Acupuncture and the 20/80 Rule

I recently purchased the newly translated book, Lectures on Tung 's Acupuncture Therapeutic System, by Dr. Young Wei Chieh.  It's a grand old book full of meat.  Clinical gems abound on every page, as well as theoretical concepts ranging from the I Ching, Shang Han Lun, Holographic corespondences and the Tai Ji, and the 5- Elements.  The meandering style of transcribed (and oddly translated) lectures allows for circular reading yet manages to create a cohesive whole.

However, I had no idea that buried in this book would be a one of the foundational truths of Community Acupuncture.  Right on  page 96, Dr. Young gets to the heart of the matter.  Or, at least, one of the hearts.  He calls it the 20/80 rule.

Mixed into the clinical protocols and case studies are Dr. Young's answers to audience questions at the source lecture.  Pages 96 and 97 cover question 11, “What are your thoughts about treatment based upon syndrome differentiation and the use of specific methods?”  [“specific methods” is an awkward translation for what would read better as “empirical treatments”]

Let me quote the opening of Dr. Young's answer: “Treatment according to syndrome differentiation is characteristic of Chinese medicine and is the preferred method for treating difficult to treat miscellaneous dieases.  However, syndrome differentiation can be used as a shield to hide one's knowledge.  I would like to make an argument for specific [empirical] treatment. For example in frontal headache, the solution is usually to needle Sp9 or HuoJu (66.11).  This is simple and clear.  However, some teachers intentionally or unintentionally hide their practical knowledge.  They will recommend the selection of points or herbal formula based upon syndrome differentiation after inspection, auscultation and olfaction, inquiry and palpation, even though they use specific points and formula.”

In other words, a lot of practitoners do a lot of window dressing to make themselves look important. A patient walks in complaing about frontal headaches.  Do we need to know their family history, wether the headache feels hot or cold, and the smell of their poop?  No, we need to know Sp9 and Huo Ju (Tung's Sp4).

Ok, let's move on to the truly profound part of Dr. Young's reply.  “There is a law of 20% and 80% that exists throughout society and enterprise.  In terms of economy in social systems, 20% of the population owns 80% of the wealth, and 80% of the population owns 20% of the wealth.  In the clinic, 20% of the diseases have affected 80% of the patients.  In Chinese medicine, 20% of the acupuncture points are used to treat 80% of the diseases.”

Wow. What this guy with 40+ years of experience is saying is a wonderful summation of the concepts of “Noodles.”  The economics is not new to anyone on this forum and does not need my elaboration.  However, we CA folks often face the criticism that we do cookie-cutter / recipe book treatments.  What Dr. Young suggests is that 80% of the time that is enough. Not only is it enough, but it is the sign of an experienced practitioner. If you see enough patients, you start to understand that 80% of the time Sp9 and Sp4 will do wonders on frontal headaches, Ling Gu and Da Bai will take care of 80% of back pain, etc.  Isn't that beautiful?  What's better, is that after seeing a few thousand patients, you'll start to figure out how to treat that other 20%, and you'll probably be able to do it without having to ask a million questions.  Once you have treated that 80% enough, you'll figure out what little tid-bit you need to know to differentiate it from the 20%.

In the 10 months that my clinic has been open, I've given 1300+ treatments.  I'm starting to figure out what comprises that 80%, and learning a little bit about how to approach the 20%.  That would take a whole lot longer if I was going through the dance of the 10-questions with every frontal headache that walked through the door. 

Author: Davelcorp

I'm French-Irish-American hybrid living in SF, married to a Irish-American gal from New Hampshire. I have a son named after my hometown in Texas; he was born in the year of the Monkey (me--the Dog.) I went to school to learn how to stick needles into people in order to make them feel better. I'm broke, in-debt, and pay too much rent for a <strike>one-bedroom</strike> two-bedroom apartment. I have health insurance but owe about $2000 in medical bills and believe that CA will make my life, and others like me, more comfortable. I also have about 20 kilos of puer tea aging in a red metal cabinet -- I plan to drink it all before my days are over.  

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  1. thank you for this post…

    I agree.  This past year in practice has been illuminating, and I would have to credit seeing lots of peeps as a big factor.   I also like very much the book you mention.  keep on pokin!

  2. lovely

    david, this is so cool. i was already pretty impressed with Dr. Young from taking his class in San Jose last month, but this is awesome. i have been wanting to get that book, i guess now, i have to!


  3. Thank you.

    I have’t read Dr. Young’s book yet either, so I had not yet come across those nuggets – thank you for sharing & contextualizing them.  I especially like your argument that “not only is it enough, but it is the sign of an experienced practitioner.”  Well played, sir!

  4. cookie cutter

    “We CA folks often face the criticism that we do cookie-cutter / recipe book treatments.”

    Personally, I would rather have an acupuncturist who’s treated thousands of patients with complaints like mine and who knows exactly which points will help me feel better, stick the prescribed needles in me…as opposed to an acupuncturist who only treats 10-20 patients a week, and doesn’t have enough experience to really know what will or won’t work, and so they try a different combination of points on each patient, trying to discern a pattern amidst the infrequency…

    Thanks for the book recommendation, David.  Smile

  5. yes, thanks for this David.

    yes, thanks for this David. The 20/80 description of what issues comes through the door and what usually works for those issues is a very acurate reflection of clinical reality from my experience so far.

  6. I think this is a great post and reminder…

    It always baffles me when an acupuncturist complains of the so called “cookie-cutter” approaches being worthless… like where do you think they come from?  Did someone miss the class that explains Chinese medicine is a “pattern medicine”?

    Acupuncture 1,2,3!


    The People’s Acupuncture Clinic

    “health for the people… by the people.”

  7. great post!
    this is very

    great post!

    this is very helpful as a new practitioner…trust what has worked, over and over and over. helps take the fear and ego out and go back to trusting acupuncture.

  8. Here here

    Thanks for the reference to this book.
    I just cracked it open tonight and after reading the downright bizarre ‘Preface of The Chinese Edition” rant, I ran across this bit of info that easily ties into the letting-patients-cook-longer m.o. of many CAPs:

    “Master Tung typically retained the needles for 45 minutes…I often do (the same)… in case there is not enough beds or the patient is in a hurry, the needles should be retained for at least 30 minutes. The duration of needle retention should be prolonged for chronic conditions, severe diseases….I will retain needles for 60 minutes in cases of facial paralysis, 90 minutes could even be better.”

    This makes sense to me.