Tag Archives: traditional chinese medicine

Is this the end of the road for Chinese Medicine?

Increasingly, advocates of Chinese acupuncture are seeking validation by conducting and studying clinical trials. But has anyone stopped to consider if this is truly the best way forwards for this complex tradition, which exists within its own scientific paradigm, and stands apart from modern scientific practice?

At the moment there is a very real danger of traditional Chinese medicine, with all its depth and scope, its richness and wisdom, being usurped by the relatively narrow field of western dry needling. The distinction between the two is lost on most of the general public, so a cheap, tack-on course for physiotherapists and osteopaths becomes indistinguishable from a degree-level, and in some cases a lifetime’s, study of TCM. Furthermore, the push to “prove” Chinese Medicine through clinical trials risks the profession losing its way and becoming mired with Western methods.

(As a note, I use the term Western medicine throughout this discussion, to distinguish it from traditional Chinese medicine. Of course “Western” medicine is prevalent throughout the whole world, and could equally be termed “modern” medicine, or even “reductive”, as opposed to “holistic”, medicine; but historically its roots are in the West, and I think most people would instinctively understand the distinction.)

I’d like to make it clear that I think the regulation of Chinese medicine practitioners is certainly a good thing, for obvious reasons of public trust and safety; but there is a world of difference between being regulated, and being controlled and dictated to by governing bodies with no real comprehension of its beauty and profundity, and probably amongst some even a perception of it as being dry needling plus some new age woo-woo as an added ingredient. 

While I can see good arguments in favour of clinical trials, I have to admit this need to “prove” acupuncture has always struck me as kind of paranoid. But I’d never really thought through the consequences of its gaining full acceptance by the medical community. Its whole dynamic and character would change as it got synthesised and inevitably diluted by western institutions, which tend to be led by a drive for conformity, more often termed as standardisation. I suspect and fear it would be reduced to a collection of “clinically proved” protocols, as a kind of one-treatment-fits-all approach, which in reality might not be the best solution for the individual complexities of each patient. In Chinese medicine a headache isn’t just a headache; it is a symptom of any number of possible patterns of the human body, mind and spirit.

I guess there’s good and bad in it, as with anything, but on the whole I’m skeptical of forcing Chinese Medicine into the straitjacket of a Western model. There’s a Daoist tale by Zhuangzi about the useless tree that’s too gnarled and twisted to be any good for firewood, so it never gets cut down. At least that way it has room to grow on its own terms. But as soon as it is seen as something useful, it will get chopped up into pieces and lose its essential wholeness and naturalness.

What would be the advantages of a more rigorous testing of Chinese Medicine practice through clinical trials? Scientific inquiry means confirmation of efficacy and would undoubtedly lead to all round growth in the profession. More research would mean more acceptance by the public, and more respectability amongst the medical community. It would also help to weed out unqualified practitioners and charlatans, unfortunately an all too prevalent scourge of so-called alternative therapies.

I’d also add that properly conducted clinical trials and literature reviews help to eradicate some of the erroneous conclusions and decidedly woolly thinking that are lurking out there around the subject of energy work. There are many individuals in the field, or at least on its murky peripheries, who see nothing wrong in conflating different systems of thought, often from completely different cultures. To give an example, just because there are some similarities between the chakras of the yogic traditions, and the lower, middle and upper fields of the Chinese energy body, this doesn’t mean to say that they are exactly the same thing. They are not interchangeable, and to dilute systems in this way is to do them a great disservice. Yet it happens all the time, and this only serves to muddy the waters and lend ammunition to those who would seek to denigrate sophisticated and complete systems such as those of Daoist alchemy and Chinese medicine.

These are all really strong arguments in favour of clinical trials and application of Western methods, however my gut instinct is still one of hesitancy. Already standardised TCM practice is quite far removed from the traditional master-apprentice style of classical Chinese Medicine. In becoming assimilated by Western Medicine I feel TCM is only going to become more diluted, and will eventually be eroded and washed away by a tide of reductive “improvements”. It will become more rigid. More closed. More objective and material in its approach. More standardised. More prescriptive. Less of an inquiry. Less of a direct communication between patient and practitioner. Less of a dialogue. Less of an art. It is the difference between doctor as fixer and doctor as listener and healer. 

There’s a huge qualitative difference between fixing somebody’s problems (which often means disguising them with drugs) and truly healing them in both mind and body. I can imagine a rapid degeneration into a “this point is for this symptom” way of causative, Western logical thinking, rather than the “big picture”, pattern-led and subjective insights of the Eastern approach. I fear that by becoming more “respectable” and “scientific”, Chinese Medicine is in serious danger of losing its heart. Objectivity is a poor exchange for insight and intuition, in my opinion. We have this idea in the West that the new thing is better, that progress is always good, that ideas change and develop and get superseded by better ideas.

