abstracted & translated by Honora Lee Wolfe, Lic. Ac., FNAAOM

This is really some food for thought, folks, about how we treat our patients and why some do get better and some don’t, why some have side effects and some don’t. While I might be opening a total can of worms with this article, the information here seems important enough that maybe someone should. The type of things that this research shows us are things we need to assess when deciding on the best treatment approach for a given patient. I am open to your feedback about this, but often my own clinical experience is similar to what these doctors in China have found to be true. Here’s what the study looked like and my thoughts about its implications.

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In issue #11, 2003 of the Zhe Jiang Zhong Yi Za Zhi (Zhejiang Journal of Chinese Medicine), Xu Jun-feng of the Tianjin College of Chinese Medicine in Shandong published an article titled, “Research into the [Relationship Between] the Pulse Diagnosis of Vacuity & Repletion, Pain Conditions, & Post-acupuncture Systemic Side Effects.” This article appeared on pages 485 and 486 of that journal.

Cohort description: Sixty patients were enrolled in this study, which was conducted during August and September, 2003 on peasants seen in the Chinese author’s clinic. All 60 patients suffered from pain conditions for one year or less. These patients’ main symptom was aching and pain, and they were not afflicted with any internal organic disease process. All were 20 years old or older. All were able to receive five or more acupuncture treatments. Within these 60 patients, there were 22 males and 38 females with a median age of 40.26 years. These patients’ median disease duration was 6.24 months. Six cases suffered from neck pain, 10 from frozen shoulder, 25 from lower and/or upper back pain, and 19 from extremity pain. If these patients’ pulse had force, they were labeled as exhibiting a repletion/excess pattern. If their pulse was forceless, they were labeled as exhibiting a vacuity/deficiency pattern. Based on these criteria, there were 26 repletion pattern patients and 34 vacuity/deficiency pattern patients. Among the repletion pattern patients, there were 15 males and 11 females. Among the vacuity pattern patients, there were seven males and 27 females.

Treatment method: Depending on the location of the pain and other accompanying symptoms, a combination of local and major distal points were chosen, plus 1-2 other points depending upon the specific pattern discrimination. These points were needled with even supplementing-even draining technique, with needles being retained for 30 minutes. One treatment was administered per day for five consecutive times. After five treatments, if there were symptoms of bodily heaviness or lack of strength, these were treated with either cupping or massage.

Study outcomes: So far, this study looks fairly pro-forma. But here, in the post-acupuncture side effects discussion, is where it gets interesting for me and where the important information really lies for us as clinicians in the West. Dr. Xu measured two post-acupuncture side effects: 1.) sensations of bodily heaviness and 2.) lack of strength in the body and limbs.

In the repletion/excess pattern group, eight patients manifested these symptoms and 18 did not. Therefore, the percentage of patients in this group experiencing these post-acupuncture side effects was 30.8%. In the vacuity/deficiency pattern group, 28 out of 34 patients or 82.4% experienced these post-acupuncture symptoms. Therefore, there was a very marked difference in the incidence of post-acupuncture side effects between these two groups, with far more symptoms appearing in the deficiency pattern group.

In terms of therapeutic outcomes for the study overall, in the excess pattern group, 16 patients were judged cured after five treatments and 10 were not cured. Therefore, the cure rate in this group was 61.5%. In the deficiency pattern group, 10 patients were judged cured after five treatments and 24 were not, for a cure rate of only 29.4%. Hence, there was a marked difference in cure rates between these two groups, with significantly better therapeutic efficacy from acupuncture being seen in the patients who had stronger pulses and stronger qi.

Furthermore, in the eight patients exhibiting excess patterns cases who also experienced post-acupuncture heaviness and lack of strength, six of these saw their symptoms relieved by either massage or cupping for a side effect remission rate of 75%. Of the 28 patients (28.6%) from the deficiency group who experienced these side effects, only eight saw them relieved by cupping or massage. Therefore, there was also a marked difference in the ability of massage and cupping to relieve post-acupuncture side effects in these two groups. Again, the generally stronger patients who experienced bodily heaviness and lack of strength responded better than did the generally weaker patients to the cupping and massage for relief of their side effects.

Discussion: In his discussion of this study and its outcomes, Dr. Xu quotes the Ling Shu (Spiritual Axis) chapter titled, “Evil Qi, Viscera & Bowels, Disease & Form,” which states: “[If] yin and yang, form and qi are truly insufficient, do not choose needling but regulate with sweet medicinals.” Since I, and others with whom I have spoken, also have the experience that acupuncture, at least Chinese-style acupuncture, works better on patients with adequate qi to manipulate, this research study should remind us to think carefully about how we treat our patients.

Furthermore, the statistically average American acupuncture patient is a woman. This is notable because there was a much higher percentage of females in the deficiency pattern group (79.4%) than in the excess group in this study. Perhaps, especially with female patients, we need to question our automatic use of acupuncture as opposed to moxibustion, dietary therapy, massage, and/or internally administered Chinese medicinals in each specific case.

I remember when I studied with Miriam Lee in 1987, one of Miriam’s strong beliefs was that the very act of inserting a needle into a point drained some amount of qi from that channel. I also remember that Dr. Shudo Denmai, in his book and in his classes, stated that, in order not to drain the qi from a point, the insertion had to be virtually painless and the more painful the insertion, the more qi was drained from the channel being needled. The implication of these statements is that acupuncture, in general, is a draining, qi-moving, and qi-rectifying therapy, and not particularly great at supplementing the qi.

I also remember the first time I had an acupuncture treatment from Amy Dickenson, a local acupuncturist here in Boulder, and she asked me if my response to needles was like baking “a cookie” or “a loaf of bread”, by which she meant the length of needling time (10-15 mins. vs. 25-35 mins.). In thinking about her question since that time, it is my experience that patients with less blood and yin tend to be “cookies;” i.e., they are far better off with less stimulation, fewer needles, less time with the needles in. they also often require some internal herbal, dietary, or other yin and blood supplementing therapy, which also is not the strong suit of acupuncture.

I hope this information gives you food for thought about your private practice and how we all might serve our patients better. That is, after all, the point of what we have learned and what we hope to do in clinic every day. If acupuncture is not the best choice for improving the conditions of patients with deficiency patterns, what other treatment modalities do we have that might work better? It is always important to remember that just because we have a hammer, not everything is a nail, so to speak.

Copyright © Honora Lee Wolfe, 2010. All rights reserved.