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.
