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How long to treat, and how to stop!


#1

Hi I am a student in my clinical year with a question re sinusitis.

I have a client responding very well to treatment for sinsusitis. All credit to her she is a very positive and compliant client! Her acute symptoms reduced dramtically during the first treatment, seemed to plateau after treatment 3, then after #5 she improved again (could be my needling, i got stronger qi sensation during treatment 5). I'm tonifying wei qi via Sp-6 St-36 as well but the ben is harder to read. With her acute symptoms nearly clear, how long should i continue to tonify the underlying wei qi and how should i discharge her. At a guess I am wondering should I start to remove local points and monitor her to see if the local symptoms return?

This raises the general question of how to know when to stop treating. I feel that I need to develop a process of reducing the treatment (once their symptoms have improved) to test if they are ready to move towards to managing without weekly acupuncture. I'm sure when it stops being free this will help but that is part of my reasoning too, i mean no one minds gettting free treatments but when i start charging i need to know how to manage their treatment so they don't feel they are being kept on in order to fund my salary!

Any ideas appreciated! Many thanks

Emma


#2


Normally for treatment is ten times a term, every 2 days for one treatment, basic on your patients situation, you can longer or shorter your treatment term or frequency.


#3


That&#39s a great question Emma. You&#39ll get many opinions on this as treatment frequency is a common disagreement amongst practitioners. I, for example, treat as absolutely infrequently as possible, never more than once a week except in the absolutely rarest of circumstances and as soon as possible I move my patients to the most infrequent schedule that I feel will work for them (they can, of course, come anytime they want, but I tell them what I think they need). Others may treat far more frequently.



What is behind your question is a much bigger issue and that is what measures are you using to judge whether a treatment is "successful" or not? This is where the diagnostic tools of tongue, pulse, palpation, etc. all come into play. Basically you stop treating when these aspects are in balance and over time you learn how much (or, more importantly, how little) you will need to treat to accomplish this. Only experience teaches this but you have to practice looking at far more than the symptoms to make accurate judgements on the issue.



For example if a patient comes in with "x" condition and you diagnose them as lung qi deficiency, you would stop treating them when they no longer have lung qi deficiency. While for simple cases going off of resolution of the symptoms may be enough what distinguishes good practitioners from average ones is the ability to treat things before the person experiences symptoms and to treat conditions to a state of permanent resolution instead of conditions which reappear after a period of time. This is where relying on all of the wonderful diagnostic tools within Chinese Medicine is so important - as opposed to watching symptoms.



Treatment frequency and need for "x" number of treatments is entirely dependent on your own skill level and chosen set of techniques. You will find some practitioners that regularly resolve some conditions within a few treatments and others that get very poor results with the same conditions and yet others that seemingly can treat anything - and quickly. This ability to read your patients and to know with some significant accuracy how long they are going to take simply takes time to develop.



For me I have different plans in mind for different conditions simply based on experience but then modified based on the individual and their overall patterns. This way I can communicate with the patient what I expect to happen over time. And 85% of the time it goes more or less how I thought it would - the rest of the time it&#39s either much, much faster or a bit longer than I thought. When I started, however, I had no idea - I was just happy if they got better!


#4


Thanks for your reply! 10 times is certainly the same number as suggested by someone else. I have seen her once a week as we both have other commitments and this suited our diaries. She&#39s on treatment 6 this coming week, and if she is still good I might suggest starting to reduce frequency.


#5


Thanks Chad for your detailed and quick response. I really appreciate it.



This is a question which has not really been addressed in our training, but one I would like to start learning the answer to sooner rather than later. And as I am only starting on my clinical journey, I do not have the measure of how other patients have responded. So that is why I thought I would look for some input! I&#39ll see how she is this week and I will bear what you said in mind about looking beyond the symptoms. Otherwise thanks again for your response. I may be in touch again! All the best.


#6


The question of "how long to treat a patient" is a complex one and I think, can be looked from a couple of directions.



First of all is the question of prognosis regarding the resolution of the symptom you are focusing on primarily. This is probably your patient&#39s priority and is also what your treatment is centered upon. Although the general "recommended" course of treatments is approximately 6-10x, this is of course highly dependent on factors such as patient compliance & overall health, severity & chronicity of the problem as well as your abilities in choosing a point/herbal rx and then performing the treatment. Generally what I see in my practice is that after 3 treatments, I will be able to gauge with much better acuracy how many treatments I think a particular patient will need to resolve a particular problem. The ability to make this judgement can only come with clinical experience. I always talk to my patients about how all the factors mentioned above play a role in recovery so that they can understand how I am looking at the problem.



Another important perspective in the question of how long to treat a patient really highlights the difference between a holistic approach to healing vs. simply focusing on resolving a particular illness. "Health" is a vague term which we think we understand and yet it is difficult to get everyone to agree on exactly how to measure or describe this state. OM fundamentally understands this concept since it has built into it&#39s theory the concept of relativity. We look for evidence that a patient is moving in a positive direction both in regards to the symptom and to the overall state of health. Alopathic medicine often restricts the evaluation to changes in the complaint only and once the "symptoms" are gone, the job is considered done, even when a patient is clearly not "healthy".



When a patient has other underlying patterns of disharmony in addition to a particular symptom (e.g., digestive weakness in addition to the frozen shoulder that s/he wants treated), then resolving the symptom does not necessarily help her to be "healthy" in the broader sense. Thus, the recommended course of treatment for the patient may be much longer if the underlying goal is to improve her state of health.



A holistic practitioner who hopes to improve a patient&#39s overall "health" is juggling both treatment for symptoms and treatment for overall harmony. I think that one of the most important roles we play is to educate our patients so that they better understand themselves, their bodies and what the concept of "health" means for them. In this way, the question of "how long to treat" will really be based on the goal set by the patient herself. How far a patient wants to move toward "health" is really a very personal decision, especially once a nagging or severe symptom is resolved.



You can be flexible and supportive as a practitioner and then watch with amazement the beautiful process of another human being evolving into a state which is stronger, healthier and ultimately happier.


#7


Another thoughtful response, many thanks for your thoughts. It is indeed complex with many factors to consider, and everyone is different! Learning to be flexible is no doubt key, and working in partnership with the patient to agreed goals and managed expectations. Thanks again, I am delighted with the response on this forum so far.


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