With the start of a new trimester here at NUHS, and -- for many
-- the start of a new school year, it's the perfect time to break
it down. Just what is Traditional Chinese Medicine? How does
acupuncture fit into the picture? Do you have to use herbs, too?
What about tui na, qi gong, and tai chi?
Let's not forget about my personal favorite -- dietary therapy!
Traditional Chinese Medicine (TCM) has arguably five branches,
and I'm going to give it to you as I understand it. After two full
years in the Acupuncture and Oriental Medicine Program, a first
professional master of science degree program, I think I'm finally
scratching the surface of what the ancient Chinese had to
This is the big guy, right? Acupuncture is the most
well-known branch of TCM today in the U.S., involving the insertion
of needles into specific points on the body. While some other
fields offer an abbreviated, "stick it where it hurts" method, we
TCM acupuncturists take the entire body, its functional organ
systems, and each person's general constitution into consideration
when deciding where to stick the needles. I know it's confusing
when you say your back hurts and I put needles in your legs, ears,
and hands, but just trust me. It's all connected through energy
meridians. This is also why we ask you about your poop when you
come in for knee pain.
Yes, it smells just like marijuana, but
it's actually a different herb called ai ye in Chinese
pinyin, artemesia argyi in Latin, or Mugwort in plain old
English. It does come in a tightly rolled stick form, we do light
the end, but instead of smoking it we hold it near an acupoint on
the body. After a few minutes of pecking the moxa stick close
enough to provide penetrating heat but never burning you -- I
promise -- you will reap the benefits of not only pain relief but
tonification of certain organ systems and the freecoursing of
energy through particular meridians. It feels great, but you will
have to explain to people for the rest of the day why you smell
Like many medical systems, from western
naturopathy to Indian Ayurveda, TCM has a unique Materia
Medica, or giant book of herbs, their properties, and their
medicinal uses. While you don't have to "do herbs," most students
at NUHS work towards the full MS of Oriental Medicine (which
includes the herbal coursework in addition to the acupuncture
work). Interesting fact: not all "Chinese herbs" are plant-derived.
Many are actually minerals, such as salt or arsenic, or
animal-derived, such as deer penis or flying squirrel feces. Just
seeing if you're paying attention (but yes, those are really all in
the Materia Medica).
dietary therapy, or food therapy, into the same branch as herbal
therapy above. Because I love the application of common foods and
nutritional principles so much, I'm awarding it half status as its
own category. Some items that we'd call "food," such as garlic or
onions, are also included in the Materia Medica as medicinal herbs.
They're working together -- that's the point. Who doesn't love the
ancient Greek saying, "Let food be thy medicine and medicine thy
food?" Thanks, Hippocrates, thy father of western medicine. The
Chinese happen to agree!
Can you pronounce it? Try this: twee nah.
Good job. This is most easily compared to the practice of massage.
Often called "Asian Body Work," these pushing and pulling movements
applied by the TCM provider to the patient's body accomplishes many
of the goals of general massage, such as relaxation and improved
circulation of blood and energy.
also where we are going to mention the practice ofcupping. Stick a
fire into a glass cup to create a vacuum that pulls toxins out of
the blood and releases the exterior in a "wind-cold invasion" and
you have a happy patient. In my admittedly limited clinical
experience, everyone loves cupping, but mind your manners. The
clinic is not an a la carte menu for your pleasure. Let the intern
and the clinician decide which modalities are best for your
condition each day.
Another new phrase for the day. Practice: chee
gong. Not so bad, is it? Qi gong offers the
practitioner a chance to step back, relax, and renew his or her own
energy and well being. Maybe you've seen images of elderly Chinese
individuals at the park, wondering why they are punching the air in
slow motion. That was a group of people cultivating their
qi. As Dr. Yurasek tells us interns, "You can't
give it if you don't have it!" Thus, practice your qi gong
postures and movements before you head in for your clinic
So, there it is--most of Traditional Chinese Medicine. We could
also tie in tai chi or talk about gua sha, but I
have to save something for next time! If you haven't tried TCM, now
is a great time. Interns are fresh off a nice two-week break, white
lab coats are pristine, and everybody's anxious to try out their
skills. See you in
I get this question all of the time: "Do you acupuncture
Yes, kind of, not really, I don't know what I'm supposed to say
exactly. Do I put needles in people? Yes, of course. Should I?
