How to formulate a point protocol.

Something that I’ve noticed to be very lacking among both students and teachers at my TCM-oriented school clinic (as opposed to CCM or Classical Chinese Medicine)is a real understanding of how to choose and differentiate points for an acupuncture treatment. I’ve noticed that methods tend to fall into the categories of either what I call the Patented Prescription or what I call the Arbitrary Stack.

The Patented Prescription method goes something like this: patient has a complaint, the treater and supervisor narrow down what pattern they believe they are seeing, and then apply a commonly used combination of points that is indicated by textbooks, experience, Master Tung, Richard Tan, etc. as being useful for that condition. This is then augmented with other points to account for other presenting symptoms.

The Arbitrary Stack works like so: patient has a complaint, pattern is deduced, supervisor starts naming off points: “Well, Lv-3 is good for moving Qi and Qi stagnation, LI-4 and LI-11 can release Heat from the Yang Ming, they’ve got Stomach Heat so we’ll use St-44 and then also St-36 has a similar action so we’ll throw that in too” and so on.

You may ask, “Yeah..so what’s the problem? That’s how everyone does it. People seem to get well when we treat them.”

The problem is that both of these methods fail to take into account the presentation of pattern, symptoms, and physiology of the patient at that very moment. In other words, these methods are grossly inaccurate and result in only a fraction of the efficacy we could (and should) get if we knew WHY to do things a certain way and knew HOW to make the treatment strong enough to get solid results.

It is my belief that the above methods are the product of the homogenization of acupuncture in China during and after the Cultural Revolution. I don’t for a second believe that the way acupuncture is practiced in China NOW is an accurate reflection of how it was practiced in the days of the great masters like Li Dong Yuan, Zhang Zhong Jing, and so on. A lot of the reduced efficacy of what we do is attributed to the increasingly deficient condition of modern man and the invention of new pathogens (a subject I plan to argue extensively at a later date for all you fans of controversy out there) when in fact I believe it has much more to do with the practice of inferior medicine.

So, if there is another method out there,then what is it? Well may you ask. It is my understanding that in a Tang dynasty political purge, a large contingent of physicians practicing according to the Nei Jing model sought refuge in Vietnam where they continued to practice according to the model that had been developed in the early Han dynasty. Through the work of Dr’s. Nguyen Van Nghi and Tran Viet Dzung I have been made aware of a different and far older method of treatment with its roots in an accurately translated version of the Ling Shu which unlike the method we are commonly taught today actually does hold up to scrutiny versus the Classics from which our art comes.

The following method comes from Dr’s. Nguyen and Tran. This is presented in my own personal understanding, any inaccuracies are purely my fault. I should note that there is argument over this method between the camps that believe you should never use more than eight needles and those who have no problem using as many as thirty. I personally don’t have a definitive opinion on this subject as I’m still trying to decide what i think on the subject.

Here then is the method followed by an example from my own experience:

Initially of course, you must make the correct diagnosis. I personally prefer a method I picked up from the writings of Dr. John H. F. Shen which is to decide on a primary pattern, then a secondary pattern, then symptoms. With a correct diagnosis, we can then get to work.

The key to the whole thing is that we are building a framework that supports itself. It’s no use just throwing points in because you see a symptom for it or are told that its useful for a condition. We have to use points that all work together and are mutually strengthening so that we can get the maximum possible effect in the treatment. The way I look at it is that every step away from exactly right weakens the therapeutic effect of the treatment. Go far enough away from the necessary ‘force’ and you will have a treatment that doesn’t accomplish anything, which of course is bad for the patient, bad for your business, and bad for Chinese Medicine as a whole. So don’t be that guy. Bring every appropriate weapon to bear when you treat.

We are taught in our point location classes the assorted categories of points, but then in practice seem to go away from them in favor of experiential combinations. This is a mistake. The categories exist to assist with building that framework and so that we can understand what we are doing. To paraphrase Dr. Tran, if you puncture a point and you don’t understand why you’re doing it, you can expect the results to not be very good. The categories in question are: Ah Shi, Luo-connecting, the Five Shu-Antique points (erroneously translated as Transport points in most texts), Command points (also known as Hui-Meeting or Reunion), Confluent points, Front-Mu and Back-Shu, Xi-cleft, Lower He-Sea, and finally Jing-Passage (referred to in most modern texts simply as meeting points). There are also Root and Summit points as well, but this falls outside the scope of my current experience so I won’t address them here.

Now obviously you’re not going to use points from every single category on every single patient. You have to take into account constitution of the patient, strength of the disease, necessity for particular types of support,and so on. The best place to start is with Ah Shi points, as even if there isn’t prominent pain, you’re likely to find a tender spot near the are in question that will give you further cl