same principles may also apply in the case of acupuncture.  Often, acupuncture can act as an instantaneous release, but in other instances where neural pathways are constantly "on," it becomes important to respond to the body in motion as it relearns what it is like to be in a balanced state.  Dynamic approaches in such instances perform an important role in an overall lasting recovery.  

Conclusion

In all, a pointed approach to the whole person centers around a proper health history, palpatory techniques that affirm the veracity of such approach, and a continued responsiveness to the change that a patient undergoes as the body balances.  Rote approaches are no doubt beneficial, but  given the typical constraints of delivery here in the States, there is likely greater demand to practice acupuncture in the ways it was originally intended, where protocols act as a kind of guide as opposed to a script.

Tea is a Part of Chinese Medicine

Did you know that tea is a part of Chinese medicine?  It's true.  Most of us are aware that tea (Camillia sinesis) comes from China, but you might not know that its original use was as medicine.  Tea has been a part of the Chinese herbal pharmacopoeia for almost 2,000 years, even though the herbal system itself goes back more than 3,000 yrs.  Many plants, like dandelion, rooibos, and verbena, cooked into a broth are commonly referred to as "tea," but technically these are called "tisanes."   

An important thing to understand about the philosophy of Chinese herbalism is the premise that nature provides everything for our physical wellbeing and overall balance.  Chinese herbalists not only specialize in knowing the function of herbs, but also specialize in determining an herb's appropriateness given the individual's diagnostic markers. These diagnostic markers are based on the body's function, that is hyper-function or hypo-function. Not all individuals will benefit from green tea, for example, despite its many researched benefits, which probably comes as a relief to those of you who have suffered from gas and bloating after drinking it.  A Chinese medicine herbalist can explain to you why green tea may or may not be a good choice based upon your personal hyper- or hypo-functionality.  In very general terms this has to do with whether a person runs on the cold, hypo, or hot, hyper, side.  

Among the many teas, white, green, red, oolong and black, there are many distinguishing attributes.  Chief among them is their ability to either up- or down-regulate the body.  This is not simply a matter of any one constituent in tea, such as caffeine.  All tea contains caffeine, but the way in which a tea is processed impacts the nature of the tea, which can vary from warming, those teas with greater oxidation and processing like black and red teas, to cooling the green and whites.   Processing here does not mean artificial procedures.  Rather, it refers to the "curing," aging and preparation of the tea.   

A person who has a hypo-functional body will not respond well to a down-regulating tea.  Using the example above of green tea, it is fair to conclude that if someone does not respond well to green tea that they have a hypo-functioning body.   In instances of hypothyroid or weak digestion, it is easy to see why a condition could be made worse.  

Tea can be a fabulously healthful complement to one's lifestyle given the right circumstances, which can be determined through a little trial and error or by consulting a Chinese medicine herbalist. As a rule of thumb, less processed teas tend to be cooler and have a down-regulating action on the body, whereas the more processed and oxidized teas are more up-regulating.  It is important to understand how those actions will work in your body depending upon whether you run hot or cold.  In many cases, people may run a combination of hot and cold, so having guidance on balancing tea by amount and time of day can make a big difference in the benefit achieved.  It is also important to note at which times a person favors a particular temperature, in the evening or late afternoon for example.  These are all diagnostic factors of vital import in determining whether, when, which type and how much tea is right for you.  Remember, tea is medicine, so check with a primary care professional to find if it is right for you, particularly if you are already on medications.  Licensed acupuncturists are primary health professionals in the state of California.  

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Three Clues Suggesting why the Benefits of Chinese Medicine Cannot be Dismissed as "Psychological"

1) Clinical trials prove Chinese Medicine's efficacy.  The whole point of clinical trials is to determine the degree to which a procedure demonstrates a statistically significant efficacy over and beyond a control, usually a placebo.  In numerous instances, acupuncture and herbal medicine have proven they work.  See here.

2) Patients enjoy benefits beyond the condition for which treatment was sought.  A patient being treated for arthritis may report improved vision.  The factor underlying both in such instances is circulation.  A patient taking a formula for weight management might report better, that is more regular and less painful menstrual cycles, as the hormones stored in fat are eliminated from the body with the loss of weight.  The point here is that if Chinese medicine were purely psychological, then we would expect its benefits to be confined to the problem area, but in case after case benefits are greater.

3) The constituents of modern pharmaceuticals have their basis in traditional herbal remedies.     If Chinese herbalism were purely the product of cultural belief systems then there would be little interest in these practices beyond the culture in which they developed.  However, disciplines like "pharmacognosy," half-anthropology and half-chemistry, focus on finding learning what the traditional medicines are and then determining the bioactive compounds in those medicines.  Among traditional medicines, that is pre-pharmaceutical medicines, Chinese medicine distinguishes itself for the wellspring of information it provides Western researchers because of its extensive catalog of recorded data.

There you have it.  Three rational bases for attestign to why Chinese medicine's efficacy is not in your head. 

Tell a friend. 

