Another Person's View
Posted September 27th, 2007 by Skip
For the past week or so Lisa has been participating in a listserv run by the publisher of paradigm books, Robert Felt. Its an interesting listserv with various acupunks who have been around for quite a long time. Lisa has been talking about her beliefs and CAN (which most people have at least heard of) and the discussion has been at turns interesting and frustrating.
But what I am posting here is a post by Robert Felt that he has given us permission to reprint. As you will see I find it wonderful: he [u]gets it[/u]. Please I encourage you to post comments below. So without further adieu, Robert Felt:
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All,
I'm sorry I have not had a chance to join this discussion but I've been too far
behind with too much.
There is one thing I would like to add to the discussion from the view point of CM's
acculturation in Western societies. I think this observation applies to most
western populations. I think everyone probably assumes this to some extent but I
think it should be explicitly stated: There is no demographic of medical
needs that should not be served by Chinese medicine and acupuncture.
In my view, this has a corollary in relation to education: CM education would be
unwise to center curriculum on a single practice style or target
population.
Medicine is a service. We don't think of it that way but in terms of its utilization
it is a service "industry." To increase the "market penetration" (the numbers of
persons who know it can be accessed and why) it needs to be available at all the
various social and economic "levels" and there needs to be sustainable practice
models that are suitable for each of those socioeconomic classes and various needs
for medical intervention. The private practice model (one or more clinicians in an
independent office) is a historical artifact, not a reasoned plan for integrating
Chinese medicine and acupuncture into the medical delivery system. It derived in
the late 1960's and early 1970's when the only legal practices were those with
"physician supervisors" who tended to be GPs, MD homeopaths, etc.
I don't know whether there is still a brouhaha about non-licensed acupuncturists
(counselors) practicing the NADA protocol but were Chinese medicine and
acupuncture successfully limited to a single practitioner class, it would be really
horrible marketing (not to say that it wouldn't also be terribly unfair). What we
want (whether we know it or not) is for everyone in our own societies to think of
Chinese medicine and acupuncture like biomedicine, accountancy or computer
programming -- as a normal professional services. There needs to be an operative
intersection between need and affordability. In the same way that you might hire
an architect to design a house, an engineer to design the systems, carpenters,
plumbers and electricians to accomplish the specialized building work as well as
general laborers for the basic needs of a construction project, we need to match
the intellectual demands and costs of entry level Chinese medicine and
acupuncture to specific medical needs. Just as the costs of architecture must
support the preparation for, and cost of, an architect's education, the preparation
for, and cost of, any level of CM service must appropriate to the potential income.
If for no other reason than the fact that 21st century medical economics (which we
really must change) are driving medicine toward a kind-of economic triage for
services, we need to make our services available everywhere they are reasonably
needed at affordable costs.
To me this means that Scholar-Physician, Working Class, NADA-style, and more
practice models need to be created, refined and understood in light of their
educational and start-up costs and cost of application. For example, suggesting a
three month course that taught nurses on an orthopedic ward a set of standard
protocols for post surgical recovery is quite controversial. But, looked at from the
acculturation perspective it makes tremendous sense. Not only would patients'
recoveries benefit, justifying the expense of an acu-nurse to the hospital, those
patients would become potential clients for other acupuncture services. The idea
that clinicians would lose patients by this means is unfounded. In the same way,
Working Class Acupuncture not only meets a demand, it also creates a demand,
because every patient contributes to a milieu in which acupuncture is a "normal"
choice.
When I say that CM education would be unwise to concentrate on a single practice
model (today we more or less graduate single-office, single-practitioners), I don't
mean that every school needs to produce every imaginable type of clinician, only
that our view of the licensing and sharing our skills needs to drop the scarcity
model, which assumes that anyone else performing any aspect of CM or
acupuncture is taking patients from us. We need to study, plan and implement
education models that fit with medical service models in terms of educational cost,
depth and breadth of skill, and potential income. People often see the biomedical
component of CM education as the limiting factor, and there is some sense to that
argument. But, in my opinion, the greater problem is the notion that the essential
data of our skills (things like point location and medicinal indications and
contraindications) are in some way benefited by proprietary transmissions. What I
mean by proprietary transmission is the framing of essential data, (consider
acupoint or medicinal indications), as individual expression ("my name for it").
Once we accept that there is a huge body of data that can and should be
standardized such that it can be accessed reliably we can save hundreds of hours
in education because we would need to teach people how to reason and access, not
assign them vast memory chores.
This has gotten long, so in sum: If we look at medical needs in our own cultures
and organize an education system that places CM and acupuncture services into
the broadest range of those socioeconomic and medical needs, the profound change
in how our cultures evaluate and value our services will so increase demand for
those services that everyone will benefit. A rising tide lifts all boats.