Well, that's where you've got me. Technically, I'm not a licensed
acupuncturist yet, so I take that to mean that I can't
charge people for acupuncture yet. Is it safe for me to
needle people? Well, I do have my Clean Needle Technique
certificate filed away somewhere....
Do I know what I'm doing?
Can I help someone feel better? I don't want to be a pretentious
jerk and assume the answers are "yes" here, but over the past year
I've certainly had some good feedback. As a sometimes full-time and
sometimes part-time student in the acupuncture program, I'm
somewhere around Tri 5. I've completed a large chunk of the
coursework, the whole observation phase in the clinic, and now I'm
actively practicing on everyone who schedules an appointment with
me in the AOM clinic on campus.
For the next year, I'll continue along in this internship,
enjoying the opportunity to test out treatment strategies, hone my
diagnosis skills, and figure out if "patient consents to treatment"
actually belongs in the "A" or the "P" portion of the SOAP note.
I'll do intakes; I'll form diagnostic impressions; I'll pow-wow
with Dr. Cai, Dr. Stretch, and any other clinician I can find. I'll
needle patients; I'll moxa their cold feet; and I'll do as much
moving cupping as my forearm strength permits. If you're really
special, I'll do tui na and I'll gua sha you
afterward. Want some herbs? Sure, we have raw, granules, or patent
pills. Right this way!
While the patient visits are the most important and most fun
parts of the clinic internship experience, the clinic lottery is
the part that causes the most anxiety among the interns. "Will I
get my same shifts next tri?" "Which clinician will I work under?"
"Which interns or observers will be on my shift?" All of these
panic-stricken questions and many more can be heard all over campus
right now -- the infamous Week 12 clinic sign-up and resulting
lottery has arrived!
interns get to sign up for their preferred shifts and locations for
clinic internships. We AOM students have the luxury of choosing the
on-campus Lombard Whole Health Center clinic or driving to Stroger
(Cook County Hospital) in Chicago for an off-site experience. My
45-minute commute is plenty, so I try to keep it simple and stick
to the main campus. There we all are, fluttering around the sign-up
sheet in the clinic lounge room, which is busting at the seams on a
regular day, elbowing the interns who are actually trying to sit
nicely and write SOAP notes that day.
If all goes well, there is a nice white empty slot shining and
waiting just for you on the day and time that you've decided would
be perfect for your upcoming trimester. In reality, someone else
probably agreed and already signed up for that one. In the end,
many interns are able to secure an acceptable shift and everyone
survives the sign-up week. Some lucky individuals end up in the
clinic lottery, where randomly drawn numbers allow devastated
interns to play a sort of game-show rendition of "This will be your
life next trimester."
In my two years at NUHS, we haven't lost anyone yet! The sign-up
process can be stressful for some, but by the time the next
trimester rolls around, we're all just excited to start treating
our patients and working with our clinicians to hone our skills. I
have one more year of this endearing learning process, and then
it's out into the real world for me (again). No more clinicians to
ask questions of, no more easily accessible chiropractors down the
hall to consult with on orthopedic issues (thanks, Dr. Anderson!),
and no more half-days of work! Maybe this whole clinic deal is
pretty great after all....
Yes, I said "we." I'm
lumping you all in with me and almost everyone else I know. We're
wimpy. My sister said it best several years ago in a comment about
the "wussification of America." No, I'm not sure how to spell that.
She was speaking about the general wussiness of people these days,
and I'll see that new word and raise it to
another contextual use.
I'm sure you know what I'm talking about. If you have had a baby
in the past 10 years, you've certainly had to explain to a
grandmother (your kid's or otherwise) why baby has to ride in the
car seat for every little trip. "Yes, grandma, I know
we're just riding up the street to the corner store. Yes, she still
needs to be strapped into her car seat. Just because." Grandma
undoubtedly replies, "I never strapped your father into a car seat,
and he lived. He would ride all the way to Florida to visit Aunt
Ida every year and nothing ever happened to him." Then simply to
justify my own wussiness, I make up something about how I'll be
arrested if the police see me with my kid riding on my lap.
