Fundamental Reasons Treatment Goes Wrong

    Currently, there are many, so called, styles of acupuncture.  Each style has its leaders proclaiming the superiority of that particular style.  Why are there so many styles, and why do they not work on every patient?  Ling Shu, chapter one states, “Those who say that diseases are incurable have not mastered the art of acupuncture.”  Eastern medicine can treat every patient no matter what the disease.  If this is so, then why do so many patients claim, “Acupuncture didn’t work for me?”  When an acupuncturist today is baffled at the lack of progress of his patients and feels as though acupuncture cannot cure the patient, there is a reason.  When a practitioner begins to believe that the effect of acupuncture is weak compared to the effect of western medication, there is a reason for failure in acupuncture.  The failure is the doctor, not the needle, moxa, or the herbs.  Acupuncture cures the most severe of diseases, but according to Nei Jing the patients that are not cured have only the doctor to blame.  Ling Shu, chapter four also lists the cure rate at 60% for “Low Level” doctors, and 90% for “High Level” doctors.
    Chapter seventy-seven of the Su Wen, entitled, “Five Mistakes in Treatment,” and chapter seventy-eight, entitled, “Four Losses in Treatment,” explain the reasons for failure in diagnosis and treatment. The Su Wen even goes as far as giving checklists for doctors to find out where the treatment went wrong.  Chapter seventy-seven lists the five faults as:
1. Failure to gather a thorough history of the patient’s life.
2. Failure to gather information on the patient’s diet and emotional status.
3. Inability to read the pulse.
4. When the doctor waivers on his treatment course.
5. The doctor does not understand disease progression, etiology, and treatment.
    Chapter seventy-eight lists more examples of “losses” in the practice of acupuncture:
1. When the doctor diagnoses without clear thought and understanding Yin and Yang and how to regulate “逆” “counter-flowing.” 
2. Absurd needle technique.
4. Not having a clear history of the patient leads to an imprecise diagnosis.
5. Failure to ask about the onset of the disease.
This list is very simple yet, is a precise summary of the many mistakes made by acupuncturists from antiquity until now.

Failure to Gather a Thorough History of the Patient’s Life

    A proper history is the first step in making a proper diagnosis.  The many events in a patient’s life can have a long lasting effect on their health.  The first instance that Nei Jing lists is the trauma associated with the change from rich to poor.  In the second paragraph of chapter seventy-seven, Huang Di explains, “必问贵后贱,虽不中邪,病从内生,名曰营;富后,名曰矢精;五气留连,病有所并。医工之, 不在脏府, 不变形, 之而, 不知病名;身体日, 气虚无精, 病无气, 酒酒然时, 病者, 以其外于卫, 内于。良工所失, 不知病情, 赤治之一过也.” “You must ask whether the patient was once rich then poor after, although not the central cause of the disorder, disease arises from the interior, this is called ‘peeling away the nutritive,’ To have wealth at first then to become impoverished is called,‘Losing Jing.’ When a middle level doctor tries to make a misinformed diagnosis, they cannot tell if the disease is in the zang or fu organs, they cannot tell if it has changed the body shape, they diagnose the accompanying symptoms, they do not know the name of the disease.  The patient’s body deteriorates day-by-day, the qi becomes deficient and the jing empties, the disease deepens until there is no more qi left.  This is the first mistake in treating.”
    In this case, the subject was change from wealth to poverty.  There is one more example given later in this chapter, “If a person was a high ranking official then demoted…”  The practitioner should not be so ridged in thought to think that these are the only type of experience that can affect a person in such a profound way, there are many different traumas that can adversely affect the health of the patient, especially the long term health of the patient.  Huang Di reiterates later, “虽不中邪, 精神内伤,身必败亡。” “Although not the central pathogen, their jing, shen, and internal organs are injured, the body can weaken and die.”  This is why thorough history taking is very important to making a proper diagnosis.  
The same paragraph explains that a low level doctor would be lost and never find a proper diagnosis or treatment if they do not collect enough information.  If only more doctors would take the time to learn these simple lessons, there would be more successful practices.

Failure to Gather Information on the Patient’s Diet and Emotional Status

    This principal is similar to the previous section in that it requires the acupuncturist to ask the patient about their emotional status regarding their lives and their diets.  Yet, in the following passage, they add an extra point, knowing proper treatment method once a diagnosis is made. 
“凡欲诊病者,必问饮食居处,暴乐暴苦,始乐后苦,皆伤精气。精气竭绝,形体毁沮。暴怒伤阴,暴喜伤阳,厥气上行,满脉去形。愚医治之,不知补写,不知病情,精华日脱,邪气乃并, 此治之二过也。”
“When making a diagnosis, the doctor must ask the patient about their eating, drinking habits as well as how they are getting along in their daily life, if they are suddenly happy or suddenly sad, if they start off happy then later become sad, all of this can harm jing and qi.  The jing and qi are exhausted, the body is destroyed.  Sudden anger injures the yin, sudden joy injures the yang, and then deficient energy will rise to fill the channels and the form of the body leaves.  A lower level doctor cannot treat the disorder, they do not even know how to properly tonify and sedate, they do not know pathology, the patient’s jing diminishes day-by-day, as the pathogen gets stronger.  This is the second mistake in treating.”
    This should leave the doctor with much to think about and consider when making a diagnosis.  This paragraph emphasizes the strong influence that emotion and diet have on health, regardless of the prominent symptoms that the patient is showing.  The doctor must remember that this patient had pervious experiences and eating habits that may have left a weakness in the body.  Therefore, the patient’s history must be remembered when making a proper diagnosis.