Bob
Re: Another Person's View
Someone up above mentioned that herbs are not food. I find this interesting because I think of herbs as food, and I often explain it to my patients like this: garlic does something different for your body than green peppers do, and cucumbers and ice cream have a different effect on the body. Herbs are leaves, branches, roots and tubers just like parsley, potatoes and garlic are. The herbs have a much stronger and more precise effect on the body and so you need to watch out not only what you are taking but how you are combining them.
Just my take.
Sandy
Re: Another Person's View
All,
I would like answer Thomas' question:
What do I mean by "proprietary transmission?"
There are two aspects:
(1) Orienting information to a particular audience. There are generally two ways that information and data residing in a foreign language are presented in another language, "source" and "target" orientation. Source orientation is generally considered the appropriate means of presentation for professional, expert audiences. Target orientation is generally considered the appropriate means for presentation to non-professional, lay audiences. The techniques for presentation to lay audiences have generally dominated textbook creation in the English language. This creates two problems, an untraceable variability in expression (how we call things) and simplification. Open standards, simple published Chinese-English lists of terms as used by different writers, solve the variability issue in many fields. Thus, all that is required is professional recognition of their value. Simplification, on the other hand, is a more difficult problem because the notion of what a target audience needs is personal to a writer and unsubstantiated by any shared or objective principle. If you look at:
http://www.paradigm-pubs.com/sites/www.paradigm-pubs.com/files/files/Liv...
and search for "Measuring Conceptual Richness" you will find a table that compares source and target presentations (the paper is actually about something else but this is an easily-read example and the sources of the numbers are included at the end of the paper for those who wish to vet my work).
(2) Non-standard, personalized expression defeats the use of modern reference and teaching methods. There is much in acupuncture and CM that is standardized. Many years ago I was one of the people who lost the argument that the modern Chinese standardization (TCM)should be our field's exclusive license standard, so I'm not arguing that TCM is a one-and-only way --- it is however the way that was chosen, is taught, and it is highly standardized. Thus, much could be done with effective databases, on-line learning, and a concentration on applying principles such as pathomechanisms rather than memorizing acupoint locations, contraindications, functions, or information about materia medica. What defeats this potential is, again, the target audience orientation of what we teach. Again, all that this takes is simple lists of Chinese-English equivalents. Without these a database referencing, for example, the indications of materia medical is, by definition, unreliable because it will produce both false positive ("hits" that aren't) and false negative ("hits" that should have been).
Thus, to me the absence of open standards denies the field the ability to produce the tools that would both create time in education for application and establish our field's control over its own data, information and practices.
Bob
Re: Another Person's View
Yeah, I gotta say something too.
If you want an example of someone who does both herbs and acupuncture exceedingly well, look no further than Sun Si Miao. Much of the Shang Han Lun continued to exist because of his writings, and many of his original formulas are still in use today. Not only that, but his works were/are highly influential in the realm of acupuncture. If you need proof of that, just pull Deadman and Kafaji's acupuncture text off the shelf and leaf through it, you will find innumerable references to the "Thousand Ducats". The fact is that the set-up of TCM hospitals is largely responsible for the split in the whole (idiotic, and more than likely Western) "herbs vs acupuncture" debate. BOTH WORK. You can use one or the other, or you can use both. Saying that you can only be "good at" one or the other would probably baffle all of the great doctors of the past, and quite a few "folk" doctors of the present. Heck, look at the barefoot doctor movement, even this, steeped as it was in TCM, sought to teach the basics of both herbology AND acupuncture to the lowest class of people. . .
While we're talking about ol' Sun, his primary imperative was helping the patient. That should be ours too. I think this is largely where education has gone wrong. We're still fighting for a legitimacy that we already have. It's no longer illegal (in most places) to put needles in people. We don't need research studies or legislative comities or more prestige. Even "integration" is more a red herring than useful objective. We need patients.
The only thing that's going to get us more patients is more practitioners, and getting more practitioners means graduating people who are not bankrupt and know enough to "above all, do no harm". It is commendable to cure a patient with 1 perfectly selected and placed needle, but if I can get there with 8, what's the big deal? Especially if I can do it in a quarter of the the time, ie at a fraction of the cost.
To all of the CAN nay-sayers: How many patients do you see in a day? How many do you think Sun saw? (I would bet dollars to doughnuts it was not 6-12!!!) What is more important: your depth of understanding/your erudition OR how many people you help/how helpful you are to your patients?
In ANY form of health care, the measure of success is not your skill, but how your patients feel at the end of the treatment. THAT'S what we need to get back to. I think that's what Bob was getting at in his original post. Using needles to help heal people does not "belong" to us--while I don't like the idea of an MD with little training doing acupuncture, who am I to say that it's "wrong"? There are lots of carpenters and plumbers, and they run the gambit in skill, and I am sure that the best command higher prices. However, we inhabit a VERY different market reality than they do, so the more $$$ = better treatment argument is ridiculous!
