Supplementing vs Draining Acupuncture Technique and Needle Retention

[Guest guest]

Is anyone aware of any primary sources that say that needle retention

time affects whether acupuncture treatment is supplementing or

draining? It is a commonly held belief in the West that prolonged

needle retention (generally past 20 minutes or so) causes an

acupuncture treatment to be draining in nature- many teachers warn

students not to leave needles in for too long in patients with vacuity

cases, lest their supplementing needle treatments reverse and have a

draining effect on the patient's channels.

 

However, despite this widespread belief, I have been unable to find

any Chinese sources that support this notion, and I am beginning to

suspect that it may be an urban myth amongst Western practitioners. I

have asked the dept head at the acupuncture dept in the hospital where

I study, I have asked other senior acupuncture doctors in the dept,

and I have asked the younger resident doctors who have recently

finished a cutting-edge modern TCM education. All of them are totally

perplexed by my question and all state that whether acupuncture is

supplementing or draining is completely dependent on needle technique,

not needle retention. They've never even heard of the notion that

prolonged retention would affect supplementing vs. draining.

(Incidentally, they consider good supplementing technique much more

difficult to master than good draining technique.)

 

I have also investigated mainland Chinese and Taiwanese standard

textbooks on acupuncture, and have been completely at a loss to find

anything remotely reinforcing this idea.

 

I would love to hear from anyone with a primary source that supports

the idea that needle retention can change acupuncture from

supplementing (bu3) to draining (xie4). In the absence of primary

sources, I would be interested to know what secondary sources promote

this idea so that they may be investigated more extensively.

 

I suspect that this notion comes from the frequent mistranslation of

xie4, draining, with the word " sedating. " Chinese doctors will

sometimes laugh upon hearing that Westerners refer to " sedating " an

acupuncture point. In Chinese, sedating/sedation is a totally

separate concept from draining. Draining is a method of needle

manipulation, an action that can be done to an acupuncture channel, as

well as a method of treatment in internal medicine (da huang, for

example, is a draining medicinal). To the Chinese, sedation is

something that is achieved by drugs such as diazepam, and they would

never use the term to express what we achieve through xie4 fa3 needle

technique.

 

It seems that many people have the tendency to equate the

pharmacologic notions of stimulating and sedating with the CM notions

of supplementing and draining. Indeed, short needle retention is more

stimulating and prolonged needle retention is more sedating. But

whether the effects on the channel qi are supplementing or draining is

independent of this. The effect on channel qi is determined by needle

technique; we supplement vacuity and drain repletion. We should not

superimpose our Western notions onto CM concepts without a clear

understanding of what the CM concept is.

 

We have seen as-yet-unsubstantiated claims that ginseng should not be

used with stimulants, presumably based on the equation of the CM

notion of supplementing qi with the Western notion of stimulants. We

are also apparently seeing widespread belief that the sedation

achieved by acupuncture in general (known to be largely mediated

through endorphin release according to WM) is equitable with the CM

notion of draining.

 

The belief that 30 minute needle retention is contraindicated for

vacuity patients is extremely widespread in the West. We should

examine the veracity of this belief before assuming that it is true.

Therefore, I would ask the group to please come forward with our

sources for this information. I am completely open to updating my

hypothesis at the first sign of evidence to the contrary. But does

the evidence exist in the primary literature?

 

Eric Brand

[Guest guest]

suspect that this notion comes from the frequent mistranslation of

xie4, draining, with the word " sedating. " Chinese doctors will

sometimes laugh upon hearing that Westerners refer to " sedating " an

acupuncture point.

>>>>I suspect its more about the fact that patients are much more likely to feel

tiered after prolonged retention than a short one. This is a very common

clinical observation.

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

The belief that 30 minute needle retention is contraindicated for

vacuity patients is extremely widespread in the West.

>>>By the way Miriam Lee did say that length of time affects this, although she

also said that after 45 minutes long retention becomes tonifing again. She used

to say it had to do with the time it takes for qi circulation, just under 30

minutes for one cycle

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

, " "

<alonmarcus@w...> wrote:

> >>>>I suspect its more about the fact that patients are much more

likely to feel tiered after prolonged retention than a short one. This

is a very common clinical observation.

 

 

Obviously, this is the whole point. Everyone knows that the effects

of acupuncture are sedating, especially with prolonged needle

retention. No one is contesting that acupuncture is not sedating.

My point has to do with the supplementing or draining effect upon the

channel qi. I don't think it is necessarily correct to assume that

something that makes someone feel sedated necessarily constitutes xie4

fa3 (draining technique). Exercise is generally strengthening to the

body, but it does provoke endorphin release and induce sedation, even

when done at an appropriate intensity.

