Follow-up to All the Things: Some Contradictory-Ass Things

Comrades, over the last week I am having a perfect storm of Internet Things. They all somehow relate to my last blog post, so I'm calling this a follow-up: Some Contradictory-Ass Things.

If you have seen the latest POCA Tv offerings, you know where we got our title. One of Andy's Situational Punking exercises involved patients asking for lifestyle advice; we tried to make a video about it, but things… devolved. At one point, Wade spontaneously announced, “There is some contradictory-ass shit in the body of knowledge that is Traditional Chinese Medicine.” (Experience it for yourself: https://pocacoop.com/pocatv/post/weight-loss-stop-smoking-lifestyle-advice)

Not that I needed confirmation or anything, but I was fascinated to find this post on Matt Bauer's site. You should go read the whole thing yourself, but here is a summary:

“Have you ever wondered what would happen if several top acupuncturists were to diagnose and set treatment plans for the same patient? Just such a thing took place about 25 years ago on stage at an acupuncture conference. I was in the audience that night…(t)he speakers included Ted Kaptchuk, the “Web That Has No Weaver” author and Harvard Medical school professor,  J.R. Worsley,founder of the Western Five Element school of acupuncture, Kiiko Matsumotto, popular author and lecturer with Japanese style techniques, Joseph Helms, the M.D. who founded the American Academy of Medicinal Acupuncture and taught M.D.s an acupuncture course at UCLA, T.W. Woo, the inventor of the Korean Hand Acupuncture system, Tran Viet Dzung of the Vietnamese/French energetic school who substituted for Nguyen Van Nghi as his health prevented his traveling , and a TCM doctor from China whose name I do not recall. The patient was a young woman with a few common health issues…Guess what happened? Only two of them agreed with each other on the findings/diagnosis and that was the Chinese TCM doctor and Dr. Tran Viet Dzung who follows a similar school of thought. Each of the other five acupuncturists had quite different ways of describing this patient’s condition and advice for treatment.”

I love it that Matt is making an effort to pass on the history of the profession to the rest of us who weren't there, and who would otherwise be unable to appreciate the many contradictions. But I did not find this story inspiring. Fascinating, yes; inspiring, no.

Finally, a blog post titled, Abbreviated Courses in Acupuncture for Physicians Pose a Serious Problem, popped up in my Facebook newsfeed. The comments are pretty much what you'd expect.

And then I remembered that I am the executive director of an acupuncture school, and I thought, God hates me.

The take-home message from Matt's post, and from our whole history as a profession really, is that there is no genuine standard for how to think about acupuncture, let alone how to implement it in a clinic. The theories and their application vary so widely that they are, for the purposes of training practitioners, virtually meaningless. If the luminaries in the field can't agree on a garden variety case, how are we lowly workers supposed to understand the theory behind what we're doing every day? You guys, you are not making a convincing case for yourselves.   So the fact that a lot of acupuncturists, including some community punks, really believe that it's a terrible thing that physicians and PTs and chiropractors aren't spending thousands of hours learning the same contradictory theories that we L.Acs have to, well, I'd say it's a joke but it's not funny.

Speaking of luminaries, you know another joke that's not funny? Ted Kaptchuk's degree, apparently.  (Dan Bensky's too.) If you want to go down that rabbit hole, start here, second post down. Spoiler alert: the absolute best case scenario is that they're not doctorates, they're diplomas — assuming the school existed. Nice to know that POCA Tech students will be at least as educated as Kaptchuk and Bensky, I guess. But if there's outrage about undertrained practitioners going around, I'm wondering why none of it is directed at the Macau Twins.

Don't get me wrong: I'm not a fan of acupuncture dilettantes, either. But what makes a good acupuncturist is not a head full of theories; it's a sophisticated range of human skills that you can only develop by treating a lot of people with acupuncture. To be a good acupuncturist, more than anything else you need the opportunity to work. That is sadly denied to many acupuncture school graduates because of the sheer economic dysfunction of the profession; but it's also a kind of humble working-class desire that a lot of them are apparently too refined to have. They don't know what they're missing.  The range of human skills that make a good acupuncturist has nothing to do with aspirational props like professional middle class culture, thousands of hours of theory, books and lectures. What matters is access to ordinary people who will let you work with them, their bodies and their troubles — patients who will be your teachers.

