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Hospice and Palliative Care Acupuncture

Hospice and Palliative Care Acupuncture

A handbook for acupuncturists and healthcare practitioners on the use of acupuncture for end-of-life care. The book covers the major hospice and palliative care diagnoses from a Chinese medicine perspective, as well as grief and loss, and includes the roots of Chinese historical perspectives on death and dying. The acupuncturist is introduced to the working medical model of hospice care and the interdisciplinary team approach and provided with evidence-based strategies for the use the acupuncture in symptom management.

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JCM Review

'Torii Black has expertly combined history and modern research with ancient medical theory to create an essential resource for anyone interested in integrating acupuncture services into end-of-life care. Hospice organizations will appreciate the detailed introduction to acupuncture and herbal medicine, while acupuncture providers will find the suggested treatment protocols helpful and insightful.'
- Cole Alexander, DAOM, LAc – Executive Director at Free Range Health

'A must read for both new and seasoned Acupuncturists. Descriptions of the treatment protocols used to assist in the dying process are extremely valuable and can be readily utilized. A well researched reference on the systems of hospice and palliative care, Hospice and Palliative Care Acupuncture is a foundational handbook for treating hospice clients and their families.'
- Whitney Madden, Lic Ac, CBHC (Certified Brain Health Coach)

'Evidence shows acupuncture to be both valuable and lacking as a complement to conventional palliative and hospice care. This book offers practitioners context, clinical support and the necessary language to bridge the gap in this particularly wonderful continuum of care.'
- Paula McPhail, practitioner, Lic Ac, MSc(Res)


JCM review issue 123 (June 2020)

I have heard many anecdotes from people who confess that they would rather cross the road than walk past the hospice where I work, so as to avoid getting too close to death. It is widely believed that hospices are places where you go in through the front entrance but leave through the back door in a box. At St Joseph’s Hospice (Hackney, London) where I work, 36 per cent of patients admitted for symptom control are discharged home to their usual place of residence, whilst many outpatients attend the hospice for life-affirming activities such as qigong, choir, physiotherapy and complementary therapies. The taboo around death and dying remains strong. Elizabeth Kübler-Ross wrote in 1972, ‘We isolate both the dying and the old, and it serves a purpose. They are reminders of our own mortality.’ If we consider the possibility of a ‘good’ death - what that might look and feel like, and how we might plan for it - we first have to lean in towards the fact that we are all going to die. Research tells us that most people want to die at home, but currently (COVID-19 aside) most people die in hospital. By 2030 it is predicted that most people will die in care homes.

This book covers major hospice and palliative care diagnoses from a Chinese medicine perspective, as well as exploring grief and loss. Primarily drawing on models of care in the United States (US), the chapter on the history and philosophy of hospice and palliative care also delves into the development of hospice provision in the United Kingdom (UK) championed by Dame Cicely Saunders, whose famous quote serves as inspiration to many interested in working with people at the end of life: ‘You matter because of who you are. you matter to the last moment of your life, and we will do all we can, not only to help you die peacefully, but also to live until you die.’ In the early chapters of this book the author looks at strengths and weaknesses of hospice and palliative care provision in the US and People's Republic of China (PRC), the most obvious being that they both have large populations, many of whom are uninsured and underserved by their healthcare systems. This gap in widespread, accessible, palliative care services offers a huge opportunity for acupuncturists. To this end, Black goes to some length to introduce practitioners interested in working in this field to the conventional medical language and acupuncture research required to work confidently alongside other healthcare professionals.

What I found particularly helpful, as I read this book and thought about colleagues who may have limited or no experience of being with patients who are very close to death, was the chapter on assessment, diagnosis and treatment of patients at end of life. Black takes the reader on an intimate and descriptive journey through what to look for and expect when assessing a dying patient - harnessing all the senses to identify changes in the body, demeanour, head, face, eyes and other sensory organs, skin tone, voice, tongue, and so on. On a subject that many of us experience difficulty in facing or contemplating, there is a delicate and poetic quality to Black's writing, for example her description of the quality of the cough as a person reaches the end of life ‘Auscultation over the lung fields may reveal wheezes, stridor, rhonchi, rales, crackles or crepitation.’ Black also discusses the important phenomena of death-bed visions which, research shows, can manifest as lucid dreaming, visions or hearing things inaudible to those around them. Acknowledging these experiences can often ease anxiety and reduce the fear of death, both for the dying person and the practitioner in attendance. There is more poetry when Black discusses pulse diagnosis, where she refers to the 34th volume of the Yi Zong Jin Jian (Golden Mirror of Ancestral Medicine, translated by Bob Flaws in The Secret of Chinese Pulse Taking). For example, ‘The Spleen expiry [pulse] is like a sparrow pecking. It may also be like a roof leaking … No rescue on the fourth day. Whereas the expiry of the Life Gate pulse is like a fish hovering or shrimp swimming. It may also arrive like a bubbling spring. Nothing can persuade the patient to stay.’ 

The chapter on the five phases/elements shares interesting insights into the use of spirit points, ancestor points and other points to use with patients who are experiencing fear. She invites the practitioner to consider points such as KID-21 Youmen (Hidden/Dark Gate) to actively work with a patient in their passage from life to death. I was reminded of Lonny Jarrett’s explanation in The Practice of Chinese Medicine (2003) of the transition of qi through the Kidney channel from KID-20 Tonggu through KID-21 Youmen to KID-22 Bulang: ‘through the valley to the dark gate symbolises the entry into the domain of the upper kidney points and the burial ground of the emperor.’ From this I get a sense of a journey with illness - maybe long, perhaps relatively short - towards death and the spirit path represented by the Kidney points of the chest. I find this a helpful way of looking at how as practitioners our intention and needling might support the transition from illness to death. There is a useful tabular illustration in this chapter providing a five phase correspondence reference guide. For example, when a patient is grappling with a sense of injustice about their illness, struggling to come to terms with incompletion of life, Black suggests acupuncture points such as LIV-3 Taichong, LIV-13 Zhangmen, LIV-14 Qimen and GB-40 Qiuxu to facilitate forgiveness (of self and others), relaxation and completion. 

The penultimate chapter, and by far the longest, lists major hospice diagnoses under 10 categories including cancer, dementia, heart disease, HIV/AIDS, liver disease, neurological disease, pulmonary disease, renal failure, stroke or coma, and terminal illness (with a six month prognosis or less). Black looks at hospice criteria for each life-limiting condition and includes information about each specific disease category and patient profile, as well as suggestions for acupuncture and Chinese herbal medicine.

This is a valuable book for practitioners already working in, or wanting to develop a practice in, palliative and end of life care. The descriptive clinical detail of dying patients facing the last few days of life will be reassuring to those approaching this field of work for the first time. Thanks to Torii Black for writing an informative book to help guide acupuncture practitioners in the intimate work of being with death and dying.

As a final thought to those considering this valuable field of work, here is Zen Night Chant from Being with Dying by Joan Halifax (2009) 

"Life and death are of supreme importance

Time passes swiftly and opportunity is lost

Let us awaken awaken...

Do not squander your life. 

Simon Robey


AuthorTorii Black
Publication Date21/02/2020
PublisherSinging Dragon
Number Of Pages224
Book FormatPaperback

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