47. Integration with TCM – a brief introduction to how a practitioner can integrate the two styles
The similarities and differences between Five Element and TCM styles of treatment377
Integrating the strengths of both styles377
This chapter is primarily written for practitioners and students who have a background in TCM and who wish to integrate TCM with Five Element Constitutional Acupuncture. It is also for practitioners who have studied both styles of treatment and who are not currently integrating them.
Some practitioners choose to treat patients using only Five Element Constitutional Acupuncture. For these practitioners there is no need to read this chapter – unless of course they are a little curious! As practitioners we have spent many years using this style of treatment exclusively, so we know the strengths it possesses. Subsequently we have used TCM and Five Element treatment together and believe that there are significant benefits to be gained from using them together.
Integrating different styles of treatment is far from being without precedent. Practitioners of Chinese medicine have always integrated or brought together different lineages. In the Footsteps of the Yellow Emperor describes how Five Element Constitutional Acupuncture evolved from many styles of acupuncture treatment from both the Orient and the West (Eckman, 1996). What is currently called ‘TCM’ was created from the classics of Chinese medicine and thousands of years of clinical practice. It was largely re-formulated during the 1950s and is still changing today (Fruehauf, 1999 and Scheid, 2002). All medicine has to adapt to the environment, culture and needs of the people it serves.
The main benefits of combining the two styles of treatment are as follows:
• Practitioners have a greater variety of diagnostic methods and paradigms to use. This sheds more light on the nature of the patient’s suffering and ultimately allows practitioners to treat a wider range of patients.
• The two styles together form a whole. They use the same underlying theory and do not overlap in any inconsistent way.
• The patterns when used in combination are relevant to typical patients in the West.
An integration of the two approaches allows the practitioner to treat a wide range of patients who have conditions stemming from any of the causes of disease. These conditions may vary between acute and chronic problems, problems affecting the channels and/or the Organs, and also between conditions affecting people physically as well as psychologically.
Because practitioners of Five Element Constitutional Acupuncture focus their treatments at the root of the patients’ problems, they can help people who have no symptoms but want to improve how they feel. They are also adept at treating patients with a cacophony of symptoms that don’t easily fit into any pattern. Both styles of treatment provide something very special to the well-being of the patients they treat.
This chapter will take a practitioner through some important aspects of integrating the two styles of treatment. The following chapter (Chapter 48) will then use case histories to illustrate how an integrated diagnosis and treatment can be carried out.
The similarities and differences between Five Element and TCM styles of treatment
These two systems have the same umbrella term of ‘acupuncture’ and of course have large areas of theory and practice in common. Where they overlap may seem obvious to many acupuncturists, but it is important to specify them. Following this the differences in each style are clarified. This will provide a foundation for discussion about the benefits of each style and how the two styles can be integrated.
What do the two styles have in common?
Table 47.1 summarises the similarities in emphasis between Five Element and TCM diagnosis and treatment.
|aThese four ancient methods of diagnosis were first described in the ‘Annals’ of Su Ma Qian in the Han dynasty 206–220 BCE (Eckman, 1996, p. 144).|
|bMaciocia, 2005, p. 355.|
|Main area of emphasis||Areas where the two styles overlap|
|Traditional diagnosis||The structure of the diagnosis carried out by practitioners of both styles of treatment is based around ‘to see’, ‘to feel’, ‘to ask’ and ‘to hear’. a Practitioners from both traditions ask their patients similar questions from the ‘ten questions’. The questions cover areas such as ‘food and drink’, ‘stools and urination’ and ‘sleep’ – all areas that are as important to a patient today as they were 400 years ago.|
|Observation||Practitioners from both traditions observe signs such as the posture, gestures, facial colour and voice tone. The degree of emphasis varies according to the tradition.|
|Theory of the Organs/Officials||TCM describes ‘the functions of the Organs’ and Five Element Constitutional Acupuncture describes ‘the functions of the Officials’. By using these terms both systems are clarifying that the ‘Organs’ of Chinese medicine are different from the organs described by a practitioner using a Western medicine diagnosis.|
|Pulse taking||Both Five Element and TCM practitioners use the pulses as part of their diagnosis. All practitioners feel for pulses at six different positions and at more than one depth on the wrist and all use the first three fingers of the hands when feeling pulses. Pulses have been designated slightly different positions in different lineages of Chinese medicine but there is a consensus over most of the positions. b|
|Point locations||The basic positions of the points and channels are the same for practitioners of both styles.|
How are the two styles different?
