Published on 09-25-2013
Submitted By: pugsy00
I've had multiple patients in the past year experience dramatic improvement from lumbar pain after their first treatment, only to regress by the second treatment and never reach that level of improvement again. Their western medical dx's run the gamut, from herniation to spondylopathy. TCM differentiation anything from Ki def to Qi and blood stagnation. It has happened to about 5 people now and I'm at a loss for how to explain it or how to rectify the situation. I typically start out with distal points and only move to local PRN. Any thoughts or advice on how to get these patients feeling good again?
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comment by "Volesky"
on Sep 2013
It depends on how you are applying distal acupuncture. I use distal acupuncture almost exclusively. One very important thing you need to remember is that when a patient comes to you with pain, their proprioceptive pathway is not firing strongly enough to get the body to release enkephalin (which is why their pain never goes away). Because this proprioceptive signal is not strong enough, they will often feel the pain in a much greater area than is actually the true problem. I find that with subsequent acupuncture visits, it is often important for you to be more diligent with how you are selecting your distal points to make sure you are in fact getting the area that was affected in the first place. A good example of this is hip pain. Very often people come in and there whole hip hurts (gluteus maximus, medius, minimus, piriformis, etc.). So you use a few points that affect the proprioceptive pathway and their pain diminishes. The next visit, pay very close attention, because the patient's pain will likely be a little more specific. Not a whole area but probably more localized. This means you need to more closely mirror that area with your distal points. It is also very important to make sure you are getting an immediate change in the pain. If you just put in the same points as the last time and don't assess the pain, you won't realize that you didn't actually affect the right area.
Also, be very diligent about which channel it is that you are treating. This is more important than thinking of kidney deficiency. Know which muscles are "serviced" by which channels. A great guide for this is Donald Kendall's book the Dao of Chinese Medicine. It includes which muscles belong to which channels. One common mistake made by people is that the deep muscles of the back and neck are actually part of the kidney channel, not the bladder channel. This is why Lingku and Da Bai work so well for lower back pain (LI treats Kid). Also, don't be afraid to add needles where appropriate and get some stimulation. I have very commonly used 3-4 needles in the Si3-4 area to take away a person's pain.
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comment by "ChadD" (acupuncturist)
on Sep 2013
You will likely get very different answers to your question, so you will have to find out what works best for you. Personally I never treat distally only for pain and we always use the full range of techniques (heavily utilizing cupping and tuina). So I would recommend that you don't hold off on points and techniques that can be very helpful using a wait and see approach. Most of our pain cases are significantly improved in 1-3 treatments and rarely experience any regression except when they start feeling better and spend a weekend doing intensive yard work or something along those lines...
In our system we heavily utilize huatuo points along with properly differentiated distal points, deep tuina and for many pain patients cupping afterwards. All in all, while always exploring ways to achieve better results, I'm very happy with the results we get from these techniques.top Login/Comment