Pointed techniques: an experience of acupuncture and western medicine [Perspective]

The orienting principal underlying Western medical practice is objectivity. Rejecting a tradition that relied on nebulous concepts such as ‘humors’ and their imbalances, we have devoted years of study to identifying what is really happening when a person becomes sick. The locus of our objectivity is the physical world – we have used gross anatomy, autopsies, pathology and now genetics to identify how our organs work, how they connect to each other, and how they change when a person becomes ill. We locate disease in some physical change in some level of the body, either concentrated in a specific organ or dispersed via hormones or floating cells.

The physical organization of our body structures our thinking and our practice. Often this works, but sometimes it does not. I once met a patient who was diagnosed with diffuse metastatic cancer from an unknown primary. She was bed bound and in physical pain from vertebral metastases, and badly needed treatment by an oncologist familiar with these complications. But until she knew whether she had metastatic breast cancer, lymphoma or melanoma, no oncologist would see her. Other patients with mysterious illnesses, particularly pain syndromes, often travel from specialist to specialist, learning what they do not have but not what they do have.

Yet, despite these flaws, our system is comfortingly concrete. When Jenny told me my heart and small intestine manifest themselves in the same pulse, it jarred my sense of physical reality. I also knew that Advil would affect my kidneys sooner than my liver. I later realized she didn’t mean my physical liver and my physical small intestine in the way I thought of them, but that insight didn’t help me understand what she was talking about, and it made me skeptical.

Jenny next got out her needles and started to ask me questions. “Do you have any health problems or any aches and pains?” My chief complaint was ready.

“I get terrible tension headaches.”

She nodded understandingly and started to insert the needles. “Any other problems? GI problems?”

“I sometimes get terrible stomach cramps.”

She nodded again and started to insert another set of needles.

“Skin problems?”

“I get heat blisters sometimes.”

More needles.

In that warm dark room, beneath her understanding nods, I forgot about my liver and started telling her everything. All the occasional aches and pains that were too trivial to mention to my doctor, I told her. She didn’t ignore any of them or explain that they didn’t seem to be impairing my life. She simply expanded her treatment to include them. Jenny then dimmed the lights further, turned on some soothing music, and left.

Western medicine trains us to sift through the stories our patients tell us. From a list of symptoms and concerns, we listen for the ones we think are serious. Heartburn? Common. Back pain? Common. Unintentional weight loss? Serious. Our job is not to take a symptom at face value but to identify what is causing the symptom and to determine whether and how to treat it. It is because there might be a difference between what patients think is important and what we think is important that a good history always includes a review of systems (or, as a friend calls it, a review of symptoms).

Our patients know this. They often omit symptoms that they think are trivial or apologize for bringing up little things. When Jenny took my history, no symptom was unimportant. She wasn’t focused on identifying an underlying physical process, she was interested in how my body was working for me. And because my stomach pain and my headaches were not divided by different pathophysiologic processes, she could incorporate them all into her therapy. As I lay there I did not understand the why of my symptoms any better than I had, but I nonetheless could hope that they were being treated.

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