Supplementing vs Draining Acupuncture Technique and Needle Retention

[Guest guest]

Alon,

That is the key to a better education. Our profession is behind the ball on

this one.

 

 

Mike W. Bowser, L Ac

 

 

 

> " " <alonmarcus

>

>

>Re: Supplementing vs Draining Acupuncture Technique and

>Needle Retention

>Tue, 28 Jun 2005 15:15:58 -0700

>

>How many

>people in America do you know who even have all their formula

>ingredients memorized? This is extremely basic stuff in the eyes of

>Chinese practitioners.

> >>>>Eric this for me is a difference in value systems. When i teach i tell

>all my students to not memorize anything, i try to only teach principles so

>that the student can think independently, not try to memorize steps of

>techniques or ingredients of formulae. To me that is a waste of time, even

>though i did this in my basic training. Looking back at the time i spent

>memorizing ingredients or any other list, i now think it was a waste of

>time that i would have used much more productively. Understanding

>principles and having excess to the lists (books etc.) makes much more

>sense.

>

>

>

>

>Oakland, CA 94609

>

>

>

[Guest guest]

I think assigning numbers to such issues is folly... and I am not directing this

at anyone. I would agree that it is a slippery slope to say hey a 5 min tx is

supplementing and a 30 min one is sedating. One obviously has to individually

analyze each situation / patient... it is not about 20-30 minutes-->

>>>>By the way i think the whole premise of the discussion is ridicules: there

is no Chinese source therefore its wrong.

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

Jason -

 

I have seen many " kick-ass " hospital based acupuncturists in China - who

got incredible results.

 

I haven't been able to be on-line in a few days so I am a bit behind in

this conversation, but I started doing some reading today in the Nan Jing,

the Jia Yi Jing and the Nei Jing. None of these texts seem to discuss the

idea of leaving in the needles for longer/shorter in relation to draining

or supplementing. What the Jia Yi Jing said was that the needle should be

retained and manipulated until qi is obtained and that in a vacuous person

this may take longer - don't have the book with me right now but I will try

to reference the page tomorrow. Interestingly, CAM also does not mention

length of treatment as a supplementing/draining technique. All of these

books talk about other techniques of supplementing/draining including

breath, opening/closing the hole, needling with/against the channel,

inserting rapidly, removing slowly/inserting slowly, removing rapidly,

etc. In the Bensky translation Acupuncture: A Comprehensive Text (the

" shanghai text " ) it states that treatment may last from 2 minutes to

several hours, depending on the condition being treated.

 

What all of the texts also discussed was the importance of technique and of

obtaining the qi. One of the things I saw a lot of in China - in the

schools more than the hospitals - was teachers encouraging and teaching

students how to practice different techniques of manipulating the

needles. Not many practitioners use these techniques in the West because

they elicit a very strong response from patients, and most Chinese

practitioners will tell you that their Western patients don't want to feel

qi (that sensation is what they call pain) and even when they do get qi, it

is not nearly as strong as what they would try to obtain in China.

 

So, yes, clinical experience is absolutely necessary, but I think that one

can have lots of experience and still have poor technique. How many of us

do hand strengthening exercises every day? How many of us do free hand

needling with thicker needles? (we had this discussion before). As far the

the " depleted " patient becoming exhausted after a longer treatment, I

personally think that perhaps that has more to do with technique than with

time. Perhaps although the points needled were supplementing points, the

technique itself was draining. I agree with Eric and his teachers that it

is much harder to learn good supplementing technique than draining

technique. I too have seen the patients who are exhausted after treatment

- but I think that there are more variables than just the length of the

treatment. Including, diet/when they last ate, sleep, and, actually I

think that the most important variable is the state of the liver qi. Often

it is those who have depressed liver qi who get the most wiped out when the

qi gets moved during treatment. So, just to say that based on clinical

experience of seeing more vacuous patients get wiped out after a long

treatment, is, I think an insufficient analysis of who is getting wiped out

and why.

 

I think that Eric's original question is a very good one. Why do we have

this concept in the west if it is not a concept in China/Taiwan, or in any

of the texts to which we look supposedly look for authority. Where did it

come from - I suspect that it is a misconception or misunderstanding of a

few statements in the Nei Jing or Nan Jing.

 

So, in fact this question bears further discussion - although perhaps not

on the CHA forum if Todd doesn't want us to. Where did this concept come

from. I am very curious to hear from Nigel on this. I recall Bob Flaws

saying once that our concept of a 20 minute treatment was flawed - that in

fact, needles could simply be inserted and removed, and that as long as the

technique was appropriate and qi obtained, this could be either draining or

supplementing. From my brief review of the Nei Jing, Nan Jing and Jia Yi

Jing today this is exactly what was said - there seemed to be pretty clear

consensus on not retaining needles. While this does not support Eric's

teachers in terms of the idea of a longer treatment being more draining, it

does support the concept that we have added in an additional method of

treatment - perhaps because we are trying to fulfill our and our patient's

fantasy of what holistic medicine is. And, as Bob Flaws said, and I think

Eric also said, a good 20 minute nap will never hurt!

 

As far as the term sedate goes, I think it is EXTREMELY important that we

be specific. Draining is absolutely not the same as sedating, and I think

that when you use the term sedate to a patient when you mean drain, you are

really going to confuse them. I do not see an acupuncture treatment as

similar to taking a sedative, but if you use the term, this is what your

patients will think. Sedating bears a closer relationship to subduing - as

in subduing hyperactive liver yang - but that also is not

draining. Remember, that Hyperactive rising of liver yang is based in a

vacuity of liver yin, which means that you do not want to drain the liver

yang, it is not actually replete - it is only replete in relation to the

liver yin, and draining it would damage it - so you want to subdue it, or

downbear it so that the liver yin can be restored. As far as I know, the

term sedate was first used by Felix Mann in his 1962 edition of

Acupuncture: The Ancient Chinese Art of Healing and How it Works

Scientifically when he was trying to use the analogy of electricity to

explain the channels and movement of qi. Mann does state the the concept of

leaving the needle in for a longer time influences the outcome of the

treatment (although he does not say how) but, he also says in

parenthetically that this method is " doubtful " .

willing, perhaps we can hear more on this topic as we learn more.

