Editor's Note: This is the first installment of "On Point," a new column by the author of our ongoing Planetary Herbalism column.
One of the most important texts in acupuncture and Chinese medicine is the Ling Shu or "Spiritual Pivot," one of the two parts of a larger medical work known as the Huang Di Nei Jing or "Yellow Emperor's Inner Cannon." Let's focus on two key lines from this inspiring text and explore how we can use these ideas to improve the patient experience during acupuncture sessions.
Timing Is Everything
"An acupuncturist must examine the patient's physical body and pulse before needling"
This statement may seem like common sense to the majority of clinicians; however, in my many years in clinical practice and teaching practitioners, it is extremely common to see acupuncturists race to implement specific acupuncture points before taking the time to examine the state of the patient.
This line from the Ling Shu encapsulates the basic ideas which eventually evolved into the concepts of pattern differentiation and "treating the patient, not the disease" – foundational ideas in TCM. You should always examine tongue, pulse and overall physical presentation before formulating a protocol for needle insertion.
This line also conveys another important idea for clinicians to ponder: slow down and listen to the patient. I use this famous statement by the inspiring physician William Osler as a daily reminder in the clinic: "Listen to the patient, he/she is telling you the diagnosis." I always remember this statement when considering the aforementioned verse from the Ling Shu. Clinicians should always remember to slow down and clear their minds before approaching each clinical encounter. This can be particularly important when treating a patient over many months or in complex recalcitrant cases. Always be patient and watch for any potential changes in patient presentations, even in cases which seem simple.
While taking the time to "examine the patient's physical body and pulse before needling," clinicians should also clear their minds of any preconceptions and be open to any new clues which may be revealed in the environment of the clinical encounter.
If you are rushing to insert needles while assuming nothing has changed in chronic cases, you may miss important clues. Even in chronic cases with deep-seated patterns, the patient's mental state can vary depending upon the seasons or daily experiences. This should always be considered before inserting the needle.
Each clinical encounter is an opportunity for clues to be revealed for healing the patient; therefore, we must slow down, clear the mind and listen to the patient's unique expressions.
Set the Stage for Success
"At the time of needling the acupuncturist should be in a room with closed doors and windows so they can fully concentrate on the needling not distracted by any noise."
This verse clearly presents the importance of privacy and the role of a calm environment in the treatment room. But the point I wish to focus upon in this discussion is the "fully concentrate on needling" aspect. In my opinion, this is one of the most important parts of the clinical encounter in acupuncture sessions.
It is extremely important for clinicians to fully concentrate on not only the aspect of needling, but also the actions and indications of the points selected for needling. Take the time before needling to not only listen to the patient, but also to consider the most effective points which can help balance the patient's state of disharmony. This is one of the most common issues I encounter with acupuncturists: choosing and using points by rote.
It is imperative that you have clear intent and focused knowledge of each point selected for needling. In my opinion, blindly using the same points with every patient is not professional acupuncture.
One activity I suggest for all acupuncture students and practitioners to implement is to pick one to two points each week and memorize all energetics and actions of the points until the points become solidified in the mind. After choosing one to two points to memorize, ponder when and why you would use the selected points.
Why would one of the selected points be chosen over another point? What are the unique characteristics of the selected points which would serve the patient in the most effective manner? For example, why would you choose Sp 3 over Sp 4? What symptoms, indications or patterns would more effectively be resolved with Sp 3 or Sp 4? Why choose Liv 2 over St 44? These are the types of questions each of us should ponder daily in practice with each patient.
If the clinician has a clear conception of the actions and indications of the chosen point(s), the intent and focus of the needling will be more effective. Clear knowledge of the actions and indications of the chosen points is also extremely important for comprehensive charting of cases. The practice of choosing one to two points a week to contemplate and memorize will allow for greater clinical focus and eventually greater clinical freedom in improving treatment outcomes.
Take-home Points
As acupuncturists, we should not be limited to a simple handful of points; and points used for needling should not be chosen in a cavalier fashion. Each point chosen should have a clear clinical intent, and once you grasp the needle, your intent and focus should be calm and clear. You can even use contemplation and memorization of acupuncture points as a meditation exercise to improve your ability to eliminate distractions and focus the mind with precision and intent.
I hope these ideas stimulate some creative thinking when needling patients; and I hope every time you grasp a point, clear, calm, focused intent is guiding the way. Until next time, best wishes!
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