Compliance is frequently used to describe medication-taking behavior. The definition of compliance is “the extent to which the patient’s behavior matches the prescriber’s recommendations.”1 But little is known about compliance in acupuncture clinical care.
Several observations in acupuncture trials and clinical care suggest compliance and adherence are determining factors in acupuncture effectiveness.2-3 Acupuncturist-patient communication, personalized treatment, feedback on treatment experience and outcomes, as well as indirect regulation of diagnosis and treatment environment on patient's psychology，may influence patient's cognition, expectation, attention, preference, confidence, fear, perceptions and side effects, and facilitate treatment compliance and adherence.2-4
The perceived attitudes of health care providers may change patients’ adherence. It is important for providers to address behavioral issues and provide emotional support, which can be critical in terms of improving compliance, adherence and clinical outcomes.5-6
Taking medicines and receiving treatments according to prescription and recommendation is patient compliance with treatment. Treatment adherence is “the extent to which a person's behavior, taking medication, following a diet, and/or executing lifestyle changes, corresponds with agreed recommendations from a health care provider.”1 In this sense, compliance is more of a passive act, whereas adherence is a proactive behavior.
The Key: Provider / Patient Concordance
Acupuncture treatment compliance and adherence are, or should be, more than just coming to each appointment and being needled. The acupuncturist and patient should decide on the appropriate acupuncture treatment after a proper discussion that involves talking, listening, repeating, and accepting each other's perspectives.
Lin Shu (chapter 9: From Beginning to End) says: “One must be one unity with the spirit. This is the will of the needle.”7 The communication and interaction between the acupuncturist and the patient is a process of refining the qi, mind, intellect, memory, and spirit – tiao shen. Both provider and patient are to be held jointly responsible for compliance, adherence and even concordance.
In the true sense of the process of achieving compliance and adherence during treatment, the patient is an indispensable protagonist. During the acupuncture process, the patient will, based on their own beliefs, personal circumstance, and knowledge base, enter a mind- body integrated state by following the guidance of the acupuncturist.
The language, communication and guidance will appear pale and limited, and even counterproductively bring more tension, when the thoughts of a “to-do” list, or the emotion of sprinting through traffic, still lingers in the patient’s mind and shows on the skin; or when the ability to relax the body, partially or completely, is lost due to the self-protection posture produced by long-term pain of the body.
The Power of Acupuncture
Acupuncture needling can often help both acupuncturist and patient achieve a united state of mind and body. In this state, both the acupuncturist and the patient experience sensations from the needles.
Acupuncturists accept the patient’s tolerance and adjust each needle while breathing, feeling, waiting and following the qi of the patient. Through needling, acupuncturists assist patients in entering a state of relaxation, thoughtlessness, and mind and body integration; a state which is optimal for therapeutic effect.
Ling Shu (chapter 73: Sense and Capabilities) says: “There are the necessities of using the needle; do not forget the spirit”;8 while Su Wen (chapter 25: The Preservation of Health) says: “The key to acupuncture is first of all to concentrate and focus.”9
Needle techniques such as reinforcing-reducing method by respiration;10 opposing-following technique;11 conduct the qi technique;12 needle the distance road method;13-14 needling sequences used in certain acupoint formulas, such as the 13 ghost acupoints;15 and needle and hand coordination, such as rubbing and pressing method used in tonify needling,10 all require the full attention of the acupuncturist, feeling the qi changes of the patient through the needles, guiding the qi through the needle.
Pain and the Patient’s Process of Reaching a Unity State
The IASP definition of pain is: “An unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.”16 Feeling pain is the pivot of the physical body and mind. In the process of needling, feeling the needle piercing through the tissues, experiencing “heaviness,” “distention,” “tingling,” “soreness,” - in one word, pain, the patient’s qi-attention-mind-shen travel through the body.
The “painful feeling” creator – the needle – is inserted with a reinforcing-reducing method by respiration. It observes the qi quietly.
Once the qi arrives, the needle follows, assisting the qi and agitating attention. This is the opposing-following and conducting the qi techniques. Eventually, the needle and the painful sensation created by the needle are recognized and accepted mutually by the patient’s body, qi, attention, mind, and shen. In the process, the patient re-recognizes the feeling of being relaxed in a mind-body integrated state; and learns the path of getting there.
This is a personalized process, even different from treatment to treatment. After repeating the process, treatment after treatment, the patient can reach the unity state through the paths learned during treatments in their daily life.
Acupuncturists can work together with patients to go through this process – tiao shen – to reach the unity state of mind and body – a state meeting the acupuncture level of compliance and adherence. As a result, shang gong (superior master) acupuncture care is accomplished.8
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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