5 Myths of Community Acupuncture
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. 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.
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My Ode to You
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!
- You are Unique - I have never met anyone who is a "textbook case" and I am certain that I never will - it simply is not possible! Like each one of the thousands of flowers in a spring meadow, you are rare and unique and it is so lovely to have made your acquaintance.
- You Care - You care about your health, for that is how I know you. You also care deeply about your friends and family, and want them to be happy and prosperous. You care about your pets, furry, feathered, or otherwise. You care about humanity and you care about our shared home, planet earth.
- You Hold the Power of Transformation Within You - It is amazing to see how you shift and change over time. You process through transition, balance out, get well, move on, loose weight, draw boundaries, overcome obstacles, re-focus, recharge, decompress, regain your strength, and so much more. Do not forget that you are always and forever in the process of transformation and that you can tap this inner power at any time.
- You are Positive - It is true what they say, that everybody's got troubles. However, even in the toughest of times you hold you ground, believing that there are better days ahead. Even in the most difficult of situations, you can see the good that comes from it. In truth, your power of positive thinking has inspired me many times and I thank you for that.
- You Live with Intention - You try so hard to do good, to make a positive mark on the world, to make a difference in the lives of others less fortunate than yourself. You live with great purpose and intention and admire you for that. I aim to follow your example.
- You are Wise - You have taught me so much - thank you. From you I have learned a million things about the practice of medicine. From you I have learned a million things about what it means to be a good person, to be human. You have enriched and enlightened my life. This is my ode to you.
Summer-Heat: Chinese Medicine and Seasonal Exposure
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!
Winds of Change: A Chinese Medicine Understanding of Airborne Disease
In Chinese medicine there are just a handful of categories into which every type of disease can be sorted. Some are very easy to understand, like Heat. This category includes diseases with symptoms such as fever, inflammation, infection, hot flashes, and night sweats. Another is Cold, which includes chills, frostbite, pain where the tissue is cold to the touch and improved with the application of heat, and diseases where there is an under-functioning system, like low metabolism, hypothyroidism, and certain types of infertility.
One of the other categories is Wind, which is not as easy to grasp and includes many seemingly unrelated conditions. To understand Wind as a metaphor for disease it is helpful to look outside to the wind itself and observe its characteristic behaviors: it comes on quickly, changes rapidly, travels fast, and causes movement, blowing the trees around and pushing the clouds across the sky. Wind conditions have these same characteristics. For example, since strokes come on so rapidly, cause immediate and dramatic change, and are accompanied by spasmodic movements, they are categorized as Wind. Other examples of Wind include tremors, epilepsy, and even itchy skin conditions like eczema and hives.
Interestingly, respiratory diseases caused by airborne pathogens are also categorized as Wind. I find this especially amazing considering that Chinese medicine predates the invention of microscopes and the germ theory of disease by thousands of years. Still, the ancient Chinese were able to understand that certain symptoms were related to something carried by the wind. They couldn't see it directly but they knew the pathogen was there by its effects. Think about it; just like the Wind diseases above, symptoms of airborne viruses come on fast, change quickly, sometimes even by the hour, spread rapidly from person to person, and cause movements like shivering, chills, or even the convulsions that come with dangerously high fevers.
Since COVID-19 I've been thinking a lot about Wind. This airborne disease in particular has come on so fast and spread so quickly, traveling around the entire world in just in a matter of months. Because of its speed and far-reaching scope I think this disease is behaving a lot like the Black Death and other historically significant diseases before it, resulting in rapid social change. Since the pandemic, it seems like we are all pausing and reflecting, reevaluating everything from how we socialize and communicate to how we work and travel. Even mundane tasks like going to the grocery store or getting gas have taken on a whole new meaning. It is clear that our society at large is going through some sort of major shift or transformation and COVID-19 is accelerating the process. I don't know where we are heading but I sincerely hope that all of this reevaluation and reflection brings about a lot of positive changes.