When I was a student over 25 years ago there were very few books about acupuncture and certainly no websites or apps. One college in particular was very sniffy about any kind of technology being applied to it suggesting that do do so would in some way obstruct the “purity” of treatment and the flow of Qi. We were even discouraged from much needle practice on the basis that inserting needles without assessing a persons case and the state of their Qi might be harmful. But we have moved on a long way since then. Acupuncture has become much more popular and accepted and it is generally recognized that there are many different ways to do it. Recently one of my graduates recommended an app called TCM clinic aid, its one of many available but has the advantage that it only costs £15. In my view this is welcome, it enhances our potential and does not turn us into acupuncture robots as some may fear. We were treating in the student clinic this week for example: we had taken a case, made a diagnosis and selected points. When we put one of the patients main concerns “belching” into the app it suggested points we had not considered. This set us off on a train of thought in addition to what we had so far considered and stimulated a broader and more comprehensive consideration of the condition and the options.
When you mention acupuncture most people think of China but that is not the whole story. In 1991 the mummified body of “Otzi the Iceman” a five thousand year old Neolithic hunter was discovered on the mountainous boarder between Switzerland and Italy. He appeared to have tattoos or burn marks on his back indicating that some kind of treatment had been applied. These marks were at a point we now know as Bladder 23, it is a point still considered useful for back pain. The Chinese Medicine theory we have fully translated has been described to me as the tip of the iceberg but there is a landmark reference book known as “The Yellow Emperors Classic of Internal Medicine”. It was written in about 2000BC and is a definitive work generally considered to be the source of most contemporary theory. However, it was not written until approximately a thousand years after the iceman died. So it seems clear that the origin of using needles or heat to treat acupuncture points goes way back into human history. We don’t know who actually did it for the first time, where they were, or even how they developed the idea. But what we can reasonably assume about medical care throughout the ancient world is that it was localised. There was no Internet or any other realistic means of wide communication and healers in different regions would probably practice according to their own traditions. This would have reflected their local environment and the characteristics and requirements of the people. For example, it seems likely that moxabustion was first used in colder places. Chinese Medicine (CM) therefore developed all over a vast continent and over an extended period of time. It is also clear that there are many similarities to both Tibetan and Indian traditions and that Japan and Korea have had a big influence on modern practice as well. If you read the Yellow Emperors Classic (and unless you read ancient Chinese characters it will be a translation of course) you will find that it speaks in an unfamiliar and poetic language. It speaks of living with the environment, the changing seasons, the climate and the Dao. The book takes the form of a dialogue between the Emperor and Chi-Po his medical advisor and it is very much a reflection of its time and culture. We may assume that what we are learning now is “Chinese Medicine” but actually it must be only a selective and interpreted sample of some of it. Sometimes it is difficult to relate what Chi-Po says to what patients want and need in the treatment room today because so much has changed in four thousand years. The classic does not mention electricity, geopathic stress, antibiotics, sugar, meeting deadlines, Catholicism, cannabis or atmospheric pollution. So although it is accepted that the book records the origin of the theory it has still to be seen as only a guide to what we do in a modern context. Some of it will have been lost in translation and there must have been lots that didn’t get recorded for all kinds of reasons. Consideration must be given to issues like politics, power struggles, levels of literacy and the role of religion. We really don’t know how life and practice actually was for the acupuncturists of the past but we can speculate about it. For them the time was now as it is for us and although human nature may not have changed much it seems clear that many other things have.
Traditional methods brought from all over the East and recently revived and modified in the West bring us to the current situation. We are in fact using a combination of different ideas, theories and protocols and this is probably as it has been for centuries. The evolutionary changes have never stopped and it seems clear that CM has been continuously revised and re-invented. I believe we should not be afraid to push forward the process of the evolution of acupuncture to adapt it to a modern context. We should not allow ourselves to be constrained by rules or traditions if we see no benefit. If we find that what we have read and been shown is working well then we can use it. But if something seems unnecessary or we have an easier and more effective alternative then lets use that. Traditions are useful up to the point that they stifle creativity and innovation at which point they can actually become repressive. When I was a student some of my teachers inadvertently convinced me that there were rules or laws about acupuncture. But now I know that beyond sensible health and safety practice there are not. I prefer to call what we do Modern Acupuncture because I think this is a more accurate description of what it actually is. Despite the fact most acupuncturists like to call themselves traditional and will disagree with that, there are probably just a few things that 90% of them would agree about:
1, Acupuncture recognises the presence of Qi running through a system of meridians in the body.
2, Qi can be accessed by using needles at places along those meridians called acupuncture points.
3, The purpose of acupuncture is to rebalance Qi and promote holistic healing.
4, Acupuncture can be a spiritual practice.
5, Acupuncture is not well suited to scientific evaluation.
The other 10% would be those who do what we call Dry Needling or Medical Acupuncture. There are various systems of acupuncture acceptable to science and evidence based research. They are perfectly workable and reasonable and benefit patients every day, but they are not the subject of this discussion. However even though the theories medical acupuncturists are using may be very different to those we are discussing here many of the observations will still apply.