 

Eric

[Guest guest]

>

>

> On Behalf Of Eric Brand

> Sunday, June 26, 2005 11:41 PM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> , " "

> <alonmarcus@w...> wrote:

> > >>>>I suspect its more about the fact that patients are much more

> likely to feel tiered after prolonged retention than a short one. This

> is a very common clinical observation.

>

>

> Obviously, this is the whole point. Everyone knows that the effects

> of acupuncture are sedating, especially with prolonged needle

> retention. No one is contesting that acupuncture is not sedating.

> My point has to do with the supplementing or draining effect upon the

> channel qi. I don't think it is necessarily correct to assume that

> something that makes someone feel sedated necessarily constitutes xie4

> fa3 (draining technique). Exercise is generally strengthening to the

> body, but it does provoke endorphin release and induce sedation, even

> when done at an appropriate intensity.

>

> Eric

[Jason]

Eric,

 

I think you bring up an interesting question...But I don't find it that

confusing (or should I..? I am still thinking about it...) I.e. If the

patient leaves completely sedated! and tired then what should I conclude

about the treatment...? To turn this around, I would ask, " how would

supplementing the channels create this??? "

I would conclude that whatever I did was a draining or sedating treatment

(Call it what you will)... If IT drained the channels (or whatever) I gauge

it on the effect, meaning how they feel... I have left needles in too long

and zonked people out for days.. (I am not proud of this, but it is

something one must pay attention to, at least in my experience)... I would

not call this supplementing... I consider a supplementing treatment when the

person gets off the table and feels good, not like a zombie, or within a

very short amount of time they perk up... It is easiest to see such

differences in treatment times with really deficient patients... For some

patients just putting in a needle for 5 minutes is tooo much... I have

concluded that too many needles and too long can ZAP someone's ENERGY! That

to me seems like it is NOT supplementing - So you can give it a name...I am

fine with sedating or draining... So I don't have a primary or even

secondary source, but I find that this phenomenon in the clinic is pretty

clear... but I will think about it some more...

Finally maybe there is some difference between whole body effect and

specific channel effect that you are after... I.e. will someone with an

acute bladder infection, which is purely EXCESS, respond better to leaving

the needles in longer or does time not matter... That seems like it might be

a different question and one that I cannot answer...

 

-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]

, " "

<@c...> wrote:

> [Jason]

> Eric,

>

> I think you bring up an interesting question...But I don't find it that

> confusing (or should I..? I am still thinking about it...) I.e. If the

> patient leaves completely sedated! and tired then what should I conclude

> about the treatment...? To turn this around, I would ask, " how would

> supplementing the channels create this??? "

> I would conclude that whatever I did was a draining or sedating

treatment

> (Call it what you will)... If IT drained the channels (or whatever)

I gauge

> it on the effect, meaning how they feel... I have left needles in

too long

> and zonked people out for days.. (I am not proud of this, but it is

> something one must pay attention to, at least in my experience)... I

would

> not call this supplementing... I consider a supplementing treatment

when the

> person gets off the table and feels good, not like a zombie, or within a

> very short amount of time they perk up... It is easiest to see such

> differences in treatment times with really deficient patients... For

some

> patients just putting in a needle for 5 minutes is tooo much... I have

> concluded that too many needles and too long can ZAP someone's

ENERGY! That

> to me seems like it is NOT supplementing - So you can give it a

name...I am

> fine with sedating or draining... So I don't have a primary or even

> secondary source, but I find that this phenomenon in the clinic is

pretty

> clear... but I will think about it some more...

> Finally maybe there is some difference between whole body effect and

> specific channel effect that you are after... I.e. will someone with an

> acute bladder infection, which is purely EXCESS, respond better to

leaving

> the needles in longer or does time not matter... That seems like it

might be

> a different question and one that I cannot answer...

>

> -Jason

 

I don't really have a conclusive answer to this anymore than you do.

However, two things come to mind. The first is that many patients

with significant vacuity are lacking in sleep and restoration time.

When you get them melting into the table, their mind gets a chance to

turn off and rest. If they fall asleep for 30 minutes of restorative

sleep, did you strengthen them or weaken them?

 

The other thing that comes to mind is that a lot of the doctors in the

acupuncture dept at my hospital say that good supplementing technique

is more difficult than draining technique. Thus, many of us with only

modest needling skill may have difficulty achieving really good

supplementing technique, whereas we easily can do decent draining

techniques.