A Meal with Guli: Brick Tea and Cholesterol

This is a qualitatively different post from most. It's about the veracity of folk traditions, truths that continue to deeply impress me in my practice. I thought that I'd relay a conversation that came up with me and my Uighur buddy Azigul, in Mandarin just Guli, once while eating in Xingjiang Cun, a long-since-gone row of Uighur restaurants in Beijing's Western District.

Xinjiang is a semi-autonomous province in the far Western regions of China, and as the name suggests "New Territories" holds a fairly distinctive place in the history of China as a bridge between East and West. Uighur are the largest ethnic tribe of Xinjiang. Most all of the "nationalities" or tribes or ethnicities are what could be best described as Central Asian, an assortment of different Mongol groups who tend to be desert, steppe, and mountain people who eat lots and lots of heavy meats, especially lamb. These are the people of the proverbial Silk Road, they formed the armies of the Manchus and the Mongols, most of them, with the exception of the Mongols themselves, converted to Buddhism and from Buddhism to Islam, people at the crossroads China, India, Persia and Russia.

Anyway, on this one occasion in Xinjiang Cun, we happened upon the topic of tea. In Beijing, the tea of choice is hands down "hua cha", i.e. jasmine tea. All of the restaurants serve it. The grades, that is quality, can vary greatly but jasmine is the tea of Beijing. Chinese visitors to the capital city are apt to maintain their preference for their local tea. All of these teas are green and consumed, usually, quite casually, without ceremony, that is. I never encountered, let alone drank any of the oolong "red" tea most typically served up with teabags on a string in Chinese restaurants here in the States. This is because that particular tea isn't actually oolong (Wu-long) but Keemun. It hasn't a very long history and is drunk primarily by foreigners. There are many very fancy tea shops in Beijing, many more not so fancy, the grades and expense can boggle the mind, but all of this to do is over green tea and wulong, most certainly not black teas.

The Uighur, in some ways not dissimilar from Chinese from other regions, favor their local tea as well, the only thing is that it is neither local nor green but from the Southwestern part of the empire and black. The Uighur drink something called brick tea. It tastes like tobacco and resembles hefty plugs of Redman itself. Guli explained that for a very long time, relations with people on the periphery of empire, Muslims and Tibetans, were regulated through the trade of tea. These places didn't grow their own, but tea was so basic to life that even today, black tea from China is money in Tibet. From afar, it seems perhaps like a case of misplaced priorities. Guli told me that it was understood among the meat tribes, all of the western steppe "barbarian" types, that brick tea was essential to digestion of the animal fats core to their diet. It didn't make the tea taste any better, but I washed down cumin-roasted lamb kabobs with onion and sesame naan, hot from the tandori, perhaps with more earnest slurps.

Later on, I raised to a Western friend the prospects of brick tea actually imputing health benefits based upon what Guli told me. His perspective was satisfactorily "anthropological," that is he was not apt to believe that knowledge of brick tea could actually be correct, but at the same time he would not be so coarse as to say so, preferring to think that "if they so believe, so it is." This is the quaint necessity of the politically correct Westerner, who vests "knowledge" in Western institutions and Western experts, but is still bent on believing that non-Western knowledge, either by conviction or arrogance, is in the "native's head." Of course, the facts totally belie this, otherwise, there would be no disciplines such as ethnopharmacology and pharmacognosy, fields dedicated to the extraction of indigenous knowledge for pharmaceutical, proprietary, and market-driven purposes.

Safely removed from anthropology now, as one dedicated to making a difference in people's health through natural means, I revisited my conversation with Guli to help my patients with a natural means of balancing the effects of cholesterol. It looks like modern research is proving that the understanding about the effects of brick tea for breaking down bad fats is more than just a subjective fancy. Here is just one study supporting what the barbarians have known all along.

All in the Family: A Chinese Meridian Perspective

The body is an organic whole. This means that all of its parts relate to and interact with other parts. The engineers in the audience may have to correct me, but an organic system stands in contrast to an inorganic system by virtue of the sheer degree of possible interactions of a live system, as opposed to a closed, mechanical system. The urinary, respiratory, and circulatory systems, for example, are interacting. However, in so-called Western medicine, these systems are viewed discretely. In fact, specialization orients the acquisition of knowledge with ever greater specificity at the cost of the whole. By contrast and even in circumstances where a doctor of Chinese medicine specializes, Chinese medicine necessarily seeks to establish relationships between the various systems and organs of the body. Interestingly, the language used to establish these interactive dynamics is framed in terms of familial relationships. Hence, a tip of the hat to "ole Awchie" wherever he is, as we embark for the next few missives upon a novel discussion about family dynamics as it relates to Chinese Meridian Theory.

Acupuncture Helps Arthritis: Three Illustrations

Acupuncture isn't for everyone, but for those seeking natural remedies to pain, it can be "just what the doctor ordered." Let's take a glimpse of some actual cases. Patients names are fictitious to protect privacy.

Marsha, 65, came in with severe arthritis in her hands: she couldn't button her sweater and felt shooting arm pain at night. Depressed and fearful of her ability to work, Marsha committed to a three session a week for three months, then taping to twice and then once a week for 10 months. The swelling in her hands is gone and, despite a few previous surgeries, are strong and pain-free for her work as master gardener.

