Gentle Acupuncture & Needle Fear

I think I’m pretty good at working with people who have some fear about acupuncture because of the needles. For one, I let patients know that in No Event am I going to do something they don’t want me to do and that I will only perform acupuncture after asking them if it’s okay. I also remind them that I will only be working in a specific location that we’ve talked about and that they have the power to say “not there”.

So essentially, I:

  • remind them that they’re in control
  • that nothing happens without their consent
  • that they can consent and then change their mind

In the treatment room, I can use needles that are more gentle, intended for children or babies, and employ techniques that are mild in nature.

I let them know that some patients, on the other end of this spectrum, prefer “stronger techniques” and that as practitioners, we don’t always know which techniques a patient will prefer or respond best to. Communication is key.

I assure them that I’ll be conservative in my approach and will give a lighter treatment, even at the risk of non-effectiveness, instead of a stronger treatment, and that we can always build up to stronger-feeling treatments if they like and as they’re ready.

Some patients prefer to see the needles first while others prefer not to, so together we decide best approaches to facilitate comfort and ease. I can also describe how thin needles are, more similar to the width of a hair than what they may have experienced at doctor’s offices. I also ask if they have any concerns or questions around safety and that I’m trained to be safe.

Also, some prefer to chat or listen through the act of insertion and others prefer silence so they can breathe in/out without disruption. We discuss their preferences and then I take steps to honor them. At any time, we can slow down or stop altogether.

So this:

  • creates the expectation of mellow, starting simple/light
  • reminds them that different people respond and prefer different techniques
  • reminds them they’re in control and we’re in this together

If they elect for just one insertion, I let them know this is a great start and that some entire treatments are just that: they shouldn’t feel like it’s not a full treatment. If they like, I will hang out with them for a few minutes making sure they’re comfortable with the feeling acupuncture produces, which is typically quite calming but is also something one feels.

We discuss whether they want me to check in on them and I give them a bell to ring me if they need me to come for immediate assistance. If they say they want to be checked in 5 minutes, I tell them that “I will return in 5minutes, not 6 or more minutes. I’m going to set a timer” and then I do.

Together, we make agreements that are followed, which helps establish trust. Anxiety and/ or panic can rise and blossom so I try to be very diligent in approach so that they trust that I’ll be there if they need me.

Acupuncture is typically relaxing, calming, sometimes even sedating, and some describe a sort of floaty sleep-like session, an “acu-nap”. Acupuncture can be very good for people who have anxiety, insomnia, depression, etc. Once they feel it, they typically come back for more. Acupuncture can be great for sensitive people.

 

 

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Evolving Ancient Medicine

Often when I see writings about Chinese medicine, including my own, there’s some mention about how old it is, which is thousands of years.

Sometimes we may be highlighting this, in part, to help substantiate it, as if to lend credence. Of course, just because something’s old doesn’t make it better, nor does it make it worse. But with thousands of years of practice, it does mean that there’s been a lot of experience, many treatments, and many patients.

Even if one can’t quickly go find the perfectly matching RCT (randomized-controlled trial) that best matches the condition for which one seeks medical evidence of efficacy, that doesn’t necessarily mean that acupuncture hasn’t helped someone with it before. It also doesn’t mean it doesn’t exist (might need translation.)

So, how old is this medicine?

A longer timeline of Chinese medical history can be found at http://www.shen-nong.com/eng/history/chronology.html , but summarized parts of it (with my notes) are here:

~2000 BC, Antiquity: Yellow Emperor & Shen-nong: They are said to be the founders of traditional Chinese medicine (TCM).

1700-1100 BC, Shang: Inscriptions on bones describe the use of wine and hot water, use of needles and knives for surgical instruments, diseases and illnesses discussed.

1100-221 BC, Zhou Dynasty: Organized medical system in the emperor’s court. Specialties in surgery, diet, disease, veterinarians. The Huang Di Nei Jing: The Yellow Emperor’s Internal Classic: A&P of the human body. Foundation for TCM. Yin Yang and Five Element Theory.

221 BC-220 AD, Qin and Han Dynasties: Earliest reference to Chinese pharmacology: Shennong Bencaojing. List of 365 Chinese medicines and herb prescriptions / combos. Zhang Zhongjing: establishes diagnosis based on signs and symptoms. Shang Han Lun

220-580 AD, Chinese Middle Ages: Pulse Classic. Earliest complete reference guide to acupuncture and moxibustion. 349 acupuncture points with therapeutic properties for each. A handbook written for Emergencies.

618-907 AD, Sui and Tang Dynasties: Imperial Medical Academy. The first medical encyclopedia comprised of 30 volumes and 5,300 prescriptions, also disease prevention and health preservation. (Sun Si Miao) — NOTE: Preventive health

960-1279 AD Song Dynasty: First official prescription book with 16,834 prescriptions. (weblink lists ~40 books/treatises during this period) — NOTE: That’s a lot of prescriptions! 

