Treat The Damn Knee Pain
I was pretty lucky to have Dr. Cai as one of my instructors. We would look at case studies in class together and when it was time to design a treatment, he would always ask, “Now, what was the patient’s chief complaint again? That’s your first treatment principle: relieve their chief concern.”
For years, patients have been coming in to see me and they fill out their intake forms the same way: they list a few health concerns but one is their top priority. Plus, I often unearth a lot more during the initial interview. Barring no emergencies such as heavy menstrual bleeding or severe constipation, I focus a good chunk of my time and energy towards whatever is their number one concern.
Branch and Root
Many practitioners are taught that if they don’t treat the root the condition will not improve - and this is correct thinking that we must treat the branch and root at the same time. However, I believe there is often a severe imbalance in the way acupoint prescriptions are created. Either a patient is left with 30 needles in them, or there is too much focus on the root.
The same can happen with tongue and pulse - there is an overemphasis on tongue and pulse diagnosis to the point where what the patient tells us is almost completely disregarded. Just like I should never make an acupoint prescription based solely on tongue and pulse, I should never build a treatment based entirely (or mostly, even) on the root.
Let’s look at a concrete example…
A patient presents with left knee pain that is sore underneath the kneecap when they walk up and down stairs. After the initial interview we discover the patient also suffers from some acid reflux, has a sore lower back, and also experiences the odd headache. The tongue is red and shows a slightly thick-yellow coating. The tongue is rapid and forceful.
What should we do? REN12 and ST44 for the acid reflux? LI11, SP9, ST40 for the Damp-Heat of the tongue? UB23 and UB40 for the back pain? Maybe an LI4 and GB20 for the headaches? Maybe all of them plus a couple acupoints for the knee? However, just Ex-LE5 (Xiyan), SP10, SP9, ST34, ST36 all on the left, and bi-lateral GB34 is likely better. The treatment has focus towards the chief concern, and the patient has less needles which guards against the separation of Yin and Yang (loss of consciousness, also known as needle shock).
The same can be said when a patient comes in for systemic problems. Again, there are usually two or three. The goal with any treatment is to figure out which root is the cause of their chief concern and go after that one instead of all of them at the same time. Focus. Less needles. Results.
Building Rapport
If we really listen to what our patient wants, they tell us: They just want their problem to go away. If we can improve their quality of life in 2-3 treatments we’ll build trust. If we can build trust, we can educate. If we can educate, we can get our patients to come back for a few more sessions, prescribe them herbs, ask them to make dietary changes - and treat more of the root!