What is a healing crisis? Do healing crises happen in the context of Chinese medicine? How can we differentiate a healing crisis from a simple exacerbation or a new illness?
A healing crisis occurs when a person becomes ill in the service of becoming more healthy.
We could think of a deep seated abscess finally coming to a head as a kind of healing crisis. It is a term that is often associated with homeopathy. A homeopath sometimes expects a healing crisis as a sign of the remedy working. However, the term “healing crisis” is not often used in the context of Chinese medicine. Do our patients experience healing crises while in the process of getting better with Chinese herbs or acupuncture?
In the world of alternative medicine we have all perhaps seen the concept of a “healing crisis” used to explain away a patient’s lack of response to treatment and worse, to explain away a negative reaction to a treatment. “My naturopath told me that this rash is the toxins coming out” or “my chiropractor told me that these headaches are part of the process of getting better”. And yet, the rash just gets worse or the headaches don’t go away…..Perhaps we’ve all had the experience of a patient reporting a new symptom such as a rash, headache, nausea, aching etc. and we have wondered if this is perhaps a healing crisis. I’ve seen many hopeful patients wanting to believe that a new symptom is arising in the service of getting well, so much so that it would be very easy to encourage them to believe that the new symptom or exacerbation of a symptom is part of the healing process.
In my own practice, it is not uncommon for me to see patients going through healing crises.
Yet, when a patient comes in with an exacerbation of a symptom, or a new symptom, my first task is to make absolutely sure that the symptom is not arising due to mistreatment on my part.
How do we tell? I’ve developed guidelines for myself. These are helpful not only for me but for patients themselves. When they use these guidelines, they can pay attention to what is happening and evaluate for themselves if it is indeed a healing crisis or simply a worsening of their health. Here are the guidelines I use:
- The new symptom or symptoms comes on AFTER the patient has been feeling noticeably better or their main complaint is noticeably better.
- The new symptom or symptoms are less severe than the main complaint (i.e. a common cold is less severe than hypertension)
- The patient has a distinct intuitive sense of strength or well-being while the symptoms are happening or the symptoms actually feel really good.
- The new symptom or symptoms change rapidly and go away quickly
- After the new symptom or symptoms are gone, the patient feels better than they did before the symptoms arrived.
If the crisis meets these guidelines, I will define it as a healing crisis. If not, it is just my patient getting sick in a new way…back to the drawing board for me!
The main reason we need to recognize a healing crisis for what it is is because we need to recognize when our patient’s exacerbation or new symptoms is NOT a healing crisis and they are just getting worse! Above all do no harm.
The common healing crises I have seen are:
- Common colds (especially in people with chronic illness who have not gotten a good old-fashioned common cold for a long long time)
- Emotional discharges
- Crying(I’ve seen people cry and cry for a week after acupuncture. One woman had not cried for 20 years, even through the death of her beloved husband)
- Anger (I had a patient finally start speaking up for herself and get out of a very unhappy marriage – but for a week she just could not believe how angry she was!)
- Short lived insomnia
- Short lived extreme fatigue (usually people who have been hyperactive or hyper-alert for a long time)
- Diarrhea or Constipation
One colleague of mine thinks that inducing a healing crisis is a sign of poor pacing in our clinical approach. He thinks that proper use of methods would avoid healing crisis altogether. I’ve pondered this thought. What I have come to is that, for me, the healing crisis always comes as a surprise that is after the fact. In other words, I can’t go back and try treating differently. In each case, I think back to the methods I used and, without exception, they seem right-on to me and the healing crisis seems like a welcome relief – like this hypothetical boil coming to a head. My sense is that the concept of “healing crisis” needs to be carefully integrated into our repertoire. I believe that these guidelines must be diligently used. We must be very willing to recognize and admit a real exacerbation.
The Shang Han Lun and Wen Bing texts supply some interesting discussions and guidelines on what we call the ‘healing crisis’ today. For example, in the introduction to Tai Yin disease (Mitchell/Wiseman/Ye version of SHL), it states “in tai yin disease, if center qi returns, the evil can shift into yang ming.” In line 278, it says “at seven or eight days, although there is sudden vexation and diarrhea, ten or more times a day, it will spontaneously cease, because the the spleen domain is replete and the putrid foulness should be eliminated.” This is describing a resolution of tai yin disease by expelling evils through the large intestine. A similar mechanism is described in resolving ying fen/construction aspect evils through the qi aspect with hot diarrhea. I think this describes a true ‘healing crisis’.
One of the things that hangs us up in the West is that we tend to ignore the cold, vacuous symptoms associated with the yin channel stages described in the Shang Han Lun, because they are not as acute as yang channel diseases. So if illnesses are pushed inside by inappropriate treatment (using medicinals that are too cold or draining, antibiotics, steroids, etc.), we accept the cold extremities, bloated abdomen and other symptoms and don’t consider them accordingly. So we miss the opportunity to expel evils with the return of evil heat, and may reflexively ‘push them down’ into the yin channels again. .
I can imagine an great article on Healing Crisis in the Shang Han Lun…Good start for it.
