Tuesday, December 05, 2006

Doing Acupuncture

Doing acupuncture is kind of a funny thing. What points do you pick? What is the process you go through when you give someone a treatment? You'll get a lot of different responses if you ask different acupuncturists. Here's mine:

For me, acupuncture has become a kind of energetic interaction with the patient. A person will come in with some symptom - a headache, for instance, or a skin problem. I usually spend some time asking questions: what part of the head hurts? Does your itching get worse at night? Is it worse or better when you get your period? Etc. I usually look at the tongue and feel the pulse, both standard Chinese medical practice. I was trained in acupuncture school to come up with "patterns" based on the presenting evidence, then treat by using points that fit the pattern. For instance, based on the location and type of pain, you might decide the patient has a "dampness headache," and pick points such as Stomach-40, which drains dampness, and Large Intestine 4, which alleviates pain especially in the face and head. You might also throw in Spleen 3, which strengthens the digestion, thereby treating the "root" as well as the "branch" (weak digestion is thought to create "dampness" in the body).

What I have found, however, is that this type of cookbook acupuncture often doesn't work. What has happened historically is that in the re-packaging of "traditional Chinese medicine" (TCM) in the modern era, acupuncture took a back seat to Chinese herbal medicine. So much so that acupuncture, which has always had its own set of theories and classical writings associated with it, got reformulated to better fit the theories of herbal medicine. So acupuncture points, which had formerly been thought of as apertures through which one could drain or supplement qi ("energy") to restore balance in an interconnected series or loops of channels in the body, were assigned functions or actions much like herbs. Hence in TCM we now say that Stomach 40 "drains dampness," much like a diuretic herb such as alisma is said to "drain dampness."

It was only after graduating from acupuncture school that I regained a sense of wonder and appreciation for acupuncture. This was because I began studying with Dr. Anryu Iwashina (a.k.a. "Dr. Bear"), a blind master acupuncturist from Morioka, Japan. Dr. Bear challenged my entire concept of acupuncture by treating patients - quite spectacularly and effectively, I might add - without ever puncturing their skin with his needles. At first I couldn't really tell what he was doing. With one hand he would feel the patient's skin on the arm or belly,and the other hand would gently hold the needltip against the skin somewhere else. Sometimes he would stay at a point for a long time, as if waiting for something to happen, holding the tip with his index finger and thumb, and the shaft with the thumb, index finger, and middle finger of his other hand. Other times his hand would dance over the surface of the patient's skin, the needle gently tapping the skin over a large area. Sometimes he would hold a thick golden needle on one point and a thick silver needle on another point, and wait. The impression I got was that he was constantly trying things out, waiting for a response, then moving on. Suddenly, he would announce that he was done, and the patient would get off the table with an amazed look on his or her face.

I've been studying with Dr. Bear for about ten years now, and use his method about 90% of the time (I still use TCM methods of physical medicine such as scraping and cupping, as well as TCM-style herbal medicine). It took me a couple years of trying his technique before I really felt anything happen between my fingertips. I was treating a patient who suffered from breast and liver cancer. She was going through chemotherapy and different experimental drugs, and I was fortunate enough to be able to join her inspiring support team. Maybe it was because she had gotten so weak that the "noise" of her various bodily processes was less than it normally would have been. Or maybe it was because in the process of preparing for death she had become so energetically "clear" that that clarity of energy could be felt even by a beginner like me. In any case, when I placed the needle against her skin, I felt a faint tingle, a mild electrical tingle that came and went, signifying according to Dr. Bear that the "qi had come."

So I've been practicing this way ever since. I haven't abandoned the theories and "patterns" that I learned in school. But I consider them working hypotheses rather than diagnoses per se. I test these hypotheses by trying out different points, and seeing if something happens. That something can be the tingly feeling that I feel between the fingertips holding the needle; it can be the patient reporting feelings of movement or warmth or tingliness at the point or elsewhere in the body; it can also be a shift in the patient's pulse or a relaxing of her musculature.

I find that the best acupuncture happens when I just "play", when I don't attach to outcomes or to particular theories of what is going on. I may notice a tight area, and needle there. The patient reports a warm flowy feeling down the leg and into the big toe, so I palpate the ribs and umbilical area (which are associated with the liver and spleen, whose channels run down the leg and into the big toe) and check points on the liver and spleen channels. While I'm working on the leg,I might notice that the whole right leg is sort of stuck, and begin pushing muscles and points and joint edges around the knee, working my way up and ending up treating stuck points in the hips and sacrum. I often end up doing something completely different from what I set out to do, following the thread until what needs to happen happens.

Sometimes, especially if I'm feeling stuck, I'll over-intellectualize things and start applying models like crazy, like "now that I've drained the gallbladder connecting-point I'll tonify the spleen source-point," or "let's try that right knee point for this left elbow pain." And that can be fun too, and the theories that have been worked out over many centuries of observation and experimentation are truly useful and sometimes work great. But what I have learned from Dr. Bear is that you always have to try things out and check for an effect; don't just apply theories blindly and then leave the room to put together an herb formula. And I think that the best treatments happen when you leave the theory behind, or just leave it running in the background as a kind of hunch-provider, and act spontaneously. It's also more fun that way!

That's why I have so much fun doing acupuncture. Each treatment is an exploration. If I find small "blood stasis" venules I might bleed them. If I find a mushy deficient spot I might burn moxa on it. If the patient reports a new pain I'll try out different things until the pain goes away. I get to combine hands-on experimentation with rational problem-solving and a kind of artistic sensibility. And best of all, I get to experience my patient feeling better!

I've benefited so much, and I believe my patients have benefited too, from Dr. Bear's teachings. Acupuncture is a very mysterious thing, and when acupuncturists start talking about "energy" and "yin" and "yang," it's easy for Westerners to dismiss it as hopelessly unscientific. And, indeed, if acupuncturists memorize the Chinese theories and terminologies by rote and spout them to whomever will listen, they will only serve to confuse and alienate people. But I don't think that we should do the opposite, namely talk about acupuncture only in scientific terms such as endorphins or the gate theory of pain. I believe that when we scientize acupuncture, we substitute a rich living empirical tradition with an incomplete and clinically inferior model. Certainly we should research acupuncture and try to figure out how it works. But if you want to learn acupuncture, I say, learn from a real acupuncturist! I consider myself fortunate that I have been able to do just that.

1 comment:

Anonymous said...

You have identified my number one gripe with TCM, its cookbook approach to treatment. Having had treatments from practitioners who stick the needles where they were taught in school and those who can actually feel qi, meridians and the different qualities of qi; I can say that the rote school approach can work, but the practitioners who can actually sense qi strongly are far more efficacious in their treatments. Perhaps the word "Traditional" should be taken out of TCM and be replaced by "Emasculated PRC Party-Line" Medicine. Some people have a natural sensitivity to qi, but I believe sensitivity can be taught and nurtured in almost anybody. Dr. Bear sounds like he is one who can teach a more intuitive approach to medicine. I hope your practice thrives and you can expand the Dr. Bear tradition in Santa Cruz, especially now that Chikurin is returning to Japan. And perhaps you can return to Five Branches and teach some post-graduate courses of your own!