Thursday, November 28, 2013

Acupuncture myths #2 - 'You shouldn't feel the needles if the practitioner is good'

One thing I've become sure of is that needling sensation is usually part and parcel of a good treatment.  The aim of a skilled practitioner is to create particular sensations and reactions in a patient, based on their situation.  For example, if someone is weak and cold, the ideal sensation should be one of a spreading warmth.  If there is an obstruction in a channel, there should be a sense of movement in that channel in order to re-establish proper flow, and so on.  The idea that a point is 'good for headaches' for example, is I believe flawed.  Any point will only bring about beneficial change if it is needled correctly, which involves deliberately attempting to elicit specific sensations, some of them quite strong.

In my experience patients will generally tolerate strong sensations happily if this is explained to them beforehand.  The treatment process becomes more interesting and satisfying for both parties as particular reactions are sought through needle manipulation by the practitioner, and feedback from the patient.

Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.

Friday, March 9, 2012

100 days of Qi

Having watched some of Andrew Nugent-Head's fascinating free webinars, I've decided to challenge myself to regular Qigong practice for 100 days.  I've always been somewhat of a 'Qi sceptic', or at least I've been very cautious not to claim anything I can't back up with personal experience.  I'm currently on day 3, and I will post updates occasionally in case anyone is interested.

Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.

Sunday, March 4, 2012

Acupuncture myths #1

I believe there are many myths that have the potential to become barriers to good treatment in acupuncture.  I'll start with a very commonly used point - GB-21.  There is no reason I've started with this - I'm not suggesting it is the most important or destructive myth by any means.  It's just somewhere to start.

GB-21 lies on the top of the shoulder, at a point where many people accumulate tension.  It's perhaps the first place you would think to massage someone if you wanted to relax them.  It has a reputation of 'descending Qi' - i.e. you needle or apply pressure to this point, and energy will descend.  In my opinion, this is a great example of a point which has gained a reputation for the wrong reasons.  Many people who suffer from stress will gather tension at GB-21, particularly in our modern-day society - sitting at a desk, typing at a computer in a stressful environment is a reliable way to build 'stuck Qi' at or around GB-21.  And therefore, tension will tend to accumulate in the head, potentially causing headaches, neck strain etc.  In these cases, needling or releasing the point in other ways will likely cause a release of symptoms, and allow 'Qi to descend'.  But that doesn't mean the point itself causes Qi to descend.  What it does - in my opinion - is to allow Qi to escape from the head if there is a blockage or build-up in the area.  Needling here can create a downward movement of Qi, but that does not mean the point causes Qi to descend.  KID-1, SP-6, BL-60 may all be better examples of points that encourage Qi to descend regardless of the general state of Qi in the body.

There are countless examples of similar truisms in modern-day acupuncture.  I will gradually add more examples that occur to me, but if you are a practitioner with a questioning mindset, please feel free to add comments and suggestions.

N.B. Andrew Nugent-Head makes a similar point in one of his excellent free webinars available here.

Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.

Tuesday, February 28, 2012

Acupuncture - anyone can do it!

I occasionally get angry comments left on my youtube page, and recently had one stating that 'quackery' such as acupuncture shouldn't be tolerated 'in such modern times'. I replied that there was a growing body of scientific evidence for acupuncture, and was then confronted with a BMJ acupuncture trial from 2009. The trial concluded that acupuncture only has a mild effect in pain relief, and most of this could probably be put down to practitioner bias etc. I thought the suggestions the authors made for future trials were very revealing, and highlight the kind of obstacles that stand in the way of acupuncture's acceptance into mainstream healthcare:

'We suggest that future trials on acupuncture for pain ... try to reduce bias by ensuring blinding when possible. For example, blinding of the healthcare provider can be achieved by having the needling done by acupuncture naïve clinicians blinded to the hypothesis of the trial.'

In other words, the best way to achieve a fair test of acupuncture is to have it performed by someone who has never done it before! And these trials, presumably, would be used to 'prove' that traditional acupuncture has no merit. This seems to reveal the authors' own bias - traditional acupuncture can't possibly work, so the training of the practitioner shouldn't affect the results. Would a fair test of a surgical procedure be to see if it worked when a 'surgery naive clinician' cut people open?

As I've talked about in other posts the insistence on a placebo control really does hinder acupuncture research. Why not look more seriously at comparative trials - i.e. is acupuncture undertaken by a trained professional more or less effective than other interventions?  Maybe because these trials tend to produce much more positive results... 

Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.

Friday, January 27, 2012

Pulse miracles

Having said in another post that I don't emphasise pulse diagnosis especially in my current way of working, I wanted to share a pivotal experience I had during my acupuncture training.  We were a few weeks into the course, and I was struggling quite seriously to buy into some of the concepts of Chinese medicine.  Pulse diagnosis was one of them.  How could feeling the pulse give more than basic information about the way the patient's heart was pumping blood around the body?

We had a class on pulse taking, led by an experienced tuina practitioner, and advocate of qigong.  She asked for a volunteer.  Being entirely sceptical, and feeling as though some others may be inclined to agree with whatever was being said in a similar way to victims of cold reading, I put my hand up.  Perhaps it was fate, but I was chosen to come to the front.  I had not spoken to the teacher before that day.