Even here in Portland--where there are two Schools of OM, a DC school, a ND school and dozens of massage programs, not to mention small empires of health food stores and co-op's, I encounter on a daily basis people who only have the slightest inkling of what acupuncture even is, let alone what it does. People don't even know we exist. A nurse doing sloppy acupuncture is at least raising awareness. Ever heard the saying "no press is bad press"? It's true. What we need is press.
Don't get me wrong, I also care about the quality of practitioners. To me that is a question of education, but the current system serves nobody. Does anybody (CAN, private, low cost, high cost) still do what they learned in school--in mean from your school's curriculum, not from mentors/senior practitioners you studied with while there? Probably not. Again, yes it might be possible to teach people at a level that we'd be graduating little Sun Si Miao's, of course, that level of training might take 10 years. Why not graduate people with a fraction of that skill (which would still be plenty to help multitudes of patients) in a fraction of the time and cost. They'll be just as good in 10 years. Whether your energy is spent in the highest level of study or the highest volume of practice, I think the common denominator is TIME. It is only with time that we can truly come into our own in this medicine, which is what I think Ken was getting at with his comment about the heterogeneity of classical theory--we need to find what works for US, personally, and that takes time.
The current educational and licensing systems rob us of valuable time, both in terms of actual time and in terms of money. This absolutely MUST CHANGE, otherwise none of this discussion/debate/name calling will even matter, acupuncture (and herbs) will die, "not with a bang but a whimper". Sorry for the long post, but this is a very dear issue to me, thanks for the indulgence.
--Matthew
Re: Another Person's View
Tatyana,
I was just stating an example that there could be long reaching effects from herbs that we just plain don't know about yet. Herbs aren't food.
In this example, nobody knew that Mu tong was harmful to the kidneys at that time. (Yes, you make a great point about Long Dan Xie Gan Tang... I wouldn't think of using it like he did either... but apparently he made a name for himself in his day and "helped" many people using this formula as a base.
With the agricultural and business practices of China, we just can't be sure that the herbs are safe and of good quality. Just because a patient gets better doesn't mean that the herbal medicine is not doing harm to another of the bodies functions. And these problems don't always show up right away.
Ben
Re: Another Person's View
ok, i have to chime in here about the herbs:
from earthwater:
It is even more crucial in traditions such as mine, where acupuncture is all we do. It's all we do because (1) we don't think there is anything herbs can do better, and (2) it can take a lifetime to do either one really well, so why be half-excellent at two things? I have heard that for long periods of history, acupuncture and herbology were separate professions, with the exception of a few extraordinary physicians.
Some practitioners use herbs as a way to extend the treatment between acupuncture treatments, because the herbs are more affordable than the acupuncture.
from me:
i really do not care about this whole "half-excellent" and "extraordinary physician " crap. extraordinary according to whom? i also think it is insulting to to say that someone cannot be good at both prescribing herbs and doing acupuncture. it also seems like a fearful statement to me, as in coming from someone who is intimidated by herbs. i practice both, i am probably not the biggest expert in either, but nor do i care to be. ever. i would prefer to keep enjoying learning and expanding my horizons. i am effective enough to help plenty of people and this is why i keep doing it. it is not really about me in the end, but about the people i serve. i happen to understand herbs pretty well, have a good amount of experience working with them and good memory, which helps a lot. i want to use what talents i have to practice what i know. everyone's relationship with CM is different and evolves according to their interests and abilities.
from ben:
A good example is that famous physian in China who got great results with patients of all kinds using variations of Long Dan Xie Gan Tang. He is dead now... but I wonder how many of his patients were afflicted with failing kidneys in old age from overuse of Mu Tong.
from me:
i don't know about any famous doctor like this, but i must say this is just silly - long dan xie gan tang is perfectly helpful in appropriate situation and short term, and mu tong is perfectly safe when used appropriately - this example does not make sense!
-tatyana
Re: Another Person's View
earthwater- Tan/Tung acupuncture deals with internal diseases too. If you are interested in finding out more about Richard Tan or Master Tung, Susan Johnson etc they have websites of their own with forums where you can ask questions if you want. Or go to a workshop! Broadening one's perspective is always a good thing.
Re: Another Person's View
Ann, "We aren't treating zang fu patterns." . . . "Where is the problem? What meridian is it on?" . . . "you should get results."
So I take it that with Tan's treatments you are by and large dealing with tendinomuscular issues, and almost all of your clients come in for pain treatment. Surely you are not dealing with fertility issues, Parkinson's disease, or bipolar disorder using only distal points?
If pain treatment is the main deal with this style of acupuncture, that helps me make sense of another post, where someone says if after 10 treatments (frequent Tx, or about 3-4 weeks) the person isn't getting better, you are not helping them and need to refer them for other kinds of treatment. I have seen many cases of more serious illness where 3-4 weeks is not enough time to evaluate progress, no matter how frequently you treat.
