TCM: What to Expect at Your First Appointment

If you've been following along with my Traditional Chinese Medicine series, you know that we've covered the branches of TCM that I use in my practice. In this post, let's pull back the curtain and take a look at what to expect during your first acupuncture appointment. Welcome to my clinic!

After you book an appointment, I'll send you an online form to fill out before your appointment. This form covers your medical history and any symptoms and conditions you may currently have. It's a head to toe assessment that gives me an overview of your health from a TCM perspective. If you don't have access to the internet, you can book via phone and arrive early to fill out the form on an iPad before your appointment.

On the day of your appointment, wear loose, comfy clothing. Many treatments can be done while you're clothed, and paper gowns and sheets for draping are used for treatments that expose more of the body.

First we'll sit down together to talk about TCM and your history and present concerns. I like to share a short slide show introduction to TCM to encourage any questions you may have about your treatment and to share an understanding of this ancient holistic model of medicine. Next it's time to get physical for the examination. I will check your pulse and sometimes your back or abdomen, depending on the issue being treated. The silliest part is that acupuncturists are the only people who ask you to stick out your tongue! There are regions of the tongue that correspond to different internal organs, and checking the appearance of these is part of my diagnosis. After the exam, I share what I'm seeing and recommend treatment. I like to  write and use diagrams as well as explain verbally because it’s more comprehensive and helps patients understand their treatment.

For your initial acupuncture treatment, I will usually leave the needles in for 10-20 minutes. During this time you can choose to listen to music if that helps you relax. You may be pleasantly surprised when you see the needles! They are only 0.25mm thick, as opposed to hypodermic needles which are about 3mm thick. Jitters before getting poked the first time are normal, and most people come to feel comfortable with it and look forward to it later!

After your treatment I'll share my observations and recommendations for your treatment plan. Please know that I am open to collaboration with other practitioners you may be working with. Often treatments can be more effective when everyone is working together, and potential problems such as conflicting advice can be avoided.

First appointments are about an hour long and follow ups are 30-60 minutes on average, depending on the condition and needed treatment.

Ready? Set. Let's get started!

TCM: Acupuncture and Moxibustion

We’ve finally arrived at acupuncture! Acupuncture is one of the first things Westerners think of when they think of Traditional Chinese Medicine, but I’ve left it for the end because the other branches of TCM lay the groundwork for effective acupuncture treatments.

Acupuncture

Like the other treatments we've explored, acupuncture works to restore and maintain the balance of qi in your body. Qi flows through the body by a system of channels, or meridians. You can think of these as similar to the circulatory or nervous systems. Acupuncture points are areas on the meridians where needles are placed to influence the flow of qi. Acupuncture is used to treat a wide variety of conditions, from colds to chronic pain. Some of the most common ailments I treat include: back pain, sciatica, migraines, other types of pain, digestive issues, infertility, and cancer care support.

One of the biggest questions people often have about acupuncture is, “Does it hurt?” Since most of us have had experience with immunizations and blood work, this question is completely understandable! We're used to thinking that needles cause pain. Acupuncture needles are designed differently: they are much thinner, about the size of a human hair, and they are solid because they are not designed to insert or remove anything. Also, they do not go deeply into muscle tissue or blood vessels. Patients will sometimes feel a pricking or stinging sensation when the needles are placed, but this fades quickly.

Moxibustion

Acupuncture and herbal medicine come together in a treatment called moxibustion. This treatment is almost always used with acupuncture in China; the literal translation of the character for “acupuncture” is actually “acupuncture-moxibustion”! Moxibustion is a technique that uses the herb mugwort, which is placed on acupuncture needles or directly on the skin and is burned, creating heat and warmth in those areas. Moxibustion is especially helpful for patients who have a deep weakness, which is termed qi and/or blood deficiency, in one or multiple systems. While I don't practice moxibustion in the clinic, there is a form that I can prescribe for self-treatment at home. This is called “pole moxibustion” and it uses a cigar-like stick of mugwort that is hovered over the area to be treated until it is pink and warm. A patient I saw had a hairline fracture in his radius (the bone in the forearm closest to the thumb). It was not severe enough to be casted, but was immobilized with a brace. At the time of the fracture, his arm was in too much pain to apply needles to it directly, so this was a perfect opportunity for pole moxibustion. The patient applied the pole moxibustion twice a day for one week and then once a day until the pain dissipated. Each time he did the treatment, the pain decreased and he could feel the whole arm get comfortably warm. This treatment was combined with acupuncture in other regions to help with the pain and inflammation from a systemic standpoint.

