Unexpected outcomes

Want to know one of my favorite things about being an acupuncturist? Watching people experience healing in unexpected ways. Someone comes in for shoulder pain, right? I treat her for a few weeks with LI 4, LI 11, TB 14, SI 10, TB 10, SI 11, and a few ashi points and her shoulder gets better. She’s happy about this, obviously, but then as we’re chatting about preventive care and other things, she says “Look at the nail on my index finger! It’s finally better.” This nail had been a nuisance to her for a long time because of a really gnarly crack right down the middle. Now it was growing normally. What a treat to share in her excitement. What a treat to watch people walk away with more healing than they had thought possible

And, of course, fellow professional acupuncturists will just nod their heads, because although the details of unexpected outcomes such as this can’t be predicted beforehand, the occurrence is by no means a surprise. I never explicitly said this to her, but I wasn’t directly treating her main symptom, shoulder pain. I was treating qi and blood stagnation in the TB, SI and LI channels for her shoulder but also liver qi stagnation, which is a common diagnosis and if treated properly will create a lot of change for the patient. Sometimes this is referred to as the root and the branch. The root cause is a fundamental imbalance that needs addressing, the branch is the specific symptom. If I am successful in resolving the root cause, the “main complaint,” or branch, will respond. But removing the root cause unleashes the possibility of an effect on any number of symptoms for which the patient wasn’t seeking treatment.

The phenomenon of fingernail healing

The patient’s surprise became my surprise when I was reading an article by Daniel Schulman in The Journal of Alternative and Complementary Medicine (abstract; sorry, you’ll have to go to the library to see the entire article). His article is titled The Unexpected Outcomes of Acupuncture: Case Reports in Support of Refocusing Research Designs. His main focus is on research (and I’ll get back to that myself in a minute), and he describes two clinical cases of unexpected results. Guess what one of them is. You’re right, a fingernail healed. This time, a thumbnail. A woman who had come in for treatment of acid reflux and headaches, among other things, never mentioned her thumbnail until one day she happily reported that this longstanding problem was gone.

Unexpected outcomes as a challenge in research methods

The existence of unexpected results such as these points to one of the difficulties that the scientific community is having in designing relevant tests – particularly when comparing the results of acupuncture to conventional biomedical treatments – for the effects of acupuncture. If either my patient or Daniel Schulman’s had been in a clinical trial for effectiveness of acupuncture in the treatment of their “main complaint,” would unexpected outcomes such as these even be documented? I haven’t read a case in which they have. Even more of a puzzle presents itself if a clinical trial reveals no statistical difference between treatment and no-treatment for a symptom. What if my patient still experienced shoulder pain, but slept better, was happier in general, and experienced any number of other unexpected outcomes?

I’m not a scientist, but I’m aware that the so-called “gold standard” of clinical research, randomized, controlled trials (RCT’s) have their inherent limitations and there are many challenges facing those in the research community who are interested in comparing different treatment modalities. I’ve just begun reading some of what Ted Kaptchuk has been writing about all of this (here’s his amazing bibliography) and look forward to learning more.

Until then, what to make of this fingernail phenomenon? How common is it?

Leave a Reply