Some of you might not be
convinced about the car seats. They're important. Even I strap my
kids into those things just to ride up the street, and I don't
consider myself a huge wussy. Just start extrapolating this theory,
though, and you'll surely jump onto the "wussification of America"
bandwagon. We all drink light beer. Every kid gets a trophy. They
cancel school when it snows. I'm so hot walking the 10 feet from my
air-conditioned car to my air-conditioned office. I have to wait 3
whole seconds for my Facebook page to load on this old phone.
How does this relate to Acupuncture and Oriental Medicine? Well,
the wimps don't leave their wimpiness at the door of the clinic.
That is for sure. I can write this post without fear of offending
anyone, because I, myself, am a needle wuss. That's right. I don't
want to feel the needles. I'll needle you, but don't you
try to needle me.
Clearly I am not alone. Sure, you have a few patients who never
flinch when you insert a needle. They never complain that something
hurts or feels weird. These are the lovely "exception" patients,
and they are few and far between. Most of us recoil in pain -- pain
that is really just an unfulfilled apprehension of pain --
with the insertion of each needle. At first, I liked seeing this
reaction from patients, because it justified my own wimpiness. Now,
though, I've evolved. As I become less wimpy about needling myself
and letting others needle me, I think I subconsciously expect more
of my patients, too.
The people in Nicaragua
never flinched. We would jab those needles right into the sore back
or the tired feet, and the patient would hardly notice. Are
Nicaraguans simply a stronger people than Americans? Probably, but
I didn't stop there. No, what about the Chinese needling? So deep,
so hard, so scary for most Americans. Are they inherently stronger
than us, too? They want to feel that moxa until it burns a
blackened memorial into ST36. I would move to Japan, home of
"shallow needling," to avoid those 6-inch needles I've been told so
much about from the Chinese professors and clinicians.
No, I don't think it's
that Nicaraguans are freakishly strong or that Chinese people are
particularly masochistic. I just think Americans are caught in the
throes of the recent trends towards wussification. Be careful,
don't get hurt; don't let the sunshine get you! I reject
wussification insofar as I legally can, but I am still and will
always be one of the wimpy ones in the clinic when I'm on the
receiving end of that needle business. So, if you're afraid of
needles and therefore have not yet tried acupuncture, this post is
for you. If I can do it, you can do it.
I get really annoyed when I'm reading the results of a
scientific study about the effectiveness of acupuncture, and the
author concludes that actual acupuncture was "not significantly
more effective than sham acupuncture." What they seem to be saying
is that acupuncture is not effective at treating X condition. What
they are actual discovering is that needle insertion almost
anywhere in the body will have an effect on the body's condition,
often providing relief from X condition.
I like this part. As Dr. Kwon always told us in
Point Location class, you can still help the patient even if you
don't stick the needle in the exact acupoint. This realization
saved my sanity on more than one occasion when trying to palpate
and count thoracic vertebrae to locate the oh-so-important points
of the Governing Vessel running up the spinal column. It's supposed
to be located at T6, but T7 will be good enough? Awesome. Thank you
for your flexibility, ancient wisdom.
So, back to the studies that drive me nuts. Here's how they
commonly shake out:
Exactly 100 patients were studied for chronic knee pain, with 25
receiving no treatment, 50 receiving actual acupuncture (inserting
needles at specifically proscribed points), and 25 receiving sham
acupuncture (inserting needles randomly in the body). Guess what?
The patients receiving no treatment did not experience improvement.
The patients receiving actual acupuncture reported a 50%
improvement, and those receiving sham acupuncture reported a 45%
I call that good news. The study concludes, instead, that actual
acupuncture is not significantly more effective than sham
acupuncture at treating knee pain. Wrong. What they actually did is
prove Dr. Kwon right -- not that he needs any additional
validation, seriously -- that even when needles are inserted at the
"incorrect" location, acupuncture still has therapeutic benefits
for the patient. Is the goal of an acupuncture treatment for knee
pain simply to eliminate the knee pain? Not exactly.
Any time acupuncture happens, that patient's body experiences a
shift in energy. We can usually feel a difference in the person's
pulse after treatment, compared to before. The qi (energy) has
moved, and in western terms, circulation usually improves. Sure,
the knee pain is improved, but the patient might also sleep better
than usual that night, awake with more energy than usual the next
day, or even notice that a new head cold has resolved
Were these other effects coincidental?