 

Marnae

 

 

>----

> > " Eric Brand " <smilinglotus

> But in pure technical skill

> > and mastery of the basics of internal medicine, I think we are

> > generally far behind the majority our Chinese colleagues. How many

> > people in America do you know who even have all their formula

> > ingredients memorized? This is extremely basic stuff in the eyes of

> > Chinese practitioners.

>

>This I do agree with.. but this is another issue...

>

> >

> > First of all I still say

> > > that in general longer retention times are relatively more sedating /

> > > draining.

> >

> > More sedating, yes. But does that automatically make it a xie4 fa3

> > treatment method? Is sedation ultimately draining to the channel qi?

> > Are these two concepts not independent of each other?

>

>Well I think you are getting hung up on semantics... I think the source

>that I supplied plus many people's personal experience at least validates

>that leaving needles in too long can drain / sedate (or whatever one calls

>it) qi! One then asks, " where is qi located ..? " well in the channels...

>it seems like a no brainer...

>

> >

> > Patients who walk around like zombies for days after treatment are in

> > the extreme minority. They are obviously more sensitive than most or

> > the practitioner has given them far too strong of stimulus for their

> > constitution.

>

>Again minority or not is not the issue... it happens... But the point that

>they are sensitive is important… When one observes people more on the edge

>(i.e. extremely deficient patients) one can see effects of such

>subtleties... But more important I think (??) is that many practitioners

>observe the channel’s qi directly and evaluate that the needle’s retention

>time so as not to be too depleting...

>

> >

> > > Second I was under the impression that Eric was questioning the

> > validity of

> > > the concept of needle retention time, calling it an urban myth here

> > in the

> > > West. I see this as 2 separate concerns.

> >

> > Well, I think any reasonably minded person would obviously conclude

> > that staying out of the extremes is the most desirable approach to any

> > such question. I simply think that the idea that a 30 minute

> > retention could somehow obliterate the positive effects of

> > supplementation provided by a 20 minute retention is based on an urban

> > myth.

>I think assigning numbers to such issues is folly... and I am not

>directing this at anyone… I would agree that it is a slippery slope to say

>hey a 5 min tx is supplementing and a 30 min one is sedating… One

>obviously has to individually analyze each situation / patient... it is

>not about 20-30 minutes--> it is about when the tide turns from

>supplementation to depleting... The question that I think that is more

>important, is how one evaluates that.. I think for beginners that shorter

>time / longer time criteria is a good place to start, and correct.. but

>then one must expand and cater to the individual, figuring out how much

>time it really is… Obviously if a new practitioner was unaware that

>leaving a needle in too long could deplete someone then we have a real

>problem… Therefore there is a necessary teaching step to make such

>generalizations.

>

> It appears to be an idea prominent in the West that is not

> > prevalent in Chinese sources, and I think it ties in with the

> > mistranslation of draining (xie4) as sedation.

>

>

>Maybe a semantical issue, maybe not… Does it really matter what one calls

>it?? I think if one thinks about this in simple terms, meaning does it

>tonify or deplete? that is very easy IMO.

>

> >

> > I'm sorry to hear that you have not met a single Chinese practitioner

> > who was doing something that you find unique and deeply true to the

> > spirit of the medicine.

>

>Just to be clear I never said that…I think you are exaggerating what I

>said… I have met plenty of practitioners that are mind blowing (both acu

>and herbalist)… (but the mind blowing acus that I have met have been have

>been Japanese or western practitioners… Like I said I am open to anyone

>that has the ‘goods’… As far as herbs I find the Chinese the most superior

>and have met too many excellent practitioners to name… But again these are

>generalizations, but one can only go on what one experiences, reads etc…

>So I until I meet those kick ass Chinese acus I will stick to my opinions

>and BTW I have observed quite a few ­ I don’t think it matters if they are

>in China or not ­ If they are Chinese and have worked in the hospitals and

>have good educations that the location IMO is moot and there Chinese Style

>can be evaluated. Now that I think about I can’t think of one person,

>except for Jason Robertson, who has really said anything mind blowing

>about Chinese style acupuncture in China… but

> actually he studied with what he called a classical style meridian style

> (I think) Chinese non-hospital old school practitioner… Most are

> unimpressed… Have others had mind-blowing experience with Chinese style

> acus treating internal medicine complaints effectively and efficiently???

>

> > that you need to get out and have more experience with Chinese culture

> > before setting your opinion so solidly about a huge group of people.

>

>Come on.. I am out plenty… that is an argumentative cop out- IMO the proof

>is in the pudding… I always ask show me the goods…

>

> > Some of the most creative and brilliant minds in Chinese medicine

> > are Chinese.

>

>No disagreement here, that again is not the issue… Acu skills are what I

>am talking about…

>

> The West has great minds as well, and both places have

> > some people who just don't get it. If you really think that

> > " flexible, creative doctors whose orientation is true to the medicine "

> > are only rare exceptions in Chinese society, you should try to gain

> > more awareness of the real situation.

>I think I will direct you to the article that Bob quoted about flexibility

>and creative doctors… I think it is a real issue as evidence by that

>article and Chinese doctors that have expressed the same views to me.. you

>can take it up with them… but I agree both places have great minds and

>both have slackers… but there is a definite difference between meridian

>style (Japanese) acu and Chinese style hospital acu ­ And to date my

>opinion has clinical experience, journal articles, and observation of

>practitioners to back it up… But everyone has their opinion and I am not

>saying mine is any more true than anyone else’s… IT is just what I have

>seen... So I question the concept of ‘real situation’

>

>-Jason

>

>

>

>

>Chinese Herbal Medicine offers various professional services, including

>board approved continuing education classes, an annual conference and a

>free discussion forum in Chinese Herbal Medicine.