 

Intense stimulation (via needle manipulation and lots of needles)

tends to be draining and mild stimulation tends to be supplementing.

This is a standard and accepted aspect of needle technique. This

variable could be another factor in some of what we see.

 

Personally, I find that I feel just about right with a 20 minute

retention on each side. At the hospital where I am, all the

outpatients retain their needles for 20 minutes, while the inpatients

upstairs (the ones in comas, with pneumonia, hypoxia, etc) get 45

minute retention times. 20 minutes seems generally appropriate, not

long enough to make the person get restless but sufficient to let the

effect kick in.

 

Steven Slater has pointed out a reference to duration of treatment in

Fundamentals of Chinese Acupuncture. There is a chart discussing

classical factors influencing supplementing and draining that lists

shorter duration of treatment with supplementing and longer duration

of treatment with draining. We are working to track down the source

text for this (Nigel is out of town) to follow up on it. The

discussion surrounding this chart (which also references such things

as the twirling 6 times vs 9 times, etc) state that most of these

factors are considered by modern doctors to be rooted in superstition

and not useful clinically. The fact that none of the modern Chinese

doctors that I know here have heard of this, in conjunction with its

marked absence in several major Chinese texts on supplementing vs

draining needle techniques (including a big book on 120 methods of

needle technique), as well as its absence in the Zhong Yi Da Ci Dian

entry on needle retention, all makes me conclude that the Chinese do

not consider modest differences in needle retention times to be of

clinical significance where supplementing and draining are concerned.

Certainly whatever classical reference provided the Fundamentals

source was not written by someone with a stopwatch, so its relevance

to our modern 20 minute milestone is hard to determine. Big thanks to

Steven for finding a reference for further investigation!!!!

 

I still do not think that mixing our Western concept of sedation with

the TCM concept of draining an acupoint is a good idea.

 

Eric

[Guest guest]

>

>

> On Behalf Of Eric Brand

> Monday, June 27, 2005 8:43 AM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> , " "

> <@c...> wrote:

> > [Jason]

> > Eric,

> >

> > I think you bring up an interesting question...But I don't find it that

> > confusing (or should I..? I am still thinking about it...) I.e. If the

> > patient leaves completely sedated! and tired then what should I conclude

> > about the treatment...? To turn this around, I would ask, " how would

> > supplementing the channels create this??? "

> > I would conclude that whatever I did was a draining or sedating

> treatment

> > (Call it what you will)... If IT drained the channels (or whatever)

> I gauge

> > it on the effect, meaning how they feel... I have left needles in

> too long

> > and zonked people out for days.. (I am not proud of this, but it is

> > something one must pay attention to, at least in my experience)... I

> would

> > not call this supplementing... I consider a supplementing treatment

> when the

> > person gets off the table and feels good, not like a zombie, or within a

> > very short amount of time they perk up... It is easiest to see such

> > differences in treatment times with really deficient patients... For

> some

> > patients just putting in a needle for 5 minutes is tooo much... I have

> > concluded that too many needles and too long can ZAP someone's

> ENERGY! That

> > to me seems like it is NOT supplementing - So you can give it a

> name...I am

> > fine with sedating or draining... So I don't have a primary or even

> > secondary source, but I find that this phenomenon in the clinic is

> pretty

> > clear... but I will think about it some more...

> > Finally maybe there is some difference between whole body effect and

> > specific channel effect that you are after... I.e. will someone with an

> > acute bladder infection, which is purely EXCESS, respond better to

> leaving

> > the needles in longer or does time not matter... That seems like it

> might be

> > a different question and one that I cannot answer...

> >

> > -Jason

>

> I don't really have a conclusive answer to this anymore than you do.

> However, two things come to mind. The first is that many patients

> with significant vacuity are lacking in sleep and restoration time.

> When you get them melting into the table, their mind gets a chance to

> turn off and rest. If they fall asleep for 30 minutes of restorative

> sleep, did you strengthen them or weaken them?

[Jason]

Eric,

 

That is a totally different phenomenon.. I am talking about a patient who

leaves feeling not like they got restorative sleep, but are more tired and

Zombified than previous to getting the tx...

But more importantly, IMO there is no set rules, everyone is different... 30

min for 1 person maybe sedating / draining and 30 min for another maybe

restorative... One must consider the individual and evaluate on a case by

case basis... I have a hard time excepting generalizations as GOSPEL because

of this, but they do give us guidelines.. My observation, is that more

(needles, time etc) is most likely to be sedating / draining...

