Shayla Thompson, MAOM, LAc, Dipl. OM
Editor’s Note: Part 1 of this article appeared in the November issue.
As modern medical standardization continues, the field of traditional Chinese medicine has the advantage of comprehensive personalization. For rare or complex cases, deeper consideration of constitution is invaluable. Many patients seek out an acupuncturist after trying numerous other practitioners and modalities. Proper constitutional assessment, especially with first-time clients, can guide desirable and predictable outcomes. This leads to a higher rate of return, and greater trust between you and your patient.
Throughout seven years of diverse, post-graduate acupuncture practice, I have become very confident with first-time treatments. Out of the nearly 700 first timers I have worked with (as of mid-2024), there have only been a handful, early in my career, I wouldn’t consider ideal. These learning experiences have improved my success with first-time treatments. I will briefly share the four most notable case studies below before discussing what they have in common.
Four Clinical Cases
- Case #1: male, 60s, lower-body paralysis from age 7. Only LV 3 was done on the lower body; all other points were in the upper body. Multiple days after his first acupuncture session ever, he had severe cramping in his legs.
- Case #2: male, 50s, post-full cervical fusion after skydiving accident. The client repeatedly requested points near the occipital ridge be treated, such as GB 19, 20 and BL 10, despite the practitioner explaining it might be too direct and strong. After this session he had a debilitating headache, and did not want to reschedule.
- Case #3: female, 70s, currently undergoing chemo and radiation. Location of this treatment was on a cruise ship at sea; points were simple and nourishing, such as ST 25, 36. During the session, needles needed to be removed so the patient could vomit.
- Case #4: female, 40s, experiencing radiculopathy down her left arm. Overall, points were simple and ahshi/local. Severe nausea was experienced after all four acupuncture sessions, as well as after referred massage therapy sessions.
Common Features
Upon review of these cases, each had a compromised system. There were three main culprits they all had in common: stress, toxic diet, and lack of previous bodywork. These factors were independent from others such as weight and physical appearance. All clients mentioned above had robust physiques and even temperament. This reinforces the need to make inquiries when assessing constitution, not just subjective observation.
Stress is a burden on bodies, leaving them exhausted, sensitive, and inflamed. Pain is stressful in general. The acute cases of post-surgery and chemo had been exposed to foreign elements, adding to the stress. The chronic cases of paralysis and radiculopathy had higher-than-average lifestyle stress. Specifically, the female in her 40s with radiculopathy had been dealing with insomnia and overtime work in a corporate position for years.
All the above patients had red, thick-coated tongues. This diagnostic indicates their bodies were fighting heat and damp, or in other words, inflammation and microbial overgrowth. Low-grade digestive infections can also limit the body’s resources to heal. After each of these patients had a physical detox, I asked about their diets, which were full of refined sugar, processed meats, and oil.
Lastly, none of the patients had or was receiving regular bodywork. The nature of bodywork is detoxifying, helping open and regulate bodily functions. Other patients I’ve had with stress and toxic diets who were getting regular massage, chiropractic, etc., had a higher tolerance during their acupuncture sessions. Asking the patient if they receive bodywork or have ever detoxed is now routine.
Other Considerations
There are two extra considerations to make, not shared by all cases. In terms of case #2, it is important that a practitioner be confident in their treatment strategy and prognosis, regardless of the client’s opinion. When clients like that cross my path, I am firm on my standards and decisions. Gentle first-time treatments are non-negotiable; even if they have had acupuncture before, I need to observe how their body responds.
In terms of case #3, the environment of the treatment should be considered. This not only includes giving treatments on boats, but also if the client is aggravated by light, sound, smells, or temperature. Many people will suffer in silence. I make sure to give options on lighting, music, essential oils, and fans for each session. A person may even be different day to day.
A final note to ensure success lies in managing the expectations of post-treatment experience. No patient should be left uncertain about a side effect, response, or sensation after going through the invasive, vulnerable experience that is acupuncture – with you, who is a still basically a stranger on their first session. Not only do I encourage a day of rest after, but I also let them know that changes in energy, digestion, emotion, and dreams are all normal.
When you consider the entire experience from their perspective, it changes the approach. Hopefully this information will help support your practice as well as the reputation of acupuncture at large.
