"Give her a Brazilian in Room 1!" This is the new catchphrase
around Stroger. That's right, we're giving Brazilians at the pain
clinic in Cook County Hospital. I occasionally worry that a passing
doctor thinks I'm waxing ladies in the treatment room, but the
concern quickly fades as I get down to business. This Brazilian is
all in the ears, and the only intimate part is the bleeding. I
always think bleeding is sort of a personal interaction.
According to a successful acupuncturist in Brazil, the best
treatment for relieving joint pain with heat signs is to tonify the
energy of the major internal organs, direct it towards the affected
joints, and then bleed it out of the body. How do we do this
exactly? Here's a sample case: inflammatory knee pain, let's say on
the left knee. It's painful, the area is red, swollen, and warm to
the touch. The patient often reports feeling warm, the pulse is
slightly rapid, and the tongue is often red.
The Brazilian technique is essentially a three-step process.
First, we needle the following points on the ear of the
non-affected side: Shen Men, Sympathetic, Liver, Kidney, Heart, and
Lung. Six needles so far, if you're counting. Then, we needle the
corresponding painful body parts on the ear of the affected side of
the body: Knee. OK, we're up to 7 needles so far. Totally doable.
Now we let those needles rest for a while while we enter the SOAP
note in the lovely electronic medical records system at
After about 10 or 15 minutes, we take those needles all out.
Next step, we get intimate. It's time to bleed the Ear Apex on the
affected side. I like to give it a few hard squeezes to ensure I'm
stealing as much hot blood out of this person's body as possible.
Don't worry -- it's usually just a drop or two.
What happens next? Well, it varies. Often times, though, it goes
like this. The patient stands up, wiggles around to "test" for any
perceptible changes in pain level and range of motion, and starts
to smile. "I feel better!" Pain levels are dropping from 10/10's to
4/10's in that 15-minute treatment time. Is it unorthodox?
Somewhat. Is it effective? Seems to be. Will we keep giving
Brazilians at Stroger? You bet.
What could the two possibly have in common? No, you guess first.
Something to do with swords? Nope. OK, I'll tell you.
I was cooking dinner last night, and
the recipe did not call for celery. I had a flash memory
of a friend on Facebook posting that she added a bunch of random
things to the granola she was making that day, because she wanted
to clean out her pantry. I've been there. Two handfuls of raisins
kicking around in the bottom of the snack pantry (in a container -
I'm not that gross)...about a tablespoon of crushed pecans that
I'll save for years rather than throw out -- come on, those things
are expensive! Into the granola they go....
There I am, cooking dinner, the dinner that did not
call for celery. This is about to relate to acupuncture, just wait
for it. I look into the fridge and notice I have two giant packs of
celery from the previous two weeks. My son had been on a celery
kick for months, inhaling several stalks per day, and of course he
suddenly hated it as soon as I stocked up. "I'll just chop some up
and toss it into the pan with the onions and garlic I'm sautéing
for the stuffed peppers recipe." Boom. In it goes.
No harm done, right? Maybe.... In the
Traditional Chinese Medicine branch called Dietary Therapy, we
learn the nature and properties of foods from kelp to congee and
oats to oranges. Here's the medicinal profile for celery according
to TCM: cooling, sweet, slightly bitter, benefitting the stomach
and spleen, calming an irritated liver, improving digestion, drying
dampness, purifying the blood, reducing nervousness and vertigo,
clearing heat from the eyes, urine and mouth, and relieving
headaches caused by stomach heat and stagnated liver qi (Pitchford,
2002, p. 539).
That would have been fine. Even if you didn't understand most of
that, trust me, it would have been fine. Who doesn't have some
stomach heat and stagnated liver qi these days! Then, as quickly as
I tossed the chopped celery into the recipe that didn't call
for it, I heard Dr. Zhu's voice in my head, reminding us that
we cannot just throw in some extra needles just because we
opened a 10-pack!
What's the big deal about haphazardly
adding things in after the recipe (yes, we could call an
acupuncture point prescription a "recipe")?
As Dr. Zhu explained, the point prescription is just that -- a
prescription. You should take it seriously and respect the balance
and harmony of the points that are working together. There are
master-couple points in there; I saw a guest-host thing going on. I
know she's tonifying the mother and sedating the child on the Lung
channel. Someone said "extraordinary." Seems like it's getting
crazy, but really it's not. It's very calculated...complete and
time you find yourself in the kitchen with some extra celery to use
up, are you going to throw it into the pan when the recipe doesn't
call for it? Maybe... But, the next time you acupuncture interns
find yourselves in rooms full of open packs of needles, I hope you
do the right thing and leave them on the clean field instead of
just adding in the 3 extra opened needles. Just don't tell Dr. Kim--he
does not like wasted needles!'