First and best known of the alternative medicine theories is what is called Traditional Chinese Medicine (TCM). Most colleges teach this and most acupuncture books are written about it. What we are calling TCM was essentially invented in the 1960’s when Chairman Mao demanded the establishment of a standard. It seems almost certain that during that process much was lost, ignored or not collected from the far corners of the country. TCM is therefore a rationalised and restructured sample of Chinese philosophy, traditions and theories. The system uses theoretical standardised patterns of disharmony of the organs to make a diagnosis. In very simple terms you learn to recognise syndromes and what combination of syndromes are present.
One key problem with TCM theory is that it lends itself to herbal medicine more than it does to acupuncture. Herbal medicine tends to be about the effect of nutrition (herbs) on the organs, whereas acupuncture is about Qi running through the meridian system. These things are related but they are not the same. This contradiction has even prompted one expert to say that most TCM has no relevance to acupuncture at all. I think it is quite a revelation that colleges all around the world are teaching TCM theory to acupuncturists when it is almost irrelevant. And how can you call a fifty year old methodology traditional anyway, shouldn’t it be called MCM? Despite this we still teach basic TCM because it is useful and it is the standard system used everywhere. It is a good starting point because you can work with a formula or a very simple interpretation of the original theory. This builds comprehension and confidence while students find their feet. More on this anomaly later when we discuss how and why acupuncture works.
The other popular theoretical perspective that you will hear a lot about is “Five Element Acupuncture” (5E). This is an idea that confuses the Chinese because five elements theory is part of TCM and it is used extensively in Japan and elsewhere. You might even say that TCM was created by one mans directive and 5E on another mans whim. His name was Jack Worsley and he was an Englishman who travelled to Korea and Japan in the 1960’s. He put together various ideas and techniques that he learned and founded one of the first acupuncture colleges in the UK. His style of 5E talks about Qi in that some of the techniques are directly Qi related. For example the akabani test which is a method of checking the balance of Qi in the meridians. But he also incorporated other traditional methods like the possession treatment, which is an updated version of an ancient ritual best classified as demonology. The main emphasis of 5E is customarily in diagnosing according to observing the nature of the five elements reflected in a person. This is done by observing colour, sound, odour and emotion (CSOE) and then using those observations to establish which element is key. However in my view the consultations usually focus most attention on emotion and building rapport by understanding emotional responses. What the system does well is to speak a language Westerners understand and can relate to through their own feelings and life experience. It seems to be about people rather than their signs and symptoms of illness and this is the main difference. Many people in the field of alternative healthcare use the term Mind/Body/Spirit omitting to mention emotion. But emotion is the key and we find that we return to it again and again as we seek to understand the process of acupuncture and its healing potential. Our lives are all about emotion and it is through emotions or feelings that we find ways to access a higher vibration. We can give that higher vibration various names such as Spirit, God or Dao as best suits us, I’m calling it Consciousness most of the time. 5E also includes certain protocols you will not find in TCM and some of these like the Aggressive Energy drain (AE) and Possession treatment can be really useful in their own right. No system is perfect but understanding and emphasising the role of emotion was Worsleys great contribution to acupuncture.
A practitioner I know uses the possession treatment a lot, probably on about 20% of his patients. It works well and he see’s possession quite often especially as a consequence of relationship breakdown. According to the signs and symptoms associated with a diagnosis of possession it must be treated before any other treatment can take place. This is because possession is a block to other treatment working and it must be cleared. In one college where I worked we did not teach possession, so obviously we never diagnosed or treated it. This must mean that lots of possessed people treated by acupuncturists who don’t have this protocol as part of their repertoire are treated while still possessed. Or does it, does possession exist or does it only exist for practitioners who are looking for it? Or is it that people sometimes treat possession without recognising it as such or calling it possession? In any event there is no doubt that some amazing results can come from possession treatment. Just as some amazing results can come from all kinds of acupuncture treatment.
Qi is energy, so it influences everything since everything can be described in terms of energy. Some people theorise that to practice acupuncture you have to have good Qi yourself. This seems to make sense and it is why people sometimes spend years doing martial arts like Qi-Gong to develop their Qi. It is impressive to see the power that a good Tui-Na or martial arts practitioner has to direct Qi as they wish. This cultivation of Qi would appear to be fundamental to a healing modality that appreciates the nature of energy in the body. That may seem obvious but is it right? I have a story that suggests that Qi may not always be exactly as expected:
A friend of mine had terrible problems with a mysterious and incurable condition lasting for fifteen years or more. At one time he had been hospitalised and close to death with searing pain in all his joints. He had been treated with steroids that saved his life but was still in a lot of pain with quite limited mobility. He was passed from specialist to specialist and received all the NHS could offer. Most of the people had been lovely but it was one of those cases where the bottom line truth was that no one had a clue what to do with him. He finally gave up on them when he was prescribed drugs that almost drove him to suicide. Then a course of treatment from an alternative herbal specialist damaged his Liver and made him even worse. Kinesiology, hypnotherapy and Emotional Freedom Technique had helped temporarily but acupuncture had not. One acupuncturist had said it was necessary to see him three times a week for three months. At the end of the time she had said that although there was no change in his symptoms his pulse was improving! He had walked away destitute having spent all his savings and then run up a debt. He was so desperate for help he still tried acupuncture again but this time from a Chinese practitioner someone recommended.
