September 26th, Thursday, Sunny
Today’s consultation at Shanghuan Clinic, triggered by a French lady’s treatment request, turned out to be a vivid “clinical principle lesson” for the attending students. It highlighted the importance of professional judgment, especially regarding the boundaries of bone-setting and lumbar treatment, and also provided a concrete practical reference for the theoretical knowledge of “acupuncture and moxibustion taboos”.
In the morning, after the French lady explained she had dysmenorrhea, she put forward two clear requirements: first, she specified that a registered physician trainee should perform the procedure for her; second, she wanted not only lumbar acupuncture but also lumbar bone-setting, adding that she was recommended by a physiotherapist. When she finished speaking, I noticed the students looking embarrassed. It was inappropriate for a layperson to directly dictate the treatment method, even requesting bone-setting on the lumbar region—a “high-risk area housing internal organs”—and specifically asking for a registered physician trainee as the operator. This not only violated clinical norms but also put the students in a dilemma of “wanting to provide good service yet fearing to go against professional principles”.
When the students consulted me privately, I first clarified the core stance: medical practice is never a service that “meets all demands”. The doctor-patient relationship is a professional advisory one, and our practicing qualifications and clinical experience are the bottom line for patient safety—we must “adhere firmly to what is right”. Regarding her requests for “treatment by a designated registered physician trainee” and “lumbar bone-setting”, I immediately reminded the students: although registered physician trainees have basic qualifications, lumbar bone-setting has extremely high requirements for clinical experience and precise manipulation. It is necessary to first conduct a strict assessment of the stability of the patient’s lumbar joints and whether there are potential bone problems.
Moreover, for the dysmenorrhea she mentioned, traditional Chinese medicine (TCM) usually adopts distal acupoint selection for regulation, rather than directly performing bone-setting or deep needling on the lumbar region. Furthermore, Methods of Acupuncture and Moxibustion clearly emphasizes that “acupoints on the chest, hypochondrium, waist, and back (where internal organs are located) should not be needled straight or deeply” (Taboo ⑥). As a more direct manipulative therapy, bone-setting carries even higher risks, so we must not rashly let registered physician trainees attempt it just to meet the patient’s request.
I then instructed the students to first rule out whether the patient had underlying lumbar problems or was in her menstrual period through inquiry (to avoid violating Taboo ②: “Women should not receive acupuncture during menstruation unless it is for regulating menstruation”). Finally, we decided that only experienced physicians would use distal acupoints to relieve her dysmenorrhea. We politely declined her requests for “treatment by a designated registered physician trainee” and “lumbar bone-setting”, and patiently explained: “Lumbar bone-setting requires a comprehensive assessment first and is more suitable for experienced physicians to perform. The current plan balances safety and therapeutic effectiveness.”
Chapter Two: Methods of Acupuncture and Moxibustion (Class Notes)
Due to factors such as a person’s physiological functional state and living environment, the following aspects should be noted when using acupuncture for treatment:
① Patients who are excessively hungry, fatigued, or in a state of extreme mental tension should not receive acupuncture immediately. For patients who are emaciated, or have qi deficiency and blood loss, the manipulation during acupuncture should not be too strong, and the recumbent position should be used as much as possible.
② Women who are three months pregnant should not receive acupuncture on acupoints in the lower abdomen. For those who are more than three months pregnant, acupuncture on acupoints in the abdomen and lumbosacral region is also not allowed. As for some acupoints that promote menstruation and activate blood circulation, such as Sanyinjiao (SP6), Hegu (LI4), Kunlun (BL60), and Zhiyin (BL67), they should also be avoided during pregnancy. For women during menstruation, acupuncture should not be performed unless it is for regulating menstruation.
③ For infants whose fontanelles have not yet closed, acupuncture on acupoints on the top of the head should not be performed.
④ Patients who often have spontaneous bleeding or uncontrollable bleeding after injury should not receive acupuncture.
⑤ Acupuncture should not be performed on areas with skin infections, ulcers, scars, or tumors.
⑥ Acupoints on the chest, hypochondrium, waist, and back (where internal organs are located) should not be needled straight or deeply. Special attention should be paid to patients with hepatosplenomegaly or emphysema. If acupoints in areas such as the chest, back, armpit, hypochondrium, and Quepen (ST12) are needled too deeply
After the afternoon consultation, I specially gathered the students for a review. At the same time, I redistributed the class notes on Methods of Acupuncture and Moxibustion to all registered physician trainees, asking everyone to compare the notes item by item with today’s case. I pointed out: if we had blindly complied with her request for “lumbar bone-setting by a designated registered physician trainee”, we might not only have violated the “lumbar and back operation risks” specified in Taboo ⑥, but also might have aggravated potential undiagnosed lumbar problems in the patient due to improper manipulation. Additionally, this would have been detrimental to registered physician trainees in establishing a “risk-priority” clinical awareness. I emphasized: “Every taboo in the notes is a summary of previous experience. It is not a constraint, but a ‘safety line’ to protect both patients and ourselves. Patients seek medical help because of physical discomfort—we need to empathize with them, but we must not ‘indulge’ their unreasonable treatment demands. Professional responsibility means replacing ‘accommodation’ with scientific assessment and balancing needs with safe plans. This is also the core principle that should be passed on when teaching registered physician trainees.”
Seeing the students holding their notes, moving from initial confusion to a clear understanding that “refusing unreasonable demands and strictly abiding by taboo norms are also part of professionalism”, I felt deeply relieved. In medical practice and teaching, we must not only guard every clinical risk point but also make the younger generation understand: professionalism is not about being rigid. Instead, in every decision, we should prioritize patient safety, the standardized training of trainees, and every professional guideline in the notes over “meeting demands”.