Re: Another Person's View
THANK YOU ANN! especially for pointing out the meridian stuff. And thank you Diane for the work you are doing, and for this comment in particular:
"I think that as acupuncturists we can be L.Acs and "technicians " in the same treatment... ..and that is just fine."
This is part of what I was really trying to get to in my apron post.
Re: Another Person's View
Dr. Tan reminds his students that in doing acupuncture, we are doing meridian therapy. We aren't treating zang fu patterns.
Where is the problem? What meridian is it on? What other meridians can treat that meridian? What points would be effective? Put the needles in. You should see results. I have found his approach to acupuncture to be much more effective than any other I was exposed to.
I have been a family nurse practitioner and have been a nurse for over 40 years. WM is practiced with protocols (cookbooks) and a systematic process goes into diagnosis, just as it does in CM. The more educated & experienced the practitioner, the more sophisticated the diagnostic thinking.
The value of L. Ac education is in our exosure to the thinking behind the cookbooks and our ability to understand why the various protocols work. We also have more options for treatment because we can understand more. Chiropractors have come to the lectures at the annual Symposium put on by NWHSU in MPLS. They often walk out shaking their heads and muttering that they can't understand what is said. All the L. Acs are eating up the information. I don't think we have to be worried about MDs, DCs, RNs, etc. doing some acupuncture. As flawed as our schooling may be, we do get a lot of exposure to the foundations that others don''t and our pts. benefit from it.
Re: Another Person's View
I think that it is true what you say about herbs.
They are used to frequently for conditions remedied by frequent acupuncture. The great thing is acupuncture has no side effects... the needle goes in and then it comes out. You never know with herbs.
A good example is that famous physian in China who got great results with patients of all kinds using variations of Long Dan Xie Gan Tang. He is dead now... but I wonder how many of his patients were afflicted with failing kidneys in old age from overuse of Mu Tong.
Ben
Re: Another Person's View
Diane, that's beautiful, and what you said about training is so true. Perhaps I subconsciously decided to put "semi-trained" in quotes for that very reason; I could have easily left off the quotes, but I didn't want it to sound like a firm, immutable judgement. In massage school years ago, a teacher said, "When you finish your training here, you will be ready to enter the field with enough competence not to hurt anyone. You might even help them. Your real education comes as you continue your practice." Acupuncture is no different in that regard.
I love the community acupuncture model, and I agree that frequency of visits is crucial for most patients. It is even more crucial in traditions such as mine, where acupuncture is all we do. It's all we do because (1) we don't think there is anything herbs can do better, and (2) it can take a lifetime to do either one really well, so why be half-excellent at two things? I have heard that for long periods of history, acupuncture and herbology were separate professions, with the exception of a few extraordinary physicians.
Some practitioners use herbs as a way to extend the treatment between acupuncture treatments, because the herbs are more affordable than the acupuncture. With CA, if acupuncture is your thing, there is little need to sell herbs when you have patients visiting three times a week, and that is one less cost to patients with tight financial situations.
The one difference in my model is that in our area I can get away with a broader scale. If you are making more than $200,000 per year, you are going to owe me $75 for a visit, and that's going to help keep my doors open to see the $15 people, and even the occasional $5 person.
Re: Another Person's View
There are so many ideas in earthwater' Post that demand attention.Thank you for this post and the link to the article that you wanted for us all to read. I will speak just to a couple of the things that you raised
I think that we are all "semi-trained" when we exit our acupuncture programs here in the West. If the article that you cite is in fact a fair approximation of fact then it seems that those exiting the equivalent in China are also "semi-trained"
We are all "rooting" around for the "all" that we didnt get in school and the bits of this vast body of knowledge that resonate with us are what we choose to study more of. I am still "semi-trained" but that is alright I think as long as I continue to study. I will be "semi-trained" at my deathbed.
Right now for me it is studying how to get this medicine to as many people as possible so I am more concerned with the delivery of it than the studying of more of the medicine itself.Community Acupuncture is my blueprint as it provides frequency of treatment for the most people.
I feel that there is no point to knowing any of this medicine if so many people cannot access it.
They cannot access it because it is priced too high in the predominant "boutique" model for them to get the frequent acupuncture sessions that I know to give good clinical results.
When a few do access it through the "boutique "model they often dont get great results because they cannot afford the frequency of acupuncture needed to achieve those good results or they find true compliance to the herbal regime dispensed by the acupuncturists to supplement the sub optimum acupuncture frequency , too difficult to fit into their busy lives.
How often have us acupuncturists found that all those packages of raw herbs were not consumed at the dosage needed for the desired therapeutic effect or that our patients will swear blind they took their pills as prescribed and then when we go to refill their prescription we hear that they still have half the bottle left?
