Case Reports Blog
April 20, 2021 - Discussing a Case Report on Jingjin Sinews
A case report written by David Legge and published in the Journal of Acupuncture and Meridian Studies describes a 69-year-old woman with a 40-year history of chronic low back pain. For years, she had received many acupuncture treatments focused on lower back local points followed by manual therapy, which gave her some relief, but the pain was intermittent and would inevitably return. One day, because she complained of additional hamstring tension, the practitioner needled tender ashi points along the Bladder sinew channel into hamstrings and gastrocnemius, after which both her hamstring and her chronic back pain felt significant relief. The author includes a diagram of the Bladder sinew channel, and discusses reasons why this approach might have been effective, suggesting a number of possible biomedical mechanisms.
One salient point about this case is that it compares the effectiveness of one type of treatment (local needling and manual therapy) to a second type (the sinew meridian approach). Case reports are often considered less strong as medical evidence because the link between the intervention and the outcome is not certain if variables not tightly controlled. In this case, because two different approaches were used on the same patient, the patient was essentially her own control group. Comparing the outcomes from two different approaches on the same individual/same presentation strengthens the usefulness of the case report from a practical standpoint.
This case is useful as a basic introduction to jingjin treatment, particularly for students and new practitioners who may not have had as much exposure to a variety of styles beyond straightforward TCM. Some readers might wish for more specifics on the exact location of the points used by the author to be able to replicate the treatment. However, the point of the article is not to suggest a protocol for a future clinical trial; its purpose is to outlines a traditional approach that may be useful if standard treatment is not working for a clinician in practice.
Although traditional theory is sometimes seen as antiquated and ‘non-scientific,’ the theory in this case enables a practitioner to solve a difficult problem, by predicting where to look to address confounding factors to local treatment. Approaching a musculoskeletal issue by only addressing motor points (i.e., dry needling) may not be as effective as using acupuncture’s traditional framework to access related areas for more sustained recovery.
The full text of the article is available at the following link:
David Legge has written a book on the subject, Jingjin: Acupuncture Treatment of the Muscular System using the Meridian Sinews. Other notable orthopedic acupuncture instructors are Whitfield Reaves and Matt Callison, who also share their extensive experience through their own books and classes. Grounding the material taught in books and seminars in case reports reflecting actual clinical practice can demonstrate how these strategies can be adopted, as well as providing concrete evidence for their use.
Writing a detailed case report can establish you as an expert, make a record that others can learn from, and work to preserve the practice of traditional acupuncture. Furthermore, case reports describing new acupuncture techniques and new interpretations may help to grow the field into the future.
May 5, 2021 - On the Practical Benefits of Acupuncture research
Many resources and much energy has been invested into acupuncture research. The search for an overarching acupuncture mechanism still eludes science, but over the last fifty years, researchers have learned of specific physiological effects of acupuncture point stimulation which include neurological, hormonal, immune-modulated, muscular effects, and more.
The goal of mechanism research is to explore how acupuncture works, as understood within the biological model of health. An equal if not more important goal of research, beyond merely identifying mechanisms to explain patient experience, is to advance knowledge in ways that will further improve patient care. In pharmacology, learning more about physiological mechanism potentially enables the creation of new and better applications in the form of medications. In acupuncture mechanism research, various avenues such as fMRI technology, analysis of hormonal anti-inflammatory pathways, and identification of neural signaling effects have helped us to validate acupuncture’s observed effects. The heroic efforts of researchers have brought credibility to the procedure, and with this type of evidence, patient interest and access have increased. But knowing that acupuncture modulates the brain’s limbic system does not boost its effectiveness; acupuncture performed a century ago modulated the limbic system in much the same way. Being able to validate acupuncture’s effects has been instrumental to its acceptance, but this research does not necessarily improve patient care.
Clinical trial evidence is guided by similar goals. With thousands of clinical trials completed around the world, efficacy has been established for a wide spectrum of symptoms and conditions. But the main goal of these trials is to determine the efficacy of acupuncture procedures – again, for validation. Some trials test fixed protocols against individualized acupuncture, which is the first step towards comparing two types of acupuncture to find out which might on the average be more useful. However, simply knowing that an acupuncture protocol has efficacy does not necessarily improve acupuncture point choices or effectiveness in patient care; knowing that an acupuncture protocol has proven efficacy in the treatment of lower back pain doesn’t make today’s treatments any more effective than they were as compared to treatments given fifty years ago. Arguably, leaning too heavily on a proven protocol in practice might even decrease a practitioner’s overall effectiveness, because treatment then drifts away from being patient-centered (one of the mandates of evidence-based medicine).
Validation research has been instrumental in establishing acupuncture as an accepted modality, for governing bodies, insurance companies, referring physicians, and patients. However, we would be wise to consider what other types of research directions may help us to enhance the effectiveness of acupuncture treatment. One important direction is case reports, which have the potential to alert practitioners to new ideas and interpretations, as well as to provide a window into the clinical thought process that enables practitioners to see how to match a treatment to an individual patient. By using a case report as a practical demonstration of patient-centered care, practitioners can learn to provide care designed to benefit the patient at hand.