Table 47.2 summarises the different emphasis placed on diagnosis and treatment by practitioners of the two traditions.
|Main area of emphasis||Five Element||TCM|
|Organising theory||Five Element theory||Yin/yang theory|
|Substances||Five Element practice refers mainly to ‘qi’ and to the spirit (shen), but does not include jing, body fluids or blood.||In TCM practice and diagnosis, the full range of Substances is used – jing, body fluids, qi, blood and shen. They are used in diagnosis and point functions.|
|Aetiology||Internal or emotional causes are emphasised.||External, climatic causes and miscellaneous lifestyle causes are emphasised.|
|External causes||Emphasis is on the effect of seasons.||Emphasis is on the effect of climate.|
|Relationship to nature||The observation of nature is regarded as being a major path to understanding people and illness.||There is no emphasis on observing yin/yang and the Five Elements in nature.|
|Ben (root) or biao (manifestation)||More emphasis on the ben (root) via treatment of the CF or constitution and the Officials. The CF is regarded as the most fundamental imbalance.||Emphasis on both the ben (root) and the biao (manifestation). Treatment of Pathogenic Factors and yin/yang, Substances and Organs, ‘syndromes’or ‘patterns’ cover both ben and biao according to their context.|
|Treatment of chronic versus acute||Emphasis on treating chronic conditions especially those resulting from constitutional predispositions and the emotions. Preventive treatment is also carried out.||Emphasis on both chronic and acute illnesses. ‘Channel problems’ and joint problems commonly treated but many other problems also treated.|
|Level of treatment||Emphasis on mind and spirit.||Emphasis is on the patterns with no reference to level. ‘Nourishing Blood’, for example, can affect the mind or spirit.|
|Diagnosis using signs or symptoms||As the CF patterns are mainly diagnosed via signs (colour, sound, emotion and odour), there is a strong emphasis on signs and sensory acuity of the practitioner.||TCM places a mixed emphasis on signs and symptoms, with often a greater reliance on symptoms.|
|Pulse diagnosis||Emphasis is on the strength and harmony of the pulses and the changes throughout the process of treatment.||Emphasis is on 28 pulse qualities and combinations of depth, width, strength, shape, rhythm, rate and length. Pulse often not taken after treatment.|
|Method of questioning||Rapport and assessing the emotions is emphasised. Emphasis is on the patients and how they describe their experience. Information about systems is used to assess the progress of treatment.||Emphasis is on factual gathering of information. This information is used to make a diagnosis of the patient’s overall patterns of disharmony.|
|Relationships||Emphasis on the relationship between the Elements through the sheng and ke cycles.||Emphasis on relationships between the syndromes and how they lead to each other.|
|Balancing qi||Emphasis on harmonising the Five Elements.||Focus on nourishing yin and warming yang.|
|Blocks to treatment||Aggressive Energy, Husband–Wife imbalance, possession, Entry–Exit block.||Pathogenic Factors – Wind, Cold, Damp, Dryness, Heat, Fire, Phlegm, Blood Stagnation and qi Stagnation.|
|Number of points used per treatment||Smaller number, 2–6 per treatment.||Larger number, 4–12 per treatment.|
|Needle technique||Gentle needle techniques. Immediate withdrawal of needle when tonifying (reinforcing). Gentle technique when sedating. (Sedation is most similar to ‘even’ technique.)||Stronger needle techniques are used when clearing Pathogenic Factors. Needle is retained when reinforcing (tonifying). Even technique is used when reducing but underlying qi is deficient.|
|Width of needles||Finer needles are used because of emphasis on spirit.||Thicker needles are used especially when emphasis is on clearing pathogens.|
|Moxibustion||Moxa often employed using small cones directly on the skin.||Moxa often used indirectly with moxa stick or on a needle.|
|Use of points||Emphasis on the category of the point, the ‘spirit’ and/or the name of the point. Also emphasis on ‘command points’.||Emphasis on the ‘function’ or action of points.|
|Outcome of treatment||Most emphasis on enhancing the patient’s underlying qi in order to deal with the main complaints and prevent further potential disease.||Most emphasis on dealing with the patient’s presenting condition.|
|Other areas of diagnosis and treatment specific to the tradition|
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