Maybe, but probably not. Any acupuncture is better than no
acupuncture, and the results of studies comparing no treatment,
sham acupuncture, and actual acupuncture will often reveal this
truth. In fact, this little "secret" is why I'm not against other
practitioners doing acupuncture on patients. We've all heard the
buzzword "dry needling," which is when say, your physical therapist
needles your arm when your elbow isn't healing as nicely as you'd
like. I know several chiropractors who have completed the 100-hour
certification in acupuncture, and they can often be seen sticking
some needles into a sore back muscle.
Some acupuncturists are completely against this concept of
non-acupuncturists needling patients, but I'm pretty much OK with
it. I know the patient is probably receiving some benefit
regardless of whether or not the needle goes in at an exact
acupoints. What's important to me is that the patient is aware that
dry needling or someone sticking some needles in where it hurts is
not all that acupuncture has to offer. Those techniques have
benefits, but not the full array of benefits that needling specific
acupoints on specific meridians can produce.
So, if you know someone who's been needled before and didn't
experience a great symptom reduction, it's still worth their time
to try acupuncture from an acupuncturist. Crazy, I know. It's not
that other providers are doing anything wrong; it's just that they
aren't receiving the more complete system of treatment via
acupuncture that we acupuncture students use.
"I hope the points aren't just nerves being shocked by needles,"
I said to AOM classmate Irene. As one of the few AOM students who
originally came into the program to focus on herbal preparations
and dietetics, I felt particularly uninformed about this whole
acupuncture thing. So, there in one of the first courses on the
theory of point energetics -- what the acupoints do and how they do
it -- I finally vocalized, albeit in a whisper-like fashion, my
growing fear: Maybe there's no meridian or point energetics beyond
just sticking a needle into a nerve and hoping it stimulates
something productive in the patient's body. Sure, that might still
help, but it certainly doesn't have the mystique that interested me
in the first place.
"Moving blood and qi," "balancing
energy," and "harmonizing yin and yang"...these concepts are
intriguing, promising, and yes, darn near magical in my opinion. If
we're just jabbing people with needles and shocking them wildly,
then I'm not sure I have the buy-in that a 3-year master of science
in oriental medicine degree requires. So there I sat, giving power
to my secret fear by speaking it aloud, not knowing what Dr. Yihyun
Kwon was going to say to pull me back over to his side of the
fence, and hoping that there was something more -- more ancient,
more Daoist, more qi-related in any way. (Spoiler Alert. Dr. Kwon
Irene surprised me with her response, which I recall as being
something along the lines of, "So what if acupuncture is
just stimulating nerves with needles?" How could she be so callous
to this deep fear that I'd been subconsciously fostering for the
first three months of our program? Didn't she understand that I was
sitting there, suffering in silence, desperate for some oriental
What Dr. Kwon went on to explain in that first Energetics class,
and even more so the following year in Neurophysiology of
Acupuncture class, was a concept that bridged the gap between the
mysticism and the mundane. He simultaneously satisfied my cravings
for evidence-based medicine as well as ancient tradition. Dr. Kwon
= 2. Juli's irrational fears = 0.
Yes, he explained, some points are located right
beside or above a nerve -- grazing it ever so slightly and
eliciting that loved or hated sensation we call "de qi," when
energy arrives along that meridian. Further research and
dissections have confirmed that many of those points not located at
a nerve are actually located exceptionally close to an artery or
vein. Here's where he blows my mind in 3...2...1....
Next, he tells us that these vessels and other structures
harboring acupoints are essentially wrapped up in nerve fibers
themselves. Yes, readers, we've come full circle in Juli's
understanding of neurophysiology (which doesn't take long). Many
acupoints are on a nerve; those that aren't, still kind of are.
And now to process this information.... Do I hate this answer?
Does it ruin the grandeur of ancient energy meridian theory? Nah. I
took the news fairly well, all ignorance and expectations
considered. In today's health care climate, I like that modern
science keeps proving acupuncture theory to be true. Time and time
again, I see modern western research pointing to the validity of
traditional medicine. At the end of the day, or the century, who
doesn't like being told, "You're right"?
• So What Is Chinese Medicine?
• Jabbing Nerves with Needles
• Mission in Nicaragua
To read older blog posts, scroll to the bottom and click the "Older Posts" button.