 

-Jason

[Guest guest]

A very important issue in acupuncture as in herbal medicine is

dosage. In every case, the practitioner needs to calibrate needle

gauge and depth, use of moxa, number of points/holes chosen, needle

stimulus, and length of treatment. This is determined by patient's

constitution, age, pattern differentiation, psyche (for example

needle fear), season, climate, time of day/month and other factors.

 

This is the main constant in acupuncture

treatment. . .individualizing treatment based on these complex

factors in every case and in every treatment.

 

 

On Jun 27, 2005, at 11:33 AM, wrote:

 

> But more importantly, IMO there is no set rules, everyone is

> different... 30

> min for 1 person maybe sedating / draining and 30 min for another

> maybe

> restorative... One must consider the individual and evaluate on a

> case by

> case basis... I have a hard time excepting generalizations as

> GOSPEL because

> of this, but they do give us guidelines.. My observation, is that more

> (needles, time etc) is most likely to be sedating / draining...

 

 

 

 

[Guest guest]

>

>

> On Behalf Of

> Monday, June 27, 2005 12:38 PM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> A very important issue in acupuncture as in herbal medicine is

> dosage. In every case, the practitioner needs to calibrate needle

> gauge and depth, use of moxa, number of points/holes chosen, needle

> stimulus, and length of treatment. This is determined by patient's

> constitution, age, pattern differentiation, psyche (for example

> needle fear), season, climate, time of day/month and other factors.

>

> This is the main constant in acupuncture

> treatment. . .individualizing treatment based on these complex

> factors in every case and in every treatment.

[Jason]

Very well said.. It seems like the modern China trend is a gross

oversimplification off all of this... (This is also happening with herbalism

as Bob presented previous...)

 

I would like to present a Rx that was given to a 9 year old boy for enuresis

that came from a supposedly well respected doctor at a Beijing Hospital...

To me this Rx is completely insane and the way I read it is, a lack of focus

on pathomechanisms, over emphasis on symptom control, as well as trying to

address too much at once... comments?- Mine is ugly... BTW - this is 1 day

dose!!!

 

zhen zhu mu 30

shenglonggu 25

shengmuli 25

wubeizi 10

danshen 15

cundong 15

dashouwu 25

wuweizi 10

sangpiaoxiao 15

lianxu 10

lianxin 3

baiguo 12

shanyurou 20

jinyingzi 10

buguzhi 10

gouji 15

baji 10

fupenzi 15

yizhiren 10

yuanzhi 10

shichangpu 10

chaozaoren 25

 

The Rx has not worked to date (I think 4 weeks??), but the Mom mentions that

the boy is so well behaved; he does whatever I tell him... Funny eh?? Can

you say SEDATION! 330 grams a day... (I think they are doing 1 bag for every

2 days) -

 

-Jason

 

 

>

>

> On Jun 27, 2005, at 11:33 AM, wrote:

>

> > But more importantly, IMO there is no set rules, everyone is

> > different... 30

> > min for 1 person maybe sedating / draining and 30 min for another

> > maybe

> > restorative... One must consider the individual and evaluate on a

> > case by

> > case basis... I have a hard time excepting generalizations as

> > GOSPEL because

> > of this, but they do give us guidelines.. My observation, is that more

> > (needles, time etc) is most likely to be sedating / draining...

>

>

>

>

[Guest guest]

On Jun 26, 2005, at 8:42 AM, Eric Brand wrote:

 

> We should

> examine the veracity of this [needle insertion time] belief before

> assuming that it is true.

 

Reuters.com is reporting today on a study that looks at consumers'

misconceptions regarding cancer myths. Kind of the same topic,

really. Misconceptions, Myths, Mistranslation.

 

http://www.reuters.com/newsArticle.jhtml?type=healthNews & storyID=8905102

 

or search for " cancer myth " in the http://reuters.com search box.

 

--

 

Pain is inevitable, suffering is optional.

[Guest guest]

Jason,

I've also seen some enormous prescriptions in Chinese journal

articles in the past (there are some huge ones in some old ACTCM

journals I have). This prescription looks to me like the physician

is 'shot-gunning' it, large dosages of astringing medicinals and

warming yang medicinals. The CM equivalent of allopathic treatment

seems to be to use large numbers of medicinals in a single category

in large doses.

 

 

On Jun 27, 2005, at 11:58 AM, wrote:

 

>

>

>

>>

>> A very important issue in acupuncture as in herbal medicine is

>> dosage. In every case, the practitioner needs to calibrate needle

>> gauge and depth, use of moxa, number of points/holes chosen, needle

>> stimulus, and length of treatment. This is determined by patient's

>> constitution, age, pattern differentiation, psyche (for example

>> needle fear), season, climate, time of day/month and other factors.

