During the Oriental Medical evaluation 10 questions are typically asked. Although the questions vary somewhat, they typically refer to diet, elimination, emotions, temperature sensations and preferences. The purpose is to better understand the patient's qi dynamic through a series of correlations.
Asking detailed but flexible questions based on the patient's degree of self and qi awareness can further enhance treatment. These questions are asked before and during treatment and may be generically (and colloquially) summarized by asking "how you doin'?"
Determining the patient's initial qi-awareness is simple. If the patient is able to form a "qi ball" they will likely experience non-physical sensations of treatment. One forms a "qi-ball" by holding their hands about six inches apart and gently and slowly moving them towards and away one may feel sensations as "magnetic," tingling or temperature change.
How to ask the questions
Begin by asking simple open ended questions followed by opposing alternatives. For example, a patient who complains of pain is asked the exact location of their pain followed by questions regarding the quality and intensity. One type of question is if the affected region feels "heavy or weak."
The questions should become progressively detailed. After the exact location has been found the patient is asked if there are variations in the quality, intensity and heaviness/weakness of the pain of the affected and surrounding region. These finer detailed questions help determine the layer- cutaneous region to bone-and if the imbalance is a combination of excess and deficiency conditions.
Questioning continues during the administration of treatment. If the pain is active while the treatment is being administered then ask the patient exactly how the pain is changing in terms of location, quality and intensity. Sometimes part of the pain will immediately reduce. An acupuncture point may reduce a portion of the affected region or one component such as pain, but not heaviness.
If the main complaint is not observable or active at the time of treatment then questioning is directed towards the subtle sensations. These include tingling, heavy or light, increasing calmness to changes of thoughts and emotional experiences.
Gentle encouragement is important when inquiring about detailed and subtle experiences. Patients are sometimes uncomfortable describing details as this since they are foreign. However, as they become more aware of their own bodies and minds they become more comfortable articulating their sensations. However, the practitioner should question only to the degree the patient is comfortable at the time. It is equally important to prevent the patient feeling inadequate or frustrated because they don't "feel it."
Here are some sensations and their meanings:
Patient Experiences Related to Treatment
Initial needle insertion depth may cause different qi flow sensations and adjustment of the needle may change sensations. Patients may describe the affects of acupuncture point combinations. The "Four Gates" (Liv 3 Tai Chong and LI 4 He Gu) cause a centrifugal, counterclockwise motion about the center of their body. Their body tends to feel more "even" after treatment.
Patients may enhance acupuncture needling by describing sensation and/or symptom reduction upon acupuncture point palpation prior to insertion. Initial needle insertion depth may affect symptoms differently. A patient with low back pain and Temporal Mandibular Joint (TMJ) pain noted shallow needle insertion of SJ 5 (Wai Guan) decreased her TMJ pain but deeper insertion decreased her low back pain. Another may feel tingling along the channel at a superficial level but an organ sensation at a deeper level.
Moving Forward
Developing correlations between the patient experience and Traditional Chinese medicine terminology further develops the practitioner and profession.
A patient presents with knee pain aggravated by cold weather. The practitioner interprets the symptoms into a pattern as Cold Qi trapped and stagnating in the knee joint. The treatment plan is to "expelling" or "releasing" Cold Qi from the joint. Local acupuncture points are chosen. As the needles are retained the patient may describe the sensation of cold emanating from the interior of the knee joint towards the skin. Needles are retained until the cold sensation ceases. The patient's experience confirmed the diagnosis and treatment plan. The patient also gained an empirical understanding of the Oriental Medical theory behind the treatment. Now, the patient can explain the treatment to others and generate referrals.
The 11th question is a simple, logical extension of the ancient methods questioning. It is a "low-tech" method to gather information regarding changes of the patient's qi dynamic during treatment that is as easy as asking "how you doin?"
References:
Chronic pain afflicts over 20% of the adult population. Sadly, most MDs have essentially no education in treating pain, beyond offering a few toxic medications. Then they tend to steer people with pain away from those health practitioners who are trained. This puts the acupuncture community on the front lines for addressing this epidemic.
When the body is going through a stressful event, the sympathetic system is activated. This activation will help the body with a life-threatening situation. If this state is activated for prolonged periods of time, it starts to consume energy. These traumatic events that generate stressors in the autonomic nervous system (ANS) will eventually become internalized.
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One of the things that makes acupuncture so difficult to measure is that the medicine actually does contain some esoteric aspects. There have been numerous studies that demonstrate the neurochemical reasoning behind why acupuncture points stimulate the autonomic nervous system to enact change However, not all the benefits of TCM can easily be measured by randomized, controlled trials. But does that make them fundamentally and definitively untrue?
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