Acupuncture: Expectation or Expertise?

While recently listening to a lecture by Honora Lee Wolfe, co-founder of Blue Poppy and one of the best teachers and practitioner of acupuncture in the U.S.,  I was struck by her comment that the function of an acupuncture point depends on the expectations of the practitioner.  Ms. Wolfe's intriguing observation started me thinking about one of the central conundrums that I have been mulling over throughout my professional career:  what role does intention play in the clinical outcomes of acupuncture treatment?  Now almost two decades into practice, I finally have enough experience to be able to come to some conclusions on this topic.

During my teaching career, I supervised students in clinic for more than a decade.  As a specialist in diagnosis, I carefully reviewed the patient charts to ensure that students developed good diagnoses based on the evidence.  Furthermore, on my watch students were expected to generate logical treatment methods and select points or formulas consistent with their treatment plan.  Occasionally I would run across a case where, despite a diagnosis unsupported by the evidence and a lack of coherence in the clinical process, the patient reported considerable improvement.  When the student practitioners themselves were unable to explain their treatment choices or why they had led to good results, I was perplexed.

Given the deviation from the proven clinical methodology, I came to the only reasonable conclusion:  the sincerity, compassion, and attention of eager students had a beneficial effect on the patient's qi.  If we recall that qi gong and tai ji practitioners tell us that the "mind leads and the qi follows", it is not surprising that the care and concern of a student could positively influence the flow of qi in the body.  These experiences seem to corroborate the theory that intention is a key ingredient in a successful acupuncture treatment.

On the other hand, it would be an egregious mistake to dismiss the critical role of expertise in the effectiveness of acupuncture care.  Although it is difficult to definitively parse out skill from the expectations of the practitioner, clinicians with years of experience have many stories of treatments where the outcomes exceeded anything for which one could have ever hoped.  Of course, there is also no shortage of cases where, despite expectations for great results, success can only be had by reassessing the situation and devising a better treatment plan.  From these experiences one realizes that intention alone simply will not yield the best results. 

I recall a student many years ago who was required, as part of clinical training, to demonstrate the ability to do a point joining needling method.  She selected a point, and I left the room to check on other students.  When I returned, I discovered that she had not joined points with a through-and-through method but, instead, had inserted the needle just into the superficial surface of the skin. When questioned about why she did not perform the required technique, she replied that she had “joined” the points with mental intention alone.

The point of the story, of course, is that intention and action naturally go hand in hand.  Imagining an activity is not to be confused with intending to act a certain way followed by actually performing that act.  I have long contended that great acupuncturists spend a lifetime moving back and forth from study to practice, honing their skills and knowledge through clinical experience, tempered and guided by the insight of historical doctors.  Considering the recent popularity of mindfulness, we should remember that thousands of years ago in the acupuncture classics, doctors were encouraged to bring complete attention to their practice, as if “holding a tiger by the tail.”  Cultivating this serious attitude, we see how both intention and technique could be developed to the highest level in order to provide our patients with superlative results.