>

>

>

>

[Guest guest]

>

>

> On Behalf Of Marnae Ergil

> Tuesday, June 28, 2005 7:26 PM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> Jason -

>

> I have seen many " kick-ass " hospital based acupuncturists in China - who

> got incredible results.

[Jason]

Marnae,

 

Thanx for your input...

 

Some questions that I would like to know are:

 

1) what do you think made them " kick-ass "

2) What conditions were they treating?

3) What style did they practice? TCM, some meridian based system etc.

4) Did they have some individualized approach or was it fairly systemized

based on Chief complain or Disease?

 

That is a start.. Just for the record I AM NOT saying that these doctors

don't exist... I have just never met them... So I would like to hear more

about them... thanx,

 

-Jason

[Guest guest]

Ikeda's new Japanese book also makes reference to i.e. retaining the needle

for a short amount of time to supplement...etc,...

Also in toyohari supplementing techniques tend to end up being much quicker

and draining / sedating techniques are longer.

For what its worth...

 

-Jason

[Guest guest]

>

>

> On Behalf Of Marnae Ergil

>

> So, yes, clinical experience is absolutely necessary, but I think that one

> can have lots of experience and still have poor technique. How many of us

> do hand strengthening exercises every day? How many of us do free hand

> needling with thicker needles? (we had this discussion before). As far

> the

> the " depleted " patient becoming exhausted after a longer treatment, I

> personally think that perhaps that has more to do with technique than with

> time. Perhaps although the points needled were supplementing points, the

> technique itself was draining. I agree with Eric and his teachers that it

> is much harder to learn good supplementing technique than draining

> technique. I too have seen the patients who are exhausted after treatment

> - but I think that there are more variables than just the length of the

> treatment. Including, diet/when they last ate, sleep, and, actually I

> think that the most important variable is the state of the liver qi.

> Often

> it is those who have depressed liver qi who get the most wiped out when

> the

> qi gets moved during treatment. So, just to say that based on clinical

> experience of seeing more vacuous patients get wiped out after a long

> treatment, is, I think an insufficient analysis of who is getting wiped

> out

> and why.

>

> I think that Eric's original question is a very good one. Why do we have

> this concept in the west if it is not a concept in China/Taiwan, or in any

> of the texts to which we look supposedly look for authority. Where did it

> come from - I suspect that it is a misconception or misunderstanding of a

> few statements in the Nei Jing or Nan Jing.

>

> So, in fact this question bears further discussion - although perhaps not

> on the CHA forum if Todd doesn't want us to. Where did this concept come

> from. I am very curious to hear from Nigel on this. I recall Bob Flaws

> saying once that our concept of a 20 minute treatment was flawed - that in

> fact, needles could simply be inserted and removed, and that as long as

> the

> technique was appropriate and qi obtained, this could be either draining

> or

> supplementing. From my brief review of the Nei Jing, Nan Jing and Jia Yi

> Jing today this is exactly what was said - there seemed to be pretty clear

> consensus on not retaining needles. While this does not support Eric's

> teachers in terms of the idea of a longer treatment being more draining,

> it

> does support the concept that we have added in an additional method of

> treatment -

 

[Jason]

Yes there has been much added since 1500 years ago... I would hope so... But

such a statement not occurring in these texts would means what?

 

To explore some more... You have stated that many of these Chinese

techniques are not used in the west because they are too painful... Ok...

You also query, " How many of us use free hand and thicker needles? " Well

personally I think this hits an important nail on the head at least for real

time Western Clinical practice... If even the Chinese are not able to pull

off their Pain filled techniques which they should be much more skilled then

us at, why would I try? Especially when I can learn a system that gets

equal if not better results that has a)minimal pain, b) pays seemingly more

attention to the individual c)also has precise needle technique for

draining, supplementation, harmonizing etc etc. Why would I even bother with

thicker needles and painful free hand insertion...? {And I don't buy that

free hand is less painful than Japanese style seirin tube insertion...Not

for a second...}

This is IMO why Japanese Meridian style (i.e. toyohari style) is so

popular. One can get the results without the brutality! You choose what

you like, but lecturing us on how we don't use freehand thick insertions is

futile... Even my Chinese profs all used tubes. Now maybe I had horrible

Chinese teachers at PCOM... and maybe all the Chinese / Taiwanese

practitioners that I observed were just monkeys.. But I never once saw them

evaluate how the treatment was working (i.e. pulse or whatever) - they all

used TCM formulated point prescriptions etc... They rarely chose points

based on some individual presentation, manifestation etc... what this all

says to me is yes there are expectations like Marnae may be mentioning, but

the system as a whole , at least how I was taught and what I have observed

is formulated, pedantic, generalized, and somewhat dense...

Where meridian style as a whole (at least what I have studied), all

the practitioners are practicing these individual evaluating techniques,

i.e. trying to determine exactly how long to retain the needle etc. Picking

points based on the person and complaint. Evaluating how well a

supplementing technique is working etc. Having a root treatment (person)

and a branch treatment (symptoms)... This is all built into the system..

That is how it is taught...

So even if the 2 systems are equal in efficacy, I will choose the more

flexible, creative, and less painful system... That is what I like...

Everyone has there nature...

 

But there seems to be clearly two styles...

 

This is what interests me... 2 styles... One that can over micro-manage (to

detriment sometimes) and the other that could care less... Do both get the

same results? Is there something to being able to pick the technique based

on the individual and not just the pattern / disease...?

 

I do find it curious that such a statement in regard to length of time of

needle retention is not found readily in the Modern Chinese Literature yet

is in the Japanese... This may just exemplify the difference between the 2

styles. Maybe the Japanese just have a better grasp on how to evaluate this

type of technique... this would support my observations that Meridian style

(jap) just pays in general more attention... Comments?

