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 Elements, 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.
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