Focus On a Medicine That Zooms Out

There are 409 standardized acupoints and countless combinations. Patients come into our clinics with a list of concerns. In a medicine that asks us to zoom out, it can be hard to have focus in our treatment. Browsing social media photos is proof of this; many patients are seen laying down with 20, even 50, needles in them.

Acupuncture is as much an art as it is a science.

From a scientific point of view, collecting branches on a tree (read: symptoms) allows us to find a common root problem. It is ‘too simple’ to just place more than 15 needles in someone to treat every system imaginable, and it negates having to do any type of diagnostic analysis in the first place. Why bother with the initial interview, checking the tongue and feeling the pulse if a practitioner wishes to just use: GB20, LI11, LU7, SI3, TW5, PC6, REN17, REN12, REN6, REN4, ST25, GB31, SP10, ST36, SP9, ST40, SP6, SP4, SP3, KD7, KD6, KD3, UB62, GB40, GB41, LV3, and LV2. Or, as I have seen time and time again: GB21, and UB11 through UB32.

Due to the fact that Chinese medicine is metaphorical medicine, it is important that we understand what focus means via an analogy. If I were a boss of a corporation and had one person come into my office with a request, I am most sure I would be able handle it. Two employees at the same time? Likely. Three? It may be a stretch depending on their requests, but possibly. Four? That’s where any sane human would draw the line (plus, the number 4 in Chinese culture is synonymous with dying and death).

From an artistic point of view, it’s important to view the human body as a canvas. When painting according to the Taoist tradition, empty space is not a place to be filled, but instead functions to help tell a story. Words would not be legible without the white space that surrounds them. Music would not be so pleasant without a pause here and there.

Chapter 11 of the Tao Te Ching reads:

Thirty spokes join in one hub
In its emptiness, there is the function of a vehicle
Mix clay to create a container
In its emptiness, there is the function of a container
Cut open doors and windows to create a room
In its emptiness, there is the function of a room

Therefore, that which exists is used to create benefit
That which is empty is used to create functionality

Mark Mitchell, artist, says:

In traditional Chinese and Japanese art, the use of empty space is given the name yohaku; large areas were left blank and unpainted, and these blank spaces were considered to be a vital part of the composition, just as important as the painted spaces.

As you can see, empty spaces in artwork are not simply an absence of content; they are their own content, and carry their own meanings. By noticing the emptiness, the absences in the piece as well as what is present, you can see more of the whole.

The study of analogies, Taoism and art then begs the question, “How does one gain focus in a medicine that zooms out?” It first has to do with the most important person in the room: the patient.

The intake form and the initial interview goes hand in hand. Under the heading ‘Chief Concerns’ is where the patient writes their most uncomfortable conditions. During the initial interview, it is the practitioner’s place to uncover the how’s and why’s the condition came to be. What can also happen is that a larger and more severe condition reveals itself. To tactfully navigate how to communicate with a patient becomes an art unto itself.

For example, let’s picture a patient who is seeking help for knee pain. After the initial interview, we believe that using Ex-LE5 (Xiyan) is a good option. We also discover severe constipation - the patient only has one bowel movement every week. We know that if we treat the constipation, the Yangming channels will function better and help relieve the knee pain - LI11, ST25, REN6, TW6 and KD6. However, what it is imperative in the communication between practitioner and patient is that at no point must the patient be made to feel that their chief concern is not going to receive the attention and care it deserves. We must also never forget that by focusing on the knee for a few weeks, while ‘ignoring’ other concerns, will increase the patient’s trust. Developing rapport in the clinic is key if we are to have the patient open up to the idea of us treating other conditions.

When it comes to building a point prescription, I address it from a 4-step process. The reason for this is to help me focus on the task at hand: the patient’s chief concern. It also keeps my acupoint prescriptions below 16 needles, allowing the art of white space to flourish.

1. Where is the problem?

In the above case, it’s the knee. This speaks to the most local acupoint. Ex-LE5 is a good choice.

2. What’s next to the problem?

These are adjacent acupoints: ST34, ST36, SP10 and SP9. If we’re dealing with only one knee, we’ve used 6 needles in total so far.

3. What is the problem?

This is the root concern. During the initial interview we discover it is Bi Syndrome. Let’s say we determine it’s local to the knee and was due to injury. Therefore, it is Tendon Bi with Qi and Blood Stasis. GB34 is Influential of Tendon, SP10 is the Sea of Blood, and REN17 (Influential of Qi) and REN6 (Sea of Qi) are both excellent Qi acupoints. That’s 12 needles now (treating GB34 and SP10 bi-laterally.)

4. Who can help?

Key/Command, Confluent, Influential and distal acupoints augment a treatment. We’ve already used an Influential acupoint, so perhaps we can choose a couple of distal points. If the pain is inside the left knee, choosing the right elbow’s LU5 and LI11 would be a good mirroring choice.

Now we have an acupoint prescription that has 14 needles and a laser sharp focus. It is up to the practitioner to decide how they want to tackle the constipation concerns, but it might be best left for a few weeks while the knee heals and rapport is built. Adding extra acupoints into the prescription would detract from the focus that has been created to treat the knee concern.

For another illustrative approach, please visit my online acupuncture school (the lesson on building point prescriptions is free): https://kentonsefcik.thinkific.com/courses/my-top-20-conditions