Too Much of a Good Thing: When Over-Treatment Happens to Your Patients
By Kailey Brennan L.Ac.
Over-treatment is not a widely recognized concept in the field of traditional East Asian medicine, but it is useful to consider as it may provide an explanation for what may be occurring when patients fair poorly after a session of acupuncture, or rather than improving during a course of treatment start to experience a deterioration in their wellbeing.
If acupuncture is to be understood as a means of facilitating a response from the body that signals we’ve engaged the body’s own capacity to self-regulate and heal in a optimal manner, overtreatment can be viewed as providing an overabundance of therapeutic input, thus overshooting the body’s capacity to properly assimilate and metabolize the treatment. The patient’s system becomes maxed out.
Intuitively the concept of over-treatment may land for you if you see a predomanince of weakened and debilitated patients in your practice, or have adapted specialized needle techniques to better work with highly sensitive patients. But even patients with overall robust constitutions can be subject to over-treatment.
What does over-treatment feel like for patients?
Patients who have been over-treated in the course of an acupuncture session may get up off the table and simply put, feel like hell - they may feel exhausted, spaced out, dizzy, disoriented, or just feel generally unwell.
Students at TCM schools who are receiving two, three, or even four treatments per week from their fellow classmates may start to feel progressively more fatigued and depleted in the course of getting treated, overly sensitized to the needles, and even become adverse to being treated altogether.
Palpation as a means to assess over-treatment
Palpation provides a means to gauge whether a patient is approaching over-treatment.
Assessing the Yang Rhythm (YR) can provide feedback as to whether a patient is approaching over-treatment. The YR is understood as an expression of the Yang Qi. It reflects the state and activity of the Yang Qi both locally and systemically throughout the body. It’s felt as a wave-like sensation, completing 6-12 cycles per minute with a rhythmic expansion and relaxation phase. In the osteopathic tradition, the YR is known as the Primary Respiratory Mechanism (PRM) or the Cranial Rhythmic Impulse (CRI). The YR is a whole body motion that can be palpated anywhere in the body. A healthy, vigorous Yang Qi is felt as having a larger amplitude.
When a patient is approaching over-treatment, the YR will start to feel sluggish and gummy, almost like it is moving through a thick and viscous fluid like molasses. This thick and viscous fluid is the Yin Fluids. When the YR is pushed to the brink, it is unable to mobilize and propel the Yin Fluids.
More signs of over-treatment
The tongue body will show teethmarks. If teethmarks were already visible, they will become more pronounced.
The pulse will become disorganized.
The Manual Thermal Layer will thin at all three burners.
The Channels will start to feel buzzy.
Checking in with the YR after inserting each needle provides the opportunity to apprise whether the YR is being optimally supported, or becoming maxed out.
Applying a remedy
When the above signs of over-treatment become apparent, it’s an indicator that the body can no longer assimilate anymore treatment. When you catch the amplitude of the YR becoming diminished and moving through a feeling of motor oil, this most likely will necessitate removing the previous needle that was inserted.
If a patient approaches over-treatment even before all the needles utilized in a given point protocol have been inserted, it’s wise to listen to what the patient’s system is expressing. If you stop at this point and the patient does not appear to have benefitted from the treatment you have a few choices. One may be that this protocol is inappropriate for this patient; another is the protocol just contains the stimulation of more points than that patient can process; yet another is that that the order in which the points are needled may need to be re-evaluated to see if a different sequence gives a better result
Even when attuning diligently for the potential for over-treatment to occur, it can still happen at times. This may provide insight that can inform a diagnosis or provide guidance for further treatment structuring, knowing that a patient’s system is particularly sensitive to being over-treated at this time.
Additionally, there are instances when a patient can show up for an initial appointment at your office and their Yang Qi is already completely depleted. This is especially common if a patient has been working with multiple providers or receiving multiple forms of bodywork simultaneously (acupuncture, chiropractic adjustments, physical therapy, Rolfing, etc). Contrary to what may be a commonly held assumption in the West, more is not always better.
One way to think about replenishing the Yang Qi is through herbs. Another option is moxibustion. With moxibustion, patients can experience a replenishing of their Yang Qi in realtime. In Engaging Vitality trainings, practitioners will place their hand on a fellow participant while a cone of moxa is burning down, often on a point on the forearm. Practitioners are able to feel as the fellow participant’s Shape of Qi (SOQ) becomes more settled and suppled as the moxa cone burns down. A building wave-like sensation can be experienced in the SOQ, and as the wave crests signifying that the Yang Qi is coming back on line, the moxa is taken off. The patient’s pulses will also come up and exhibit a little more life in them. Often if the tongue had significant teeth-marks, these will disappear.
Is it really a “healing crisis” after all?
The utility of palpation in the practice of traditional East Asian medicine is wide-ranging to support beneficial outcomes for our patients. The ability to assess for whether or not our therapeutic interventions are initiating an optimal response from the body or further maxing our patients’ system out can and should form the bedrock for our assessments as acupuncturists.
Palpation as a global assessment tool can get us out of heads and into our hands, providing valuable information that can inform diagnosis, treatment, and treatment planning. To our surprise, we may come to discover that our outwardly robust, marathon-running patient has blown out their Yang Qi and can’t tolerate vigorous trigger-point needling, or that our longterm fertility patients may benefit from bi-weekly treatments as opposed to weekly visits. Over-treatment may provide a possible explanation for why our patient is feeling wrecked after our treatments, and not that they are moving through some kind of nebulous “healing crisis.” For these reasons and more, keeping in mind and assessing for over-treatment is worthwhile, potentially altering our patient’s treatment trajectory for the better.