More dynasties and many more books: The Jin Yuan period, Ming Dynasty, Qing Dynasty, Modern China (1950 future medical policy to include both Chinese and Western medicine options)…

There’s been a lot of time to practice, theorize, iterate, publish, proliferate, and evolve. 

Balance

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Our bodies are in transition. We are always in transition. As long as we are alive, change is inevitable. Chinese medicine looks at normal and abnormal patterns of change and gently moves the body towards harmonious balance.

This constant ebb and flow is also recognized in Western medicine through a primary concept of homeostasis, meaning we maintain balance in the body through multiple physiological processes. Homeostasis is the continual balancing act. There are many examples of homeostasis in the body: I can’t begin to count them all nor do I believe science has identified them all. We are all still learning. 

A simple example illustrating homeostasis is our body’s relatively narrow range of normal temperature. If we get too hot, we sweat to cool down. If we get too cold, we shiver to generate warmth. 

A concept of balancing is essential to Chinese medicine. If something is moving too fast, we attempt to slow it. Too slow, quicken it. Too hot, cool it. Too cold, warm it. Too wet, dry it. Too dry, moisten and lubricate it. And so on…

Where did this ancient but ever-evolving medicine look to produce theories of change in the human body? They went macro: they looked at patterns of change in nature, on the land, in the sea, and in the sky. They looked at harmonious nature, always in flux, and they considered what happens when the ever-balancing act is not functioning properly. If we move outside the norm of balance, we either recover and get back in balance, or we develop pathology. Chinese medicine has treatments to support normal physiology as well as pathophysiology. It’s all a spectrum. 

Examples with conditions and balancing treatment principles: 

Too hot: fever -> clear heat

Too cold: some infertility -> warm the uterus

Too wet: moist rash -> dry it out

Too dry: itchy flaky skin -> moisten and lubricate

Too slow: elderly constipation -> move the bowels

Too fast: anxious mental chatter -> slow, calm mind

Or, another way to consider this is to examine one common condition, for example, constipation. We look at the root, the cause of constipation, to determine principles of treatment. Example:

Constipation caused by slow motility -> move the bowels (abdominal massage, acupuncture)

-or- 

Constipation caused by dry stools -> moisten (fluid intake) and lubricate (oily foods)

-or-

Constipation caused by too much heat creating dryness -> clear heat and moisten

Whereas constipation is one common symptom, there are different treatments depending on cause. Chinese medicine seeks to discern patterns of harmony and disharmony in the body to help bring them back into balance.

One reason Chinese medicine can preventively treat a condition is because patterns of disharmony arrive before disease. If we can recognize the pattern early, it’s easier to treat.

Commonly quoted but still so useful to remember, “An ounce of prevention is worth a pound of cure.” -Benjamin Franklin

Heart

I will always treasure this heart, made and given to me by my friend’s aunt, a retired pediatrician, and someone I got to know while helping out recently.

My friend’s success story:

Not long ago, a dear friend called as she was leaving her doctor’s appointment with medical news that no one wants to get. The next morning we drove over to the hospital and spent the day in appointments.

It was a challenging day, but her doctors and nurses were amazing. Their approach was so spot-on and it really helped her (and me) in staying calm, a gift in and of itself.

My friend went through the whole thing with unflagging positivity coupled with down-to-earth honest vulnerability. She was so inspiring! She was fierce in her dedication to address all that she could and work hard to be her best, even in the wake of so many uncertainties. She was so lucky too as she attained the best possible outcome. Such a relief!

Language Curiosities

Studying Chinese medicine entails some study of the language itself even though (unfortunately) I don’t speak Mandarin or Cantonese. Here’s something I find curious about the Chinese language: 

Say you’re trying to talk with someone who speaks another language, like you’re monolingual and you only speak English and you try to talk with someone in Spanish, typically you’ll resort to hand gestures or something to communicate a simple thing, like “Where is the bathroom?”

However, something different happens with Chinese. Characters that make up written Chinese are shared among multiple spoken languages. You can have someone who only speaks Cantonese communicating with someone who only speaks Mandarin and instead of resorting to hand gestures, they can use a language they do share: written Chinese.

While studying abroad in China, I was told that I might see two people get stuck on a word/concept they don’t share a language for and one will draw the character in the palm of their hand to communicate meaning.

This quote from Wikipedia (https://en.wikipedia.org/wiki/Chinese_language)

“The written form of the standard language (中文; Zhōngwén), based on the logograms known as Chinese characters (汉字/漢字; Hànzì), is shared by literate speakers of otherwise unintelligible dialects.”

So two people who don’t understand what each other says, can read the same paper. Fascinating.

Even two people don’t know written Chinese, with Google translation one can enter “Hi. How are you?” and quickly get the written Chinese for it. It also provides the Pinyin (a transliteration that romanizes Chinese to aid in pronunciation). Neat! USEFUL.

Example:

Hi. How are you? – English

你好。 你好吗?- Chinese (simplified)

Nǐ hǎo. Nǐ hǎo ma?  – Pinyin