The room was cold and the practitioner was frail and appeared to be ill. My friend lay shivering on the couch wondering why he had listened to the person who had referred him. The practitioner even had to leave the room at one point and he could hear him coughing outside. But when it came to the actual treatment the Qi sensation he experienced was something special. The practitioner used the same common points as everybody else (the ones you will be using) but seemed able to do something different with them. My friend described the needling as painless but that he could feel the warm, dynamic, healing Qi coursing through his body. I wont pretend that the treatment cured him because that is another story, but it did offer relief of symptoms in a way that nothing else had. So if you do need good Qi to practice acupuncture we probably need to redefine what good Qi is. It seems that the nature of Qi may sometimes be dependent upon things other than traditional Qi cultivation methods. It is not as simple as to say there is only one way or type of Qi or one way of developing it. Qi is a mysterious form of healing energy and the forms it can take are ultimately indefinable and infinite. Certainly the idea proposed by some people that practitioners always need to be physically, mentally and emotionally balanced people does not hold true at all in my experience. If it did half the practitioners I know would have to retire.
Jack Worsley was described by one observer as: “The greatest shamanic healer I have ever seen”. He went on to suggest that he may in fact have been relying upon his Christian faith and beliefs more than his acupuncture ones. We don’t know how much of what he was doing was acupuncture and how much was something else. But what we do know is that the system of acupuncture he created still works well and has many devotees. So whether he was more Shaman, Priest or Acupuncturist does not seem to matter when others use his methods that are still very real to them.
Dr Van Buren founded The International College of Oriental Medicine in East Grinstead (ICOM) where students had the opportunity to observe his clinic. Sometimes he would use unusual methods like horoscopes and charts to plan his treatments. This is a method known as Stems and Branches and it draws upon another rich vein of Chinese theory and philosophy that is not mainstream. Occasionally he would even look at the charts and decide which points he was going to use before the patients arrived. One time he did this and said it was a day when acupuncture was forbidden. I asked what he was going to do and with a little smile he said he would use moxa. He didn’t, he used acupuncture as normal and it still seemed to be effective. So he must have had more than one theory and methodology at his disposal. It seems that so long as you have a system of practice available you can use one in place of another as it suits you. There is never only one way to do an acupuncture treatment even when the alternatives contradict one another. Some of the students and staff at ICOM were of the view that Van Buren was also drawing upon his shamanic abilities. He was certainly a man of mystery and you never knew quite what he was up to.
A colleague of mine went to China and spent quite a time in conversation with one of the doctors there. She had noticed that almost every patient seemed to be treated using an acupuncture point on the ankle known as Ki3. So when they came to discuss a case she thought she could show him how well she understood Chinese Medicine. He listened and nodded politely as she explained in detail why she had chosen Ki6 (also on the ankle) as an ideal alternative point for one patient. He agreed that she had made a really good case for it using sound CM theory. Then he carried on and used Ki3 after all. It seems that with all his experience he could do everything he wanted to do with Ki3, even when there was a good case to be made for Ki6 being a better option.
I once found myself in the unfortunate position of being employed to teach acupuncture to a group of people who already had their own theoretical viewpoint. They were members of a cult like organisation with a leader who had suggested that they learn from me (I don’t know why). The situation was very difficult because they were uninterested in most of what I was trying to teach. However they did want to take pulses and I was able to give feedback on that. One of the best ways to learn pulses is to monitor them in a treatment environment. This is because even if you are unable to recognise and name pulse qualities you can still observe pulse changes as treatments progress. We were taking the pulses of one of the group one day and observed a very wiry Liver pulse. I suggested a point on the Liver meridian known as Liv3 to calm and smooth the Liver Qi. We did that and noticed that the pulse did not change very much. Then one of the group suggested needling a point on the arm, it was a point I knew nothing of. Apparently their leader had his own points based upon his theory of 30,000 chakras (energy centres) and this one on the arm did something according to that. He also had his own brand of needles and needle technique not involving Qi as I know it. They did the treatment and contrary to my expectations the pulse I felt changed completely. It was now much smoother, softer and less wiry. So the level of their conviction (as patients and practitioners) about what worked was enough to alter the pulse from my perspective and against my expectation as well.
A practitioner friend of mine treated a young woman who had a chronic bad back. She was in constant pain and had been x-rayed and told that she needed an operation to correct spinal damage. With little to lose she tried acupuncture and made a rapid and complete recovery. It transpired that the cause of the problem was actually her marriage and treatment had helped her to see that and decide to end it. I asked my friend what she had done, to which she replied that she had used the point known as Sp3. Since she was trained in 5E she saw the patient as an Earth person and simply used the Source point of the Spleen. Why did that treatment work so well, was it because the theory she used was so profound and powerful, was it because she was committed to it, or was there some other reason? None of the books I have read mention that Sp3 is a good point for back pain. I wonder if the treatment would have worked if someone else had done Sp3 and would it not have worked just as well if she had justified Sp4 to herself and used that?
There is no standardised Japanese acupuncture technique because there are many different styles used in Japan. But speaking to people who use Japanese techniques I note that the diagnosis tends to be done more on the body than with other approaches. The idea is to sense where the Qi is blocked, excess, or deficient in the meridian system and balance it. When it comes to needling they often seem to use long needles, sometimes made of precious metals but only insert them a couple of millimeters deep. I also note that whereas most acupuncturists expect their patient to feel Qi as some kind of ache, dullness or tingling these practitioners do not. With this system only the practitioner needs to feel Qi in order for the treatment to be effective. This seems to contradict most Chinese systems of acupuncture quite directly. But the treatments obviously still work and from a nervous patients perspective this is a great way to experience acupuncture.
