"Maintaining order rather than correcting disorder is the ultimate principle of wisdom. To cure disease after it has appeared is like digging a well when one feels thirsty or forging weapons after the war has already begun." – Nei Jing
When patients present themselves in the clinic, are they not already thirsty? When they complain of hot flashes, night sweating and pain in the knees, is it not too late to just treat the root? Within the constraints of private practice, group or private room treatment alike, the approach in the West generally allows for a limited amount of treatments on a regular basis before spacing them out to bi-weekly or monthly visits. With third-party coverage only available for 8-9 treatments, this doesn't leave a lot of time to work on chronic 'root' conditions. Already, within the construct of our healing paradigm and the limitations due to societal time and monetary constraints, I believe facing the reality rather than offering a Band-Aid approach is most important and most effective.
After years in practice, I have only ever had one patient come in, who had Type I Diabetes, and ask for maintenance treatments even though she had no pressing issues. She also did Crossfit, and saw a naturopathic doctor.
Another patient, a physician with severe lower back pain, shows the other side of the spectrum. She saw me once (yielding results) before the pain specialist told her not to see me anymore to determine if the nerve root blocks were working or not. They didn't and she opted for a radio frequency ablation (read: burn the nerve). Finally, after her going through the health care system for a couple of months, she's back in my care – with the same amount of pain. I have limited time to make a difference and this is after everyone else has had their fun with her back.
"Wherever there is pain, there is a point" could be the most basic maxim of our ancient healing approach. Again, this lends to the importance of treating what the patient is experiencing in the present moment. This is not barring that Chinese medicine theory has always spoke on treating branch and root at the same time; however, there are times when I find too much concentration on the root of the treatment leaving good results to be desired.
Instead of an egocentric based approach, I feel it's important to get back to a patient-centric approach. More explicitly, instead of telling ourselves that we are practicing some esoteric, high-level, root-based medicine, we should ask what our patients want which is always: "Fix me. Fast."
Getting caught up in the inner workings of an industry is common. We find ourselves looking around to see what others are doing and how they are marketing themselves. Everyone wants to stand out. An issue arises when we are standing so close to the tree we can't see the forest. A medicine designed to zoom out has us zooming in – and in the wrong direction.
Changing to patient-centric goals would immediately have us discover that we need to get results – and fast. I'm no different than anyone else. While I educate my patients that a course of treatment is once a week for 10 weeks, I only have one to two treatments to make a difference, and make them a believer in both the me and the medicine.
When I need to influence a major change I use what I call "heavy-hitters." These are acu-points that will yield the greatest results in many areas at one time; acu-points that take up pages and pages in the history books. There is a time and a place for more subtle acu-points such as Liver 4; yet most times Liver 3 will do with greater results. Treating subtly or with just the root in mind are appropriate strategies for, perhaps, the aforementioned patient who was coming in for maintenance.
Due to the demographic in my area, I see many patients who present with hot flashes and night sweating. For most of us, we learned that this is most likely due to a Kidney-Yin Deficiency. So, simply, a Kidney 3 or Kidney 6 should do. The problem remains that this type of treatment may require a long time to take hold. Another combination, empirical and symptomatic, yields better results: Small Intestine 3, Heart 6, and Kidney 7. There could be other causes of hot flashes, such as overabundance of Heart and Lung Heat, Liver Qi Stagnation or sometimes even a cyst on the ovaries and/or liver. However, more often than not, the above-mentioned treatment quashes the problem.
Constipation is another one that reacts well to symptomatic treatment. Large Intestine 4, Large Intestine 11, and Stomach 25 are great points for getting Heat out and moving the stool. When constipation is quite severe or the patient isn't responding to the usual, I implore Triple Warmer 6 and Kidney 6 to increase peristalsis of the intestine and increase the water to "float the boat" on out.
In an ever-stressful world, many ailments are due to Liver Qi Stagnation. Chinese medicine's Liver Qi Stagnation is akin to Naturopathic Medicine's Adrenal Fatigue. I call them the two types of burnouts: burnout from stress, and burnout from overwork.
Liver Qi Stagnation can manifest as many different symptoms. A common one is clenching of the jaw, which can cause TMJ. Symptomatic points are Stomach 6, Stomach 7, and Large Intestine 4. Hypochondriac pain can be symptomatically treated with Triple Warmer 6 and Gallbladder 34. And abdominal distention responds well to Ren 6 and Stomach 36.
A group of points I find myself using in the home quite frequently are for fever. Having young children wake in the middle of the night can be unnerving, especially when they have a very high temperature. Large Intestine 4, Large Intestine 11, and Du 14 all work well for bringing the fever down – often immediately. These are the basis for all fever conditions that I use, adding in others depending on a Wind-Cold (Gallbladder 20, Lung 7) or Wind-Heat (Gallbladder 20, Triple Warmer 5) presentation. Kidney 7 is also a good one to add when there is anhidrosis.
Often, when one is ill, breathing problems can ensue. Ren 17 and Pericardium 6 relieve the feeling of a suffocated chest. Ren 22 and Ex-B1 Ding Chuan relieve cough and asthma conditions. If there are breathing problems due to Liver Qi Stagnation, a combination of two groups can be combined, for example: Pericardium 6 and Gallbladder 34.
The last group of points I would like to comment on are for lower back sprain. I find myself cringing at the sight of my patient painfully, and not very gracefully, making their way out of the car. The worst case I'd ever seen was when one gentleman was lying down in the back of his car; I pretty much had to carry him into my clinic.
Any type of debilitating pain requires the quickest relief possible to improve quality of life – a key goal for me in clinic. I may not be able to obliterate a condition, but improving quality of life to 80-100% over a course of treatment is what I'm all about.
Ex-UE7 Yao Tong Dian and Du 26 are a very powerful combination – one I have dubbed the "Chinese Robaxacet." I find almost an immediate response and decrease in pain and find these points imperative before jumping into a local treatment, which is equally important. Decreasing the spasm and pain before treating an area is a great symptomatic protocol when it can be used (example: Ex-UE8 Luo Zhen, Stomach 38, etc).
A lot can be said for symptomatic points and local (Ashi) points to relieve conditions. Essentially, this is how point prescriptions are made: local, adjacent, distal, Key/Command/Influential/etc, and root treatment. If we can augment the result by having certain protocols floating around in our heads, we succeed in more ways than one.
Bruce Lee, a famous martial artist, had a teacher by the name of Ip Man when he studied Wing Chun in Hong Kong. There are stories that Ip Man used to say, "Go out and try it for yourself. I might be tricking you!" This was not meant to be interpreted that the aging instructor was lying or teaching false knowledge; it implies that one must prove it to oneself that it works or not. This is especially true in combative arts.
The same can be said for any knowledge. A great time to experiment is when the clinic slows down. Try using symptomatic points. Try not using them. Try these options over a few treatments and make up your own mind based on what your patient is telling you. Because at the end of the day it's really just about my patient, sitting across from me in clinic, telling me their life story. And it's my hope, through the vehicle of acupuncture and Chinese medicine, that I've made a difference.
Click here for previous articles by Kenton Sefcik, RAc, DiplAc, DiplTCM.