Pitchford, P. (1996). Healing with whole foods: Oriental
traditions and modern nutrition. Berkeley, Calif: North
Dr. Yurasek and I scrubbed into the isolation unit, donned our
masks, and needled an in-patient right in her hospital bed. I knew
that shift would be different. It was only my third day, but it
just felt different when I punched in that morning...and I was
Between our usual out-patient pain
clinic cases at Cook County Hospital, Dr. Yurasek, the other
morning interns, and I were discussing some of the more remarkable
results achieved with auricular acupuncture. That's putting needles
on ears, for the laypeople reading today. He told us about a
patient in a wheelchair who rolled in with several bullet wounds
and walked out the same day after the acupuncture
treatment. We told him about patients whose pain level went from
10/10 to 0/10 after their acupuncture treatment. It was basically
"one time at band camp" day at Stroger.
Dr. Yurasek was explaining that these types of staggeringly
effective results are the reason that acupuncture has been making
its way into the world of western medicine. Specifically, he said
it was the "portal to acupuncture ecstasy." That's actually the
start of an entirely different "one time at Stroger" story from
last week... but we aren't talking about that one here.
The point was that with the obvious decrease in patient pain
after a 10-minute needling and tui na treatment, it's hard
to shut the door in the face of the acupuncturist who wants to
treat the people. Let us into your hospitals! Share your space with
us, MDs! We were all on board... but how would we get the
administration to give us the time of day?
Then, the call came. The sixth floor
had an in-patient in acute abdominal pain, and her doctor wanted
the acupuncturist to come up and lend a hand -- a hand with a
needle at the end of it. And, since they called Dr. Yurasek, it
would be a big hand with a really, really big needle on the end of
it. We all know he likes those 6-inch needles. I don't even
near-faint anymore when he whips them out and drives them into a
patient's leg. I still look at the other side, though, expecting to
see the needle sticking out back there... I do still do that.
I had just hooked up my patient to the E-Stim machine and dimmed
the lights in her treatment room, when Dr. Yurasek peeked his head
in my room and said, "Let's go." Where were we going? I didn't know
yet. He calmly said, "There's an inpatient on the 6thfloor in acute
abdominal pain, and we're going up to needle her." Alrighty. If you
say so, sir. I walk next to him, fumbling through the pockets in my
white coat, knowing I probably needed to be bringing supplies or
Halfway upstairs he, very casually, mentions that the patient is
actually in an isolation unit, and we'll need to take extra
precautions. OK, ummm, is it too late to go back downstairs? What?
Thoughts of bringing home some exotic virus (other than the ones
I've already had) to my kids were flying through my mind.
Well, now I'm so nervous that I don't even know
where I am. Where are we heading? East wing? West wing? Where's the
lake? Finally, we make it to her unit. The nurses glance up at us
like, hey, no big deal, go on in. She's through that set of doors,
and then through that next set of doors... the ones with those red
signs taped to the window. OMG. "Droplet isolation"! I don't even
know what that means, but I'm nervous. Very nervous. We scrub in,
the nurse finally steps in and helps us with our facemasks before
we tied them on backwards, and basically pushed us through the next
set of doors.
Well, too late to back out now. Here we go. Luckily I had
needles in my pocket. Or he did, I can't even remember. The next 30
minutes were a blur, mostly because I was nearly passing out from
the recirculating carbon dioxide in my facemask. How do people wear
those for extended amounts of time? Clearly I was doing it wrong.
First timers, right here.
"Where's your worst pain right now," Dr. Yurasek asks the
patient, who I definitely thought was unconscious when we first
walked in, splayed out in her bed with the usual useless hospital
gown covering her nothing. "My back, and my leg, all the way down
to my foot," she says. Well, she's conscious. Great news for my
burgeoning anxiety. Abdominal pain, back pain, she's got it all,
but her back hurts the most right now. So, we treat her back pain.
Cue the 6-inch needles into the ancient secret lock-and-key points
now called "Gall Bladder 30" and Gall Bladder 34." Sciatic pain
relief on the way!
The patient is in less pain and is visibly more relaxed in her
body tension. She was in the middle of telling us a story, but then
she suddenly passed out asleep. OK. As long as she's not dead, I'm
going to make it. I run around like a crazy person in a crazy mask
looking for a gauze pad so we could take the needles out, and
finally, our job is done here. We walk back downstairs to the
outpatient pain clinic and resume our day.
"How's your internship at Stroger going," people keep asking me.
Awesome. It's freaking awesome. If you have the opportunity to
intern at Stroger, and you're not doing it, you're missing out.
As soon as I say, "I'm studying
acupuncture," their eyes light up. Everyone likes the idea of
acupuncture. It sounds exotic, ancient, and trendy all at the same
time. What could be better? Yes, the interest is there, but so,
undoubtedly, is the follow-up question, "What can acupuncture help
Gee, let me think. My first instinct, based on clinical and
personal experience, is to excitedly shout "EVERYTHING" in
someone's face. We all know that's not helpful, not specific, and
usually not socially acceptable. Instead, I try to reign myself in
and itemize a few conditions that might be of concern to the
individual in question. My answer then comes out sounding like,
"Oh, several things...trouble with sleep, irritability, irregular
periods, pain, you know...basically everything." I just can't
resist throwing that all-inclusive ending on there.