I have worked with many students and one I remember particularly for her intellectual brilliance. We would sit down to discuss a case she was treating in clinic and she would explain her reasoning and diagnosis with such clarity that all I could do was nod in agreement. Her knowledge of CM theory and her ability to apply it surpassed mine. When it came to the treatments themselves she was similarly able in every way. Her practical skills were good, her patients liked her, her time management was spot on and there was nothing to criticise or feed back. She had absorbed all that the course had to offer and then added more of her own. I saw that there are people who just have that kind of ability and they can use their intellect to do anything they like with ease. Even those skills that on the face of it do not require that kind of intelligence but rely more on senses were no trouble for her. She could have easily covered all the material and development in a typical three-year course in a year. She was able to learn and use acupuncture theories or scientific ones and apply them with equal ease. She went on to specialise in an area of acupuncture and did pioneering research and a PhD. She has gained the respect not only of the alternative healthcare profession but also of the conventional medical profession as well. All acupuncture was easy for her.
On the other hand I have also worked with students who just don’t get it. Even after years of training they still ask the most obvious questions demonstrating their lack of comprehension. Or they have such deep-rooted emotional or psychological problems it is almost impossible for them to focus on anything other than their own neurosis. In such cases they are usually able to demonstrate competence in terms of safety so the question arises as to what to do with them. When a student has paid thousands in college fees, passed exams and progressed they cannot really be removed from a course. Whether we like it or not these people are out there with their qualifications using acupuncture and getting results. I have met and heard about such practitioners from many different colleges and doubt that any can claim this has never happened. The question is does it really matter because in many cases it is arguable that they are just as effective in terms of what they achieve for patients as anyone else? The skills of networking, promotion and building a successful practice are quite different from those you need for acupuncture theory and Qi development. Which probably explains why so many really good graduates of acupuncture give up before they get started. What most patients care about is how they personally feel about the practitioner and the effectiveness of their treatment. So how do people get away with having such limited self-awareness, ability and skills? The answer is they practice easy acupuncture using the most basic principles!
The Yellow Emperors classic is a deeply philosophical book and it has been studied and translated extensively. Like any great work of its kind its true value is in the way it inspires and changes the student. Having met Claude Larre who studied it for many years it was obvious he had been profoundly influenced by it. The important point to me is not that the book teaches you to be an acupuncturist (it doesn’t) but that the practice of studying such deep and profound material fundamentally changes you. Coincidently I was speaking to a wise man about acupuncture theory and he said it was very interesting but that you need to see it for what it really is, he said…
“Just supposing I were to invent my own therapy, let’s call it toothpick therapy. I’d go and find out about lots of different kinds of tree and what the wood we get from them is like. Then I could go and find someone who could tell me all about those trees and how they were traditionally grown, where they were planted, what spirit and energy they have etc. I could develop some great stories about the history of the trees and how their energies came to be recognised and appreciated. I’d get toothpicks made using different types of wood and wood from different regions and of different ages of tree and parts of the tree. As I researched a story would develop about the way in which the energy of these trees can be transmitted through the toothpicks. For example I might feel that the Yew tree gives more flexibility because it’s a very flexible tree, or that the Oak gives stability and longevity. I love trees so it would not be difficult for me to really get into this and pretty soon Id be feeling that what I had created was real. The treatment itself could be done by holding or placing the toothpicks onto points representing roots and branches of the body. Perhaps I could use the established system of meridians because they have been quite well accepted as energy pathways both in the East and the West now. What I’m saying is that to the extent that I could convince myself and others of the authenticity and effectiveness of such a system it would work.
This is because all traditions and all the theories and protocols do only one thing and that is to change us. I know it may be a radical idea but I want to suggest that everything you have been told and everything you believe to be real in your life is a story. Ancient China, Daoism, Yin/Yang, TCM, 5E? That’s a story used to create something called acupuncture. No matter how profound and revered the theory may be it still requires an observer. It still requires that you are here to understand it, accept it, believe it and put it into practice. Without you here and now as a co-creator and believer it cannot exist and is utterly meaningless. You are the focus, the centre, the moment in which it is and the only way it can be. Chinese sages and others have told us that wisdom comes when you can allow yourself to let go of everything you think you know. The trouble is we don’t listen and we still think we can intellectualise our way to enlightenment.
It is completely up to you where you find inspiration. If we were to seek it by consulting another great dynasty such as that of the Mayans for example, we would find they say the era in which all the great theories were developed ended in 2012. So that would call into question how relevant they really are now? For myself, I feel that we are in a new age altogether and I see it as the age of awakening consciousness”.
How and Why Acupuncture
 Burning a herb known as moxa (mugwort) on or near the body to create heat.
 Translates as: way, road, path, course or method.
 Chinese Medicine
 Qi roughly translates as energy.
 Bob Flaws
 Modern Chinese Medicine
 Some people have been known to call it Worsleypuncture
 Translates as big Qi or Qi cultivation exercise.
 Chinese Massage.
 National Health Service
 A discussion of point classifications will follow.
 Also known as Taoism – Chinese religious tradition.
 Theory of opposites, will be discussed later.