Receiving acupuncture or acupuncture-moxibustion is normally quite relaxing. Many patients experience a deep meditative state, a sense of euphoria, or even fall asleep! This means that on top of the health benefits, getting a treatment can be like a mini vacation! Ready to get away and try something new?

TCM: Acupressure and Bodywork

Welcome back to our tour of Traditional Chinese Medicine! I already wrote about some of the ways acupressure can be used at home to help manage pain and stress, but the possibilities of acupressure go far beyond self-care. Techniques such as cupping, gua sha, and tuina are all forms of acupressure and bodywork that can be done by a trained practitioner and have different impacts than other TCM treatments. In this post I’m going to focus on the acupressure and bodywork techniques that I use in the clinic.

Cupping

Cupping uses glass cups that are heated and then applied to the patient’s body. The heat used creates a vacuum seal by burning out the oxygen. Several cups may be placed at once and they are usually left in place from a few seconds up to several minutes. Cupping changes the pressure of that area of the body, creating more space. It’s especially useful for pain relief and for breaking up mucus and phlegm in the lungs, encouraging the lungs to expand more, and stimulating a more productive cough in order to clear out the phlegm. I can also treat abdominal pain from constipation by using acupuncture to stimulate qi to open the area and using cupping to create more space in the abdomen. The patient may be able to feel things starting to move again! Take back pain, for another example: cupping brings blood to the surface and encourages the fascia to relax. Cupping can seem dramatic when you first see it, because the heat is created with flaming cotton balls. It’s safe in the clinic with a trained doctor, and also a poster child for “don’t try this at home!”

Gua Sha

Gua sha is a technique that uses plastic, ceramic, metal, or bone as tools to scrape the skin. It’s often used for pain relief and respiratory ailments. “Gua” refers to the actual scraping technique that is used. “Sha” refers to the reddening of the skin; a different effect is seen if the root issue is acute versus chronic, for example.  During the first few treatments, the sha shows me where the stressors are being held internally. A patient with chronic digestive issues will show very dark discoloration around the regions of the back that are connected to the stomach, pancreas, and liver, for example. Gua sha performed on the back can confirm which systems are the most stressed, as well as what muscles have either low tone or high tone. They’re not singing muscles! Muscle tone refers to the level of tension in a resting state as well as the ability to contract on demand.

Tuina

Tuina is a form of bodywork that is used to address issues that other branches of TCM aren’t as effective for. It’s usually not emphasized in the US because other systems of bodywork, such as physical therapy, massage, and chiropractic, are so prevalent here. Tuina has 3 basic systems: a bonesetting system that is similar to chiropractic treatments, but includes soft tissue and channel manipulation as well; gentle acupressure techniques that create a more subtle and visceral effect by causing vibration throughout the body and the organs related to the treated areas to relax; and manual therapy or bodywork that is similar to massage.  Tuina is added to a treatment when the muscles around an injury are so tight, they do not release from the acupuncture. Specific acupressure techniques will release a tight muscle immediately. Tuina is also applied before an acupuncture treatment, especially if the patient is stressed out about getting a treatment. This will help to calm the mind so that the body is comfortable getting the acupuncture.

As you can see, acupressure and bodywork techniques in TCM are varied and widely applicable! Make an appointment to learn more—singing and juggling flaming cotton balls not required.

TCM: Nutrition and Herbal Medicine

Continuing our exploration of the branches of Traditional Chinese Medicine, today let’s take a look at nutrition and herbal medicine. These two branches have many things in common, so for the sake of simplicity we’ll discuss them together.

