Dr. Matthew Fellner DACM, L.Ac.
TCM is a beautiful medicine that requires a tremendous amount of practice and refinement of skill to become truly proficient. It is a lifelong pursuit that not only requires a deep understanding of the intricacies of the medicine, but it also requires personal development of empathy, touch, and energy cultivation. One truly must live the medicine to practice it effectively. We often focus on the energetic aspect of the medicine and present the medicine as an art that cannot be explained well using western concepts. I think this is doing the medicine a disservice. There is a very powerful rational and scientific thought process that pervades the entirety of the medicine. Unfortunately, it is often overlooked or not well understood. That leads to many western practitioners and lay people to categorize TCM as a more metaphysical pursuit, without a clear scientific basis. I believe that this viewpoint is nothing more than a misunderstanding of the medicine, or a decision to only focus on a few aspects of it there are often presented in the media or in entertainment.
The reality is often quite different. Many capable acupuncturists and herbalists can decipher complex medical presentations exactly because of the mindset required in studying TCM. We need to be proficient in understanding western diseases and pharmaceuticals, as well the myriad supplements, vitamins, and “alternative” therapies that our patients often try. I believe that the mindset developed in school and in practice relies on principles that allow us to see beyond the obvious and earn a greater appreciation for how the intricacies of the body work. In fact, some principles that guide our treatment plans that may seem obvious to us, are often completely overlooked by other practitioners, including physicians.
I have had 3 recent examples of this in my own clinical practice which clearly highlight the importance of how TCM provides an insightful framework for providing good medical care.
1. A 73 year old female came to me with a chief complaint of neck pain due to degenerative arthritis in the cervical spine. She had seen a Physical Therapist for 8 weeks who suggested she try Dry Needling. After the needling session the patient was in worse pain for at least 3 days. Finally, the pain returned to the previous level and she sought a different treatment method. It obvious to me very quickly that she was not a good candidate for dry needling. Dry Needling is a very aggressive form of acupuncture that is akin to trigger point needling. It is usually more appropriate for a patient who is very stagnant or “excess” in our TCM parlance. This patient was what we would describe as very “deficient”, especially in blood and Qi. When a needle is manipulated aggressively like in Dry needling, it strongly stimulates the Qi & blood. But what if the patient is weak or deficient? What happens if you ask the body to respond so strongly when it is not capable of handling the load? I decided that the appropriate method of treatment for her would be a balance of more gentle needling and Tui Na massage techniques. I also treated the root of her problem which was the deficiency of Qi & blood. It took some time but after 3 weeks she reported a consistent reduction in pain and is now approximately 50-60% better. It will take time and she may never be completely pain free, but using an aggressive, “results now” approach, actually made her feel worse.
2. A 55 year old female came to see me with a diagnosis of SIBO, which is Small Intestine Bacterial Overgrowth. Her main symptoms were diarrhea, acid reflux, fatigue, and ravenous hunger. Her GI doctor had suggested to her that she eat a lot more fiber including vegetables. The patient loves salad and the doctor agreed that would be good for her. Of course, vegetables are healthful, but it seemed that she was taking it a little to the extreme. She ate at least 1 salad per day and often had raw vegetables in addition to the salads. TCM preaches balance, including eating appropriate to the seasons. We should not eat anything too cold, too spicy, too fast, too late at night, etc. It seemed to me that she was creating more of a problem with her food choices. My exam of her further confirmed my suspicions. Her abdomen felt cool to the touch, and she tended to crave warm things. But she was convinced that she had to eat her veggies. I simply explained some of the principles that we learn in school and encouraged her to cut back on the raw food and add some cooked veggies and to always drink warm tea with her salads. After 1 week her diarrhea subsided, her energy increased by nearly 50%, and her hunger subsided. She continues to be a work in progress because SIBO can flare up very easily, but a few simple dietary changes based on a clear understanding of principles goes a long way.
3. A 60 year old male came to see me complaining of low back weakness, insomnia, and hot flashes with sweating(especially at night). He was a Leukemia survivor who was in remission. He previously had several rounds of chemotherapy but not since last year. He presented with classic signs of what we would diagnose as “yin deficiency with heat”. This is a very common diagnosis in both men and women, especially as they age. The body tends to dry out, and it becomes more crucial to retain essential fluids and electrolytes. Chemotherapy was a necessary treatment to combat the cancer, but it can have a devastating effect on our overall energy, cells, and fluid metabolism. This patient was trying to incorporate more healthy habits into his life including starting a yoga routine. He tried a hot yoga class and really seemed to enjoy it. Naturally, he also started noticing an increase in thirst and frequency of urination. His symptoms seemed to be worsening since he increased the hot yoga to twice weekly. On the surface, yoga would seem to have no potential side effects. But for this patient, the hot yoga was clearly aggravating his yin deficiency. Instead of protecting his fluids, he was sweating more, and then trying to compensate for the sweating by drinking a larger volume of water, which in turn caused more urination causing more fluid loss, and so on…
It may not have been obvious to anyone without a background in TCM why this pattern was exacerbated by the hot yoga. But understanding the principles were a key to creating a personalized treatment for him. With switching back to regular yoga and adding herbal supplements to his twice weekly acupuncture sessions, this patient was able to sleep normally without hot flashes or sweating in less than 1 month.