And while I’m sure it would be incorrect to claim that Chinese Medicine hasn’t had its pioneers or benefited from new ideas and approaches over the centuries, at its fundamental core it has remained static because that core is perfectly in line with the way things are in nature. A practitioner might always be able to improve their skill, but the art itself is already complete and universal. So why then this seemingly rather paranoid urgency to prove Chinese Medicine a worthy endeavour? It’s very difficult to make any experiment watertight, and doubly so with something like acupuncture. I’d even say it feels precariously close to a disrespect to the masters of its 2,000 year (and almost certainly far longer) history.

By reducing Chinese Medicine to graphs, charts and tables of experimental results, severed from the individual patient and their place in the environment, you’re forcing a holistic and largely inductive system into a reductive and deductive paradigm. You depersonalise it. You throw out subjective factors entirely in favour of the objective and measurable. And by taking out the subjectivity you remove its most characteristic and effective factor.

One of the biggest differences between modern “Western” medicine and TCM is that the Chinese approach engages with the individual in each case, and treatment is inextricably interwoven with that individual, whereas modern medical methods largely stand independently of the patient. By which I mean, if you have a headache, you and everybody else should take this particular pill; as opposed to the TCM method of looking more deeply into causes – lifestyle, diet, sleep, stress, etc. – and not just plastering over the underlying problem by making the pain go away.

The objective approach might make sense for chemistry or physics experiments, but our minds are intrinsically involved in our health; I’d say it’s a mistake to leave subjective factors out when it comes to medical efficacy. And of course, often the very act of measuring can greatly influence results. Scientists looking at the subatomic world have already found this to be true. The very act of looking, of paying attention to something, alters its behaviour fundamentally.

Evidence-based medicine is an excellent model for the reductive and specific approach of Western science. But it leaves out some crucial elements that are essential to the effectiveness of a treatment…

The expertise and experience of the practitioner.

Their diagnostic insight.

Their skilful technique.

Their clear-minded intention and close attention to the patient.

The clarity and honesty of communication between practitioner and patient.

Trust and expectations, including the well-documented and often underestimated placebo effect.

The environment in which a treatment is carried out.

And other peripheral but no less important circumstances, such as variations in patients’ lifestyle, outlook, diet, emotional disposition, mental acuity, air quality, environmental climate, sleep patterns, relationships, work, life history…

A human being is all of this, and when we try to narrow the parameters to test things in isolation, we leave out so much of value.

In Chinese Medicine there is great importance placed upon the Yi of the practitioner, which comprises skill, insight, knowledge, focus and intent; and their quality of Ting, which is a measure of their ability to listen to and observe the patient. All of this is largely disregarded by the homogenised nature of clinical trials. Generally, experiments of this type endeavour to leave out human factors as far as possible. What’s more, control groups are often arrived at through highly unsatisfactory methods such as sham acupuncture. And often, studies are simply neither large enough nor rigorous enough to be of any real use.

On balance I do welcome clinical trials, but we should be very wary of promoting their importance too much. I think they bring an interesting dimension to Chinese Medicine. But that’s as far as I’d go. I don’t think they’re imperative or even particularly useful at all. And I wonder with some trepidation where they will lead us. That’s just my take on the subject. I appreciate there are lots of differing and totally valid viewpoints.

The trouble is that as an Eastern art gets drawn into modern Western science, and Western science becomes increasingly prevalent in the East, there are fewer and fewer people who really have a feel for the particular mental approach that guides the skilful and subtle art of Chinese Medicine, so their voices don’t get listened to. Practices become steered more and more by Western ways of thinking and working, and in the end we are left with a medicine that is a shadow of its former self, impersonal and stale.

That would be a real shame, a tragedy in fact, so I think we have to be careful about how much weight we lend to the double-blind trials and (no doubt well-intentioned) scientific journals that publish them. No experiment is perfect. Especially in a field of research like Chinese Medicine, faults can always be found in terms of the comprehensiveness of trials, the effectiveness of sham acupuncture, timescales, control groups, etc.

I think both Chinese and Western medicines can happily coexist, and they definitely have their respective strengths. If you’re depressed and suffering from IBS, anxiety, migraines or insomnia, go get some herbs or needles. But if you’re having a heart attack or an arterial bleed, do go to A&E and not your local acupuncturist! But just because the two medicines can coexist doesn’t mean that they can’t stand apart. They don’t have to speak the same language. Something always gets lost in translation.

Needling thoughts

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.