Re: Another Person's View
"If the scope of MDs, DCs, and RNs could be similarly limited to helpful treatments they are competent to perform, great, and the more the merrier. Then I would say the public perception of acupuncture will improve and lead them to visit LAc's."
It may also help to create more dialog between different ways of thinking about health and healing. As well as the nature of illness. I have had a few conversations recently with people who have seen Greys Anatomy, or the spinoff Private Practice, which portrays an MD who practices acupuncture. "Can you really do that with acupuncture?", I have been asked. The thing is that Acupuncture be taken out of a space where it is simply weird or voodoo or whatever and made accessible as a commonly accepted form of therapy.
Re: Another Person's View
Everyone should read Heiner Freuhauf's essay, "Chinese medicine in crisis: science, politics, and the making of TCM." You can read it at
http://www.qiwithoutborders.org/classical-TCM2.html
and after you read that page, be sure to click the link for the second half of the essay. This will shed some light on CCM/TCM, pattern versus individual, and other incidental issues in this thread.
As for the main discussion, I have mixed feelings about whether the 'semi-training' of nurses, chiropractors, MDs, or others to do simple 'cookbook' protocols would be good for the acupuncture profession or not. On the one hand, I can resonate with the idea, above, that the more the public is exposed to the benefits of acupuncture, the better, and if they get a little relief for their hurt knees (or whatever) then they might seek out a higher level of acupuncture treatment.
But then again, they might not. In my area, there is an MD who is marketing "medical acupuncture" as his exclusive practice, and with the amount of training he has, his success is limited. But people think that an MD acupuncturist must be the best kind. One woman who went to him said she had 35 needles inserted between one knee and the toes, and not only was every single insertion very painful, but the treatment didn't help her at all. Evidently there is enough population for him to do this to each person once and not run out of patients for several years. Do you think he is helping the acupuncture profession?
And the chiropractors with 100 hours of training, maybe if they just stuck to a few musculoskeletal issues they would mostly benefit people. What tends to happen, though, with some of them, is that they take on everything from asthma to zoophobia, because now they are Acupuncturists with a capital A, and they plug some symptoms into their Q-Puncture program and out pops a formula they inflict on the patient. Do you think that is good for the profession?
NADA, on the other hand, I see as good for the profession, because NADA technicians are limited to five specific ear needles for the treatment of addiction, and that is their scope, period. There is little chance of their practice exceeding their competence, and NADA treatment seems to really benefit people who want to be clean. If the scope of MDs, DCs, and RNs could be similarly limited to helpful treatments they are competent to perform, great, and the more the merrier. Then I would say the public perception of acupuncture will improve and lead them to visit LAc's.
I can't tell you how many people have said to me, "I've tried acupuncture and it doesn't work." Usually they have visited an MD or chiropractor, but sometimes it has been a TCM practitioner who tried to make that person fit into one of their patterns instead of seeing the bigger picture. I've had to tell these patients, "If acupuncture is not working for you, don't blame acupuncture, try a different acupuncturist. Ask around, and go to someone who has a good reputation." Disappointing patient experiences may be why so many acupuncturists are 'underemployed,' if that's really true. I know quite a few acupuncturists who have as many patients as they care to see, because they are working at that higher level that T. Ruthbeknown is alluding to above, and the word gets out. (Until you read Freuhauf's essay, linked above, please do not accuse anyone of saying "my style is better than your style." That's not my intention here.)
The Lingshu says that the superior physician cures 9 out of 10 patients; the mediocre physician cures 7 out of 10; and the poor physician cures 6 out of 10 (which is pretty good compared to Western allopathic treatment for many ailments). But those figures only apply to physicians who understand what Huangdi and Qibo are discussing :)
Re: Another Person's View
For some strange reason I never studied patterns of disease in acupuncture school (only for National Boards), and I can't really say that acupuncture "protocols" work or they don't.
But I can say that practicing acupuncture more from the perspective of health & normal energetic physiology rather than the standpoint of disease appears to be quite effective.
A part of this great art we often neglect is the science behind it (the energetic physiology). To me, this is the greatest downfall of modern CM education.
Re: Another Person's View
Ken, Your words are far more eloquent and diplomatic than my attempt to contribute meaningfully. I especially appreciate your emphasis on the importance of keeping this ages old conversation alive - not resorting to hardened stances defending dogma, but genuine open minded inquiry.
Also, your closing words on the importance of training seems much in resonance with Lisa's post on building a patient base and the importance of being mindful of the energy (physical, emotional, spiritual) that we bring to our respective clinics.
Thank you for sharing your knowledge,
Re: Another Person's View
T. RuthB,
Does it make you uncomfortable that there exist valid realities other than the interpretation of phenomena bubbling up within your noodle? No disrespect or provocation intended here - merely a little needling! :)
Your accusation of elliptical understanding seems a case of the pot calling the kettle black. And couldn't this criticism be fairly leveled at the great classical treatises of our medicine? Has this conversation degenerated to word splitting?
