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.


1 comment:

  1. Hi Tom, good post and some interesting ideas.

    I think in the west there is an over emphasis on tonification in general, while in clinical reality regulating Qi, Blood and Body Fluids is often a much more effective strategy. I totally agree that just putting something into a patient and nourishing them is not always effective. When i first started in practice I would tend to think a lot in terms of deficiency and stomach/spleen but have had a real change in approach in the past year or two.

    I think in the west herbs are often perceived to better at nourishing, but interestingly two of the (many) herbal schools of thinking are to do with the treatment of damage from heat and damage from cold, and there are a much larger number of herbs that clear heat and toxic heat for example than tonic herbs.

    I'm particularly interested in styles of chinese medicine practice (acupuncture and herbs) that focus on regulating the body's internal mechanism or qi dynamic and a well crafted herbal prescription does exactly that, for example there is a concept of increasing the bodies yang qi not by adding yang tonic herbs but by using a light touch and gently draining excess fluid from the body through the urine, in effect using something to drain to actually strengthen by allowing the yang qi to circulate more freely.

    I also think acumoxa practice rooted in well developed palpatory skills can achieve the same results or regulating the qi dynamic.