 Wise men or teachers such as Confucius.
 Pre Columbian culture of Mesoamerica and Northern Central America.
In the mid-1970s, Michael Smith, a medical doctor at Lincoln Hospital in the South Bronx area of New York, modified an existing system of auricular acupuncture into a simple technique for the treatment of many common drug addictions as an alternative to methadone. This selection of ear points proved to be extremely effective in the treatment of addictions, and became what is now referred to as the “NADA protocol.”
NADA – which is Spanish for “nothing” – is also the acronym for the National Acupuncture Detoxification Association. NADA was founded in 1985 by Dr. Smith and others who were interested in promoting the integration of the protocol in the treatment of addiction.
The original NADA protocol consisted of electrical stimulation on the Lung point of a patient’s ear. It was soon discovered, however, that manual needling of the same point produced a more prolonged effect than that produced by electric stimulation. Gradually, the protocol was expanded by adding Shen Men, a well-known ear point that produces a sensation of relaxation. Over the next few years, other points were added based on pain resistance, sensitivity, and other clinical factors. The NADA protocol as it exists today consists of the insertion of small, stainless-steel, disposable acupuncture needles into five points on the outer surface of a person’s ear. The points used in the NADA protocol are Sympathetic, Shen Men, Kidney, Liver, and Lung.
In a typical session, both ears of the patient are needled at the same time, usually for between 30 minutes and 45 minutes. Unlike many forms of acupuncture, the NADA protocol is delivered in a group setting. This is done to help build support among those being treated, and to break down factors of isolation.
In most cases, patients are cared for in a quiet, comfortable room, which gives them ample space to relax. All patients are treated equally, using the same protocol, which allows patients to overcome feelings of denial, and allows a practitioner to treat many patients at the same time. Depending on the location offering care, patients are often allowed to remove the needles themselves when the treatment session is over.
Addicts treated with the NADA protocol often report an improved sense of well-being. Clients often state that they feel “energized,” “lighter” and “more relaxed” after undergoing a session. Some practitioners assert that the insertion of the needles also provides a non-verbal tool, which allows patients to sit in a safe, supportive environment, and helps them prepare for the next step in the detoxification process.
Dozens of studies have documented the effectiveness of the NADA protocol. Among the benefits reported by patients and health care providers are: improved retention in drug treatment programs; more optimistic attitudes about detoxification and recovery; reductions in cravings and anxiety; fewer episodes of sleep disturbance; and reduced need for pharmaceuticals.
While the NADA protocol is an important component of any detoxification program, it is by no means the only component. A patient’s behaviour and attitude, along with the perceptions of the clinician delivering care, are also integral to successful treatment. The NADA protocol is often used with other treatment modalities, such as counselling, support groups and self-help programs, to increase the overall effectiveness of care.
There are currently several thousand NADA-trained practitioners worldwide.
(Info from Bucks Acupuncture http://bit.ly/24Qy5GC)
When you mention acupuncture most people think of China but that is not the whole story. In 1991 the mummified body of “Otzi the Iceman” a five thousand year old Neolithic hunter was discovered on the mountainous boarder between Switzerland and Italy. He appeared to have tattoos or burn marks on his back indicating that some kind of treatment had been applied. These marks were at a point we now know as Bladder 23, it is a point still considered useful for back pain. The Chinese Medicine theory we have fully translated has been described to me as the tip of the iceberg but there is a landmark reference book known as “The Yellow Emperors Classic of Internal Medicine”. It was written in about 2000BC and is a definitive work generally considered to be the source of most contemporary theory. However, it was not written until approximately a thousand years after the iceman died. So it seems clear that the origin of using needles or heat to treat acupuncture points goes way back into human history. We don’t know who actually did it for the first time, where they were, or even how they developed the idea. But what we can reasonably assume about medical care throughout the ancient world is that it was localised. There was no Internet or any other realistic means of wide communication and healers in different regions would probably practice according to their own traditions. This would have reflected their local environment and the characteristics and requirements of the people. For example, it seems likely that moxabustion was first used in colder places. Chinese Medicine (CM) therefore developed all over a vast continent and over an extended period of time. It is also clear that there are many similarities to both Tibetan and Indian traditions and that Japan and Korea have had a big influence on modern practice as well. If you read the Yellow Emperors Classic (and unless you read ancient Chinese characters it will be a translation of course) you will find that it speaks in an unfamiliar and poetic language. It speaks of living with the environment, the changing seasons, the climate and the Dao . The book takes the form of a dialogue between the Emperor and Chi-Po his medical advisor and it is very much a reflection of its time and culture. We may assume that what we are learning now is “Chinese Medicine” but actually it must be only a selective and interpreted sample of some of it. Sometimes it is difficult to relate what Chi-Po says to what patients want and need in the treatment room today because so much has changed in four thousand years. The classic does not mention electricity, geopathic stress, antibiotics, sugar, meeting deadlines, Catholicism, cannabis or atmospheric pollution. So although it is accepted that the book records the origin of the theory it has still to be seen as only a guide to what we do in a modern context. Some of it will have been lost in translation and there must have been lots that didn’t get recorded for all kinds of reasons. Consideration must be given to issues like politics, power struggles, levels of literacy and the role of religion. We really don’t know how life and practice actually was for the acupuncturists of the past but we can speculate about it. For them the time was now as it is for us and although human nature may not have changed much it seems clear that many other things have.