>>

>> This is the main constant in acupuncture

>> treatment. . .individualizing treatment based on these complex

>> factors in every case and in every treatment.

>>

> [Jason]

> Very well said.. It seems like the modern China trend is a gross

> oversimplification off all of this... (This is also happening with

> herbalism

> as Bob presented previous...)

>

> I would like to present a Rx that was given to a 9 year old boy for

> enuresis

> that came from a supposedly well respected doctor at a Beijing

> Hospital...

> To me this Rx is completely insane and the way I read it is, a lack

> of focus

> on pathomechanisms, over emphasis on symptom control, as well as

> trying to

> address too much at once... comments?- Mine is ugly... BTW - this

> is 1 day

> dose!!!

>

> zhen zhu mu 30

> shenglonggu 25

> shengmuli 25

> wubeizi 10

> danshen 15

> cundong 15

> dashouwu 25

> wuweizi 10

> sangpiaoxiao 15

> lianxu 10

> lianxin 3

> baiguo 12

> shanyurou 20

> jinyingzi 10

> buguzhi 10

> gouji 15

> baji 10

> fupenzi 15

> yizhiren 10

> yuanzhi 10

> shichangpu 10

> chaozaoren 25

>

> The Rx has not worked to date (I think 4 weeks??), but the Mom

> mentions that

> the boy is so well behaved; he does whatever I tell him... Funny

> eh?? Can

> you say SEDATION! 330 grams a day... (I think they are doing 1 bag

> for every

> 2 days) -

>

> -Jason

>

>

>

>>

>>

>> On Jun 27, 2005, at 11:33 AM, wrote:

>>

>>

>>> But more importantly, IMO there is no set rules, everyone is

>>> different... 30

>>> min for 1 person maybe sedating / draining and 30 min for another

>>> maybe

>>> restorative... One must consider the individual and evaluate on a

>>> case by

>>> case basis... I have a hard time excepting generalizations as

>>> GOSPEL because

>>> of this, but they do give us guidelines.. My observation, is that

>>> more

>>> (needles, time etc) is most likely to be sedating / draining...

>>>

>>

>>

>>

>>

[Guest guest]

, " "

<zrosenbe@s...> wrote:

> This is the main constant in acupuncture

> treatment. . .individualizing treatment based on these complex

> factors in every case and in every treatment.

 

Z'ev has hit the nail on the head here when it comes to actual

practice. My intention of bringing up this subject was to point out

that many practitioners in the West tend to be fervently bound to the

concept that there is a dramatic difference in treatment effect

between 18 minutes and 28 minutes. The Chinese view is less extreme,

and people tend not to think that a supplementing treatment will be

ruined by the difference in 10 extra minutes of retention.

Different patients have different responses and different needs- this

a subject upon which we all agree. I was just trying to illustrate

the fact that some things that are presented as gospel in Western

education are not necessarily representative of the standard CM

viewpoints.

 

Eric

[Guest guest]

Like I tell my students... Why use one herb when three herbs will do just as

well?

doug

 

 

 

, " " <zrosenbe@s...>

wrote:

> Jason,

> I've also seen some enormous prescriptions in Chinese journal

> articles in the past (there are some huge ones in some old ACTCM

> journals I have). This prescription looks to me like the physician

> is 'shot-gunning' it, large dosages of astringing medicinals and

> warming yang medicinals. The CM equivalent of allopathic treatment

> seems to be to use large numbers of medicinals in a single category

> in large doses.

>

>

> On Jun 27, 2005, at 11:58 AM, wrote:

>

> >

> >

> >

> >>

> >> A very important issue in acupuncture as in herbal medicine is

> >> dosage. In every case, the practitioner needs to calibrate needle

> >> gauge and depth, use of moxa, number of points/holes chosen, needle

> >> stimulus, and length of treatment. This is determined by patient's

> >> constitution, age, pattern differentiation, psyche (for example

> >> needle fear), season, climate, time of day/month and other factors.

> >>

> >> This is the main constant in acupuncture

> >> treatment. . .individualizing treatment based on these complex

> >> factors in every case and in every treatment.

> >>

> > [Jason]

> > Very well said.. It seems like the modern China trend is a gross

> > oversimplification off all of this... (This is also happening with

> > herbalism

> > as Bob presented previous...)

> >

> > I would like to present a Rx that was given to a 9 year old boy for

> > enuresis

> > that came from a supposedly well respected doctor at a Beijing

> > Hospital...