Nutrition

Most Westerners are used to thinking in terms of calories and nutrients. Like the rest of TCM, the approach to nutrition is more holistic than the Western approach. Nutritional guidelines include aesthetics and presentation, references to season and geographic location, and encourage eating foods of a variety of colors because the visual stimulation affects the energy of internal organs. TCM nutrition is not “one size fits all” as many Western nutrition recommendations or research results are presented. Instead, the 5 Elements and the concept of Yin and Yang are used to create personalized recommendations for an individual based on their constitution and current health needs.

Herbal Medicine

Herbal medicine is taken internally, and is more potent than food. There are a couple different approaches to integrating herbs into your life. One is to include local or regional herbs in your diet. For example, dandelion can be a salad green or made into a tea. It supports the liver and helps with detoxification. For more specific effects, practitioners will customize a Chinese herbal formula, taking into account your constitution and your signs and symptoms. It’s also important to know the nature of the herb, whether it’s cooling, warming, drying, or moistening (more on this characterization later in this series).

These Branches Work Together

Nutrition and herbal medicine act internally to help balance qi. For example, if you have issues with digestion, there may be an imbalance in your system such as a low level of digestive enzymes. Enzymes can be boosted with both food and nutritional supplements. Chewing your food well also helps, because digestion begins in the mouth. Cravings are a sign of imbalance and could indicate an organ system stress or a lack of an enzyme.

Nutrition and herbal medicine work together: nutrition sets the stage for the body to get the most out of any herbs you take. It's important to note that taking Chinese herbs is different from popping a pill. Herbs help to support the body's natural functions to balance qi and help the body heal itself.

Chinese nutrition and herbal medicine guidelines recognize the uniqueness of each person, so another important thing to realize is that finding out what works for you will probably require experimentation. Remember the tangled knot from the introduction? This is another opportunity for patient and practitioner to work together and figure out what the patient's body, mind, and spirit need to be healthy and vibrant.

If you want to explore the role of nutrition in healing and maintaining your health, let's talk!

TCM: Meditation

By now we have all probably heard of the benefits of meditation. For thousands of years, teachers in Eastern traditions have been encouraging the practice of meditation as a way to become more present, calm, and empathetic and to address a range of issues from the physical to the spiritual. Recent scientific research supports those claims by demonstrating how the brain actually changes when you meditate regularly.

Meditation is a foundational branch of Traditional Chinese Medicine. Remember that all the branches of TCM work together to balance your qi? Meditation does this both in the moment when you’re meditating and over time when you practice regularly. Immediate benefits can include a lower heart rate and increased relaxation. Longer term benefits can include enhanced immune function, increased ability to focus, and an overall sense of wellbeing.

What is meditation?

A simple definition of meditation is that it is a way of bringing your awareness into the present moment. You may notice that you often spend time thinking about things that have already happened or that may happen later. When you meditate, you deliberately set all that aside to focus on the here and now: your body, your breath, the world around you. There are thousands of different meditation practices and no “right” or “wrong” way to do it. There is only the way or ways that work for you. Finding what works can require some experimentation, so patience and self-compassion in that process are essential.

How do I meditate?

A simple way to meditate is to focus on your breath as it flows in and out on its own. I encourage you to close your eyes to minimize distractions, then feel your breath as it enters your nostrils, fills your lungs, and then again as it leaves your body. Simply notice the physical sensations of breathing.

For people who find sitting still to be a challenge, I like to recommend a combination of qigong or acupressure and meditation. In the previous series on Acupressure & Qigong, I shared that, “Qigong helps to manage stress in a number of different ways. Not only can it help to balance and direct energy during times of mental and/or emotional stress, it also acts as a meditative practice, helping to calm the mind and slow the incessant stream of thoughts that are often at root of our stress-related symptoms.” Qigong itself is a moving meditation, and movement is a yang energy. Sitting still is a yin energy. Doing a gentle qigong practice can help to bring excess yang energy under control and serves as a bridge from your everyday life to a more sedentary meditative practice. Similarly, acupressure can help to release stuck or blocked energy throughout the body and makes sitting still easier.

Acupressure and Meditation for Sleep

Let’s say that it’s an hour past your bedtime and you’re still tossing and turning, unable to fall asleep. (Maybe this even happened last night!) What can you do to help yourself unwind, relax, and fall asleep?