Philip is a 65 y.o. actor and avid golfer. His couldn't raise his right shoulder. During examination, he discovered his left shoulder was in no better condition. Inspection reveals scars on the right arm and both legs from an accident occurring in the 70s. Philip came in twice a week for six weeks. He continues on a weekly schedule to "let me do what I do," as he put it, because besides improved range of motion, he noticed less urge to go at night and his eczema improved. His golf game is benefitting too.

Valerie is a 45 y.o. violinist, who was experiencing "nervy" pain and hypersensitivity in her middle finger and weakness in the thumb of the right hand. Inspection revealed much imbalance at the neck, where she also had discomfort. Seeking to address the root issue, Valerie stuck to a schedule of once a week for six weeks and some exercises to do at home. She comes in every three weeks for maintenance. The nerviness is gone and she is able to play longer without irritation.

Acupuncture is not a quick fix for chronic cases. The up-side is that there are not only no side-effects, but the benefits build with time, perhaps like fine wine.

Nausea and Hangover Formula

I thought some of the Chinese medicine people out there might like to learn of this simple but effective formula for treating nausea and hangovers. Success from this formula occurred after administering, to no effect, Guangci Tang's (hereafter GCT) Wen Dan Pian for nausea associated with migraines. The 29 yo female's migraine expression (anomalously on the left) had been effectively relieved with acupuncture and GCT's Shaofu Zhuyu Pian.

GCT Wen Dan Pian focuses on resolving phlegm with ancillary action of detoxing and regulating the liver. Its ingredients are listed below:

zhi ban xia
zhu ru
chen pi
fu ling
lian qiao
jin yin hua
yu jin
zhi shi

The formula I switched to comes from a book published in 1999 by Chinese Medical Technologies Publisher (zhongguo yiyao keji chuban she, 中国医药科技出版社）, entitled Tea Remedies Herbal Foods (cha liao yao shan, 茶疗药膳）. In it is a chapter on various formulas that are appropriate for the seasons. Therein, I found a formula under "spring," that I felt was worth giving a try. The ingredients are listed below:

green tea
shi hu
xiang yuan/fo shou
ge gen

The text notes that the formula "clears heat, generates fluids, calms the stomach, clears food stagnation, detoxes alcohol (xing jiu, 醒酒) and resolves irritability." It goes on to boast, "It can frequently constitute the most ideal beverage for detoxing alcohol. For resolving the difficulties of spring, its efficacy is particularly apparent (p.128). "

Even though it is listed last among ingredients, interestingly ge-gen, which we know by its Japanese name kudzu, begins the short discussion on herb function. Practical knowledge around ge-gen has shown it to have positive effects on hangovers. Research has shown that ge-gen reduces alcohol craving and diminishes the quantity of alcohol consumed. These properties informed my selection of this formula from among eight others for the treating of spring disorders because my patient expresses concern over her keenness for alcohol, which she consumes daily in an amount that would likely be considered unremarkable in France or Italy. As an herb whose action focuses powerfully on the yang-ming channel, ge-gen is a very sensible selection, particularly in light of ban-xia and zhu-ru's disappointing performance for her.

Just for the record, I didn't use fo-shou, rather I swapped it out for some top-notch chen-pi that I picked and dried myself. Also, all the ingredients were ground into a powder and the patient was instructed to take three to five grams before going to bed and anytime she felt nauseated.

I understand that there may be some difficulty in sourcing shi-hu. Among the yin tonics, it is deceptively similar to the diuretic tong-cao given it's styrofoam nature. Han-lian cao is non-cloying, but it is a much grassier substitution. Other possible substitutions, like mai men dong, sha-shen, or yu-zhu, if selected, should probably be used in their prepared granulated form instead of raw. Under no circumstances would I consider sheng-di an appropriate substitution because of its heaviness. I personally would probably use tian-hua-fen as a substitution because it also generates fluids, is non-cloying, grinds up easily, and has virtually no taste--thus fewer complaints! Also, since phlegm is a principle cause of nausea, tian-hua-fen appears a particularly appropriate substitute.

Finally, the question regarding the actual meaning of "spring disorders" looms, particularly in light of my administering the formula in July. Of course, we know that constitutionally speaking we all lean toward expressing a certain "season." The problem is that I don't practice "constitutional acupuncture." It's way over my head. The diagnosis of "liver over acting on spleen," sounds logical, but there's such a laundry list of conditions that fall under this diagnosis that I'm altogether skeptical of its existence. In other words, I very much doubt that the above formula could be administered for the sundry cases called, "liver over acting" with any degree of benefit, unless we are specifically speaking upon nausea. Still, the association of alcohol with liver and ge-gen's proven effect on alcohol points to it as a possible lynchpin herb for balancing the yang-ming, jue-yin, shao-yang, tai-yin quadriad. Considering the complementary herbs of green tea and fo-shou, this speculative assertion seems reasonable.