Monthly Archives: May 2013

More Cross-Pollination

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Once again, here is some writing I did for one of my listserve groups. This is in response to a conversation about the proper translation of jingmai from the Huang Di Nei Jing.

I’ve been hesitant to participate in this dialogue. I am not a Sinologist or deeply familiar with the Chinese Classics. Furthermore, my past experience with these sorts of debates is that at the conclusion we are all likely to feel further justified that we are right and everyone else is an idiot.  It isn’t all that unusual for these debates to devolve into personal attacks. The early comment in this thread regarding “their emotional but ungrounded negative responses” put the brakes on my initial desire to participate.

However, Matt’s inquiry re. the thread subject “Use of the concept of Meridians has Crippled the promotion of Acupuncture in the West” touches on issues that are near and dear to me.  Combined with his hope that others would get involved, I am finally going to offer a contribution.

Regarding the thesis that the term jingmai in the HDNJ was the blood vessels, again, this is not an area in which I have the expertise to come to a conclusion. Personally, I’d want to find out what Elizabeth Rochat and Heiner Fruehauf had to say on the matter. They are my personal experts when it comes to the Classics, the Chinese of the Classics, and a deep knowledge of Chinese Medicine itself. In Heiner’s case he also works and studies with practitioners with long unbroken lineages going back many generations.

From my initial training as a cultural anthropologist, I’d caution against the belief that there could be any direct one-to-one translation from a Classical Chinese term to the current use of Western anatomical term. Not only are we dealing with different languages, but different language families and different cultures.  I think Matt Bauer’s posts and writings addressed this.

My rudimentary knowledge of the Classics, along with my somewhat more developed experience as a practitioner, along with a quick read of even the most recent articles and our own conversations about mechanism of action make it seem unlikely that any practitioner or scholar of the past or present would think that when we are talking about the effective pathways of acupuncture that we mean the blood and blood vessels.

I don’t know what the myth of the Meridians is, exactly.  Can one of you explain? It seems like we have something of a straw man (or red herring?) here. Much of this conversation centers on dismissing a myth that none of you have described. Certainly I don’t know of any LAcs who refuse to accept any sort of modern scientific theory. I do know many LAcs who are, I believe, appropriately skeptical that the latest study or current understanding of how the body works is the total and complete truth.  Within my years of practice probiotics have gone from something that the western establishment dismissed with an eye roll to something they prescribe, and the appendix has gone from a worse than useless evolutionary vestige to a structure that may have important roles in the immune system and maintaining gut flora, to give only two examples.

Given the ever-evolving understanding of physiology and appreciation for the limits of what we currently know, along with the knowledge that the effect of acupuncture cannot be fully explained by blood vessels, I can’t see how insisting that the jingmai are blood vessels would serve the profession at all. Wouldn’t it be far more helpful to explore our languaging of the Meridians, making sure that all practitioners could describe their complexity, rather than substituting a term that doesn’t address that complexity? I fear using the term blood vessels would only further confuse the establishment.

As for what is behind the crippled promotion of acupuncture in West, is it crippled? Just this week I received an email Can Acupuncture Relieve Your Pain from WebMD, various emails about PT’s, MD’s, and others who are trying to “steal” our medicine, a notice of a job opening from one of the three acupuncture schools (of questionable quality) that have opened within 10 miles of my office, numerous requests for referrals for LAcs around the country, links to three different studies looking at acupuncture efficacy and mechanism of action, and news that POCA clinics did over 600,000 treatments in 2012 .  I also began treating an MD, and had several new clients referred to me by their MD’s, DC’s, or other providers. Overall, I’d have to say that Acupuncture is doing pretty damn well for itself in the West.

The promotion of the “profession”, though, that is a different question entirely. The debate over terminology does point to what I believe is the crux of the dysfunction within the profession.  When it comes to the risk/benefit analysis of accommodating ourselves to the trappings of the western medical establishment, most of us have strong feelings, and are rarely consistent about them even on a personal level, never mind across professional communities. Combine that conflict with the lack of trust, connection, mutual respect, and the venue necessary for exploring these issues in a productive way and the profession itself is certainly limping.

