When Less Equals More

This is my second in a series or articles written in an effort to share some of the lessons I have learned from my years in private practice. I hope the information given in these articles might prove useful, especially to those newer to acupuncture practice. In this article, I want to share what has been one of the most clinically useful lessons I have learned: the power of doing less.

When I fist opened my practice in the mid-1980s, I approached my work with the attitude that I might be able to make up for my lack of acupuncture experience with sheer effort. I had some massage and bodywork background, and I regularly supplemented my acupuncture techniques with a generous dosage of massage and acupressure. I guess I felt that if the acupuncture didn't work, at least my patients would get a decent massage for their money.

In my third year of practice, I began to rethink this strategy. While I was generally pleased with the results I was seeing and had learned to accept that even the best practitioners don't cure everyone, I had a few cases that bothered me. Every once in a while a patient would return for follow-up treatment and report that their symptoms had become exacerbated after their last treatment. Some of these cases were the result of a normal healing response; these patients soon enjoyed marked improvement. Others were coincidental to the treatment and were caused by something else. Some, however, despite my good intentions and decent track record, were cases in which I had aggravated the patient's condition.

As I thought about this, I realized it was most likely the acupressure/massage techniques that caused these instances. I decided to try doing less hands-on therapy and relied more on acupuncture alone. I still did some acupressure/massage after removing needles, but altered my technique to a lighter one that complimented the acupuncture rather than adding one primary therapy on top of another. I also confronted my insecurity about my diagnosis and point selection by staying longer with my original treatment strategy and not switching to different techniques whenever patients reported no dramatic improvements right away. Lastly, I stopped throwing in extra "insurance" points. Following this approach, I not only saw the instances of exacerbation dwindle to almost zero, I also saw an overall improvement in treatment outcomes.

In my previous article in the December 2001 issue, I gave advice on how to more closely measure your patient's progress and subjective complaints. The first stages of progress following acupuncture can be subtle and may not be noticed by your patient. When you see signs that your patient is improving, such as improved pulses or noticing less muscle tension, etc., stay with that treatment. It is probably just a matter of time before your patient notices he or she is feeling better. If you change your treatment approach whenever your patient tells you they haven't felt any improvement, you may be changing from an effective treatment to one less helpful. Trust your training and respect your instincts. Your first hunch is usually your best. Carefully measure your patient's progress, and give the treatment time.

Lao Tzu once said, "The softest of all things can overcome the hardest of all things," and he praised "wu wei" -- the art of "doing by non-doing." Gentle therapeutic nudges often get better results than strong therapy workouts. Acupuncture gives our natural healing system a critical nudge; then nature and time do the rest. In healing, doing more does not necessarily equal doing better. Have faith in your ability and the power of acupuncture. Try doing less - you may find it does more.