You may have already heard of the NADA protocol (National Acupuncture Detoxification Association) and this is another useful technique for students to consider. Once you have learned how to do this it is not too difficult to expand into more general ear acupuncture if you so wish. You may even want to consider doing the one-week NADA course itself because this covers detox in depth and allows you to join their register. NADA has more universal recognition than any other kind of acupuncture and has been tested and proven to work on terms set by scientists and Western Medical professionals. This means it is funded in prisons and detox centres all over the world. Even if you are not treating drug addicts or think you are not, here is what a wise man said about addiction:
Almost all people are addicts but they may not be aware of their addiction. It may be that they are if they are addicted to a substance like coffee, alcohol or food (sugar). But it is less likely if it is a habit addiction like using social media, work, exercise, tanning, dieting, chasing sexual conquests or even studying Chinese Medicine. But the thing everyone is addicted to is thinking because it’s so normal and so universal we don’t recognise it as such.
NADA is not a cure all for that but it does help withdrawal from substances and it does calm people down. The protocol involves putting five small needles (7mm X 0.20 gauge without guide tubes) into each ear and leaving the person to relax for up to 45 minutes. There are a couple of clear advantages to ear acupuncture including not needing to undress or lie down. Some people have real problems lying on a couch or they may be immobile or in a wheelchair. Another thing about ear acupuncture is that it is an alternative to body acupuncture and it is good to have another option sometimes. Much of the ear acupuncture theory is Western in origin and it’s nice to be able to look things up and treat things like the brain or nervous system directly.
I do have one word of warning. On a couple of occasions I have found that NADA has really wiped people out for a period of time. This is not easy to predict although I think it’s more likely when people are older. There have been no bad long-term effects and my guess is that these are cases where the Liver has been over extended. NADA relaxes everything and although what these people actually needed was rest they have found the sudden change a bit much.
Summary – Easy Ear Acupuncture
Use the NADA protocol for anyone who has toxins in their system or who is up tight and stressed out. It’s also a good starting point for anyone who is serious about kicking a habit like smoking or drinking.
Massage to Complement Acupuncture
If you met someone socially and said that you were training to be an acupuncturist and needed people to practice on how confident would you be that you would get a positive response? Then compare that to the response you would expect if you said you needed people for massage.
This gives us a clue about the potential for massage to complement acupuncture and it is why we include massage on our courses and encourage students to undertake a basic massage course. Training in massage is a very good way to learn how to build a therapeutic relationship and to get familiar with taking cases, handling bodies, dressing and undressing etc.
Massage theory speaks about lymph drainage, muscle stimulation and relaxation and the movement of blood. Acupuncture speaks of Qi (energy) running through a system of meridians. Of course both treatments are complete in their own way but they also have a lot of potential to combine effectively. For example there are distal acupuncture points (away from the pain area) which can influence Qi while a massage is being performed, particularly on the neck and back.
It is amazing how well appreciated a short massage is during the course of an acupuncture treatment and it is probably one of the most effective methods I know to encourage patients to return for more treatment.
When I was a student of acupuncture in the early 90’s I remember the concepts of damp and phlegm being briefly explained to me. If you want to understand the nature of damp you can go out in England and experience it simply enough. It is heavy, it is misty, it’s usually cold and it tends to slow things down and block them up. When the Sun shines dampness evaporates so it is more of a problem in the winter.
I understood that damp forming within the body is almost always a consequence of deficiency of the Spleen and therefore very common. Then it was explained to me that it could give rise to phlegm, which could block the orifices of the Heart and “mist the mind”. But I had some vague notion that it was in fact a lot more complicated than that. Were there not different types of phlegm doing different things in different places? You can see phlegm when you have a cold but was this the same phlegm that could “Block the orifices?” And what about damp heat, phlegm heat and phlegm fire? It was in some ways a relief to move on to study at a different college where phlegm and damp were not even mentioned. In fact, any mention of such things was discouraged since it was (at that time) considered unnecessary or in some way not true to the colleges tradition. So I happily forgot all about phlegm for a while.
When I started working at the London College of Traditional Acupuncture I did the Chinese Medicine theory course to refresh my memory. Phlegm was back and I was shown a book some two inches thick on “Phlegm diseases” I learned that “Phlegm goes up and damp goes down” and that there are indeed two types of phlegm “substantial” and “non-substantial”. Just as I was beginning to get mildly depressed about it someone said “Its ok all that stuff is really just for herbalists”. It seemed to me that there was only one main point prescribed for damp and phlegm anyway, St40 (Feng Long). Then perhaps Sp9 (Yin Ling Quan) for damp heat and Gb34 (Yang Ling Quan) and one or two others. I felt that one seemed to do a lot of theorising just to pick the same couple of points each time! So maybe I knew enough already and should leave the complexities of phlegm to the herbalists? Someone else said that in China a doctor had said “If in doubt treat phlegm” So I started using St40 rather a lot after that.