Inability to Read the Pulse

Inability to read the pulse is perhaps the single most important aspect of making a diagnosis.  Reading the pulse properly is necessary for a doctor to know what points to tonify and to sedate, and to know when the patient is going to die if they are suffering from a terminal disease.  All of these aspects are explained in other chapters of the Nei Jing.  This chapter explains the importance of pulse reading as follows,“善为脉者,必以比类奇恒,从容知之,为工而不知道,此诊之不足贵,此治之三过也。” “The physician that is good at reading the pulse will definitely know easily the type of disease.  The low level doctor will not know the proper method to read the pulse, his diagnosis will be worthless, this is the third mistake in treating.”

When the Doctor Waivers on his Treatment Course

    When a doctor has made a diagnosis and knows how to treat the disease, there must be no wavering on the treatment plan.  The treating doctor must not waiver on the treatment method for any reason, even if it requires somewhat painful procedures.  “医不能严,不能动神,外为柔弱,乱至失常,病不能移,则医事不行,此治之四过也。” “If the doctor is not resolute, then they will not be able to move the patient’s spirit, treating the surface in an easy accommodating way, this doctor will get bad results often, the disease cannot be removed, this kind of medical treatment does not work, this is the fourth mistake in treating.”

When the Doctor Does not Understand Disease Progression, Etiology, and Treatment

    Just as it is common in modern times to find an ignorant doctor, (eastern and western doctors alike), it was also common in antiquity.  Like today, there were many unqualified doctors practicing on patients, and like today, they do not find much success in curing disease.  This chapter describes this phenomenon as follows:
“凡诊者,必知 终始,有知余绪。切脉问名,当合男女,离绝菀结,忧恐喜怒,五藏空虚,血气离守,工不能知,何术之语。尝富大伤,斩筋绝脉,身体复行,令泽不息。故伤败结,留薄归阳,脓积寒炅。粗工治之,亟刺阴阳,身体解散,四肢转筋,死日有期,医不能明,不问所发,唯言死日,亦为粗工。此治之五过也。”
“The doctor must know the beginning and the end of the disease, the doctor must also know all that is involved in treating the disease.  The doctor must know how to unite male and female, to sever and unite, the four emotions, whether the five zang organs are empty and deficient, how to disperse and protect the qi and blood.  The low level doctor cannot know, cannot speak the language of the art of acupuncture.  They greatly injure the qi, sever the sinews and exhaust the meridians, the body regresses, the detriment does not cease.  The injuries compound, weakness remains affecting the Yang, pus accumulates and cold increases.  The careless doctor treats rashly, weakening the body, the four limbs transform, death draws closer, [the careless] doctor is not able to comprehend, cannot even ask what occurred, but can only say the date of the patient’s death, this is what the careless doctor is like, this is the fifth mistake in treating.”
This chapter goes on to describes what a high level doctor knows and how they treat patients.  “圣人之治病也,必知天地阴阳,四时经络,五脏六腑,雌雄表里。刺灸砭石,毒药所主:从容人事,以明经道,贵贱贪富,各异品理,问年少长勇惧之理;审于分部,知病本始,八正九候,诊必副矣。” “When the sagely doctor treats, the sage knows heaven, earth, yin and yang, the four seasons, the meridians, the five zang and six fu, the feminine and the masculine, the external and the internal, interior and exterior; they have mastered acupuncture, moxa, surgery,1 and herbal medicine: from the appearance they can tell the patient’s condition, they can tell the condition of the meridians, discern the precious from the substandard, the poor from the wealthy, everything unusual can also be managed, [they] inquire the age, height, if the patient is courageous or fearful; [they] examine all aspects of the body, [they] know the root of the disease, the equinoxes and solstices,2 the diagnosis must [therefore] match.”  The main requirement for becoming a sagely doctor is time spent studying the entire Nei Jing, meaning both volumes, the Su Wen and Ling Shu.  This level of doctor is hard to find, then and now, but if one were only to read the entire Nei Jing one could learn everything necessary to become a sagely doctor.

