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How do acupuncturists find the right place to treat?

Q: How do acupuncturist find the right place to treat since there are many meridians and combinations of meridians that could treat a problem?

A:   This question highlights the central difference between conventional medicine and traditional Chinese medicine. We are very used in the West to the idea that the work of diagnosis is rather like the forensic work of a policeman and lawyer, gathering evidence and sifting facts. This comes to a single conclusion which explains what is going on and then provides a set tariff of treatments which have to be followed one after another, like NICE guidelines. The TV series House starring Hugh Laurie was/is a great example of this, where the tortured genius lets the observed facts and diagnostic test results mould into a unique and brilliantly presented conclusion.

By contrast, Chinese medicine is inherently pluralistic. At various times during its 2500 year history there have been innovations which at some levels have contradicted the mainstream theories, but as long as they worked in well-defined conditions they were retained as another string to the practitioner's bow. A modern practitioner of Chinese acupuncture might employ TCM, the rather skeletal and simplified framework first written down in the 1950s as a system, or Five Element Acupuncture which is rooted in the classics but developed heavily in France and Japan, or Stems and Branches, a numerologically based system which has existed for over 2000 years, or Japanese Meridian Therapy which, designed with blind apprentice-trained practitioners in mind has a huge palapatory bias, and so on. Each of these systems has ways of working with the whole which are a mixture of the same root understanding of the core energetics of the body mind and spirit, and a heuristic framework which allows scope for the skill and art of the practitioner. Each of the variations, and in the modern practitioner these might all find their way to the diagnostic mix they employ, offers a way of bringing balance back to the whole.

The question for each practitioner is really what is the most elegant and effective way with the least intervention to achieve overall balance. Because of the nature of the interaction between patient and practitioner concepts like 'intention' and 'rapport' can play a part in the diagnostic and treatment choices, and in many ways each practitioner may generate a different solution to how best to treat a single patient. There may well be common agreement about the main features of a case, but each practitioner may favour a slightly different strategy for dealing with the information.

You can see immediately why such a flexible system is often derided in the West as nothing more than a placebo, especially since the practitioner's extraordinary range of choices and personal involvement in the process lend themselves to the pejorative interpretation that no-one has 'an answer' and that it is the 'will' of the practitioner which conditions the patients to improve.  This is sad, because in nearly every other form of skillful endeavour it is readily accepted that an overall goal or aim can be achieved in many different ways, like putting a destination in google maps and seeing four choices emerge. With a complex organism like a human being it seems perverse to say that this and this alone is the problem, and this the solution, when we all realise that most problems cascade more widely than the simple origin.

Anyway, to return to your original question, even if two practitioners agreed on a diagnosis they might each find different ways of effecting change. Such is the vast number of interconnections between the different channels, there are often dozens of ways to influence the internal Organs, or to have an effect on a specific part of the body. This can be a valuable resource in itself; if a woman has had a mastectomy with lymph nodes stripped and can no longer be needled on the arm, then it is always possible to find ways of treating the lower limb to 'reach' the affected area. The same applies to treatment of a limb encased in plaster; needling the equivalent points on the other limb can have a major impact.

In short, the system is such that there are dozens of variations in the diagnostic systems, and dozens of possibilities within each system, for achieving the same results. They are all based on the same understanding of the channel systems and the same location of the points (broadly speaking - some of the Japanese systems pay more attention to blockages which are where you find them!), but each system will use a slightly different understanding of the these shared resources to effect change. We often used to refer to this phenomenon as 'unity in diversity', the sharing of a tradition founded on the same underlying principles but showing the inherent strength of something which has developed in different strands for over 2500 years.     


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