What a strange year it has been, paradoxically both speeding by and slogging on. A year full of stress, anxiety, political division, a pandemic, and a future unknown. Though it has been hard for me to find balance in these times I have found much solace in the ideas behind Chinese medicine. For example, in the theory of yin and yang the universe is made of two opposing forces that are always moving toward balance. This can be seen in the yin yang symbol below in which there are two equal halves, black and white. This process of balance is dynamic, not static, so that when things swing too far in either direction, it is guaranteed that they will eventually swing back. So, if things feel imbalanced now please know that balance will be retuned once again.
Yin and yang are also interdependent and cannot exist without each other. This is why both halves of the yin yang symbol contain a dot of color of the other. For example, there cannot be day without night, expansion without contraction, or activity without rest. Basically, yin and yang are really just two different aspects of the same singular unity that is constantly shifting from one form to another. In this time of great political division it is important to remember that we are all interdependent, too, and cannot exist without each other. Hopefully one day we too shall be unified.
The concept of chi symbolizes this unity as well. In this theory everything has a common denominator, everything in the universe is a different manifestation of chi. Chi is an ancient Daoist concept that refers to the primary force that forms, connects, and governs the interplay of everything in existence. It is the basic power of the universe that enables things to go, move, change, shift, and transform. The theory of chi is very similar to the theory of energy as it is understood in physics; everything is chi and chi can neither be created nor destroyed, only transferred or converted to another form. This theory is an important reminder that we are all one, that we are all in this together we will get through this together. It is also a reminder that everything is in a constant state of change and that nothing lasts forever; the universe is always in a process of transformation. By their nature major transformations can be bumpy so hang in there. I'm looking forward to the next phase, aren't you?
Since 2006 there has been a new style of medical clinic popping up all over the country that goes by the name “community acupuncture.” Practitioners at these clinics treat multiple patients at the same time in the same room, dividing their overhead costs among a higher volume of patients. This allows them to charge a lower rate per treatment, which makes their services accessible to more people. However, this system requires that they divide their time and attention among that many more patients and it significantly limits which acupuncture points can be used. While I agree that healthcare in our country is overpriced, and that the more people receiving acupuncture the better, imitating the high volume model of mainstream medicine negatively affects quality of care. Paradoxically, those who practice community acupuncture advertise their services as more traditional and more effective than private one-on-one sessions. Below are five points that are commonly found on the websites of community acupuncture clinics and a refutation of each.
In the long history of medicine in Asia, acupuncture has been practiced in many different ways. For example, there were the traveling healers (the famous "barefoot doctors") who made a living doing the rounds of nearby villages on foot. Then there were the practitioners who worked for the upper class and royal families, who offered private treatments on a strict one-on-one basis, considered to be the optimal ratio for the highest quality health care. Often, these highly skilled acupuncturists would be hired exclusively by a wealthy family to be their personal physician. Yes, there were also clinics where patients were seen together in large rooms.
Even today in China practitioners work in a variety of settings, including community clinics, just as they do here in America. However, there are two very important distinctions between Chinese and American community clinics. First, in China it is not considered taboo to disrobe in front of strangers like it is here in America, especially in a medical setting. Because of this, Chinese patients may completely undress, even if there are others around. Since this is not done in America, it means that community acupuncture here is limited to the points that can be accessed only while fully clothed. Second, in China clinics use regular examination tables for treatments while here community acupuncture is usually done with patients reclining in armchairs. This means that in America community acupuncture is typically limited by the inability to access any of the points on the back of the body. So in community acupuncture, as it is practiced in America, over half of the total acupuncture points are inaccessible. This is especially problematic when dealing with chronic conditions, which respond best when the area is treated directly.