The Doctor Diagnoses Without Clear Thought and Understanding

    Nei Jing: Su Wen, chapter seventy-eight, entitled, “Four Losses in Treatment,” further elaborates on the subject of erroneous treatment.  In this chapter, Huang Di explains the four losses to the young doctor Lei Gong.  He explains that a young doctor tends to have less wisdom and is sometimes unable to focus their thoughts, but youth is not a loss in treatment.  Huang Di further explains the importance of mental focus, “夫经脉十二,络脉三百六十五,此皆人所明知,工之所循用也。所以不十全者,精神不专,志意不理,外内相失, 故时疑殆。 诊不知阴阳逆从之理,此治之一失矣。” “Humans have twelve meridians, and three hundred sixty-five acupuncture points, all of this must be keenly known, [the principles] are therefore obeyed and used.  The doctors that are unstable, cannot focus their jing and spirit, cannot control their thoughts and intentions, the internal and external are equally lost, they constantly doubting their knowledge and endanger [patients].  In diagnosing, they do not know how to regulate the counter-flowing of Yin and Yang.  This is the first loss in treating.” 
This type of mental instability can occur at any age.  This passage might challenge the common notion that the older acupuncturist is better than the younger acupuncturist, because it shows that the real test of knowledge and skill is to see if the doctor is able to focus his mind on the medicine and the patient; and just how closely the doctor follows the principles of the Nei Jing.

Absurd Needle Technique

     The Nei Jing emphasizes, “absurd” practice is a direct cause of “loss” or failure in treatment.  Huang Di says, “受师不卒,妄作离术,谬言为道,更名自功,妄用砭石,后遗身咎,此治之二失也。” “[The doctor that] absurdly uses some random needle method, talks erroneously about the medicine, uses some famous method and claims that it is his/her own, absurdly uses surgical procedures, later he/she can only blame himself/herself for mistaken treatment.  This is the second loss in treatment.”
    There is no room to argue in this passage.  When a doctor practices in an absurd and careless way then the patients do not get better, and their conditions might even get worse.  If a doctor studies and understands the principles in the Nei Jing then there would be no reason for a doctor to look elsewhere for “some random needle method.”  The passage reflects the current situation with the popularity of misguided acupuncture gurus.

Not Having a Clear History of the Patient Leads to an Imprecise Diagnosis

    Just as in the previous chapter seventy-seven, the idea of proper history taking is reiterated.  All the same topics are restated in this paragraph, like diet, and living situation.  The end of this paragraph reads, “。。。不知比类,足以自乱,不足以自明,此治之三失也。” “…not knowing this information [about the patient], leaves the doctor confused, without understanding.”  Just like the paragraph in chapter seventy-seven, the doctor must collect a thorough history of the patient.  As this is a restating of a fault in the previous chapter, there is no reason to expand further.

Failure to Ask About the Onset of the Disease

    An example is given in this paragraph explaining the importance of asking the onset of disease. The example of a patient suffering unable to leave the bedroom is given.  If the doctor fails to ask the onset of disease he might miss the possibility that the patient merely has food poisoning and not some more serious disease.  If a doctor begins treatment rashly there is large possibility that the procedure might be for a different disease.  Then there would be no effect or a worsening of the patient’s condition.  This is the “fourth loss in treatment.”
    Asking the onset of disease can be very important in making a proper diagnosis.  In an emergency, knowing the onset can help determine the severity of the disorder.  Knowing can also let the doctor know if the current disorder is related to previous problems or if it is unrelated. 

Additional Consideration

    The Nei Jing leaves a checklist for doctors of all generations to follow.  The study of the Nei Jing should never end.  There are countless principles to learn from the Su Wen and the Ling Shu.  When the doctor feels that he is at a sufficient level to practice, there is a quick review sheet for the doctor to remember the main reasons for faulty treatment.  Both chapters never lay blame on the patient, the doctor is the soul cause of failure in treatment.  A good doctor must be in control of the patient’s treatment, including acupuncture and daily activities of the patient including the diet.  When the doctor’s knowledge of the Nei Jing is sufficient, then there is no reason for failure in treatment, no matter the severity of the disease.
    If the knowledge of the Nei Jing was more precise and in depth than what is taught in the modern eastern medical universities of the world, then there would be absolutely no reason for the acupuncture gurus of the ages.  If the doctor only studied the Nei Jing they would be able to see through all the sophistry of the modern gurus and even many so-called “classic” Chinese medical texts that give illogical reasoning for the mistreatment of patients. 
    The Nei Jing places responsibility on failure in treatment solely on the doctor.  Text explains all aspects of medicine that one would ever need to know.  Famous doctor, Zhang Zhong Jing tried to promote the Nei Jing in his writing.  From his praising of the Nei Jing in this preface, to him using the six-stages as a framework to explain when to use his herbal formulas.  If only modern doctors would take the time to learn about the Nei Jing, eastern medicine could be elevated in the world as a leading treatment for all types of diseases.
    All doctors should strive to be a high level doctor with a 90% success rate.  All patients should try their best to be open and honest with their doctors.  Patients should also look for a doctor that is thorough like the high level doctor described in the Nei Jing.

1 Some consider the stone needle as the ancient instrument used to perform surgery in ancient China.  砭石 , Bian Shi, literally means stone probe.    

2 The equinoxes and solstices are a determining factor on the depth of needle insertion.  They mark the changing of a season, and consequently the changing of the depth of needle insertion.

Published by Raul Ramirez, L.Ac., Ph.D.

Physician, Catch Wrestler, Kickboxer, Vegan, Progressive

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