At the IEP Clinic, there are three basic modes of treatment; the primary one is acupuncture. Acupuncture is expected to produce quick and obvious results that are often felt at the time of treatment and persist to some extent for hours or days thereafter. This treatment method is most easily adjusted in response to patient reports of symptoms of concern. The theory of acupuncture treatment holds that needling has, as one of its major functions, the alleviation of obstruction of qi circulation and consequent normalization of qi and blood flow for the treated meridian. The impact of acupuncture at points on one or, as more common, a few meridians treated in a single session is not limited to the freeing up of circulation in those particular meridians; it has a beneficial impact on the entire system. Acupuncture points are frequently selected because of their individual indications rather than strictly on the basis of a meridian diagnosis, yet, in the overall analysis, meridians are a central feature of treatment strategies. A treatment session might involve a dozen or more needles; additional needles might be applied to the outer ear or the scalp.
Acupuncture is complemented by a form of massage therapy referred to as “Zen Shiatsu.” This is a modern variant of the traditional Japanese pressure massage; it was developed by Shizuto Masunaga (1925-1981) and it is of particular interest in relation to an acupuncture program because the treatment strategy is largely based on meridian therapy. The meridian pathways used by the shiatsu practitioners are similar to the Chinese ones, the main difference being an extension of each meridian to range from legs to arms, passing through the associated diagnostic region of the abdomen. Zen Shiatsu reinforces this meridian-opening effect; it is not necessary for the meridians treated by this application of pressure to be the same meridians as those treated by the acupuncturist: the mutual benefits of opening and stabilizing circulation in one meridian upon the functional capabilities of others allows these two similar but distinctive systems of diagnosis and therapy—acupuncture and Zen Shiatsu—to reinforce one another.
The third mode is Chinese herbs plus nutritional supplements and diet counseling; these considerations—involving both Chinese and Western approaches to the analysis and selection of ingredients—are bound together as one modality based on the Chinese concept of the close relationship between administering herbs, especially the mild herbs we are able to use in modern practice, and dietetic treatments. A group of practitioners who have training in both Chinese medicine and naturopathic medicine are available during one portion of the clinic schedule to assist IEP patients in the area of diet and nutrition (as well as other naturopathic therapies), while Chinese herbs are recommended throughout the program.
These three modes of therapy, covering many aspects of adjunctive care, are not comprehensive. One could add, for example, qigong exercises and other natural health care approaches from the Chinese tradition as well as incorporate health care practices from other cultures (e.g., yoga). The three modes that are provided at IEP fit within the limited availability of physical space, the constraints of practitioner and patient time for participation, and the primary range of expertise at the Institute for Traditional Medicine. The plan described to patients interested in utilizing IEP services is that they will come to the clinic for acupuncture twice per week during the first several weeks of treatment; the frequency may decline to once per week during periods when there is less physical and emotional distress. Shiatsu services are made available to an extent that allows for treatment every other week, which is almost always provided immediately before or immediately after acupuncture. Typical of supportive shiatsu therapy is pressing along the stomach and spleen meridians, especially at the legs, and along the triple heater (sanjiao) and heart protector (pericardium) meridians that traverse the arms. Acupuncture and shiatsu sessions are just a half hour each; in other settings, the practitioners might spend 45 minutes for an acupuncture visit and an hour for a shiatsu visit, but the shorter treatment duration fits with the concept of offering more frequent and lower cost treatment.
Herbal and nutritional supplements are selected according to particular patient needs, but are often provided in accordance with a basic model of “supporting normality,” that is, following the “fuzheng” concept developed in China. Standard nutritional supplements recommended to patients include a broad mixture of minerals and vitamins and a mixture of antioxidants intended to replace the multiplicity of products that are recommended in the literature. These provide a substantial quantity of the substances that may be insufficient for health needs under the circumstances (for example, as the result of reduced food consumption and/or poor absorption) and in particularly high need in light of the disease process or the impact of medical therapies.
A naturopathic consultation is offered close to the beginning of the acupuncture series and may be followed up from time to time, with average duration between consultations of about three to four months. At each visit, the patient’s current symptoms, lab test results, drugs, Chinese herbs, nutritional supplements, and daily activities are reviewed. There may be suggestions made for some additional laboratory testing, for undertaking certain diet and exercise strategies, and for supplements not routinely included in the IEP model. Among common recommendations associated with these consultations are eating multiple small meals to manage the problem of reduced appetite, utilizing various concentrated protein sources (whether isolates or high-protein foods), taking supplemental fish oil and vitamin D3, using probiotics, taking melatonin for sleep (also used for symptom relief at higher than usual dosage, such as 20 mg/day), and getting basic exercise (even if limited to 20 to 30 minute walks, though more is encouraged when possible). Such direct suggestions are supplemented by referrals to specialists who might assist with other methods of addressing unique symptoms or by providing additional treatment programs.