Jueyin disease mentions that if a patient develops heat effusion, that this is a sign that the condition is improving, whereas increased coldness is a sign of worsening. In our fever-phobic modern world, this response by the body’s correct qi will often be misinterpreted as a worsening condition, and if we put out the fire in a jueyin disease, we risk causing potentially fatal consequences.
A naturopath came to see me back when I was first practicing. She had taken herbs from a Vietnamese guy, but complained that every time she took them she started bleeding vaginally, bleeding black blood, blood that smelled bad. I looked at the herbs and it was only Xiao Yao San.
Is that a healing crisis? She had asked the guy why she was bleeding, but he couldn’t offer any good reason.
Without the background information it might be confusing. But with it, there is a new angle. It turns out that she had been pregnant the year before, but the fetus died.
“So, you had a D&C?” I asked.
A look of shock. “No way!” she said. “That is completely unnatural.”
But lacking any other way to expel the residual now-dead tissue, it had simply remained, stuck inside, for all those months. With the Xiao Yao San, there was a slight assistance to the body to attempt to expel this tissue, but it was not strong enough. I used some stronger blood-stasis resolving herbs and she passed a few large black clots, and all was fine after that.
Most of the time I can predict the symptoms that may seem strange or alarming for patients, and warn them; I’m sure we all do this. When something occurs that I really can’t explain, I usually take it as a part of their pathology that I have insufficiently understood, and that needs more attention. A significant portion of the time, though, at the end of the recital of the reactions “from the herbs” they will say something like: “Oh, and by the way, I had just had a series of vaccination injections for my overseas trip. You don’t think it could be that, do you?” :-)
On the other hand, as Z’ev has pointed out (and Zhou Xue-Hai too), the body will use any available avenue to expel a pathogen, and we should assist it to do so, seeing the signs and facilitating that route out of the body. Ideally, however, we should be able to predict that this is going to happen and tell the patient in advance. But there is no end to learning in this medicine, that’s what makes it so fun.
(Just to be clear, I do not think one needs a D&C after each miscarriage, but I will certainly use fairly strong blood-stasis clearers in a matrix of whatever else the patient needs constitutionally; naturopaths AFAIK don’t have Western herbs like this or don’t use them in this situation: Yi Mu Cao would be perfect if they only knew.)
Nice discussion. thanks for bringing this topic up. I love the picture!
I do agree about some of the leanings to undermine cold symptoms as Zev describes, and have seen this clinically when folks have treated themselves with popular heat clearing medicinals.Causes troubles. Hoping that as a profession our tendency to see heat in a diagnosis can be refined to support more accurate treatments.
This is an interesting topic that has many different aspects that relate to the practice of Chinese Medicine. Understanding what a healing crisis is and how it differs from a mistake in treatment is crucial for all practitioners. I also liked Steve Clavey’s comment: “Ideally, however, we should be able to predict that this is going to happen and tell the patient in advance.”
It is definitely better to tell a patient about a healing crisis is before it happens. I can clearly remember treating a patient who had extreme fatigue, seeing the patient recover beyond my expectations, and then feeling the disappointment in having that patient quit because she felt a dramatic pain in her neck for eight hours. She even told me that it was the same pain she had after the auto accident that had precipitated her years of chronic fatigue. I told her that it was a healing crisis and explained it to her but it wasn’t enough. She didn’t come back.
In one of Sharon’s classes she mentioned the delicate thread that connects us to our patients. This is a great concept that deserves some consideration. How does the thread get started? How does our reputation or personal integrity strengthen the thread? I have seen it broken because patients couldn’t spare the time or money to continue treatments and I have seen it grow stronger as patients see good results from their treatments.
If I had told my chronic fatigue patient about the possibility of a healing crisis before it happened I’m sure that she would have continued treatment. Since that time I made it a policy to have every patient read a sheet that tells them about the possibility of a healing crisis before their first treatment. Then we have a short discussion to make sure they understand the concept. Time and time again I have seen how this step in my practice has strengthened that delicate thread of connection and made it easy for patients to move past a healing crisis. It has also prevented patients from suppressing their healing crisis with medications.
Just this week I had a patient tell me that after her first treatment she felt better and then felt like she had been hit by a Mack Truck. When I asked what that felt like she said that her muscles ached all over like she had worked out too hard. “It didn’t last long”, she said, “and you had told me that something like this might happen so it was no big deal.”
I had my 3rd session of acupuncture to anxiety on Wednesday. That night I experienced uncontrollable muscle twitching/spasms for about 10 minutes or so, but it felt like an eternity. They went away, but since then, I have had diarrhea, fatigue & hot flashes on and off. I was told by my acupuncturist that this is normal and to drink lemon and ginger tea and stay hydrated because he truly believes that when this all subsides, that I’m going to feel great. He says that my body is going through a detoxification process. I suffer from health anxiety so anything out of the norm makes me really nervous and anxious, which is why I did acupuncture to begin with. I alamlsy went to urgent care before I called him. Should I be concerned? He didn’t seem to think so and has been practicing for 23 years, but everything I have read says this is usually only lasts a day. He says everyone is different. I need son honest and legit feedback so that I can have some peace of mind. Any information from a well known source would be greatly appreciated!!! Thank you!