the Anywhere Clinic

It is always exciting when things shift the way you intended them to, sometimes sooner than expected. It is also sometimes puzzling and terrifying too, to face that moment when the patient comes back and says,

"That was great! Can you replicate it?"

I'm no longer in the 'no, I was totally guessing' phase as a practitioner, but often (too often for comfort) I find myself unsure of how or what to do next. I have always been annoyed by patients who want me to do the exact same point combination that worked for them last week, but the truth is that the one I come up with this week does not necessarily work better, and I'm not good enough yet to know why. True mastery allows us to replicate a positive experience, or at least predict the trajectory of a desired outcome with accuracy. Livingston was talking about this in clinic last module: prescribing Tao He Cheng Qi Tang (I think) to someone with dark purple spots on a dusky tongue and telling him not to make any plans over the weekend because he would be on the toilet for 2-3 days straight expelling the blood stasis causing his inguinal hernia via bowel movements. 16 years of pain removed in a weekends' worth of diarrhea. There's mastery for you.

I look forward to the day when this becomes more true for me. Forget patients; I can't even do it for myself. I managed to sleep through the night on Tuesday this week, and have not been able to replicate the experience. You can't get much more compliant and motivated than yourself, and you know way more visceral information than could ever be gotten out of an intake, but (since starting this DAOM and actually tracking/trying things again) I've literally done this twice: once after Wen Jiang's 'yang not entering yin' acupuncture, and once this week, experimenting with passionflower tea & Hong Jin's Sleep Formula in granule form. Similar treatments don't seem to do anything. Argh.

I can resonate with the patients who want to hang on to something that works, especially when so many other things they've tried have not worked. Also, I feel like the frustration of trying to educate certain patients about 'why we might not want to replace your 4-hourly regimen of Benadryl with one weekly acupuncture treatment of all your favorite anti-allergy points' outweighs the potential benefit of the treatment itself. So, unless last week's treatment was for an external condition that has since been cleared, I tend to defer to these requests, trying not to discount the psychological benefits of predictability and routine self-care. I've been doing one-size-fits-all auricular group acupuncture for chronic pain at Kaiser for the last 4 months (we do shenmen, thalamus, kidney, zero, and sympathetic bilaterally with red seirins) and some of the results are surprisingly good. For a number of the patients who are benefitting from this treatment format, I think the very act of making an appointment to take care of their body, reaching for a solution other than pills, & feeling taken care of by their healthcare insurance accounts for much of the pain relief they're getting. Not to say the points aren't contributing to the recovery, I'm sure they are, but the familiar routine of coming in and sitting quietly with 10 needles for 30 minutes seems to ...enhance the treatment somehow.

I do think the standardization is a bit much. A young woman with stress migraines and an older man dying of metastasized brain cancer may both report chronic head pain level 8 out of 10, but popping the same points in both of them seems almost criminally lazy. The beauty of Chinese medicine lies in its infinite versatility, in the ability to customize treatments to each unique case factoring in all the variables: constitution, compliance, convenience, season, weather, geography. To throw away the tailored approach for an 'off-the-rack' treatment in the name of standardization seems like the mistake of an immature, patriarchal medical paradigm. Standardization makes replicating the treatment easy, but does nothing for the replication of positive results. It creates the illusion that practitioners are interchangeable, and we aren't.