Today let's each go out and practice good "medicine" (or whatever terms you wish to use) for many sentient beings. It appears I may not fit into your box.
Re: Another Person's View
There is a widespread misimpression, generated by the current generation of texts, that "Chinese medicine" is some sort of orthodoxy. Historians such as Unschuld have lifted this veil of illusion for us. The term "Chinese medicine" refers to an incredibly varigated heteodoxy of ideas, beliefs and practices related to health, disease, health care, medical care, health maintenance, etc.
If you read Chinese and are patient and diligent, you can probably prove anything with a citation in some old book or other. This is not to say that discussions that focus on treating the pattern or treating the individual are not worthy of our time and attention. While we need to resolve the meanings and implications involved, we most certainly should engage in such exchanges of ideas and understanding. It is in this kind of exchange that deeper comprehension takes root, I believe.
Many of the medical classics that have survived until today contain just this kind of discussion. The Huang Di Nei Jing is, as Unschuld and Tessenow point out, a highly heterodox collection of ideas. Many of the modern "translators" and interpretors of this text have attempted to render it as if it consisted of neat orthodox ideas and understandings. But the Chinese texts that constitute the textus receptus we know as the Yellow Emperor's Classic is literally full of contradictions. It's a book that was compiled over a span of hundreds of years by no less than 350 authors. It hardly seems reasonable to impose upon it a status or character as some sort of sourcebook of medical orthodoxy.
If anything, reading the classics should instill in an intelligent mind the need for diversity in understanding and approach to medical and health care problems. Later editors of the Nei Jing tended to conserve the contradictory character of passages, I believe, in order to underscore this fundamental aspect of the knowledge base it represents.
The whole theoretical infrastructure of Chinese medicine is constructed on a way of thinking that places change and adaptability as the primary foundation of all phenomena. This suggests to me that what we need to focus on is a two fold approach to understanding and application of the material we think of as Chinese medicine.
This two fold approach includes an appraisal of the contexts of its origin as well as those into which it is introduced. This is an age old problem in Chinese medicine, by the way. Each successive generation of doctors, patients, scholars, teachers, and transmitters of Chinese medicine have had to struggle with reading and understanding the legacy of the past and adapting it to the needs of their contemporary circumstances.
One of the expertise skills in Chinese medical history is intepretation of the ebb and flow of medical ideas as they have passed through the successive ages of doctors and writers who have used and passed them on.
Again, the body of literature and lore is so vast as to support virtually any conclusion...on any topic.
What matters most, I believe is finding a way of self cultivation and refinement of understanding and skill so that as individuals we become more capable at dealing with the challenges that walk through the door day by day, hour by hour.
One of the most amazing things about acupuncture and Chinese herbal medicine (as well as massage and other related modalities) is the incredible variety of approaches to understanding and applying them in the clinic. I've seen dozens of ways to insert...and to not insert acupuncture needles...all practiced with tremendous results.
As the great swordsman Musashi put it: the way is in training.
Ken
Re: Another Person's View
Lisa Rohleder wrote:
"If everyone got sick in a completely unique way, there would be no basis for our medicine. If a practitioner can't see patterns, if he has to start from scratch with each patient he treats, he is either 1) very inexperienced or 2) incompetent. We don't need to treat "the individual"; we need to treat the pattern in which that individual has gotten stuck."
This is just not true. It derives from an elliptical understanding of how to do acupuncture.
Chinese medicine is the study of what causes health. It places no special preponderance on pattern fitting or stereotyping because each individual is unique and specific pathological processes may only occur once in any given patient.
Re: Another Person's View
In CAN we often discuss the need to set aside our ego and simply allow this medicine to work. This can be a difficult and scary thing for a acupuncturist to do.
Re: Another Person's View
"Persons are defined by the nature of their being." And just what might that be? Are we saying something different?
I don't believe you've carefully read my post. I repeat, "patterns aren't still photographs, they are symbolic representations of fluid, ever changing life." How does that land me in reductionism? It seems you are more interested in anointing yourself as the one possessor of knowledge on how to do "Great Work", rather than having a conversation.
I have no doubt that you've studied hard and practiced at the elbows of great masters. Further, I have no doubt that you've probably benefited many people through your acupuncture practice. But please skip all the pretense of your supposed moral and intellectual superiority. It's as transparent as the number of times you've used all caps in your post.
Re: Another Person's View
"What person is there other than the one who is defined by a pattern?"