In Chinese medicine there is no frequency of treatment that is considered to be ideal for all conditions. This is actually determined in many ways, especially by how long you have had your condition and by your overall state of health. For example, the longer you have had something, usually the less often you will need treatments. This is because chronic conditions tend to both develop and resolve more slowly, gradually shifting over time. Also, if your health is poor your ability to heal can be compromised, so your condition will resolve more slowly. On the other hand, conditions that come on fast, like acute injuries or viral infections, will definitely respond and change faster, so more frequent treatments are ideal. Other factors that can influence the frequency and regularity of treatment include your age, the severity of your symptoms, and your compliance with taking herbs and making dietary and lifestyle changes. So, for some conditions frequent treatments may be ideal, while for others treatments every other week would be better. If the patient's goal is to utilize acupuncture for preventive medicine or to maintain wellness, they will need treatments even less often, say once per month to once per season.
While I agree that the high price of health care needs to be addressed so that more people can afford it, there is no absolute correspondence between cost and treatment efficacy. Efficacy has much more to do with the skill of the practitioner, especially their ability to make an accurate diagnosis. On the contrary, I would argue that the limitations of community acupuncture have a greater potential to negatively affect treatment efficacy. First is the limitation on time. Optimally, a proper initial appointment will include questions not only about the patient's chief complaint, but also about other systems and functions, as well as a physical exam, dietary and lifestyle counseling, and a discussion of the treatment plan. In addition, there should be time allotted to answer the patient's questions and, especially in the case of pain, to do some of the other traditional therapies that practitioners of Chinese medicine are also trained in, like acupressure and cupping. There is simply no way to complete all of this when you are seeing multiple patients per hour. Second is the significant limitation on which acupuncture points can be used, as mentioned above.
I don't think the best way to address the high cost of healthcare is for the practitioner to increase patient volume, especially if this means sacrificing quality of care. More effective solutions include simply charging less per patient, reserving a certain number of appointments per week for low-income individuals, or volunteering a certain amount of your time for free as a practitioner.
Actually, throughout the centuries, this medicine has been practiced in many different cultures and in many different ways. In China there has been everything from traveling doctors to court physicians, from integrative hospital practitioners to guarded family lineages. In India there is an ancient form of acupuncture that is part of Ayurvedic medicine that is based upon the Suchi Veda, a 3,000 year old text that predates the written record of Chinese medicine. In this tradition the needles were dipped in herbal liquids before insertion. In Japan traditional acupuncturists use needles that are much thinner than those used by the Chinese and there is one particular style in which only one point is needled per treatment. The Japanese also developed shoni-shin, a type of pediatric treatment in which various metal tools are used to stimulate the acupuncture channel system without piercing the skin. They even have a 400-year old tradition of blind acupuncturists, representing about a third of all acupuncturists in that country today. In Korea there is a focus on needling the hands only. This is a kind of "microsystem" acupuncture in which the different areas on the hands are said to have a one-to-one correspondence with other specific areas of the body. Another microsystem form is auricular (ear) acupuncture, which is used extensively in America by members of the National Acupuncture Detoxification Association to help patients break drug addictions. There are also separate traditions in other countries like Vietnam and Tibet. In truth, there have been many different ways in which this medicine has been practiced, and community acupuncture actually represents something totally new.
I agree that receiving a treatment in a group can raise the qi dynamic and enhance healing, but it can also lower it. For example, I have heard from multiple people who have tried community acupuncture that being in a room where people are constantly coming and going, snoring, listening to music on headphones, and having emotional releases can be very distracting. While I do agree that under certain circumstances group endeavors can raise the energy, I think it is important to acknowledge that this is not the only circumstance under which this can happen. In my experience, the more deeply we can rest during a healing session, the better. A private, quite room free of distractions, with soft music and low lighting can also be very effective at raising the qi dynamic. The qi dynamic also depends on the practitioner's approach, especially their intention, skill, and bedside manner. If the room you are in has a peaceful ambiance, if you are comfortable and warm, and if you really feel like the practitioner is attentive and caring, healing will also undoubtedly be enhanced.
