Treating What You See

Don’t Miss the Mark

Mark comes to see you for his first acupuncture treatment. He aggravated his lower back two days ago after lifting his toolbox out the back of his truck.

During the initial interview, you discover that Mark has two kids. His two children, 5 and 8 years old, are always bringing bugs home from school, and while his wife seems to remain unscathed, Mark is always getting sick. In fact, he hasn’t been able to shake this awful, phlegmy cough that he’s had for nine months now.

You also discover that his stool is quite soft and he just can’t tolerate beer like he used to. A night out with the boys leaves his stomach rolling and he has diarrhea the following day.

Mark’s been unable to fall asleep for years – he stares at the ceiling for hours. He’s been to his medical doctor, a naturopathic doctor, and even tried hypnotherapy, but nothing has helped. He thinks his sleep is a lost cause. Usually when he goes to bed at the end of a busy workday, his mind won’t shut off and he can feel his heart beating in his chest a bit.

After examining Mark’s tongue, you discover a thick, white coating sitting on a slightly red tongue body. The tongue seems swollen and there are teeth marks present. Looking closer, you discover a centerline crack that does not reach the tip, and a few horizontal cracks at the back of the tongue. The pulse feels quite taut; however, the left-front position is a little weaker than the rest of the pulse.

X Marks the Spot

For a beginning acupuncturist, a case like Mark’s can seem complicated due to the fact there are so many patterns going on. After the first treatment doesn’t go so well, the practitioner starts to lack confidence.

Reaching out for some help seems like a reasonable way to go about it, so the budding acupuncturist sends a message to their favorite Instagram personality. They bravely explain the case, going into excruciating detail and also sharing how ill-equipped they feel they are.

The senior acupuncturist, skipping over the entire message, but at least addressing the new practitioner’s confidence concerns, answers back with five very insensitive words: Just treat what you see.

The senior acupuncturist isn’t wrong; it’s just that their advice is misplaced and misused. The idea of “just treating what you see” is supposed to be given to someone who is getting a little mixed up in the miasma of patterns and which is causing which (e.g., Are years of heavy menses in a female patient causing a liver-blood deficiency, which is leading to a heart-blood deficiency?).

When we get mixed up, it’s best to just view all the patterns as they are in the present moment and write them all down as is.

When it comes to the aforementioned case, what the practitioner is looking for guidance on is to create a treatment that has focus. Oftentimes, a new graduate will place a needle or two in the lower back, and then add a bunch of needles all around the body for all the other concerns (wei qi deficiency, retention of phlegm in the lungs, heart-blood deficiency, dampness, predisposition to stomach yin deficiency, spleen qi deficiency, and the start of some kidney yin deficiency).

The patient returns with the same amount of back pain, and the practitioner is left wondering why the treatment results were subpar. And therein lies the answer: Just treat what you see in regards to the patient’s chief complaint, and if you have any room left in your prescription, you can add in a few other pattern acupoints.

The patient has an acute back sprain. This causes qi and blood stagnation. In reality, this is the only pattern that is of concern right now. This is the only pattern that we need to “see.” A practitioner should concentrate their efforts on the lower back area, adding a couple of points to move qi and blood, and then adding some key/command and confluent pairs to aid the zone they’re working on.

Mark My Words

You’ve only got a few treatments to make a difference and build rapport. You’ve got only so many needles to use before a treatment becomes watered down. So, you’ve got to (just for the time being while you’re treating this primary health issue) ignore any patterns that don’t fit with the patient’s chief concern.

After you’ve squashed that issue, it’s, as Jay-Z says, on to the next one – which is finding which patterns fit into that other health concern.

Treatments need focus. Focus brings results. Craft a treatment that resembles a river that is narrow and deep; not wide and shallow.