> > To me this Rx is completely insane and the way I read it is, a lack

> > of focus

> > on pathomechanisms, over emphasis on symptom control, as well as

> > trying to

> > address too much at once... comments?- Mine is ugly... BTW - this

> > is 1 day

> > dose!!!

> >

> > zhen zhu mu 30

> > shenglonggu 25

> > shengmuli 25

> > wubeizi 10

> > danshen 15

> > cundong 15

> > dashouwu 25

> > wuweizi 10

> > sangpiaoxiao 15

> > lianxu 10

> > lianxin 3

> > baiguo 12

> > shanyurou 20

> > jinyingzi 10

> > buguzhi 10

> > gouji 15

> > baji 10

> > fupenzi 15

> > yizhiren 10

> > yuanzhi 10

> > shichangpu 10

> > chaozaoren 25

> >

> > The Rx has not worked to date (I think 4 weeks??), but the Mom

> > mentions that

> > the boy is so well behaved; he does whatever I tell him... Funny

> > eh?? Can

> > you say SEDATION! 330 grams a day... (I think they are doing 1 bag

> > for every

> > 2 days) -

> >

> > -Jason

> >

> >

> >

> >>

> >>

> >> On Jun 27, 2005, at 11:33 AM, wrote:

> >>

> >>

> >>> But more importantly, IMO there is no set rules, everyone is

> >>> different... 30

> >>> min for 1 person maybe sedating / draining and 30 min for another

> >>> maybe

> >>> restorative... One must consider the individual and evaluate on a

> >>> case by

> >>> case basis... I have a hard time excepting generalizations as

> >>> GOSPEL because

> >>> of this, but they do give us guidelines.. My observation, is that

> >>> more

> >>> (needles, time etc) is most likely to be sedating / draining...

> >>>

> >>

> >>

> >>

> >>

[Guest guest]

>

>

> On Behalf Of Eric Brand

> Tuesday, June 28, 2005 12:09 AM

>

> Re: Supplementing vs Draining Acupuncture Technique and

> Needle Retention

>

> , " "

> <zrosenbe@s...> wrote:

> > This is the main constant in acupuncture

> > treatment. . .individualizing treatment based on these complex

> > factors in every case and in every treatment.

>

> Z'ev has hit the nail on the head here when it comes to actual

> practice. My intention of bringing up this subject was to point out

> that many practitioners in the West tend to be fervently bound to the

> concept that there is a dramatic difference in treatment effect

> between 18 minutes and 28 minutes. The Chinese view is less extreme,

> and people tend not to think that a supplementing treatment will be

> ruined by the difference in 10 extra minutes of retention.

> Different patients have different responses and different needs- this

> a subject upon which we all agree. I was just trying to illustrate

> the fact that some things that are presented as gospel in Western

> education are not necessarily representative of the standard CM

> viewpoints.

[Jason]

Before we bash the WEST, let us step back.. First of all I still say

that in general longer retention times are relatively more sedating /

draining. And I do not find it presented as Gospel... It is a guideline

like everything else...Education in general, even in China, starts out with

'statements of facts' or 'truths' from a bad teacher and 'guidelines' or

'ideas' from a good teacher, or a smart student who sees through it...

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.

But to pontificate a moment on who is more extreme, the amalgamation

of acupuncture that has emerged in the West I find much more 'true' to the

medicine (flexible, creative etc)than what I have seen from Chinese

Practitioners (in the West) / Taiwanese Doctors and represented in the

Chinese journals (In general of course, there will always be exceptions, but

I have actually never found / met 1 Chinese exception yet) - Meaning modern

TCM that I have witnessed (for acupuncture) seems to make use of such a

cookbook style and somewhat ignore the individual - Purely based on patterns

or chief complaints. I have never seen one journal article talk about

modifying the acupuncture for the individual. " They " systematize the

protocol and apply it over a large population (for better or worse)... When

in Taiwan, patients clearly got the 'standard protocol' for whatever their

complaint was... In the west, and I think mainly because of the Japanese

acupuncture influence, I see many more practitioners that really modify

there acu ideas based on the individual. This is coupled with the fact that

we have more time with each patient. For example one will modify the pulse

and actually see when the needles have been in too long etc... (this is all

for better or worse)...Meaning if one can see 10 people in 1 hour and get 5

of them better, where I can only see 1-2 hour and lets say I get 100% of

them better... Who is helping more people??? Quality vs. Quantity...

