Published in the North American Journal of Medicine Vol. 24 No. 69, March 2017
The focus of this issue of NAJOM is on tools. I hope to meander with you through various thoughts I have on the topic. I think it’s an important one—more important than we might think at first glance.
We humans are toolmakers. This seems to set us apart from other species on our shared planet. Other higher mammals might be surprisingly intelligent, they seem to have language of a sort, but they do not really make and use tools like we do. As toolmakers we seem to be quite alone on the planet.
TEAM practitioners use a great many tools. Perhaps the general public would identify actual acupuncture needles as the main tools in our profession, but that is no longer the case for me. I have come to specialize in treating patients with chronic Lyme disease, and I have found this special group of patients needs to be treated with “kid gloves.” What this means is that I rarely insert a needle any longer in a chronic Lyme patient.
Chronic Lyme disease patients (Junji Mizutani, Mayu Onishi, and I have previously written in NAJOM about this condition) exhibit a very particular type of anxiety. I have gotten so used to it that it has become almost diagnostic for me. Occasionally patients will come with a perplexing variety of symptoms to my clinic and wonder if they have chronic Lyme disease. If they do not have this unique type of anxiety, fatigue, and tremendous upper back and neck tension, then I do not generally believe that they have chronic Lyme. They have some other problem for sure, but I am always doubtful that it is Lyme without this constellation of symptoms. Other symptoms might or might not be there—wandering pain, brain fog, digestive issues, insomnia, weakness, various neurological symptoms, and many other possible complaints—but I have found these three to be nearly universal.
I have learned with these chronic Lyme patients to be oh-so-careful with my language. Just one careless word and a huge worry can be created for them. The anxiety condition is such that they will take anything, and I mean just about anything, and turn it into a new concern. I have learned this the hard way, i.e., by making the mistake of saying something fairly innocent and having it taken the wrong way. With these patients language itself is a very important tool. The Ling shu tells us this: “With a knowledge of its importance each word can have a result.”
My general treatment flow with non-Lyme patients is to check in with them very briefly and then get them right up on the table so that I can do my assessment of abdomen, channels, pulse, tongue, forearm, and so on. But with chronic Lyme patients I find this is not possible. They NEED to sit down and tell you the complete story of their life since the last time they saw you. It often requires 15-20 minutes of listening, which is a good deal more than I do with other patients.
In working with these chronic Lyme patients I have had to evolve my way of practicing. They have collectively pushed me in the direction of gentle. At this point I virtually never do a needle insertion on any of them. Their nervous systems are too over stimulated by the Lyme infection as it is. The tools developed in Japan, most of them originally for shonishin purposes—zanshin, chokishin, Yoneyama zanshin, teishin, enshin—have become what I use to treat chronic Lyme patients. Sotai and moxa are also indispensable and find their way into every Lyme patient treatment; herbal treatment, which I realize is not possible in Japan for acupuncturists, is crucial. With this sort of care these patients improve treatment by treatment and gradually get their lives back. If I can treat them every week, we can get somewhere. The focus in this treatment style is on restoring the zheng qi, not on killing a particular pathogen. Our medicine excels at this.
Yesterday I taught a two-hour webinar on the use of teishin, and I mentioned how I use it in the treatment of chronic Lyme patients and never insert needles into these patients. From around the US over one hundred participants listened in. I was surprised, but encouraged, that there was that much interest. At the end though there was only one question, and two others said thank you. I am not sure what to make of that meager response to what undoubtedly is a provocative topic to a TCM audience. I am guessing that the idea of acupuncturists treating effectively without inserting needles is a shocker, and the participants did not properly know how to respond. Still, I think it is good that I had the opportunity to put the teishin idea in front of an audience that had not yet considered it.
Of the sixty or so accredited colleges of Chinese medicine in the US probably five at the most teach the use of these tools in even a minimal way. NUNM where I teach is unique in that students can take an entire year of Japanese acupuncture studies, including extensive exposure to teishin techniques. In this year they learn Mizutani-style moxibustion, Meridian Therapy, Miyawaki-style 8EV use, Dr. Bear’s point checking method and his “fundamental treatment,” and contact needling techniques with needles and teishin. Additionally, in another class all students get at least 12 weeks of Sotai instruction. So they graduate well equipped, at least in comparison to students at other TCM colleges, to work effectively and gently with their patients.
There is one question that students always pose about tool quality when they are learning to use a teishin: How important is it to have an expensive teishin? It’s a good question. Teishin come in a price range of approximately $20 to almost $2000. That is quite a wide range. Can good work be done with a $20 teishin. I have a clear answer to that: YES. Absolutely it is possible to do even great work with a low cost teishin. This is not to say that tool quality is irrelevant, but much more significant than tool quality is the quality of our technique—far more important in fact.
What I told those in the webinar is that they ought to just buy an affordable teishin to start with and use it for a few years. Instead of immediately buying an expensive one they should invest their money in a seminar or two with an advanced practitioner who can help them develop their treatment skills. That is a much better use of the money. Three years down the road if they fall in love with teishin therapy, they can then invest in a more expensive one.
Numerous teachers have helped me hone my skills with these tools. Chief among these teishin teachers have been (in no particular order): Brenda Loew, Dan Zizza, Dr Bear (Iwashina Anryu sensei), Jeffrey Dann, Funamizu Takahiro sensei, Kuwahara Koei sensei, and Kobayashi Shoji sensei. Of these teachers only Dr. Bear uses teishin exclusively—no needle insertions at all. His example and tutelage gave me the courage to strike out and offer treatments free of insertions. Without his example and help I would not have managed it. I think my chronic Lyme patients have benefitted from this approach, and I encourage others with these patients to experiment as well.
Blessings on all these teachers above and others not named since they were not teishin teachers per se, but nonetheless have helped me greatly in my mission to improve my treatment skills and my clinical thinking.
Bob Quinn teaches full-time in the School of Classical Chinese Medicine at NUNM in Portland, OR. With Ryan Milley he operates Portland Traditional Japanese Medicine Seminars.