In other news —

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I participate in conversations on various listserves and I often touch on topics I would like to share here, but don’t have time to flesh into a full post or make a proper introduction. I’m going to go for content over polishing and am hoping you all can manage to pick it up on the fly (which is how it was written) —

This is from a thread that began in response to the SNL acupuncture skit.  Some colleagues were upset that it would scare people away from acupuncture, which led to posts about how practitioners already have to reassure potential clients that acupuncture doesn’t hurt, which led to posts pointing out that sometimes acupuncture does hurt, which led to this post (slightly edited, and with some formatting issues I can’t correct. Sorry.) —

This makes me think of the conversations I have with acupuncturists about TPDN.  Often one concern is that “dry needling” is acupuncture and we acupuncturists are the best trained people to be doing this technique.  Another concern is that people go to PT’s and have this treatment and it hurts and then they think that acupuncture hurts.  Among the things I usually ask when I’m in this dialogue —
1)  Did you learn this technique in acupuncture school and were you using it regularly?  (I was not taught it at TAI and from the conversations I’ve had NESA Tri-State is the only [US] school where most students were learning the technique prior to when LAcs felt threatened by the PT’s “stealing” it.)
2)  If you used this technique didn’t you notice that it is painful even when done by an LAc?  After all, you are sticking needles into a tender spot and lifting and thrusting until the muscle releases.
3)  Since when are we guaranteeing that our treatments will be pain free?  Is this something we want to start regulating — if it hurts you can’t do it?
4)  If this technique is uncomfortable and gives people the wrong impression about acupuncture, why are we insisting that the PT’s use that term?  If you want consumers to think of acupuncture as pleasant and painless, isn’t it better to call this technique dry needling?
That’s this afternoon’s contribution to “In other news.”  Just some things to think about.

“Jerk MD!”

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Have you ever found yourself thinking that a client’s physician has missed something important?  Have you ever attempted to communicate to the physician, either directly or via the mutual client, that you believe there is something that deserves further attention?  Have you ever had the response reveal that the physician gives no value to your observations and thinks you are unqualified to have any thoughts about a patient’s medical condition?

Most of us who have been in practice a while have had a few such experiences (though we likely have had positive interactions with MD’s too). It is maddening! One would expect that a healthcare provider would welcome any input that could provide new insight to benefit a client. It is a shame, and a risk to quality healthcare, when arrogance or ignorance or a bad attitude interferes with a respectful consideration of another professional’s input.  It’s easy to see why a colleague used “Jerk MD” as the subject line of a post about a dismissive MD.

What response would we like in such a situation? — Thank you for sharing your concerns, I’d like to hear your observations? Even better would be a conversation, with each of us sharing our thinking. Perhaps an ongoing referral relationship of mutual respect could develop, serving our clients and our own professional development.

In a recent conversation with a fellow acupuncturist about non-LAcs doing acupuncture (or, using acupuncture needles, depending on our definitions), my colleague was outraged that a PT had suggested to a mutual client “mention to your acupuncturist that I think your Kidneys need special attention.”   The sputtering — “how can that PT, with a 30 hour course, presume to think they might know something I don’t already know.” I’ve had similar conversations with colleagues in the past and I can relate. I’ve had clients come to me with similar news — oh, my DC said he thinks the problem is my Liver meridian — and my initial internal response has been a dismissive tossing away of the input along with the thought that there is nothing about acupuncture and Chinese Medicine that a 200-hour acupuncture wanna-be could tell me.

We, in effect, become the “Jerk MD” in these interactions. The input from another provider, who no doubt wants only the best for the client, is disregarded, and our self-serving sense of superiority is stroked. We indulge our arrogance.

Let’s be the change we would like to see in the world. Let’s welcome input from others who are caring for our clients. Let’s be willing to have a dialogue about what they are observing and consider whether it might be helpful to us, regardless of our judgments about their training. Let’s share what we know that makes us think they might be off-base or on the right track. Perhaps an ongoing referral relationship of mutual respect could develop, serving our clients and our own professional development! And let’s be sympathetic to the MD who might think we, with our limited training in western medicine (most of us), are presumptuous if we have thoughts about a western diagnosis. We know what it feels like to have someone with less training offering us their assessment.