Peacefulness. Listening. Communication. Consideration. These are the more abstract and innate elements of medical practice that don’t necessarily emerge from text books and lectures.
I’ve been observing a few acupuncture treatments in clinic recently, and there were a number of interesting details that cropped up, and which should hopefully guide my own practice in the future.
One was the personal interaction between practitioner and client. It struck me as quite a fine balance between professionalism and friendliness. Not that these two are necessarily opposites that must be balanced against each other. But an over-familiarity would harm the interaction, I think, and therefore consequently the treatment.
Conversely, too much playing a role would put up a barrier that might hinder a genuine exchange and understanding. There was a palpable and genuine sense of warmth and caring from the acupuncturist in clinic that I think unfortunately is all too rare amongst Western GPs.
To be clear, I’m not saying I think GPs are cold and heartless – far from it; I just think there’s a level of detached professionalism in their approach (speaking very generally, of course) that probably arises partly from time and performance pressures, partly from their training, and partly from the Western method of dealing with the symptoms or disease rather than the whole person.
In the acupuncture clinic there is a luxury of not running against the clock so much, and also of the necessity of a thorough conversation with the patient to arrive at a penetrating diagnosis.
There’s also a need to be quiet, focused and methodical when inserting the needles. A rushed treatment is liable to be ineffective. There’s a requisite that the acupuncturist find a connection between themselves and the client – a focused Yi and perhaps even an exchange of Qi through the needle. And that takes a good degree of peacefulness and attention.
A sense of spaciousness and calm permeated the whole consultation and treatment process, as well as an emphasis on the patient as participant. They weren’t there to have a treatment “done” to them. The needles work by stimulating the body to heal itself.
The 20 minutes or so just sitting quietly by themselves with the needles in is an essential element of the treatment. Time for the body to receive and respond to the instructions of the needles. Time to be quiet and pay attention inwardly. And with busy modern lives, how many of the patients, unless they are meditators, really give themselves opportunity to sit silently and rest the mind?
Patients were asked what it was they wanted from the treatment. Did they want balancing? Energising? Calming? Which symptoms would they prioritise? Not that the acupuncturist was there to simply pander to the client’s wishes, either. There was an exchange here. The patient offered the practitioner their trust and respect, and allowed them to plan a treatment that was appropriate and went to the root of the patient’s condition.
Likewise, the practitioner paid attention to what motivated the client. They weren’t just a thing to be dealt with, a set of symptoms to be gotten rid of. No judgment, only kindness. The patient was a rounded individual whose poor physical or emotional health was impacting upon their daily lives and ability to function in relation to their families, friends and colleagues. And on their relationship with themselves. The practitioner approached the patient as a learned friend, with an attitude of informed inquiry, and real interest, rather than a slightly ambivalent or disinterested mechanic who could categorise the issue, give them a label, and then “fix” them. There’s a big distinction there between the Western and Eastern methods. Western medicine fixes a problem. Eastern medicine restores balance and harmony.
Sometimes, of course, the former approach is necessary. Acute conditions often need surgical or pharmaceutical solutions. But so much can be addressed by holistic treatments. Especially with regard to things like chronic pain, anxiety and depression, digestive disorders, and the like; Chinese Medicine offers a far more elegant solution.
Anyway, I did feel that, while there was a professionalism maintained throughout the treatments, partly due to the automatic subconsciously ingrained respect, subservience even, to the “white coat”, the acupuncturist managed to convey a genuine sense of compassion and empathy for the client – a compassion that’s perhaps sometimes lacking in other fields that are more pressured and that hone in on the dysfunction or pathogen rather than observing the whole. It was shown in the warmth of the eyes and smile, in the reassuring touch that accompanied and completed the pulse taking, and in the needling itself.
Any massage that was conducted was gentle, or at least started gentle and never became aggressive. I could tell that the patients felt looked after, cared for and safe. There was no brutal spine-cracking Thai massage here. I think making the client feel like they’re in a safe space is a really crucial aspect of treatment. It allows the mind and body to relax and be receptive. It takes people out of the flight or fight mode that so many are permanently locked into to some degree.