 

-

[Guest guest]

Whenever we have discussions of this nature, we should emphasize that

there is a general overview and specifics, including exceptions. I

agree in general that Japanese styles of acupuncture have more

emphasis on classical sources, careful technique, and individualizing

of treatment. I think the present-day mainland Chinese acupuncture

is clearly in the back seat when compared with herbal, internal

medicine at least in the national system. This doesn't mean that

there aren't great modern Chinese acupuncturists, I've heard of a few

such as Jason Robertson's teacher (Dr. Wang), Wang Le-ting and Cheng

Dan-an earlier in the 20th century. However, the trends are such

that the Japanese have done a better job in presenting acupuncture

as a primary modality than mainland China has.

 

 

 

On Jun 28, 2005, at 9:15 PM, wrote:

 

> I do find it curious that such a statement in regard to length of

> time of

> needle retention is not found readily in the Modern Chinese

> Literature yet

> is in the Japanese... This may just exemplify the difference

> between the 2

> styles. Maybe the Japanese just have a better grasp on how to

> evaluate this

> type of technique... this would support my observations that

> Meridian style

> (jap) just pays in general more attention... Comments?

 

 

 

 

[Guest guest]

Jason, I have studied with some Chinese acupuncturists in Nanjing that

I found really good. I'll give you the names of two practitioners,

namely Sheng Canrou and Xiao Shaoqing. There are many more

practitioners that are not as famous as these two, and are also very

good at their profession.

Sheng Canrou taught Peter Deadman and Giovanni Maciocia when they were

in Nanjing. He also travelled to London on several occasions to

lecture on various topics, and transcripts of those lectures have been

provided in the Journal of . His technique is amazing.

He seems to not have to puncture to penetrate the skin; he more or

less just pushes the needle in, to the desired depth while twirling

the needle at the same time. He only works part-time now in Nanjing

Shi, but when he does he sees lots of patients.

Xiao Shaoqing is professor Emeritus of NJUTCM, He was 81 when I

studied with him and he still was seeing quite a few patients. His

technique was different, perhaps more painful, but he got good

results. His specialty seemed to be to use Extra points, more so than

other teachers I had seen. He has written a book on this subject as

well (in Chinese).

>Some questions that I would like to know are:

>

> 1) what do you think made them " kick-ass "

Sheng Canrou is obviously talented, experienced and determined. Xiao

Shaoqing was a very humble and joyful human being. He would make sure

that all the students in his small bedroom (sometimes 6 students at a

time) would have everything they need, and would patiently answer all

their questions. He would point out passages to us and explain why he

needled this or that point in certain conditions.

> 2) What conditions were they treating?

Practically anything- headaches and other pain complaints, diabetes,

stroke and facial paralysis, skin disorders, twisted ankle and other

traumata, HBP and dizziness,...very varied.

> 3) What style did they practice? TCM, some meridian based system etc.

I believe Sheng Canrou practiced more TCM style, but that does not

mean they do not know the classics. Far from that. Using " big points "

like many Chinese doctors do, does not make them less fancy, I

believe. There are very good reasons for choosing big points. They

have classical references and they have proven their effectiveness.

One combination of points can treat many disease, cfr Miriam Lee.

Xiao Shaoqing used very long needles. He knew what he was doing with

them. I wish I knew as well as he does.

> 4) Did they have some individualized approach or was it fairly

systemized

> based on Chief complain or Disease?

Individualized- but let's not forget that there can be no

individualization without a system.

 

Tom.

[Guest guest]

On Jun 28, 2005, at 9:25 PM, Marnae Ergil wrote:

> - perhaps because we are trying to fulfill our and our patient's

> fantasy of what holistic medicine is.

--

 

Hi Marnae!

 

In my very limited observation of acupuncture treatment in China (I was

there to study internal medicine), the practitoners there also seem to

use 20 minutes as a rough standard, and I would have thought they were

not indulging this fantasy. Was this not true in your experience?

 

Rory

 

 

 

[Guest guest]

>

>

> On Behalf Of

> Tuesday, June 28, 2005 11:11 PM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> Whenever we have discussions of this nature, we should emphasize that

> there is a general overview and specifics, including exceptions. I

> agree in general that Japanese styles of acupuncture have more

> emphasis on classical sources, careful technique, and individualizing

> of treatment. I think the present-day mainland Chinese acupuncture

> is clearly in the back seat when compared with herbal, internal

> medicine at least in the national system. This doesn't mean that

> there aren't great modern Chinese acupuncturists, I've heard of a few

> such as Jason Robertson's teacher (Dr. Wang), Wang Le-ting and Cheng

> Dan-an earlier in the 20th century. However, the trends are such

> that the Japanese have done a better job in presenting acupuncture

> as a primary modality than mainland China has.

[Jason]

Yes this is the point...There are always exceptions like Jason R's teacher.

But the real question for me is about the actual system's qualities,

strengths and weaknesses, and one can only grasp that through generalities

(i.e. the way it is taught to the masses) not by few exceptional healers

(but I like hearing about these people). Therefore I would like to hear

others perceptions and experiences of the differences of Japanese and

Chinese Acu...

I think that understanding this will help tie this into the original

question... My hypothesis is that Chinese Acu has become somewhat rote and

systematized and they do just leave the needles in for a set amount of time

(that is what I observed in Taiwan and heard others say about China)... They

do not teach how to evaluate how long to leave needles in.. They may just

feel that it doesn't matter, which is a valid thought... But we do find a

contrary thought in Japanese acupuncture and therefore must look at its

potential validity. I just think the Japanese have thought much more about

the subject in recent years. They seem to have a much more sophisticated

grasp of qi also.

 

Finally Urban myth or not?