The foundation for a good night’s sleep starts with good sleep hygiene. Sleep hygiene refers to the physical attributes of your bedroom (such as temperature, ambient light, and type of mattress and pillow) as well as to your behaviors at bedtime (such as consumption of alcohol or caffeine, screen time, and having a bedtime routine). If falling asleep easily is an ongoing challenge for you, I encourage you to learn more about sleep hygiene and to make changes to improve your quality of sleep.

Here is an acupressure and meditation routine to help you wind down and fall asleep:

  • First, if you sense a restless energy in your body, try some gentle stretches to help you wind down.

  • Next, spend about five minutes massaging your ears (you can do this seated or lying down). Your ears are a microcosm of your body, containing points that correspond to your muscles, joints, nerves, and internal organs. Massaging your ears helps to clear excess yang energy, relieve stress, and calm your mind.

  • Then give yourself a scalp massage or brush your hair. Excess energy often gets locked in your head; there are many meridians that pass through your scalp, so stimulating them with massage or brushing helps to restore the flow of qi. While seated or lying down, brush 100 times or more, or spend about 5 minutes massaging.

  • Finally, lie down in bed and place your hands on your lower abdomen below your navel. Focus on deep abdominal breathing and feel your body settle into your bed as you drift off to sleep.

  • If you find yourself still restless, the above steps can be repeated as necessary until you fall asleep.

Integrating Your Meditation Practice with the Other Branches of TCM

Your personal meditation practice sets the stage for the other modalities and treatments of TCM, allowing them to have the most positive healing effect possible. As you explore and experiment to find out what types of meditation work well for you, you’ll begin to notice the benefits in your daily life. If you’re feeling stumped or having trouble starting or maintaining a practice, I’d love to talk to you about it. There’s no reason for meditation to be “sink or swim”; my role as a TCM practitioner is to suggest qigong, acupressure, and meditation routines that are appropriate for your needs, support you as you develop your practice, and to help you troubleshoot if you encounter difficulties. If you want to start meditating or learn how to connect your practice with your current physical, emotional, or spiritual needs, please make an appointment. 

Introduction to Traditional Chinese Medicine

After reading my Acupressure & Qigong series, you may be wondering how that fits in with acupuncture and what happens in my clinic. Let’s take a step back and learn about Traditional Chinese Medicine.

Practiced in China for 5000 years, Traditional Chinese Medicine (TCM) has a rich and complex history with philosophical underpinnings that are different from Western medicine. For Western patients, TCM can be beneficial but also confusing. It’s my goal in this series to shed light on what TCM is and how it works in a way that’s accessible and applicable for patients.

Many people think that TCM = acupuncture. Actually, TCM has eight branches, with acupuncture being the last one. The other branches are: meditation, qigong, nutrition, acupressure, cosmology, feng shui, and herbal medicine. In my practice, I focus on meditation/qigong, nutrition, acupressure, herbal medicine, and acupuncture.

Why so many branches? Unlike Western medicine, which views the body as a series of systems that sometimes malfunction and need to be fixed by the relevant specialist, TCM takes a holistic approach to health. Everything is interrelated: The energy of this organ affects your energy level and mood, which affect your dietary and exercise choices, which affect the original organ. The factors that influence your state of health are both internal (like thoughts, feelings, diet, genetics, and physical symptoms) and external (like environmental stresses, toxins, and the weather). Picture it like a large knot you’re trying to untangle: When you tug on one part, all the other parts are affected.

You may already sense the holistic impact of some of your choices and symptoms, but other factors in your health may not be as obvious. Don’t worry, you don’t have to untangle the knot by yourself. In TCM, the patient and practitioner work together to discover what the patient needs to heal, recover, and stay healthy.

As I shared in my Acupressure & Qigong posts, prevention is the real strength of TCM. There are many things that can disturb the balance of your qi. The different branches of TCM work together to restore and maintain the balance and flow of your qi before a temporary imbalance becomes long term and causes illness or pain. In the remaining posts in this series, we’ll take a closer look at the branches of TCM that are the focus of my practice, the roles of patient and practitioner, and what to expect when you have an appointment.

In the meantime, if you’re chomping at the bit to learn more, I’d love to meet you.

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