The acupuncturist was constantly checking in with the client, partly to make sure they were comfortable, but mainly to check that there was some communication there between body and needle. The acupuncturist is looking for some sensation. No sensation means, in all likelihood, an ineffective treatment (unless the patient is Qi deficient, that is, or has some nerve damage). Pain is undesirable, and most probably indicates that the acupoint has been missed, but a dull ache or throb is a good sign that the body is responding. The practitioner would stand back sometimes to “zoom out” of their intense focus, to look at the overall picture of the needles and make sure they were properly following the channels.
There is feedback from the needle, too. The acupuncturist, as well as the patient, can feel the flesh “grab” the needle. It’s crucial that the practitioner be tuned into their tools. And it’s likely there will be some sensation of resistance and redness on the skin around the insertion, too. All good signs.
By asking the patient how they’re feeling, the acupuncturist can both reassure and get a measure of whether the needle needs “working” a bit to induce a response, either by turning it or moving it up and down in the flesh. It also ensures that the patient’s awareness is focused on the needle, which also increases the likelihood of efficacy.
At one point, Baihui (Du 20 – the 100 meetings) was being needled at the top of the head. The needle was placed at an angle to direct the Qi downwards, back down the Du channel, as the patient had too much rising energy and was suffering with headaches and other signs of excessive Yang. The practitioner, having placed some needles in the head and upper body, then massaged Yongquan (Kid 1 – Bubbling Well) in order to help ground the patient and bring things down further. There was real purpose behind that touch – it wasn’t just an idle gesture, but an integral part of the procedure.
The order of inserting needles was important too – working from top down to help descend the Qi. And, in another case, ensuring there was a stabilising, balancing needle around the level of the Lower Dan Tian along the Ren channel before other points were needled. Or, in the case of radiating pain, the needles were sequenced in the same direction as the flow of sensation, so as to draw it along and disperse it rather than creating a conflict or barrier that might cause further stagnation.
The acupuncturist’s phrasing was attended to, as well. Patients with deficient patterns were talked to in terms of “building resilience” through the treatment, rather than saying it was going to be a “powerful” treatment that might sound like too much and block the parasympathetic response. They tended to be given less needles too, so as not to overwhelm the body.
Taking needles out was given equal importance to insertion. The sequence of removal was considered, as well as the quality of the action – by which I mean, they weren’t just “yanked out” but removed carefully, with as much attention and intention as they were inserted. If pathogens needed to be released, there was no pressure applied to the area. But if the treatment was tonifying, the practitioner would keep some pressure on with the cotton bud so that nothing “leaked”.
There were a few other new things for me. I’d never seen threading before, or even some supplementary treatments such as ear seeds. But it was the quality of the approach that absorbed me most. And the honesty and communication with the client, too. For example, when a patient was treated for stagnation they were warned that the release of pressure could send things upwards and cause headaches. They weren’t just sent out the door with no concept of possible emergent effects.
There were no miracle cures promised, either – patients with chronic or severe symptoms knew that several sessions would be needed and often could expect only temporary relief rather than a complete and permanent cure. Nothing was ruled out. Hopes weren’t callously dashed, but false hopes weren’t fed, either.
And the patients were really listened to. There was an open, welcoming space that invited the patients to open up and made them feel looked after. They were encouraged to express themselves and vent their inner experiences. From their point of view, here was someone who actually cared about what they were going through and genuinely wanted to help.
I think they were reassured by the obvious skill of the practitioner, too. Palpating along the channels, the acupuncturist could feel what was going on with the body. They were tuned in, sensitive and… well, frankly borderline psychic in some cases. If you feel stagnation at a point you know is associated with unexpressed grief or frustration, and ask the client if that’s something they can relate to, you begin to enter the realm of the uncanny…
The pulse-taking is a seemingly rather mystical art, too. I think it will take a long time to reach any degree of skill at reading pulses. I could see an almost sedative effect on the patient, too, as everything went quiet while the practitioner just touched and listened to their body. It was like a few minutes of meditation in the middle of the consultation and felt quite powerful. In fact, everything about the sessions was calm, unhurried, precise, and deeply considered.
So, these are just a few impressions. You can read all the books and learn all the theory, but it’s these details of actual practice, along with experience of course, and a comprehensive grasp of point actions and the complexity of each client’s pattern, that turn you from a competent practitioner to one with real skill, awareness, and understanding for the patient.
It might sound a little trite, but above all you have to be human. Not a doctor. Not a specialist. Not a professional or a sage. But one human being engaging openly and deeply with another.
The Azure Dragon 