Abstract
Acupuncture mechanisms may be like the Rube Goldberg machine. They may be very complex and entangled. We place a few simple needles into the patient, wait for about 20–30 minutes eagerly anticipating our results, but sometimes the results are not obtained so simply.
A few weeks ago, a patient of mine—for whom every Western treatment known for pain and every acupuncture technique, known to both myself and colleagues, failed—had his pain reduced to 0 for the first time, because I increased his electro-acupuncture treatment from 30 minutes to 2 hours. This patient was pain-free for the first time in about 7 years.
Inserting the needles is simple, but the biological and psychological mechanisms involved may be slow and very complicated. There are mechanisms associated with acupuncture that we are not aware of, which may require decades to elucidate. We have been working on this for several thousand years. Indeed, like the Rube Goldberg machine, it takes time for the mechanism to produce effects. From the clinician's and patient's shared perspective, we want a very simple endpoint to occur; we want the pain gone in less than 30 minutes. When these clinical results—whether they be pain reduction or something else—are not obtained, we add other therapeutic modalities. Each modality produces its own mechanisms of actions and perhaps competes with other modalities, which may cause delays to get to the desired endpoint. Eventually, we may have a “Nutty Professor” situation in which the patient has needles everywhere but nothing much is happening. My practice is to use the least amount of needles possible and wait it out. I have observed clinicians adding needles during the treatment period right up to the traditional 30 minutes.
Might a better solution be to increase the treatment time beyond 30 minutes in these resistant cases? I have had patients that responded after 1 hour of therapy but not at a half hour. We all have had patients respond several hours later when the needles were already pulled out.
I would recommend that we proceed slowly from simple to slightly more complicated acupuncture techniques, keeping in mind that the entire biological mechanism leading to the end result may be taking place like the Rube Goldberg machine chain reaction.