Well American (or Western) Acupuncture is a mix of Chinese, Korean,

European, and Japanese (etc). I think we are creating a new system that

caters to Westerners. I think it is folly (or just plain limiting) to just

take i.e. Chinese Acu and apply it, AS IS, over here. For 1 people just

don't like it, it is really painful, therefore for many NOT healing.

Anyway, if there is a mixing of systems, and if this concept of needle

retention time is valid in Japan, then I say it is (potentially) valid here.

We should investigate Eric's question from this viewpoint... AS Alon wisely

pointed out - just because there is NOT a CHINESE source does NOT make it

NOT valid!

But anyway, one possible scenario is that this Japanese / classical Chinese

idea got crossed with standard retention times of China, and whala - 20

minutes = supplementing and 40 draining. But I don't think anyone here has

said that this latter idea is some ultimate truth. We all agree that we

should needle and retain needles for the individual. I think we would all

agree that blindly following a 'general guideline' is going to work with

some and fail with others.

So we have question #1 - Why are many Chinese not attempting this? And just

leaving them in for a set time... #2 Why are many Japanese doing the

opposite?

 

-

 

 

 

 

 

>

>

> On Jun 28, 2005, at 9:15 PM, wrote:

>

> > I do find it curious that such a statement in regard to length of

> > time of

> > needle retention is not found readily in the Modern Chinese

> > Literature yet

> > is in the Japanese... This may just exemplify the difference

> > between the 2

> > styles. Maybe the Japanese just have a better grasp on how to

> > evaluate this

> > type of technique... this would support my observations that

> > Meridian style

> > (jap) just pays in general more attention... Comments?

>

>

>

>

[Guest guest]

My experience of the time frame was more about how much time the

practitioner had. It would usually take about 10 - 15 minutes to get

everyone's needles in, then see new patients, then remove needles and get

the next crew in. Sometimes it would be 20 minutes, sometimes longer

depending upon the new patient situation. It was never timed, but it often

turned out to be 20 - 30 minutes.

 

Marnae

 

 

At 07:59 AM 6/29/2005, you wrote:

>On Jun 28, 2005, at 9:25 PM, Marnae Ergil wrote:

> > - perhaps because we are trying to fulfill our and our patient's

> > fantasy of what holistic medicine is.

>--

>

>Hi Marnae!

>

>In my very limited observation of acupuncture treatment in China (I was

>there to study internal medicine), the practitoners there also seem to

>use 20 minutes as a rough standard, and I would have thought they were

>not indulging this fantasy. Was this not true in your experience?

>

>Rory

>

>

>

[Guest guest]

, Marnae Ergil <marnae@p...> wrote:

> My experience of the time frame was more about how much time the

> practitioner had. It would usually take about 10 - 15 minutes to get

> everyone's needles in, then see new patients, then remove needles and get

> the next crew in. Sometimes it would be 20 minutes, sometimes longer

> depending upon the new patient situation. It was never timed, but it often

> turned out to be 20 - 30 minutes.

>

> Marnae

>

>

> At 07:59 AM 6/29/2005, you wrote:

> >On Jun 28, 2005, at 9:25 PM, Marnae Ergil wrote:

> > > - perhaps because we are trying to fulfill our and our patient's

> > > fantasy of what holistic medicine is.

> >--

> >

> >Hi Marnae!

> >

> >In my very limited observation of acupuncture treatment in China (I was

> >there to study internal medicine), the practitoners there also seem to

> >use 20 minutes as a rough standard, and I would have thought they were

> >not indulging this fantasy. Was this not true in your experience?

> >

> >Rory

> >

> >

> >

[Guest guest]

Robert Chu, in his unique way, calculated, I believe, 28.5 minutes treatment

time based on

the speed of qi moving through the body. 20 minutes is usually thought to be the

amount

of time of one cycle but I've forgotten the details of how that is calculated.

In any case, the

modern Chinese model seems to be a blend of this concept with the economic

practicalities. As is the case with all of our practices.

I was struck last time in China how " Western " the group treatments Marnae

describes well

below were. The doctors were quiet during the treatment time and I almost

expected an

Enya CD to be playing in the background.

I know I try to ainduce a Theta type state, between sleep and dreaming, in my

patients...

some patients, they just can't go there and stare up at the ceiling. Obviously

these patients

never go beyond 20 minutes before they want the needles out. What I do may be

dangerously close to what Mark Seem calls endophonizing acupuncture but I find

it

restorative for the patients. Obviously we are talking about internal Zang-fu

type cases

and not pain, where I may spend a full hour in the room, prodding and poking.

doug

 

 

, Marnae Ergil <marnae@p...> wrote:

> My experience of the time frame was more about how much time the

> practitioner had. It would usually take about 10 - 15 minutes to get

> everyone's needles in, then see new patients, then remove needles and get

> the next crew in. Sometimes it would be 20 minutes, sometimes longer

> depending upon the new patient situation. It was never timed, but it often

> turned out to be 20 - 30 minutes.

>

> Marnae

>

>

> At 07:59 AM 6/29/2005, you wrote:

> >On Jun 28, 2005, at 9:25 PM, Marnae Ergil wrote:

> > > - perhaps because we are trying to fulfill our and our patient's

> > > fantasy of what holistic medicine is.

> >--

> >

> >Hi Marnae!

> >

> >In my very limited observation of acupuncture treatment in China (I was

> >there to study internal medicine), the practitoners there also seem to

> >use 20 minutes as a rough standard, and I would have thought they were

> >not indulging this fantasy. Was this not true in your experience?

> >

> >Rory

> >

> >

> >

[Guest guest]

, " "

<@c...> wrote:

> [Jason]

> I think that understanding this will help tie this into the original

> question... My hypothesis is that Chinese Acu has become somewhat

rote and

> systematized and they do just leave the needles in for a set amount

of time

> (that is what I observed in Taiwan and heard others say about China)...