Persons are not defined by patterns. Persons are defined by the nature of their being, if they are indeed able to be "defined" at all. Your point of view is illustrative of the very reductionist mentality that I am citing as a paradigmatic failure on the part of the Western mindset to understand Classical principles of Chinese medicine. As long as we think we can "Define" a person by specific patterns and ailments, the person is never a Person, but a group of associated symptoms, just like in Western medicine. This is a philosophy question and one it would serve all of us well to think a little more about.
Re: Another Person's View
"Teaching a nurse "cookbook" treatments in order to further the profession is a different issue than an acupuncturist practicing community style."
I don't think I am confusing the issue. To practice in a community setting generally requires that the Acupuncturist move quickly from patient to patient. It allows a lot of room for assumptions about what is actually going on with the patient, and relies greatly on what has been termed in this thread as "Cookbook" treatments. It is all well and good if the protocols applied address the specific ailment(s) of the patient, but it is not a much higher level of practice than teaching a nurse to do the same kinds of protocols.
Qi Bo states, "The 'Little Worker' pays attention to the Form. ... The 'Great Worker' looks to the Shen."
Most acupuncturists are not taught to practice at the high level of Huang Di and Qi Bo, or even given the tools to learn. We pay lip service to the idea of treating the entirety of the patients energetic state, but rely on incomplete methods to do so. This is not the fault of individual acupuncturists, but of the reductionism inherent to TCM style acupuncture. It is simply incomplete.
This may have something to do with Graduate retention in the industry.
"I think this gets to the heart of the matter. What do we value? What do we hold dear?"
It is important that we grow Acupuncture here in the US, and that all manner of people are exposed to its efficacy. But I disagree with the idea that we should sacrifice the potential for 'Great Work' for the ability to treat more patients in shorter amounts of time. More and more people will be taught this way until the Classical medicine is more dissolute than it already is.
"The Community Acupuncture Network is filled with educated and passionate acupuncturists offering GOOD acupuncture to every patient."
The Community Acupuncture Network seems to me to be about offering AFFORDABLE acupuncture. I'm not saying that that's a bad thing, and I don't mean to belittle the work these people are doing. Acupuncture needs to be accessible to people. I think, in many ways this conversation has been steered by various AGENDAS and that people's agendas dictate their words and deeds. My agenda is to perform the best possible acupuncture I can and eventually to pass on the knowledge I have gained. I study very hard and have spent great amounts of time at the elbows of my 'elders'.
Not only should we be concerned with the quality of care we are able to provide, we must also be careful not to give up the thing that makes acupuncture great in this society and brings us many patients- time spent talking and learning about the patient. I'll call it the Re-Humanizing factor.
Thanks to all contributors of this thread. I respect anyone out there plying this medicine and helping patients get well. My opinions are not meant as attacks, but as support for Classical principles.
Re: Another Person's View
"Symptom patterns belong to persons."
What person is there other than the one who is defined by a pattern? Remember, patterns aren't still photographs, they are symbolic representations of fluid, ever changing life.
To focus on the supposed person is to delude yourself with projections of your ego - which itself may appear quite solid but is also only smoke and mirrors.
This may seem abstract and meaningless, but I posit that if we try to treat persons, we are leaning in the wrong direction. In addition to reinforcing our own deluded ego, we also end up reinforcing the deluded ego of our patient. Hardly what the tao of healing is ultimately aiming for.
We don't heal anyone in some final way, however skilled and experienced an acupuncturist we are. We only help them get to the next level of refinement in health.
Seeing people one on one is fine and charging whatever you please has legitimacy. Nobody is disputing or denigrating that model. Sounds like there is a hidden assumption being advanced that a higher price implies higher quality. Any regular reader of the CAN forum has seen that emperor unclothed more than a few times.
What better way to become "the experienced acupuncturist" with a high degree of knowledge than to see many many patients?
Re: Another Person's View
Walter, you are confusing two issues. Teaching a nurse "cookbook" treatments in order to further the profession is a different issue than an acupuncturist practicing community style. The Community Acupuncture Network is filled with educated and passionate acupuncturists offering GOOD acupuncture to every patient.
Re: Another Person's View
I want to add a comment or two and append a few questions to this fascinating thread.
My background in Chinese medicine is rooted in taijiquan, and my training before Chinese medicine was largely centered in martial arts of various kinds. In such arts, you don't train to be anything but the best you can possibly be. One of the meanings of the martial metaphor is that your life depends upon your understanding, development and application of skill.
Of course the same can and should be said of medicine. Lives depend on it. And therefore lives depend on medical education, as it is in the course of such education...and training...that we learn the skills we need to take care of people and save their lives. The purpose of medicine is to save and protect and to nourish life.
If education doesn't set and hold the highest conceivable standards, where will people learn to make of themselves the best they can possibly be at saving, caring for and nourishing the life in and around them?
One of the essential elements in Chinese medical history is the teacher-student axis. It is along this axis that the development and transmission of values propagates and moves from one generation to the next. In traditional China this teacher student relationship had a particular character and flavor, quite different from those of contemporary education. But when we talk about Chinese medical education in the modern context we should bear in mind that without these values we cannot possibly conceive of any standards.