She had me sit down, placed her fingers on my wrist, and closed her eyes.  I was expecting to hear something like 'You have some kind of medical condition, don't you?' - something vague that everyone would answer 'yes' to if they wanted to believe.  But I was astonished when she said 'You've had a pain in your left shoulder, haven't you - not at the moment, but a few months ago?'.  She put her hand on my upper back in the exact area I had struggled with a nagging pain for some time - as she correctly said, it had cleared up quite recently. She went on to reveal most of my significant medical history, including my asthma, and several other past and present ailments.  Nothing she said was wrong.

From that day on, I had a new perspective on pulse taking, and what was possible in Chinese medicine.  I don't think it is possible for most people to reach that level of skill, but I now believe it can be done by some, and that anyone can get to a level where meaningful and clinically useful information is obtainable from the pulse.

So for me, rather than dismissing the power of pulse-taking, it's a case of acknowledging my current limitations and building an overall picture of the patient from all available sources.

Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.

Tuesday, January 24, 2012

Acupuncture for 'excess', herbs for 'deficiency'?

One of the first things acupuncturists and Chinese herbalists try to gauge is the relative state of the patient's energy - is their system generally in a state of excess (e.g. there is too much heat present), or deficiency (e.g. not enough energy)?  There is a school of thought that acupuncture is best suited to treating excess, whilst herbs - because they are able to physically add substance - are more applicable to deficiency.  I would generally agree with this.

However, I also think 'pure' excess or deficiency conditions are very rare - there is virtually always a mix, even if the signs aren't obvious.  I've often been disappointed with the results of treating apparently deficient patients with a standard TCM (Traditional Chinese Medicine) approach.  For example, if a female patient gets cold easily, has low energy, and is having trouble conceiving, an obvious strategy might be to use moxa to warm points such as Bladder-23, Ren-6, Stomach-36 etc.  And this may well help, but in my experience it can be more beneficial to search out the potential excess or stagnation present in order to free the flow of blood and energy.  By doing this, the signs and symptoms of deficiency will often recede, as the patient's system reorganises itself and begins to self-regulate more efficiently.  This excess/stagnation may take the form of premenstrual stress, physical constrictions such as neck or back ache, feelings of tightness in the chest etc.  Acupuncture can be excellent at improving these types of symptom.

I even wonder whether the use of moxa and needles on Bladder-23, for example, may sometimes be beneficial not because they somehow 'inject' Yang into the Kidneys as is commonly thought, but because the 'moving' aspect of moxa and needling releases tight paraspinal muscles.  This may in turn release any constriction of local blood vessels and nerves.  It makes perfect sense to me that this could benefit kidney and adrenal function, for example, and therefore improve energy levels, fluid regulation etc.

Of course, this is all speculation, and in a way perhaps it doesn't matter how it all works or what model of understanding the practitioner uses, as long as results are obtained.  But I do find it useful to think in terms of acupuncture's strengths in moving, freeing-up and regulating rather than introducing energy as such.

The usual problems of old age can be viewed in a similar way.  In TCM and in common thought, the general weakness/fragility associated with the ageing process are usually seen as a factor of weakness - 'I think I'm just getting old', patients often say.  But as eminent Chinese doctor Yan De-Xin proposes in his book 'Ageing and Blood Stasis', most common conditions of old age can be understood better in terms of a long-term build-up of stagnation through a lack of physical and emotional free-flow.  He argues that treatment principles such as moving Blood and regulating Liver Qi (treating excess) are more effective than simply tonifying the Kidneys (treating deficiency).

So whilst I generally agree that acupuncture isn't the first choice therapy to directly boost deficient energy, I think it can achieve the desired results when its strengths are utilised.

Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.

Saturday, January 21, 2012

How important are tongue and pulse diagnosis?

As I've mentioned in other posts, my treatment style (at least currently) emphasises palpation of the patients body for tight and tender areas, as I believe this often gives the most relevant clinical information.  But the whole process of diagnosis and treatment is a balancing act, and because there is limited time, I try to concentrate on what I think will give me the most relevant information.

For example, if a young and apparently fit and healthy patient presents with an acute back pain, it is quite possible I won't take their pulse or look at their tongue, unless there is reason to believe there is an underlying organ imbalance contributing to the picture.  I find TCM-style Zang Fu theory can easily confuse the picture in these cases - there is always an internal pattern of disharmony if you're determined to find one, but quite often what really needs to be examined and treated are the superficial sinew channels (i.e. tight and tender muscles).

If someone presents with gynaecological problems for example, the pulse and tongue will no doubt give vital clues.  But even with what is seemingly a purely internal pattern, I think palpation of relevant channels is often just as important as tongue and pulse, if not more so.  There are practitioners who will take the pulse very carefully, base their entire treatment on the information they glean, refer again to the pulse through the course of the treatment, and judge their success or failure on any perceived changes.  This is fine if it leads to improvements in the patient's condition, but sometimes this priority seems to be lost - as long as the pulse is 'improving', the practitioner is happy.  This seems odd to me - if the pulse changes radically for the better, but next week the patient comes back with the same back ache, has the patient really been served well?

Everyone develops their own style, and certainly I've come across a few experienced practitioners who can uncover remarkable information from the pulse, but I think this is rare.  As a mere mortal, I generally use the pulse to get an 'overview' of the patient's internal condition, but only use this information as one piece of the puzzle.  The tongue gives another, more objective level of information.  Questioning fills in other gaps, and palpation often makes sense of the whole picture.  Then, changes in the presenting condition over time let me know whether I'm on track or not.

Please note: this blog is intended for educational and general interest purposes only. If you have any health concerns, please discuss them with your doctor.