Maybe I'm not way out of line in doing
so. In ancient China, obviously Chinese medicine was the entire
medical system, including preventive care, acute care, chronic
care, you name it. Your acupuncturist could needle your face, moxa
your feet, gua sha your shoulders, tui na your back, and even
perform certain surgeries. Back then, "What does acupuncture treat"
would have definitely received my favorite answer, "EVERYTHING!"
Although, that's probably too rude and aggressive for ancient
China. They probably would have responded with something much more
humble, and then surprised the pants off you with their amazingly
effective acupuncture treatment.
Let's look for a compromise. In America
today, you can't just walk around saying that something that's not
a drug can treat, prevent, or cure a disease. You can't say it. So,
what can we say? In these delicate cases, I defer to the World
Health Organization, which lists conditions that acupuncture has
proven to be an effective treatment through controlled trials.
Although the list we all seem to use is incredibly old -- from 1996
-- we continue to see additional conditions helped by acupuncture
in individual studies such as those found via www.pubmed.gov.
Here's our old starting list:
Plus, for our reading pleasure, the World Health Organization
also gives us some hopeful additional categories. They list over 60
additional conditions and diseases that acupuncture has been
demonstrated to be effective for, but for which additional research
is needed. There are about 15 other conditions for which
acupuncture has been shown effective for in individual cases, or
for which conventional treatment is difficult or ineffective.
So, next time someone asks
me what acupuncture can help them with, I'm going to give in and
shout, "EVERYTHING," at them. After all, odds are I'd be right.
Does it treat this? Check. Does it treat that? CHECK!
If you don't pray, put them together anyway. In the
age of anything goes, I've taken to the lazy practice of praying
silently in my head while lying in bed at night. I don't know where
my hands are exactly, but they sure aren't folded nicely in front
of my chest like the iconic prayer image of the olden days.
Who cares? Why bother pressing your hands together and holding
them in that fairly awkward position that drove me nuts as a
Catholic school kid? I'll be the first to admit that I let my
fingers fall and intertwine into the sloppy prayer paws pose as
soon as the priest looked the other direction.
Now I realize I was screwing myself out of some real benefits.
Sure, God was probably disappointed in my faulty direction
following, but I'm not focusing on the spiritual deficit here. I'm
focusing on the physical and even the psychological benefits I --
and many other lazy prayers -- had been missing out on all my young
This whole conversation hinges on one
important point -- an acupuncture point -- called Pericardium 6, or
"PC6" as we call it, because again we're all too lazy to stick to
the formalities in life. What does PC6 have to do with prayer paws
(as my kids call them)? This now famous spot, two inches proximal
to the inner wrist crease, has been dubbed the most researched
acupoints of the modern day. You know those "anti-nausea"
motion-sickness type bracelet bands, with the ball that presses
into the inner wrist? That thing's stimulating good ole PC6.
Why is PC6 such a beneficial acupoint? Our trusty
guide to acupuncture points and meridians and their energetic
functions is a beefy, rust-colored book usually referred to by its
author's last name, "Deadman." What does Deadman say about PC6? Oh,
nothing too exciting. Just that it treats all diseases of the
chest, particularly the heart, but also benefits the lungs, too. It
can be used for heart surgery analgesia. What? Yes! No anesthesia
necessary...just squeeze PC6 for me while I go under the knife!
In TCM terms, PC6 "unbinds the chest and regulates
qi," "regulates the heart and calms the spirit," "harmonizes the
stomach to relieve nausea," and "clears heat." It's indicated in
conditions such as heart pain, palpitations, cough, asthma,
insomnia, anxiety, abdominal masses, fevers, malaria, irregular
menstruation, and swellings in the armpits. Nothing important
there, right? Not! PC6 does just about everything you could want an
acupoint to do.
During a recent advanced seminar class with Dr. Robin Fan, we
discussed the benefit of stretching the Kidney meridian in cases of
heel pain. Suddenly, all I could picture was the traditional prayer
pose--hands out front, pressed gently together, stretching and
stimulating the bulk of the Pericardium meridian!
It makes sense. What is the function of prayer if
not to calm the mind and spirit? It's not just Catholics and other
Christians who have always used this prayer pose, either. As my
mind wandered -- sorry, Dr. Fan -- around the globe, I saw the
Chinese practicing qi gong poses, the Indians practicing
yoga poses, etc. Every tradition I could think of involved some use
of this position.
In anthropology, when we see similar customs or values amongst a
variety of cultural groups around the world, we call those core
elements "cultural universals." In other words, everybody's doing
it. Why? The answer is one that, despite my need to create an
evidence-based practice, I've always secretly promulgated;
sometimes, you don't need to sit around waiting for a formal
research study to prove a truth. It's lovely that western medicine
has put together some studies that do show the efficacy of PC6 in
some conditions, but I'm not waiting for them to prove the rest.
I'm going with Deadman and the ancient world traditions on this
Pray on, prayers!
• So What Is Chinese Medicine?
• Jabbing Nerves with Needles
• Mission in Nicaragua
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