I would love to hear others comments about this, because I am sure

others have experienced things differently, and I am sure I have been

heavily influenced by some really good Western Practitioners that I have

come into contact with...

 

-

 

 

>

> Eric

>

>

>

>

> 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

For example one will modify the

> pulse

> and actually see when the needles have been in too long etc... (this

> is all for better or worse)...

[Jason]

This should read " ...modify treatment BASED on the pulse to gauge how

long to retain needles " or something of that nature...

Furthermore, it is interesting that many Chinese Doctors that I have

met have said that here in the US they have much more freedom to

practice the 'real' CM (in reference to herbs), because in China they

have many many constraints... I don't see why acu would be any

different. If one is seeing 20 people an hour (which BTW does little

to impress me) what can one expect??

 

-

[Guest guest]

I've also seen some enormous prescriptions in Chinese journal

articles in the past (there are some huge ones in some old ACTCM

journals I have).

>>>>I think i shared this in the past, but by far the most popular OLD Dr in the

hospital I worked in in china used such huge formulas all the time. as i said

before it was impossible for me to make sense of them based on what we know as

TCM. People claimed he got the best results and he saw at least 300 patients per

morning.

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

To further elaborate with an actual source: (from Oriental Medical Journal)

Japan presented by Inoue Keiri reprinted in Koei’s book:

 

" If needles are retained too long, ki [qi] will be lost rather than gathered... "

 

So call it draining, sedating, urban myth or whatever, there are REAL pros that

think leaving needles in too long is depleting, meaning qi is lost not

supplemented... Do others read this differently??

 

Furthermore,

" as was previously mentioned, a major concern in acupuncture is determining the

depth of the needle insertion and long to needle. This is difficult to

determine without being able to sense the arrival of ki. Yet, this skill is one

of the most important mysteries that lie at the heart of the ART, and as such is

a topic that acupuncture practitioners must spend a lifetime studying. "

 

In general I have found Japanese or meridian style practioners much better at

able to feel qi, whatevet that is… Others?

 

-

 

----

> " "

> Re: Supplementing vs Draining Acupuncture Technique and Needle

Retention

> 28 Jun 2005 15:28:19

>

> >

> >

> > On Behalf Of

> For example one will modify the

> > pulse

> > and actually see when the needles have been in too long etc... (this

> > is all for better or worse)...

> [Jason]

> This should read " ...modify treatment BASED on the pulse to gauge how

> long to retain needles " or something of that nature...

> Furthermore, it is interesting that many Chinese Doctors that I have

> met have said that here in the US they have much more freedom to

> practice the 'real' CM (in reference to herbs), because in China they

> have many many constraints... I don't see why acu would be any

> different. If one is seeing 20 people an hour (which BTW does little

> to impress me) what can one expect??

>

> -

>

>

>

>

>

> 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]

Alon,

 

And what did you see as far as results??? I know that you are always

skeptical (as am I) of any such claims... WHen I personally have seen

such large formulas, they either work, or they make the person sick

(Side-effects big time).. what is your observation?

 

-

 

, " "

<alonmarcus@w...> wrote:

> I've also seen some enormous prescriptions in Chinese journal

> articles in the past (there are some huge ones in some old ACTCM

> journals I have).

> >>>>I think i shared this in the past, but by far the most popular

OLD Dr in the hospital I worked in in china used such huge formulas

all the time. as i said before it was impossible for me to make sense

of them based on what we know as TCM. People claimed he got the best

results and he saw at least 300 patients per morning.

>

>

>

>

> Oakland, CA 94609

>

>

>

[Guest guest]

, " "

<@c...> wrote:

> [Jason]

> Before we bash the WEST, let us step back..

 

There are a number of things that we do well in the West. We are very

good at therapy and Western practitioners often have a very good

bedside manner and give very personal care to their patients. This is

partially influenced by the more readily-emotional style of

communication prominent in Western society as well as the fact that

most patients pay practitioners 15-30 times as much per treatment.

Getting $60 a pop gives us a much more luxurious amount of time to

spend with our patients, and it benefits them (except financially)

while giving us a much nicer pace for our workday. We are able to

form very personal relationships with our patients and we often get to

know them very well in the process of treatment. There are many

upsides to the Western world of CM and arguably several areas where we

excel compared to our Chinese colleagues. 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.

 

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?

 

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.

 

> 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. 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.

