Compliance challenge in Chinese medicine
One of the most stubborn challenges in medicine is patient compliance. It is very difficult to have a patient who takes necessary medication regularly, let along altering a lifelong habit such as smoking, over-eating, or even merely adopting a healthier diet.
This is also true in case of Chinese medicine. It is a regular component of a Chinese medicine treatment plan to include lifestyle changes. This is usually necessary so that the patient is not acting in a way that runs contrary to what the practitioner is trying to achieve.
If we are able to bring the patient into energetic balance, persisting in destructive activities will certainly bring the patient out of balance again.
A patient prone to heat or fire, for example, will be resistant in giving up hot spices or cigarettes or wine with dinner, and the dietary heat will lead to liver fire or liver Yang rising. Here we come up against something in the patient’s psychology that overrides our needles, herbs, recommendations, advice, coaching, and exhortations.
Patients persist in making the same choices and repeating the same behaviours even after their physician has explained that it is harmful. Often unintentional, there is something within them that is resistant to change. We might call this a stickiness in the flow of their life energy; a variant of the stagnation of Qi.
The challenge of promoting lifestyle changes pertains as much to the treatment of emotional imbalance as to somatic disorders. Chinese medicine case histories report the abatement of psychological symptoms, even long-standing depression and anxiety. But here, with somatic disorders, we are faced with the same problem: to maintain the changes, the herbs and acupuncture have induced lifestyle changes that need to be made.
The re-balancing that is accomplished is done via exogenous influences. The practitioner’s needles or herbs have not hanged the patient’s endogenous organisation.
The fundamental organisation of the self that devolved into the psychological symptom in the first place remains intact; the perception of self and other, the perception of the world, the ways of self and other, the perception of the world, the ways of organising one’s experiences, the life narrative remain intact.
These are the underpinnings of what we commonly think of as lifestyle. The application of the exogenous treatment may produce a sense of well-being and a feeling a freedom, but the patient has not learned how and why the symptoms evolved in the first place nor how to recreate the new state for himself. The stickiness of Qi will lead the patient out of balance again unless the organisation of the stagnation is addressed and freed.
Physicians see this phenomenon every day in their offices. A patient comes in with temporomandibular joint syndrome and temporal headaches.
His trigger points are released and the symptoms abate. But since the patient won’t give up weight lifting, caffeine, and late hours of work, the symptoms return again. This amounts to repeated retraumatisations.
The author is Head of Acupuncture at Sir Ganga Ram Hospital, New Delhi