Like I said before, it's hard to escape the conclusion that the people who tried to scare us away from doing community acupuncture really had no idea at all about how acupuncture works — never mind that they were acupuncturists. And you know what? They still don't. A friendly heads-up, Internet: just because we're making an acupuncture school doesn't mean I'm going to shut up about all the contradictory-ass things. Yeah, unfortunately we have to put a bunch of them into our curriculum; there's no way around that if we want our graduates to get licenses. Given that, I feel more of a responsibility than ever to admit it when they don't make sense. Abbreviated courses in acupuncture pose a serious problem — a serious branding problem for acupuncture education and all its contradictory-ass things.

lisafer
Author: lisafer

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  1. As the one responsible for re-posting the article about abbreviated acupuncture courses being too brief, I want to clarify some things here.

    There will always be controversy about what is thorough enough education and what is not, what should be included, and what should not. I especially feel strongly around the promulgating the mistranslations regarding such basic and concrete things as Oxygen & Vessels (QI & Mai) being something ‘not real’ or findable on examination. I wholly agree that we need to get real here folks. We are manipulating oxygenation, blood flow, nutrients, and other body substances with our powerful, yet tiny needles.

    However, please don’t mistake my intent – I believe that we need to give enough time to training such that acupuncturists know what side effects are possible when we stick needles into them. The article in question was by a Medical Acupuncturist urging the Medical Acupuncture Association to be sure folks are trained thoroughly in acupuncture. He had attended a 172 hour (at least it was a generous amount of time compared to many) course where the entire thing was taught by 1 person who wrote the book, designed the classes, and video tape needling training. He felt the training was perfunctory, and inadequate so he decided to go to NCNM.

    I cited an example the recent case in Canada of an Olympic Judo champion going to a PT for neck/shoulder pain and that person had attended one of those even more abbreviated, 3 weekend long courses in acupuncture – about 72 hours of training. He or she needled St 12 but apparently had no idea that it was possible to cause a pnuemothorax, so when the patient complained of SOB & pain, she was not sent to the ER. She is now permanently disabled d/t the severe complications of complete lung collapse and infection.

    Of course, there are a certain number of pneumos caused every year by L.Ac.’s, and even the best of us can have this happen to our patients, but we are trained to know that it is a possible outcome of our needling at particular points, and to be alert to the signs and symptoms of a pneumo.

    I think that it is the height of irresponsibility to train folks in acupuncture without training in the full knowledge of possible serious side-effects of what we do, and how to respond to them. Do we need to buy in to the ‘mumbo jumbo’ – no. Do we need to require MD’s & PT’s 1000’s of hours of Acupuncture School – no. I was not in any way advocating that. But, we should always check to be sure that all acupuncture training includes basic safety in needling at each acupoint. Despite being an MD or PT, that does not automatically mean they would know how deep to put a needle at any particular point. So, we should be concerned about the very, very short acupuncture courses out there, as like any ‘fly by night’ education, they fall very short of the mark in providing for public safety. And it does behoove us as acupuncturists, to monitor that kind of cavalier approach to what we do. We can HARM people so we need enough training to avoid that. How much is enough is why we discuss such things.

    Can one manage to get through acu-school and still be unsafe? Yes, despite the 1000’s of hours of training, as that depends on the quality of the internship – not our ‘theory part’. Could one get through an apprenticeship with a Master as Dan Bensky and many of our other senior acupuncturists did and still be unsafe? I think less likely. A Master is concerned that his/her apprentices actually master their trade, gives personal oversight to training and does not hand over a needle to a student not yet ready for it, and watches closely as they grow in technique.

    However, it is often the weak point of all ‘factory education’ that folks can pass a test while being completely incompetent at the same time. Most medical schools try to avert this by having graduates go through a rather long internship – 3 to 5 years depending on specialty. They are paid while training (though we can discuss the inadequacies, abuses & poor pay for them while training too).

    One of the reasons I love POCA tech, is that it is also striving to bring back some sense to the equation here. Have students working in clinics so that they get thoroughly grounded in acupuncture and patient care, with intimate oversight by a competent punk. Didactic training in classroom settings at an affordable rate and concentrating on one aspect of East Asian Medicine so students are well grounded in that one area without getting strung out by covering too much material.

    And finally, yes Lisa, unfortunately some mumbo-jumbo has to come with it because our governing bodies deem it so. But seriously Lisa, would you ever consider leaving out teaching side effects of needling at each point? I don’t think so….

    As a recap – 1. Definitely not advocating 1000s of hours of Acu school required to be excellent acupuncturist (

  2. Oops – hit wrong button in my excitement:

    1. no need acu school to be excellent acupuncturist – actually, I think Master/Apprentice is the best way as those years of personal training one to one is really the natural way to go.