 

> But to pontificate a moment on who is more extreme, the amalgamation

> of acupuncture that has emerged in the West I find much more 'true'

to the

> medicine (flexible, creative etc)than what I have seen from Chinese

> Practitioners (in the West) / Taiwanese Doctors and represented in the

> Chinese journals (In general of course, there will always be

exceptions, but

> I have actually never found / met 1 Chinese exception yet) - Meaning

modern

> TCM that I have witnessed (for acupuncture) seems to make use of such a

> cookbook style and somewhat ignore the individual - Purely based on

patterns

> or chief complaints.

 

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. There is nothing I can say to this except

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.

Some of the most creative and brilliant minds in Chinese medicine

are Chinese. 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.

 

Eric

[Guest guest]

, " "

<@c...> wrote:

> Furthermore, it is interesting that many Chinese Doctors that I have

> met have said that here in the US they have much more freedom to

> practice the 'real' CM (in reference to herbs), because in China they

> have many many constraints...

 

????? The " real " CM is not practiced in China? Doctors don't have the

freedom to write prescriptions as they choose? You really should try

going to China, you might be surprised.

 

> I don't see why acu would be any

> different. If one is seeing 20 people an hour (which BTW does little

> to impress me) what can one expect??

 

Doctors who see huge patient loads do so because they become famous

from their success and are in very high demand. In Taiwan, they could

elect to only treat the wealthy by moving to private clinics, and some

do. No one likes to see a high volume of patients and everyone agrees

that it is far from optimal for patient care. But clinically

successful doctors must choose between turning away people in need or

fitting them all in somehow.

 

Eric

[Guest guest]

----

> " Eric Brand " <smilinglotus

> Re: Supplementing vs Draining Acupuncture Technique and Needle

Retention

> 28 Jun 2005 18:16:09

>

> , " "

> <@c...> wrote:

> > Furthermore, it is interesting that many Chinese Doctors that I have

> > met have said that here in the US they have much more freedom to

> > practice the 'real' CM (in reference to herbs), because in China they

> > have many many constraints...

>

> ???? The " real " CM is not practiced in China? Doctors don't have the

> freedom to write prescriptions as they choose? You really should try

> going to China, you might be surprised.

 

Hey I am just repeating what CHINESE doctors that have worked in Chinese

hospitals for years say (here in the US)... Take it any way you like, but I get

what they are saying... You can argue with them... I personally have no desire

to study acupuncture in China, I prefer Japan... I have never been that

impressed with Chinese Style acupuncture.. granted maybe I have not met the

right Chinese teachers, but from what I have seen from Chinese practitioners

here and in Taiwan they do not impress me... and as for Herbal Rx's I prefer

Taiwan... So at the moment I see no need to explore the Chinese hospitals, but

maybe my mind will change. Have you Eric, studied in the Chinese hospitals and

found things different?? Alon, has always expressed lack of amazement from his

experiences in the hospitals, would Alon like to chime in??? Most students I

have talked with that have studied in Chinese Hospitals have not been that

impressed… Do others have comments about the acupuncture practiced there?\

 

>

> > I don't see why acu would be any

> > different. If one is seeing 20 people an hour (which BTW does little

> > to impress me) what can one expect??

>

> Doctors who see huge patient loads do so because they become famous

> from their success and are in very high demand. In Taiwan, they could

> elect to only treat the wealthy by moving to private clinics, and some

> do. No one likes to see a high volume of patients and everyone agrees

> that it is far from optimal for patient care. But clinically

> successful doctors must choose between turning away people in need or

> fitting them all in somehow.

>

There are plenty of doctors in hospitals that see many many patients that are

not famous, nor that great...

 

-Jason

[Guest guest]

And what did you see as far as results??? I know that you are always

skeptical (as am I) of any such claims... WHen I personally have seen

such large formulas, they either work, or they make the person sick

(Side-effects big time).. what is your observation?

>>>>Because i could no make sense of the formulas and i was not allowed to ask

questions (by the way even chinese interns were not allowed to ask questions) i

did not spend much time, so i cant answer your question. I could not reliable

information when i asked other doctors about him because there was a lot of

emotional baggage in the hospital around this Dr.

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

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]

Alon, has always expressed lack of amazement from his experiences in the

hospitals, would Alon like to chime in??? Most students I have talked with that

have studied in Chinese Hospitals have not been that impressed. Do others have

comments about the acupuncture practiced there?\

>>>>>>>

My experience is 20 years old, i hear things have changed a lot in china. Also,

last year when i was in Taiwan i saw a couple of very famous Dr seeing lots of

patients and no one can tell me they got good results. I know Dr reputation is

not always based on clinical skills. This is true in the US as well as in china

and Taiwan.

 

 

 

 

Oakland, CA 94609

 

 

 

[Guest guest]

----

> " 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