 

I wouldn't describe the Chinese approach as simply rote and

systematized. There is certainly an emphasis on using big points that

are capable of propagating a strong qi sensation, and there is a

tendency to use similar treatments for similar disorders, but this

method is chosen because it is clinically effective, not because the

doctors are uncreative or have failed to pursue a diverse education.

 

One thing that is clearly emphasized heavily is needle technique.

Different conditions are treated by specifically propagating the qi

sensation along a channel in different directions to different places.

Doctors creatively pursue methods of eliciting qi sensation and

constantly challenge and refine ideas and approaches until they find

something that they like and something that works. If so many of them

come to agree that these commonly seen point combinations are

effective, then that combination is worth paying attention to. And

the fact that they nearly universally agree that good needle technique

and well-propagated qi sensation are essential features of successful

treatment is worth paying attention to as well.

 

They

> do not teach how to evaluate how long to leave needles in.. They

may just

> feel that it doesn't matter, which is a valid thought... But we do

find a

> contrary thought in Japanese acupuncture and therefore must look at its

> potential validity. I just think the Japanese have thought much

more about

> the subject in recent years. They seem to have a much more

sophisticated

> grasp of qi also.

 

The Japanese approach is also a clearly valid and successful system.

But Japanese and Chinese medicine differ in many ways and the rules of

one are not necessarily applicable for the other. They differ hugely

on factors such as needle depth, thickness, intensity of qi sensation,

use of the pulse as an instant feedback method for needle therapy,

etc. Japanese acupuncture can not be judged to be ineffective just

because it doesn't prioritize a deep, aching qi sensation; Chinese

acupuncturists can't be judged to be insensitive just because they

don't take the pulse midway through. Both systems work and both

systems are well-developed. Herbal medicine and acupuncture are both

based on totally different premises in each system, it is apples and

oranges to compare the two.

 

Methods of treatment vary dramatically, but there are a few things

that the Japanese, Koreans, and Chinese all agree upon. They all

emphasize the importance of classical literature, for example.

Interestingly, another thing that they all agree on is the existence

of a wide-range of technical terminology. Top representatives from

Japan, Korea, and China have had many meetings for the World Health

Organization (WHO) to discuss terminology standards. One of their

recent projects was to go through a large term list and assess which

technically important concepts needed standard terms and which phrases

should be phased out of use. Very few terms were discarded from the

list, and they ended up with some 4000 technical terms. The fact that

one can have elite representatives from these three countries actually

agree on something is very significant. When the official voices of

Japan, China, and Korea jointly endorse a 4000+ concept term list, it

makes people in the West arguing that CM has only a few hundred

technical terms appear to be standing on very dubious ground.

 

> Anyway, if there is a mixing of systems, and if this concept of needle

> retention time is valid in Japan, then I say it is (potentially)

valid here.

> We should investigate Eric's question from this viewpoint... AS Alon

wisely

> pointed out - just because there is NOT a CHINESE source does NOT

make it

> NOT valid!

 

No one is questioning the validity of any approach. People can decide

for themselves what works and thus what is valid. I am not making a

judgement of validity or anything like that, I am simply calling

attention to the fact that this emphasis on needle retention does not

seem to play a big role in Chinese acupuncture. I am merely

attempting to illustrate information; informed people can form

whatever opinions suit their fancy. We should have a clear

understanding of where our information comes from and where our

primary sources stand on such matters, that's all.

 

Eric

[Guest guest]

According to Nei Jing (sorry for not pointing to a particular page of an English

version, as I read the Chinese version), the Qi circulates 50 times a day.

Simple math: 24x60 divided by 50 gives 28.8. A number of my friends and myself

have been following the rule of thumb of leaving the needles in for 30 minutes

or longer, but not longer than twice the amount of 28.8 minutes for internal

medicine topics. However, duration aside, I believe, following Su Wen and Nan

Jing, the most important thing is to ensure the proper presence and flow of qi.

(The classics mention " hou qi, " or, awaiting qi in many places.) As a rule of

thumb, I go back to the patient to ensure proper qi manifestation a few times

while the needles are still on. There also pre- and post-needling steps to

orient and close on the treatment. I do not take what's being practiced in

China (neither wrt Taiwan) en mass for granted, and I am not surprised to hear

that some reported not very good result.

 

Mike L.

 

wrote:

Robert Chu, in his unique way, calculated, I believe, 28.5 minutes treatment

time based on

the speed of qi moving through the body. 20 minutes is usually thought to be the

amount

of time of one cycle but I've forgotten the details of how that is calculated.

In any case, the

modern Chinese model seems to be a blend of this concept with the economic

practicalities. As is the case with all of our practices.

I was struck last time in China how " Western " the group treatments Marnae

describes well

below were. The doctors were quiet during the treatment time and I almost

expected an

Enya CD to be playing in the background.

I know I try to ainduce a Theta type state, between sleep and dreaming, in my

patients...

some patients, they just can't go there and stare up at the ceiling. Obviously

these patients

never go beyond 20 minutes before they want the needles out. What I do may be

dangerously close to what Mark Seem calls endophonizing acupuncture but I find

it

restorative for the patients. Obviously we are talking about internal Zang-fu

type cases

and not pain, where I may spend a full hour in the room, prodding and poking.

doug

 

 

 

 

 

 

 

[Guest guest]

, " "

<@c...> wrote:

>> > Jason -

> >

> > I have seen many " kick-ass " hospital based acupuncturists in China

- who

> > got incredible results.

> [Jason]

> Marnae,

>

> Thanx for your input...

>

> Some questions that I would like to know are:

>

> 1) what do you think made them " kick-ass "

> 2) What conditions were they treating?

> 3) What style did they practice? TCM, some meridian based system etc.

> 4) Did they have some individualized approach or was it fairly

systemized

> based on Chief complain or Disease?

 

I'll mimic Tom's style of answering these questions with some of my

own experiences with Chinese doctors.

 

I study with four doctors in the acupuncture dept right now.