I have not been to China but I have met quite a few Chinese practitioners here. My difficulty has usually been communication, Ive often felt that they held a great deal of knowledge but my lack of any Chinese language and their poor English really limited my learning. But In about 2001 I did get the opportunity to speak to Dr Huide Jin. There is something special about hearing the Chinese speak about Chinese medicine because they can the whole thing sound easy and natural. At such times one can remember that the origin of Chinese Medicine is not a textbook but humanity as an integral part of the natural environment. The theory seems to be almost engrained within the Chinese subconscious, it’s really in their bones or “Jing”. It’s like hearing an English person complain about the weather because it flows so naturally. Diagnosis tends to be clear-cut, like “Yin deficiency” or “Blood stagnation”. One of Jin’s favourite prescriptions is simple too: “Cupping” which he seems to use for all kinds of conditions, but that’s another story.
I am always mindful of the phrase “To be a master you must master the basics” and this was an attempt to establish exactly what the basics of phlegm and damp are.
Q. Dr Jin Could you define what damp and phlegm are?
Dr J. Damp and phlegm are two different things but from the same origin. Firstly you can have internal and external damp. External comes from outside, from the weather and it can invade the body causing Bi (Painful obstruction) syndromes.
Q. And this could come into the channels or directly into the organs?
Dr J. Yes like the Stomach, damp can invade the Stomach and Spleen directly and that can impair their functions. When I say that phlegm and damp are of the same origin I am speaking of internal damp. Internal damp and phlegm are the results of poor circulation of the body fluids. Three main organs are involved here, Lung, Spleen and Kidney.
Q. Would you only ever get phlegm if you had damp first, the damp developing into phlegm?
Dr J. Well theoretically yes because phlegm is the thick form of damp. In damp weather the dampness cannot necessarily be seen but it can cause the symptoms inside. Now with phlegm there are two types, substantial is visible as sputum, its thicker so you can actually see it. It’s the result of accumulation of dampness, but practically speaking phlegm can occur directly without passing through the dampness stage.
Q. So you may get someone without signs and symptoms of damp but they do have say….. Phlegm misting the mind?
Dr J. Yes that is non-substantial phlegm.
Q. Is phlegm typical of certain organs in the way damp is, you said damp is mainly the concern of Spleen, Kidney and Lung?
Dr J. When we talk about the Lungs we don’t use the word dampness, you will never have heard of retention of dampness in the Lungs.
Q. No, I’ve heard of retention of fluid in the Lungs what is the difference?
Dr J. We have 4 forms of accumulated body fluids. Dampness, Water, Retained fluid and Phlegm. Water is thicker than dampness, like its there on the floor whereas damp is in the air, while retained fluid is even thicker and phlegm thickest of all. (Despite the fact that you can’t see it phlegm is the thickest)
Q. So if you’ve got phlegm its serious?
Dr J. Well it also depends upon areas, In the Lungs its always substantial phlegm. We have all had a cold sometime and it was not that serious. Non-substantial phlegm is more difficult.
Phlegm and damp are very common pathological factors and they cause many diseases. For example acupuncture is widely used in cases of invasion of external damp or for Bi syndrome for painful joints when it combines with wind, cold or heat. So we are using all kinds of points for damp and phlegm: local areas, channel points, distal areas and if damps invading the Spleen causing diarrhoea then acupuncture is very good for that. In the treatment of diarrhoea we treat the dampness primarily because diarrhoea itself is accumulation of the dampness. Of course it can be from outside (invasion) or it can be based on deficiency of the Spleen. In some cases acupuncture can be as effective as herbal medicine in these cases.
Q. And how do we treat phlegm?
Dr J. It also depends on where it is if its misting the mind we have to resolve it but first we have to establish which organs are most effected. These patients will normally have Heart involved, Spleen involved and Liver involvement. Kidney can also be involved sometimes and treatment depends on the balance of organ involvement. Phlegm misting the heart can give rise to palpation’s and mental disorders; the main cause of conditions of mania, depression and epilepsy is phlegm.
Q. And would one necessarily be treating the Spleen, Sp6 (San Yin Jiao), St40 for that?
Dr J. We have to analyse but generally I think the points on the head should be used like Du 20 (Bai Hui), Gb 20 (Feng Chi), St 8 (Tou Wei). In China we use Electro acupuncture on the head for mental depression those points on the head help to clear phlegm. You would also use points like P 4/5/6 (Xi Men, Jian Shi, Nei Guan) and Heart points depending on the condition.
Q. Ok so it really depends where the damp and phlegm is, it’s not a blanket term?
Dr J. For dampness we use different terms to describe the different ways of treating. If there is damp in the middle jiao we use the term resolve damp, points like Ren12 (Zhong Guan), St 36 (Zu San Li), Sp6 together. In the lower jiao we use the term “promote dieresis” to get rid of the damp e.g. Ren 3 (Zhong Ji) or in a chronic case Ren 4 (Guan Yuan) and Sp 9 and 6.
Q. And you don’t get damp in the upper jiao?
Dr J. We don’t use the word dampness, for the Lung and Heart we often use the word phlegm e.g. retention in Lung or misting the Heart.
Q. Do you get phlegm in the middle and lower jiao’s?
Dr J. Of course it goes everywhere?
Q. Can you give an example?
Dr J. Phlegm in the middle jiao, namely the Stomach and Spleen can cause nausea, vomiting, poor appetite, fullness etc…..
Q. I’ve never heard anyone say phlegm in the Stomach and Spleen?
Dr J. Oh yes you get phlegm as well as dampness in Stomach and Spleen but when there is damp the nausea and vomiting are not that pronounced. It is those factors which indicate the presence of phlegm but we don’t usually use the term phlegm in this context. Your acupuncture points won’t vary that much but if one is using herbal medicine then the herbs to resolve phlegm are different from those to resolve damp.
