The TCM Vs. Five-Element Acupuncture Divide

I had no idea when I began receiving acupuncture that there can be such animosity between practitioners of various systems. However, as I have attended symposia and training events, I've started to hear the squabbles between "camps," from arguments that break out after conference presentations to snide remarks made in restrooms. The debates I've witnessed are heated, often nasty, and at times inappropriately personal. As a patient, the whole mess is unseemly, as to me, the discussions mimic the in-fighting between devotees of different sects of the same faith. I do not take sides or participate. From my perspective, it's all acupuncture.

I will not outline the richness of the debate between adherents to one dogma or another. Unfortunately, attention placed on fighting paradigmatic battles and the territoriality of one camp attempting to assert its superiority over another draws practitioners and scholars alike from important and pressing questions of our day. How can practitioners of Asian medicine have a greater voice and stronger position in the national debate on health care and health care reform? Is Asian medicine, particularly acupuncture, a cost-effective alternative or adjunct to Western medical practice(s)? Since the randomized clinical trial, while the gold-standard for most medical research, does not lend itself well to the research of Asian medicine, how might efficacy studies on various systems of acupuncture be done? Who will fund this research? These are questions leaders in the field are asking, and they are much more important and pressing issues than discourse on the application of a particular nomenclature by practitioners of one system or another.

This is not to say that there is not a time and place for discussion about nomenclature, source citation, and the ontological and epistemological underpinnings of various treatment methods. Scholars take these matters seriously and spend a great deal of effort laying bare the ideas and assumptions behind practice. However, for these discussions to be fruitful, they must take place with a high degree of professionalism and academic rigor. Those untrained in scholarship and research must hone their skills to participate in this discourse, to bring about meaningful consensus that moves the field forward.

Upon hearing the assertion that one type of acupuncture is superior to another, I went to the library. As a patient, I want to receive treatment from the most qualified practitioner using the most effective system. As a scholar, I'm interested in the veracity and proved effectiveness of various claims. However, I found not one study indicating that one type of acupuncture is more clinically efficacious than another. My personal experience mirrors that finding. I have been treated by those trained in various methods and while I have found a practitioner with whom I am comfortable, the outcomes I received were equally impressive from each system.

I have received both TCM and Five Element treatments. The first acupuncturist I saw was Chinese; she received her training in China in the TCM system. I was referred to her because I had multiple chronic physical conditions (for which my physician prescribed four medications) and manifestations of an old trauma that were so physically and emotionally painful, I sometimes could not get out of bed. This practitioner was well-regarded in our city. She teaches for at least one of the acupuncture schools here. Her specialty is fertility and I know several women who consider her the reason they have children. At my first treatment, she told me that she would see me twice a week for three months, once a week for the next three months, and that if, at the end of six months she was unable to cure me, that I should see someone else, for she would have exhausted her treatment plan. Before the end of three months, I no longer needed half the medications I had been taking and one chronic condition, which had plagued me for more than a decade, was cured.

Even though the results were excellent, I stopped seeing her. The problem was not the efficacy of the system of medicine. My results were far better than I ever imagined. Frankly, I didn't think getting stuck with a few needles would do anything for me, but the outcomes did not bear out that jaded assumption. The problem for me was interpersonal. I could not talk with this practitioner. She relied heavily on pulse and tongue diagnosis to know what was wrong with me. Less than five minutes of each session was allocated for discussion; I was dealing with too much trauma to get out what I needed to say in that small window. Before I knew it, my pulses had been checked, needles were inserted, and she was out the door. My inability to express myself was frustrating for her too. Once, when she came into the treatment room and found me crying and unable to tell her why, she also started to weep. "I worry I cannot help you," she said. I worried about the same thing too.

Physically stronger, but emotionally in a tailspin, a friend referred me to a different practitioner. This practitioner was a long-time student of JR Worsley. He received his training directly from Worsley and teaches Classical Five-Element acupuncture to postgraduates. He is known for his ability to communicate effectively with patients. He practices as he was taught; he does not mix systems or styles.

I was referred to this practitioner because my friend believed I would respond well to him. In my first session, he made me feel safe. The things I needed to say came tumbling out. The things I could not say, I shared later in an e-mail. Immediately, he was able to get to the heart of my emotional upset and give me relief. We spend a half hour or more talking before he needles me. He doesn't leave me during a treatment, giving us more opportunity to interact. Not everyone wants this kind of relationship with their practitioner. For me, it works.

While my personal experience of the two systems is by no means intended to be, or presented as, a comprehensive comparative study of TCM and Five-Element acupuncture, I believe it highlights two important features that those who choose to engage in the debate about various systems of acupuncture might keep in mind.

Communication: I did not choose one system or practitioner over another because of the efficacy of treatment. The outcomes I had from the TCM-trained practitioner were excellent. In fact, I marveled that acupuncture could do so much for me. However, I chose to be treated by a Five-Element acupuncturist because the extensive communication between the patient and clinician emphasized by that system is comfortable for me. It's the communication, not the system, that helped me fully to participate in the healing process with my practitioner. It helped too that the practitioner and I share the same religion, culture and social network. The brief window of opportunity to talk with the TCM practitioner doomed our relationship and thwarted her treatment plan. I believe that had I been able to speak with her as I do my current acupuncturist, that she likely could have helped me as he has. Communication, not just the acupuncture itself, is a critical ingredient to treatment efficacy in any system.

Patient/Practitioner Rapport: Those who squabble seem, to me, to be arguing about inconsequential matters and fail to realize or remember that treatment efficacy rests heavily in the hands of the patient. In most instances, I do not believe that patients can be passively needled back to health. We must choose whether or not to take our herbs if prescribed, eat according to the diet that is suggested, sleep, exercise, and even evacuate our bowels as directed by our practitioners. This means that we, patient and practitioner, must be in the healing process together. This relationship will take different forms for different patients. Some will respond very well to one practitioner or style, while others will incline toward another. This is a matter of personal preference for the patient and the ability of the practitioner to build rapport with various types of people, not a value judgment or statement about a system.

Hoped for treatment outcomes result from the interplay of myriad variables. Results are generated from far more than adherence to a philosophy or a particular diagnostic or needling technique. No system has cornered the market on healing. Almost any patient helped by any practitioner of any system can remind you of that.