Exposure to the elements can be a significant contributing factor in illness and imbalance, but isn't one we often think about in modern times because we are indoors so much. Most of us are outdoors just minutes per day as we move between our car and various buildings with controlled environments. Air conditioning, central heating, and devices that control humidity help us modify our interior spaces, significantly neutralizing extremes in temperature and moisture. While inside we are also protected from major weather events like blizzards and hurricanes. During earlier times in human history, however, we spent much more time outdoors, and protecting ourselves from exposure was a daily concern. It is during this time that Chinese medicine was developed, so there is more of an understanding in this field about how environmental factors can contribute to illness and disease.
Summer-heat is a seasonal condition that is caused by exposure to excessive heat and humidity. In western medicine this condition is called heat-exhaustion or, if more severe, heat-stroke. We are particularly susceptible to this and other types of exposure in modern times for three main reasons. One is that we spend so much time in controlled environments that we are actually less acclimated to the outdoors. Our bodies just aren't as practiced at neutralizing the effects of the elements, whatever they are. Another reason is that we don't know to prepare. For our ancestors, exposure was a real concern and they were faced with it on a much more regular basis. We, on the other hand, have become spoiled by easy access to artificial environments and can easily escape. Thinking about exposure is usually outside the scope of our day-to-day consciousness so we are less likely to do the things we need to do to protect ourselves. The third reason is that we have lost a lot of the general collective knowledge and awareness of what the early symptoms of exposure are so we are less likely to see the warning signs. Unless you were in the scouts or are trained in first aid, odds are you just don't know.
Summer-heat affects our bodies by causing them to overheat and dry out. The first signs of overheating are sweating and clammy, pale skin as our bodies attempt to release excess heat to help regulate our internal temperature. The heat makes our mouths dry and increases our thirst, causing us to crave the cooling fluids that we need. As our bodies dehydrate our blood volume actually decreases, leading to low blood pressure. Low blood pressure plus low blood volume means headaches and dizziness because we literally lack enough blood to nourish the uppermost reaches of our bodies. The effort to eliminate extreme amounts of heat through copious sweating saps our energy, causing fatigue and physical weakness. If a person with these symptoms does not rest, drink fluids, and remove themselves from the sun and heat, the condition may progress to the next level: poor appetite, nausea, vomiting, diarrhea, and dark urine. Though rare, this condition can even become so extreme that it is life-threatening.
The best treatment for summer-heat is prevention: dress lightly when it is hot out, don't exercise in the late afternoon when the temperature peaks, avoid extremes of heat and sun, and and stay hydrated. If you or someone you know starts to have early symptoms of summer-heat, lie them down in a cool and dark place and give them plenty of fluids. Fluids that contain electrolytes, like coconut water or sports drinks, are best at replacing both the water and salts that are lost to sweating. If symptoms progress to the next level, medical attention may be necessary. In western medicine the most common treatment would be re-hydration with fluids and electrolytes through an IV drip. In Chinese medicine acupuncture and herbs are used to reduce internal heat, promote moisture in the body, and give relief from symptoms like nausea, vomiting, and diarrhea.
Traditional southern remedies like iced honeysuckle flower tea re-hydrate us and cool us from the inside out. In Chinese medicine honeysuckle flower is considered to be so effective an herb for eliminating heat from the body that it is prescribed not just for summer-heat, but also for fevers, sore throats, inflamed sores, intestinal abscesses, and infectious dysentery. Watermelon is another important Chinese herb for summer-heat. The sugars in this fruit boost energy and the juiciness replenishes fluids. Watermelon is also loaded with electrolytes, especially the pulp that is closest to the rind, and promotes urination. This combination stimulates the urinary system to eliminate heat from the interior of the body out via the kidneys and bladder. Stay cool!
The study of medicine, ultimately, is the study of humanity. I feel very fortunate that my line of work requires me to meet so many new people on a regular basis. You, as in the collective you, have taught me many things, not just about medicine but about what it means to be human. You have my sincere admiration and gratitude. This is my ode to you!