Q. But St 40 is not our only answer, it’s a point commonly used but it would depend?
Dr J. Well take for example a case of wind cold, you have phlegm but St40 is not an obvious choice of point in that case. St40 is an excellent point to resolve phlegm however, its probably the main leg point.
Q. Now how about phlegm in the lower jiao?
Dr J. You can get phlegm in the Kidney too it’s mostly what leads to the pain symptoms related to Kidney. Like back pain and knee pain, it is still phlegm we just don’t tend to call it that.
Q. And if you were to give phlegm to an element it’s the earth element, right?
Dr J. Yes, The origin of damp and phlegm is the Stomach and Spleen but the Lungs are the place of storage of phlegm.
Q. Are we all storing some?
Dr J. Theoretically not, phlegm and damp are pathogenic factors so only present in disease states.
Q. And finally, the phlegm and damp pulse?
Dr J. There are two main pulses for phlegm and damp conditions the Huo or slippery pulse and the Fu or floating pulse but you cant say that’s phlegm and that’s damp it depends upon the accompanying signs and symptoms etc.
So Dr Jin did help clarify some key points for me:
Substantial (visible) phlegm only occurs in the Lungs.
Non-substantial phlegm occurs all over the body and accumulation of phlegm is often a way of explaining the cause of pain.
There are different common terms used to explain damp and phlegm and their treatment depending upon which organ is most effected.
Since damp and phlegm are often caused by deficiency of the Stomach, Spleen and Lungs certain points like St36, Sp6, St40, Co4 (He Gu) seem to be prescribed a lot to treat them. But actually phlegm and damp could be treated by almost any point if it were appropriate.
I was conditioned to be opposed to doing acupuncture by prescription. It goes against all my instincts and my training, which says that if we are working with holistic medicine we must by implication look at the whole case. This system of medicine is about people not conditions so prescriptions will only offer temporary relief of symptoms at best. My colleagues and I have always looked upon Medical Acupuncture as an inferior version of what we do because it does not work with traditional theory. The point functions are learned in a prescriptive manner with no acknowledgement of the existence of Qi. Now I hear that you can buy computer software where you type in signs and symptoms to give you a diagnosis and points prescription.
The problem with my long-term opposition to prescriptive acupuncture is to know what to say when someone asks what is wrong with it. I can’t claim its unsafe because so long as people are following Health and safety guidelines and proper CNT and the usual guidelines about drugs, pregnancy etc. It clearly is not. I can’t claim that it does not work because there are too many people who say it has worked for them. I can’t even claim superiority for another system because it is all very subjective and open to interpretation. So frankly I’ve decided that it’s about time to accept that there is nothing wrong with a bit of prescriptive acupuncture. In fact if we are honest about it a lot of acupuncture is prescriptive anyway we just don’t say so. Becoming an effective acupuncturist is mostly about confidence and a feel for Qi gained through practice. Why can’t prescriptive acupuncture be a way in for people who wish to start off simply? I think it would be silly not to acknowledge this.
You can get a diploma in acupuncture, you can get a simple certificate and you can get a full degree. Ultimately there is nothing to stop you calling yourself an acupuncturist without any qualification at all. So we need to see if a full degree course is a worthwhile option. Lets have a look at whats available from different colleges:
If you attend one of the three year courses at a universtity or a universtity accredited college you will probably get a degree. Alternatively you can obtain a diploma in acupuncture or a certificate at any number of other colleges. Courses vary in length from a few months to three years but before you make a decision there are a few questions its worth asking.
1, Who are the institution to issue the degree or diploma in acupuncture and what gives them that authority?
2, What does it actually mean in terms of recognition by the public, the NHS, in law and/or abroad?
3, What is the cost of a diploma in acupuncture?
4, Will it guarantee quality of training?
5, Will it make any difference to your employment prospects?
If you want a full course with classroom study over 3 years, lots of clinical work and a degree from a recognised institution backed up by a rigorous structure of accreditation and accountability, then you will choose one of the major colleges. It will cost you about £30,000 and approximately 40 days a year for 3 years. Upon graduation you will be able to join the BAcC, one of the organisations for acupuncturists (there are others).
If you want a faster route to learn how to practice acupuncture (without doing research or detailed study of Western medicine, etc) you might be better off on a shorter course like ours. Especially if you already have qualifications or previous experience in a related field. Our course will get you there faster but will need to take responsibility for your own study to a greater extent and learn through practice and CPD.
However, this is the most important bit and frankly what most people wont tell you:
No matter where you train or what qualification you have you are on your own when you qualify. Qualifications do not open doors, they have no recognition in law, there are no jobs advertised for acupuncturists. You must market yourself and build your own practice on your own. Most members of the public are not interested in what association you are a member of or even what qualification you have. They are much more interested in other factors like celebrity endorsement, media exposure and above all personal recommendations.
So before you spend lots of time and money on your acupuncture training do think about your objectives and weigh up the available options. Either you see it as a vocation and wish to study for reasons other than only work, or you hope to earn a living from acupuncture. If the latter is the case do think about who your patients will be, where you will work and how you will build a practice when you qualify.