The Ever-Present Question: How Much Treatment is Just Right?
By Bob Quinn DAOM, L.Ac
The first Japanese style of treatment I learned is called Manaka’s Yin-Yang Channel Balancing. If you have heard of ion-pumping cords, it is the style that incorporates the use of these tools in a multi-step process. Dr. Yoshio Manaka, MD was a giant figure in modern Japanese AOM until his passing in 1989. He published many books, articles, and research papers, always demonstrating his probing mind and innovative thinking.
In one article he discussed a question which was sadly little touched upon in my education: How much treatment is ideal for a given patient on any given day? He wrote that this question should never leave us, and that it never becomes an easy one. We might see a professional athlete with toned muscles and imagine that he or she requires a significant degree of needle stimulation, but this type of overly simplistic thinking is exactly what Dr. Manaka called into question. Sticking with this example of a professional athlete, witness that the San Francisco Giants have for years employed a full-time acupuncturist, Haro Ogawa, who practices gentle Japanese Meridian Therapy. By all accounts Haro’s treatments are greatly admired and appreciated by the players. So, it simply is not true that deep needling is needed to treat sport injuries or well-muscled people. To disprove something in science all that is required is one instance in which the theory does not hold. This is just one example; many more could be provided.
Conversely, it might well be the case that someone of a slighter build experiences more benefit from deeper and more significant needle stimulation. The point is that we cannot simply look at a patient’s build and get the necessary information about how much treatment is ideal. The question is a deeper one that demands of us a subtlety in our examination of the patient. This includes close questioning, assessment of pulse, channels, and abdomen. From all of this information we can begin to form an accurate picture of the patient; then we can design a treatment plan that will provide the level of stimulation needed for the desired changes—and not any more stimulation than this ideal amount. Why pour more tea into a cup once it is full?
I am certain that in my anxiousness to provide helpful treatments to patients that I have many times overtreated them. I wish I did not have to admit this, but I know it is true. In an earlier blog I wrote about the Engaging Vitality (EV) style of treatment developed by Dan Bensky, Chip Chace, and Marguerite Dinkins. (Chip sadly passed away a year ago, and his teaching duties have been take over by Rayén Antón.) In the EV training (I have completed it twice) there is a fairly precise way to assess whether the patient is being overtreated, and I am sure Dr. Manaka would be happy with this development. It is beyond me to explain this assessment, but in the EV training all participants learn to utilize it. I have found it to be reliable. An idea of this assessment can be found in the article, “The Shape of Qi.”
What happens when a patient is overtreated? The patient’s pulse, if it had initially improved in quality due to your treatment, will degenerate to exhibit poorer qualities, e.g., a subtle vibration might appear, or it might bound to the surface layer after earlier being quite settled and calm. We might notice the patient has become slightly restless on the table, or we could observe the ears and face reddening, signaling that the qi is rising too much. At this point more needle treatment would be a mistake. There are some small measures we can apply with direct moxa that can help somewhat: half-rice direct moxa on GV-14, LI-11, or ST-36 often helps rescue the treatment from significant side-effects. The practitioner needs to keep applying the moxa threads until the problematic pulse qualities start to change. You should stop at that point.
A friend who was teaching at a California acupuncture college told me that in recent years three times elderly patients have been so overtreated that they left the student intern clinic in such a state of confusion that they drove into the waiting room, instead of backing their car up as they needed to do. I hope everyone recognizes that whatever happened for those patients in that clinic did not constitute an appropriate level of treatment. It was clearly too much. And it is with the elderly, the very young, and the chronically ill that we need to be particularly sensitive to treatment dose. In writing this blog my main goal is to simply propose a question that was never mentioned much in my education and to argue for its importance—I believe we may have been told with the elderly and the chronically sick to put in fewer needles and to use a thinner gauge and shorter retention time. This is simply not enough of an adjustment though. Entirely different techniques, and sometimes tools, are often needed. And we need a different mindset for many of these sensitive patients for whom dose is all important. I invite readers to investigate the link given above and to start to consider this question.
Kind regards all around,
Bob Quinn