    2. we should be concerned with the content of what is taught ‘out there’. We should give serious thought to what minimal training would look like. Maybe even shorter than something like POCA tech for other health professionals who wish to change careers. But 36 – 72 hours only? Yup, probably too short.

  3. I don’t know. For people who are already trained as medical practitioners, with at least as much A & P as we get? The list of points where you can damage an organ or the brain stem or anything else by needling too deeply is a short one. “I think that it is the height of irresponsibility to train folks in acupuncture without training in the full knowledge of possible serious side-effects of what we do, and how to respond to them.” For people who already knew their way around the body, you could do that in an afternoon.

    What I’m objecting to is a general sense of alarm which mixes up “danger — pneumothorax” with “danger — a clueless MD might needle Sp 6 when really a well-trained acupuncturist would have needled Liv 3 and won’t somebody think of the public with their fragile energetic systems???”

    Also, want to take a bet on how long it will be before the MD who wrote that article is *teaching* for NCNM? I give it 6 months tops. She’s demonstrated that she can advertise for them, which is really the most important skill most acupuncturists get — how to advertise for their schools.

  4. Oh Lisa, you are too right. We all have blinders on, and I never jump to or even imagine the scenario where someone is going to object to Sp 6 vs. Lv 3 and ‘damaging fragile energetic systems’. Mostly because that whole ‘fragile energetic system was made up by Westerners and doesn’t really exist (to my knowledge) in the classic texts. They refer to physical systems in our physical bodies as they relate to input from nature or pathological changes within the body – and how we can correct these things. I have even heard that Chinese TCM practitioners are somewhat amused by us in the West talking about ‘energy medicine’. Sigh.

    However, I have also never been a fan of TCM with its intellectual herbalization of acupuncture. It is why I do Japanese Meridian Therapy. The body tells you which vessels need treatment and knows what to do with your input. Nature is so very wise and we fool ourselves if we think we are smarter.

    And yes, you would think that MD’s & PT’s would be able to be trained in an afternoon about what points can cause serious side-effects, but the fact is, that it seems many of these very, very short courses do not! Or at least, not supervising how students are needling and giving feedback about it. Otherwise, the poor PT who made the error would have known this. They clearly stated that they had no idea that point could cause such a problem and assumed it was a sore muscle from vigorous needling technique.

    Indeed, you would be surprised how many ‘medically trained folks’ don’t really know where physical organs are in the human body by palpation, as palpation is just not taught much. Surgeons have to know, but not other specialties. PT’s & Massage therapists you would think get that training, but really, they are taught more about musculo-skeletal palpation – not where organs are when you palpate. So it is really necessary to never assume anything.

    You may be right about the MD who wrote the article having a future teaching at NCNM. Professor churn is high at all schools it seems. And she is a fan.

  5. Just a short comment about A&P. From meeting and talking with lots of PT’s, Massage Therapists, and doctors, they were all taught (to a greater or lesser degree) about anatomy. Most learned the placement of organs, many saw it in dissections, surgeons certainly hands-on. But if they don’t work with it every day, many of them think of anatomy as topography, not in 3 dimensions. Heck, lots of acupuncturists don’t get the 3 dimensional nature of acupuncture points. So, in any class for western medical personnel, I think it would be handy to at least go over the proximity of organs related to the depth of needling certain points. Like DU15-16, like LU1-2, and some others.

    That being said, I’ve taught acupuncture anatomy, and the “in-between” points put you to sleep. So a short rundown should be enough. But I would never assume that medical personnel “know” everything their diplomas say they should know.

  6. If those points are so dangerous to needle then maybe nobody should be sticking needles in them in the first place. This is especially true when you can get wonderful results with distal treatments strategies.

    The truth is that pneumothorax cases from acupuncture are rare and the PT mentioned above could just as easily been an LAc. I’m not convinced that PTs, DCs, or MDs are any more dangerous than an LAc. These cases just get jumped on and sensationalized by The Profession. This is turf warfare and a poor justification for our bloated acu-education requirements. We really need a comprehensive look at the data to determine who the dangerous ones are…

    If you omit the “dangerous points” from acupuncture practice then how long would the necessary training be?

    To be honest, the extent of my training on needle depth what “Just put it in a little bit” and “you have to be extra careful here because you might puncture a lung”. Seems like something that could be learned in a weekend…

  7. That program for massage therapists to learn acu sounds AWESOME!

    A couple program mods to make sure they are being safe: Distal techniques only, no deep needling, and no vigorous needling.

    If they included that in their program then I think it would be perfectly acceptable.

  8. Distal techniques for massage therapists would be so much more effective. You could be treating a sore shoulder with ankle points and massaging it at the same time!