I think this gets to the heart of the matter. What do we value? What do we hold dear? How does our study and practice of acupuncture and Chinese medicine reflect and forward these values?
Ken
Re: Another Person's View
So then what is offered?
Excellent/Good/Fair/Poor? and how much does each cost?
I personally don't offer patients different treatment based on what amount they are paying... I just givem' what they need to change.
Re: Another Person's View
Thank you Bob for the thread. And thanks Diane for some great insight and information.
I believe that contemporary training in Acupuncture, particularly the TCM style acupuncture of Beijing, was developed by the university hospitals and government of China for the very purpose of standardization. It could then be taught to many people and exported as a "scientific" system of medicine accessible to Western medical minds.
The truth of the matter is that pattern diagnosis and treatment protocols would not exist if they did not have some practical merit. Most of the acupuncture in China, as I understand it, is in hospital wards dedicated to its practice and not in private practice settings, as in the West. We need more people making rounds and helping more people in dire situations. Hospitals provide great sick people to work on, and Acupuncture could really find a footing in America through its use in traditional medical delivery systems. Using basic techniques that work well for this situation is good, but why not hire a licensed acupuncturist? She or he would ultimately provide a better quality of care to the patient, and probably wouldn't cost much more than a senior level RN.
Most experienced acupuncturists will admit that for acupuncture to be Very effective, a high degree of knowledge of the patient is required. As is proper training in the classical principles of treatment (Yin-Yang, Wu Xing, Zhang Fu, etc).
"We don't need to treat "the individual"; we need to treat the pattern in which that individual has gotten stuck."
I think this is the root of many misunderstandings in CM and acupuncture as taught in Beijing. Symptom patterns belong to persons. They exist because of internal disharmonies and relative weakness or excess in energetic relationships, not because some magical state of affairs has chosen to "Stick" with someone. To treat the underlying reasons for the presence of a particular illlness is to consider the individual. The fact of the matter is that acupuncture treatments have always been individualized. Anyone who tells you otherwise is selling you something.
Acupuncture removed from the context of classical Chinese Medical theory may still be Acupuncture, but the Bird's song may not be sung by one who soars.
In the models presented above, the CAN practice model and Bobs model, which recommends teaching basic skills and techniques, we may find that we are opening acupuncture to the ills of American society as a whole. Whereas the less wealthy and even the indigent may expect some level of basic healthcare (and I may have contention with that idea, being among the uninsured), what occurs is that we end up in long lines, with generally poor medical service. The wealthy and the well insured are able to choose their Doctors as consumers of medicine. If you could pay for it, you would find the best Doc possible, right? And rightly so. So in trying to bridge the gap in who can have acupuncture and who can not, lets not settle for who can have GOOD acupuncture and who can not.
I'm not saying that Community Acupuncture doesn't have its place. It just doesn't have a place in my office. I will offer a fair service for a fair price.
Re: Another Person's View
Western medicine is noted for working almost totally on precedent . Most of it is unproven. I dont say this as a blanket generalization. I say it because it is what those studying how to improve it know to be the fact.
The Institute for Healthcare Quality Improvement is a highly respected think tank within this country and around the world. They go into hospitals and try to work with all the levels of health care delivery within that hospital to try to improve patient outcomes.
They work to try and provide some type of standardization of health care delivery that will mean that when you have a procedure the chances for it actually working in a predictable successful way are good. These people start their class with the lovely statistic that 80% of Western Medicine has no basis in fac:that it has never been tested using rigorous scientific method ,either because the methodology of testing was flawed or that it simply never was put up to that level of irrefutable scientific investigation. The next juicy stat is that 120,000 people in this country die of iatrogenic ailments(acquired because of treatment ) per year.This stat does not take into consideration those maimed as a result of allopathic intervention.
The Institute then takes the hospital on a trip into a brave new world of prevention and most of it consists of standardizing care .For example . If one standardized the way in which an orthopod writes orders for x-rays by providing him with a standard pad with the right view and body part requiring a check mark , we could cut the amount of re-work needed at all the other parts of care delivery...save money, time, frustration...a leg .....
Here we have these wonderful powerful points,diagnostic tools and prescription protocols that have been passed onto us by generations of acupuncturists that have gone before.These are precedents that have legs. ....They are our "80%"...... to provide care that often helps a patient and rarely harms one....
Re: Another Person's View
Reading the threads here reminded me of the Japanese and Chinese styles of needling and stimulation or non-stim. of the needles. Advocates of each style swear by them, w/ little or no stim. (Japanese style), and stimulating almost every needle (Chinese style, or as a former favorite clinic instructor used to say, "No pain, no gain").
The funny and interesting thing is-- they both work.