 

Dr. #1 (Dr. Sun) is the department head. He mostly treats kids with

cerebral palsy, some stroke patients, some orthopedic cases, and a bit

of everything else. He uses incredibly graceful freehand technique,

strong qi propagation, and fairly consistent points for certain

illnesses,generally based on scalp acupuncture and TCM, with the use

of trigger points and modern techniques for orthopedics. He laments

at the paucity of time for pattern diagnosis because he sees 100-150

patients per shift. He " kicks ass " because he gets goods results, he

helps a lot of people, and he has absolutely beautiful needle

technique. He is the top acu doctor in Taiwan for cerebral palsy.

The other day, we had a stroke patient who has been coming in for the

past two years. He was unable to speak, pushed in lying down on a bed

two years ago; now he walks well, does his own zippers,gives a big

smile and flashes a big thumbs up sign, and he has regained a good

deal of speech ability.

 

Dr. #2, Dr. Chen, is primarily interested in the classics. He needles

only a few points, which are often selected based on classical

references and lesser-known aspects of channel theory; I am mystified

by his motives in point selection, although most of the points are

points that get a good qi sensation. He insists on getting a distinct

qi sensation at three different tissue depths and is very into

needling technique, soft music plays in the background, and the

patient load is relatively light. He also uses methods from Dr. Dong

(popularized by Miriam Lee and Richard Tan in America), and his

students focus a lot on the nei jing and other texts. He " kicks ass "

because he teaches me and the resident doctors a lot of theory and

motives for point selection that we have never heard. His treatments

are the most individualized, but I am not convinced that they are as

good as some of the more standard methods by the other physicians.

 

Dr. #3, Dr. Lin, inserts tons of needles and sees a lot of stroke

patients. He does a lot of scalp acupuncture and uses a lot of big

points to propagate a strong qi sensation to a certain area and to

free the channels and network vessels. He " kicks ass " because he is

extremely well-informed on the PRC criteria for modern pattern

diagnosis for study designs, and he is very involved in acupuncture

research that incorporates traditional pattern diagnosis.

 

Dr. #4, Dr. Qiu, is an old, super nice guy who specializes in eye

disorders. A former surgeon, he does lots of deep needling on

jingming (BL 1) and qiuhou for his eye patients, in conjunction with

scalp acupuncture. He sees lots of incredibly difficult cases and

gets amazing results. Why he kicks ass: He has many patients who were

blind and can now see. Every week I see a boy who was " permanently "

blind a year ago yet now sees seven colors. He had a brain tumor

removed, the optic nerve was damaged, and WM definitively says that he

is blind for life. I have seen several of his patients with similar

stories, and one of his old patients is being presented to an

international conference on opthamology in Hong Kong next month-

simply because the effect that has been achieved is unknown to

conventional medicine.

 

In my personal rounds in one dept of one hospital, we can see a wide

spectrum of approaches. You ask " What style did they practice? TCM,

some meridian based system, etc? " Where does one start and the other

begin? Is not TCM meridian based? Is scalp acupuncture TCM? We have

one guy putting needles in the thumb to treat neck pain and another

guy putting needles two inches deep into the orbital cavity to treat

blindness. One guy doing pattern diagnosis and one guy completely

leaving it out. One guy is needling St 40 based on some obscure

reference in the nei jing, and another guy is putting needles into

virtually every big yang channel point on the limbs. Is there such a

lack of creativity and diversity in Chinese treatments?

 

Eric

[Guest guest]

Robert Chu, in his unique way, calculated, I believe, 28.5 minutes treatment

time based on

the speed of qi moving through the body

>>>>>Doug, this is a typical Tong-style idea. Remember that usually in

tong-style you treat as far away from the problem as possible and therefore it

is said you need a minimum of 30 minutes for the qi to arrive to the lesioned

area. It is interesting however that Miriam lee used to say that after 45

minutes a longer retention can become tonifying.She also used to say that

acupuncture is basically a sedating technique

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

it

makes people in the West arguing that CM has only a few hundred

technical terms appear to be standing on very dubious ground.

>>>>>Eric if you look at WT you can see that many so called different terms are

just OBVIOUS compound terms. If count every one of these as a different term

you easily get thousands. I would not however

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

He was unable to speak, pushed in lying down on a bed

two years ago; now he walks well, does his own zippers,gives a big

smile and flashes a big thumbs up sign, and he has regained a good

deal of speech ability.

>>>>Eric, have you ever looked at the normal recovery rate from strokes. I do

not know anything about your patient but many stroke patients recover all you

describe in two years with little or no therapy.

By the way i did meet Dr. Qiu and watched him treat eye disease, i do not think

many parents in USA would allow one to do what he does. A couple of the kids i

saw were screaming when he put in the needles.

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

>

>

> On Behalf Of Eric Brand

>

> I wouldn't describe the Chinese approach as simply rote and

> systematized. There is certainly an emphasis on using big points that

> are capable of propagating a strong qi sensation, and there is a

> tendency to use similar treatments for similar disorders, but this

> method is chosen because it is clinically effective, not because the

> doctors are uncreative or have failed to pursue a diverse education.

>

[Jason]

Well this is your opinion, but surely there are MANY that feel that Chinese

acupuncture is not that effective for internal complaints, many on the list

have commented that it is herbs that are used for internal problems not

acupuncture and that acupuncture results are greatly exaggerated...As Z'ev

has just mentioned Acu has taken a back seat to herbs for internal

problems.. I think there might be a reason for that... I guess there is just

debate here...

 

-

[Guest guest]

>

>

> On Behalf Of Eric Brand

>

> One thing that is clearly emphasized heavily is needle technique.

> Different conditions are treated by specifically propagating the qi

> sensation along a channel in different directions to different places.

> Doctors creatively pursue methods of eliciting qi sensation and

> constantly challenge and refine ideas and approaches until they find

> something that they like and something that works. If so many of them

> come to agree that these commonly seen point combinations are

> effective, then that combination is worth paying attention to. And

> the fact that they nearly universally agree that good needle technique

> and well-propagated qi sensation are essential features of successful

> treatment is worth paying attention to as well.

[Jason]

I certainly agree with this, if it is Japanese, Chinese, or whatever, I

think needle technique is fundamental and essential...

 

 

 

>

> They

> > do not teach how to evaluate how long to leave needles in.. They

> may just

> > feel that it doesn't matter, which is a valid thought... But we do

> find a

> > contrary thought in Japanese acupuncture and therefore must look at its

> > potential validity. I just think the Japanese have thought much

> more about

> > the subject in recent years. They seem to have a much more

> sophisticated

> > grasp of qi also.

>

> The Japanese approach is also a clearly valid and successful system.

> But Japanese and Chinese medicine differ in many ways and the rules of

> one are not necessarily applicable for the other. They differ hugely

> on factors such as needle depth, thickness, intensity of qi sensation,

> use of the pulse as an instant feedback method for needle therapy,

> etc. Japanese acupuncture can not be judged to be ineffective just

> because it doesn't prioritize a deep, aching qi sensation; Chinese

> acupuncturists can't be judged to be insensitive just because they

> don't take the pulse midway through. Both systems work and both

> systems are well-developed. Herbal medicine and acupuncture are both

> based on totally different premises in each system, it is apples and

> oranges to compare the two.

[Jason]

I agree, but one must look at why the Japanese do things differently and

visa versa... I think we are in a unique time because of technologic and

informational advances that we can take the best of both worlds. We are a

melting pot on many levels, for better or worse. Both systems have pluses

and minuses.

 

>

> > Anyway, if there is a mixing of systems, and if this concept of needle

> > retention time is valid in Japan, then I say it is (potentially)

> valid here.

> > We should investigate Eric's question from this viewpoint... AS Alon

> wisely

> > pointed out - just because there is NOT a CHINESE source does NOT

> make it

> > NOT valid!

>

> No one is questioning the validity of any approach. People can decide

> for themselves what works and thus what is valid. I am not making a

> judgement of validity or anything like that, I am simply calling

> attention to the fact that this emphasis on needle retention does not

> seem to play a big role in Chinese acupuncture.

[Jason]

Yes.. that is fine, but I felt in the beginning of this, you started making

some strong accusations that Western acupuncture was WRONG because the

'Chinese' did not support this idea, calling it urban myth... I think we

need to look at a broader picture (i.e. Japan) before pointing fingers...

But thanx for bringing up this interesting topic.

 

-Jason

[Guest guest]

>

>

> On Behalf Of

> Wednesday, June 29, 2005 2:26 PM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> He was unable to speak, pushed in lying down on a bed

> two years ago; now he walks well, does his own zippers,gives a big

> smile and flashes a big thumbs up sign, and he has regained a good

> deal of speech ability.

> >>>>Eric, have you ever looked at the normal recovery rate from strokes. I

> do not know anything about your patient but many stroke patients recover

> all you describe in two years with little or no therapy.

> By the way i did meet Dr. Qiu and watched him treat eye disease, i do not

> think many parents in USA would allow one to do what he does. A couple of

> the kids i saw were screaming when he put in the needles.

[Jason]

Yes while in Taiwan I saw many people screaming when getting needled... And

this becomes a real issue when you start practicing in a place like boulder

Co. - All that I know is that it doesn't have to be painful...

 

-Jason

[Guest guest]

I have made many trips to Taiwan and observed several hundred, if not thousand,

acupuncture sessions but I have not seen *anyone* screaming.

 

Mike L.

 

wrote:

 

 

>

>

> On Behalf Of

> Wednesday, June 29, 2005 2:26 PM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> He was unable to speak, pushed in lying down on a bed

> two years ago; now he walks well, does his own zippers,gives a big

> smile and flashes a big thumbs up sign, and he has regained a good

> deal of speech ability.

> >>>>Eric, have you ever looked at the normal recovery rate from strokes. I

> do not know anything about your patient but many stroke patients recover

> all you describe in two years with little or no therapy.

> By the way i did meet Dr. Qiu and watched him treat eye disease, i do not

> think many parents in USA would allow one to do what he does. A couple of

> the kids i saw were screaming when he put in the needles.

[Jason]

Yes while in Taiwan I saw many people screaming when getting needled... And

this becomes a real issue when you start practicing in a place like boulder

Co. - All that I know is that it doesn't have to be painful...

 

-Jason

 

 

 

 

 

 

 

 

 

 

[Guest guest]

>

>

> On Behalf Of

> Wednesday, June 29, 2005 2:17 PM

>

> Re: Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> it

> makes people in the West arguing that CM has only a few hundred

> technical terms appear to be standing on very dubious ground.

> >>>>>Eric if you look at WT you can see that many so called different

> terms are just OBVIOUS compound terms. If count every one of these as a

> different term you easily get thousands. I would not however

>

>

>

>

[Jason]

IS there somewhere to see this 4000 character list that the WHO adopted.

Wiseman's electronic dictionary has over 32,000 terms, many are compounds...

 

-Jason

[Guest guest]

> > it

> > makes people in the West arguing that CM has only a few hundred

> > technical terms appear to be standing on very dubious ground.

> > >>>>>Eric if you look at WT you can see that many so called different

> > terms are just OBVIOUS compound terms. If count every one of

these as a

> > different term you easily get thousands. I would not however

> >

> >

> >

> >

> [Jason]

> IS there somewhere to see this 4000 character list that the WHO adopted.

> Wiseman's electronic dictionary has over 32,000 terms, many are

compounds...

>

> -Jason

 

They are talking about individual terms, not compound terms. The

30,000 plus number in the electronic dictionary includes compounds,

the ~4000 WHO standard terms are based on individual terms.

 

Eric